How To Get Medicaid In Ga

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While Medicaid is a federal program, it is administered by each state individually. If you are a resident of Georgia with low income, you may qualify to get Medicaid through the Division of Family and Children Services (DFCS). If you are over 64 years of age, you automatically qualify as long as your income is below the maximum level set each year. If you are under 64, in addition to meeting the income requirements, you must be pregnant, have a child under the age of 18, be disabled, or care for someone in your household who is disabled.^[1]

1
Confirm that you are eligible for Medicaid. In Georgia, Medicaid covers parents and caretakers of children under 19, children under 19, pregnant women, people 65 and older, and people who are blind or disabled. Your income must fall below the threshold to be eligible for assistance.^[2]
- Generally, if you have very low income and few assets, you will likely qualify for Medicaid. Georgia doesn't have a specific calculator you can use or offer information for you to determine ahead of time if you qualify for Medicaid. If you think you might qualify, you should apply.
- If you receive other government assistance, such as TANF or food stamps, you likely also qualify for Medicaid.
2
Gather documents to verify your income and citizenship. Your application process will be shorter if you have the right documents handy for the Medicaid eligibility specialist to verify the information you provided in your application. While you may not need all of these documents, types of documents you might need include the following:^[3]
- Your birth certificate or immigration documents
- Government-issued photo ID
- Social Security numbers for each person in your household
- Award letters for any other benefits you receive
- Current health insurance cards or policies
- Life insurance policies
- Recent bank statements
- Your most recent tax return
- Information about any real estate or investment property you own
Tip: If you need help finding any of these documents, call 877-423-4746 or 877-427-3224.
3
Apply online through Georgia Gateway. Provided you have internet access and a valid email address, the easiest way to apply for Medicaid in Georgia is to go to https://gateway.ga.gov/access/. If you don't already have an account, scroll down and click the "Create Account" button to get started.
- Once you've created your account, select "Medical Assistance" as your program to complete the application. The online application is available in English and Spanish.
4
Visit a local Medicaid office in person to apply. If you want to apply in person, take the verification documents you think you'll need and fill out an application at your county Division of Family and Children Services (DFCS) office. Health departments, nursing homes, and some hospitals also accept Medicaid applications.
- To find your county DFCS office, go to https://dfcs.georgia.gov/locations and click on the name of your county.
- If you're already receiving Supplemental Security Income (SSI), you can also apply for Medicaid at your local Social Security Administration office.
5
Provide any requested documents to your eligibility specialist. Once your application is received, an eligibility specialist will review the information you provided and send you a list of documents they need to verify your information. Make arrangements to submit these documents as soon as possible to avoid any unnecessary delays.^[4]
- If you have any medical bills that you are unable to pay, include copies of them along with your application. If your application is approved, Medicaid may cover some of those bills.
6
Wait for your benefit determination letter. Within 45 to 60 days of the date you applied for benefits, you'll get a letter that tells you whether you are eligible for Medicaid. If you are pregnant and eligible, you can get a Medicaid certification form on the day you apply so you and your baby can start prenatal care immediately.^[5]
- If you are approved, you'll receive a plastic Medical Assistance card that looks similar to a credit card. You'll need to keep this card with you at all times, so put it in your purse or wallet immediately.
- If you are denied, the notice will provide a reason for the denial and give you instructions on how to request a fair hearing if you disagree with the decision.
Tip: If you are found ineligible for Medicaid, your information will automatically be sent to the federal marketplace at healthcare.gov to determine if you qualify for subsidies or premium tax credits on private health insurance. Signing up for insurance on the marketplace does not affect any appeal you've filed.

1
Choose a health plan if you are assigned to Georgia Families. Georgia Families is a managed care program that operates similar to private insurance plans. There are 4 health plans available in Georgia: Amerigroup, CareSource, PeachState, and WellCare. Some of those plans may not service your area. Initially, Georgia Families will assign you a plan that services your area.^[6]
- You'll get notice of the plan that has been chosen for you, along with a separate card for that plan. If you want to choose a different plan, you have 90 days to make your selection.
2
Carry your cards with you when you go to get medical care. Keep both your Medical Assistance card and your Georgia Families plan card (if you have one) with you at all times. You will need to show them whenever you get medical treatment or services or fill a prescription.^[7]
- If you lose your card, call the Member Contact Center at 866-211-0950 as soon as possible to get a replacement. Representatives are available Monday through Friday from 7 a.m. until 7 p.m.
3
Contact your county office if your living situation changes. If you get a different job, your family size changes, or you move to a new home, the change could impact your Medicaid coverage. Report the change as soon as possible by calling 877-423-4746 or 877-427-3224. You can also report changes through Georgia Gateway if you have an online account.^[8]
- If you are receiving SSI, you must also call the Social Security Administration at 800-772-1213.
Warning: If you don't report life changes immediately, you may end up losing your Medicaid coverage, even if those changes wouldn't have affected your eligibility. As a condition of receiving Medicaid, you have a responsibility to report these changes.
4
Report your Medicaid benefits on your tax returns. Each year, you'll receive an IRS Form 1095-B from the Georgia Medicaid program. The information on this form is also transmitted to the IRS on your behalf. However, you must also enter this information on your tax return for the years you receive Medicaid.^[9]
- If you get a 1095-B form you are required to file a tax return, even if you wouldn't otherwise be required to do so, such as if you have no income to report.
5
Renew your Medicaid every 12 months. You will receive a notice in the mail a month before your renewal month. You can renew your Medicaid using the same method you used to apply initially. The renewal application requires information similar to what you provided on your initial application.^[10]
- If you reported changes in your household, you may have received an administrative renewal. This renewal extends your Medicaid for another 12 months, but it also changes your renewal month. If you're not sure when your renewal month is, call your local DFCS office or check your online account.

1
Check the notice you received for appeal instructions. The notice you got in the mail informing you that your Medicaid application was denied has instructions on the back about how to appeal the decision if you think it was wrong. You'll also find a form you can use to file that appeal.^[11]
- Look carefully at the reason that was given for the denial of your application. If you have documents or other evidence that can prove that reason is wrong, you should ask for a fair hearing to set the record straight.
Tip: You only have 30 days from the date on the letter – not the date you received the letter – to request a fair hearing, so act fast.
2
Fill out the fair hearing form on the back of your notice. The easiest way to request a hearing is to use the form on the back of your notice. Make a copy of your notice before you fill out the form so you have the notice for your records.
- If you have an online account with Gateway Georgia, you can also access the form through your account.
3
Take your fair hearing request form to the local DFCS office. Once you've completed your request form, make a copy of it. Take both the original and the copy to your local DFCS office and give them to a DFCS representative. Ask them to stamp the date and time the request form was received on the copy.
- You can also mail in your request. However, if you do this, make sure you're not too close to the deadline. If you decide to mail in your request, use certified mail with return receipt requested. When you get the green card back, note the date your request was received and keep the card with your other Medicaid-related information.
4
Find out the date, time, and location of your hearing. Within a week or two after your request is received, the Office of State Administrative Hearings will send you a notice letting you know when and where your hearing is scheduled to take place. If you don't think you'll be able to attend the hearing on the date scheduled, contact the Office as soon as possible and let them know. Use the contact information on the notice.
- If you need a translator or other accommodations, call the Office and let them know what you need. Make these requests as soon as possible or they may not have time to make the necessary arrangements.
5
Contact legal aid if you want help at your hearing. While you may not be able to afford to pay a private attorney, you may still be able to get legal assistance for free through legal aid. This can be helpful if you get anxious or intimidated by the prospect of a hearing.
- Outside metro Atlanta, call 404-206-5175 to apply for free legal help. In metro Atlanta, the number to call is 404-524-5811.
6
Tell the hearing officer your side of the story. The hearing officer will begin the hearing by asking the Medicaid representative to explain the decision the agency made. Then you will have the opportunity to tell the hearing officer why you think that decision was wrong.
- You will also have the opportunity to provide documents or call witnesses that back up your claim. For example, if the agency determined that you were ineligible for Medicaid because you were not disabled, you might bring medical records and have your doctor testify on your behalf about your disability.
- You can also ask the Medicaid representative or the hearing officer any questions you may have about Medicaid or your denial.
7
Wait for written notice of the hearing officer's decision. A few weeks after the date of your hearing, you'll get a written notice in the mail that sets out the hearing officer's decision. If the hearing officer decided in your favor, your county DFCS office is required to comply with the hearing officer's decision and grant you Medicaid coverage for 12 months.
- If the hearing officer sided with the Medicaid agency, the notice will include information on how you can file an additional appeal of that decision. If you're at the point that you've already been ruled against twice, make sure you have an attorney to help you at the next stage.

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