Each child in
the program has a Georgia Better Health Care primary care provider, who
coordinates the childs care.
Who
is eligible for PeachCare for Kids?
Children in Georgia, under age 19, who dont have insurance or
Medicaid and are
in families with incomes less than or equal to 235 percent of the federal
poverty limit are eligible for PeachCare. In real terms, that means a
family of two can earn up to $28,000 per year, a family of three can earn
$35,000 per year and a family of four can earn up to $42,000 per year and
still be eligible. (For each additional family member, add $6,825 per
year).
If your
child is eligible for Medicaid, your PeachCare application will instead be
referred to Medicaid for processing.
Citizenship Requirements:
To be eligible for
PeachCare, children must be citizens of the United States or have
resided legally in the United States for at least 5 years. Note:
Citizenship applies ONLY to the child. Citizen children of
non-citizen parents ARE eligible for PeachCare. To prove residency
status, you may be asked to provide the following documents:
Refugees
I-94 with stamp "Admitted
as a refugee pursuant to Sect. 207 of the I & N Act
I-551 with one of the
following codes on front or back of card: RE1, RE2, RE4, RE5, RE6,
RE7, RE8 or RE9
Asylees
I-94 with stamp
"Asylum status granted indefinitely pursuant to Section 208 of
the Immigration and Nationality Act."
I-551 with one of the
following codes on front or back of card: AS6, AS7, AS8 or AS9
Six-month Uninsured Provision
PeachCare for Kids was created to provide health care to
uninsured children. For this reason, children must be uninsured for
six months prior to applying for PeachCare.
There are exceptions for children who have lost coverage
involuntarily (for example, if a child were covered through a
parent's employer and the parent lost the job, or the employer
dropped coverage for dependent children). The waiting period does
not apply to families who had independently purchased private insurance
outside of an employer group.
How
much will I have to pay for PeachCare?
There is
no cost for children under age 5. Currently, the cost per month for
PeachCare for Kids coverage is $10 to $35 for one child and a
maximum of $70 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 displayed.
There
are no co-payments or deductibles required for benefits covered by
PeachCare for Kids.
How
do I apply?
To apply for PeachCare call 1-877-GA-PEACH (1-877-427-3224). Enrollment
forms are also available at local county DFACS offices, health
departments, and doctors offices. Applications can be filled out at home
and mailed in or families can schedule a face-to-face interview with a
Right From the Start Medicaid Caseworker by calling the toll-free
PeachCare number. Families can also log onto www.peachcare.org
to apply for PeachCare.
What Information is Needed to
Complete an Application?
The parent will need to know the following information to complete an
enrollment application:
Social Security numbers of family members (parents and
children). (If social security numbers are not available, PeachCare staff
will provide the applicant with a temporary enrollment number.)
Amount and source of income and how often it is received
Amount and source of child care expenses and how often they
are paid
Health insurance status of family members
Current address
US Citizen/Lawful alien status
How Soon Do Benefits Start?
Benefits go into effect the first possible month after eligibility has
been established and the first premium has been received. Because there
are no premiums for children ages 5 and under, benefits begin for those
children on the first possible month after eligibility has been
established. Once an application is processed and applicable premiums are
received, the recipient is issued a PeachCare for Kids identification
card. Cards will be mailed to recipients prior to the first month of
enrollment. If an applicant is unsure of coverage or has not received an
identification card, confirmation can be provided by calling the toll-free
information line: 1-877-GA-PEACH.
How Will Parents Know When Their
Premiums Are Due?
Parents or guardians will receive a coupon book with a years worth
of coupons inside it. Payments are due by the first of the month. If
premiums have not been received by the first of the month, a letter will
be sent on the 5th, and then another letter will be sent if the
payment is not received by the 12th.
After that, children will not appear on the roster for that month
and will be ineligible for benefits. So, its important that premiums
are paid on time.
Do Parents Ever Need to
Re-apply?
Yes. Parents or guardians will be mailed a renewal application each
year to re-apply for PeachCare for Kids.
If an Applicant is Part of
Welfare to Work or Some Other Transitional Program, How Does That Work?
Applicants whose families are transitioning from Medicaid to PeachCare
for Kids will transfer smoothly from one program to the next and will not
need to change providers. Providers who accept Medicaid will also be able
to accept PeachCare for Kids.
Similarly, if a familys financial circumstances change, its
entirely possible that a child in PeachCare for Kids will then be eligible
for Medicaid benefits. Parents are required to report changes in income,
and coverage will end if the change makes the child ineligible (above 235%
federal poverty level). Eligibility will be reviewed at least once a year
for everyone enrolled.
PeachCare
for Kids: List of Benefits
Inpatient services delivered
during a hospital stay are covered in full, including medical and surgical
services.
Outpatient services covered
include outpatient surgery, clinic services, and emergency room care.
Physician services are
covered in full, including services provided by a participating physician
for the diagnosis and treatment of an illness or an injury.
Surgical services are
covered in full.
Clinic services
(including health center services) and other ambulatory health care
services are covered.
Prescription drugs (from
participating rebate manufacturers) and supplies approved by DMA (Dept.
Medical Asst.) and dispensed by an enrolled pharmacist are covered in
full.
Over-the-counter
medications the following non-prescription drugs are covered in
full: Multi-vitamins, multi-vitamins with iron, enteric coated aspirin,
NIX, iron, meclizine, diphenhydramine, insulin, insulin syringes, insulin
delivery unit systems (NOVO pen for example) and urine test strips. No
other over-the-counter medications are covered.
Laboratory and
radiological services medically necessary laboratory testing is
covered if performed by a physician. Radiology services are covered in a
hospital setting or in a physicians office only.
Prenatal care and pre-pregnancy
family services and supplies are covered in full. This includes
Childbirth Education Services, a series of 8 classes regarding the birth
experience and tools to prepare for a healthier pregnancy, birth and
postpartum period.
Inpatient mental
health services, including services furnished in a state-operated mental
hospital and including residential or other 24-hour therapeutically
planned structural services. Inpatient mental health services are
covered only for short-term acute care in general acute care hospitals up
to 30 days per admission. Services furnished in a state-operated mental
hospital are not covered. Services furnished in an Institution for Mental
Illness are not covered. Residential or other 24-hour therapeutically
planned structural services are covered only through the DHR MATCH
program. Psychotherapy is limited to 10 hours per calendar month.
Outpatient mental
health services are covered through Community Mental Health Centers,
subject to limitations specified in DHR standards.
Durable medical
equipment and other medically-related or remedial devices (such as
prosthetic devices, implants, eyeglasses, hearing aids, dental devices,
and adaptive devices) prescribed by a physician are covered.
Home and
community-based health care services ordered by a physician and
provided in the enrollees home, including part-time nursing services,
physical, speech, and occupational therapy, and home health aide services
are covered for 75 visits per calendar year.
Nursing care services
are covered as follows: The Nurse Practitioner Services Program
reimburses for a broad range of medical services provided by participating
Pediatric, Family, Adult, and OB/GYN Nurse Practitioners, as well as
Certified Registered Nurse Anesthetists. Nurse Midwife services are also
covered and include primary care services in addition to obstetrical care.
Abortion only if
necessary to save the life of the mother or if the pregnancy is the
result of a rape or incest.
Dental and oral
surgical services are covered as follows: 2 visits (initial or
periodic) for dental exams/screens and 2 emergency exams during office
hours and two emergency exams after office hours per calendar year are
allowed; 2 cleanings per calendar year; 1 restorative (filling) procedure
per tooth per restoration; the maximum number of surfaces covered is four
(4); sealants for first and second permanent molars only; orthodontic
services with prior approval.
Inpatient substance
abuse treatment services and residential substance abuse treatment
services are covered only for short-term acute care in general acute care
hospitals up to 30 days per admission.
Outpatient substance
abuse treatment services are covered through Community Mental Health
Centers, subject to limitations specified in DHR standards. Outpatient
short-term acute care and substance abuse treatment services are covered
in general acute care hospitals.
Physical therapy,
occupational therapy, and services for individuals with speech, hearing
and language disorders are covered as follows: 1 hour per day up to 10
hours per calendar month for physical therapy, 1 session per day up to 10
sessions per month for individual speech therapy.
Hospice care is
covered under a plan of care when provided by an enrolled hospice
provider.
Emergency ambulance
services are covered for an enrollee whose life and/or health is in
danger. Non-emergency transportation is not covered.
Health check:
Regular physical examinations (screening), health tests, immunizations and
treatment for diagnosed problems are covered.
Vision care services including
eyeglasses, refractions, dispensing fees, and other refractive services
are covered. Medically necessary diagnostic services are also covered.
Childrens
intervention services are covered for children from birth through 18
years of age, including audiology, nursing, nutrition, occupational
therapy, physical therapy, social work, speech-language pathology and
developmental therapy instruction.
Family planning: Covered
services include initial and annual examinations, follow-up, brief and
comprehensive visits, pregnancy testing, birth control supplies, and
infertility assessment.
Pregnancy-related
services: Covered services help reduce infant mortality by providing
home visits that assess the mother and child and teach the mother about
specific subjects that will reduce infant mortality.
Podiatry services include
diagnosis, medical, surgical, mechanical, manipulative and electrical
treatment of ailments of the foot or leg as authorized within the Georgia
statute governing podiatric services.
Physicians assistant
services are limited to primary care services and anesthesiologists
assistant services authorized in the basic primary care job description,
approved by the Georgia Composite State Board of Medical Examiners.
End stage renal
disease (ESRD) dialysis: Services and procedures designed to promote
and maintain the functioning of the kidney and related organs are covered
when provided by a provider enrolled in the ESRD program. Acute renal
dialysis services are covered under other programs.
