2194 PeachCare for Kids® | Medicaid

PeachCare for Kids® (PCK) provides health insurance for uninsured children under the age of 19 living in Georgia. These children are in families with incomes between 134 to 247 percent of the federal poverty limit. Eligibility is determined based on the Modified Adjusted Gross Income (MAGI).

PCK health coverage is available to children from birth through the last day of the month of a child’s 19th birthday.

PCK uses Modified Adjusted Gross Income (MAGI) rules to determine eligibility. Refer to Section 2610 - MAGI Budget Groups / Assistance Units and Section 2245 - Living with a Specified Relative/Tax Filer/Non-Filer Status.

Countable income must be less than or equal to 247% fo the FPL. Refer to Appendix A2, Financial Limits for Family Medical Assistance.

All income received by the applicant must be verified electronically or manually.

PCK recipients must meet the Medical Assistance citizenship/immigration criteria. Citizenship/immigration status must be verified. Refer to Section 2215 - Citizenship/Immigration/Identity.

Referral of the non-custodial parent (NCP) to DCSS does not apply.

Enrollment in PCK begins the first day of the month in which a complete application or renewal, including all applicable verifications and initial premium payment have been received.

PCK does NOT provide prior month coverage. If prior month medical bills are owed, the child may be potentially eligible for Family Medicaid Medically Needy.

Gateway will automatically screen each application or renewal for all Medicaid Classes of Assistance (COA).

A PeachCare for Kids® enrollee who becomes pregnant can apply for Pregnant Woman Medicaid. If the pregnant PCK enrollee is determined Pregnant Woman Medicaid eligible, then the PCK enrollee is no longer eligible to receive PCK.

If the PeachCare for Kids® enrollee’s pregnancy has ended by delivery or termination and the individual is in their 12-month postpartum period, then the PCK enrollee will remain PCK eligible through the last day of the month of their 12-month postpartum period regardless of any changes in circumstances that may affect eligibility (e.g. income, household composition, aging out, nonpayment of premiums or becoming Medicaid/SSI eligible).

If the PeachCare for Kids® enrollee voluntarily request closure of their PCK case during their 12-month postpartum period, the PCK enrollee would not be eligible for the remainder of their 12-month postpartum period if later approved for a Medicaid class of assistance.

A Care Maintenance Organization (CMO) and a primary care physician must be selected for children eligible for PCK. This may be done after approval through Georgia Families®. If no CMO and primary care physician are selected, a CMO and physician will be assigned according to the area in which the child lives.

Any physician, medical practice, clinic or hospital that accepts Medicaid also accepts PCK.

PCK health benefits will not start until after the initial premium payment is received. A 45-day initial premium payment period will be given to new PCK applicants. A 30-day initial premium period will be given to PCK enrollees at renewal.

PCK enrollees will no longer lose coverage for non-payment of premiums after the initial premium payment is received for each new enrollment period, which includes the initial eligibility determination at application and annual renewals, due to continuous eligibility restrictions.

Monthly premium payments will still be accrued, and a quarterly statement will be sent to the customer. Premium payments are due 30 days before the first day of the month that enrollees receive PCK health benefits.

Premiums are calculated on a sliding scale based on household income, ranging from $11 to a family maximum of $72. The premium schedule for PCK is shown in the chart below.