Georgia Medical Assistance: The Georgia Medicaid Program
Georgia Medicaid, also known as the Georgia Medical Assistance program, is both a federal and Georgia-state funded health care program for those in financial need. As of September 2018, GA Medicaid provides medical coverage for:
- 1 out of every 12 adults
- 2 out of every 5 kids
- 5 out of every 7 nursing home residents
- 3 out of every 8 disabled persons
On the national level, Medicaid pays for about one out of every six dollars spent on health care, and about half of all national long-term care services. If GA Medicaid is that prominent, you might be eligible!
This Guide to the Georgia Medicaid Program Includes:
- Georgia Medicaid Eligibility and Income Limits
- Georgia Medicaid Coverage
- Medicare and Medicaid in Georgia
Georgia Medicaid Eligibility and Income Limits
Georgia Medicaid eligibility is based largely on your yearly income related to your household size. You must also be a U.S. citizen, legal alien, or permanent resident living in Georgia.
Using the Georgia Medicaid Application
If you think you’re eligible, you can use the Georgia Medicaid application online through “Georgia Gateway.” If you have not applied for Medicaid in the state of Georgia before, you’ll need to create an account. Once you have a Georgia Gateway account, you can check, renew, and apply for benefits all online.
If you prefer, you can complete the Georgia Medicaid application in person at your local County Division of Family and Children Services (DFCS) office or Social Security office, or call 1-877-423-4746 (TTY 1-800-255-0135). Alternatively, you can download the Georgia Medicaid application here. Once you complete it, either mail, fax, or bring in your application to your local DFCS office. You can also apply for food stamps with this application.
Georgia Medicaid Coverage
Your GA Medicaid Coverage will depend largely on your age, your financial status, and whether or not you have another form of insurance.
GA Medicaid coverage can include the dental, vision, and hearing coverage you and your family needs. Kids can get more dental, vision, and hearing coverage than adults can. Kids can generally get preventative dental care, exams, X-rays, cleanings, fluoride treatments, sealants, fillings, crowns, and some surgeries like wisdom tooth extractions. Pregnant women get most of those same benefits, but non-pregnant adults only get emergency services as well as some extractions, x-rays, and exams.
This list can help you find a dentist in your area that accepts Medicaid patients.
Vision and Hearing
Georgia Medical Assistance covers vision services for:
- Kids up to age 1 with a family income up to 205% of the FPL
- Kids ages 1-5 with a family income of up to 149% of the FPL
- Kids ages 6-18 with a family income of up to 220% of the FPL
- Parents with family income up to 35% of the FPL
- Those who are elderly, blind, or otherwise disabled
Covered vision services include a yearly exam and yearly pair of eyeglasses. If medically necessary, a second exam, a second pair of glasses, contact lenses, polycarbonate lenses, and vision therapy may be covered. Replacement of broken eyeglasses may be covered with prior approval, but lost eyeglasses are not covered. A copay of up to $3 may be applicable.
If you are not eligible for Medicaid but live in Georgia and still need vision assistance, you can apply for help through the Lighthouse Foundation and their mobile clinic. They also partner with the Georgia Hearing Aid Distribution Program to provide hearing aids to those with or without Medicaid who are in need.
You can receive hearing aids through the Georgia Hearing Aid Distribution Program if your income is at no more than 200% of the FPL, you’ve been a Georgia resident for at least a year, and you have a legitimate recommendation from a Georgia state licensed hearing provider. If a person under the age of 21 is in need of hearing aids, they may be able to find coverage through the Georgia Hearing Aid Distribution Program even without Medicaid eligibility (as long as they meet the other requirements). Recipients will have access to up to two digital hearing aids with a three-year warranty, one set of ear molds, and up to four appointments with a provider approved through the Georgia Lions Lighthouse Foundation.
Click here to download the application for hearing services through the Georgia Hearing Aid Distribution Program and the Georgia Lions Lighthouse Foundation.
Doctors and the Provider Network
To find a doctor near you that accepts your GA Medicaid plan, visit the Georgia Department of Community Health website. Keep in mind that you have a secondary insurance plan or if you are dual eligible for Medicare and Medicaid and have benefits from both, your provider network may be different. If you have a Medicare Advantage plan, you’ll need to check with your plan details to find out what doctors and pharmacies are within your plan network.
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Transportation with Logisticare and Southeastrans
Georgia Medicaid provides non-emergency medical transportation through two vendors: Logisticare and Southeastrans. Logisticare services Central, Southwest, and East Georgia, while Southeastrans services northern Georgia and metro Atlanta. To request service, use this chart to find the number for your county. Then, call between the hours of 7 AM and 6 PM from Monday to Friday to schedule your medical transportation. This is NOT for ambulance services – this is for helping you get to your doctor’s appointments or pick up your prescriptions.
GA Medicaid waiver programs help the elderly and/or disabled stay living at home instead of having to enter a care facility. The programs cover service coordination, personal support and home health, emergency response systems, and respite (caregiver relief). Programs include:
New Options Waiver Program (NOW) and Comprehensive Supports Waiver Program (COMP): For those with intellectual or developmental disabilities. Complete and submit this form to apply.
Independent Care Waiver Program (ICWP): For adults with severe physical disabilities or traumatic brain injury who need nursing facility or hospital level of care. Contact the Georgia Medical Care Foundation to apply at 678-527-3619 or 800-982-0411, ext. 3619.
Community Care Services Program (CCSP) and Service Options Using Resources in a Community Environment (SOURCE): For frail, elderly, and disabled Georgians. Apply through the Georgia Aging and Disability Resource Connections office (ADRC) in your area.
Georgia Pediatric Program (GAAP): For kids with multiple system diagnoses. Apply directly through the GAAP program agency by calling 404-657-7882.
Peachcare for Kids
Peachcare For Kids is the Georgia state Medicaid program for those under age 18. Eligibility income limits are based on household income and household size:
- Family of 1: Less than $29,988 annually
- Family of 2: Less than $40,656 annually
- Family of 3: Less than $51,336 annually
- Family of 4: Less than $62,004 annually
Eligible kids in Georgia can get coverage for physicians, specialists, dental, vision, hospitalization, emergency services, prescriptions, and mental health. You will have a choice of a CMO (Care Management Organization). This will act as a private health plan responsible for coordinating your child’s Peachcare For Kids services. Peachcare For Kids is free for kids under six. Otherwise, costs range from $0 to $36 for one kid and no more than $72 for two or more kids living in the same household. Kids over six may have a copay as little as 50 cents or as high as $12.50. There are currently no copayments for emergencies, preventative care, immunizations, and routine dental services.
Peachcare for Kids Application
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Medicare and Medicaid in Georgia
If you qualify for Medicaid in Georgia based on your income, you can still qualify for Medicare and get benefits from both programs! To qualify for Medicare, you need to either be over the age of 65 or diagnosed with ALS or ESRD.
If you think you may qualify for both Medicare and Medicaid, you may be eligible for great savings. Submit your name, contact information, and location so that we can help you learn about the benefits available in your area. Submit your information here or call us at 833-438-3676.