Georgia Medicaid Eligibility
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Medicaid provides health insurance coverage to 1.8 million residents of the state of Georgia. In this post, we will provide a general overview of Medicaid in Georgia, explain the Georgia Medicaid eligibility criteria and how you can apply for Medicaid if you qualify.
This Post will Cover:
- What is Medicaid?
- Medicaid In Georgia
- Georgia Medicaid Eligibility
- Georgia Medicaid Income Limit
- What Does Medicaid In Georgia Cover?
- How Do I Apply for Medicaid in Georgia?
What is Medicaid?
Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities.
The program is administered by states, according to federal requirements. Medicaid is funded jointly by states and the federal government.
Eligibility levels determine who can receive Medicaid coverage. States set eligibility levels based on personal income and assets.
Medicaid in Georgia
Georgia Medicaid provides healthcare coverage to almost 1.8 million Georgians including 1.3 million children, and 500,000 seniors and people with disabilities.
The Georgia Medicaid program is managed by the Georgia Department of Community Health (DCH).
PeachCare for Kids (PeachCare) is Georgia’s name for the Child Health Insurance Program (also called CHIP), which provides health insurance to children whose families earn too much to qualify for Medicaid.
Here are facts about the impact of Medicaid in the state of Georgia.
50% + of all Births – Georgia Medicaid covers more than half of all births in Georgia.
75% Nursing Home Stays – For 75% of all nursing home stays in Georgia, Medicaid is the primary payer.
168,000 low-income Georgia Seniors – Medicaid pays the premiums and other costs of Medicare for 168,000 low-income Georgia seniors.
50% Georgia children – Half of all Georgia children, including all current and former foster children, are covered by Medicaid and PeachCare for Kids.
2:1 Ratio – Federal to State Funding – The federal government provides the bulk of Georgia’s Medicaid funding. For every $1 Georgia spends on Medicaid benefits, the state receives more than $2 in federal funds
Medicaid Expansion In Georgia
Georgia is one of the 14 states that have not expanded Medicaid coverage to low-income adults without dependents.
As a result, about 726,000 adults with low income who would otherwise be covered by Medicaid expansion are left without coverage.
Given that Georgia has one of the highest uninsured rates in the nation, this leaves many people without the coverage they need.
Georgia Medicaid Eligibility
The state of Georgia has set very restrictive Medicaid eligibility when compared to other states.
In general, you should apply for Medicaid if your income is low and you match one of the descriptions below:
- You think you are pregnant (see our Georgia Pregnancy Medicaid post here).
- The parent or caretaker of a child and/or teenager under the age of 19.
- You are a child or teenager age 18 or under.
- An adult age 65 or older.
- You are legally blind.
- Living with a disability or disabled.
- You are in need of nursing home care.
Note: Your child may be eligible for Medicaid if he or she is a U.S. citizen or a legal
immigrant — even if you are not. Eligibility for children is based on the child’s status, not
the parent’s; however, the parent’s income is counted toward the income limit.
Other situations that may make you eligible for Georgia Medicaid include:
- In need of health coverage and are leaving Temporary Assistance for Needy Families (TANF).
- You’re a family with children under 19 and have very low or no income.
- If your income is higher than the limits and you have medical bills you owe (and you are pregnant, under 18 or over 65, blind, or disabled).
- Your child is in foster care or adopted.
- When you or someone in your family needs health care, you should apply for Medicaid even if you are not sure whether you qualify.
In addition to the criteria above, you must also meet the following eligibility requirements:
- You must be a US national, citizen, legal alien or permanent resident.
- A resident of the state of Georgia.
- Have an annual household income (before taxes) that is below a certain amount, based on your household size (see income limit below).
Georgia Medicaid Income Limit
The Medicaid income limit is generally calculated as a percentage of the Federal Poverty Line. Here is the Federal Poverty Level (FPL) for 2018.
Georgia Medicaid Eligibility Criteria
Below is the Georgia Medicaid eligibility levels for children and adults (pregnant women, parents, and other non-disabled adults) as of January 2018:
- Households with children up to age 1 with family income up to 205 percent of FPL
- Any children ages 1-5 with family income up to 149 percent of FPL
- Children ages 6- 18 with family income up to 133 percent of FPL
- Pregnant women with family income up to 220 percent of FPL
- Parents of minor children with family income up to 35 percent of FPL
- Individuals who are elderly, blind and disabled with family income up to 75% of the FPL
- Women with Breast and Cervical Cancer with Family Income up to 200% of the FPL
As indicated in the image limit tables above, Georgia Medicaid eligibility for some is also determined using resource limits.
For those who have to meet resource limits, here are examples of resources counted in determining eligibility:
- Checking accounts
- Savings accounts and certificates
- Christmas or vacation clubs
- Stocks and bonds
- Some trust funds
- Life insurance
- Revocable burial funds
- Non-resident property
Examples of resources not counted in determining eligibility include:
- Your home
- Revocable and irrevocable burial reserves subject to specified limits
- Burial space and marker
- One motor vehicle
What Does Georgia Medicaid Cover?
It’s always a good idea to ask your doctor or pharmacist whether the specific service or item you need is covered by Medicaid.
Generally, Medicaid covers the following services:
- Doctor and nurse office visits
- Lab tests and x-rays
- Prescription medicine
- Inpatient hospital services
(services you receive in the hospital when you spend the night)
- Outpatient hospital services
(services you receive at the hospital even though you don’t spend the night)
- Nursing homes
- Emergency ambulance services
- Preventive dental care for children
- Certain emergency dental care for adults
- Non-emergency transportation to get to and from medical appointments
- Medical equipment and supplies prescribed by a doctor for use in your home (such as wheelchairs, crutches, or walkers)
- Exams, immunizations (shots), and all necessary treatments for children
- Family planning services (such as exams, birth control, treatment, and counseling)
- Vision care for children
- Hearing services for children
There are some limits to these services and some may require you or your doctor to get permission from Medicaid first (this is called prior approval).
How Do I Apply for Medicaid in Georgia?
Medicaid and PeachCare for Kids enrollment is open year-round
There are two ways to apply for Georgia Medicaid:
You can apply for Medicaid online using the Georgia Gateway website. If you already have a Gateway account, click here for Gateway Login help.
Apply In Person
Your County Division of Family and Children Services
Call the Division of Family and Children Services (DFCS) information line at 1-877-423-4746 and be directed to a local office. To find your DFCS office near you, click here.
Right from the Start Medical Assistance (RSM) Group offices.
Right from the Start Medicaid sites help with Medicaid for children, pregnant woman, parent/caretaker, or family planning for women ages 18-44. To find an RSM site, click here
or call 800-809-7276.
If you are aged (65 or older), blind or disabled
Apply for Supplemental Security Income (SSI ) and Medicaid by contacting your local Social Security office. Call 800-772-1213 or visit http://www.ssa.gov. If you are deaf or hard of hearing call the TTY number 800-325-0778
Other Places you can apply for Georgia Medicaid in person include:
- Social Security Administration offices
- County Public Health Department offices
- Select hospitals and nursing homes
Apply by Mail
You can call your DFCS county office and ask them to mail you an application. You can return it by mail, fax, or in person.
Note: If you apply for Medicaid for your children and learn they are not eligible because of income, ask about PeachCare for Kids or call 877-427-3224. You can also apply online at www.peachcare.org.
Families that earn too much money for Medicaid may be able to enroll their children in PeachCare for Kids.
If you have any questions about how Georgia Medicaid, you can ask us in the comments section below.
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