Georgia Pregnancy Medicaid Eligibility

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If you are pregnant and on a low income, you may qualify for Georgia Pregnancy Medicaid, which is part of the Right from the Start Medicaid (RSM) program. In this post, we will explain the Medical Assistance options available to low-income pregnant women in the state of Georgia, the income limit, eligibility requirements and how to apply.

This Post Will Cover:

  • What is Medicaid
  • Who is Eligible for Medicaid
  • Medicaid Coverage Available to Pregnant Women
  • Presumptive Eligibility (PE) Medicaid
  • Georgia Pregnancy Medicaid
  • Medically Needy Medicaid

"Georgia Pregnancy Medicaid Eligibility"

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. The federal government and the states jointly fund Medicaid.

Eligibility levels determine who can receive Medicaid coverage. For instance, 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). In other words, PeachCare provides health insurance to children whose families earn too much to qualify for Medicaid.

Medicaid Coverage Available to Pregnant Women

Georgia currently has two programs which cover pregnant women: Right from the Start Medicaid and the Medically Needy Program.

Before we explain what the two programs are about, you should first look into Presumptive Eligibility (PE) Medicaid. This program can provide you with temporary Medicaid coverage right away while you apply for Medicaid benefits.

Presumptive Eligibility (PE) Medicaid

If you are currently pregnant in the state of Georgia and don’t have insurance coverage, the first thing you need to do is see if you qualify for Presumptive Eligibility (PE) Medicaid.

Pregnant women may complete a short application for Presumptive Eligibility (PE) Medicaid coverage. After that, have the local county health department make a determination the same day for benefits.

This will usually allow the applicant to receive a Medicaid number right away.

PE Medicaid is temporary and is valid from the date approved to the end of the following month or when a full Medicaid determination is made.

The purpose of PE Medicaid is to provide pregnant women temporary coverage while they go through the process of determining their eligibility for Medicaid coverage.

It covers most Medicaid services except inpatient hospital services and labor and delivery.

To see if you qualify for PE Medicaid:

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.

You can also contact a Right from the State Medicaid Group site for help.

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.

Georgia Pregnancy Medicaid

If you are pregnant, you may qualify for Medicaid in Georgia if your income is at or below 220 percent of the federal poverty level. This is a part of the Right from the Start Medicaid (RSM) program.

Right from the Start Medicaid (RSM) for pregnant women pays for medical care for pregnant women, including labor and delivery, for up to 60 days after they give birth.

A pregnant woman is counted as two people in the calculation of family size.

Her husband is also counted, although husbands do not receive RSM coverage.

In addition, a woman meeting the income standards may become eligible within 60 days after giving birth, even if she did not apply during pregnancy or delivery.

Infants, born to women receiving Medicaid on the day the child is born, receive Medicaid until they reach their first birthday.

The Income chart below provides details of the income limit for the RSM program for Pregnant women in Georgia.

Georgia Pregnancy Medicaid Income Limit

"Georgia Pregnancy Medicaid Eligibility"

In addition to the income limit above, you have to also meet the following requirements:

"Georgia Right From the Start Medicaid Eligibility"

What Does RSM Medicaid Cover?

Right from the Start Medicaid (RSM) for pregnant women pays for medical care for pregnant women, including labor and delivery, for up to 60 days after they give birth. Benefits include:

  • Doctor visits
  • Drugs ordered by a doctor
  • Labor and delivery
  • Lab tests and X-rays
  • Hospital care
  • Glasses
  • Rides to the doctor

Benefits of Medicaid for Pregnant Women

First, you will be given a list of medical providers who accept Medicaid or given a website to look for a provider in your area.

Second, pregnant women are covered for all care related to the pregnancy, delivery and any complications that may occur during pregnancy and up to 60 days postpartum.

Third, as long as you receive care from a Medicaid provider, your health care costs will be submitted through Medicaid and will be covered, in accordance with Medicaid regulations and guidelines.

Finally, Medicaid usually gives Pregnant women priority in determining Medicaid eligibility. Most offices try to qualify a pregnant woman within about 2-4 weeks.

If you need medical treatment before then, talk with your local office about PE Medicaid as explained above.

Medically Needy Program

Pregnant women in Georgia who are not eligible for RSM Medicaid because their income or assets are over the Medicaid program limits may qualify for the Medically Needy program.

Individuals enrolled in the Medically Needy Program must have a certain amount of medical bills each month before Medicaid can be approved.

This is referred to as a “share of cost” and varies depending on the household’s size and income.

How the Medically Needy Program Works

The Medically Needy Program has no income maximum. Individuals are allowed to use medical expenses to “spend down” the difference between their income and the medically needy income level (MNIL).

The MNIL is $317 for an individual and $375 for a couple. Medically Needy is calculated on a monthly basis and only pays for medical bills incurred after the spend-down is met.

Also, once an individual meets the spent down limit for the month, the individual must contact DFCS to get approved for Medicaid for the remainder of the month.

Medically Needy Income Limit (MNIL)

To qualify for the Medically needy program, you have to meet the following spend-down limit before your Medicaid is approved to cover the remainder of your eligible medical bills for that month:

"Georgia Medically Needy Income Limit"

How Do I Apply for Pregnancy Medicaid in Georgia?

There are three ways to apply:

Apply Online

You can apply for Medicaid online using the Georgia Gateway website. If you already have a Gateway account, click here for Gateway Login help.

If you do not have a Gateway account, click here to create a Gateway Account. To visit the Gateway site directly, click here.

You can also apply for Georgia Medicaid online at www.healthcare.govClick here to learn more on how to set up an account and apply.

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.

Other Places you can apply for Georgia Medicaid in person include:

• County Public Health departments.
• Some 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 Pregnancy Medicaid, you can ask us in the comments section below.

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