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Benefits for Young People

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    Benefits for Young People

    Medicaid Eligibility for Young People

    Medicaid helps people with low income pay for their visits to the doctor, hospital stays, prescription drugs, medical equipment, and other medical services.

    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 the eligibility information discussed here.

    If not, you may qualify for:

    You can apply for them:

    Medicaid if You Are 18 or Younger

    If you are 18 or younger, you may qualify for either Medicaid for Children Under 19 or for PeachCare for Kids if your family’s income is 252% of the Federal Poverty Guidelines (FPG) or less ($6,752 per month or less for a family of four). It doesn't matter how much your family has in resources or whether you have a disability.

    Check whether your family's income is low enough for you to get Medicaid for Children Under 19 or PeachCare for Kids:

    Health Coverage Income Limits for Your Family
    Is the income limit for PeachCare for Kids 247% or 252% of FPG?

    You may see the income limit for PeachCare for Kids listed as 247% of the Federal Poverty Guidelines (FPG). However, when Medicaid counts your income, they’ll knock 5% of FPG off your household income if you make more than 247% FPG. That's why we say that you can make up to 252% of FPG, because it more accurately shows how much income you could have and still get PeachCare for Kids coverage if you are under 19.

    Note: Some young people with disabilities who don't get SSI and don't qualify for income-based Medicaid may still qualify for disability-based Medicaid. If you have any questions about this, talk to a benefits expert.

    Medicaid Waiver Programs

    Medicaid Home and Community Based Services (HCBS) Waiver programs pay for services that help people with disabilities live in their own homes instead of in nursing homes or other institutions. To qualify for a Waiver program, you must have disability-related needs that require more services than Medicaid usually covers. Each Waiver program helps people with different types of needs.

    If you have needs that mean you could qualify for a Waiver, there's a higher income limit than other Medicaid programs have. This means you might be able to get Medicaid coverage even if you don't qualify for the programs discussed below. Learn more about Medicaid Waiver programs.

    Georgia Pathways to Coverage if You Are 19 or Older

    If you are 19 or older, you may qualify for Georgia Pathways to Coverage Medicaid if your family’s income is 100% of FPG or less ($1,305 per month or less if you are single). For Pathways, a person must also do a qualifying activity, which could include working, going to college, getting other training, or doing vocational rehabilitation with the Georgia Vocational Rehabilitation Agency (GVRA).

    If you are pregnant, you can get Medicaid if you have income up to 225% FPG ($3,966 per month if you are single and having your first child; the baby counts as a family member according to Medicaid). It doesn't matter how much your family has in resources or whether you have a disability. Medicaid coverage lasts a year after giving birth.

    Check whether your income is low enough for you to get Georgia Pathways to Coverage Medicaid:

    Health Coverage Income Limits for Your Family
    Is the income limit for Pathways Medicaid 95% or 100% of FPG?

    Some places may show the income limit for Pathways Medicaid as 95% of the Federal Poverty Guidelines (FPG). However, when the Medicaid counts your income, they’ll knock 5% of FPG off your income if you make more than 95% of FPG. That's why we say that you can make up to 100% of FPG, because it more accurately shows how much income you could have and still get Medicaid through Georgia Pathways to Coverage. For Medicaid for pregnant women, this means we show 225% of FPG as the limit, rather than 220%.

    Learn more in DB101's article on Georgia Pathways to Coverage.

    Note: If you have a disability, don't get SSI, and make too much for income-based Medicaid, you may qualify for disability-based Medicaid or for a Medicaid Waiver program.

    Individual plans on Georgia Access

    If you don’t qualify for Medicaid or a Medicaid Waiver program, look into other health coverage options on Georgia Access. Learn more about private health insurance.

    Learn more

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