Georgia Medicaid Community Health Workers: Coverage Guide

In Georgia, Medicaid has no community health worker (CHW) benefit you can ask for by name. It does cover 12 months of postpartum care, and case management inside its home and community-based waivers. CHW coverage is built state by state, and Georgia has built less of it than some states. That matters because the doulas, peer specialists, and outreach workers doing CHW work here are largely funded through grants, health-center budgets, and managed-care case management. This guide explains what Georgia Medicaid actually pays for today, the federal pathways states use to fund community health workers, and how a Georgia family can find a CHW, peer specialist, or doula now.1,2

In This Guide

• What Is a Community Health Worker?
• Does Georgia Medicaid Cover Community Health Workers?
• How Does Medicaid Pay for Community Health Workers in Georgia?
• Georgia's Maternal-Health Crisis and Medicaid Response
• Georgia's Behavioral-Health Peer Support
• How to Find a Community Health Worker or Doula in Georgia
• Frequently Asked Questions
• Learn More

What Is a Community Health Worker?

A community health worker (CHW) is a frontline public health worker who is a trusted member of, or has a close understanding of, the community they serve. CHWs bridge families and the systems meant to help them: explaining benefits, arranging rides, coaching on a chronic condition, and connecting people to food, housing, and care.

The role goes by many names: promotor or promotora de salud, lay health worker, peer support specialist, peer recovery specialist, community health representative, patient navigator, and doula (specific to pregnancy, birth, and the postpartum period). What unites them is trusted, community-based workers who improve health by improving relationships and follow-through.

That trust model is why CHWs are not interchangeable with social workers or nurses. A licensed clinical social worker provides therapy; a care coordinator is usually a nurse or social worker focused on the care plan. A CHW adds the community-based connection the others often cannot.

Does Georgia Medicaid Cover Community Health Workers?

Georgia Medicaid does not have a standalone benefit you can request called "community health worker." This is not unusual: Medicaid has no CHW benefit category of its own, so a state that wants to pay for CHW work slots it into an existing category such as preventive services, and coverage is limited and varies by state. A review by the Medicaid and CHIP Payment and Access Commission (MACPAC) in 2021 identified at least 21 states paying for some CHW services.2

What exists instead are several places where CHW-type work happens, one of them a service Georgia Medicaid clearly pays for and two of them worth asking your plan or the state about:

• Behavioral health, through the DBHDD system. DBHDD runs Georgia's public behavioral-health and crisis system.3 Peer support, delivered by workers with lived experience of recovery, is the CHW-style role associated with that system, but Brevy could not confirm from a Georgia agency source whether Georgia Medicaid pays for it as a distinct billable service. Ask DBHDD or your care management organization.
• Care coordination and case management in HCBS waivers. Georgia runs at least four Home and Community-Based Services (HCBS) waivers. The Elderly and Disabled Waiver Program covers case management for service coordination, and its SOURCE model adds enhanced case management coordinated through a primary care physician, work that resembles what a CHW does.6
• Managed-care case management. If you are enrolled with a care management organization (CMO), ask the plan directly what care management it offers for a high-risk pregnancy or a chronic condition. This varies plan by plan rather than being a benefit you request by name.

Doula services and a comprehensive CHW benefit are the two gaps. Georgia is absent from the National Academy for State Health Policy's tracker of the 26 states and Washington, DC that reimbursed doula care as of March 2026; that absence, bounded by NASHP's own date, is the whole of the evidence, and no Georgia state page says either way. The Georgia Maternal Health Momnibus Act (House Bill 925, 2025-2026 session) was introduced April 4, 2025 and died in committee, its last recorded action a House second reading on January 12, 2026.4 Because a state changes a Medicaid benefit by submitting a State Plan Amendment to the Centers for Medicare and Medicaid Services (CMS), after first sending it to the Governor for review and comment, the Georgia Department of Community Health's approved State Plan Amendments are the place to confirm the current list.7

How Does Medicaid Pay for Community Health Workers in Georgia?

Because there is no single CHW benefit, states that pay for CHW work do it through other Medicaid authorities. Knowing which authority your state used tells you what a CHW can be paid to do, and for whom. These are the main pathways, and where Georgia stands on each.

State plan amendments for preventive services

States authorize payment for CHW services through their Medicaid state plan or under managed care arrangements.2 A state adds or changes state-plan coverage by submitting a State Plan Amendment to CMS, after first sending it to the Governor for review and comment.7 Brevy found no Georgia State Plan Amendment establishing a comprehensive CHW benefit as of 2026; the Georgia Department of Community Health's approved State Plan Amendments are where to check the current list.

Section 1115 demonstrations

Section 1115 of the Social Security Act lets the Secretary of Health and Human Services approve experimental or demonstration projects that promote the objectives of Medicaid, waiving certain state-plan requirements to do so.8 Several states have used Section 1115 demonstrations to fund maternal-health doula and CHW services, or to pay for housing, nutrition, and transportation supports with CHW navigation. Georgia's is Georgia Pathways to Coverage, a limited expansion covering adults 19 through 64 with household income up to 95 percent of the Federal Poverty Level (effectively 100 percent once the 5 percent income disregard applies, which is why the state's consumer pages advertise 100 percent) who complete at least 80 hours of qualifying activities a month; it includes no CHW or social-needs provisions.9

Targeted case management

Targeted case management (TCM) is an optional Medicaid state-plan service under Section 1915(g) of the Social Security Act. It helps eligible people gain access to medical, social, and other services, and a state may target it to specific classes of people, such as people with AIDS or AIDS-related conditions, chronic mental illness, or developmental disabilities, or to people who live in specified areas of the state, rather than offering it comparably statewide. Targeting has a boundary: it cannot restrict a person's free choice of provider.10 CHWs can deliver TCM where a state has adopted a target group that fits their caseload.

HCBS waivers

Section 1915(c) Home and Community-Based Services waivers let a state cover home- and community-based services for people who would otherwise need an institutional level of care, such as nursing-facility care.10 That institutional level-of-care determination, known in Georgia as nursing-facility level of care, is the gateway to most of these waiver services.11 Four of Georgia's 1915(c) waivers are established by the state's own published sources, and no source read for this guide enumerates every one it runs: the Elderly and Disabled Waiver Program (EDWP), which delivers its services through the Community Care Services Program (CCSP) and Service Options Using Resources in a Community Environment (SOURCE) models, the Independent Care Waiver Program (ICWP), the New Options Waiver (NOW), and the Comprehensive Supports Waiver Program (COMP). Their case management and care coordination are often delivered by staff who function much like CHWs.6

Health centers and 340B

Many Federally Qualified Health Centers (FQHCs) employ CHWs on the care team rather than billing for them separately; the cost is built into the center's operations. FQHCs are also covered entities under the federal 340B Drug Pricing Program, which lets them buy covered outpatient drugs at a discounted price. One federal rule shapes how that interacts with Medicaid: a manufacturer is not required to provide both a discounted 340B price and a Medicaid drug rebate on the same drug, and a covered entity must have mechanisms in place to prevent that duplicate discount.12

Georgia's Maternal-Health Crisis and Medicaid Response

Georgia's maternal-health numbers are the clearest reason CHWs, doulas, and peer specialists matter here. According to the Georgia Department of Public Health (DPH) Maternal Mortality Review Committee, Georgia recorded 30.2 pregnancy-related deaths per 100,000 live births for 2018-2020, and non-Hispanic Black women died at 48.6 per 100,000, more than double the ratio for non-Hispanic White women (23.3 per 100,000 in the committee's full case-review report, 22.7 in DPH's one-page factsheet for the same period). Of the 89 pregnancy-related deaths that occurred after delivery, a majority, 53 or 60 percent, were insured by Medicaid at the time of delivery. Of the 113 pregnancy-related deaths in the period, 101 (89 percent) had at least some chance of being prevented, and the committee determined that all deaths attributed to hemorrhage, mental-health conditions, cardiomyopathy, cardiovascular and coronary conditions, and preeclampsia and eclampsia were preventable. "Preventable" is a careful term here: it means the committee found at least some chance the death could have been averted by reasonable changes to patient, family, provider, facility, system, or community factors, not that it was certainly avoidable.5

Georgia Medicaid's most important response is the postpartum coverage extension. Georgia covers pregnant women with budget-group income at or below 220 percent of the Federal Poverty Level, measured against a household counted as at least two people, the woman and the unborn child, and larger if she is carrying twins. Effective November 1, 2022, it extended postpartum Medicaid from 60 days to a full 12 months after the end of pregnancy, with eligibility ending at the end of the month in which the 12th month falls.1

Inside those 12 months the protection is broader than most families expect. A woman correctly determined eligible stays eligible through the end of that period regardless of changes in income, household composition, gaining SSI, or aging out, and Georgia lists exactly four reasons coverage can end early: she asks to end it, she moves out of state, the enrollment was invalid, or she dies. Two conditions sit on the front of it, though. A woman who was not already receiving Medicaid, or not eligible as a pregnant woman, in or before the month her pregnancy ended does not get the 12-month period at all; and a woman approved for Emergency Medical Assistance (EMA) is not automatically eligible for it either, though she may still qualify for additional days of EMA during that period if she receives pregnancy-related emergency treatment.1 This option comes from the American Rescue Plan Act of 2021 and was made a permanent state option by the Consolidated Appropriations Act of 2023.13 Because the highest-risk maternal period is after delivery, the extra months let a mother keep behavioral-health treatment, chronic-disease care, and peer or doula support going through the dangerous window.

Doula support is a recognized CHW role for pregnancy and birth, and 26 states and Washington, DC reimbursed it under Medicaid as of March 2026. Georgia is not among them, so families here generally pay out of pocket or rely on grant-funded community doula organizations.4 It is still worth asking your care management organization what maternal-health supports it offers.

Georgia's Behavioral-Health Peer Support

Behavioral health is where a Georgia family is most likely to meet a CHW-style worker. DBHDD runs the state's public behavioral-health services and crisis system.3 Georgia also strengthened behavioral-health access through its Mental Health Parity Act, House Bill 1013, signed by Governor Brian Kemp on April 4, 2022. Read that law for what it actually does: it does not require an insurer to cover mental-health or substance-use care in the first place. What it requires is that an insurer who does cover those conditions provide that coverage in accordance with the federal Mental Health Parity and Addiction Equity Act of 2008 and apply generally accepted standards of care.14

The peer workforce is the part of this system that most resembles a community health worker: a person with lived experience of mental-health or substance-use recovery, trained to support others in treatment. Brevy could not confirm from a Georgia agency source how Georgia credentials peer specialists or whether Medicaid pays for peer support as a distinct billable service, so treat those as things to ask about. Your community mental-health provider, DBHDD, or your care management organization can tell you what is available.

For a family in crisis, the front door is the Georgia Crisis and Access Line (GCAL), available for calls, text, and chat 24 hours a day, 365 days a year. GCAL is the home of the 988 Suicide and Crisis Lifeline in Georgia, and Lifeline calls are routed to it. Its professionals provide crisis intervention by phone and can dispatch mobile crisis teams, also available 24/7. DBHDD directs residents to call GCAL at 1-800-715-4225, and adds that anyone in suicidal crisis or emotional distress can call or text 988.3

How to Find a Community Health Worker or Doula in Georgia

Because Georgia funds CHW work through programs rather than a single benefit, you find a CHW through the program that already serves your situation.

For pregnancy and postpartum:

• Ask your obstetrician, midwife, or care management organization about high-risk pregnancy case management and any maternal-health supports, including community doula programs.
• Confirm you are enrolled for the full 12 months of postpartum coverage, and use those months for behavioral-health and chronic-disease care.1

For chronic-disease management:

• If you get care at a Federally Qualified Health Center, ask whether a CHW or care coordinator is on the team.
• Ask your care management organization about case management for your condition.

For behavioral health:

• Ask your community mental-health provider about peer support specialists.
• For crisis help or a referral, call or text 988 to reach the Georgia Crisis and Access Line.3

For everyday needs (housing, food, transportation):

• Dial 211 to reach 211 Georgia for connection to local resources.
• For an older adult or person with a disability, the Georgia Aging and Disability Resource Connection (ADRC) can help arrange services such as home-delivered meals and transportation.

One note on a program families sometimes ask about: the Program of All-Inclusive Care for the Elderly (PACE), which wraps medical and social services around frail older adults, is a Medicaid and Medicare benefit nationally.15 Georgia has gone further with PACE than its own website suggests. The state ran a competitive procurement that closed June 4, 2025, and as of September 2026 the procurement record carries Notices of Award for the Gainesville and Savannah regions and Notices of Intent to Award for Athens, Savannah, and Gainesville. What no state source says is whether an awarded center has actually opened to participants, and DCH's own PACE Updates page still shows nothing past the 2025 request for proposals.16 So ask DCH directly before counting on a Georgia PACE site, and in the meantime look to the ADRC and the HCBS waivers above.

What This Looks Like for Two Georgia Families

The following are illustrative, hypothetical examples, not real individuals.

Example #1: A new mother in Savannah. A mother eight weeks postpartum is struggling with depression. Because Georgia extended postpartum Medicaid to 12 months, her coverage does not end at 60 days in the middle of treatment, and a raise at work would not end it either.1 Her provider connects her with a peer specialist who has lived experience of postpartum depression.

Example #2: An older man with diabetes in Albany. A man with uncontrolled diabetes gets primary care at a Federally Qualified Health Center. The center employs a CHW on its diabetes team, paid out of its own operating budget rather than billed as a separate Medicaid service. The CHW helps him understand his medications, connects him to food assistance, and tracks his readings with his doctor.

Learn More

Find personalized help understanding community health worker and doula coverage in Georgia at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.