Georgia Pathways to Coverage

Georgia Pathways to Coverage logoWe are happy to serve our new Georgia Pathways to CoverageTM members throughout the state of Georgia. If you were assigned to another insurance company for your Georgia Pathways to Coverage plan, you can switch to CareSource within the first 90 days of enrollment. Learn more in the “How to Apply” section, below.

Georgia Pathways to Coverage™️ is a new program that can give Georgians who are working or getting ready to work, a chance to get health care coverage through. Medicaid Georgia Pathways to Coverage covers many of the same services as other Medicaid plans.

Learn more about what is covered.

Eligibility Requirements

The Division of Family and Children Services (DFCS) sends you a letter to let you know if you’re eligible for Georgia Pathways to Coverage.

You are eligible for Georgia Pathways to Coverage if you:

  • 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 one or more qualifying activities for at least 80 hours per month
  • Not be incarcerated
  • Not be eligible for any other category of Medicaid

Even if you have a disability, you may still qualify for Georgia Pathways to Coverage. You must still complete 80 hours of qualifying activities or ask for a reasonable modification.

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.

For more information, visit the Georgia Pathways to Coverage website.

Qualifying activities

You must do 80 hours per month of qualifying activities to get coverage through Georgia Pathways to Coverage. You may qualify with 80 hours per month of one activity, or 80 total hours per month of more than one activity. These activities include:

  • Full-time or part-time employment
  • Self-employment
  • On-the-job training
  • Job readiness assistance programs
  • Community Service
  • Vocational Education training
  • Higher Education
  • Enrollment in the Vocational Rehabilitation program of the Georgia Vocational Rehabilitation Agency (GVRA)

How to Apply

You can apply for Georgia Pathways to Coverage in the online customer portal at www.gateway.ga.gov. This is the easiest way to apply.

Other ways to 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.

If you were assigned to another Georgia Medicaid Care Management Organization (CMO) for your Georgia Pathways to Coverage plan, you can switch to CareSource in the first 90 days. Use the portal above to switch to CareSource!

Keeping Your Coverage

To be eligible for Pathways, you can perform one or more qualifying activities for 80 hours each month. 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. 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.

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.

Questions? Refer to your Navigate Member Handbook, the Georgia Pathways to Coverage FAQ, or call us.

Member Services: 1-855-202-0729 (TTY: 711)