If you are pregnant or have breast or cervical cancer, you may apply for Presumptive Medicaid at your local county health department. County health departments are designated as qualified providers to enroll eligible applicants in the Medicaid program through Presumptive Eligibility (PE). This is a temporary coverage prior to a formal determination of eligibility by the local Right from the Start Medicaid (RSM) Project or the Division of Family and Children Services (DFCS). There are two categories that may be applied for in the health department:
Presumptive Eligibility (PE) for Women with Breast or Cervical Cancer
Women’s Health Medicaid is a program that pays for cancer treatments for women who have been diagnosed with breast or cervical cancer and cannot afford to pay for treatment. Any woman who has been diagnosed with breast or cervical cancer may apply for Presumptive Eligibility Women’s Health Medicaid in their local health department.
To be eligible for PE Women’s Health Medicaid, an applicant must meet the following criteria:
- You must be under 65 years of age.
- You must be a U.S. citizen or a lawfully admitted immigrant.
- You must be currently residing in Georgia.
- You must have breast or cervical cancer. This may include precancerous conditions of the breast or cervix.
- You may not have existing health insurance that pays for cancer treatments. Additionally, you may not be currently receiving Medicaid or Medicare.
How to Apply
To apply for for the Women’s Health Program, contact your local county public health department. All health departments within the Southeast Health District can be reached at 1(855)473-4374.
Although this program has to be applied for at a health department, an RSM specialist will contact the applicant to notify them of their eligibility. If denied, an RSM worker will attempt to refer the applicant to a program that may be able to assist them.
Presumptive Eligibility (PE) for Pregnant Women
The Presumptive Eligibility for Pregnant Women program is designed to provide medical assistance coverage during the processing period and to remove barriers to the availability of prenatal care that is critical in positive affect the birth outcome and health of mothers. As soon as you find out you are pregnant, you can apply to see if you are eligible for PE Medicaid to help cover your costs throughout your pregnancy. Costs that are covered can include provider visits, prescription medicines, labor and delivery, and inpatient and outpatient hospital services. In 2020, nearly 50% of Georgia’s pregnancies and births are covered by Medicaid.
In order to be eligible to receive PE Medicaid, an applicant must meet the following criteria:
- You must be pregnant.
- You must meet income requirements (listed below).
- You must be a U.S. citizen or meet certain immigration status requirements.
The income requirements change depending on how many people are in your household. For Medicaid purposes, the unborn child is counted as a member of your household. You can see the Modified Adjusted Gross Income (MAGI) Limits for PE Pregnant Women below. These income limits are effective as of March 1, 2023.
|2023 Income Limit (220% of the Federal Poverty Level)
For each additional family member over 12 persons, add $943.00.
How to Apply
Pregnant women may apply for PE Medicaid through your county health department.
What Happens After I Apply?
After your presumptive application has been approved, it will be forwarded to a Right From the Start Medicaid caseworker for final review and for Pregnancy Medicaid approval. A caseworker from DFCS may contact you to conduct a required phone interview. Afterward, the caseworker may request additional verifying information such as paystubs or proof of residency.
DFCS must make a decision about your Pregnancy Medicaid application within 10 days of your submission. If you do not hear back within 10 days or you are denied when you think you are eligible, you can call Georgia Legal Services Program at 833-GLSPLAW (457-7529) or visit www.glsp.org.
What Happens After I Have Been Approved?
Once your Pregnancy Medicaid application is approved, you’ll be contacted to choose a Care Management Organization (CMO). A CMO will be your source for all things related to PE Medicaid, such as network providers, coverage and more. Some examples of CMOs include Amerigroup, CareSource, Peach State, and WellCare.
Keep these things in mind before choosing a CMO:
- CMOs all provide the same core benefits but offer different incentives and have different provider networks.
- If you already have a provider, you can call that provider to check if they are in the CMO’s network.
- Call the providers listed as in-network for each CMO and make sure they are accepting new patients.
- Call each CMO and see which one is the easiest to reach in case you have future questions or concerns.
You can start using your Medicaid benefits right after you are approved!
What Happens After I Give Birth?
The Medicaid for Pregnant Women program pays for medical care for women for up to 6 months after giving birth; however, it may last longer due to the COVID-19 pandemic (see below). After you give birth, your baby will automatically be eligible for Newborn Medicaid. Newborn Medicaid lasts until your baby turns 1.