The five conditions
- Age 18 or younger. Eligibility ends with the month your child turns 19.
- A disability determination that meets federal childhood disability rules.
- Institution-level care needs. Your child's needs are serious enough that they'd be a candidate for a hospital, nursing facility, or intermediate care facility for people with intellectual disabilities. Alliant Health Solutions must approve this level of care.
- Cost-effective at home. Caring for your child at home can't cost Medicaid more than the institution would.
- Financially ineligible for SSI once parents' income is counted, and otherwise meets Georgia Medicaid rules. In other words, Katie Beckett is the path when regular routes don't work.
Parents' income and resources are not counted toward eligibility. Your child's own income and resources are.
What "level of care" means
It's a medical judgment about how much care your child needs. Reviewers look at the doctor's forms, records, and when needed, a psychological or developmental evaluation (no more than three years old), therapy notes, an IFSP or an IEP. Strong, specific records matter more than the diagnosis name.
The cost comparison
The caseworker compares what Medicaid would spend caring for your child at home with what the matching institution would cost. Your private insurance is part of that picture. If home care would cost more than the institution, the application is denied.
Questions
Does my child need SSI to qualify?
No. Georgia no longer requires an SSI screening or referral. The child needs a disability determination, which DFCS arranges as part of the process.
What if my child is in the hospital right now?
Children in the hospital can apply, and length of stay isn't a requirement. Ask the hospital social worker for help with the packet.