Georgia Pathways to Coverage^TM

Georgia Pathways is a new program to help low-income Georgians qualify for Medicaid who otherwise would not qualify for traditional Medicaid.

Georgia Pathways members are eligible to receive the same state plan benefits as other Medicaid groups, with the exception of non-emergency medical transportation (NEMT). Only members ages 19 and 20 who are receiving EPSDT may access NEMT as part of their benefits.

Visit the Georgia Department of Community website to learn more about the Georgia Pathways program and other programs.

Copays

There are currently no copays for Georgia Pathways members.

Visit the Announcements & more to learn more about What's New.

Have questions? Get answers from your Quick Start Guide!

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To get Georgia Pathways, you must meet income limits and:

• Be a Georgia resident.
• Be a U.S. citizen or legally residing non-citizen.
• Not be eligible for any other Medicaid coverage.
• Be between ages 19 through 64.
• Have a household income up to 100 percent of the Federal Poverty Level.
• Prove you are doing one or more qualifying activities for at least 80 hours per month.
• Not be incarcerated.

Visit here to find out more about income guidelines.

When applying to Georgia Pathways, you must:

• Show you are currently engaged in at least 80 hours per month of a qualifying activity or combination of activities.
• Provide one source of documentation for verification per qualifying activity reported.
  • Documentation must verify hours reported for the most recent four weeks available within the eight weeks prior to the application submission date.

Qualifying activities include:

• Full-time or part-time employment, including self-employment.
• On-the-job training.
• Job readiness assistance program.
• Community service.
• Vocational educational training.
• Enrollment in an institution of higher education.
• Enrollment in the vocation Rehabilitation program of the Georgia Vocational Rehabilitation Agency (GVRA).

Qualifying activity requirements will only apply to Pathways and not to those who are enrolled under the traditional Medicaid program.

To keep your status active, you can report your qualifying hours and activities via:

• The easiest way to report your hours each month is online at gateway.ga.gov through ‘Report My Changes.'
• By mailing a paper form to your local Division of Family & Children Services (DFCS) office.
• In-person at your local DFCS office. To find the location and business hours, visit dfcs.ga.gov/locations.
• By phone at 877-423-4746 or 711 for those who are deaf, hard of hearing, deaf-blind or have difficulty speaking.

You must report and prove your hours by the 17th of each month.

With Amerigroup, you get extra benefits to help support you while completing your qualifying activities:

• Dental and vision for 21 and older.
• Free approved over-the-counter items with a prescription.
• $75 toward electric, water and heating bills for eligible members.
• GED exam voucher for all tests for ages 19 and older ($200 value).
• Community Resource Link: find housing, food, jobs and more.
• Work wardrobe and Uber gift card for college students.
• Free flu shots and Flu Pandemic Kit.
• Free 24-hour Nurse HelpLine.

Limits and restrictions apply. Benefits may change.

You can redeem some benefits online through your secure account. View the extra benefits you’re eligible for on the Benefit Reward Hub or call Member Services at 800-600-4441 (TTY 711) Monday through Friday from 7 a.m. to 7 p.m. Eastern time.

We work with CarelonRx to get you the medicines you need. We cover a wide range of prescriptions and many over-the-counter medicines.

Our pharmacy page can help you find a pharmacy near you and check if your medicine is covered.

Getting you the right care

The Amerigroup case management team is made up of healthcare experts who will help you by:

• Working with you to make healthy life choices.
• Sharing health tips, like how to take care of asthma.
• Helping you take control of your health by completing a health risk screening.
• Making sure you get the most out of your health plan.
• Connecting you to healthcare programs like Condition Care.

If you'd like a case manager to call you:

Send an email with: 

• Your phone number.
• The best time to reach you.

Or call our Case Management department at 833-763-2459. Available Monday through Friday 8:00 a.m. to 5:00 p.m. Eastern time.

Everything we talk to you about is private.

How to enroll in Condition Care:

• Call 888-830-4300 (TTY 711) toll free.
• Send an email. Include your:
  • Full name.
  • Amerigroup ID number.
  • Date of birth.
  • Address.
  • Phone number.
  • Condition(s) for which you’d like case management services.

Your case manager will call you within five days to let you know you’re enrolled. If you don’t get a call, call 888-830-4300 (TTY 711) toll free Monday through Friday from 8:30 a.m. to 5:30 p.m. Eastern time. Once you’re enrolled, you can leave private messages for your case manager 24 hours a day.

There are many kinds of specialists. A specialist is a doctor who gives care for a certain illness or part of the body. One kind of specialist is a cardiologist, or heart doctor. Another kind of specialist is an oncologist. An oncologist is a cancer doctor.

Your primary care provider (PCP) may send you to a specialist for care. This is called a referral. If your PCP wants you to go to a specialist, they may help set up your visit with the specialist.

You don’t have to see your PCP first to go to a women’s health doctor for well-woman checkups. An obstetrician/gynecologist (OB/GYN) is a women’s health doctor.

You do not have to see your PCP first to see a behavioral health provider for mental health, alcohol abuse, or substance abuse services.

A referral is when your PCP sends you to another provider for care. This care is often from a specialist. As an Amerigroup member, you don’t need a referral to see a provider who is not your PCP, as long as the provider works with your plan.  

What is precertification?

Precertification is needed for:

• Inpatient admissions.
• Certain behavioral health services like skills training.
• Psychological testing.
• Certain prescriptions.
• Rehabilitation therapies (physical, occupational, respiratory, speech).
• Care from a provider who doesn’t work with your plan.

As a member, you don’t make the request. Your PCP, specialist, or other provider should send in the request. If your case doesn’t meet the rules for medically needed, we’ll send you a letter. The letter will tell you we could not OK the service and why.

Other benefit details can be found in your member handbook. If you have questions or would like a copy of your member handbook mailed to you, call Member Services at 800-600-4441 (TTY 711).