Georgia Medicaid Office

Georgia Medicaid office (DCH)

Georgia is among the states that did not adopt the ACA's full Medicaid expansion. The Department of Community Health (DCH) administers traditional Medicaid and Georgia Pathways to Coverage™ — a state demonstration program that opens a limited coverage path for adults who would not otherwise qualify for traditional Medicaid. Most Medicaid members receive care through Georgia Families®, the statewide managed care program that partners DCH with three care management organizations (CMOs).

How to reach DCH

• Georgia Families member services — 1-888-423-6765 (or visit georgia-families.com) for plan information, MCO enrollment, and care coordination.
• Georgia Gateway — gateway.ga.gov handles applications, renewals, and changes for Medicaid, SNAP, TANF, and child-care assistance from a single account.
• Agency website — medicaid.georgia.gov for program rules, policy bulletins, and provider directories.
• Pathways to Coverage — dch.georgia.gov/georgiapathways for the demonstration program's enrollment requirements.

Most applications are processed by the Division of Family and Children Services (DFCS), which sits in the Department of Human Services and operates field offices in counties across Georgia. The Georgia Gateway portal lists DFCS contacts by county.

Who qualifies for Medicaid in Georgia?

Georgia's coverage rules split into two tracks. Traditional Medicaid covers children, pregnant individuals, parents at the state's family income standard, older adults, and people with disabilities under federal categorical rules. Georgia Pathways to Coverage™ adds a narrow eligibility path for adults who would not otherwise qualify, with monthly reporting and activity requirements set by the demonstration.

Traditional Medicaid categories

• Children — Medicaid through age-specific income tiers; PeachCare for Kids® (CHIP) covers higher-income children up to age 19 with monthly premiums tied to family income.
• Pregnant individuals — covered during pregnancy; Georgia's Postpartum Extension Demonstration (created from HB 1114, 2020) added postpartum coverage beyond the federal 60-day minimum. Confirm the current extension length at medicaid.georgia.gov.
• Right from the Start Medical Assistance (RSM) — outreach group that helps families, pregnant women, and women with breast or cervical cancer enroll.
• Planning for Healthy Babies® (P4HB) — family planning Medicaid for women ages 18–44 who don't otherwise qualify.
• Aged, Blind, or Disabled — Non-MAGI categories for adults 65+, blind, or with disabilities; income and resource limits apply.
• TEFRA/Katie Beckett — Medicaid for eligible children with significant disabilities under the TEFRA §134 pathway.
• Breast and Cervical Cancer Program — Medicaid coverage for women screened and diagnosed through Georgia's breast and cervical cancer screening program.
• Long-term services and supports — separate financial and functional tests; the applicant must require a nursing-facility level of care.

Georgia Pathways to Coverage

Pathways is the only Medicaid pathway in Georgia for non-disabled, non-pregnant childless adults. Eligibility includes a monthly qualifying-activity reporting requirement (employment, education, training, or community service). Verify the current income ceiling, activity rules, and premium structure at dch.georgia.gov/georgiapathways before applying.

Asset rules and the coverage gap

MAGI categories carry no asset test. ABD categories apply a $2,000 individual resource limit and $3,000 for couples, excluding the home, one vehicle, and burial assets. Childless adults who don't qualify under Pathways and earn below the federal marketplace subsidy floor (100% FPL) generally fall in the coverage gap — no Medicaid eligibility, no premium tax credits.

Renewals

DCH attempts ex parte renewals first using federal and state data. When data confirms eligibility, coverage continues without paperwork. When it doesn't, a renewal packet appears in Georgia Gateway and by mail; members must respond within the printed deadline or coverage closes.

Georgia Medicaid income limits

Georgia publishes income limits across several categories: traditional Medicaid for children and pregnant individuals, PeachCare for Kids (CHIP), Pathways for low-income adults, and Aged-Blind-Disabled (ABD) categories. Specific dollar amounts and FPL percentages shift annually with the federal poverty level update each January and with state policy changes — verify a current figure at medicaid.georgia.gov before relying on it.

Where to find the current numbers

• Medicaid eligibility — medicaid.georgia.gov publishes current income standards for children, pregnant individuals, parents and caretakers, and ABD categories.
• PeachCare for Kids® — dch.georgia.gov/peachcare-kids publishes the current CHIP income tier and the premium schedule by family size and income.
• Georgia Pathways to Coverage™ — dch.georgia.gov/georgiapathways publishes the current income ceiling, monthly activity requirement, and premium structure.
• Aged, Blind, or Disabled categories — SSI-related categories follow the federal SSI Benefit Rate and the $2,000 individual / $3,000 couple resource limit; nursing-facility and HCBS waiver categories follow the 300% SSI special-income standard.
• Medicare Savings Programs (MSP) — QMB (up to 100% FPL), SLMB (100–120% FPL), and QI-1 (120–135% FPL) follow federal MSP standards updated annually by CMS.

Parents and caretaker relatives in Georgia qualify at a much lower income standard than expansion states — childless adults above the Pathways threshold and below 100% FPL fall in the coverage gap.

How to apply for Georgia Medicaid

Georgia accepts Medicaid and PeachCare for Kids applications through Georgia Gateway, by mail using Form 94A, or in person at a county DFCS office. The same Gateway account screens for multiple state benefits — Medicaid, PeachCare for Kids, SNAP, TANF, and child-care subsidies — from a single submission.

Online: Georgia Gateway

The Georgia Gateway Customer Portal is the statewide benefits portal. Create an account to apply, upload pay stubs and ID, check status, report changes, and renew. Community-based organizations can register as Gateway partners and submit applications on a household's behalf.

Paper: Form 94A

The Medicaid Streamlined Application (Form 94A) is published on medicaid.georgia.gov in English and Spanish, with English and Spanish attachments. Print, complete, and mail or hand-deliver the form and attachments to the county DFCS office. DCH also publishes an Understanding Medicaid booklet in both languages as a plain-language guide to programs and eligibility.

In person at DFCS

The Division of Family and Children Services (DFCS) operates field offices throughout Georgia. DFCS staff can complete an intake interview, accept documents, and screen for SNAP, TANF, and child care at the same visit. Find DFCS contacts by county through Georgia Gateway.

Emergency-only coverage for non-qualified non-citizens

Per the agency's how-apply page, non-qualified non-citizens or undocumented immigrants may be eligible for emergency medical assistance only. The same Form 94A and Gateway submission paths apply.

Decision timelines

Federal rules give DCH up to 45 days to decide a non-disability application and up to 90 days when the basis is disability. Coverage can be retroactive up to three months before the application month for households with qualifying medical bills.

What Georgia Medicaid covers

Georgia Families® delivers managed care to most Medicaid and PeachCare for Kids members through three care management organizations (CMOs). Members choose a CMO at enrollment and then pick a primary care provider in that CMO's network. Georgia Families 360°® is a separate statewide CMO contract that covers children in foster care, adoption assistance, and the juvenile justice system.

Georgia Families care management organizations

• Amerigroup Community Care — myamerigroup.com/ga
• CareSource Georgia — caresource.com/ga
• Peach State Health Plan (a Centene Corporation subsidiary) — pshp.com

For current member-services phone numbers and to compare CMOs side by side, visit georgia-families.com.

Core medical benefits

• Primary and specialty care, urgent care, emergency services
• Hospital inpatient and outpatient care, surgery, anesthesia
• Prescription drugs via the Medicaid preferred drug list
• Lab and imaging
• Maternity care, with continued postpartum coverage under Georgia's Postpartum Extension Demonstration
• Behavioral health: outpatient counseling, inpatient psychiatric, substance use disorder treatment
• Non-Emergency Medical Transportation (NEMT) to covered services

Services for children

Children enrolled in Medicaid or PeachCare for Kids receive EPSDT services — preventive care, screenings, and treatment that goes beyond adult coverage limits. The Autism Spectrum Disorder program covers assessment and treatment for ASD for individuals under 21 based on medical necessity. The TEFRA/Katie Beckett pathway provides Medicaid for eligible children with significant disabilities under TEFRA §134.

Long-term services and supports

Georgia covers nursing facility care for ABD-eligible members and uses HCBS waivers and the Independent Care Waiver Program (ICWP) to fund at-home care. Money Follows the Person helps Medicaid members transition from institutions to community settings. DCH publishes the full Long-Term Services and Supports overview at medicaid.georgia.gov.

Other state Medicaid pages