O.C.G.A. § 49-4-141 (2019)
Definitions
As used in this article, the term: (1) “Applicant for medical assistance” means a person who has made application for certification as being eligible, generally, to have medical assistance paid in his or her behalf pursuant to the state plan and whose application has not been acted upon favorably. (2) “Board” means the Board of Community Health established under Chapter 2 of Title 31. (3) “Commissioner” means the commissioner of the department. (4) “Department” means the Department of Community Health established under Chapter 2 of Title 31. (5) “Medical assistance” means payment to a provider of a part or all of the cost of certain items of medical or remedial care or service rendered by the provider to a recipient of medical assistance, provided such items are rendered and received in accordance with such provisions of Title XIX of the federal Social Security Act of 1935, as amended, regulations promulgated pursuant thereto by the secretary
of health and human services, all applicable laws of this state, the state plan, and regulations of the department which are in effect on the date on which the items are rendered. (6) “Provider of medical assistance” means a person or institution, public or private, which possesses all licenses, permits, certificates, approvals, registrations, charters, and other forms of permission issued by entities other than the department, which forms of permission are required by law either to render care or to receive medical assistance in which federal financial participation is available and which meets the further requirements for participation prescribed by the department and which is enrolled, in the manner and according to the terms prescribed by the department, to participate in the state plan. (7) “Recipient of medical assistance” means a person who has been certified eligible, pursuant to the state plan, to have medical assistance paid in his or her behalf. (8) “State plan” means all documentation submitted by the commissioner in behalf of the department to and for approval by the secretary of health and human services, pursuant to Title XIX of the federal Social Security Act, as amended (Act of July 30, 1965, P.L. 89-97, Stat. 343, as amended). (9) “Third party” means an individual, institution, corporation, or public or private agency, other than the department, that is legally liable to pay all or any part of the medical costs incurred by a recipient of medical assistance on account of any sickness, injury, disease, or disability to such a recipient.
History
Ga. L. 1977, p. 384, § 3; Ga. L. 1979, p. 1293, § 1; Ga. L. 1994, p. 97, § 49; Ga. L. 1999, p. 296, § 17; Ga. L. 2009, p. 453, § 1-7/HB 228.
U.S. Code. Title XIX of the federal Social Security Act of 1935, referred to in paragraphs (5) and (8) of this Code section, is codified at 42 U.S.C. § 1396 et seq.
Annotations
JUDICIAL DECISIONS Public agencies as third parties. - When the Georgia Department of Community Health (DCH) filed a departmental lien against plaintiff recipient’s settlement proceeds to recover Medicaid sums that it expended to pay providers for the recipient’s treatment, and the recipient filed a declaratory judgment suit, seeking a declaration that the DCH’s lien was invalid, the trial court properly granted the summary judgment motion of the defendant, the Commissioner of the DCH,
as, contrary to the recipient’s contentions, the DCH’s lien under O.C.G.A. § 49-4149(a) was not invalid even though the DCH was seeking to enforce the lien against another public agency (the board of regents of Georgia’s university system, doing business as a medical college) because § 49-4-149(a) allowed the lien against moneys owed by a third party for its liability leading to the recipient’s injury and, applying the definitions in O.C.G.A. § 49-4-141(4) and (9), third par-
ties included other public agencies. Padgett v. Toal, 261 Ga. App. 154, 581
S.E.2d 744, 2003 Ga. App. LEXIS 579 (2003).
OPINIONS OF THE ATTORNEY GENERAL Limited use of state funds to pay for abortion. - Georgia’s statutory language that assures payment for items of care “rendered and received in accordance with” the Social Security Act indicates that state funds, like federal funds, should
not be used to pay for any abortions except those in cases where the mother’s life would be threatened if the fetus were carried to term. 1977 Op. Att’y Gen. No. 77-64.
RESEARCH REFERENCES ALR. Transsexual surgery as covered opera-
tion under state medical assistance program, 2 A.L.R.4th 775.