Georgia Medicaid

Updated August 2026

Georgia Medicaid is the joint federal-state health insurance program for low-income Georgians who meet specific eligibility categories. The Georgia Department of Community Health (DCH), through its Medical Assistance Plans (MAP) division, administers the program. Eligibility determinations for most groups run through the Georgia Gateway online portal at gateway.ga.gov, or through the Division of Family & Children Services (DFCS) county offices.

NOT expanded

Standard ACA expansion not adopted

~35% FPL

Parent income limit

4 CMOs

Georgia Families managed care

gateway.ga.gov

Apply via Georgia Gateway

Georgia Pathways extended through December 2026; new federal rules follow in 2027

CMS has approved a temporary extension of Georgia Pathways to Coverage through December 31, 2026, along with simplified rules: enrollees now verify qualifying hours and activities once a year instead of monthly, and coverage starts the day the application is submitted rather than the following month. Starting January 1, 2027, Georgia must align Pathways with the federal work requirement created by H.R. 1 (signed July 4, 2025), which applies nationwide to income-based adult Medicaid coverage and adds twice-yearly eligibility checks. A separate federal change narrowing immigrant eligibility for Medicaid takes effect October 1, 2026. Check medicaid.georgia.gov and pathways.georgia.gov for updates as rules are finalized.

What is Georgia Medicaid and who administers it?

DCH reports roughly 2.2 million Georgians enrolled in Georgia Medicaid and PeachCare for Kids combined as of recent program data — a figure that reflects all coverage categories, from children and pregnant women to seniors in nursing facilities.

Most enrollees receive care through the Georgia Families managed care program rather than traditional fee-for-service billing. DCH contracts with four Care Management Organizations (CMOs): Amerigroup Georgia, Peach State Health Management (a Centene subsidiary), WellCare of Georgia (also Centene), and CareSource Georgia. New enrollees choose a CMO or get auto-assigned.

The coverage gap: who falls through

In the 40+ states that fully expanded Medicaid, non-elderly adults qualify up to 138% of the Federal Poverty Level — roughly $21,000 per year for a single person in 2025. Georgia does not cover that group through standard Medicaid. A 40-year-old earning $18,000 per year with no children and no disability likely has no Georgia Medicaid path unless they qualify under the Pathways waiver.

Parents with dependent children do qualify — but at very low income thresholds. Working parents of dependent children qualify at approximately 35% FPL, one of the lowest parent income limits in the country per KFF state Medicaid eligibility data. That translates to roughly $8,800 per year for a family of three.

Federal marketplace subsidies are available to some adults in the coverage gap through enhanced premium tax credits, but subsidy eligibility and amounts can change with federal legislation. Check healthcare.gov or call 1-800-318-2596 for current options.

Georgia Pathways to Coverage: the limited expansion

Launched July 1, 2023 under a federal Section 1115 demonstration waiver, Georgia Pathways to Coverage is the only Georgia Medicaid pathway for most non-disabled adults without children. It covers adults ages 19–64 at or below 100% FPL who complete 80 hours per month of qualifying community engagement activities. Qualifying activities include paid work, job training, vocational education, and volunteering.

Pathways applicants must apply through Georgia Gateway and submit documentation of their qualifying hours and activities. As of October 2025, DCH moved reporting from a monthly requirement to verification at initial enrollment and annual renewal, and also added new qualifying activities — including caregiving for a child under 6 and compliance with SNAP work requirements. The program has faced legal challenges since its launch and is currently approved only through a temporary extension ending December 31, 2026; applicants should verify current program status at medicaid.georgia.gov.

Pathways does not cover the full income range that standard ACA expansion covers. Adults between 100% and 138% FPL remain ineligible for Georgia Medicaid and may qualify for marketplace plans with subsidies instead.

Who qualifies for Georgia Medicaid?

Georgia covers the following categories, per DCH eligibility rules:

Children under age 19 — up to 247% FPL through Medicaid and PeachCare for Kids combined
Pregnant women — up to 215% FPL for pregnancy-related services
Parents and caretaker relatives of dependent children — approximately 35% FPL (very low threshold)
Adults ages 19–64 who complete 80 hours/month of qualifying activities through Georgia Pathways (verified annually as of October 2025, not monthly), at or below 100% FPL
SSI recipients — automatically eligible for Georgia Medicaid
Aged (65+), blind, or disabled adults who meet income and asset limits
Former foster care youth under age 26 — no income limit

Adults without children, without a disability, who do not qualify for Pathways are not covered. That is a direct result of Georgia's non-expansion status.

How Georgia Medicaid delivers care: Georgia Families

The Georgia Families program is DCH's primary managed care delivery system. Once enrolled, you select one of the four CMOs — or DCH assigns you one. Your CMO provides your primary care, specialist referrals, pharmacy benefits, and behavioral health services. You receive a member ID card from your CMO within a few weeks of enrollment.

Georgia Families 360°: A separate managed care program for children and youth involved in the foster care system or juvenile justice system. Georgia Families 360° provides integrated medical, behavioral health, and care coordination services to this population through a specialized CMO structure.

Fee-for-service (FFS): Some populations, including certain individuals with complex needs, receive care through traditional fee-for-service rather than managed care. DCH determines FFS eligibility. Most enrollees, though, are in Georgia Families managed care.

To compare CMOs or request a plan change, contact DCH's enrollment broker at 1-888-GA-ENROLL (1-888-423-6765) or visit medicaid.georgia.gov.