Medicaid Rules That Change

At 18, your child can manage his or her Medicaid benefits and make medical decisions privately. You won’t have access to your child’s medical records unless he or she authorizes it. That's why it's important to teach your child how to make health decisions and manage benefits now, so that your child will know how to do them later.

PeachCare for Kids and Georgia Pathways to Coverage

PeachCare for Kids covers children 18 or younger if the total combined income of everybody who lives in the same household is 252% of the Federal Poverty Guidelines (FPG) or less ($6,752 per month or less for a family of four).

When your child turns 19, PeachCare for Kids eligibility ends. As an adult, your child will have a new Medicaid option called Georgia Pathways to Coverage. It covers adults in households with income under 100% of FPG ($2,679 per month for a family of four). For Pathways, a person must also do a qualifying activity, which could include getting a job, going to college, getting other training, or doing vocational rehabilitation with the Georgia Vocational Rehabilitation Agency (GVRA).

If your child doesn’t qualify for Pathways Medicaid as an adult, there are other options:

• If you or your child’s other parent can get employer-sponsored coverage, your child can be on that plan until turning 26.
• If employer-sponsored coverage is not available, your child may get help paying for individual coverage on Georgia Access if household income is 100% of FPG or higher.

Note: If you don’t claim your child as a dependent on your taxes, your child might qualify as a single person living alone.

Health Coverage Income Limits for Your Family

Your family size:	123456789101112
Income limits for your family:
	$15,650
	$5,500
	$15,060
	$5,380
	252
Georgia Pathways to Coverage Medicaid (100% FPG)
PeachCare for Kids (252% FPG)
Subsidized private plans, reduced fees (100% FPG - 250% FPG)
	to
Subsidized private plans (no upper income limit)	--
If your family's income is within the limits for a program, you may qualify if you meet other program rules. Notes: Some types of income do not count against these limits, including SSI benefits. Different programs sometimes use slightly different numbers for the Federal Poverty Guidelines (FPG). Not all Medicaid categories are included here. For private plans with subsidies, your monthly premium amount depends on your income.

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Rules that Don't Change At 18 or 19

Most other eligibility rules for Medicaid and private health insurance don't change when your child turns 18 or 19:

• Disability-Based Medicaid covers children and adults who get Supplemental Security Income (SSI) benefits and some low-income people with disabilities who don't get SSI. Note: It may be easier for your child to qualify for SSI and disability-based Medicaid as an adult, because parental income is no longer counted and does not affect eligibility.
• Employer-sponsored coverage through your job or your child’s other parent's job has to allow your children to be on the plan until their 26th birthday.
• Individual coverage is an option for children and adults if employer-sponsored coverage is not available. Households may get help paying for it on Georgia Access if household income is over 100% of FPG.