Georgia Medicaid CMO Enrollment & Switching 2026

If your Medicaid coverage in Georgia runs through a private Care Management Organization (CMO), you have more control over which plan you are in than the enrollment paperwork suggests. As of July 2026, Georgia Families, the state's Medicaid and PeachCare for Kids managed care program, contracts with three CMOs: Amerigroup Community Care, CareSource, and Peach State Health Plan.1 You can pick your plan when you first enroll, change it without giving a reason during the 90 days after enrollment, change again at the yearly open enrollment, and switch for good cause at any time.2

In This Guide

• Who Are the Three Georgia CMOs?
• How Does Georgia Medicaid CMO Enrollment Work?
• How Do You Switch CMOs?
• What Counts as Good Cause to Disenroll?
• Who Is Not in a CMO?
• Frequently Asked Questions
• Learn More

Who Are the Three Georgia CMOs?

Georgia Families is the umbrella name the Georgia Department of Community Health (DCH) uses for its Medicaid and PeachCare for Kids managed care program. As of July 2026, it contracts with three CMOs: Amerigroup Community Care, CareSource, and Peach State Health Plan.1 Each operates under a multi-year contract with DCH and is paid a fixed per-member-per-month capitation rate for every enrolled member, so the plan bears financial risk and builds its own provider network and prior-authorization rules.4

A CMO is a Medicaid managed care organization as federal regulation 42 CFR 438.2 defines it: an entity holding a comprehensive risk contract that must make services as accessible to its Medicaid enrollees as to other Medicaid beneficiaries.5

WellCare is no longer a separate Georgia Families CMO, and "Wellpoint" is the national rebrand of Amerigroup's plans in some other states, not a fourth Georgia plan.1 A 2024 reprocurement could change the slate later: the Georgia Department of Administrative Services issued a Notice of Intent to Award on December 2, 2024 naming a different group of plans (CareSource, Humana, Molina, and UnitedHealthcare), but the current three-CMO contracts were extended through June 30, 2027 while the procurement worked through a protest phase, and DCH has not published a confirmed member-transition date.1 Until DCH announces a new slate is live, the three CMOs above remain the plans you choose among. Confirm your options when you call Georgia Families.

How Does Georgia Medicaid CMO Enrollment Work?

When DCH determines you are eligible for managed care, it sends a choice-counseling notice listing the CMOs you can pick from. You select a plan through Georgia Families, the DCH managed-care enrollment program: visit georgia-families.com or call 1-888-GA-Enroll (1-888-423-6765), or the TDD line at 1-877-889-4424, where a representative can give you information about the CMOs and their healthcare providers.3

If you do not actively pick a plan within the time the notice allows, DCH enrolls you in one automatically, and you then have 90 days from that health plan's start date to change to a different plan.3 An automatic assignment cannot know which doctors you want to keep. That is the core reason to choose actively: a CMO sets your provider network and its own prior-authorization rules, so the plan you land in decides how easily you reach specific care.

Provider network is the factor that matters most for most families. Before you select, check each CMO's online provider directory for your primary care doctor, your children's pediatrician, any specialists, and your OB-GYN, and call the office to confirm the plan is accepted, because directories can be out of date. CMOs in Georgia must meet network time-and-distance standards that DCH sets in the Georgia Families Contract and enforces, with each CMO filing geographic-access analyses; the federal rule 42 CFR 438.68 requires the state to set and enforce those quantitative standards.6

How Do You Switch CMOs?

You have three ways to change plans, set by federal rule 42 CFR 438.56:2

• Within 90 days of enrollment, for any reason. You may change CMOs without cause during the 90 days following your initial enrollment or the date the state sends you notice of it, whichever is later. Georgia states its version of this window on the Georgia Families member site: a new member is enrolled in a health plan automatically and has 90 days from that plan's start date to change to a different plan.3
• At least once every 12 months, for any reason. After the initial 90 days, federal rule guarantees a without-cause change at least once a year. DCH runs an annual open enrollment for this; watch for DCH notices about your window.2
• At any time, for good cause. Outside the windows above, you can disenroll for cause whenever a qualifying problem arises.2

To switch, call Georgia Families at 1-888-423-6765 (TDD 1-877-889-4424) or DCH Medicaid member services.3 Ask when the change takes effect, because it is not immediate, and ask the incoming CMO what its transition-of-care policy covers. Contact both the outgoing and incoming care coordinators and bring documentation of any active prior authorizations, so a treatment already underway is not interrupted while the new plan reviews it.

What Counts as Good Cause to Disenroll?

Federal regulation 42 CFR 438.56(d)(2) lists the specific reasons that qualify as "good cause" to switch CMOs outside the 90-day and annual windows:2

• You move out of the plan's service area.
• The plan does not, because of moral or religious objections, cover a service you seek.
• You need related services performed at the same time, not all are available in network, and a provider determines that receiving them separately would put you at unnecessary risk.
• For members who receive long-term services through a managed care plan, a residential, institutional, or employment-supports provider moves from in-network to out-of-network and that disrupts your residence or employment.
• Other reasons, including poor quality of care, lack of access to services covered under the contract, or lack of access to providers experienced with your care needs.

That last category is broad: if your doctor leaves the network, you cannot get a covered service, or care quality is poor, you can request a for-cause switch at any time. To file, call DCH member services or submit a written request, state the specific reason, and provide any supporting documentation.2 If DCH approves, you transfer to the new CMO. Ask for the effective date in writing and keep using your current plan until it arrives, because the switch does not take effect the day it is approved.

Who Is Not in a CMO?

Some Georgia Medicaid members are not in managed care or follow a different pathway:

• Nursing facility residents and people on a home- and community-based waiver follow a separate long-term-care pathway. Georgia Medicaid delivers long-term services and supports at home through the Elderly and Disabled Waiver Program, whose Community Care Services Program (CCSP) and SOURCE models serve people who otherwise qualify for a nursing facility level of care.7 Ask Georgia Families how your long-term-care services are administered before you assume a CMO covers them.
• Dual-eligibles (people with both Medicare and Medicaid) carry a Medicare plan alongside their Georgia Medicaid coverage. Some enroll in a Dual Eligible Special Needs Plan (D-SNP), the Medicare Advantage plan type built for people with both coverages, which must include Medicare Part D drug coverage. Which D-SNPs you can join depends on where you live, because insurers decide where they do business, and DCH placed a moratorium on contracting with any new D-SNPs starting August 1, 2025 while it works out how the two programs will fit together.7
• American Indians and Alaska Natives cannot be required to enroll in a non-Indian managed care entity and may choose managed care voluntarily, under federal Medicaid law at Section 1932(a)(2)(C) (42 U.S.C. 1396u-2(a)(2)(C)). See Georgia Medicaid tribal health coverage for the full protections.8
• Some children on the TEFRA pathway and certain Aged, Blind, and Disabled members may have specific carve-outs or specialized enrollment.
• Foster children, former foster youth, and children receiving adoption assistance are served through Georgia Families 360, the specialty plan administered by Amerigroup, rather than the standard CMO choice.1

The 2024 federal Medicaid and CHIP Managed Care Access, Finance, and Quality Final Rule (CMS-2439-F), effective July 9, 2024 with provisions phasing in afterward, is strengthening appointment wait-time standards and network-adequacy oversight for managed care, which affects all CMO members over time.9

Where to Get Help With Georgia Medicaid CMO Enrollment

For grievances and appeals against a specific plan, contact your CMO's member services first; for a state fair hearing, contact DCH.

Learn More

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.