The State of Georgia’s version of the State Medicaid Plan is online at the Department of Community Health Website. Researchers should contact the Department for recent changes or check for amendments at Medicaid.gov. As with all pages on this website, this page is provided as a courtesy. It should not be relied on as a substitute for appropriate legal counsel.
Downloaded August 21, 2022
Georgia State Plan Effective August 21, 2022
Downloaded April 2021
Georgia Medicaid State Plan Numbered Pages
Organization of the Single State Agency Attachment 1
Member Coverage Attachment 2
Amount, Duration and Scope of Services Attachment 3
Case Management Attachment 3.1-A Supplement 1
Provider Reimbursement Attachment 4 (Attachments 5 and 7 included)
GA Citation Listing Attachment 5 (see above Attachment 4)
Nondiscrimination Attachment 7 (see above Attachment 4)
Every State that participates in the Medicaid program must have a State Plan. Among other requirements, “[a] State plan for medical assistance must— provide that it shall be in effect in all political subdivisions of the State, and, if administered by them, be mandatory upon them.” 42 U.S. Code § 1396a(a)(1). In Harris v. McRae, 448 U.S. 297 (1980), at 308-309, the Supreme Court discussed Medicaid State Plans in the context of an abortion case. There, it held:
The Medicaid program created by Title XIX is a cooperative endeavor in which the Federal Government provides financial assistance to participating States to aid them in furnishing health care to needy persons. Under this system of “cooperative federalism,” King v. Smith, 392 U. S. 309, 392 U. S. 316, if a State agrees to establish a Medicaid plan that satisfies the requirements of Title XIX, which include several mandatory categories of health services, the Federal Government agrees to pay a specified percentage of “the total amount expended . . . as medical assistance under the State plan. . . .” 42 U.S.C. § 1396b(a)(1). The cornerstone of Medicaid is financial contribution by both the Federal Government and the participating State. Nothing in Title XIX as originally enacted, or in its legislative history, suggests that Congress intended to require a participating State to assume the full costs of providing any health services in its Medicaid plan. Quite the contrary, the purpose of Congress in enacting Title XIX was to provide federal financial assistance for all legitimate state expenditures under an approved Medicaid plan. See S.Rep. No. 404, 89th Cong., 1st Sess., pt. 1, pp. 885 (1965); H.R. Rep. No. 213, 89th Cong., 1st Sess., 72-74 (1965).
Since the Congress that enacted Title XIX did not intend a participating State to assume a unilateral funding obligation for any health service in an approved Medicaid plan, it follows that Title XIX does not require a participating State to include in its plan any services for which a subsequent Congress has withheld federal funding.
Title XIX was designed as a cooperative program of shared financial responsibility, not as a device for the Federal Government to compel a State to provide services that Congress itself is unwilling to fund. Thus, if Congress chooses to withdraw federal funding for a particular service, a State is not obliged to continue to pay for that service as a condition of continued federal financial support of other services. This is not to say that Congress may not now depart from the original design of Title XIX under which the Federal Government shares the financial responsibility for expenses incurred under an approved Medicaid plan. It is only to say that, absent an indication of contrary legislative intent by a subsequent Congress, Title XIX does not obligate a participating State to pay for those medical services for which federal reimbursement is unavailable.
State Plan – Single Document (Downloaded February 3, 2008)
CURRENT AS OF DECEMBER 3 2007 FROM STATE WEBSITE
State Plan Under Title XIX of the Social Security Act, Medical Assistance Program (Note: Sections 1 through 7 of this Table of Contents appear in this consolidated PDF document. Attachments and Supplements are linked below)
Section 1: Single State Agency Organization
Section 2: Coverage and Eligibility
Section 3: Services: General Provisions
Section 4: General Program Administration
Section 5: Personnel Administration
Section 6: Financial Administration
Section 7: General Provisions
List of Attachments
Section 1 – Single State Agency Organization
- 1.1 Designation and Authority
- 1.2 Organization for Administration
- 1.3 Statewide Operation
- 1.4 State Medical Care Advisory Committee
- 1.5 Pediatric Immunization Program
- 1.6 State Option for Managed Care
Section 2 – Coverage and Eligibility
- 2.1 Application, Determination of Eligibility and Furnishing Medicaid
- 2.2 Coverage and Conditions of Eligibility
- 2.3 Residence
- 2.4 Blindness
- 2.5 Disability
- 2.6 Financial Eligibility
- 2.7 Medicaid Furnished Out of State
Section 3 – Services: General Provisions
- 3.1 Amount, Duration, and Scope of Services
- 3.2 Coordination of Medicaid with Medicare Part B
- 3.3 Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases
- 3.4 Special Requirements Applicable to Sterilization Procedures
- 3.5 Meicare Cost Sharing
- 3.6 Ambulatory Prenatal Care for Pregnant Women during Presumptive Eligibility Period
Section 4 – General Program Administration
- 4.1 Methods of Administration
- 4.2 Hearings for Applicants and Recipients
- 4.3 Safeguarding Information on Applicants and Recipients
- 4.4 Medicaid Quality Control
- 4.5 Medicaid Agency Fraud Detection and Investigation Program
- 4.6 Reports
- 4.7 Maintenance of Records
- 4.8 Availabiity of Agency Program Materials
- 4.9 Reporting Provider Payments to the Internal Revenue Service
- 4.10 Free Choice of Providers
- 4.11 Relations with Standard-Setting and Survey Agencies
- 4.12 Consultation to Medical Facilities
- 4.13 Required Provider Agreement
- 4.14 Utilization Control
- 4.15 Inspections of Care in Skilled Nursing and Intermediate Care Facilities and Institutions for Mental Diseases
- 4.16 Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees
- 4.17 Liens and Recoveries
- 4.18 Cost Sharing and Similar Charges
- 4.19 Payment for Services
- 4.20 Direct Payments to Certain Recipients for Physicians’ or Dentists’ Services
- 4.21 Prohibition Against Reassignment of Provider Claims
- 4.22 Third Party Liability
- 4.23 Use of Contracts
- 4.24 Standards for Payments for Skilled Nursing and Intermediate Care Facility Services
- 4.25 Program for Licensing Administrators of Nursing Homes
- 4.26 Drug Utlization Review Program
- 4.27 Disclosure of Survey Information and Provider or Contractor Evaluation
- 4.28 Appeals Process for Skilled Nursing and Intermediate Care Facilities
- 4.29 Conflict of Interest Provisions
- 4.30 Exclusion of Providers and Suspension of Practitioners Convicted and Other Individuals
- 4.31 Disclosure of Information by Providers and Fiscal Agents
- 4.32 Income Eligibility and Verification System
- 4.33 Medicaid Eligibility Cards for Homeless Individuals
- 4.34 Systematic Alien Verification for Entitlements
- 4.35 Remedies for Skilled Nursing and Intermediate Care Facilities that Do Not Meet Requirements of Participation
- 4.36 Required Coordination Between the Medicaid and WIC Programs
- 4.38 Nurse Aide Training and Competency Evaluation for Nursing Facilities
- 4.39 Preadmission Screening and Annual Resident Review in Nursing Facilities
- 4.40 Survey and Certification Process
- 4.41 Resident Assessment for Nursing Facilities
Section 5 – Personnel Administration
- 5.1 Standards of Personnel Administration
- 5.2 RESERVED
- 5.3 Training Programs; Subprofessional and Volunteer Programs
Section 6 – Financial Administration
Section 7 – General Provisions
- 7.1 Plan Amendments
- 7.2 Nondiscrimination
- 7.3 Maintenance of AFDC Effort
- 7.4 State Governor’s Review
- 1.1-A Attorney General’s Certification
- 1.1-B Waivers under the Intergovermental Cooperation Act
- 1.2-A
- 1.2-B Organization and Function of Medical Assistance Unit
- 1.2-C Professional Medical and Supporting Staff
- 1.2-D Description of Staff Making Eligiblity Determination
- 2.1-A Definition of an HMO that is Not Federally Qualified
- 2.2-A Group Covered and Agencies Reponsible for Eligibility Determinations
- Supplement 1 – Reasonable Classifications of Individuals under Age of 21, 20, 19 and 18
- Supplement 2 – Definitions of Blindness and Disability
- Supplement 3 – Method of Determining Cost Effectiveness of Caring for Certain Disabled Children at Home
- 2.6-A Eligibility Conditions and Requirements
- Supplement 1 – Income Eligibility Levels – Categorically Needy, Medically Needy and Qualified Medicare Beneficiaries
- Supplement 2 – Resource Levels – Categorically Needy, Including Groups with Incomes up to a Percentage of the Federal Poverty Level, Medically Needy and Other Optional Groups
- Supplement 3 – Reasonable Limits on Amounts for Necessary Medical or Remedial Care Not Covered under Medicaid
- Supplement 4 – Section 1902(f) Methodologies for Treatment of Income that Differ from those of the SSI Program
- Supplement 5 – Section 1902(f) Methodologies for Treatment of Resources that Differ from those of the SSI Program
- Supplement 5a – Methodologies for Treatment of Resources for Individuals with Incomes up to a Percentage of the Federal Poverty Level
- Supplement 6 – Standards for Optional State Supplementary Payments
- Supplement 7 – Income Levels for 1902(f) States – Categorically Needy Who Are Covered Under Requirements More Restrictive than SSI
- Supplement 8 – Resource Standards for 1902(f) States – Categorically Needy
- Supplement 8 Addendum – Resource Standards for 1902(f) States – Categorically Needy
- Supplement 8a – More Liberal Methods of Treating Income Under Section 1902(r)(2) of the Act
- Supplement 8b – More Liberal Methods of Treating Resources Under Section 1902(r)(2) of the Act
- Supplement 8c – State Long-Term Care Insurance Partnership
- Supplement 9 – Transfer of Resources
- Supplement 9a – Transfer of Resources
- Supplement 9b – Transfer of Resources
- Supplement 10 – Consideration of Medicaid Qualifying Trusts – Undue Hardship
- Supplement 11 – Cost Effectiveness Methodology for COBRA Beneficiaries
- Supplement 12 – Eligibility Under Section 1931 of the Act
- Supplement 12 Addendum – Eligibility Under Section 1931 of the Act
- Supplement 13 – Section 1924 Provisions
- Supplement 14 – Consideration of Transfer Assets and Trusts – Undue Hardship
- Supplement 17 – Disqualification for Long-Term Care Assistance for Individuals with Substantial Home Equity
- 3.1-A Amount, Duration, and Scope of Medical and Remedial Care and Services Provided to the Categorically Needy
- Supplement 1 – Case Management Services, Part A
- Supplement 1 – Case Management Services, Part AA
- Supplement 1 – Case Management Services, Part AAA
- Supplement 1 – Case Management Services, Part AAAA
- Supplement 1 – Case Management Services, Part B
- Supplement 1 – Case Management Services, Part BB
- Supplement 1 – Case Management Services, Part BBB
- Supplement 1 – Case Management Services, Part BBBB
- Supplement 1 – Case Management Services, Part C
- Supplement 1 – Case Management Services, Part CCC
- Supplement 1 – Case Management Services, Part CCCC
- Supplement 1 – Case Management Services, Part DDD
- Supplement 1 – Case Management Services, Part DDDD
- Supplement 1 – Case Management Services, Part E
- Supplement 1 – Case Management Services, Part EEE
- Supplement 1 – Case Management Services, Part EEEE
- Supplement 1 – Case Management Services, Part F
- Supplement 1 – Case Management Services, Part FFF
- Supplement 1 – Case Management Services, Part FFFF
- Supplement 1 – Case Management Services, Part GG
- Supplement 1 – Case Management Services, Part GGG
- Supplement 1 – Case Management Services, Part GGGG
- Supplement 1 – Case Management Services, Part H
- Supplement 1 – Case Management Services, Part HH
- Supplement 1 – Case Management Services, Part HHH
- Supplement 1 – Case Management Services, Part HHHH
- Supplement 1 – Case Management Services, Part I
- Supplement 1 – Case Management Services, Part II
- Supplement 1 – Case Management Services, Part III
- Supplement 1 – Case Management Services, Part IIII
- Supplement 1 – Case Management Services, Part J
- Supplement 1 – Case Management Services, Part JJ
- Supplement 1 – Case Management Services, Part JJJ
- Supplement 1 – Case Management Services, Part JJJJ
- Supplement 1 – Case Management Services, Part KK
- Supplement 1 – Case Management Services, Part KKK
- Supplement 1 – Case Management Services, Part KKKK
- Supplement 1 – Case Management Services, Part L
- Supplement 1 – Case Management Services, Part LL
- Supplement 1 – Case Management Services, Part LLL
- Supplement 1 – Case Management Services, Part LLLL
- Supplement 1 – Case Management Services, Part M
- Supplement 1 – Case Management Services, Part MM
- Supplement 1 – Case Management Services, Part MMM
- Supplement 1 – Case Management Services, Part MMMM
- Supplement 1 – Case Management Services, Part N
- Supplement 1 – Case Management Services, Part NN
- Supplement 1 – Case Management Services, Part NNN
- Supplement 1 – Case Management Services, Part NNNN
- Supplement 1 – Case Management Services, Part O
- Supplement 1 – Case Management Services, Part OO
- Supplement 1 – Case Management Services, Part OOO
- Supplement 1 – Case Management Services, Part P
- Supplement 1 – Case Management Services, Part PP
- Supplement 1 – Case Management Services, Part PPP
- Supplement 1 – Case Management Services, Part Q
- Supplement 1 – Case Management Services, Part QQ
- Supplement 1 – Case Management Services, Part QQQ
- Supplement 1 – Case Management Services, Part R
- Supplement 1 – Case Management Services, Part RR
- Supplement 1 – Case Management Services, Part RRR
- Supplement 1 – Case Management Services, Part S
- Supplement 1 – Case Management Services, Part SS
- Supplement 1 – Case Management Services, Part SSS
- Supplement 1 – Case Management Services, Part T
- Supplement 1 – Case Management Services, Part TT
- Supplement 1 – Case Management Services, Part TTT
- Supplement 1 – Case Management Services, Part U
- Supplement 1 – Case Management Services, Part UU
- Supplement 1 – Case Management Services, Part UUU
- Supplement 1 – Case Management Services, Part V
- Supplement 1 – Case Management Services, Part VV
- Supplement 1 – Case Management Services, Part VVV
- Supplement 1 – Case Management Services, Part W
- Supplement 1 – Case Management Services, Part WW
- Supplement 1 – Case Management Services, Part WWW
- Supplement 1 – Case Management Services, Part X
- Supplement 1 – Case Management Services, Part XX
- Supplement 1 – Case Management Services, Part XXX
- Supplement 1 – Case Management Services, Part Y
- Supplement 1 – Case Management Services, Part YY
- Supplement 1 – Case Management Services, Part YYY
- Supplement 1 – Case Management Services, Part Z
- Supplement 1 – Case Management Services, Part ZZ
- Supplement 1 – Case Management Services, Part ZZZ
- Supplement 2 – Alternative Health Care Plans for Families Covered Under Section 1925 of the Act
- 3.1-B Amount, Duration and Scope of Services Provided Medically Need Groups
- 3.1-C Standards and Methods of Assuring High Quality Care
- 3.1-D Methods of Providing Transportation
- 3.1-E Standards for the Coverage of Organ Transplant Procedures
- 3.1-F Ehnaced Primary Care Case Managers as Disease Management
- 3.1-F Georgia Better Health Care – DSM Services
- 3.1-F(i) Care Management Organizations, and Primary Care Case Managers
- 4.11-A Standards for Institutions
- 4.14-A Single Utilitation Review Methods for Intermediate Care Facilities
- 4.14-B Multiple Utilization Review Methods for Intermediate Care Facilities
- 4.16-A Cooperative Arrangements with State Health and State Vocational Rehabilitation Agencies and with Title V Grantees
- 4.17-A Liens and Adjustments or Recoveries
- 4.18-A Charges Imposed on Categorically Needy
- 4.18-B Medically Needy – Premium
- 4.18-C Charges Imposed on Medically Needy and other Optional Groups
- 4.18-D Premiums Imposed on Low Income Pregnant Women and Infants
- 4.18-E Premiums Imposed on Qualified Disabled and Working Individuals
- 4.19-A Methods and Standards for Establishing Payment Rates – Inpatient and Hospital Care
- 4.19-B Methods and Standards for Establishing Payment Rates – Other Types of Care
- 4.19-C Payment for Reserved Beds
- 4.19-D Methodis and Standards for Establishing Payment Rates – Skilled Nursing and Intermediate Care Facility Services
- 4.19-E Timely-Claims Payment – Definition of Claim
- 4.19-F Enhanced Primary Care Case Management Fee
- 4.19-F Disease Management Enhanced Primary Case Management Fee
- 4.20-A Conditions for Direct Payment for Physicians’s and Dentists’ Services
- 4.22-A Requirements for Third Party Liability – Identifying Liable Resources
- 4.22-B Requirements for Third Party Liability – Payment of Claims
- 4.22-C State Method on Cost Effectiveness of Employer-Based Group Health Plans
- 4.30 Sanctions for Psychiatric Hospitals
- 4.32-A Income and Eligibility Verification Systems Procedures: Requests to Other State Agencies
- 4.33-A Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals
- 4.34-A Requirements for Advance Directives Under State Plans for Medical Assistance
- 4.35-A Criteria for the Application of Specified Remedies for Nursing Facilities
- 4.35-B Alternative Remedies to Specified Remedies for Nursing Facilities
- 4.35-C Enforcement of Compliance for Nursing Facilities, Temporary Management
- 4.35-D Enforcement of Compliance for Nursing Facilities, Denial of Payment for New Admissions
- 4.35-E Enforcement of Compliance for Nursing Facilities, Civil Money Penalty
- 4.35-F Enforcement of Compliance for Nursing Facilities, State Monitoring
- 4.35-G Enforcement of Compliance for Nursing Facilities, Transfer of Residents
- 4.35-H Enforcement of Compliance for Nursing Facilities, Additional Remedies
- 4.38 Disclosure of Additional Registry Information
- 4.38-A Collection of Additional Registry Information
- 4.39 Definition of Specialized Services
- 4.39-A Nursing Home Preadmission – Categorical Determination
- 4.40-A Survey and Certification Education Program
- 4.40-B Process for the Investigation of Allegations of Resident Neglect and Abuse and Misappropriation of Resident Property
- 4.40-C Procedures for Scheduling and Conduct of Standard Surveys
- 7.2-A Methods of Administration – Civil Rights (Title VI)
- Section 901 Scope of Service
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