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| Who is eligible for PeachCare for Kids? | Child 18 years or younger whose family's income is too high to qualify for Medicaid but is less than 235% of the Federal Poverty Limit. |
| How much does it cost parents? The state? | There are no premiums for children through age 5. For children age 6 or older, premiums are $10.00 for one child in a family, and $20.00 for two or more in one family. The state has budgeted $20 million for the first year's costs; federal matching funds will pay the remainder--more than 70% of the program's costs--for a total first-year budget of more than $70 million. |
| What kind of benefits do children receive under the program? | Children receive the same kind of benefits they would receive under private insurance, and in some cases, broader coverage. No pre-existing conditions exclusions can keep a child from being enrolled in the program. Doctors' visits--preventive and urgent care--are paid for, as well as hospital inpatient and outpatient care, dental care, vision care, and other medically necessary treatment. Non-emergency transportation costs are not covered. |
| Are there premiums or co-payments? | Yes, there are premiums (see above), but no co-payments are required. |
| How do I sign up? Do I have to go to the welfare office to do it? | Applications are available at several
locations in local communities, not just at the local county DFCS offices
(although they are available there). They are "mail-in" applications
that a parent can pick up, take home, fill out there, and mail in.
Parents can also have an application and
brochure mailed directly to them by calling 1-877-GA-PEACH. Staff
members at this number can also provide assistance with completing the
application.
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| How much are doctors, hospitals, etc. paid under PeachCare for Kids? The same as Medicaid, or more ... or less? | All health care providers who work with Georgia's PeachCare for Kids program are paid the same rates that they would under Medicaid, and their claims are paid in the same manner. |
| Do children enrolled in PeachCare for Kids have to go into HMOs? | No, but they have the option if their parents choose to enroll them in one of the managed care organizations (MCOs) with which Georgia Medicaid does business. If they choose not to enroll in an MCO, they will be enrolled in Georgia Better Health Care (GBHC), the agency's primary-care case management program. GBHC pays doctors on a fee-for-service basis, the same as "regular" Medicaid, and helps ensure that children on Medicaid have a medical "home" and go to the same doctor for checkups and other visits. |
| Do they have a choice of doctors? | Yes. If they enroll in GBHC, they may be able to stay with the doctor they're already seeing. If they enroll in an MCO, they will choose from the doctors who work with that plan. |
| Can we still use with the doctor we've been using? | Very possibly. Even if that doctor isn't a Medicaid -enrolled doctor, he or she can sign up to become a Medicaid provider. The vast majority of physicians who work with Medicaid like and sign up with GBHC as well. |
| What if my income exceeds 235% of the FPL? | Parents are required to report changes in income and coverage will end if the change makes the child ineligible. Eligibility is reviewed at least once a year for everyone enrolled. |
| What if I lose my job and can't pay the premium? | If a family's financial circumstances change for the worse, it is entirely possible a child in PeachCare for Kids will then be eligible for Medicaid benefits. It will be important to report this change to the PeachCare for Kids program, so you can find out what to do to get your child enrolled in Medicaid. |
| How soon will I get my card? | 4-6 weeks |
| Which doctors take the card? | All GBHC providers are PeachCare for Kids providers. In addition, all Medicaid providers are deemed to be PeachCare for Kids providers. |
| Does PeachCare for Kids pay for counseling sessions, dentist, emergency room visits and eye glasses? | PeachCare for Kids covers the same services as Medicaid with the exception of targeted case management and non-emergency transportation. |
| How often will I get the card? | The PeachCare for Kids card is a one-time small plastic card, much like most insurance cards. Families will not receive monthly documentation as in Medicaid. |
| What about previous unpaid medical bills? | PeachCare for Kids provides ongoing coverage. No prior bills are covered. |
| Will I be billed for the premiums? | Families receive a monthly coupon book to use as a reminder to send in their payment. |
| Can we use the card while we are out of town? | Emergency out of town treatment procedures are the same as Medicaid. A toll-free number is listed on the back of the PeachCare for Kids card. Prior authorization is required for out of state services. |
| I received a letter stating my application was sent to Medicaid and my check went in with my application. My check has cleared the bank. Will I get a refund? | Yes. |
| If my insurance is canceled because my job is ending, do I still have a three-month waiting period? | No. Be sure to put this explanation on your application. |
| Do you count the unborn in the budget group? | No. |
| Is DFCS actually contacting applicants if they think the application is incorrect or incomplete? | Yes. |
| Is the applicant's statement accepted as verification of application information? | Yes. |
| Once approved, how long can my children stay on PeachCare for Kids? | As long as the family continues to meet eligibility requirements, the children can remain eligible up to age 19. Families are redetermined for eligibility once a year. |
| Can my child be approved if he had a pre-existing condition? | Yes. |
| Can I drop my health insurance at work and sign up for PeachCare for Kids? | Yes, but there is a three-month waiting period. Please be aware that once your health insurance is lost, you may have a hard time getting it back. Your child will remain eligible for PeachCare for Kids as long as your income is below the limit. |
| Do I list my husband and his income on the application if he is not the father of my children? | His income is not counted unless he has legally adopted the children. |
| How do I report changes such as income or address? | Call 1-877-GAPEACH. |
| How can I check the status of my application once it has been filed? | After four to six weeks, call 1-877-GAPEACH. |
| Why can't state employees apply if their income is below the limit? | Federal legislation prevents state employees from receiving PeachCare for Kids. |
| Can I choose PeachCare for Kids instead of Medicaid? | No, if you qualify for Medicaid, you must receive Medicaid. |
| How is the income for self-employed families determined? They make different amounts each month. | It is the same as RSM. |
| If the family is approved for Medicaid instead of PeachCare for Kids, is the date of application for Medicaid the same as the date on the PeachCare for Kids application? | Yes. |
| Can fathers/mothers apply for PeachCare for Kids for their children who do not live in the home with the parent who is applying? | The children must live in the home of the parent who applies for PeachCare for Kids. Either parent can mail in the premium. |
| Is PeachCare for Kids the same as Peach Child Care? | No, Peach Child Care is offered through the Department of Family and Children Services. Families should not call the 1-877-GAPEACH number to inquire about Child Care information. |
| Does PeachCare for Kids cover adults over 19 years old? | No, PeachCare for Kids only covers children up to their 19th birthday. |
| If I pay less than $100 per month for my employer sponsored insurance, do I still have the three-month waiting period before applying for PeachCare for Kids? | Yes, there is a three-month waiting period. Please be aware that once your health insurance is lost, you may have a hard time getting it back. Your child will remain eligible for PeachCare for Kids as long as your income is below the limit. |