Georgia PeachCare for Kids: CHIP Eligibility, Premiums, and Benefits

PeachCare for Kids is Georgia's Children's Health Insurance Program (CHIP) under Title XXI, covering children in families that earn too much for Medicaid but cannot easily afford private insurance. It enrolls tens of thousands of children in moderate-income families, with no premium for younger children and modest monthly premiums above 150 percent of the federal poverty level.

PeachCare for Kids is Georgia's Children's Health Insurance Program under Title XXI, enrolling tens of thousands of children in moderate-income families across the state.

PeachCare exists because most American children fall into one of two coverage situations. Children in low-income families qualify for Medicaid, which is robust and free. Children in higher-income families qualify for parental employer coverage or family Marketplace plans. The challenge is children in the middle: families that earn too much for Medicaid but cannot reasonably afford private insurance.

Title XXI of the Social Security Act, enacted in 1997, created the Children's Health Insurance Program (CHIP) to cover this middle group. Georgia adopted Title XXI in 1998 and named its state program PeachCare for Kids. Today PeachCare covers children in families earning between 138 percent and 247 percent of the federal poverty level, with modest monthly premiums for families above 150 percent FPL and small copays for non-preventive services.

This guide is the canonical Georgia PeachCare for Kids playbook. It walks through the federal Title XXI framework, the Georgia implementation details, the income thresholds and premium structure, the benefit package, how PeachCare differs from Medicaid and from private insurance, common application mistakes, and six worked examples showing the practical financial impact for typical Georgia families.

What PeachCare for Kids is

PeachCare for Kids is Georgia's separate CHIP program (sometimes called S-CHIP). Title XXI allows states to design CHIP in one of three ways: as a Medicaid expansion (M-CHIP), as a separate CHIP (S-CHIP), or as a combination. Georgia chose S-CHIP, which means PeachCare is administratively distinct from Medicaid.

Key features:

• Eligibility: children under 19 in families earning 138 to 247 percent FPL (varies by child's age, see below)
• Premiums: none for families up to 150 percent FPL; a modest monthly premium per child above that, set on a sliding scale by income, with family caps (see Georgia's current premium schedule)
• Copays: small copays for office visits, prescriptions, and ER non-emergency
• Benefits: comprehensive package mirroring Medicaid EPSDT
• Network: three Care Management Organizations (CMOs): Amerigroup Community Care, CareSource, Peach State Health Plan
• Continuous eligibility: 12 months under CAA 2023 section 5112
• Enrollment: rolling year-round, no open enrollment period

Federal authority

42 USC 1397aa-1397mm (Title XXI)

Enacted as part of the Balanced Budget Act of 1997. Title XXI created CHIP as a block-grant federal-state partnership. Title XXI's structure mirrors Medicaid's federal-state framework but with an enhanced federal match for CHIP that exceeds the standard Medicaid FMAP, more flexibility on benefit design, and the ability for states to impose modest premiums and copays.

Three design options for state CHIP programs:

1. Medicaid expansion CHIP (M-CHIP): the state simply expands Medicaid to higher income levels; benefit package is full Medicaid including EPSDT
2. Separate CHIP (S-CHIP): the state creates a separate program with its own benefit package, premiums, and copays
3. Combination: the state uses M-CHIP for some children and S-CHIP for others

Georgia chose separate CHIP.

42 USC 1397cc (benefit design)

Separate CHIP programs must offer one of:

• Benchmark coverage: comparable to FEHB Standard Option (federal employees), state employee plan, or largest HMO in the state
• Benchmark-equivalent coverage: actuarially equivalent to a benchmark plan, covering at least 75 percent of the benchmark's coverage for each of inpatient, outpatient, surgical, physician, lab/x-ray, well-baby/well-child, and prescription drugs
• Secretary-approved coverage: any other plan the HHS Secretary approves
• Medicaid look-alike: the same benefits as the state's Medicaid program for children

Georgia chose benchmark-equivalent / secretary-approved coverage and structured it to mirror Medicaid EPSDT.

CHIPRA 2009 (Children's Health Insurance Program Reauthorization Act)

Signed by President Obama in February 2009 as Public Law 111-3. CHIPRA reauthorized CHIP funding through FY 2013, required citizenship documentation matching Medicaid procedures, required dental as a mandatory CHIP benefit, required mental health parity in CHIP under the Mental Health Parity and Addiction Equity Act (MHPAEA), and created the "unborn child" option at section 214 that some states (including Georgia) use to cover prenatal care for some pregnant women who would not otherwise qualify.

ACA section 2101 (2010) and subsequent extensions

The Affordable Care Act extended CHIP authorization, required state maintenance of effort (MOE) preventing reduction of eligibility below 2010 levels, and extended federal funding. Subsequent reauthorizations (HEALTHY KIDS Act 2018, Bipartisan Budget Act 2018) extended funding further.

CAA 2023 (Consolidated Appropriations Act of 2023)

Two critical provisions for Georgia PeachCare:

• Section 5101: extended CHIP federal funding through FY 2029, giving long-term funding stability
• Section 5112: required 12-month continuous eligibility for children in CHIP and Medicaid effective January 1, 2024

The 12-month continuous eligibility requirement is significant. Before 2024 children could lose coverage mid-year if family circumstances changed; now they stay covered the full 12 months regardless of income fluctuations.

42 CFR Part 457

CHIP implementing regulations. Key sections: eligibility (457.310-340), benefits (457.420-430), cost sharing (457.505-570), financial framework (457.700-780), and administration (457.800-902).

Georgia implementation

Legal authority

PeachCare is established under O.C.G.A. section 49-5-270 et seq. The Department of Community Health (DCH) administers the program; the Division of Family and Children Services (DFCS) conducts eligibility intake.

Income thresholds (2026)

The income thresholds vary by the child's age, with more generous Medicaid limits for younger children and PeachCare covering the gap above those limits up to 247 percent FPL. For current age-banded eligibility thresholds, apply through Georgia Gateway or contact DCH directly.

Premium structure

Premiums are billed monthly. Nonpayment triggers a 60-day grace period before disenrollment. The federal cap on total family cost-sharing (premiums plus copays) is 5 percent of family income annually.

Copay structure

Copays apply only to non-preventive services. ACA Bright Futures preventive services have zero cost-sharing.

Copay amounts vary by service and income tier. Contact your CMO or DCH Member Services at 1-866-211-0950 for the current copay schedule.

Application and enrollment

PeachCare applications go through the same channels as Medicaid:

1. Georgia Gateway online: gateway.ga.gov is the primary application portal
2. Phone: PeachCare for Kids at 1-877-427-3224
3. In person: any DFCS county office
4. HealthCare.gov: Marketplace applications that find Medicaid or PeachCare eligibility are routed to the state

Enrollment is rolling year-round (no open enrollment period). Coverage is effective the first of the month following determination, with some retroactive eligibility available in certain circumstances.

CMO assignment

PeachCare children are enrolled in one of three CMOs that also serve Georgia Families Medicaid: Amerigroup Community Care, CareSource, or Peach State Health Plan. Families have 30 days to choose or switch from the auto-assignment.1

WellCare is no longer listed as a separate Georgia Families Medicaid CMO. A 2024 reprocurement of the Georgia Families contracts is, as of 2026, 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). Confirm your child's current plan options through Georgia Gateway or DCH Member Services.

Waiting period

Historically Georgia had a 90-day waiting period (to prevent crowd-out, the substitution of public for private coverage). Most circumstances are now waived including loss of employer coverage, job change, family financial hardship, death of the primary insurance holder, and voluntary cancellation of private coverage for affordability. In practice nearly all current applicants proceed without a meaningful waiting period.

12-month continuous eligibility

Under CAA 2023 section 5112, PeachCare provides 12 months of continuous eligibility. Children stay covered for the full 12 months even if family income rises, with limited exceptions (death, moving out of state, fraud, voluntary withdrawal, aging out at 19).

Renewal

Annual renewal is required. DCH attempts auto-renewal using available electronic data sources first. If auto-renewal fails, families receive a renewal packet. Failure to respond results in coverage termination at the end of the renewal month. Families can renew through Georgia Gateway or by phone.

Coverage scope: the PeachCare benefit package

The PeachCare benefit package is structured to mirror Medicaid EPSDT. The following sections describe the practical coverage.

Well-child and preventive care

• Newborn screenings
• Bright Futures well-child visits at all recommended intervals from birth through age 20
• Immunizations per CDC ACIP schedule (including HPV, meningococcal, COVID, influenza, etc.)
• Lead screening at 12 and 24 months
• Vision and hearing screenings
• Developmental and behavioral screenings (including autism at 18 and 24 months)
• Anticipatory guidance
• Adolescent preventive services including reproductive health counseling
• Sports physicals
• TB risk assessment and testing when indicated

Primary and sick care

• Routine office visits
• Sick visits and urgent care
• Telehealth
• After-hours care

Specialty care

• Pediatric subspecialty consultations: cardiology, neurology, gastroenterology, endocrinology, pulmonology, allergy/immunology, dermatology, rheumatology, nephrology, hematology/oncology
• Surgical specialty: orthopedic, ENT, ophthalmology, urology, plastic, general
• Specialty referral typically via the PCP

Behavioral health

PeachCare covers comprehensive behavioral health with mental health parity:

• Outpatient therapy (individual, family, group)
• Psychiatric medication management
• Crisis services
• Intensive Outpatient Programs (IOP)
• Partial Hospitalization Programs (PHP)
• Inpatient psychiatric admission
• Psychiatric Residential Treatment Facility (PRTF)
• Substance use disorder treatment including medication-assisted treatment (suboxone, naltrexone)
• ABA therapy for autism after diagnosis and treatment plan
• Mobile crisis response

Hospital and emergency

• Inpatient hospital (medical and surgical)
• Outpatient hospital
• Emergency department
• Ambulance
• ICU and NICU

Pharmacy

PeachCare covers prescription medications through a state formulary administered by the CMOs. Coverage includes:

• Antibiotics
• Asthma inhalers (rescue and controller including biologics like dupilumab when indicated)
• ADHD medications (stimulants and non-stimulants)
• Insulin and diabetes medications
• Anti-epileptic medications
• Mental health medications
• Vaccines

Vision

• Annual eye exams
• Eyeglasses (typically one pair per year; replacement when broken or outgrown)
• Contact lenses when medically appropriate
• Vision therapy for amblyopia and convergence insufficiency

Dental

• Cleanings (twice per year minimum, more if medically needed)
• Fluoride treatments
• Sealants
• X-rays
• Fillings
• Crowns
• Root canals (endodontic services)
• Extractions
• Orthodontia when medically necessary (cleft palate, severe malocclusion impairing function)
• Hospital-based dental procedures for medically complex children

Hearing

• Audiology evaluations
• Hearing aids when medically necessary
• Cochlear implants when audiologically indicated
• Auditory-verbal therapy
• Replacement hearing aids when outgrown or broken

Therapy

• Physical therapy
• Occupational therapy
• Speech-language therapy
• Feeding therapy

Durable medical equipment

• Wheelchairs, walkers, gait trainers
• Hospital beds
• Standers
• AAC (augmentative and alternative communication) devices
• CGM and insulin pumps
• Nebulizers and CPAP
• Apnea monitors
• Incontinence supplies when medically necessary

Non-emergency medical transportation (NEMT)

Available for medical appointments through regional transportation brokers.

How PeachCare differs from Medicaid

The practical coverage is similar, but several technical differences matter.

EPSDT entitlement

Medicaid under 42 USC 1396d(r) imposes the EPSDT entitlement: ALL medically necessary services, including services not covered for adults. PeachCare under Title XXI is not subject to EPSDT. Georgia structured the PeachCare benefit package to mirror EPSDT, so the practical coverage is largely the same. The technical difference matters if a service is denied: an EPSDT appeal under Medicaid has a stronger legal basis than a coverage dispute under CHIP.

Premiums

Medicaid for children has no premiums. PeachCare has modest premiums above 150 percent FPL.

Copays

Medicaid for children has minimal or no copays. PeachCare copays are slightly higher but capped at 5 percent of family income annually.

Federal match

CHIP programs receive an enhanced federal match that exceeds the standard Medicaid FMAP. The enhanced match is one of the reasons states find PeachCare-style separate CHIP financially attractive.

Continuous eligibility

Both Medicaid and PeachCare now have 12-month continuous eligibility under CAA 2023 section 5112.

How PeachCare interacts with other programs

Family movement between Medicaid and PeachCare

As family income changes (rises or falls), children may move between MAGI Medicaid and PeachCare. The state administrative system is designed to make this transition automatic. Families do not need to reapply when crossing the income threshold between the programs.

Newborns

Babies born to Medicaid- or PeachCare-enrolled mothers are deemed eligible for Medicaid for their first 12 months under 42 USC 1396a(e)(4) if the mother was Medicaid-eligible at the time of birth. After 12 months they transition to MAGI Medicaid or PeachCare based on family income.

Private insurance

Children cannot generally have PeachCare and comprehensive private insurance simultaneously. If a family acquires private coverage they typically must terminate PeachCare. Limited exceptions exist for children with high-deductible or limited private plans.

Marketplace

If a family becomes ineligible for PeachCare because income rises above 247 percent FPL, the children may be eligible for Marketplace coverage with Advance Premium Tax Credits. Families must apply through HealthCare.gov within 60 days of PeachCare termination to access a Special Enrollment Period.

Katie Beckett (TEFRA)

For a moderate-income family with a child who has significant disabilities, both PeachCare and Katie Beckett are potentially available. Katie Beckett opens Medicaid (with the full EPSDT mandate) regardless of family income; PeachCare provides similar practical coverage but with premiums and copays and without the explicit EPSDT entitlement. Most disabled-child families who qualify for Katie Beckett prefer it over PeachCare because EPSDT's any-other-necessary-care override is stronger leverage for denied services. See our companion guide.

CHIPRA section 214 (unborn child option)

Georgia uses CHIPRA section 214 to extend prenatal coverage to pregnant women who would not otherwise qualify (typically because they are within the 5-year bar after qualifying immigration or are undocumented). The unborn child is enrolled in PeachCare, and the resulting prenatal care effectively covers the mother. See our companion guide at /medicaid/georgia/pregnancy-coverage.

Six worked examples

15 common mistakes families and providers make

1. Not knowing PeachCare exists. Many families assume they earn too much for any public coverage and never apply.

2. Applying through HealthCare.gov first instead of Georgia Gateway. Both work, but Gateway is the better direct path for PeachCare enrollment.

3. Confusing MAGI Medicaid with PeachCare. They are different programs with different income thresholds, premium structures, and cost-sharing. Understanding the boundary helps you predict cost.

4. Missing the auto-renewal because of an unreported address change. Keep your address current with DCH/DFCS to ensure renewal notices reach you.

5. Not appealing denials based on incorrectly counted household income. Household composition counting is technical (the MAGI rules under 26 USC 36B(d) apply). Denial because of a miscounted dependent is common and reversible.

6. Failing to report changes in family income. Twelve-month continuous eligibility now protects against losing coverage mid-year due to income increase, but you still need to report at renewal.

7. Letting premium nonpayment lead to disenrollment. A 60-day grace period exists; pay within the grace period to avoid coverage termination.

8. Assuming a child cannot have PeachCare because they have other limited private coverage. Some limited private coverage (catastrophic only, etc.) may not disqualify.

9. Not enrolling in a CMO during the 30-day choice window. Auto-assignment may not match your child's preferred specialists. Choose actively during the 30-day window.

10. Missing the immunization documentation requirement at well-child visits. Bring shot records to every visit.

11. Not requesting NEMT for specialty appointments. PeachCare covers non-emergency medical transportation through regional brokers.

12. Letting dental visits lapse. PeachCare covers comprehensive dental including orthodontia when medically necessary. Twice-yearly cleanings are free and prevent costly future restorative work.

13. Not requesting behavioral health services believing PeachCare does not cover them. PeachCare covers comprehensive behavioral health with mental health parity, including ABA, IOP, PHP, PRTF, and SUD treatment.

14. Not requesting hearing aids or vision therapy believing they require Medicaid. PeachCare covers both. Hearing aids and cochlear implants are covered when medically necessary.

15. Not appealing premium hardship. Premium reductions and hardship exemptions are available in some circumstances.

Putting it together: applying for PeachCare

1. Determine likely eligibility. Compare your family income to the FPL thresholds for your child's age. A household of 4 earning roughly between the Medicaid ceiling and the PeachCare upper limit (138 to 247 percent FPL) likely qualifies for PeachCare for school-age children. Households below those thresholds qualify for MAGI Medicaid.

2. Gather documents. Proof of identity, citizenship or qualifying immigration status, Georgia residency, household income (paystubs, tax return), Social Security numbers.

3. Apply. Through Georgia Gateway (gateway.ga.gov) or by phone at 1-877-427-3224.

4. Wait for the determination. Typically issued within 45 days.

5. If approved, enroll in a CMO within the 30-day choice window. Check that your child's pediatrician and any specialists are in the CMO's network.

6. Pay the premium monthly (if applicable) to maintain coverage.

7. Use the benefits. Schedule well-child visits, dental cleanings, vision exams, and any other care your child needs.

8. Renew annually when the renewal notice arrives.

9. If denied, appeal. Request a State Fair Hearing within 30 days. Atlanta Legal Aid Society (1-404-524-5811) and Georgia Legal Services Program (1-404-206-5175) provide free help.

What Brevy is tracking

We at brevy.com maintain a state-by-state map of CHIP program design including PeachCare. We track the income thresholds, premium structure, copay structure, and benefit package against Title XXI requirements; the relationship between CHIP and Medicaid in each state; and the practical access patterns for moderate-income families. Georgia's PeachCare is among the more comprehensive separate-CHIP programs nationally, with a benefit package that closely tracks Medicaid EPSDT and premiums that remain modest as a share of family income.

PeachCare for Kids bridged a real gap in coverage and now provides health insurance to tens of thousands of Georgia children whose families would otherwise face the costly choice between expensive private insurance and going uninsured. The program remains underutilized.

Who to Call in Georgia

• PeachCare for Kids enrollment line: 1-877-427-3224
• DCH Member Services: 1-866-211-0950
• DFCS (eligibility intake): 1-877-423-4746
• Georgia Gateway (online application): gateway.ga.gov
• Amerigroup CMO: 1-800-600-4441
• CareSource CMO: 1-855-202-0729
• Peach State Health Plan CMO: 1-800-704-1484
• Children's Healthcare of Atlanta: 1-404-785-5437
• Marcus Autism Center: 1-404-785-9444
• Voices for Georgia's Children (advocacy): 1-404-521-0311
• Atlanta Legal Aid Society: 1-404-524-5811
• Georgia Legal Services Program (outside Atlanta): 1-404-206-5175

Learn More

• Georgia Medicaid Overview
• Georgia Medicaid Eligibility and Income Limits
• Georgia Medicaid for Children and EPSDT
• Georgia Katie Beckett (TEFRA) Pathway
• Georgia Medicaid Managed Care Plans
• Georgia Medicaid Pregnancy Coverage

Find personalized help navigating PeachCare for Kids 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.