In this Spotlight:   Georgia Health Care Basics
Great Start Georgia Resource Spotlight     
 April 2017 * Number 4
Georgia Health Care. Let's Learn the Basics.
Medicaid, PeachCare for Kids, Planning for Healthy Babies...we hear about these options in Georgia but what do they really mean? How can you explain these options to families during home visits and help them determine which programs might be right for them? How do they apply for or renew services? This Resource Spotlight will help sort it out!
Georgia Health Care Programs
Medicaid is a health insurance program that covers medical bills for eligible low-income families and pregnant women.  Eligibility is determined by family size and income. Medicaid can cover prescriptions, doctor visits, inpatient and outpatient hospital care, lab tests, x-rays medical equipment and supplies, transportation services and dental services...the list goes on! 
Medicaid for Pregnant Moms
Pregnant women who are eligible for Medicaid will receive medical care for pregnancy, labor and delivery . This type of Medicaid is called Right from the Start Medicaid (RSM). Pregnant women who qualify are receive medical services including physicians' visits, prescriptions, and inpatient and outpatient hospital services.  Click on the link above for more information about income limits and eligibility. Just to give you an idea, the monthly income eligibility limit for a pregnant mom who lives alone is currently $2,211. If eligible, a pregnant mom will receive benefits the same day she applies.  These benefits expire 60 days after mom gives birth.
Medicaid for Families
So how can mom continue her coverage 60 days after she gives birth? There isn't a one-size-fits-all solution, but Medicaid for the whole family may be a possibility.  Income eligibility limits are lower for family Medicaid so not all parents will qualify but it's important for you to know that this coverage is available to very low income parents!  Families who may be eligible should apply for benefits. The approval process takes around 45 to 60 days.   Another option for mom is Planning For Healthy Babies (P4HB). You can read more about this program further down in this Resource Spotlight.
Medicaid for Children
Babies born to moms on Medicaid are covered up until the first year of age.  Medicaid coverage for children can be renewed each year until age 19 provided that the child continues to meet eligibility requirements. 
Depending on the family's income and other factors, children whose families have higher incomes may not be eligible for Medicaid.  How can these children get insurance coverage?  Keep reading! 

PeachCare for Kids 
PeachCare for Kids is a program that provides comprehensive health care to children until age 19 who do not qualify for Medicaid but are in families with limited incomes.  Again, check the PeachCare website for specific criteria, but as an example, the monthly eligibility income limit for a family of three is $4,204. Refer to the PeachCare for Kids fact sheet for information.
Planning for Healthy Babies
The goals of Planning for Healthy Babies (P4HB) are (1) to prevent the number of very low weight births in Georgia (that is, babies who weigh less than 3 pounds, 5 ounces at birth) and (2) to help women who give birth to very low weight babies. Low-income women aged 18-44 who are not pregnant but can become pregnant may be eligible for benefits including annual exams, pap smears, contraceptives, sterilization, pregnancy tests, vitamins with folic acid, and STD testing and treatment.  Women who give birth to a very low birth weight baby and are eligible for P4HB can receive primary care, substance abuse treatment if needed, and access to peer and emotional support from a "Resource Mother" who can also provide information on parenting, nutrition and healthy lifestyles.  P4HB is not considered health insurance but it does provide benefits to women to help reduce the number of low birth weight babies in Georgia.
Choosing a CMO 

Once eligible for Medicaid, PeachCare for Kids or P4HB, an individual can select a care management organization (CMO) such as Amerigroup, CareSource (available on July 1, 2017), Peach State Health Plan, or Wellcare as their health plan. While each plan offers the same basic health services, they also offer different extra benefits.  If a family does not select a CMO and primary care provider, one will be assigned to them. 

Not sure which CMO is the best choice?  This handy brochure  can help weigh the options.

Helpful Hints When Talking With Families about CMOs
As home visitors, you can help families think through important questions that will help them decide which health plan(s) to choose.
  • Do you want to go to the doctor or hospital you go to now? If you do, see if that doctor or hospital works with the health plan.
  • Does one of the health plans offer other services you want or need, such as classes to help you stop smoking or lose weight?
  • Are the specialists, counselors, or special services that you and your children use part of any health plans?
  • Are the specialists, counselors, or special services that you and your children use part of any health plans? 
How Will I Keep These Facts Straight
During My Home Visits?
for  Home Visitors!

Let's face it, Georgia health care can be confusing for families - and for home visitors.  This handy guide provides quick information on features, eligibility requirements and application instructions for health insurance options for low-income families in Georgia.

Download it and keep it with you at all of your home visits.

A New Gateway to Services
What is Georgia Gateway?
Now that you know the basics, the most important thing you can offer families is information about the new portal to services.  Called Georgia Gateway, this system replaces COMPASS as the self-service portal where families apply, renew and manage their benefits.  Georgia Gateway is Georgia's brand new system of determining eligibility and maintaining benefits for many health and human service programs.  

What do You Need to Apply?
  • Legal name, address, telephone number
  • Date of birth and Social Security Number
  • Tax forms, pay stubs and/or other forms of income
  • Proof of citizenship and Georgia residency (examples include US passport, certificate of naturalization/US citizenship, birth certificate, adoption papers, military records, etc.)
  • Medical history and information about others residing in the home

Important Information for Families
Families currently receiving PeachCare for Kids or P4HB must create a new account through the  Georgia Gateway Portal  or call  1-877-423-4746 . Families can also call this number if they are missing any requested documentation to help determine their eligibility.

For families currently receiving other social service programs, benefit information will automatically be transferred from COMPASS to Georgia Gateway.

Download the Georgia Gateway brochure. Print and share with families to help guide them through these important changes.