Georgia Medicaid Eligibility [2020 Guide]

"Georgia Medicaid Eligibility"

If you are trying to see if you are eligible to apply for Medicaid in Georgia (Georgia Medical Assistance) or need more information about Georgia Medicaid eligibility, you’ve come to the right place. The Georgia Medicaid Program provides free or low-cost health coverage to needy persons. In this post, we will explain everything you need to know to successfully apply for Medicaid.

If you are a Medicaid recipient, we will answer the most common question about Georgia Medicaid and how you can get the most out of your Medicaid benefits.

This article on Georgia Medicaid eligibility will cover:

  • What is Georgia Medicaid?
  • Georgia Medicaid Expansion
  • Georgia Medicaid eligibility
  • Should I apply for Georgia Medicaid?
  • 2020 Georgia Medicaid Income Limit
  • What is Counted as Income for Medicaid?
  • What does Medicaid cover in Georgia?
  • How do I apply for Georgia Medicaid?
  • Documents you need to apply
  • What happens after I apply?
  • Medicaid Recertification (Renewal)
  • Who Accepts Georgia Medicaid?
  • Georgia Medicaid Transportation
  • Georgia Medicaid Phone Number

"Georgia Medicaid Eligibility"

What is Medicaid?

Medicaid is a public insurance program that provides health coverage to low-income families and individuals, including children, parents, pregnant women, seniors, and people with disabilities.

The program is funded jointly by the federal government and the states.  Each state operates its own Medicaid program within federal guidelines.

The Children’s Health Insurance Program (CHIP) offers health coverage to children in families with incomes too high to qualify for Medicaid, but who can’t afford private coverage.

Medicaid in Georgia

Georgia Medicaid (also known as Georgia Medical Assistance) provides healthcare coverage to almost 1.8 million Georgians including 1.3 million children.

Application for Medicaid is handled at the state level by the Georgia Division of Family and Children Services (DFCS)

The Medicaid program in Georgia is administered by the Georgia Department of Community Health (DCH).

PeachCare for Kids (PeachCare) is Georgia’s name for CHIP, which provides health insurance to children whose families earn too much to qualify for Medicaid.

Georgia Medicaid Expansion

Georgia is one of the 14 states that have not expanded Medicaid coverage to low-income adults without dependents.

As a result, about 267,000 adults with low income who would otherwise be covered by Medicaid expansion are left without coverage.

Georgia proposes partial Medicaid expansion

Georgia enacted legislation in 2019 that allows the state to seek federal permission to expand Medicaid.

The state introduced a waiver proposal that calls for partial Medicaid expansion, effective in July 2021, that would cover adults age 19-64 with income up to 100 percent of the poverty level.

The Affordable Care Act (ACA) made Medicaid expansion available to adults who make up to 138 percent of the poverty level.

The waiver proposal will also require recipients to work at least 80 hours per month.

Georgia Medicaid eligibility

You may qualify for Medicaid in Georgia if your income is low and you match one of the descriptions below:

  • You think you are pregnant.
  • You are a child or teenager, under age 19.
  • You are age 65 or older.
  • You are legally blind.
  • You have a disability.
  • You need nursing home care.

In addition, you must be a resident of the state of Georgia, in need of health care or health insurance assistance.

Furthermore, you must also be a U.S. national, citizen, or have satisfactory immigration status.

When you apply for Medical Assistance, your application will be carefully reviewed by an Eligibility Specialist for the most appropriate type of coverage you qualify for.

Should I apply for Georgia Medicaid?

The Medicaid program is an entitlement program. This means anyone who meets the eligibility requirements will receive benefits.

You will not be taking away benefits from someone else if you apply.

In addition, the Medicaid program is a health assistance program and not a welfare cash assistance program (which is called TANF). You do not have to be receiving TANF to get Medicaid.

Even if you don’t qualify for Medicaid based on income, you should apply.

You may qualify for other medical assistance programs offered by your state, especially if you have children, are pregnant, or have a disability.

You can apply for Medicaid at any time of year — Medicaid and CHIP do not have Open Enrollment Periods.

2020 Georgia Medicaid Income Limit

Like most states, Georgia has multiple Medicaid programs based on categories.

To be approved for Medicaid, you have to know the income limit for the eligibility category you fall under.

Here are the main eligibility categories:

  • Children Ages 0-1
  • Children Ages 1-5
  • Children Ages 6-18
  • Children – CHIP
  • Pregnant Women
  • Parent & Caretaker Relatives
  • Seniors & People w/ Disabilities
  • Adults – Medicaid Expansion

How the Georgia Medicaid Income Limit is Calculated

The Georgia Medicaid Income limit is calculated as a Percent of the Federal Poverty Level (FPL).

In general, if your household income is at or below the current 133 percent FPL for your household size, your family is likely to be eligible for Medicaid.

Below are the Medicaid Eligibility levels for the state of Georgia as a percentage of the FPL by category.

Georgia Medicaid Eligibility Levels (as a % of Federal Poverty Level)

Children Ages 0-1 205%
Children Ages 1-5 149%
Children Ages 6-18 133%
Children – CHIP 247%
Pregnant Women 220%
Parent & Caretaker Relatives 32%
Seniors & People w/ Disabilities 74%
Adults – Medicaid Expansion No Expansion

Here is the 2020 Federal Poverty Level information, based on Household Size as released by the US Department of Health and Human Services.

Federal poverty levels in 2020
Household Size Poverty Guideline
1 $12,490
2 $16,910
3 $21,330
4 $25,750
5 $30,170
6 $34,590
7 $39,010
8 $43,430
Over 8 people Add $4,420 per extra person

The federal poverty level in Alaska ranges from $15,600 (for one person) to $54,310 (for eight people). The federal poverty level in Hawaii ranges from $14,380 (for one person) to $49,940 (for eight people).

The Georgia Medicaid Income Limit for 2020

Based on the Federal Poverty Level numbers above and the Medicaid Income Category Chart above, here are the 2020 Georgia Medicaid Income limits.

For simplicity, the chart is broken down by Children and Adults.

Georgia Medicaid for Children covers Ages 0-1, 1-5, and 6-18.

Children whose household income is too high to qualify for traditional Medicaid in Georgia may qualify for CHIP (Peachcare for Kids).

Georgia Medicaid Income Limit 2020 – Children
Children Medicaid Ages 0-1 Children Medicaid Ages 1-5 Children Medicaid Ages 6-18 Children Separate CHIP
% FPL 100% 205% 149% 133% 247%
Household Size
1 $12,490 $25,605 $18,610 $16,612 $30,850
2 $16,910 $34,666 $25,196 $22,490 $41,768
3 $21,330 $43,727 $31,782 $28,369 $52,685
4 $25,750 $52,788 $38,368 $34,248 $63,603
5 $30,170 $61,849 $44,953 $40,126 $74,520
6 $34,590 $70,910 $51,539 $46,005 $85,437
7 $39,010 $79,971 $58,125 $51,883 $96,355
8 $43,430 $89,032 $64,711 $57,762 $107,272

Here is the chart for adults, which inclues Pregnant Women, Parents or Caretakers of Children under 19, Seniors, and people with Disabilities.

Note that since Georgia did not expand Medicaid to adults without dependents, that category is not populated.

Georgia Medicaid Income Limit 2020 – Adults
Pregnant Women Medicaid Adults (Medicaid) Parent/ Caretaker Seniors & People w/ Disabilities (Medicaid) Adults (Medicaid) Expansion to Adults
% FPL 100% 220% 32% 74% NO
Household Size
1 $12,490 $27,478 $3,997 $9,243 N/A
2 $16,910 $37,202 $5,411 $12,513 N/A
3 $21,330 $46,926 $6,826 $15,784 N/A
4 $25,750 $56,650 $8,240 $19,055 N/A
5 $30,170 $66,374 $9,654 $22,326 N/A
6 $34,590 $76,098 $11,069 $25,597 N/A
7 $39,010 $85,822 $12,483 $28,867 N/A
8 $43,430 $95,546 $13,898 $32,138 N/A

What is Counted as Income for Medicaid?

For Medicaid application purposes, income is all money, earned or unearned, cash or any type of support received from any source by you or your household that can be used to meet basic needs for food, clothing or shelter.

Income eligibility is determined by your modified adjusted gross income (MAGI), which is your taxable income, plus certain deductions.

For most people, MAGI is identical or very close to your adjusted taxable income, which you can find on your tax return.

Non-taxable income is excluded in the eligibility determination based on federal rules.

Excluded Income

Some examples of excluded income are adoption assistance payments, earnings from the Census Bureau, Child Support, Veteran’s Benefits, and Supplement Security Income (SSI).

In addition, Earned Income Tax Credits, Disaster relief assistance, and TANF (formerly AFDC) benefits are also excluded.

Income is considered on a monthly basis and is used to determine financial eligibility and benefit level.

Whether your income level qualifies you or your family for Medicaid depends on the size of your family and the Medicaid program for which you are applying.

How Can I Verify My Income?

Income verification can be provided in a variety of ways, including:

  • Pay stubs covering at least the past four weeks.
  • Copy of check reflecting gross income.
  • Form 809 – Wage Verification form.

What does Medicaid cover in Georgia?

Here are the major services that are covered under Georgia Medicaid:

  • Doctor and nurse office visits (when you visit a doctor or nurse for checkups, lab tests, exams, or treatment)
  • Prescription drugs
  • Inpatient hospital services (room and board, drugs, lab tests and other services when you have to stay in the hospital)
  • Outpatient hospital services you receive in a hospital even though you do not stay in the hospital overnight
  • Nursing facilities (nursing homes)
  • Emergency ambulance services
  • Preventive dental care, fillings and oral surgery for children
  • Certain emergency dental care for adults
  • Non-emergency transportation (to get to and from medical appointments) 19 Understanding Medicaid
  • Medical equipment and supplies prescribed by a doctor for use in your home (such as wheelchairs, crutches or walkers)
  • Exams, immunizations (shots), and treatments for children (see box below)
  • Family planning services (such as exams, drugs, treatment and counseling)
  • Home health services ordered by a doctor and received in your home (such as parttime nursing, physical therapy or home health aides)
  • Hospice care services provided by a Medicaid hospice provider
  • Vision care for children (limited services for adults)
  • Hearing services for children

For a complete list of services that are covered under the Georgia Medicaid program, click here.

How to Apply for Medicaid in Georgia

There are 3 ways you can apply for Medicaid in Georgia.

Option 1 – Apply online

To apply online, please visit the Georgia Gateway online application portal.

You may also find out if you qualify and apply online through the Healthcare.gov Marketplace.

Option 2 – Apply at DFCS Office Near You

You can apply in person at the Georgia Division of Family and Children Services (DFCS) office near you. Click here to locate a DFCS office.

Option 3 – Download Georgia Medicaid Application

You can download an application, complete it and mail it to your county DFCS office or submit it in person.

If you are pregnant or have breast or cervical cancer, you may apply for Presumptive Medicaid at your local health department or call 404-657-2700.

Documents you need to apply

Here are the documents you are going to need to apply for Medicaid in Georgia:

    • A copy of your birth certificate or other proof of identity and citizenship or immigration status
    • ID cards issued by federal, state or local government agencies or entities either containing a picture or identifying information, such as name, date of birth, sex, height, eye color and address to confirm identity
    • Social Security numbers, for each person requesting Medical Assistance
    • Paycheck stubs, payroll records or recent W-2 forms covering at least the past four weeks
    • Letters or forms that show your income from Social Security, SSI, Veterans Administration, retirement, pensions, unemployment, worker’s compensation or all sources of income
    • Current health insurance policies, health insurance cards, or other health insurance information
    • Life insurance policies
    • Recent bank statements or bank books, and/or most recent tax return
    • Information about property you own (such as land, or stocks and bonds)

What happens after I apply?

Once you complete an application for Medicaid, a Medicaid caseworker will interview you and review your application.

If you have medical bills from the past three months that you were not able to pay, let your caseworker know about them when you apply.

If you are eligible for Medicaid, it is possible that the program may pay for some of these bills, even if you were not enrolled in Medicaid at that time.

A decision on your Medicaid application will be made within 45 days after you apply.

You will receive a letter in the mail telling you whether or not you are eligible.

Georgia Medicaid Card

If you are eligible for Medicaid, you will receive a plastic Medicaid card in the mail.

You should receive your Medicaid card within one to two weeks of being determined eligible.

Just like you would with any other health insurance card, you should carry your Medicaid card with you at all times, in your purse or wallet.

That way, you will have it with you when you need to show it to a doctor or pharmacist to receive services or prescriptions.

If you are enrolled in a Georgia Families Care Management Organization, you will also need to carry your Georgia Families health insurance card with you.

Your doctor, pharmacist or other medical care providers will need to see this card as well as your Medicaid card.

Medicaid Recertification (Renewal)

Since your personal situation may change – for example, if you get a different job or if your family size changes – the Medicaid program will review your situation from time to time to make sure that you are still eligible. If your situation changes, you must call your DFCS caseworker or the Social Security Administration office as soon as you know about any changes.

Who Accepts Georgia Medicaid?

If you do not belong to Georgia Families, you will not be assigned to a doctor or organization for your medical care.

Georgia Families is a program that delivers health care services to members of Medicaid and PeachCare for Kids

However, when you need a checkup or any medical services that are covered by the program, you can present your Medical Assistance card and another insurance card to any doctor, dentist, pharmacist or clinic who accepts Medicaid.

After you receive your medical services and other health insurance policies have been billed, the Medicaid program will pay the doctor or clinic directly for all remaining covered services.

On the other hand, if you receive services from a medical care provider who does not accept Georgia Medicaid or Peachcare for Kids, then Medical Assistance will not
pay for the services.

You will be responsible for the cost of that care.

Georgia Medicaid Transportation

The Georgia Medicaid provides Non-Emergency Medical Transportation (NEMT) to eligible Medicaid recipients who need transportation help to get to their medical appointments.

To be eligible, you must have no other means of transportation available.

If approved for Georgia Medicaid Transportation, you will only be transported to those medical services covered under the Medicaid program.

These include transportation for the purpose of:

  • Medical treatment
  • Medical evaluations
  • Obtaining prescription drugs
  • Obtaining medical equipment

To schedule Georgia Medicaid transportation, contact the NEMT Broker in your region.

See below for NEMT Brokers in Georgia by region.

Logisticare 1-888-224-7981 (Central Georgia ), 1-888-224-7985 (Southwest Georgia), 1-888-224-7988 (East Georgia)

Southeastern 1-866-388-9844 (North Georgia) and 404-209-4000 (Atlanta, Georgia)

Georgia Medicaid Phone Number

Here’s how to contact Georgia Medicaid.

Peachcare for Kids 877-427-3224
Georgia Medicaid Eligibility 404-651-9982
Georgia Medicaid Member Services 866-211-0950
Georgia Medicaid Provider Services 800-766-4456
Georgia Medicaid Customer Service/Claims Resolution 404-657-5468
Medical Policy 404-651-9606
Hospital Services 404-651-9606
Long-Term Care 404-232-1411

Georgia Medicaid Eligibility Summary

We hope this post on the Georgia Medicaid Eligibility was helpful.

If you have further questions about Georgia Medicaid benefits, please let us know in the comments section below.

Be sure to check out our other articles on Georgia Benefits including Georgia EBT Card Balance and Medicaid Income Limits

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