PeachCare for Kids®

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Important Info About PeachCare For Kids
Your PeachCare for Kids account transitioned to a new eligibility system, called Georgia Gateway, as of February 6, 2017. Georgia Gateway does not change existing eligibility.  All of your information from the Peachcare.org has been moved. For general information about the transition to Georgia Gateway, click here.

PeachCare for Kids® is a public health insurance program that offers high quality, comprehensive health coverage for children 0-19 years of age. It covers medical, dental and vision services.*

Eligibility

Eligible children must be a resident of Georgia, a US citizen or child of qualified immigrants who either have special immigration status as a refugee or have parents who have been permanent residents for a minimum of 5 years.  Please refer to 2017 Income Eligibility Sheet.

PeachCare for Kids® was created to provide health care to uninsured children. For this reason, children must be uninsured for the two months prior to applying for PeachCare for Kids®. There are exceptions to the waiting period for children who have lost coverage involuntarily or experience a life changing event.

Exceptions to the two-month uninsured waiting period:

  • Change in employment resulting in a child’s loss of employer-sponsored insurance (including leave of absence without pay or reduction in work hours).
  • When the child’s eligibility and enrollment in Medicaid or another insurance affordability program is terminated.
  • The employer stopped offering coverage of dependents (or any coverage) under an employer-sponsored health insurance plan.
  • The loss of health insurance coverage as a result of the death of a parent.
  • The cost of coverage for the child or family coverage that includes the child exceeded 5 percent.
  • The child has special health care needs.
  • The child lost coverage due to the divorce of a parent.
  • The child’s parent is determined eligible for advance payment of the premium tax credit for enrollment in a QHP through the Marketplace because the ESI in which the family was enrolled is determined unaffordable in accordance with 26 CFR 1.36B-2( c) (3)(v).
  • Cancellation of COBRA or an individual insurance policy.
  • The child was born during the two month waiting period.
  • Parent on leave of absence without pay, or reduction of work hours.
  • Employer cancellation of entire group plan.

What is needed to apply

  • Birth certificate (Georgia-born residents do not have to have a copy to apply)
  • Form of Government-issued Photo ID: e.g. Driver’s License, Passport (US or foreign) State issued identification card, consular identification card.
  • Social Security number for each child or proof that a card has been applied for.
  • Income documents (for one month- i.e. one month’s worth of paystubs or Form 809 for cash-only income from one employer or Form 126 – 3 months for cash-only self-employed income

Non-US Citizen Parents/Legal Guardians

Non-U.S. citizens who apply for Medicaid or PeachCare for Kids® for their U.S.-born children do not have to prove citizenship, legal residency status or present a social security number. Applying for services does not trigger any action with USCIS Immigration Service.

Cost

There is no cost for children under age 6. Currently, the cost per month for PeachCare for Kids® coverage is $0 to $36 for one child and a maximum of $72 for two or more children living in the same household. Once you complete the application, information about paying your premium will be displayed.

Co-Payments

A co-payment is a small fee you will have to pay at the time of your visit to a medical provider. The amount of the co-payment will be different depending on the medical services you receive. While these co-payment amounts can range from $0.50 to $12.50, most will be $2 or $3. If you have to make a co-payment, your medical provider will tell you at the time of your visit. You will have a co-payment for some medical services in the PeachCare for Kids® program, if your child is 6 years of age and older.

However, there are no co-payments for these services:

  • Emergency services
  • Preventive Care Services (routine check-ups for your child)
  • Immunizations
  • Routine preventive and diagnostic dental services (such as oral examinations, prophylaxis and topical fluoride applications, sealants, and X-rays).

You are not required to pay more than 5% of your yearly income for premiums and co-payments. If your family reaches the 5% limit, you will not be required to make co-payment and premium payments for the rest of the year. Because of this, you must tell the PeachCare for Kids® Program about any changes to your family income. Also, co-payments are not required for children in foster care or children who are American Indians or Alaska Natives. No deductible is required.

Choosing a Health Plan

After a child is enrolled in PeachCare for Kids®, parents will receive an informational packet from Georgia Families. Parents will have a choice of three health plans through Care Management Organizations (CMOs): Peach State Health Plan, Amerigroup, and WellCare of Georgia. If no choice is made, the child will automatically be assigned to and enrolled in a plan. Parents need to check to see which health plan is accepted at their preferred doctor’s office.

Applications for enrollment take approximately 45 days. If you qualify for PeachCare for Kids® PeachCare for Kids®, please apply complete a paper application and mail directly to the program. Applications done through compass.ga.gov will screen for Medicaid eligibility first taking 45 days and families will have to re-apply with a paper application for PeachCare for Kids® and wait another 45 days.

Call an enrollment assistor today for help, 912-661-3040!

*Source: www.peachcare.org. Retrieved August 4, 2016.