Medicaid is a government health insurance program that helps people with low income get health care services at a lower cost. There are different Medicaid programs in Georgia, each serving a different group of people.

What does Georgia Medicaid cover?

Georgia Medicaid pays for routine and acute health care services. This includes:

• Visits to health care providers (including physicians and nurse practitioners)
• Inpatient and outpatient hospital services
• Early and periodic screening, diagnostic, and treatment services
• Preventive care (e.g., vaccinations)
• Lab tests and X-rays
• Dialysis services
• Mental health services
• Substance use treatment
• Rural health clinic services
• Medical transportation
• Long-term care (e.g., nursing facility care, home health services)

Most states also cover optional services such as:

• Physical, respiratory, and occupational therapy
• Home- and community-based care
• Case management
• Prescription drugs
• Dental and vision care

Since Georgia Medicaid serves those with limited income and resources, people within this benefits program pay few to no out-of-pocket costs. Call 1-877-423-4746 to learn more about what may be covered.

To access your Medicaid coverage in Georgia, you must visit health care providers that participate in the program, which is managed by the Department of Community Health (DCH).

How do I know if I qualify for Georgia Medicaid?

In general, to be eligible, you must:

• Be a Georgia resident
• Be a U.S. citizen or a qualified non-citizen
• Meet the income and (if applicable) asset limit for your coverage group

If you need help with your health care coverage and costs, you should apply for Medicaid even if you think you are over the income limit or your assets are too high. This is because:

• Not all types of income are counted toward the income limit.
• You may qualify for a different form of health care assistance. For example, if you have Medicare, you may qualify for a Medicare Savings Program (MSP).
• If you are over the income limit, but you have very high medical costs, you may be able to qualify for Medicaid through Medically Needy eligibility.

What are the different Medicaid programs in Georgia?

You may be able to get health coverage if you fall into one of the following categories.

ABD Medicaid Program

The Aged, Blind, and Disabled Medicaid (ABD) Medicaid Program covers people who are age 65+, blind, or living with a disability. To qualify, you must also have limited income and resources.

SSI-Related Medicaid Program

If you receive or qualify for Supplemental Security Income (SSI), you are automatically enrolled in Medicaid in Georgia. SSI provides monthly payments to older adults and people with disabilities who have very limited income and resources. You may be able to get a monthly payment of up to $967 for 1 person or up to $1,450 for a couple. Your income, things you own, and other factors affect if you qualify for SSI and how much money you can get.

Georgia Medicaid for Workers with Disabilities (GMWD)

GMWD is a program that helps working people with disabilities get health insurance through Medicaid. Even if you make too much money for regular Medicaid, you may still qualify for GMWD if you have a job. You may need to pay a small monthly premium, but the program helps cover doctor visits, medicine, hospital care, and other health needs.

Medically Needy Program

If your income puts you over the limit to qualify for Medicaid, you may still be able to get coverage if you have very high medical expenses. This is called the Medically Needy or Spend-Down Program. You would “spend down” your income on your medical expenses until you qualify for Medicaid in Georgia. The amount you pay depends on your income and household size.

Some examples of medical expenses you can use to meet your share of cost include:

• Unpaid medical bills that have not been used to meet the share of cost before
• Health insurance premiums
• Medical bills you paid within the last three months
• Medical bills that will not be paid by health insurance (or any other source)
• Co-pays for medical bills
• Medical services prescribed by your doctor
• Transportation by ambulance, bus, or taxi to get health care services

How do Medicare and Medicaid work together?

Medicaid pays for some services not covered by Medicare. If you get Medicare, you may also be able to get help from Georgia Medicaid. Millions of Americans have both Medicare and Medicaid coverage. This is called being "dual eligible."

If you have Medicare and qualify for full Medicaid coverage, the state will pay your Medicare Part B (Medical Insurance) monthly premiums. Depending on the level of Medicaid you qualify for, the state might also pay for:

• Your share of Medicare costs, like deductibles, coinsurance, and copayments
• Part A (Hospital Insurance) premiums, if you have to pay a premium for that coverage

If you have both Medicare and Medicaid in Georgia, you should show both cards to your health care provider each time you receive services. In addition, if you are dual-eligible for Medicare and Medicaid:

• You will automatically be signed up for the Low-Income Subsidy (LIS)/Extra Help program through Medicare Part D (prescription drug coverage). This program helps people with low income pay for their medicines.
• You can get your coverage through a Medicare Advantage Special Needs Plan (SNP) instead of having original Medicare with separate Medicaid coverage. This plan can help you manage the health care services you need. SNPs may also offer more benefits than what you already get from original Medicare. In some cases, you may have no monthly premiums and/or you may pay lower co-payments. All SNP plans are different, so check with the plans to see what they cover and if you can enroll.

Note: SNPs are not available in every community. To find out if there is an SNP in your area, visit the Medicare website or call 1-800-633-4227 or 1-877-486-2048(TTY).

How do I prepare to apply for Georgia Medicaid?

When you apply for Medicaid in Georgia, you’ll be asked for important information to help determine if you qualify for benefits. Before you start, gather some basic information to make your application process easier: 

• A document that shows your age, such as your birth certificate or driver’s license
• Your Social Security card
• Pay stubs for anyone in your household who has earned income
• Documentation that shows any other form of income, such as letters from Veterans Affairs (VA) or the Social Security Administration (SSA)
• Information about your financial assets, such as bank account or investment account statements

How do I apply for Georgia Medicaid?

There are a few different ways you can apply for Medicaid in Georgia. Read below to learn more about which option might be right for you.

The quickest and easiest way to apply for Medicaid and other public assistance benefits is online through the Georgia Gateway customer portal. All your personal information is kept 100% confidential and protected by special security technology. 

Apply through Georgia Gateway

You can download and print a paper Medicaid application in your primary language, complete it, and mail it to your local DCH office. You can also drop it off in person. If you do not have a printer, call 1-877-423-4746 to request that an application form be mailed to you.

How can I get help with my application?

There are a few ways to get help filling out your Medicaid application:

• Contact your local DCH office directly or call 1-877-423-4746.
• Visit a Benefits Enrollment Center (BEC), if there’s one near you. See if there’s one in your area.
• NCOA also has a HelpLine that you can call to get free support. To get started today, call 1-800-794-6559.