HOW THE MEDICAID PROGRAM WORKS - The Medicaid Program helps financially needy individuals obtain medical assistance. There are uniform rules for eligibility determination. Eligible households receive benefits in the form of a monthly Medicaid Eligibility Certification Letter. Anyone may apply for Medicaid. Time allowed for processing Medicaid applications varies according to the type of Medicaid program.

HOW TO APPLY - Complete and sign the following forms:

• Form 94 - Medicaid Application
  Version en Español

• Form 297M - Medicaid Addendum
  Version en Español

• Form DMA-285 - Health Insurance Information

• Clayton County Medicaid Verification Checklist

• Declaration of Citizenship/Alien Status
  Version en Español

• Affidavit to Establish Identity for Medicaid for Applicants/Recipients Under Age 16

Forms may be obtained from this web site, by calling (770) 473-2300, or by applying in person at DFCS located at 877 Battle Creek Road, Jonesboro. An application must contain applicant's name, address or a way to contact the applicant, and signature. Applications may be mailed to our office or filed in person.

ELIGIBILITY - The following individuals may be eligible for Medicaid:

• Pregnant Women
• Newborns
• Children under 19 years of age
• Low income families
• Individuals over 65 years of age, blind or disabled (ABD)

RESOURCE LIMITS - Varies By Program

INCOME LIMITS - Varies By Program

NOTE: For more information call, ABD (770) 473-2351 or RSM (770) 473-2143

VERIFICATIONS - Check the Verifications To Bring For Food Stamp/Medicaid/TANF Interviews for the kinds of documentation needed.

(English) - We have a Spanish line for our Hispanic customers who may have questions regarding their benefits or any other concern. For assistance they can call 770-473-2324.

(Version en Español) - Tenemos una linea en espanol para nuestros clientes de habla hispana si tienen preguntas con respecto a sus casos o algun otro interes. Para assistencia pueden llamar al numero siete, siete, cero; cuatro siete tres; dos, tres, cuatro (770-473-2324).

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FOR CHILD SUPPORT ENFORCEMENT INFORMATION OR QUESTIONS,
PLEASE VISIT WWW.CSE.DHR.STATE.GA.US.

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