Reasonable Modifications

A young man sits at a table reading a heavy book using Braille.

The existing Reasonable Modifications provided today to individuals with disabilities who apply for or are enrolled in the traditional Medicaid program will continue to be available for Georgia Pathways to Coverage™ applicants and members following established processes outlined below. 

In addition, Reasonable Modifications unique to the Pathways qualifying activities and hours requirement will also be made available to members with disabilities*.

*The definition of a disability used for Pathways follows the ADA definition which states that an individual: (i) has a physical, mental, or sensory impairment which substantially limits one or more major life activities, (ii) has a record of such an impairment, or (iii) is regarded as having such an impairment. This is different from the definition of disability used for ABD Medicaid.

Reasonable Modifications Available for Pathways Applicants

In specific circumstances, the following Reasonable Modifications can be granted to Pathways applicants: 

  • Pending the Pathways application up to an additional 90 days to allow the applicant who indicates they have a disability to provide verification of engagement in a qualifying activity.
  • Pending the Pathways application up to an additional 90 days while the applicant who indicates they have a disability and needs support to gain employment/engage in a qualifying activity is referred by the Division of Family and Children Services (DFCS) to the Georgia Vocational Rehabilitation Agency’s (GVRA) Vocational Rehabilitation Program.

Application Process for Applicants with Disabilities who Need Reasonable Modifications

At application, an applicant with disabilities may need to do the following to request a Reasonable Modification:

  • Opt-in to Pathways by signing the Pathways contract in the Medical Assistance Plans application.
  • Self-attest to having a disability in the Medical Assistance application; OR request a Reasonable Modification for communication assistance.
  • Report qualifying hours and activities below the 80-hour threshold or report no qualifying activities whatsoever.
  • Indicate that they are requesting a Reasonable Modification because they are unable to meet qualifying hours and activities required for Pathways due to a disability.

Once requested, an eligibility worker will contact the applicant to determine next steps for providing a Reasonable Modification for Pathways qualifying hours and activities.

Reasonable Modifications for Enrolled Pathways Members

In specific circumstances, the following Reasonable Modifications can be granted for enrolled Pathways members: 

  • If the member develops a physical or mental impairment that substantially limits one of more major life activities, and they are no longer able to work or engage in a qualifying activity, the state will offer a referral to Georgia Vocational Rehabilitation Agency (GVRA). 
  • While they are referred to and going through the intake process with GVRA, the member can maintain Pathways coverage for up to 90 days. 

Requests for Reasonable Modification by Enrolled Pathways Members

To request a Reasonable Modification, Pathways members may need to notify the state of their change in circumstance and request a Reasonable Modification:

  • Online at gateway.ga.gov.
  • In-person at your local Division of Family & Children Services (DFCS) office. To find the location and business hours for a DFCS office, visit: dfcs.ga.gov/locations. 
  • By mail to your local DFCS office.
  • By phone at 1-877-423-4746 or 711 for those who are deaf, hard of hearing, deaf-blind or have difficulty speaking.

The member should be prepared to: 

  • Affirm they have a disability.
  • Provide an explanation of their circumstance.

Examples of Available Reasonable Modifications 

  • Sign language interpreter.
  • Cued speech interpreter.
  • Oral interpreter.
  • Tactile interpreter.
  • Email.
  • Face to face interview.
  • Electronic communication.
  • Teletypewriter (TTY).
  • Braille.
  • Large print.
  • Video Relay.
  • Telephonic signature.
  • Telephonic apps/renewals.
  • Telephone call reminder of deadlines.
  • Pending the Pathways application up to an additional 90 days for the applicant to have additional time to report compliance with the qualifying hours and activities prior to Pathways determination.
  • Pending the Pathways application up to 90 days while the applicant is referred and going through GVRA intake.
  • Providing continued coverage up to 90 days while an enrolled member who can no longer work/engage is referred and going through GVRA intake.