Frequently Asked Questions

If you need more help in understanding Medicaid, you can:

• Visit or call your local Division of Family and Children Services (DFCS) office.
• Get local help from Georgia Access.
• If you have a disability, talk to a benefits expert to learn more about health programs for people with disabilities.
• Call the Customer Contact Center toll free at 1-877-423-4746.

There are different ways to apply for Medicaid:

• Online using Georgia Gateway. Georgia Gateway lets you apply for other programs, like the Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for Needy Families (TANF), at the same time.
• In person at your local Division of Family and Children Services (DFCS) office.
• By downloading the Application for Benefits (Form 297), completing it, and faxing or mailing it to your local Division of Family and Children Services (DFCS) office.

If you get Supplemental Security Income (SSI) or used to and now are on SSI 1619(b), you automatically get Medicaid coverage and do not need to apply for it separately. If you need to sign up for SSI, you can apply with Social Security.

Note: For information about how to apply for a specific Medicaid waiver program, read DB101's article about waivers.

It depends on how you qualified for Medicaid. Georgia Pathways to Coverage, Medicaid for pregnant women, and PeachCare for Kids have no resource limit. However, some people with disabilities and seniors may qualify through disability-based Medicaid rules, which do have resource limits:

• Supplemental Security Income (SSI) has a $2,000 resource limit ($3,000 for a couple). If you have Medicaid coverage through SSI's 1619(b) rule, you also must have resources under this limit.
• Medicaid waiver programs have a $2,000 resource limit ($3,000 for a couple).
• Medicaid with a spenddown has a $2,000 resource limit ($4,000 for a couple).

Note: If your disability began before you turned 26, you can open an ABLE account where you can save up to $19,000 each year and not have it counted by Medicaid. Learn more about ABLE accounts.

In most cases, it does not matter how you qualify for Medicaid, because the actual medical coverage you get from Medicaid will be the same.

DB101 has information about different ways to get Medicaid:

• The Georgia Pathways to Coverage Medicaid article explains how you may qualify whether or not you have a disability.
• The disability-based Medicaid article explains common ways for people with disabilities to qualify, including getting Medicaid automatically if you get Supplemental Security Income (SSI) benefits.

If you are not sure how you qualified for Medicaid, you can ask your local Division of Family and Children Services (DFCS) office.

No, countable income is not the same as how much you make. When public programs look at your income to figure out if you should qualify, they don’t always count all of your income. What they do count is called “countable income.” This benefits you, because it means that you might have more income than the income limit for a program, but still qualify.

When Social Security reviews your income to see if you qualify for Supplemental Security Income (SSI), only about half of your earned income (money you get from work you do) is counted. For example, if you make $2,000 per month at a job and have no other income, that’s only $957.50 in countable monthly income.

Note: If you get Medicaid in a way that is not through SSI, like through a Medicaid waiver program or Georgia Pathways to Coverage Medicaid, almost all of your income is counted.

Try this tool to get an idea of how much countable income you have:

Your Countable Income:

Your Monthly Earned Income	$
Your Monthly Unearned Income (not including SSI)	$
Your Monthly Impairment Related Work Expenses (IRWEs)	$
	$1,305
	$20
	$65
	$967
Your Monthly Countable Income
Your Annual Countable Income
	$15,650
Federal Poverty Guideline
Your Countable Income as a Percent of FPG

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Yes, if you're getting Supplemental Security Income (SSI), you automatically get Medicaid as well. You do not need to file an additional application.

If you’re on SSI and Medicaid and your monthly SSI benefits drop to zero because your earned income goes up, Social Security’s 1619(b) provision lets you keep your Medicaid coverage. If you are on 1619(b), you can have up to $38,308 in total income per year, as long as your resources don’t go above the SSI resource limit ($2,000 for an individual, $3,000 for a couple).

Even if you don't qualify for Supplemental Security Income (SSI) benefits, you may still qualify for Medicaid.

If you have a disability and need extra care to keep living in your home or apartment in the community instead of moving into a facility, you may qualify for a Medicaid waiver program. With a waiver, you get regular Medicaid coverage plus additional services you need to continue living at home. Waiver programs have a higher income limit than SSI, so you may qualify even if you don't qualify for SSI. Learn more about Medicaid waiver programs.

If your income is too high for SSI and you don't qualify for a waiver program, you may be able to get Medicaid after you spend some of your own income on medical bills each month. This is called Medicaid with a spenddown. However, Medicaid with a spenddown is very expensive and you should only sign up for it if you have no other health coverage options. If you're in this situation, look into buying an individual plan on Georgia Access—it may be more affordable!

If you don't qualify for Medicaid through any of those rules, you may qualify through Georgia Pathways to Coverage Medicaid, which does not require a disability determination. Learn more about Pathways Medicaid.

Usually, if you qualify for Medicaid, you should sign up for it, because it is much cheaper than private health insurance—there are no premiums and only small copayments for certain medical services. Also, it may cover some services that private insurance won't cover.

However, if you have Medicaid with a spenddown, buying a private health plan may be a more affordable option. Medicaid with a spenddown means that you have to spend some of your own income on medical bills every month before Medicaid will start paying, which can be very expensive.

Depending on your income, the government may help you pay for a private plan through tax subsidies. You can go to Georgia Access to see how much a private plan may cost and if you may qualify for government help.

Medicaid is a public health coverage program. There are different ways to qualify for Medicaid, depending on things like your age, income, resources, and whether you have a disability.

Regular Medicaid: You may qualify for regular Medicaid coverage through Georgia Pathways to Coverage Medicaid, which only looks at your income, or through disability rules, if you have low income, low resources, and a disability. You automatically qualify for Medicaid if you get Supplemental Security Income (SSI) or qualify for SSI’s 1619(b) provision. With regular Medicaid, you only have to pay small copayments for medical services.

Medicaid with a spenddown: You may qualify for Medicaid with a spenddown if you have a disability and low resources, but your income is too high to qualify for SSI. If you are in this situation, you can "spend down" your income by paying for the first part of your medical costs each month. Once you have paid the spenddown amount in a month, Medicaid will cover your medical expenses for the rest of the month.

Note: Medicaid with a spenddown is often very expensive. For example, if your monthly countable income is $1,167, you'll have to spend $850 in a month before you can get Medicaid coverage that month. Private insurance may be a more affordable option.

Read about the different ways of qualifying for Medicaid on DB101.

There are different health coverage options as your income goes up.

If you have been getting Medicaid through Supplemental Security Income (SSI) benefits, you may be able to keep your Medicaid coverage if you go back to work through SSI's 1619(b) provision. If you're on 1619(b), you can have up to $38,308 in total income each year and still keep your Medicaid coverage.

If your income is above 100% of the Federal Poverty Guidelines (FPG) , you may be able to get government help to pay for individual insurance plans on Georgia Access.

If you have questions about the impact work will have on your health care, talk to a benefits expert or get an idea of your options with DB101’s Benefits and Work Estimator.

Yes, if your family’s income is low enough for you to qualify for Medicaid, you may do so even if your job offers insurance.

Also, if you qualify for Medicaid and you can get health insurance through your job, Medicaid may pay your premiums through the Health Insurance Premium Payment (HIPP) program, if doing so would save money for Medicaid. HIPP does not pay your deductible or copayments. Learn more about HIPP.

Yes, if you qualify for Medicare and Medicaid, it is helpful to have both at the same time. Medicaid covers many more services than Medicare, so by having both you’ll have better health care coverage. Also, Medicaid will usually pay your Part A and Part B premiums and it may also pay your Medicare deductibles, co-insurance, and copayments. With Medicare Part D, you’ll likely have cheaper prescription drug costs by enrolling in both programs.

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 and some other noncitizens who meet specific noncitizen requirements qualify 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 Medicaid, but they 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.