Redetermination is the process that Georgia is reinstating to make sure current Medicaid and PeachCare for Kids® members are still eligible for coverage. It involves collecting and verifying information, including income and contact details, as well as other requested information or documents related to determining eligibility based on your case.
The State of Georgia has 14 months from April 1, 2023, to May 2024 to review all Medicaid and PeachCare for Kids® members’ cases to redetermine who is still eligible to receive coverage.
Note: The redetermination process does not guarantee any person’s eligibility for Medicaid or other available coverage.
Based on changes in federal law, coverage may change for Medicaid and PeachCare for Kids® members. You must update your contact information now to stay informed about your Medicaid status. Before the COVID pandemic, Medicaid member eligibility had to be redetermined each year. During the pandemic, the federal government declared a public health emergency. This emergency and changes in federal law allowed all Medicaid members to remain enrolled without redetermining their eligibility for benefits. Based on new changes in federal law, Medicaid redetermination began in April 2023, regardless of when the public health emergency ends. Eligibility is once again being redetermined for all Medicaid members over the course of a 14-month window, ending in May 2024.
Yes. Anyone covered by Medicaid, including PeachCare for Kids®, will be redetermined for eligibility between April 1, 2023, and May 31, 2024.
Medicaid is a program that provides health care services to individuals who meet the requirements for income, resources, and citizenship. Coverage categories include those for low-income families with children under age 19 and adults who are age 65 or over, blind, or disabled.
Basic requirements to determine eligibility under any Aged Blind Disabled (ABD) Medicaid program include:
Basic requirements to determine eligibility under a Family Medicaid program include:
Basic requirements to determine eligibility under Georgia Pathways to Coverage:
Visit the Georgia Department of Human Services website for more information. To find out if you meet the requirements, create an account at gateway.ga.gov.
As of April 1, 2023, Georgia is checking to see who is still eligible to receive coverage. It is important that you confirm your contact information on gateway.ga.gov as soon as possible so you can receive updates and communications about your coverage.
No. First, many Georgians will still be found eligible for coverage. Secondly, Georgia began checking eligibility for all Medicaid and PeachCare for Kids® members in April 2023, but members are being redetermined in batches over a 14-month period from April 1, 2023, to May 31, 2024.
You’ll receive a letter in the mail or email about 45 days before your redetermination deadline. The letter says 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. Complete the steps listed in your letter as soon as possible to help avoid a gap in your coverage. You’ll also receive a reminder about 15 days before your deadline.
No, you can’t renew early. You must wait until you receive your letter or email. Only then does your redetermination window open.
Your individual redetermination process may occur anytime during the 14-month redetermination period, from April 1, 2023, to May 31, 2024. You will receive a letter or email about 45 days before your redetermination deadline saying that your redetermination window has begun and providing instructions for updating or submitting your documents by your deadline. This may mean you need to upload pay stubs or other materials.
You have a few options. You can upload the documents, or pictures or scans of the documents, directly through the gateway.ga.gov. You can also mail, fax, or bring hard copies of your paperwork to your local Division of Family & Children Services office.
If you are no longer eligible for Medicaid, you will be connected to other health care options. It is very important for you to update your contact information at gateway.ga.gov so you can receive this information. However, if you feel the denial decision was an error, you can appeal the decision by requesting a Fair Hearing within 30 days from the date of denial and potentially get your coverage retroactively reinstated.
You may be eligible for coverage under the Georgia Pathways to Coverage program launching July 1, 2023. The program 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 healthcare. Learn more here.
If your coverage renewal is denied, you will receive a letter notifying you of the decision and explaining the reason why. If that reason is that you “failed to submit” your documents, you can still submit your documents within 90 days after your redetermination deadline to reopen your case for consideration. Once you send them in, if you are found still eligible, your coverage will be made active back to the date of your original determination – so that you can get coverage for the medical expenses you had in the meantime.
NOTE: There are two exceptions to this: Qualified Medicare Beneficiary (QMB) and Planning for Health Babies (P4HB). For these, coverage does not start back until the month after eligibility is actually redetermined.
An authorized representative is someone who is legally allowed to assist a Medicaid or PeachCare for Kids® member continuously throughout the redetermination process. Providers, hospitals, family members, and friends who need to provide assistance to a member must become an authorized representative. To do this, members should go to Gateway to “Report My Changes” and select “Add an Authorized Representative.”
In order to receive continuous assistance from a third party, that individual must become an authorized representative. To add an authorized representative to your case, go to Gateway to “Report My Changes” and select “Add an Authorized Representative.” After adding your authorized representative to your case, have them create their own separate Gateway account. Within the “create an account” screen, they must check “Yes” to the question, “Are you an Authorized Representative?” This effectively links their Gateway account to your Gateway account. They can now assist you with any actions.
Members can request a Fair Hearing within 30 days from the date of denial if they feel that the denial decision was an error. 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 request a Fair Hearing with OSAH, you’ll receive a letter in the mail with the scheduled time and location of their Fair Hearing. Once there, you’ll have the opportunity to present your opening statement and evidence, like receipts and bills, to help support your argument. Once a decision is made, you will be notified of the decision. For a more in-depth look at the Fair Hearing process, check out this video.
Yes, if you request a Fair Hearing within 14 days from the date of your denial or termination notice, you can choose whether or not to continue getting coverage while you wait for a final decision.
If you choose to pause coverage while you wait for a decision, and the judge decides the State was incorrect and that you are still eligible for benefits, your coverage will be made active back to the date of original determination. So you can get coverage for the medical expenses you had in the meantime.
If you choose to continue coverage while you wait for a decision, and the judge decides the State’s decision to deny your Medicaid or PeachCare for Kids® coverage was correct, and that you are no longer eligible for Medicaid or PeachCare for Kids® benefits, your benefits will stop.
If the judge decides that the state’s decision to deny your Medicaid or PeachCare for Kids® coverage was a mistake, your coverage will be made active back to the date of original redetermination. This means that you can get coverage for the medical expenses you had in the meantime.
If the judge decides that the state’s decision to deny your Medicaid or PeachCare for Kids® coverage was correct and that you are no longer eligible for Medicaid or PeachCare for Kids® benefits, your benefits will remain terminated.
Follow the instructions at the top of Gateway in the section called “HELP! I am having trouble signing in or creating an account.” If you are still having trouble with your online account, we can help you in-person at one of our offices or by phone. Visit dfcs.georgia.gov/locations to find the location and business hours for your local office. If you need help reading this information or communicating with us, call 1-877-GA-DHS-GO (1-877-423-4746). 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).
If you entered the wrong username or password too many times, the system may temporarily lock you out. From the login page at gateway.ga.gov, select “Forgot User ID” or “Forgot Password” to receive a one-time PIN delivered to your mobile phone or email to recover your username or password. Alternatively, you can answer security questions to recover your username or password. If you need additional support, you can visit your local Division of Family and Children Services office. To find the location and business hours for your local office, visit: dfcs.georgia.gov/locations. If you need help reading this information or communicating with us, ask us or call 1-877-GA-DHS-GO (1-877-423-4746). 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).
If you have issues accessing gateway.ga.gov, check your internet connection first. If your internet is working correctly and you still cannot access gateway.ga.gov, it may be because the site is down for scheduled maintenance. Please visit the site again later.
If you need additional support, you can visit your local Division of Family and Children Services office. To find the location and business hours for your local office, visit: dfcs.georgia.gov/locations. If you need help reading this information or communicating with us, ask us or call 1-877-GA-DHS-GO (1-877-423-4746). 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).
When you have successfully updated your information/documents at gateway.ga.gov, you will receive a confirmation “T number” (tracking number) in your customer Georgia Gateway account. Remember to write it down for later use. If needed, you can retrieve your “T number” from the “Manage My Account” page of the Georgia Gateway.
Yes, right away! Creating an account at gateway.ga.gov is the easiest and fastest way for Medicaid representatives to contact you about your coverage. Make sure you have completed all required fields. This may include information about your current residence, income, job, household size, etc.
Go to Gateway to “Report My Changes” or “Renew” and select “Add an Authorized Representative.” After adding your authorized representative to your case, have them create their own separate Gateway account. Within the “create an account” screen, they must check “Yes” to the question, “Are you an Authorized Representative?” This effectively links their Gateway account to your Gateway account. They can now assist you with any actions.
If you have a Gateway account, you can reset your password in three ways.
Visite nuestro sitio web en español, simeprecubierto.ga.gov, para obtener recursos en español. Además, puede visitar gateway.ga.gov y hacer un clic en una de las selecciones de idioma. También puede llamar al 1-877-GA-DHS-GO(1-877-423-4746). Nuestros servicios, incluidos los intérpretes, son gratuitos.
မြန်မာစကားနှင့် ပတ်သက်သည်များကို ဤနေရာတွင် ရှာဖွေနိုင်သည်။ နောက်ထပ် gateway.ga.gov တွင် ဘာသာစကားတစ်ခုကို နှိပ်ပါ။ 1-877-GA-DHS-GO (၁-၈၇၇-၄၂၃-၄၇၄၆) ကိုလည်း ဖုန်းခေါ်ဆိုနိုင်သည်။ စကားပြန်များအပါအဝင် ကျွန်ုပ်တို့၏ ဝန်ဆောင်မှုများသည် အခမဲ့ဖြစ်သည်။
한국어 자료는 여기에서 찾으실 수 있습니다. 또한, gateway.ga.gov 를 방문하시고 언어 선택 중 하나를 클릭하실 수 있습니다. call 1-877-GA-DHS-GO (1-877-423-4746 로 전화하시면 무료로 통역 서비스를 포함한 서비스를 제공해드립니다
तपाईंले नेपाली स्रोतहरु यहाँ पाउनु हुन्छ। यसमा थप, तपाईं gateway.ga.gov मा गमन गर्न सक्नु हुन्छ अनि उपलब्ध कुनै एउटा भाषाको चयनमा क्लिक गर्ने। अथवा1-877-GA-DHS-GO (1-877-423-4746) अंकमा फोन लाए पनि हुन्छ। हाम्रो सेवाहरु अन्तर्बाचक लगायत सबै निशुल्क हो।
Você pode encontrar recursos birmaneses aqui. Além disso, você pode visitar gateway.ga.gov e clicar em uma das opções de idioma. Você também pode ligar para 1-877-GA-DHS-GO (1-877-423-4746). Nossos serviços, incluindo intérpretes, são gratuitos.
Quý vị có thể tìm nguồn nguyên Tiếng Việt tại đây. Ngoài ra, quý vị có thể truy cập gateway.ga.gov và nhấp vào một trong các lựa chọn ngôn ngữ. Quý vị có thể gọi 1-877-GA-DHS-GO (1-877-423-4746). Dịch vụ của chúng tôi, kể cả thông dịch viên, đều là miễn phí.
