Attention all Medicaid recipients in Georgia: This is no April’s Fools joke! Georgia will begin the process of determining if certain Medicaid members will continue to have coverage, including eligibility for home health care programs, on April 1, 2023.
Due to the federal Public Health Emergency (PHE), the Department of Community Health has maintained all enrolled Medicaid and PeachCare for Kids members on the rolls since March 2020, with certain exceptions (e.g., voluntary termination, relocation out of state, deceased, etc.). As a result of the PHE, the Department has not conducted any eligibility determinations since March 2020. This is changing as a result of the 2023 Consolidated Appropriations Act, which was signed into law on December 29, 2022.
The 2023 Consolidated Appropriations Act requires all state Medicaid agencies, including the Georgia Department of Community Health (DCH), to begin conducting eligibility determinations for all members. Therefore, beginning April 1, 2023, all Georgia Medicaid and PeachCare for Kids members will undergo an eligibility redetermination. The purpose of the eligibility review is to determine if the member is still eligible for Medicaid or PeachCare for Kids coverage. This process will take approximately fourteen (14) months to complete.
What To Do Right Now
The most important thing you need to do right now is make sure your contact details are accurate and updated in DFCS. If your address or phone number has changed over the past few years, you must update your contact information as soon as humanly possible. You can update your information online, by phone, or in-person at a local DFCS office. Click here to visit Georgia Medicaid’s StayCovered information portal now. StayCovered has all the information you need to update your contact details.
How The Redetermination Process Will Work
A member’s date for redetermination may be anytime between April 2023 and March 2024.
Notices and/or emails will be sent to all members approximately 45 days before their coverage is scheduled to end.
The notice will explain that the member’s redetermination process has begun, and that they may have to submit documents like pay stubs or other materials to complete their redetermination. The notices will inform the member how to complete their renewal/redetermination.
How to Complete Your Renewals (After Receiving Notice)
Members may complete their renewals online, by phone, or in-person at a local DFCS office. Online renewals may be completed by logging onto the Gateway system (visit https://gateway.ga.gov). Members may also complete their renewals by calling 1-877-423-4746. Additionally, a member may complete their renewal in-person by visiting their local DFCS office. The hours and locations for all DFCS offices are posted on the following website: https://dfcs.georgia.gov/locations.
Decisions: How You Will Be Notified
Approvals: If the state finds that a member is still eligible, the member will be notified in writing or via email, and coverage will be renewed and continued for another year.
Denials: If a member is deemed no longer eligible and is denied coverage, he/she will be notified of the decision in writing or via email, and provided an explanation of the reason for the denial. If the reason is that the member “failed to submit” their documents, they can still submit their documents within 90 days of their redetermination date. If a member has aged out of PeachCare for Kids or is no longer eligible for Medicaid, the member will be referred to the Federally Facilitated Marketplace for alternative healthcare options. If a member disagrees with the denial decision, he/she has the right to appeal the decision. Instructions on how to appeal a denial decision will be included in the notice.
For more information on Georgia Medicaid member redeterminations, please visit https://staycovered.ga.gov or https://dhs.georgia.gov/medicaid-unwinding.
