Most Georgians on Medicaid do not get their care directly from the state. They get it through a contracted managed care company, called a Care Management Organization (CMO), under a program called Georgia Families. Three CMOs share the statewide contract: Amerigroup Community Care (owned by Elevance Health), CareSource (a nonprofit), and Peach State Health Plan (owned by Centene). A separate single-CMO contract called Georgia Families 360 serves foster youth, adoption-assistance children, and youth involved with juvenile justice.

Note (verified June 2026): WellCare of Georgia is no longer a separate Georgia Families Medicaid CMO; the current statewide roster is the three plans named above. (WellCare remains a Medicare brand in Georgia, which is a different program.) A 2024 reprocurement proposed a different future slate of CMOs, but as of mid-2026 that award is in the bid-protest phase with no announced go-live date, and the current three-CMO contracts have been extended (reported through June 30, 2027).

The choice of CMO matters less than families often assume for the covered-drug list (broadly uniform statewide because DCH publishes a single Preferred Drug List), but it matters more for provider networks, care coordination quality, specialty services, and the member service experience. Picking the right CMO at enrollment can save months of frustration. And if your CMO is not serving you well, federal law gives you a 90-day right to change after initial enrollment, plus mid-year changes for cause and an annual open enrollment window.

This guide explains how Georgia Families is structured, what each CMO covers and what it does not, the carve-outs that operate outside the CMOs, who is required to enroll, the special rules for foster and adoption-assistance children, how to evaluate your options, and how to switch when your plan is not working.

In This Guide

What Georgia Families Is and Where the Authority Comes From

Georgia Families is the state's mainstream Medicaid and CHIP managed care program. It now enrolls the large majority of non-elderly, non-disabled, non-long-term-care Medicaid and PeachCare for Kids members in Georgia.

The federal authority is Section 1915(b) of the Social Security Act, which allows states to require Medicaid beneficiaries to enroll in managed care plans by waiving the standard freedom-of-choice provision. The implementing federal managed care regulations govern the program structure. Georgia's 1915(b) waiver is renewed in five-year cycles and is approved by the Centers for Medicare and Medicaid Services.

Under the waiver, Georgia contracts with full-risk Care Management Organizations on a capitated basis. The state pays each CMO a per-member-per-month rate based on the member's eligibility category and risk profile, and the CMO is responsible for arranging covered services. The CMO bears actuarial risk: if its members use more services than the capitation rate covers, the CMO absorbs the loss; if they use less, the CMO retains the difference (subject to medical loss ratio requirements).

This structure transfers some of the management complexity from the state to the contracted plans, in exchange for predictable budget and consolidated accountability. The trade-off is that members must accept the network and care management approach of their assigned plan, with limited ability to use out-of-network providers except in emergencies.

Who Must Enroll and Who Stays in Fee-for-Service

Georgia Families is mandatory for most adult and pediatric Medicaid and CHIP populations, but several important categories remain in fee-for-service or are served by different programs.

Must enroll in Georgia Families CMO:

  • Low Income Medicaid (LIM) parents and children under family Medicaid rules
  • Right from the Start Medicaid (RSM) pregnant women and infants
  • PeachCare for Kids (Georgia CHIP) children
  • Adoption-assistance children (now generally through Georgia Families 360)
  • Foster care children (through Georgia Families 360)
  • Pathways to Coverage 1115 demonstration enrollees (adults 19-64 at or below 100% FPL with work requirement; covered in our Pathways to Coverage guide)
  • Family Planning Waiver participants
  • Most other categorical Medicaid populations

Not in Georgia Families CMO (fee-for-service or different program):

  • Aged, Blind, Disabled (ABD) categorical eligibles, including SSI Medicaid and Q-track ABD
  • Nursing Facility Medicaid (long-term institutional care)
  • HCBS waiver participants: ICWP, NOW, COMP run fee-for-service through DCH directly. CCSP has fee-for-service components plus PSS/SFC. SOURCE has its own integrated capitated structure with built-in primary care assignment (covered in our SOURCE waiver guide).
  • PACE enrollees (Programs of All-Inclusive Care for the Elderly is its own capitated model)
  • Full-benefit dual eligibles in certain categories receive Medicaid services FFS while Medicare handles primary coverage
  • Medicare Savings Program-only enrollees (QMB-only, SLMB-only, QI) have no full Medicaid benefit and therefore are not in any CMO
  • Family-of-six or larger family categories with specific exclusions per DCH policy

If you are not sure which category your family falls into, the Georgia Families enrollment broker can confirm at the time of application or redetermination.

The Care Management Organizations

All three CMOs operate statewide. Members in any Georgia county can choose any of the three.

CMO Parent Company Profit Status
Amerigroup Community Care Elevance Health (formerly Anthem) For-profit
CareSource CareSource Group (Ohio-based) Nonprofit
Peach State Health Plan Centene Corporation For-profit

A few notes on the market structure:

Amerigroup has been in Georgia since the original Georgia Families launch and is owned by Elevance Health (the former Anthem). It has the deepest tenure with Georgia providers and operates the separate Georgia Families 360 single-statewide contract.

CareSource is the only nonprofit in the three-CMO mix. It is an Ohio-based nonprofit health plan focused on Medicaid and Marketplace coverage.

Peach State Health Plan is owned by Centene Corporation, the largest Medicaid managed care company in the United States. WellCare of Georgia, which Centene also owns, is no longer a separate Georgia Families Medicaid CMO; WellCare continues to operate in Georgia only as a Medicare brand, which is a different program from Georgia Families Medicaid. Members enrolling in Georgia Families today choose among Amerigroup, CareSource, and Peach State.

Georgia Families 360 for Foster and Adoption-Assistance Children

Georgia Families 360 is a separate single-statewide CMO contract for children whose health and behavioral health needs are highly intertwined with the child welfare and juvenile justice systems.

Who is enrolled in Georgia Families 360:

  • Children in foster care (DFCS custody)
  • Children receiving adoption assistance under Title IV-E
  • Youth involved with juvenile justice
  • Former foster youth ages 18-20

Why a separate program: These children typically need integrated physical health, behavioral health, and care coordination that bridges the medical and child welfare systems. The single-CMO model concentrates accountability and lets the state hold one plan responsible for the full continuum of services. Amerigroup has historically held this contract through its Elevance subsidiary.

Key features:

  • Higher-intensity care coordination than mainstream Georgia Families
  • Integrated behavioral health (mental health and SUD) with no carve-out
  • Trauma-informed care training for the CMO care coordinators
  • Wraparound services for children with multiple system involvement
  • Specialty pediatric networks (especially for children with disabilities)
  • Transition support for youth aging out of foster care

For families adopting children from foster care, the GF 360 enrollment continues for the duration of the adoption-assistance agreement.

What CMOs Cover (and What Is Carved Out)

The three Georgia Families CMOs cover a broad range of services, but several important categories are "carved out" of the CMO benefit and paid fee-for-service or through separate state contracts.

Covered by the CMO (capitated):

  • Primary care
  • Specialist care (with referral or direct access depending on CMO and specialty)
  • Hospital inpatient and outpatient
  • Behavioral health (mental health and substance use disorder treatment)
  • Maternity and newborn care
  • Family planning (with member option to use any Medicaid-enrolled family planning provider, per federal law)
  • Preventive care, well-child visits, immunizations
  • Diagnostic services (lab, imaging)
  • Therapy services (physical, occupational, speech)
  • Durable medical equipment (with prior authorization)
  • Emergency services (no prior authorization required, including out-of-network in true emergencies)

Carved out of the CMO benefit:

  • Long-term care services (NF Medicaid, most HCBS waivers)
  • Specialty mental health services delivered by Community Service Boards (often coordinated alongside CMO services)
  • Certain dental and vision services for adults (limited adult benefit)
  • Non-emergency medical transportation in some regions (regional brokers contracted separately)
  • Hospice (FFS in some configurations)

When a member uses a carved-out service, the provider bills Medicaid directly through DCH rather than billing the CMO. The CMO is not responsible for authorizing or coordinating the carved-out service, although CMOs often help with referrals.

Outpatient pharmacy is handled differently and is covered in its own section below. For most CMO members, pharmacy is generally part of the CMO benefit and runs through the CMO and its pharmacy benefit manager, not through a separate state carve-out. Only the fee-for-service population uses the state's own pharmacy administrator.

Pharmacy: Uniform Drug List, Different Administrators

Georgia Medicaid's outpatient pharmacy benefit is not run by a single statewide manager. Who administers your pharmacy claims depends on how you are enrolled, but the covered-drug list stays broadly consistent because the Department of Community Health (DCH) publishes a statewide Preferred Drug List (PDL).

Who administers the benefit:

  • Fee-for-service members. For the fee-for-service (FFS) population, OptumRx is the state's Pharmacy Benefits Manager (PBM) for the Georgia Medicaid outpatient pharmacy program. OptumRx processes FFS outpatient pharmacy claims and reimburses enrolled pharmacy providers.
  • Georgia Families CMO members. Members enrolled in Amerigroup, CareSource, or Peach State receive their pharmacy benefit through their CMO and the CMO's pharmacy benefit manager, not through OptumRx.

A note on Gainwell Technologies. Gainwell is Georgia's GAMMIS/MMIS fiscal agent and operates the Medicaid member contact center. It is not the statewide pharmacy benefit manager, and pharmacies do not all bill Gainwell for drug claims. Earlier descriptions of a single statewide pharmacy benefit manager running all Medicaid pharmacy claims through Gainwell do not reflect the current arrangement.

Why the drug list still looks the same across CMOs: Because DCH maintains a statewide PDL, the list of covered drugs is broadly consistent regardless of which CMO you choose. The state uses the PDL to set drug coverage decisions and support pricing negotiations, which is what keeps members from seeing wide swings in formulary coverage when they switch plans.

Practical implications for choosing a CMO: If your primary concern is whether a specific drug is on the covered list, the DCH statewide PDL means the answer is broadly the same across all three CMOs. What can differ are the administrative details handled by each CMO's pharmacy benefit manager, such as the prior authorization process and pharmacy network specifics. The PDL is published by DCH.

Dental, Vision, and Non-Emergency Medical Transportation

Dental. Coverage varies significantly by age and CMO contract:

  • Children under 21: Comprehensive dental coverage including preventive, restorative, and orthodontic (for medically necessary cases) under EPSDT. Delivered through CMO dental networks or DCH-contracted dental benefit manager depending on configuration.
  • Adults 21 and older: Very limited adult dental benefit in Georgia Medicaid. Emergency dental and limited extractions may be covered. Most non-emergency dental for adults is not covered through standard Medicaid.

Vision. Coverage varies by age and CMO:

  • Children under 21: Comprehensive vision benefit under EPSDT including eye exams, glasses, and treatment of eye conditions.
  • Adults 21 and older: Limited adult vision benefit. Routine eye exams are typically covered every two years; replacement glasses are limited.

Non-emergency medical transportation (NEMT). Georgia uses regional NEMT brokers contracted by DCH to arrange rides to covered medical appointments. The brokers (such as Modivcare and Verida) cover specific service regions. Members call the broker for their region, not their CMO, to arrange a ride. Eligibility for NEMT requires that the member have no other available transportation and that the appointment be for a covered Medicaid service.

How Auto-Assignment Works

When a Georgia resident is approved for a Medicaid category that requires CMO enrollment, the Georgia Families enrollment broker assigns the member to a CMO under one of two scenarios.

Scenario one: member selects a CMO. During the application process, members are asked to choose their preferred CMO. The choice can be made through Georgia Gateway, by phone, or in person at a DFCS office. The selected CMO becomes effective on the coverage start date (typically the first of the month following approval).

Scenario two: auto-assignment. If the member does not select a CMO within the enrollment window, the broker auto-assigns. The auto-assignment algorithm considers:

  • Existing family member CMO assignment (to keep families together)
  • Geographic load balancing across the three CMOs
  • Provider continuity if the member has been receiving Medicaid services from providers in a specific CMO network
  • Special needs categories (children with chronic conditions may be assigned with consideration of network depth in their condition)

Auto-assignment is intended to be reasonably matched, but it is algorithmic and does not reflect personal preferences. Members who care about which CMO they end up in should make an affirmative choice rather than allow auto-assignment.

The 90-Day Right to Change

Federal law gives every Medicaid managed care member the right to change plans without cause within 90 days of initial enrollment or auto-assignment. This is a hard federal right that Georgia must honor.

How to use the 90-day window:

  1. Call the Georgia Families enrollment broker, contact your DFCS caseworker, or log in to Georgia Gateway
  2. Select the new CMO
  3. The change typically takes effect on the first of the following month
  4. Receive new ID cards from the new CMO
  5. Schedule a new PCP appointment if needed

Why the 90-day window matters: Auto-assignment is the most common reason families end up with a CMO that does not match their needs. The 90-day window gives families time to discover that their preferred providers are not in network, that prior authorization is harder than expected, or that the care coordination is not working, and to switch without having to demonstrate cause.

After the 90-day window: Members are "locked in" to their CMO until the next annual open enrollment period or until they can demonstrate cause for a mid-year change.

Annual Open Enrollment and For-Cause Changes

Georgia operates an annual open enrollment period for Georgia Families members, during which any member can switch CMOs without having to demonstrate cause. Open enrollment timing is set by DCH and communicated to members through annual notices. After open enrollment closes, members are locked in until the next annual cycle.

For-cause changes outside open enrollment. Federal law lists permissible causes for mid-year change, including:

  • The CMO does not, because of moral or religious objections, cover the service the member needs
  • The member needs related services to be performed at the same time, and not all related services are available within the network
  • Other reasons including poor quality of care, lack of access to services covered under the contract, or lack of access to providers experienced in dealing with the member's health care needs

To request a for-cause change, the member contacts the Georgia Families enrollment broker or DFCS caseworker, explains the cause, and provides supporting documentation if available. The state evaluates the request and either grants the change or denies and explains why.

In practice, for-cause changes are granted when there is a clear network gap (the member's specialist is not in the CMO's network and no equivalent specialist is reasonably available), a quality-of-care issue (substantiated complaint about coordination or denial of services), or a continuity issue (the member needs to remain with established providers due to medical complexity).

How to Compare the CMOs Practically

Because the covered-drug list is broadly uniform (DCH publishes a statewide Preferred Drug List), dental and vision are largely uniform within each age category, and the core benefit structure is set by state contract, the practical differences between Amerigroup, CareSource, and Peach State come down to a few specific areas.

1. Provider network depth. This is the single biggest differentiator. Before selecting a CMO, check whether your family's existing primary care provider, specialists, and preferred hospital are in network. Each CMO publishes a provider directory online; verify by calling the CMO's member services to confirm participation.

2. Care coordination quality. Members with chronic conditions (diabetes, asthma, heart disease, depression), complex pregnancies, NICU graduates, or significant special needs will interact heavily with a care coordinator. Quality varies by CMO, by region within the CMO, and by individual coordinator. Asking other families with similar needs which CMO has worked well is often more useful than published metrics.

3. Member service experience. Hold times, knowledgeable representatives, mobile app usability, online portal functionality, and provider directory accuracy vary by CMO. Calling each CMO's member services line and asking a specific question (such as "I'm a new member with a child who has asthma. How would you help me find a pulmonologist?") gives a useful signal.

4. Behavioral health access. All three CMOs integrate behavioral health into the medical benefit. But the depth of the behavioral health network (especially for child therapy, psychiatric medication management, and SUD treatment) varies significantly. For families where behavioral health is a primary concern, this is a critical comparison point.

5. Specialty programs. Each CMO offers some value-added or extra-benefit programs beyond the contracted services, including diaper subsidies, school-based supplies, healthy-pregnancy rewards, GED preparation, and similar offerings. These vary annually based on each CMO's discretion and are worth checking at the time of enrollment.

6. Geographic strength. Some CMOs have stronger networks in metro Atlanta; others have stronger networks in rural counties. If you live in a rural area, check the network depth carefully before assuming all three are equivalent.

Prior Authorization Rules

Prior authorization (PA) is the process by which a CMO requires advance approval before paying for certain services. Each CMO has its own PA list, but federal law and DCH contract impose timing standards.

Timing standards: Federal law sets maximum decision timelines for PA requests. Standard decisions must be made within a set number of calendar days from receipt of the request. Expedited (urgent) decisions have a shorter federally mandated deadline. Concurrent review decisions during a hospital stay must be made within an even shorter window. Contact your CMO for the specific timelines applicable to your case.

Services that commonly require PA:

  • Non-emergency inpatient hospitalization
  • High-cost imaging (MRI, CT, PET in some cases)
  • Specialty drugs (handled through the pharmacy benefit: OptumRx for fee-for-service members, and the CMO's pharmacy benefit manager for CMO members)
  • Specialty durable medical equipment
  • Outpatient surgery (non-emergent)
  • Behavioral health intensive services (residential treatment, inpatient psychiatric)
  • Therapy beyond initial threshold visits

Services that do NOT require PA:

  • Emergency services
  • Most preventive care
  • Routine primary care visits
  • Basic lab and imaging
  • Family planning services

If PA is denied, the member receives a notice of action explaining the denial and the right to appeal. The denial notice triggers the appeal timeline.

Appeals: CMO Internal Appeal and OSAH Fair Hearing

Georgia Medicaid appeals run through two levels: an internal CMO appeal, then a State Fair Hearing through the Office of State Administrative Hearings.

Level one: CMO internal appeal.

  • Filed within the deadline stated on your notice of action
  • CMO must decide within federally mandated timeframes for standard appeals
  • CMO must decide on an expedited basis when waiting would jeopardize health
  • The CMO appeal can be filed by phone, by mail, by fax, or online through the member portal
  • Members may have a representative (family member, attorney, advocate)
  • Members may submit additional medical records or expert opinions

Level two: State Fair Hearing at OSAH.

  • Filed within the deadline stated on the CMO's appeal denial notice
  • Hearing scheduled by OSAH (typically by phone or video)
  • Administrative Law Judge issues a written decision
  • Decision can be appealed to Superior Court within the applicable deadline

Aid pending appeal. If the CMO has reduced, suspended, or terminated a service that was previously authorized, the member can request continuation of services during the appeal by filing the appeal promptly, within the deadline stated on the notice of action. The services continue at the previous level until the appeal is decided. If the member loses the appeal, the state may recover the cost of the continued services.

Legal help. Georgia Legal Services Program (statewide outside metro Atlanta) and Atlanta Legal Aid (metro counties) provide free representation in Medicaid appeals for qualifying clients.

Three Worked Examples

Example 1: New enrollee with a chronic condition selects a CMO

The Reynolds family applied for Medicaid for their two children after a job loss. Both children have asthma; one has eczema. Through Georgia Gateway, they selected Peach State Health Plan at enrollment after checking that their existing pediatrician was in network. After the first month, they realized Peach State's prior authorization process for nebulizer supplies was slower than they had expected and the asthma care coordinator they were assigned was not responsive.

Using the 90-day right to change. Within the 90-day window, they called the Georgia Families enrollment broker and requested a change to CareSource, where the same pediatrician was also in network. They submitted no documentation, no justification, and no waiting period applied. The change took effect on the first of the following month. They received new ID cards and continued seeing the same pediatrician with a different CMO as the payer.

Lesson. The 90-day window is a no-questions-asked window. Families who are not certain about their initial assignment should use this period actively.

Example 2: Mid-year switch for cause during pregnancy

Martinez is in her second trimester. She is enrolled with Amerigroup, but her preferred OB is not in the Amerigroup network. The OB is in network with Peach State Health Plan. She is more than 90 days past initial enrollment and outside the annual open enrollment period.

For-cause change request. Martinez calls the enrollment broker and requests a for-cause change to Peach State, citing the need for continuity with her established prenatal care provider and the gap in Amerigroup's OB network for her geographic area. She provides the OB's letter confirming she is an established patient. DCH grants the change after review. The new CMO assignment takes effect the first of the following month, and Peach State's care coordinator contacts her to set up high-risk pregnancy management.

Lesson. Continuity with established prenatal providers is a recognized for-cause basis. Documentation from the provider supports the request.

Example 3: Adoption-assistance child auto-enrolled in Georgia Families 360

The Johnson family finalized the adoption of their foster daughter Naya. Naya has been in foster care for three years with significant trauma history and is currently receiving therapy and psychiatric medication management. At adoption finalization, DFCS confirmed that Naya is eligible for Title IV-E adoption assistance, which automatically maintains her Medicaid eligibility.

Auto-enrollment in Georgia Families 360. Because Naya is an adoption-assistance child, she is enrolled in Georgia Families 360 rather than a standard Georgia Families CMO. The single statewide CMO (Amerigroup under the 360 contract) assigns a care coordinator who specializes in trauma-informed pediatric care, contacts the Johnsons, and coordinates the transition from Naya's foster care behavioral health providers to a network arrangement that continues the same therapy and medication providers.

Lesson. Adoption-assistance children stay in Georgia Families 360 for the duration of the adoption-assistance agreement. The integrated care coordination is one of the key benefits the program provides for this population.

Common Mistakes Members Make

  1. Letting auto-assignment happen by default. Auto-assignment does not consider personal preferences. Make an affirmative choice during the application process.
  2. Not checking provider networks before selecting. The most common cause of CMO frustration is discovering that your preferred PCP, specialist, or hospital is not in network.
  3. Missing the 90-day right to change. This window is short. Set a reminder in your calendar at enrollment so you reassess before it expires.
  4. Assuming the covered-drug list depends on your CMO. It is broadly the same regardless of CMO because DCH publishes a statewide Preferred Drug List. (Pharmacy claims are administered by OptumRx for fee-for-service members and by each CMO's pharmacy benefit manager for CMO members, but the DCH PDL keeps covered drugs largely consistent.)
  5. Confusing Medicaid CMOs with Medicare D-SNPs. The grocery cards, OTC cards, gym memberships, and similar perks heavily advertised by health plans are typically Medicare D-SNP features for dual-eligibles 65+, not Medicaid CMO features.
  6. Filing only the CMO appeal and missing the OSAH window. If the CMO denial stands, you have only a limited time to file at OSAH. Do not let this window close.
  7. Not requesting aid-pending appeal in time. The window from the notice of action is strict. Filing in time continues services; filing after the deadline does not.
  8. Not knowing about the family planning provider freedom. Federal law lets members use any Medicaid-enrolled family planning provider, even out of network, without referral.
  9. Forgetting about Georgia Families 360 for adopted children. Adoption-assistance children stay in GF 360, not a standard CMO. Trying to switch them to a standard CMO is the wrong move.
  10. Not engaging the care coordinator for chronic conditions. CMOs assign care coordinators to high-needs members. Using the coordinator actively (rather than letting them be a one-time check-in) is the difference between good and poor managed care.

FAQ

There is no single "best" CMO. The answer depends on which providers you want to use, where you live in the state, what conditions you and your family have, and what your priorities are for care coordination, behavioral health, and member service. The covered-drug list is broadly uniform statewide because DCH publishes a single Preferred Drug List, so that is generally not a differentiator. Provider network, specialty access, care coordination quality, and behavioral health depth are the main areas where the three CMOs differ. Check the provider directories online and call member services for each CMO before making your selection.

Only if your doctor is in network with the new CMO. Each CMO has its own provider network, and most providers contract with multiple CMOs but not all three. Before switching, verify network participation by checking the new CMO's provider directory or calling member services. If your doctor is in network with both your current CMO and your target CMO, you can switch and keep the same doctor.

Georgia Families 360 is a separate single-CMO contract that serves children in foster care, children receiving adoption assistance under Title IV-E, juvenile justice involved youth, and former foster youth ages 18-20. The contract has historically been operated by Amerigroup. Children in these categories are auto-enrolled in GF 360 and cannot switch to a standard Georgia Families CMO. To verify your child's enrollment, contact your DFCS caseworker or check Georgia Gateway.

Because the Department of Community Health publishes a statewide Preferred Drug List (PDL) that keeps the list of covered drugs broadly consistent across all Georgia Families members. The benefit itself is not run by a single statewide manager: fee-for-service members are served by the state's Pharmacy Benefits Manager, OptumRx, while Georgia Families CMO members get their pharmacy benefit through their CMO and its pharmacy benefit manager. Gainwell Technologies is Georgia's Medicaid fiscal agent and member contact center, not the statewide pharmacy benefit manager.

No. Nursing facility Medicaid, ICWP, NOW, COMP, and the fee-for-service components of CCSP all run outside the Georgia Families CMO structure. SOURCE has its own integrated capitated structure (covered in our SOURCE waiver guide) that is separate from Georgia Families. PACE is its own capitated program for participants 55 and older who meet nursing facility level of care. See our long-term care guide for the full overview.

Call the Georgia Families enrollment broker, contact your DFCS caseworker, or log in to Georgia Gateway. Within 90 days of initial enrollment, you can switch without cause. Outside that window, you must wait for annual open enrollment or demonstrate cause (network gap, quality of care issue, continuity of care need with established providers). The change typically takes effect the first of the month following the request.

You have the right to file an internal CMO appeal within the deadline stated on your denial notice. The CMO must decide within federally mandated timeframes for standard or expedited appeals. If the CMO denial stands, you can request a State Fair Hearing through the Office of State Administrative Hearings (OSAH) within the deadline stated on the denial. If the service was previously authorized and is being terminated or reduced, you can request continuation of services during appeal by filing promptly within the deadline stated on the notice.

No. The three Georgia Families CMOs integrate behavioral health (mental health and substance use disorder treatment) into the medical benefit. There is no separate behavioral health carve-out company that members deal with. However, public sector mental health services delivered through Community Service Boards (CSBs) and the Department of Behavioral Health and Developmental Disabilities (DBHDD) operate alongside the CMO benefit, especially for serious mental illness, IDD services, and crisis response.

No. As verified in June 2026, WellCare of Georgia is no longer a separate Georgia Families Medicaid CMO. The current statewide roster is three plans: Amerigroup Community Care, CareSource, and Peach State Health Plan. WellCare still operates in Georgia as a Medicare brand, which is a different program from Georgia Families Medicaid, so do not confuse a WellCare Medicare plan with a Georgia Families Medicaid CMO. A 2024 reprocurement proposed a different future slate of CMOs, but as of mid-2026 that award is in the bid-protest phase with no announced go-live date, and the current three-CMO contracts have been extended (reported through June 30, 2027).

Georgia Legal Services Program (statewide outside metro Atlanta) and Atlanta Legal Aid (metro Atlanta counties) provide free legal representation for Medicaid appeals and benefits issues for qualifying clients. For general member support, call your CMO's member services line directly. For applications, redetermination, and category changes, contact DFCS or use Georgia Gateway at gateway.ga.gov.

Bottom Line for Georgia Families

Georgia Medicaid managed care is built around three contracted Care Management Organizations that share the statewide Georgia Families mainstream Medicaid and CHIP market, plus a single-statewide Georgia Families 360 contract for foster and adoption-assistance children. The covered-drug list is broadly uniform regardless of CMO because DCH publishes a statewide Preferred Drug List, though pharmacy claims are administered by OptumRx for fee-for-service members and by each CMO's pharmacy benefit manager for CMO members. Long-term care and most HCBS waivers are outside the Georgia Families CMO structure entirely.

The right CMO for your family depends primarily on provider network depth, specialty access, care coordination quality, and member service experience. The 90-day right to change after initial enrollment is the most valuable consumer protection in the system; use it actively. Annual open enrollment and for-cause mid-year changes give additional flexibility. Two-level appeals (CMO internal, then OSAH Fair Hearing) provide due process when services are denied.

Brevy.com maintains additional guides to Georgia Medicaid topics for families navigating these decisions, including the eligibility framework, the application process, the long-term care pathways, the Pathways to Coverage 1115 program, and the SOURCE integrated managed care model for the elderly and physically disabled. Related guides:

Get Help With Georgia Medicaid Managed Care

If you need help selecting a CMO, switching plans, appealing a denial, or finding in-network providers, the following resources are available.

  • Amerigroup Community Care: contact member services via the number on your member ID card or the Amerigroup website
  • CareSource: contact member services via the number on your member ID card or the CareSource website
  • Peach State Health Plan: contact member services via the number on your member ID card or the Peach State website
  • Georgia Families 360: contact member services via the number on your member ID card
  • Department of Community Health: for Medicaid program questions, visit dch.georgia.gov
  • DFCS: for applications, redetermination, and category changes, contact your local DFCS office or use Georgia Gateway at gateway.ga.gov
  • Georgia Legal Services Program: free legal help statewide outside metro Atlanta
  • Atlanta Legal Aid Society: free legal help in metro Atlanta counties
  • Office of State Administrative Hearings (OSAH): for fair hearing requests, contact OSAH through dch.georgia.gov

Find personalized help navigating Georgia Medicaid managed care at brevy.com.

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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.

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