Do Georgia Medicaid care management organizations (Amerigroup, CareSource, Peach State) pay for waiver home care?

Georgia Families is the state’s Medicaid managed care program. DCH lists three care management organizations (CMOs): Amerigroup Community Care, CareSource, and Peach State Health Plan.

Two things to know:

1. For the Elderly and Disabled Waiver (CCSP and SOURCE), DCH says service agencies that are approved Medicaid providers bill the department directly. The care coordinator authorizes the services.
2. For GAPP, it depends on the child. A child with CMO eligibility gets prior approval from the CMO. A child on fee-for-service Medicaid gets it from Alliant Health Solutions.

Also, Georgia Families 360 is a separate managed care program for children and youth in foster care, adoption assistance, and some juvenile justice settings. Its CMO is Amerigroup.

Before you accept any client, check eligibility in the GAMMIS portal. It shows whether the person is fee-for-service or in a CMO, and that tells you who to bill and who approves hours.

The pages we checked do not say, in one place, which waiver members are or are not in a CMO. Ask the Provider Services Contact Center (1-800-766-4456) if a client’s coverage is unclear.