Georgia Pathways to Coverage

We've served Georgia Pathways members since 2023.

Benefits overview

Georgia Pathways is a new waiver program that gives Georgians who are not eligible for Medicaid an opportunity to gain access to healthcare coverage through 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

There are currently no copays for Georgia Pathways members.

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.

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. Documentation must verify hours reported for the most recent four weeks available, within the eight weeks prior to application submission date.

Qualifying activities include:

• Employment, including self-employment
• On-the-job training
• Job readiness
• Community service
• Vocational educational training
• Enrollment in an institution of higher education
• Enrollment and active engagement in the Georgia Vocational Rehabilitation Agency

Members can report qualifying hours and activities:

• Via Gateway Customer Portal
• By mailing a paper form to the local Division of Family and Child Services (DFCS) office
• In-person at the local DFCS office. To find the location and business hours for a DFCS office, visit:  dfcs.ga.gov/locations .
• By phone at 877-423-4746