FAQs
What is Georgia Pathways?
Georgia Pathways to Coverage™, or Pathways, is a new program to help low-income Georgians qualify for Medicaid who otherwise would not qualify for traditional Medicaid.
When will Pathways start?
Pathways is started on July 1, 2023. You can apply on or after that date. Coverage will start on the 1st of the month after you get approved. If you apply in July and get approved in August, your coverage will start September 1.
If I get disenrolled from my current Medicaid coverage, do I automatically get approved for Georgia Pathways?
No. You must apply for Pathways and meet its requirements to be approved.
How do I know if I am eligible for Georgia Pathways?
To be eligible for Pathways, you should:
- Be a Georgia resident
- Be a U.S. citizen or legally residing non-citizen
- Be between 19 and 64 years of age
- Have a household income of up to 100% of the Federal Poverty Level
- Prove that you are doing at least 80 hours of qualifying activities per month
- Not qualify for any other type of Medicaid
- Not be incarcerated
How do I know if my income is below 100% of the Federal Poverty Level?
You can use the link below to see if your income falls below the Federal Poverty Level. This depends on your family size. Family size means how many people are in your family and live with you. Federal Poverty Level Guidelines are updated annually and available here.
What are acceptable qualifying activities I can do to be eligible for Pathways?
To be eligible for Pathways, you can perform one or more qualifying activities for 80 hours each month. Qualifying activities include:
- Full-time or part-time employment
- On-the-job training
- Job readiness assistance programs
- Community service
- Vocational educational training
- Enrollment in the Vocational Rehabilitation program of the Georgia Vocational Rehabilitation Agency (GVRA)
- Higher education
Qualifying activity requirements only apply to Pathways and not to those who are enrolled under the traditional Medicaid program.
If I only work part-time, could I be eligible for Pathways?
Yes, you could be eligible but you still must complete at least 80 hours per month of qualifying activities. If you are not working 80 hours per month, then you can choose other qualifying activities to reach 80 hours each month to be eligible for Pathways.
If I am self-employed, could I be eligible for Pathways?
Yes, self-employment counts as employment and is a qualifying activity for Pathways. When you apply, you can prove self-employment by:
- Filling in a standard worksheet to show total weekly hours by client or activity
- Submitting a snapshot of your actual work calendar from the reporting month
What if I am looking for a job, could I be eligible for Georgia Pathways?
Looking for a job is not one of the qualifying activities. You may be eligible for Georgia Pathways if you are doing at least 80 hours per month of one or more of the qualifying activities. The time you spend looking for a job does not count in the 80 hours.
How do I apply for Pathways?
You can apply for Pathways starting on July 1, 2023. The easiest way to apply is online at gateway.ga.gov.
You can also apply:
- In-person at your local Division of Family & Children Services (DFCS) office. To find the location and business hours for a DFCS office, visit: dfcs.ga.gov/locations.
- By mail to your local DFCS office.
- By phone at 1-877-423-4746 or 711 for those who are deaf, hard of hearing, deaf-blind or have difficulty speaking.
Note: If you apply for Georgia Pathways over the phone, your qualifying activities may need to be verified online, by mail, or in-person at a DFCS office.
What benefits does Georgia Pathways cover?
Georgia Pathways covers many of the same medical services as other Medicaid plans, including:
- Doctor visits
- Hospital stays
- Emergency services
- Prescriptions
- Labs and x-rays
- Family planning services
- Mental health services
- Preventive and wellness services
- Chronic disease management services
- And more!
Georgia Pathways covers non-emergency transportation (rides) if you are 19 to 20 years old. If you are 21 years and older you will need to cover the costs of travel to a routine doctor’s visit or to get your medicine.
Once I am enrolled, what do I have to do to stay covered?
To stay covered you must report your hours by the 17th of each month. For instance, you would report your January hours by February 17 to stay covered in March. If you do not report your hours by the 17th of February, your coverage will stop February 28 and you will not be covered for March. Please note, your qualifying activities may need to be verified. Qualifying activity requirements will only apply to Pathways and not those who are enrolled under the traditional Medicaid program.
Once I am enrolled, how do I report my hours each month?
The easiest way to report your hours each month is online at gateway.ga.gov through “Report My Changes.”
You may also report your hours each month
- In-person at your local Division of Family & Children Services (DFCS) office. To find the location and business hours for a DFCS office, visit: dfcs.ga.gov/locations.
- By mail to your local DFCS office.
- By phone at 1-877-423-4746 or 711 for those who are deaf, hard of hearing, deaf-blind or have difficulty speaking.
Once I am enrolled, what if I do not meet my hours?
If, in a single month, you do not complete all 80 hours of qualifying activities, you may request a Good Cause Exception for the hours not completed.
What counts as a Good Cause Exception? How do I request one?
You can request a Good Cause Exception the same way you report your qualifying activities each month including:
- Online at gateway.ga.gov
- In-person at your local Division of Family & Children Services (DFCS) office. To find the location and business hours for a DFCS office, visit: dfcs.ga.gov/locations.
- By mail to your local DFCS office.
- By phone at 1-877-423-4746 or 711 for those who are deaf, hard of hearing, deaf-blind or have difficulty speaking.
Those who ask for a Good Cause Exception over the phone can give documentation of a valid reason online, by mail, or in-person at a DFCS office.
Examples of Good Cause Exceptions include:
- Family emergency or life event
- Birth, adoption, foster placement, or death of an immediate family member
- Temporary illness/short term injury
- Serious illness or hospitalization of yourself, or immediate family member
- Natural or human-caused disaster
- Temporary homelessness
- COVID-19 illness or exposure
If you have a different reason for not completing 80 hours of qualifying activities, select “Other.” You can support your reason for requesting a Good Cause Exception the same way you submit your proof of qualifying activities.
If you do not report your 80 hours of qualifying activities by the 17th of the month or receive a Good Cause Exception, your coverage will stop. To restore your coverage, you will need to report 80 hours of qualifying activities by the 17th of the month. Your coverage will then resume on the 1st of the following month.
For example, if during February you do not report your 80 hours from January, and do not have a Good Cause Exception to cover the missing hours, then your coverage will stop February 28. If you reported 80 hours of qualifying activities from February by March 17, your coverage will resume April 1.
What if something happened in my life, like I got married or got a new job that paid me more, and I need to report a change?
The easiest way to report a life event is through the online customer portal at gateway.ga.gov.
You could also report a change:
- In-person at your local Division of Family & Children Services (DFCS) office. To find the location and business hours for a DFCS office, visit: dfcs.ga.gov/locations.
- By mail to your local DFCS office.
- By phone at 1-877-423-4746 or 711 for those who are deaf, hard of hearing, deaf-blind or have difficulty speaking.
The documentation you send depends on your situation. Some life events may affect whether you still qualify for Pathways.
What if I have a disability?
If you have a disability, you could still be eligible for Pathways. If you need help doing 80 hours of qualifying activities per month, you can ask for a Reasonable Modification when you apply such as a referral to GVRA or the option for extra time to do your 80 hours.
What if I cannot do all my qualifying activities when I am applying?
To receive coverage, you must complete 80 hours of qualifying activities each month. If you have a disability, you can request a Reasonable Modification like a referral to GVRA or the option for extra time to do your 80 hours.
Can I appeal a decision about my eligibility or any decision that affects my coverage?
Yes. If you think you qualify for Pathways but do not get approved, you can appeal the decision. If a decision impacts your continued coverage, like suspension or termination, you can appeal that too. Your decision letter will have information on how to appeal a decision and who to contact if you have questions about appealing a decision.
If I enroll, could it affect my citizenship?
Medicaid or Pathways enrollment may or may not cause you to be considered a public charge which could impact your citizenship status. If you believe that participation in Pathways might impact your citizenship status, contact the United States Citizenship and Immigration Services (USCIS) before applying. It is important to understand how this might affect you. For more information on what it means to be a public charge, visit USCIS’s website at www.uscis.gov or call at 1-800-375-5283.
Is Pathways considered Medicaid expansion?
Pathways will create a new avenue to Medicaid coverage for hard-working Georgians. Qualifying activity requirements will only apply to Pathways and not to those who are enrolled under the traditional Medicaid program.
If I enroll, will I be covered through managed care or fee-for-service?
You will be covered through the Georgia Families® managed care program. This means you will be enrolled for services with a Georgia Medicaid care management organization (CMO) for your coverage.
Do I need to pay a co-pay with Pathways?
No, you will not need to pay a co-pay at this time for covered services you receive while you are enrolled in Pathways.
Will I get a doctor bill with Pathways?
No, you will not get a doctor bill for covered services you receive while you are enrolled in Pathways.
How can I tell if my doctor takes Pathways?
If your doctor accepts Medicaid or PeachCare for Kids®, they also accept Pathways.
Can my doctor opt out of Pathways?
Pathways providers are Medicaid providers. If a provider is accepting new patients, the provider will treat a Pathways member the same as a Medicaid member.
Can I get a past medical bill covered through Pathways?
No, Pathways does not cover past medical bills from before you were covered by Pathways. If you are already enrolled in Pathways, there are times when a past bill might be covered.
- If you report your qualifying activities by the 17th of the month by mail, you are still covered by Pathways for healthcare services given during coverage because you reported on time.
- You can appeal a coverage decision or request a hearing to review the decision. If you are already enrolled in Pathways, you can request that your coverage continue during your appeal and hearing.
If I see a doctor but don’t report my 80 hours that month, am I covered?
Your coverage stops at the end of the month you did not meet your reporting requirement. So, if you see the doctor in the same month you did not report, your visit would be covered. If you see the doctor the month after you did not report, your coverage would already be suspended.
Let’s say you did not report your qualifying activities in February. Any doctor visits you have in February will still be covered. Starting March 1, your coverage will be suspended. If you report your 80 hours during March, your coverage will start again April 1. If you have questions, contact the Medicaid care management organization (CMO) with which you are enrolled for coverage.
You also can find more information on DCH’s GA Pathways web page here.