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Effective: October 1, 2007 |
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03.50.10ar2 - GAMC - Hospital Only (GHO) (Archive) |
Archived: February 1, 2008 |
People who meet the eligibility requirements for General Assistance Medical Care (GAMC) except for excess income (or assets) may qualify for GAMC Hospital Only (GHO) for an inpatient hospitalization.
Note: The requirement that GAMC applicants and enrollees must have a GAMC qualifier does not pertain to GHO.
Eligibility factors are listed below with any information that is unique for this group. Links to standard program guidelines are included as well.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Other Groups/Bases to Consider.
Application Process (standard guidelines)
People with planned hospitalizations, such as elective surgery, may apply for GHO up to 45 days in advance. Do not approve coverage until you confirm that the admission has taken place.
Do not require a new application if former GHO enrollees are re-hospitalized within six months of the date of the most recent application.
The earliest possible begin date for GAMC Hospital Only (GHO) is the date of application or the date all eligibility factors (including hospital admission as an inpatient) are met, whichever is later.
Note: People do not have to be eligible for GHO in the month of application. Eligibility may begin at a later date if the applicant meets all eligibility factors by the end of the processing period.
There are no renewals for GHO; eligibility is granted only for the time that the enrollee is hospitalized.
Verifications (standard guidelines)
Follow standard GAMC guidelines.
Follow standard GAMC guidelines.
Follow standard GAMC guidelines.
Follow standard GAMC guidelines.
Insurance/Benefit Recovery (standard guidelines)
Follow standard GAMC guidelines.
Follow standard GAMC guidelines.
Follow MA Method A (and MCRE) to determine which assets to exclude and how to evaluate counted assets.
Note: For income exclusions, follow MA Method B.
Asset Guidelines (standard guidelines)
The asset limit is:
l $10,000 for a household of one.
l $20,000 for a household of two or more.
There are no improper transfer provisions for GHO.
Income limit is greater than 75% FPG but less than or equal to 175% FPG.
Note: Clients whose income is within the limit for full GAMC benefits (75% FPG) who have assets between $1000 and $10,000 must reduce their assets to the asset limit for full GAMC benefits ($1000). Do not approve GHO for these clients.
Follow standard GAMC guidelines.
Spenddowns (standard guidelines)
There are no spenddown provisions for GHO.
Benefits are limited to inpatient hospital charges and physician's services received during the inpatient hospitalization. Services after discharge, such as follow-up physician visits, are not covered.
GHO enrollees have a $1000 co-payment for each inpatient admission.
Note: This $1000 co-payment may be applied against the spenddown for household members who are applying or eligible for MA. However, no other medical expenses may be applied to reduce the GHO enrollee's co-payment.
All GHO enrollees are excluded from managed care enrollment. Coverage will be provided through fee-for-service.
Note: Do not issue MHCP membership cards for GHO.
Determine MCRE eligibility when GHO ends. However, GHO enrollees are not required to accept MCRE as a condition of future GHO eligibility.
Eligibility ends effective the date of discharge from inpatient hospitalization. Retroactive closing is allowed; no ten-day notice is required.
See note above regarding GHO applicants who meet the income guidelines for full GAMC benefits.
Consider the MCRE Limited Benefit Set starting the month after discharge.