MEDICAID IN GEORGIA

The Georgia Department of Community Health administers the Medicaid Program.

Information about the Medicaid Program can be found at: http://dch.georgia.gov/medicaid.

MEDICAID EXPANSION

Georgia does not participate in Medicaid Expansion under provisions of the Affordable Care Act (ACA).
For additional background on the State’s policy decisions regarding the Medicaid Expansion option, see: Background.

PROVIDER PARTICIPATION

Providers must enroll in the Medicaid fee-for-service program to receive payments for covered services. Information about enrolling in the Medicaid fee-for-service program can be found at: https://www.mmis.georgia.gov/portal/PubAccess.Enrollment/tabId/63/Default.aspx.
The Medicaid Program website provides information about services covered by fee-for-service payments and payment amounts: http://dch.georgia.gov/medicaid.
In order to retain access to all Medicaid patients in the state, providers must also connect to the managed care plans individually.

MEDICAID MANAGED CARE

Some Georgia Medicaid Program beneficiaries are enrolled in managed care plans, called “Care Management Organizations.”
Basic information about Care Management Organizations can be found at: http://dch.georgia.gov/care-management-organizations-cmo.
Some managed care plans cover individual Georgia counties and independent cities. The Medicaid Division website has jurisdictional information: http://dch.georgia.gov/care-management-organizations-cmo.

GEORGIA MEDICAID BENEFICIARIES PARTICIPATING IN MANAGED CARE

Managed care plans participating in Medicaid offer detailed information about covered benefits for individuals enrolling in their plans. This information is available on the managed care websites shown below.

REPORTING PROBLEMS

The state Medicaid office is primarily responsible for examining and addressing issues with the Medicaid Managed Care plans offered in the state, and for working with the companies that offer them. If you are experiencing problems as a medical provider with the Managed Care plans or companies operating in the state, or if your patients are experiencing problems with the Managed Care plans or companies in the state, including trouble with access to medications, access to preferred providers, navigating the appeals process, excessive costs, or possible discriminatory policies, or any other problems related to the Affordable Care Act, please report these problems to the state Medicaid Office:

Georgia Better Healthcare: dch.georgia.gov/Medicaid

866-211-0950

Additionally, if you are experiencing these or other problems, please report these problems to AAHIVM, so that we may track issues affecting our members, and seek additional policies remedies.

MANAGED CARE PLANS PARTICIPATING IN MEDICAID

Amerigroup Community Care GA
Plan Website: https://www.myamerigroup.com/English/Medicaid/ga/Pages/GA-2012.aspx
Provider Enrollment: https://providers.amerigroup.com/pages/ga-2012.aspx

Peach State Plan (Centene Corporation)
Plan Website: http://www.pshp.com/
Provider Enrollment: http://www.pshpgeorgia.com/for-providers/provider-resources/

WellCare of Georgia, Inc.
Plan Website: http://georgia.wellcare.com/
Provider Enrollment: https://georgia.wellcare.com/prospective_providers/new