Medicaid or PeachCare for Kids® Members During Redetermination
If your loved one is one of the 2.7 million Medicaid or PeachCare for Kids ® members in Georgia, there are several ways that you can support them through the Medicaid redetermination process. Below are resources to assist Medicaid members and families, as well as ways you can help spread the word.
You also can help a Medicaid/PeachCare for Kids® member during the redetermination process by becoming your loved one’s “Authorized Representative.” You can become an Authorized Representative by registering with the Georgia Department of Human Services. Your loved one will need to identify you as an Authorized Representative before you are able to register.
To help a Medicaid or PeachCare for Kids® member during redetermination, you must register to be an Authorized Representative through the Georgia Department of Human Services (DHS). Once registered, Authorized Representatives can provide continuous support to Medicaid members throughout the redetermination process, take part in benefits reviews, receive important notifications, and more.
If your loved one’s Medicaid or PeachCare for Kids® 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 the Federally Facilitated Marketplace for different health insurance programs. Below are several alternative options for coverage:
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 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.