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Georgia Pathways to Coverage

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    Georgia Pathways to Coverage

    Is it Right for You?

    Almost everyone should be able to get health coverage. The question is, which plan is right for you and your family?

    This page looks at whether you might qualify for Georgia Pathways to Coverage Medicaid based on your family's income. If you do, it is your best choice and you won’t qualify for subsidized individual coverage. You can see if you qualify for Medicaid at Georgia Gateway or Georgia Access.

    If you don’t qualify for Medicaid, consider other options we will introduce, including Medicare and private health insurance.

    Getting Medicaid if you have a disability

    If you get Supplemental Security Income (SSI) benefits or used to get SSI benefits and now qualify for SSI's 1619(b) status, you get Medicaid coverage automatically and do not need to worry about applying for Pathways Medicaid.

    If you have a disability determination but your income is too high for SSI, you may be able to get Medicaid through other disability-based Medicaid rules. To see if you qualify for SSI or these other programs, read DB101's article about disability-based Medicaid.

    Georgia Pathways to Coverage Basic Eligibility Requirements

    To qualify for Pathways Medicaid, most people must meet several basic requirements:

    To get Pathways coverage, you'll also have to do a qualifying activity every month. We explain what counts as a qualifying activity later on this page.

    Age 19 to 64

    Pathways Medicaid is only for adults who are under age 65. However, seniors may qualify for disability-based Medicaid. If you are 65 years or older and have low income, talk to your local Division of Family and Children Services (DFCS) office about whether you qualify for Medicaid.

    Children under 19 may get PeachCare for Kids coverage if their family's income is 252% of FPG or less ($6,752 per month or less for a family of four). Learn more in DB101's Medicaid Eligibility for Young People article.

    Not Eligible for Any Other Medicaid Category

    Pathways Medicaid is only for people who don't qualify for any other type of Medicaid.

    That means you aren't eligible for Pathways if any of the following applies to you:

    • You qualify for a Medicare Savings Plan (MSP). An MSP is a Medicaid program that can help you pay your Medicare premiums and other expenses. You may be eligible for an MSP if you have Medicare coverage, low income, and low resources (different MSPs have different income and resource limits).
      • Because of this rule, most people who have Medicare will not qualify for Pathways. However, if you have Medicare and low income but don't qualify for an MSP because you have too much in resources, you could be eligible for Pathways. Learn more about MSPs in DB101's Medicare article.
    • You have Medicaid with a spenddown, also called the Medically Needy program. Medicaid with a spenddown is for people who are determined disabled or blind and have $2,000 or less in resources ($4,000 or less for a couple), but have too much income to qualify for Supplemental Security Income (SSI). If you're in this situation, you'll get Medicaid coverage after you spend a certain amount of your income on health care costs each month. Learn more about how Medicaid with a spenddown works.
    • You qualify for Medicaid in any other way not listed here.

    Citizenship or Residency

    You must be a U.S. citizen or meet specific noncitizen requirements to be eligible for Medicaid:

    • Immigrants who have been lawfully present for five years or longer or who meet specific noncitizen requirements are eligible for the same programs that U.S. citizens can get, including Medicaid.
    • Most immigrants who have been lawfully present for less than five years do not qualify for Medicaid. However, they may qualify to get private coverage subsidized by the government through Georgia Access.
    • Undocumented immigrants cannot qualify for regular Medicaid, although some people, like children, pregnant women, and people with disabilities, may be able to get Medicaid coverage in an emergency (called Emergency Medical Assistance) if they meet all other Medicaid requirements. To learn more about Emergency Medical Assistance, contact your local Division of Family and Children Services (DFCS) office.

    Income

    To qualify for Georgia Pathways to Coverage Medicaid, your family's income must be at or below 100% of the Federal Poverty Guidelines (FPG) ($1,305 per month for an individual in 2025, $2,679 for a family of four).

    There are no limits to how much money or other resources you can have and still qualify for Pathways. Other types of Medicaid, including disability-based Medicaid, do have resource limits.

    Higher income limits for children and pregnant women

    If you are under 19 or are pregnant, you may qualify for Medicaid under different rules and not through Pathways. These rules have higher income limits:

    1. Children under 19 may get PeachCare for Kids coverage if their family's income is 252% of FPG or less ($6,752 per month or less for a family of four).
    2. Pregnant women may get Medicaid if their family's income is 225% of FPG or less. (For the purposes of calculating a pregnant women's family income, the unborn baby is counted as a family member.) Medicaid coverage lasts a year after giving birth.

    Note: You may see the income limit for PeachCare for Kids listed as 247% of FPG in some places, and the income limit for pregnant women listed as 220%. However, if you make more than these income limits, Medicaid will knock 5% of FPG off of your income when they count it. That's why we show the limits as 252% and 225%, because they more accurately show how much you could make and still get Medicaid.

    Children and pregnant women who get Medicaid do not have to do qualifying activities.

    Pathways Medicaid counts most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect Pathways Medicaid eligibility.

    Try the tool below. If your income is at or below 100% of FPG, you may qualify for Pathways.

    Health Coverage Income Limits for Your Family

    If you cannot get Medicaid because your income is too high, consider buying an individual plan through Georgia Access. See DB101’s article about Buying Health Coverage on Georgia Access.

    What are "Qualifying Activities"?

    To get Medicaid through Georgia Pathways to Coverage, you must do 80 hours or more of qualifying activities each month. Qualifying activities can include:

    You don't have to do 80 hours of the same activity. For example, you could work 60 hours each month and volunteer for 20 hours. Or, you could be a part-time student and work part time. If you are getting SNAP (Food Stamps) benefits through the Able-Bodied Adults Without Dependents (ABAWD) program, you meet the qualifying activity requirement.

    If you have a disability and need help doing qualifying activities, you can ask for a Pathways reasonable modification when you apply. A Pathways reasonable modification can:

    Learn more about Pathways reasonable modifications.

    The bottom line: If you have a disability, don't assume you won't be able to get Pathways because of the qualifying activities requirement. There are ways to get help, and meeting the requirement may be easier than you think.

    Learn more about the Qualifying Activities requirement for Pathways Medicaid.

    If you meet the main requirements described here, you should sign up for Georgia Pathways to Coverage Medicaid. We explain how to sign up later in this article.

    Different ways to get Medicaid if you have a disability

    If you have a disability, you may qualify for Medicaid through different rules. How you can get Medicaid depends on your income, your resources, and your condition.

    If you qualify for any of the following options, you'll get Medicaid that way instead of through Pathways:

    • If you get Supplemental Security Income (SSI), you automatically get Medicaid coverage. If you used to get SSI but your benefit amount went down to zero because you started working, you may be able to keep your Medicaid coverage through SSI's 1619(b) rule.
    • If you need a high level of care, you may qualify for a Medicaid waiver program. Waiver programs have a higher income limit than other Medicaid programs, so you might qualify for one even if you don't qualify for SSI.
    • If your income is too high to get SSI, but you meet the other SSI requirements, you may get Medicaid with a spenddown.

    You can learn more about these programs in DB101's disability-based Medicaid article.

    However, there are situations in which you may get Pathways even if you have a disability. For example:

    • Your disability does not meet Social Security’s definition of disability. Disability-based Medicaid is only for people who have disabilities meeting this standard.
    • You don't qualify for disability-based Medicaid because you have too much in resources. SSI, Medicaid waiver programs, and Medicaid with a spenddown all have resource limits, but Pathways does not.

    Medicaid and Private Health Coverage

    If you qualify for Georgia Pathways to Coverage Medicaid, you should sign up for it. Here we will look at what signing up for Pathways might mean if you have or want private coverage.

    Medicaid and Employer-Sponsored Health Coverage

    If you qualify for Medicaid through the Georgia Pathways to Coverage program and can get employer-sponsored health coverage (either your own or through a family member), Medicaid will either pay your employer-sponsored coverage costs, like your premiums, deductible, and copayments, or give you Medicaid coverage through a managed care plan. Medicaid will determine which coverage option to offer you after you apply, based on which option is more cost-effective for the state of Georgia; you do not get to choose.

    No matter which option you qualify for, Pathways will always be a better choice than paying for your own employer-sponsored coverage, because it is much less expensive.

    Learn more about getting Pathways while you have employer-sponsored coverage.

    Example

    Nelson is a single father living on his own with his two daughters. He makes $15 an hour repairing shoes and works 30 hours a week, so he makes a total of about $2,000 a month. Because he works 30 hours a week, his employer offers him and his daughters health insurance, but to get it, he would have to pay a $400 premium each month.

    Nelson decides to go to his local Division of Family and Children Services (DFCS) office to see if his family would qualify for Medicaid, because he doesn’t have enough money to pay the monthly premium for health coverage offered through his job. The case worker looks at his situation and explains that he does qualify for Medicaid through the Georgia Pathways to Coverage program, because his income is less than 100% of FPG for a family of three and he works more than 80 hours a month at his job.

    Because he qualifies for Pathways, Medicaid will either pay his employer-sponsored healthcare costs, including his $400 premium every month, or enroll him in a managed care plan, depending on which option is more cost-effective. Either way, he will not have to pay a monthly premium. After Nelson applies, he learns that his employer-sponsored plan was not considered cost-effective, so he is enrolled in a managed care plan.

    Medicaid and Individual Plans

    If you are eligible for Medicaid, then you will not be eligible to get government help to pay for a private insurance plan. That means the private insurance plan would be expensive for you. If you qualify for Medicaid, it will always be a better option for you than paying for an individual plan.

    Learn more

    Finding the Right Health Coverage For You

    Try this interactive guide to see your health coverage options.

    Disability-Based Medicaid

    There are several ways to qualify for Medicaid if you have a disability.

    Buying Health Coverage on Georgia Access

    You can get private health coverage on Georgia Access. The government may help you pay for it.