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Download Pathways FAQs in a PDF: General Pathways FAQs, or visit our Resources page for guides, toolkits, and other helpful information.
Georgia Pathways to Coverage™, or Pathways, is a Medicaid program for Georgians 19-64 who meet the eligibility criteria and otherwise would not qualify for traditional Medicaid.
Georgia awaits future guidance from CMS on how its innovative program interacts with the new legislation.
The easiest way to apply is online at gateway.ga.gov.
You can also apply:
Note: If you apply for Georgia Pathways over the phone, your qualifying activities may need to be verified online, by mail, or in-person at a DFCS office.
To receive coverage, you must complete at least 80 hours of qualifying activities each month. If you have a disability, you can request a Reasonable Modification like a referral to GVRA or the option for extra time to do your 80 hours.
Pathways covers many of the same medical services as Medicaid, including:
Pathways does not cover non-emergency medical transportation except for members ages 19-20 as required by Medicaid for children under 21. This means you will need to cover the costs of transportation for your medical visits. Pathways is available to cover ambulance transportation for medical emergencies.
You will need to pay co-pays for covered services while you are enrolled in Pathways, similar to other types of Medicaid. If you are unable to pay your co-pay, you cannot be denied care for a covered service. Refer to the chart below for co-pay amounts by service type.
| Service | Amount |
| Inpatient Hospitalization | $12.50 for entire stay |
| Outpatient Hospital Visit | $3.00 per visit |
| Non-Emergency Use of the ED | $3.00 |
| Primary Care | $0.00 |
| Specialist | $2.00 |
| Durable Medical Equipment | $3.00; $1.00 for rentals and supplies |
| Pharmacy | $10.00 or less: $0.50 $10.01 to $25.00: $1.00 $25.01 to $50.00: $2.00 $50.01 or more: $3.00 |
No, you will not get a doctor bill for covered services you receive while you are enrolled in Pathways.
No, Pathways does not cover past medical bills from before the first of the month in which you applied. If you are an existing Pathways member and have the unique circumstance of appealing a coverage decision, you can request that your coverage continue during your appeal and hearing.
Medicaid or Pathways enrollment may or may not cause you to be considered a public charge, which could impact your citizenship status.
If you believe that participation in Pathways might impact your citizenship status, contact the United States Citizenship and Immigration Services (USCIS) before applying. It is important to understand how this might affect you.
For more information on what it means to be a public charge, visit USCIS’s website at www.uscis.gov or call at 1-800-375-5283.
Pathways providers are Medicaid providers. If a provider is accepting new patients, the provider will treat a Pathways member the same as a Medicaid member.
If your doctor accepts Medicaid or PeachCare for Kids®, they also accept Pathways.
You will be covered starting the first day of the month when you applied. For example, if you apply in November and get approved in January, your coverage will start November 1.
Once approved for Pathways, you will be covered through a Georgia Medicaid Care Management Organization (CMO). If you receive healthcare services between the first of the month in which you applied and up to two days after the day you are approved for Pathways, those services will be covered through FFS. With Medicaid coverage on an FFS basis, Medicaid will pay providers who accept Medicaid directly for the services that you receive.
You can request a Good Cause Exception online at gateway.ga.gov.
You can also request a Good Cause Exception:
Those who request a Good Cause Exception over the phone can provide documentation of a valid reason online, by mail, or in-person at a DFCS office.
Examples of Good Cause Exceptions include:
If you have a different reason for not completing 80 hours of qualifying activities, select “Other.” Those who request a Good Cause Exception over the phone can provide documentation of a valid reason online, by mail, or in-person at a DFCS office.
The easiest way to report a life event is through the online customer portal at gateway.ga.gov.
You could also report a life event:
The documentation you send depends on your situation. Some life events may affect whether you still qualify for Pathways.
If you have a disability, you could still be eligible for Pathways. If you need help doing 80 hours of qualifying activities per month, you can ask for a Reasonable Modification when you apply such as a referral to GVRA or the option for extra time to do your 80 hours.
Yes. If you think you qualify for Pathways but do not get approved, you can appeal the decision. A decision that impacts your continued coverage, such termination, can be appealed as well. Your decision letter will have information on how to appeal a decision and who to contact if you have questions about appealing a decision.
To be eligible for Pathways, you must:
No. You must apply for Pathways and meet its requirements to be approved.
No, time spent looking for a job does not count as a qualifying activity.
Yes, self-employment counts as employment and is a qualifying activity for Pathways. When you apply, you can prove self-employment by
Yes, you could be eligible but you still must complete at least 80 hours per month of qualifying activities. If you are not working 80 hours per month, then you can choose other qualifying activities to reach 80 hours each month to be eligible for Pathways.
You must report your qualifying activity hours at the time of application and annual renewal. Please note, your qualifying activities may need to be verified. You are still required to report any changes in your circumstances, including a change in address, income, or qualifying activity details (such as employer or type of activity completed).
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.
To be eligible for Pathways, you can perform one or more qualifying activities for 80 hours each month. Qualifying activities include:
Qualifying activity requirements will only apply to Pathways and not to those who are enrolled under the traditional Medicaid program.