Georgia Medicaid Programs
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 Medicaid


A state and federal partnership, Medicaid provides coverage for people with lower incomes, older people, people with disabilities, and some families and children. Learn more about the program  below.In Georgia, Medicaid is administered by the Georgia Department of Community Health (DCH) and pays medical bills with State and Federal tax money.


Who is Eligible for Medicaid?

You may be eligible for Medicaid if your income is low and you match one of the following descriptions:

  • You think you are pregnant
  • You are a child or teenager
  • You are age 65 or older
  • You are legally blind
  • You have a disability
  • You need nursing home care

 

How can I get Medicaid?

To apply for Medicaid, contact the Department of Family and Children Services (DFCS) office in your county. (Call the Division of Public Health at 404-657-2700 to find out where to apply in your county.) The DFCS office will take your application or help you find other places to apply, such as schools, hospitals or community centers near your home.

You may not need all of the following items, but the application process will move along more quickly if you have these kinds of documents:

  • Original or certified copy of your birth certification or other proof of identity and citizenship
  • ID cards issued by federal, state or local government agencies.
  • Social security number
  • Paycheck stubs or W-2 forms covering at least the last four weeks.
  • Letters or forms that show your income from Social Security, SSI and all sources of income
  • Current health insurance policies, health insurance cards, etc.
  • Life insurance policies
  • Recent bank statements
  • Information about property you own

You will find out whether or not you are eligible for Medicaid within 45-60 days after you apply.

 

Any Special Circumstances?

If you are pregnant and eligible, you can get a Medicaid certification form on the same day that you apply. You can get prenatal care for yourself and your baby immediately.

If you are aged (65 years old or older), blind or have a disability, apply for the SSI program by contacting your local Social Security office. If you are approved for supplemental income, you will automatically receive Medicaid.

 

What does Medicaid cover?

The Georgia Medicaid program pays for many medical services to keep you healthy and to treat you when you are sick. The major services are:

  • Prescriptions
  • Doctor visits
  • Inpatient and outpatient hospital care
  • Lab tests
  • X-rays
  • Home health care
  • Hospice care
  • Medical equipment and supplies
  • Non emergency medical transportation services
  • Dental care (up to age 21)

 

How can I get Medicaid coverage for my children?

If you’re enrolled in Medicaid when your baby is born, your child is automatically eligible for Medicaid until your child’s first birthday. This means you don’t have to file a separate application for your new baby; however, he or she should be enrolled in Medicaid or PeachCare for Kids prior to his or her first birthday.



 

PeachCare for Kids


PeachCare for Kids® is a comprehensive health care program for uninsured children living in Georgia. The health benefits include primary, preventive, specialist, dental care and vision care. PeachCare for Kids also covers hospitalization, emergency room services, prescription medications and mental health care. Each child in the program has a Georgia Families Care Management Organization (CMO) who is responsible for coordinating the child's care.
 

Who is Eligible for PeachCare for Kids?

To be eligible for PeachCare for Kids, your child must be:

  • U.S. citizens, certain qualified legal residents, refugees or asylees who reside in Georgia, and
  • Age 18 and under (eligible until 19th birthday), and
  • Uninsured, and
  • Family income less than or equal to 235% of the federal poverty level, $44,868 for a family of 3 and $54,180 for a family of 4.


To ensure appropriate enrollment in the program, as of July 1, 2007, PeachCare for Kids began requiring citizenship and income to be verified for all new applicants.

Please Note: Children must be uninsured for the six months prior to applying for PeachCare for Kids®. There are exceptions for children who have lost coverage involuntarily (for example, if a child were covered through a parent’s employer and the parent lost the job, or the employer dropped coverage for dependent children). The waiting period does not apply to families who had independently purchased private insurance outside of an employer group.

 

How do I apply?

For assistance in applying for PeachCare for Kids, please call 1-877-GA-PEACH. You can also apply for online through an online application process at www.peachcare.org .
 

 

What are the benefits?

PeachCare for Kids health benefits include:

  • Care from a doctor when your child is sick
  • Preventive services such as immunizations and regular check-ups
  • Specialist care
  • Dental care
  • Vision care, including vision screenings and eyeglasses
  • Hospitalization
  • Emergency room services
  • Prescription medications
  • Mental health care


Each child will have a choice of a Georgia Families Care Management Organization, a private health plan that is responsible for coordinating your child’s health care. You will also be able to choose your child’s primary care provider.
 

 

How much does it cost?

There is no cost for children under age six. Currently, the cost per month for PeachCare for Kids® coverage is $10 to $35 for one child and a maximum of $70 for two or more children living in the same household. Once you complete the application, information about paying your premium will be displayed.

Beginning April 1, 2012, you will have a co-payment for some medical services in the PeachCare program, if your child is 6 years of age and older.

A co-payment is a small fee you will have to pay at the time of your visit to a medical provider. The amount of the co-payment will be different depending on the medical services you receive. While these co-payment amounts can range from $0.50 to $12.50, most will be $2.00 or $3.00. If you have to make a co-payment, your medical provider will tell you at the time of your visit.

However, there are no co-payments for these services:

  • Emergency services
  • Preventive Care Services (routine check-ups for your child)
  • Immunizations
  • Routine preventive and diagnostic dental services (such as oral examinations, prophylaxis and topical fluoride applications, sealants, and x-rays).


You are not required to pay more than 5% of your yearly income for premiums and co-payments. If your family reaches the 5% limit, you will not be required to make co-payment and premium payments for the rest of the year. Because of this, you must tell us (the PeachCare for Kids® Program) about any changes to your family income. Also, co-payments are not required for foster children or children who are American Indians or Alaska Natives.
 
 

 

Georgia Families

Georgia Families is a program that delivers health care services to members of Medicaid and PeachCare for Kids®. The program is a partnership between the Department of Community Health and private care management organizations (CMOs). By providing a choice of health plans, Georgia Families allows members to select a health care plan that fits their needs.
 

Who is Eligibible?

Children enrolled in PeachCare and children, pregnant women and women with breast or cervical cancer on Medicaid are eligible to participate in Georgia Families. Members will continue to maintain eligibility and enrollment through Medicaid or PeachCare.

 

How can I apply?

Health plans and primary care providers can be selected by calling a Georgia Families representative at 1-888-GA-ENROLL (423-6765) or by visiting the www.georgia-families.com.

 

What are the Benefits of Georgia Families?

Medicaid and PeachCare members will continue to be eligible for the same services they receive today as well as new services. Members will not have to pay more than they are currently paying for Medicaid co-payments or PeachCare premiums. With a focus on health and wellness, many CMOs will provide members with health education and prevention programs as well as expanded access to plans and providers, giving them the tools needed to live healthier lives. Providers participating in Georgia Families will have the added assistance of the CMOs to educate members about accessing care, referrals to specialists, member benefits, and health and wellness education.

Collaboration and partnership between CMOs and the Department of Community Health provides a more efficient delivery of health care services, better care for members and accountability to taxpayers while at the same time maintaining predictable and sustainable growth for the Department.

 

 

Health Insurance Premium Payment Program

Georgia Medicaid members that work may be eligible for premium assistance through a Medicaid program called the Health Insurance Premium Payment Program (HIPP). Working Medicaid members that cannot afford to pay the premiums, coinsurance or deductibles of their employer group health plan may be eligible for HIPP if it is determined to save money for the Medicaid agency. The Medicaid agency may save money by paying the health insurance premium of the Medicaid family if there is a person(s) in that family that has a lot of medical bills.

If approved for the HIPP program, the Medicaid member must sign-up or remain in the employer's health insurance plan. Once it is determined that a Medicaid recipient is eligible for HIPP, payments to the employer or reimbursement to the employee will begin upon the completion of the HIPP application verification process. HIPP participants must continue to be Medicaid members and meet the cost saving rules to continue to be eligible for the HIPP Program.

To determine whether you qualify for HIPP, contact your Medicaid worker at your local County Division of Family and Children Services (DFCS) and ask about the HIPP program.
 

Do you need help enrolling in health insurance? We can help. 

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