Georgia Eligibility

PROGRAM	QUALIFICATIONS			PROCESS	SPECIAL CONSIDERATIONS
MEDICAID
Categories for Adults
Right from the Start Medicaid for Pregnant Women (RSM Adults)	Income cannot exceed 235% of FPL (see chart below for current dollar amounts). No resource limit.				Pregnant women are presumptively eligible. Women are covered for 60 days following the end of the pregnancy.
Breast and Cervical Cancer	Must have been screened for and found to have breast or cervical cancer, including precancerous conditions. Must be under age 65. Must be uninsured and otherwise ineligible for Medicaid.			Women must be screened through the Centers for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP).
Categories for Families/Children
Right from the Start Medicaid (RSM Children) · Children under age 1 · Children age 1 to 6 (though age 5) · Children age 6 to 19 (through age 18)	Income cannot exceed 185% of FPL. Income cannot exceed 133% of FPL. Income cannot exceed 100% of FPL. No resource limits for any of these categories.
Katie Beckett Deeming Waiver	Children under 18 who are chronically ill and whose parents have income or resources that make them ineligible for SSI benefits.			Children must be in need of nursing home care but have good home care that costs less than nursing home care.
Low Income Medicaid	Adults and children who meet the standards of old Aid to Families with Dependent Children (AFDC) program. Income Limits: Family Size 1: $235/month Family Size 2: $356/month Family Size 3: $424/month Family Size 4: $500/month
Transitional Medicaid	Former Medicaid recipients who have gone to work and are no longer eligible because their income exceeds the income limits.			Families are eligible for up to two years after they begin work.
Temporary Assistance for Needy Families (TANF)
See Low Income Medicaid and Transitional Medicaid categories above.

Medically Needy
Covers aged, blind, disabled, children under 18 and pregnant women	Family income exceeds the established income limits for their eligibility categories.			The Medically Needy program allows a person to use incurred medical bills to “spend down” the difference between their income and the income limit to become eligible.
	Income limits for aged, blind and disabled:
		Per Mo	Per Yr
	Individual	$317	$3804
	Couple	$375	$4500
	Income limits for pregnant women and children:
		Per Mo	Per Yr
	Family size 1	$208	$2496
	Family size 2	$317	$3804
	Family size 3	$375	$4500
	Family size 4	$442	$5304
	Resource limits: Family size 1: $2,000 Family size 2: $4,000 Family size 3: $4,100 Family size 4: $4,200
Elderly/Disabled
Supplemental Security Income (SSI) Recipients	Aged, blind or disabled individuals who receive SSI
	Income Limits	Per Mo	Per Yr
	Individual	$545	$6540
	Couple	$817	$9804
	Resource Limits: Individual - $2,000 Couple - $3,000
SSI-Related Public Law Recipients	Includes former SSI recipients who have become ineligible because of an increase in Social Security benefits. Income Limits: Individual - $545 per month ($6,540 per year) Couple - $817 per month ($9,804 per year) Resource Limits: Individual - $2,000 Couple - $3,000			Certain increases in Social Security benefits can be excluded to meet the income requirements for SSI.
Hospice	Terminally ill individuals who are not expected to live more than six months may be eligible for coverage. Income Limit: $1,635 per month ($19,620 per year) Resource Limit: $2,000			Recipients must agree to receive hospice services through a Medicaid participating hospice care provider.
Nursing Home	Aged, blind or disabled individuals who live in nursing homes and have low income and limited resources. Income Limit: $1,635 per month ($19,620 per year) Resource Limit: $2,000
Waiver Programs · Community Care · Independent Care Waiver Program (ICWP) · Mental Retardation Waiver Program (MRWP) · Model Waiver · Community Habilitation and Support (CHSS)	Aged, blind or disabled individuals who need regular nursing care and personal services but can live at home with special community care services. For Medicaid recipients between 20 and 64 years who are severely physically disabled and meet other specific criteria. For developmentally disabled individuals requiring ICF/MR-level care. For children under age 21 who meet the income and resource limits for any Medicaid coverage group and meet a nursing home level of care. For mentally retarded and developmentally disabled. Income Limit for all Waiver Programs: $1,635 per month ($19,620 per year) Resource Limit for all Waiver Programs: $2,000
Qualified Medicare Beneficiary	Aged, blind or disabled individuals who have Medicare Part A (hospital) insurance. Income cannot exceed 100% of FPL (currently $769 per month for an individual and $1,030 for a couple). Resource Limits: Individual - $4,000 Couple - $6,000			Medicaid pays Medicare premiums, coinsurance and deductibles.
Specified Low Income Medicare Beneficiaries	Aged or disabled people who are entitled to Medicare Part A. Income must be greater than 100% of FPL but cannot exceed 120% of FPL. Resource Limits: Individual - $4,000 Couple - $6,000			Medicaid pays Medicare Part B premium.
Qualified Individual	Aged or disabled people who are entitled to Medicare Part A. Income must be greater than 120% of FPL but cannot exceed 135% of FPL. Resource Limits: Individual - $4,000 Couple - $6,000			Medicaid pays Medicare Part B premium.
SCHIP
PeachCare for Kids	Children under age 19 who do not have health insurance. Income cannot exceed 235% of FPL. No resource limits.			PeachCare for Kids pays for preventive services and acute medical care, as well as vision and dental care. Children are enrolled in Georgia Better Health (GBHC), the State’s Primary Care Case Management (PCCM) program.	Children must be uninsured for the three months before applying for PeachCare for Kids. There are exceptions for children who have involuntarily lost coverage (e.g., children were covered through their parent’s employer and the parent lost the job, or the employer dropped coverage for dependent children). Children cannot be Medicaid eligible and cannot have access to health insurance through parent’s employment with the State of Georgia. There is no cost for children under age 5. Starting at age 6, premiums are $10.00 per child/max $20.00 per household. Households below 150% of FPL pay $15.00 and households between 151% - 235% of FPL pay $20.00. There are no copayments or deductibles.

MONTHLY INCOME LIMITS
RSM AND PEACHCARE FOR KIDS CATEGORIES

Family Size	RSM for Pregnant Women PeachCare for Kids 235% of FPL	RSM for Children < 1 185% of FPL	RSM for Children 1 to 6 133% of FPL	RSM for Children 6 to 19 100% of FPL
1	$1,736	$1,336	$982	$739
2	$2,339	$1,841	$1,324	$995
3	$2,942	$2,316	$1,665	$1,252
4	$3,545	$2,791	$2,007	$1,509
Additional Member	$604	$476	$342	$257

GEORGIA MEDICAID AND S-CHIP ELIGIBILITY

OVERVIEW OF PROGRAMS

PROGRAM

MEDICAID

Categories for Families/Children

Medically Needy

Elderly/Disabled