Georgia Medicaid Applicants No Longer Required to Apply for Other Benefits

Medicaid is the payer of last resort so applicants have, historically, been required to apply for all other benefits before seeking Medicaid eligibility. On March 12, 2025, Georgia issued the following Memorandum changing that rule:

The purpose of this memorandum is to provide notification of the elimination of the “Application for Other Benefits” policy requirement.

This policy mandated that Medicaid applicants and beneficiaries, as a condition of their eligibility, take all necessary steps to obtain other benefits to which they are entitled, such as annuities, pensions, retirement and disability benefits, unless they can show good cause for not doing so. The  elimination of this policy is consistent with the Centers for Medicare and Medicaid Services (CMS) Streamlining Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes Final Rule of 2024.

Staff should no longer require or request an application for other benefits as a condition of eligibility for Medicaid. However, staff may suggest to the customer that they apply for other benefits for which they may be entitled.

For all programs, information on Gateway should be entered as follows: On the Other Benefits LUW, do not enter “Requires Additional Verification” for the “Verification of Application” field. You will enter “Client Statement” in the dropdown menu instead. This ensures that a VCL for Application for Other Benefits is not generated for Medical Assistance. Always review the VCL for accuracy.

All applicable Policy Manual references in PAMMS will be updated with the next appropriate Manual Transmittal, and all applicable Gateway updates will be made. If you have any questions, please contact the Medicaid Unit Bulletin Board at https://gets.sharepoint.com/sites/DHSBulletinBoard/SitePages/MedicalAssistance-Home.aspx .