How Family &
Friends Can Help

Medicaid or PeachCare for Kids® Members During Renewal

How You Can Help

If your loved one is one of the millions of Medicaid or PeachCare for Kids® members in Georgia, there are several ways that you can support them through the annual Medicaid renewal process. Below are resources to assist Medicaid members and families.

  • Send members to this site for detailed information about the annual renewal process.
  • Help members update their information at gateway.ga.gov if they need assistance.
  • If Medicaid members are unable to access services online, help them update their information in-person or by phone.
  • If members are no longer eligible for Medicaid, they may qualify for other health benefit programs with the State of Georgia. Please tell them that they will receive a letter referring them to Georgia Access for other health care options. 

You also can help a Medicaid/PeachCare for Kids® member during the renewal process by becoming your loved one’s “Authorized Representative.” You can become an Authorized Representative by registering with the Georgia Department of Human Services (DHS). Your loved one will need to identify you as an Authorized Representative before you are able to register.

How to Become an Authorized Representative 

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What to Do if Your Loved One’s Coverage Was Denied 

Read About It

How to Become an Authorized Representative

To help a Medicaid or PeachCare for Kids® member during renewal, you must register to be an Authorized Representative through DHS. Once registered, Authorized Representatives can provide continuous support to Medicaid members throughout the renewal process, take part in benefits reviews, receive important notifications, and more.

To apply to be an Authorized Representative:

  1. Have the member you are helping go to Gateway to “Report My Changes” or “Renew.”
  2. They should select “Add an Authorized Representative” and add your contact information.
  3. After the member adds you as an Authorized Representative to their case, you must create your own separate Gateway account.
  4. Within the “Create an Account” screen, please check “Yes” to the question “Are you an Authorized Representative?” This effectively links your Gateway account to the member’s account.
  5. You are now registered as an Authorized Representative for that member and can assist them with any actions.

What to Do if Your Loved One’s Coverage Was Denied

If your loved one’s Medicaid or PeachCare for Kids® coverage was denied, they will receive a letter explaining the reason why. It could be that they are no longer eligible for Medicaid, that they failed to submit the requested documents before the deadline, or various other reasons including aging out of PeachCare for Kids®, household income is over the income limit, etc.

If your loved one is no longer eligible for Medicaid, their denial letter will include information referring them to Georgia Access for different health insurance programs. Below are several alternative options for coverage:

  • PeachCare for Kids®: If ineligible for Medicaid and they have children under the age of 18, they may be able to purchase low-cost insurance for their children here.
  • Medically Needy Program: A program that allows Medicaid coverage after a monthly “share of cost” is met. Those who are not eligible for “full” Medicaid, because of income or asset limits, may qualify.
  • Federally Qualified Health Centers: A health care provider who provides medical care for clients with limited or no health insurance. Services are offered on a sliding scale based on income.
  • Georgia Access: Georgia’s health insurance marketplace where you can purchase health insurance, including low-cost, income-based plans.
  • Commercial Coverage: Provides health care coverage (including employer sponsored or private) for a monthly fee and coordinates care for clients through a defined network of physicians and hospitals.
  • Georgia Pathways to Coverage: A program that creates an opportunity for Georgians between the ages of 19 and 64, up to 100% of the Federal Poverty Level, who are not otherwise eligible for Medicaid, to gain access to affordable, quality health care.

Be sure to check the reason for the termination – if the only issue is that your loved one failed to submit all the necessary documents before the deadline, they’ll get 90 more days (without coverage) to submit the proper paperwork and potentially regain their coverage.

If your loved one’s coverage was denied for another reason and they feel that the denial decision was an error, you can help them appeal the decision and request a Fair Hearing verbally or in writing within 30 days from the date of denial. The Fair Hearing could result in your loved one getting their coverage retroactively reinstated.

The Fair Hearing process goes through the Office of State Administrative Hearings (OSAH), an independent entity that helps resolve disputes between the public and state agencies. Visit their website at osah.ga.gov for more information.

After you help your Medicaid or PeachCare for Kids® member request a Fair Hearing with OSAH, they’ll receive a letter in the mail with the scheduled time and location of their Fair Hearing. Once there, the member will be given the opportunity to say why they feel an error was made and present evidence, like receipts and bills, to help support the argument on behalf of your loved one. Once a decision is made, you will be notified of the decision. For a more in-depth look at the process, check out this video.

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Learn how to appeal your Medicaid renewal decision

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