Get Help with Medicaid Redetermination

Medicaid redetermination is the review of an existing member’s continued eligibility. Generally, both Medicaid and PeachCare for Kids® require renewals every 12 months. However, during the COVID-19 pandemic, a Public Health Emergency (PHE) was declared, which allowed everyone on Medicaid and PeachCare for Kids® to maintain their coverage for the duration of the PHE.

Due to recent changes at the federal level, Georgia is required to redetermine eligibility for approximately 2.7 million Medicaid and PeachCare for Kids® members over the next 14 months, beginning on April 1, 2023. Every Georgia Medicaid member must respond to requests for required information in a timely manner.

Every case will be reviewed by the state of Georgia between April 2023 and May 2024.

What Should You Do to Prepare for Medicaid Redetermination?

• Log in to your Gateway account at gateway.ga.gov and update your contact information.
  • This will ensure your notices are going to the mailing address or email you check regularly so you receive the notification of when your redetermination window is occurring.
• You can find more information about your redetermination deadline by logging into your Gateway account at gateway.ga.gov.

Your redetermination process will begin when you receive a letter in the mail or email about 45 days before your redetermination deadline. You’ll also receive a reminder about 15 days before your deadline (e.g., if your redetermination deadline is May 31, you will receive your first letter on April 16 and a reminder on May 16). You can also find your redetermination deadline by logging into your account at gateway.ga.gov.

The letter simply states that your redetermination window has begun, and provides instructions for updating or submitting your documents by your deadline. This may mean you need to upload pay stubs or other materials.

No matter how you want to complete your redetermination application, just make sure you do it by the deadline assigned to your case. 

You need to complete the steps listed in your notification letter or email as soon as possible to help avoid a potential gap in your coverage.

Please note that you can’t renew early. You must wait until you receive your letter—only then does your redetermination window open. The letter will have details including your case number and your client ID. Make sure you keep track of your client ID; it will be important throughout the redetermination process.

Once your redetermination window has begun, you have several options for completing your redetermination:

• The fastest way is to visit gateway.ga.gov.
• You can mail, fax, or take hard copies of your paperwork to the local Division of Family & Children Services office.
• You can call 1-877-423-4746 and complete the process over the phone through the automated system. Our services, including interpreters, are free. If you are deaf, hard of hearing, deaf-blind, or have difficulty speaking, you can call us at the number above by dialing 711 (Georgia Relay).

It’s up to you how you complete your redetermination, whether online, in person, or by phone.

The best way to access information about your Medicaid coverage and other benefits is through the Gateway online portal.

One of the easiest ways to access a computer, if you don’t have one, is to visit your local library. Not only do they have computers that are free to use, but they also have dedicated self-service kiosks that will take you directly to gateway.ga.gov.

When you visit the Gateway login page, you’ll see three buttons on the right sidebar:

• “Apply for Benefits”
• “Create an Account”
• “Manage My Account/Login”
  • You may have already used gateway.ga.gov to apply for or manage Medicaid, SNAP, TANF, MA, CAPS, or WIC benefits.

Do not click apply for benefits while you’re waiting for your Medicaid eligibility to be verified; you already have coverage.

Update Your Contact Information:

1. On the Gateway login page, click “Manage My Account/Login.”
2. Log into your account with your Gateway User ID and password.
3. Update your email address and mailing address in your account.

To update the contact information listed in your Gateway account in person, you can simply visit your local Division of Family and Children Services office. To find your local office and its hours, simply visit dfcs.ga.gov/locations.

Create a Gateway Account:

1. On the Gateway login page, click “Create an Account.”
2. On the “Setting Up An Account” page, fill in the blanks with your first and last name, email address, and mobile phone number.
3. Then, click on “Verify,” which will ensure there are no mistakes.
4.  You will then be taken to a page that has a few more questions, like your name, email address, and phone number*. From there, create a User ID and Password.
5. Once you’ve created a User ID and Password, select three security questions and fill in the answers.
6. After that, check the User Acceptance Agreement and click on “Create Account.”
7. From here, go back to the main Gateway homepage and click on “Manage My Account/Login.” Then enter the User ID and Password you just created.
8. Next, agree to the terms of the Confidentiality Agreement to complete the set up of your Gateway account.

*If you don’t have an email address or a phone number, you can still create an account, but providing that information will make it easier for you to access your account in the future. If you ever need to retrieve your Gateway User ID or reset your password, you can either answer security questions or call the Customer Contact Center at 1-877-423-4746. 

If you need extra help completing all of the steps for your Medicaid redetermination, you can appoint an Authorized Representative. An Authorized Representative is someone who is legally allowed to assist a Medicaid or PeachCare for Kids® member continuously throughout the redetermination process. This can be a family member, friend, or provider.

How to Add an Authorized Representative to Your Redetermination Case:

1. You must add this person to your case in Gateway as an Authorized Representative before they will be allowed to assist you with your Medicaid redetermination.
   • Log into your Gateway account at gateway.ga.gov.
   • Go to “Report My Changes” or “Renew” and select “Add an Authorized Representative.”
   • Or, go check out the FAQs.
2. Next, they must register in Gateway to become your Authorized Representative.
   • In Gateway (gateway.ga.gov), click “Create an Account” to create their own separate Gateway account.
   • Check “Yes” for “Are you an Authorized Representative?”
   • Complete the setup of their Gateway account.
3. Once their Authorized Representative account has been created in Gateway, they will receive a transaction number and then enter the system to be processed.
   • This links their Gateway account to your Gateway account.

Once the Authorized Representative has been added, that person can assist you with your renewal of eligibility, and other ongoing communications with the Georgia Department of Human Services.

NOTE: Even if someone has your medical or legal power of attorney, they still have to become an Authorized Representative in order to be allowed access to help you with your Medicaid redetermination.

Once your Medicaid redetermination window has begun, follow the instructions listed in the notification letter or email you received. It’s important to submit your documents as soon as you can to help avoid a potential gap in your coverage.

Once your redetermination window has begun, you have several options for completing your redetermination:

• The fastest way is to visit gateway.ga.gov.
• You can mail, fax, or take hard copies of your paperwork to the local Division of Family & Children Services office.
• You can call 1-877-423-4746 and complete the process over the phone through the automated system. Our services, including interpreters, are free. If you are deaf, hard of hearing, deaf-blind, or have difficulty speaking, you can call us at the number above by dialing 711 (Georgia Relay).

How to Complete Your Redetermination From Your Gateway Account:

1. Find your notification letter or email that has your case number and your client ID.
2. Log into your Gateway account at gateway.ga.gov.
3. Once on the homepage click “Renew Benefits.”
4. From there, fill in the information required and upload any necessary documents.
   • The documents you will need depend on the type of Medicaid or PeachCare for Kids® coverage you have.
   • You may also be asked to submit between 30 days’ and 3 months’ worth of pay stubs.
   • You can upload pictures or scans of the documents directly through gateway.ga.gov.
   • You can also mail, fax, or take hard copies of your paperwork to the local Division of Family & Children Services office. To find your local office and its hours, simply visit dfcs.ga.gov/locations.
5. After your paperwork is done, fill out the rest of the information under “Renew Benefits.”
   • Input your address, contact information, Social security number, number of people in your home, phone numbers, the best way to get in touch, and the best time to call during the work week.
6. When you have filled out all of the necessary information, select “Submit.”

What Happens After I’ve Submitted My Redetermination Information?

Your case will be assigned to a Case Manager, who will review your redetermination application within 30 days and make a decision.

NOTE: If your documents are submitted after your redetermination deadline, the Case Manager will still review your documents within 30 days, but your coverage will be suspended during that time.

Possible Redetermination Outcomes:

• If your redetermination is approved, a confirmation letter will be sent to you within seven calendar days of the decision. Your coverage will continue for another 12 months until your next annual renewal.
  • If you’re not a special case—for example, you didn’t move or have a change of income—approval status will be reflected immediately in your Gateway profile.
• If your redetermination is denied, you will receive a letter notifying you of the decision and explaining the reason(s) why your redetermination was denied.
  • If that reason is “failed to submit,” you still have another 90 days to submit your redetermination application.
  • If you were denied for any other reason, you have the option to appeal that decision.
  • If you are no longer eligible for Medicaid, you will be connected to other healthcare program options on the Federally Facilitated Marketplace.

Depending on the reason for the termination of your coverage, a couple of things can happen:

• If the only issue is that you failed to submit all the necessary documents before the deadline, you’ll have 90 more days to submit the proper paperwork and potentially regain your coverage.
• If you are no longer eligible for Medicaid, you will be connected to other healthcare program options on the Federally Facilitated Marketplace.
• If you were denied for another reason, you’ll receive a letter explaining in detail why your coverage is being terminated.

You will have 30 days from the date of denial to request a Fair Hearing and potentially get your coverage retroactively reinstated. Fair Hearings are handled through the Office of State Administrative Hearings (OSAH). You can visit their website at osah.ga.gov for more information. Their job is to help resolve disputes between the public and state agencies. And as an independent entity, OSAH ensures Georgians that state agencies act in accordance with approved laws, rules and regulations.

What to Do if You Want to Dispute Your Denial Decision

1. Request a Fair Hearing through OSAH.
2. You will receive a notice in the mail with the scheduled time and location of your Fair Hearing.
3. At the hearing, you will have the opportunity to present your opening statement and present your evidence—like receipts and bills—to help support your argument.
   • Make sure you bring at least two copies of all documents; the agency representative will get one copy and the other will go to the judge.
   • Please number each document prior to the hearing.
4. After the evidence is presented, both parties will make closing arguments.
   • This is your opportunity to tell the judge why the case should be decided in your favor.
5. Once a decision is rendered, you will be notified by mail.
   • Make sure to read that document carefully because it will contain all the information you need to dispute the judge’s decision should you disagree with it.

For a more in-depth look at the Fair Hearing process, check out this informative video. If you still have questions, check out the FAQs.