A Guide to the Georgia Medicaid DCH Plan

Enrolling in a state medical assistance program may be a practical decision if you are low-income or live with disabilities that require constant and expensive medical treatments.

According to the Kaiser Family Foundation, nearly 1.4 million adults living in Georgia do not have quality health insurance. As a result, many cannot access the care they need when managing life-altering illnesses or injuries. The Georgia Department of Community Health (DCH Georgia) provides resources for these families with comprehensive insurance programs.

In this article, you will learn about DCH Georgia-administered Medicaid and the benefits it can offer you and your family. After reading, explore how extending your insurance with help from Insurdinary can optimize your coverage to include a more comprehensive range of benefits and services by way of private health insurance.

What Is DCH Georgia Coverage?

The Georgia Department of Community Health is a Georgia State health organization that manages Medicaid for seniors and children. It also oversees Medicaid waiver programs for those living with chronic medical conditions.

Currently, it is one of four health agencies in the State serving over 10 million residents. DCH Georgia focuses on maximizing your quality of life by making health management resources accessible if you are pregnant, disabled, or a senior.

Learning what DCH Georgia covers will jumpstart your health insurance journey. You can enjoy several benefits when becoming a member, including:

Low-dollar co-pays for routine health checkups with your primary care provider
Affordable prescriptions and refills
Dental and optical coverage for your children
Access to family planning services before, during, and after childbirth
Reduced costs on emergency transportation
And more

Depending on your qualifications, you may be able to access DCH Georgia Medicaid for free or at a low cost. The Georgia Department of Community Health funds all its Medicaid programs from state and federal allowances.

What Is a DCH Card?

The Georgia Department of Community Health will issue you a membership card after accepting your application. This card will include contact information, so you can reach a representative if you have questions about your Medicaid plan. It also features an identification number.

Doctors will use your identification number to verify that your membership is valid before billing any medical expenses.

Applying for the Georgia Department of Community Health Plan

The Georgia Department of Community Health offers nearly two dozen Medicaid-funded programs on its website. You can explore these programs and decide which ones suit your medical needs. Once you find the right service, you can apply three ways:

Visit this site to enroll via an electronic portal. This web page will also direct you toward benefit and service hour information if you have questions before registering.
Contact DCH Georgia online or call (404) 656-4507 to speak with a representative. They will walk you through the online application slowly, so you don’t miss any details that may impact your eligibility.
Suppose you still aren’t sure how to apply for DCH Georgia online. In that case, you can print an application form from the website and mail it to the Department of Human Services. However, it could take staff several weeks to process your application this way.

DCH Georgia will ask for identifying documentation during your application process, including:

Driver’s licenses
Passports
SSNs
Birth certificates
Existing health insurance policies
W-2 documentation

You may not need all these materials during your enrollment, but ensure that they are neat and organized upon request. This way, DCH Georgia can confirm your eligibility as soon as possible.

Eligibility Requirements

You may qualify for Georgia Medicaid coverage if:

You are pregnant (verification necessary)
You are 18 or younger (some children may be eligible for the alternative assistance program PeachCare for Kids)
You earn a low income based on your household size

You are 18 to 26 and were under the care of a foster guardian

You live with a physical or mental disability

You are visually impaired

You have a breast or cervical cancer diagnosis

You require long-term senior care

You receive TANF or Supplemental Security Income

Some DCH Georgia programs require you to fall within specific income brackets to qualify for benefits. For example, the P4HB program for women dictates that you cannot exceed a yearly income of $58,560 if four people live in your household.

Still, you may be able to negotiate exceptions depending on your medical situation or family circumstances. A DCH Georgia representative can direct you toward the proper resources for these concerns.

Getting a DCH Card

You will receive an email with an electronic copy of your Medicaid card from the Georgia Department of Community Health. If you opt out of the electronic option, they will send you a hard copy via snail mail. This process could take up to two weeks to complete.

Print out your card and always keep it in your wallet or purse in case of emergencies.

You should fill out the DCH Georgia contact form if you have trouble receiving your card

Renewing or Replacing Your DCH Card

You can renew or replace your DCH Georgia card in one of four ways:

Sign back into the Gateway portal and fill out the renewal form electronically.
Print and fill out the 16-page Medicaid renewal form and mail it to your local Department of Human Services office.
Call 877-423-4746 to speak with a representative about renewing your membership and receiving a new card.
Bring a physical copy of your completed renewal form to the Department of Human Services and hand it to an assistant for filing.

The Georgia Department of Community Health will only authorize a new card if you pass a Medicaid redetermination audit. During this process, they will decide if you are still eligible for Medicaid, depending on your health outcomes and income changes. You can still receive benefits during this assessment period.

DCH Georgia Coverage

Different programs offered by the Georgia Department of Community Health provide different types of coverage. Here is what you can expect:

Dental

According to federal law, Medicaid must provide children under 21 with full-coverage dental insurance. DCH Georgia offers these services through PeachCare for Kids, providing free preventive and restorative dental care.

Federal law does not dictate the same type of coverage for adults. However, Georgia Medicaid provides emergency dental care coverage if you are 21 or older.

For those who have more serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in Georgia is advisable.

Prescriptions Drugs

The Georgia Department of Community Health website offers a complete preferred drug list for coverage. Georgia Medicaid generally covers any rebated prescriptions from eligible distributors with few exceptions.

Extended Health Care

DCH Georgia does not provide a supplemental plan to pay for medical care or products outside its listed eligible programs. However, you can still invest in private insurance and qualify for Medicaid coverage simultaneously. Inform your Medicaid representative about any third-party insurance you have, so they can factor that information into your benefits.

Travel and Out-of-State Coverage

In general, you cannot use your DCH Georgia Medicaid benefits out of state. However, some exceptions apply:

You may be able to use your insurance if you experience a life-threatening emergency in a different state.
If returning to Georgia puts your health at greater risk, some out-of-state providers may still cover your expenses.
DCH Georgia may cover your expenses if it partners with a participating provider out of state. This rare exception usually occurs only when the outside provider has critical medical resources unavailable in Georgia.

Contact the Georgia Department of Community Health if you are sick or injured out of state. They can provide the information you need to make an informed decision.

If you are traveling outside of Georgia for leisure, invest in proper travelers insurance.

Students & Seniors

The State of Georgia chose not to extend Medicaid coverage for people between 19 and 64 outside certain exceptions. Unfortunately, this outcome means you cannot receive special benefits as a student.

However, you may still qualify if you recently transferred out of foster care or make a low monthly income. You must ensure that you are not a listed dependent on anyone’s tax returns to seek Medicaid as an adult.

The Georgia Department of Community Health will cover your medical needs if you are 65 or older. Some of these benefits include:

Long-term care
Community care or home services
Hospice expenses
Physical therapy
Emergency transportation
Inpatient and outpatient doctor services

Coverage for Subgroups

The Georgia Department of Community Health complies with Medicaid regulations and laws protecting certain subgroups of Americans. Here is what you should know:

Indigenous Americans

You have the right to seek Medicaid coverage in Georgia if you belong to or are a child of someone who belongs to a federally recognized Indigenous American tribe or Native Alaskan tribe. If your children belong to this demographic, they will be exempt from premiums or co-pays for services like dental.

You must provide proof of your U.S. citizenship and a copy of your tribal census document or certification of indigenous status by the Bureau of Indian Affairs.

Military

The Georgia Department of Community Health does not handle veterans’ healthcare benefits. However, you may be able to seek coverage by contacting the Georgia Department of Veterans Services.

You may still receive Medicaid coverage if you qualify under DCH Georgia guidelines and already have VA benefits.

What Does DCH Not Cover?

Medicaid programs offered by the Georgia Department of Community Health do not cover the following:

Non-emergency dental care after 21

Private nurse services

Cosmetic surgeries

Experimental surgeries

Chiropractic services

HIV/AIDs testing and treatment

Funerals

The permanently or temporarily injured

Apart from the $2000 threshold, Medicaid also offers a burial stipend for funerals. Individuals are eligible for either $1500 or $5000 (depending on the Medicaid type) to cover funeral costs. This allocation must be kept in a distinct account solely dedicated to this purpose, and its use is restricted exclusively to funeral expenses. It's important to note that cemetery lots are not considered in Medicaid calculations. Considering the rising cost of burial and related fees, ensure that your family is secured with comprehensive funeral insurance.

For the permanently or temporarily injured, Georgia Medicaid does provide some coverage for those who become injured or ill either in the short or long term. Depending on the nature of the injury or illness, it’s wise to explore disability insurance options to ensure no unnecessary out-of-pocket costs are incurred.

DCH Georgia Medicaid will cover your eligible physical examinations and assessments. However, depending on your diagnosis, they may not cover subsequent treatment plans. Speak to your primary care physician to discuss your options.

Common Procedures and DCH Eligibility

Each state administers its own Medicaid policies (within federal guidelines). If you recently moved to Georgia, knowing which types of coverage are available to you can be confusing.

Learn more by exploring this list of common procedures in Georgia:

Dental
Examinations	Routine dental exams will ensure that your child’s teeth and gums are healthy and bacteria-free. However, some dental practices may charge you over $100 per child without insurance. DCH Georgia covers dental exams for your children at little to no cost ($0.50-$3 per visit).
X-rays	The Georgia Department of Community Health covers x-ray examinations and other qualifying digital screenings for children under 21. As an adult, you only receive coverage for x-ray screenings during dental emergencies.
Restorations	Dental restorations — cavity fillings, root canals, veneers, etc. — are available to children. You will not have personal coverage for these treatments as an adult.

		
					Vision
				
	    		Screenings
				The Georgia Department of Community Health does not cover optical screenings for adults. However, your children can access these services if you are a member of PeachCare for Kids.
			
	    		Corrective vision
				Your children can also enjoy full coverage for glasses, contacts, or alternative corrective solutions during visits to the optometrist. Consider extending your coverage with private insurance to access these cost-saving benefits as an adult.

Vision
Screenings	The Georgia Department of Community Health does not cover optical screenings for adults. However, your children can access these services if you are a member of PeachCare for Kids.
Corrective vision	Your children can also enjoy full coverage for glasses, contacts, or alternative corrective solutions during visits to the optometrist. Consider extending your coverage with private insurance to access these cost-saving benefits as an adult.

		
					Surgery
				
	    		Inpatient and outpatient surgery
	    		Sudden injuries can occur at any time — sometimes requiring surgeries that could cost you thousands of dollars out of pocket. Fortunately, you qualify to receive inpatient and outpatient surgery coverage if you are a member of DCH Georgia. These services typically come with a low-dollar co-pay.
	    	
	    		Transplants
	    		Organ transplants qualify under coverage with DCH Georgia. Your total co-pay may depend on how many days you are in the hospital for treatment and recovery.
	    	
	    		Anesthetics
	    		DCH Georgia covers any medical supplies or equipment needed to complete your surgery. Common procedures sometimes require the use of anesthetics. This treatment will not cost you anything extra out of pocket.
	    	
	    		Breast reconstructive surgery
	    		You may be eligible for coverage if you have a breast cancer or breast-related disease diagnosis from your physician.

Surgery
Inpatient and outpatient surgery	Sudden injuries can occur at any time — sometimes requiring surgeries that could cost you thousands of dollars out of pocket. Fortunately, you qualify to receive inpatient and outpatient surgery coverage if you are a member of DCH Georgia. These services typically come with a low-dollar co-pay.
Transplants	Organ transplants qualify under coverage with DCH Georgia. Your total co-pay may depend on how many days you are in the hospital for treatment and recovery.
Anesthetics	DCH Georgia covers any medical supplies or equipment needed to complete your surgery. Common procedures sometimes require the use of anesthetics. This treatment will not cost you anything extra out of pocket.
Breast reconstructive surgery	You may be eligible for coverage if you have a breast cancer or breast-related disease diagnosis from your physician.

Hospital
Primary care examination	As of 2016, you can enjoy full coverage for preventive health care services once a year as a DCH Georgia Medicaid member. These services include visits to the doctor, physical examinations, counseling, annual screenings, and vaccinations. These services typically do not require a co-pay or additional fees.
Hospital transportation	DCH Georgia will cover your ambulance or pre-scheduled, non-emergency hospital transportation fees. These benefits are particularly useful, as ambulances are some of the most expensive one-off services hospitals provide.
Inpatient and outpatient hospital visits	Your doctor may recommend that you stay in the hospital for two or more days. In this case, DCH Georgia will cover most of these expenses. You may have small fees depending on how many days you stay.
Hospice services	The Georgia Department of Community Health will cover end-of-life care, such as hospice and home health services. Some limitations may apply depending on how long you stay in hospice.
Lab testing	Blood tests, tissue screenings, etc., will cost you little to nothing under the DCH Georgia Medicaid plan. Ask a representative about limitations if you require more than one screening a year.

Therapy and Counselling

The Georgia Department of Community Health provides access to drug and alcohol-related health care services. Some of these benefits include personal and group counseling, substance abuse monitoring and detox treatment. You may need behavioral therapy for a developmental or onset mental health disorder in adulthood. As a member, you can access these services at a low cost with DCH Georgia insurance.

Sexual Health
Cancer screenings	Georgia Medicaid will pay for your pap tests and mammograms. However, you may only schedule one a year. Effective planning will ensure that you save money on your appointments.
STD screenings	DCH Georgia covers screenings and treatments for all STDs except HIV and hepatitis.
Family planning	Georgia Medicaid covers most forms of contraception. It also covers your visits to family planning healthcare facilities and sterilization treatment. If you are pregnant, you can receive mothers’ care management services at affordable rates.

Specialist Services
Hearing specialists	Your children can seek treatment from a hearing specialist under the DCH Georgia PeachCare for Kids program. These benefits do not apply if you are over 21.
Services for autistic children	As of 2018, DCH Georgia offers an Autism Spectrum Disorder program that covers specialist fees. Services include diagnostic screenings, treatment, and monitoring. Like many programs DCH Georgia provides, this plan is only available to children under 21.

Extending Georgia Department of Community Health Coverage

As you can see, the Georgia Department of Community Health provides coverage for many essential health services. However, you may not qualify for every program you need. In this case, it’s worth exploring alternative healthcare options to extend your Medicaid coverage. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.

At Insurdinary, we help you find and compare dozens of different insurance options for your needs. Our easy-to-navigate website allows you to assess premiums and policies from top-rated companies across the country. Many of our listed insurance providers offer affordable options if you earn a low monthly income.

We take pride in making your shopping process as painless as possible. If you are ready to begin your search, request a quote from our experienced team. We will respond quickly with the practical solutions you need.

FAQ’s

How long does it take to get approved for Georgia Medicaid?

The approval timeline for Georgia Medicaid can vary depending on individual circumstances. On average, the process takes about 45 days. Expedited processing is available for urgent cases.

What are the methods to apply for Georgia Medicaid?

You can apply for Georgia Medicaid through various means: online, in person, by mail, or at a local Department of Family and Children Services (DFCS) office. Make sure to include essential documentation like proof of income, household size, and residency when submitting your application.

Does Georgia Medicaid cover the expenses of funerals?

No, Georgia Medicaid is primarily focused on providing healthcare coverage and does not include coverage for funeral expenses. If you're seeking assistance with funeral costs, you might consider looking into options like funeral insurance.

Who is eligible for Georgia Medicaid?

Eligibility for Georgia Medicaid is determined by various factors such as income, household composition, and other criteria. Typically, the program offers coverage to low-income individuals, families, pregnant women, children, elderly individuals, and those with disabilities.

What is Georgia Medicaid?

Georgia Medicaid is a program aimed at providing medical coverage to eligible low-income residents of the state. Funded by both federal and state resources, its goal is to ensure access to essential healthcare services for those in need.

What other types of insurance does Insurdinary offer?

Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:

References

https://www.kff.org/statedata/election-state-fact-sheets/georgia/
https://dch.georgia.gov/
https://gbpi.org/overview-2023-fiscal-year-budget-for-the-department-of-community-health/
https://medicaid.georgia.gov/programs
https://dch.georgia.gov/contact-dch
https://dch.georgia.gov/peachcare-kids
https://medicaid.georgia.gov/programs/all-programs/planning-healthy-babies/eligibility
https://medicaid.georgia.gov/eligibility-faqs
https://georgia.gov/renew-your-medicaid-benefits
https://dch.georgia.gov/providers/provider-types/pharmacy/preferred-drug-lists
https://www.macpac.gov/wp-content/uploads/2020/01/Medicaid-Payment-Policy-for-Out-of-State-Hospital-Services.pdf
https://www.healthcare.gov/american-indians-alaska-natives/medicaid-chip/
https://medicaid.georgia.gov/long-term-services-and-supports
https://medicaid.georgia.gov/organization/about-georgia-medicaid/types-services
https://medicaid.georgia.gov/all-programs/planning-healthy-babies/client-benefits-services
https://medicaid.georgia.gov/programs/all-programs/autism-spectrum-disorder

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