Benefits Program

All Goverment Program benefits and Application form, income limits, documents etc.
All Goverment Program benefits and Application form, income limits, documents etc.
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NOTICE

Georgia PeachCare for Kids Program Benefits

PeachCare for Kids® began covering children in 1999, providing comprehensive health care to children through the age of 19 who do not qualify for Medicaid and live in households with incomes at or below 247 percent of the Federal poverty level. PeachCare for Kids® health benefits include: care from a doctor when your child is sick; preventive services such as immunizations and regular check-ups; specialist care; dental care; vision care, including vision screenings and eyeglasses; hospitalization; emergency room services; prescription medications; and mental health care.

Each child will have a choice of a Georgia Families Care Management Organization (CMO), a private health plan that is responsible for coordinating your child’s health care. There is no cost to families for children under age 6. Starting at age 6, premiums are determined based on the FPL and household size. 

Currently, the cost per month for PeachCare for Kids® coverage is $11.00 to $36.00 for one child and $16.00 to a maximum of $72.00 for two or more children living in the same household. Once you complete the application, information about paying your premium and the amount will be provided to you. 

What is PeachCare for Kids®?

PeachCare for Kids® is a comprehensive health care program for uninsured children living in Georgia. The health benefits include:

  • Primary services
  • Preventive services
  • Specialists
  • Dental care
  • Vision care
  • Hospitalization
  • Emergency room services
  • Prescription medications
  • Mental health care

Each child in the program is enrolled in a Care Management Organization (CMO) and has a primary care provider, who coordinates the child's care. The three CMOs have toll-free numbers and websites available for members and health care providers to find out more about enrolling with Georgia Families:

Georgia PeachCare for Kids®

In 1997, Congress created Title XXI of the Social Security Act to provide health care for the growing number of uninsured children in the United States. This legislation enabled states to create State Children’s Health Insurance (S-CHIP) programs to increase access to affordable health insurance. In Georgia, PeachCare for Kids® began covering children in 1998 and provides comprehensive coverage to uninsured children. S-CHIP was reauthorized in January 2018 for an additional 10 years. 

The health benefits include primary, preventive, specialist, dental care and vision care. PeachCare for Kids® also covers hospitalization, emergency room services, prescription medications and mental health care. Each child in the program has a Georgia Families Care Management Organization (CMO) who is responsible for coordinating the child's care.

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Who is eligible for Georgia PeachCare for Kids®?

To be eligible for this benefit program, you must be a resident of Georgia and meet all of the following:

  • Either 18 years of age and under or a primary care giver with a child(ren) 18 years of age and under (eligible until 19th birthday), and
  • A U.S. Citizen, National, or a Non-Citizen legally admitted into the U.S, and
  • Uninsured (and ineligible for Medicaid).

In addition to being a Georgia resident, children must be U.S. citizens or a qualified alien in order to receive benefits under the PeachCare for Kids® program. The child must have also been qualified for at least five years unless he/she came into the country before August 22, 1996. This five-year rule does not apply to asylees or refugees and those serving in the military. Some exceptions to the citizenship requirements do exist so work with the PeachCare for Kids® program staff to determine whether you or your children are eligible.

Georgia PeachCare for Kids Program Income Limits

In order to qualify, you must have an annual household income (before taxes) that is below the following amounts:

Household SizeMaximum Income Level (Per Year)
1$36,013
2$48,709
3$61,405
4$74,100
5$86,796
6$99,492
7$112,188
8$124,884

For households with more than eight people, add $12,696 per additional person. Always check with the appropriate managing agency to ensure the most accurate guidelines.

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What are the benefits?

PeachCare for Kids® health benefits include:

  • 12 months postpartum benefits.
  • Care from a doctor when your child is sick.
  • Preventive services such as immunizations and regular check-ups.
  • Specialist care.
  • Dental care.
  • Vision care, including vision screenings and eyeglasses.
  • Hospitalization.
  • Emergency room services.
  • Prescription medications.
  • Mental health care.

Each child will have a choice of a Georgia Families Care Management Organization (CMO), a private health plan that is responsible for coordinating your child’s health care. You will also be able to choose your child’s primary care provider.

Institutionalization:

A child must not be an inmate of a public institution or a patient in an institution for mental diseases at the time of initial application or any redetermination of eligibility.

Georgia peachcare for kids program cost

PeachCare for Kids® does not charge premiums. PeachCare for Kids® does charge a small co-payment for some medical services. PeachCare for Kids® will not resume collecting co-payments until October 1, 2024. A co-payment is a small fee you will have to pay at the time of your visit to a medical provider. 

The amount of the co-payment will be different depending on the medical services you receive. While these co-payment amounts can range from $0.50 to $12.50, most will be $2 or $3. If you have to make a co-payment, your medical provider will tell you at the time of your visit. However, there are no co-payments for these services: 

  • Emergency services
  • Preventive Care Services (routine check-ups for your child)
  • Immunizations
  • Routine preventive and diagnostic dental services (such as oral examinations, prophylaxis and topical fluoride applications, sealants, and X-rays).

*Exception: There are no premiums or co-payments charged for children that are under six years old, children in foster care, American Indians and Alaskan Natives (AI/AN).

You are not required to pay more than 5 percent of your yearly income for co-payments. If your family reaches the 5 percent limit, you will not be required to make co-payments for the rest of the year.

PeachCare for Kids® Outreach

PeachCare for Kids® Outreach Program would like to be an active partner in your community and share with everyone the comprehensive benefits that PeachCare for Kids® offers children throughout Georgia. Our goal is to get the word out about PeachCare for Kids® so that all children in Georgia have access to quality healthcare. We encourage you to include PeachCare for Kids® in your community outreach. We would love to be included in your communications, events/efforts, planning, items, and more!

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Who is eligible for PeachCare for Kids®?

Many children in Georgia under the age of 19 who don't have insurance are eligible for PeachCare for Kids®. These children are in families with incomes less than or equal to 247 percent of the federal poverty limit.

How much does it cost?

PeachCare for Kids® does not charge premiums. Many PeachCare for Kids® customers are required to pay co-payments for their children. These co-payments are paid to medical care providers on the date medical services are received. However, co-pays are not required for children under the age of 6, Foster children, Alaskan Natives, or American Indians. They are exempt from these co-payments and will not have to pay any fees for services received. If you have additional questions, please feel free to contact PeachCare for Kids® at 1-877-427-3224.

How many children are covered by PeachCare for Kids®?

As of October 2023, there were approximately 225,000 eligible children enrolled.

How did PeachCare for Kids® start?

In 1997, Congress established a new state Children's Health Insurance Program (SCHIP) to expand coverage to children in low income families. States could choose to expand the Medicaid program, use an established private health insurance plan or put together a combination of both. In 1998, the Georgia General Assembly created a program that is separate from Medicaid yet still administered by the Medicaid Division of DCH. 

The Federal/State match is about 75 percent federal funds and 25 percent state funds -- a larger federal share than "regular" Medicaid allows. SCHIP was reauthorized in 2009 as part of the Children's Health Insurance Program Reauthorization Act (CHIPRA).

Georgia peachcare for kids program eligibility

  • Income amounts are based on 247 percent of the Federal Poverty Guidelines and are updated annually.
  • PeachCare for Kids® requires verification of income at application and annual renewal. Eligibility is dependent on the successful completion of this documentation. Go to Income Verification for more information.
  • To be eligible for PeachCare for Kids® your child(ren) must be a U.S. Citizen or fall within an eligible legal immigrant category. Original documents may be required in order to verify the status of the child(ren) for whom you are applying. Parents are not required to verify their own citizenship or immigration status. For more information, go to: Citizenship Verification
  • To be eligible for PeachCare for Kids® your child(ren) must not have current coverage, or be eligible for Medicaid. 

If you are determined ineligible for PeachCare for Kids®, you may qualify for other health benefit programs with the State of Georgia or with the Health Insurance Marketplace under the Affordable Care Act. Your information may be forwarded to those programs for review.

  • When you apply for medical assistance, children who fall under the Medicaid income limits will be placed on the appropriate type of Medicaid. Children who fall within the PeachCare for Kids® income limits will be placed on Peachcare for Kids®. No separate application is needed. 
  • Application processing time can take up to 45 days. Once all documentation is provided, you will receive a notice advising you of what program your child(ren) are eligible for. You will also be notified if you will need to make a payment, the amount of the payment and the date that your payment is due. 

How do I apply for Georgia PeachCare for Kids®?

You may apply online on the PeachCare for Kids® website. Or, you can download and print an application and instructions by clicking on the link above, scrolling to the bottom of the page, and clicking on "Download English Application". For assistance with your application, or to apply by phone, call 1-877-GA-PEACH (1-877-427-3224).

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How To Apply For Georgia PeachCare for Kids Program Benefits 

You can visit www.gateway.ga.gov, call 1-877-GAPEACH (1-877-427-3224) for more information, mail in a paper application or visit one your local DFCS offices (call before visiting to ensure in-person availability). Visit the PeachCare for Kids® application page for more resources.