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?

For assistance in applying for Medicaid, contact one of our federally trained Insure Georgia Navigators at 1-866-9888246. 

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 1-866-988-8246 to speak with a federal licensed Insure Georgia navigator. 
 

 

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.
 
 

 

 

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

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