Georgia Medicaid Community Health Workers: Coverage Guide

In Georgia, Medicaid has no single community health worker (CHW) benefit, but it does cover 12 months of postpartum care and case management inside its home and community-based waivers. Coverage for community health workers is built state by state, and Georgia has built less of it than some states. That matters because the people doing CHW work in Georgia, the doulas, peer specialists, and outreach workers who help families navigate care, are largely funded through grants, health-center budgets, and managed-care case management rather than a dedicated Medicaid benefit a family can ask for by name. 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 act as a bridge between families and the health and social-service systems meant to help them: explaining benefits, arranging rides, coaching on a chronic condition, and connecting people to food, housing, and care.

The same role goes by many names depending on the setting: 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 a model of trusted, community-based workers who improve health by improving relationships, navigation, and follow-through.

That community-trust model is also why CHWs are not interchangeable with social workers or nurses. A licensed clinical social worker provides clinical services and therapy; a care coordinator is usually a nurse or social worker focused on the care plan. A CHW complements those roles by providing 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: there is no single federal Medicaid CHW benefit, coverage of CHW services is limited, and it 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 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.

What Georgia Medicaid does not yet cover are doula services and a comprehensive CHW benefit through the kind of State Plan Amendment some states have adopted. 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, and no Georgia doula State Plan Amendment has taken effect. The Georgia Maternal Health Momnibus Act (House Bill 925 of the 2025-2026 session) was introduced on April 4, 2025 and died in committee; its last recorded action was a House second reading on January 12, 2026, leaving it pending in the House Public and Community Health Committee.4 Because a state adds or 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 most reliable way to confirm the current list is the Georgia Department of Community Health's approved State Plan Amendments.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 current Section 1115 demonstration is Georgia Pathways to Coverage, a limited expansion that covers adults ages 19 through 64 whose household income is up to 95 percent of the Federal Poverty Level (effectively 100 percent once the 5 percent income disregard is applied, which is why the state's own consumer pages advertise 100 percent) and who complete at least 80 hours of qualifying activities a month; it does not include 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 HIV/AIDS, chronic mental illness, or developmental disabilities, or to people who live in specified areas of the state, rather than offering it comparably statewide.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 Georgia operates four 1915(c) waivers: 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 (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 as part of the care team rather than billing for them as a separate Medicaid service; the cost is generally 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: the same drug cannot generate both a 340B discounted price and a Medicaid rebate, a prohibition on what the statute calls a 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, for 2018-2020 non-Hispanic Black women in Georgia died of pregnancy-related causes at 48.6 per 100,000 live births, more than double the ratio for non-Hispanic White women (23.3 per 100,000 in the committee's full 2018-2020 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. The committee determined that all pregnancy-related deaths attributed to hemorrhage, mental-health conditions, cardiomyopathy, cardiovascular and coronary conditions, and preeclampsia and eclampsia were preventable.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, and 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. One limit is worth knowing before you plan around it: a pregnant woman approved for Emergency Medical Assistance (EMA) is not automatically eligible for the 12-month extended postpartum period, 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. Families who want doula support in Georgia today generally pay out of pocket or rely on grant-funded and community-based doula organizations rather than a Medicaid benefit.4 It is still worth asking your care management organization what maternal-health and high-risk pregnancy 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 peer specialist is a person with lived experience of mental-health or substance-use recovery who is trained to support others in treatment. Brevy could not confirm, from a Georgia agency source, how Georgia credentials peer specialists or whether Georgia Medicaid pays for peer support as a distinct billable service, so treat those details as something to ask about rather than something to count on. Your community mental-health provider, DBHDD, or your care management organization can tell you what is available to you.

For a family in crisis or looking for behavioral-health help, the front door is the Georgia Crisis and Access Line (GCAL), which is available for calls, text, and chat 24 hours a day, 7 days a week, 365 days a year. GCAL has been and will continue to be the home of the 988 Suicide and Crisis Lifeline in Georgia, and Lifeline calls are currently routed to it. Its professionals provide crisis intervention over the phone and can dispatch mobile crisis teams, which are themselves available 24/7. DBHDD directs residents to call GCAL at 1-800-715-4225, and adds that anyone experiencing a suicidal crisis or emotional distress can also 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 by going through the program that already serves your situation. Here is where to start.

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 As of mid-2026, however, Georgia has no confirmed operating PACE site; the state issued a request for proposals that closed in May 2025 and was still in procurement.16 Until a Georgia site opens, an older adult who needs wraparound support should 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.1 Her provider connects her with a peer specialist who has lived experience of postpartum depression, and she continues therapy and medication well past the old 60-day cutoff.

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 as part of its diabetes team, paid for out of the center's 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.