Georgia Medicaid Eligibility and Application

Georgia Medicaid provides free or low-cost health coverage to eligible needy adults and children. According to recent data, 35% of Georgia’s population is low-income (with an annual income of less than 200% of the Federal Poverty Line). The Medicaid program, therefore, provides needed medical coverage in the state. As of 2018, Georgia Medicaid and CHIP (Children’s Health Insurance Program) covered 1.8 million adults and children, accounting for 17% of the state’s population.

What You Should Know:

Who Can Get Medicaid in Georgia?

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
• You are the parent or caretaker of a child or teenager under the age of 19
• You are a child or teenager under the age of 19
• You are age 65 or older
• You are legally blind
• You have a disability
• You need nursing home care

What qualifies you for Medicaid in Georgia?

To qualify for Medicaid in Georgia, you have to meet the Georgia Medicaid Income limits below. The income limits are set as a percentage of the Federal Poverty Line. The 2018 Federal poverty line is shown in the table below.

"Georgia Medicaid Income Limit"

You can use the FPL table to determine whether your income falls within the Georgia Medicaid income limits below.

Georgia Medicaid Income Limits

To be eligible for Medicaid, you cannot make more than the income guidelines outlined below:

  • Children up to age 1 with family income up to 205 percent of FPL
  • Children ages 1-5 with family income up to 149 percent of FPL
  • Children ages 618 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

What Does Medicaid in Georgia Cover?

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

If you are unsure about whether a particular procedure or service is covered by Medicaid, ask your doctor or pharmacist.

FAQs:

How do I apply?

Apply for Medicaid coverage in One of Four Ways

  • Online – Apply for Medical Assistance by visiting Georgia Gateway website.
  • By Phone – Call The DFCS at 1-877-423-4746 (TTY: 1-800-255-0556 or 711).
  • By Mail. Fill out the form and mail it back right away to DFCS. Find the address to your local county office here.
  • In Person. Visit your local county DFCS office. Find the address to your local county office here.

Other Ways to Apply

  • Social Security Administration offices
  • Health departments, some hospitals, and nursing homes
  • Local Right from the Start Medicaid (RSM) project offices.

Did Georgia Accept Medicaid Expansion?

No, the state of Georgia of the 14 states that have not expanded Medicaid coverage to low-income adults.

That means that about 726,000 adults with low income who would otherwise be covered by Medicaid expansion are left without coverage.

Without Medicaid expansion in Georgia, some 240,000 people have no realistic access to health insurance.

How do I find a doctor that accepts Medicaid in Georgia?

There are two ways to find a Medicaid Provider in Georgia.

  1. Georgia Department of Community Health’s GAMMIS website. Click here to visit their website.
  2. Doctor.com can help you find a doctor who accepts Medicaid insurance in Georgia. Click here to use their system to find a doctor who accepts Medicaid insurance in Georgia near you.

According to Doctor.com, here are the number of providers in the state of Georgia that accept Medicaid according to their specialty (Top 10).

  • Family Doctor (1217 providers)
  • Internist (1206 providers)
  • Pediatrician (Kids / Children Specialist) (970 providers)
  • Obstetrician / Gynecologist (OBGYN) (735 providers)
  • Radiologist (465 providers)
  • Surgeon (434 providers)
  • Orthopedic Surgeon (429 providers)
  • Cardiologist (Heart Specialist) (392 providers)
  • Other Doctors (318 providers)
  • Emergency Doctor (304 providers)

How do I Sign Up for PeachCare for Kids?

To enroll a child in PeachCare for Kids, follow the instructions below to apply.

  • Online – Sign Up for PeachCare for Kids by visiting Georgia Gateway website.
  • By Phone – Call 1-877-GAPEACH (1-877-427-3224).
  • By Mail – You can mail in a paper application.
  • In Person – Visit your local county DFCS office. Find the address to your local county office here.

What’s the Phone Number for Georgia Medicaid?

To apply for Medicaid, see the application options provided above. If you have specific questions about Medicaid in Georgia, you can call the Georgia Department of Community Health (DCH) at one of the numbers below that best describes your situation.

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

You can also email the DCH by completing the online form here.

For the DCH main office, here is the address:

Georgia Department of Community Health
2 Peachtree Street
Atlanta, GA 30303

If you have any questions about Medicaid in the state of Georgia, you can ask us in the comments section below.

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