Georgia Pathways to Coverage

We've served Georgia Pathways members since 2023.

Benefits overview

Georgia Pathways to Coverage, or Pathways, is a Medicaid program for Georgians ages 19-64 who meet the eligibility requirements and otherwise would not qualify for traditional Medicaid.

Georgia Pathways members are eligible to receive the same state plan benefits as other Medicaid groups, with the exception of nonemergency medical transportation (NEMT). Georgia Pathways member ages 19 to 20 who are receiving Early and Periodic Screening, Diagnostic, and Treatment services may access NEMT, dental, and vision services as part of their benefits.

Visit the Georgia Department of Community Health  website to learn more about the Georgia Pathways program and other programs.

Copays

All Pathways members enrolled in a health plan will be required to pay copayment amounts at point of service, in alignment with other classes of assistance as reflected in the State’s Medicaid Plan. Pathways members who are unable to pay their copayment cannot be denied care for a covered service.

Copays are on a sliding scale using the calculated ingredient cost (CIC) which excludes the dispensing fee.

• Preferred drugs: $0.50

• Non-preferred drugs: CIC CIC Copay ≤$10.00 $0.50 $10.01 - $25.00 $1.00 $25.01 - $50.00 $2.00 ≥$50.01 $3.00

For more information check out your provider manual .

Who’s eligible?

To get Georgia Pathways, the member must meet income limits and:

• Be a Georgia resident.
• Be a U.S. citizen or legal resident.
• Be at least 19 years old and between the ages of 19 and 64.
• Household income up to 100% of the Federal Poverty line.
• Prove that they are doing one or more qualifying activities for at least 80 hours per month.
• Not be eligible for any other category of Medicaid.
• Not be incarcerated in a public institution.

To find out more about eligibility, visit Georgia Department of Community Health  website.

Qualifying activities

When applying to Georgia Pathways, members must show that they are currently engaged in at least 80 hours per month of a qualifying activity or combination of activities.

Members must provide one source of documentation for verification per qualifying activity reported.

Qualifying activities include:

• Employment, including self-employment
• On-the-job training
• Job readiness
• Job readiness – Skilled Nursing Facility and Job readiness - Hospital Stay
• Community service
• Community service – Relative caregiving
• Vocational education training
• Enrollment in an institution of higher education
• Enrollment and active engagement in the Georgia Vocational Rehabilitation Agency (GVRA) Vocational Rehabilitation program
• SNAP Works Program
• Parent and Legal guardian of a child under six (6)

To remain eligible for Medicaid coverage through Georgia Pathways, it is expected that an individual completes at least 80 hours of qualifying activities per month, though there is no requirement to report and upload proof of qualifying activity completion monthly. Qualifying activities will only be verified at initial application, annual renewal, and when an individual reports a change.