About Georgia Pathways to Coverage™

Georgia Pathways to Coverage is an innovative program that creates a new pathway to Medicaid coverage and healthier communities. As one of Governor Kemp’s key priorities, this program seeks to increase access to affordable healthcare coverage, lower the uninsured rate across Georgia, support members on their journeys to financial independence, and promote members’ transition from Pathways into private coverage. 

This program offers Medicaid coverage to eligible Georgians ages 19-64 who have a household income of up to 100% of the Federal Poverty Level (FPL). For example, in 2024, this equals $15,060 per year or $1,255 on average per month for one person, and $25,820 per year or $2,151 on average per month for a family of three. Eligible Georgians are not otherwise eligible for traditional Medicaid and meet the qualifying activities threshold. Qualifying activity requirements will only apply to Pathways and not those who are enrolled in other Georgia Medicaid programs.

Covered Benefits

Pathways covers many of the same medical services as traditional Medicaid, including:

  • Doctor visits
  • Hospital stays
  • Emergency services
  • Prescriptions
  • Laboratory and x-rays
  • Family planning services
  • Mental health services
  • Preventive and wellness services
  • Chronic disease management services

Pathways does not cover non-emergency medical transportation except for members ages 19-20.

Get Started

To apply to Georgia Pathways to Coverage:

Once your application is completed, if you are eligible and approved, coverage starts on the first day of the month after approval. For example, if you apply in July and are approved in August, your coverage will start September 1. You will be notified of the approval decision.

You will be covered through the Georgia Families® managed care program if approved. This means you will be enrolled for services with a Georgia Medicaid care management organization (CMO) for your coverage.

Appeal a Decision

If you think you qualify for Pathways but do not get approved, you can appeal the decision. If a decision impacts your continued coverage, like suspension or termination, you can appeal that too. Your decision letter will have information on how to appeal a decision and who to contact if you have questions about appealing a decision.

Maintain Coverage

To maintain coverage, you may be required to report one or more qualifying activities for 80 hours each month. If, in a single month, you do not complete all 80 hours of qualifying activities, you may request a Good Cause Exception for the hours not completed.

If you experience a change in circumstance that can impact your Pathways eligibility, you must report it within 10 days of the change.

Additional Information

For additional information, please reference our Pathways informational one-pagers.