Parent to Parent of Georgia

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PeachCare for Kids

This Roadmap web site is only for parents of children with disabilities. Other parents contact PeachCare directly at 1-877-GA-PEACH.

PeachCare 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 has a Georgia Better Health Care primary care provider, who coordinates the child’s care.

Who is eligible for PeachCare for Kids?

Children in Georgia, under age 19, who don’t 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.

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 year’s 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, it’s 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 family’s financial circumstances change, it’s 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 physician’s 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 enrollee’s 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.
Children’s 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 anesthesiologist’s 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.



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