Georgia DFCS Form 700: The MSP Application Form Explained
Why Form 700 Exists
Georgia has multiple Medicaid application forms — Form 94 (general Medicaid), Form 94A (streamlined), and Form 700. If your parent needs QMB, SLMB, or QI specifically, Form 700 is the one to use. It's a short-form application built for Medicare Savings Programs, which means it skips the sections about children, pregnancy, and employer-sponsored insurance that make the general application unnecessarily long for seniors.
DFCS staff and GeorgiaCares counselors recommend Form 700 for standalone MSP requests because it triggers Q-Track eligibility screening directly, reducing the chance that a caseworker routes the application into the wrong processing queue.
What Form 700 Asks For
The form collects five categories of information:
Personal identification: Name, date of birth, Social Security number, Medicare Beneficiary Identifier (MBI), county of residence, and contact information. The county matters — it determines which DFCS office processes the application.
Medicare enrollment status: Part A and Part B enrollment dates, whether premiums are currently being deducted from Social Security, and the monthly premium amount. If your parent doesn't have premium-free Part A, note this — it affects whether they can pursue conditional Part A enrollment through QMB.
Income: All sources of monthly income — Social Security retirement or disability (RSDI), pensions, VA benefits, interest, and any earned income. Report gross amounts before deductions. DFCS applies the $20 unearned income disregard and earned income exclusions during their calculation, so don't subtract those yourself.
Resources: Bank account balances, certificates of deposit, stocks, bonds, and any real property beyond the primary residence. Life insurance policies with combined face value over $1,500 require reporting the cash surrender value. The primary home, one vehicle, household goods, and designated burial funds are excluded.
Authorized representative designation: A section near the end lets you designate someone to act on behalf of the applicant — an adult child, relative, or other trusted person. Completing this section on Form 700 serves the same function as filing a separate Form 954.
Common Mistakes That Delay Processing
Reporting net income instead of gross: If your parent's Social Security check shows $1,150 after the Part B deduction, the gross amount is $1,352.90 ($1,150 + $202.90). Report the gross. DFCS will subtract the Part B premium in their budget calculation since MSP approval eliminates that deduction.
Leaving the Medicare information blank: Without Part A and Part B details, DFCS can't determine which MSP tier applies. If you don't have the Medicare card handy, call SSA at 1-800-772-1213 to get enrollment dates and the MBI.
Skipping the signature: Both the applicant and the authorized representative (if designating one) must sign. An unsigned form gets returned, and the filing date resets to whenever DFCS receives the signed version.
Filing with the wrong county: DFCS jurisdiction is based on where the parent physically lives, not where the adult child lives. If your parent is in Bibb County and you're in Fulton County, the form goes to Bibb County DFCS.
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How to Submit
Form 700 can be submitted by mail, fax, or in-person drop-off to the parent's county DFCS office. GeorgiaCares SHIP counselors can also submit it after helping complete it during a counseling session. Filing online through Georgia Gateway is the electronic equivalent, but when the portal has issues, the paper form is the reliable backup.
The filing date — the date DFCS receives the completed, signed form — establishes when coverage can start. For SLMB and QI, coverage can be retroactive up to three months before the application month if the applicant was eligible during those months. For QMB, coverage starts the first day of the month after DFCS enters the approval disposition in Georgia Gateway.
The Georgia Medicare Savings Programs & Extra Help Guide walks through each section of Form 700 with examples, includes the income calculation worksheet so you can verify eligibility before filing, and covers what to do when DFCS requests additional verification documents.
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