Here are resources to help Georgia’s Medicaid and PeachCare for Kids® members and communities prepare for eligibility checks beginning in April 2023 through May 2024.
Be ready – take charge of your family’s Medicaid and PeachCare for Kids® coverage. Visit Gateway to update your contact information. Stay informed. Stay Covered.
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?
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:
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:
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:
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:
*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:
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:
How to Complete Your Redetermination From Your Gateway Account:
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:
Depending on the reason for the termination of your coverage, a couple of things can happen:
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
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.