Georgia Medicaid: Find a Doctor & Network Access Rights

If your Georgia Medicaid plan covers a service but no in-network doctor near you can see you for months, your plan may be failing an access standard called network adequacy. You have the right to a network with enough providers, close enough and available soon enough, to deliver the care your plan covers. When it falls short, you can ask your plan to authorize out-of-network care, ask about continuity-of-care protections, and file a complaint with your plan and the state. This guide shows you how to find a Georgia Medicaid provider, what to do when you can't, and the rules that back you up.

Most Georgians on Medicaid get care through one of three managed care plans. As of July 2026, Georgia Families, the state's Medicaid and PeachCare for Kids managed care program, contracts with three Care Management Organizations (CMOs): Amerigroup Community Care, CareSource, and Peach State Health Plan; DCH has extended those three contracts through June 30, 2027 while a new procurement sits in the protest phase.1 Each plan publishes its own online provider directory. Federal rules in 42 CFR Part 438 require the state to make sure each plan keeps a network sufficient to deliver every covered service in a timely way.2 A newer federal rule adds maximum appointment wait time standards, and those phase in with managed care contract rating periods beginning on or after July 9, 2027.3 When a plan cannot give you timely in-network access, you have concrete options, and the first step is almost always a call to your plan's member services line, followed by the Georgia Department of Community Health (DCH) at 1-866-211-0950.4

How to find a Georgia Medicaid doctor or provider

Each Georgia CMO maintains its own online provider directory. Start there.

If a listing turns out to be wrong, write down what you found, when, and who you spoke to. That documentation supports a complaint later.

What to do when you can't find an in-network Georgia Medicaid doctor

If no in-network provider can see you within a reasonable time, work these options in order.

Ask your plan to authorize out-of-network care

When your plan's network cannot deliver a covered service in a timely way, ask the plan to authorize an out-of-network provider. Federal rules require the state to ensure that all services covered under the state plan are available and accessible to managed care enrollees in a timely manner, and that each plan maintains a network sufficient to provide adequate access to them.2 Put the request in writing, and ask the plan to confirm what the visit will cost you.

Use telehealth where it fits

Ask your CMO whether the service you need is covered by telehealth; for behavioral health, medication management, and routine follow-ups it is often the fastest route to care. It does not lower the bar: the state must still ensure covered services are accessible in a timely manner.2

Use continuity of care during a transition

Ask to keep your current provider through the transition (see below).

File a complaint when the network fails

Start with your CMO's member services line. If the plan does not resolve the problem, file with DCH Medicaid Member Services at 1-866-211-0950.4 For a behavioral health access problem, you can also raise a mental health parity complaint (see below).

Your timely-access rights under federal rules

Network adequacy is the requirement that a plan keep enough in-network providers, spread by geography and available within reasonable wait times, to actually deliver covered services, under the federal rules in 42 CFR Part 438.

The plan must keep an adequate network

Under 42 CFR 438.206, each state must ensure that all services covered under the state plan are available and accessible to managed care enrollees in a timely manner, and that each plan maintains and monitors a network of appropriate providers sufficient to provide adequate access to all services covered under its contract.2 Under 42 CFR 438.207, each plan must give the state assurances and documentation that it can serve its expected enrollment: at contract start, annually, and whenever its operations change enough to affect that capacity. Section 1932(b)(5) of the Social Security Act (42 U.S.C. 1396u-2(b)(5)) is the statutory foundation, requiring each Medicaid managed care organization to maintain a sufficient number, mix, and geographic distribution of providers.2

Emergency care is always covered, even out of network

Under 42 CFR 438.114, which implements Section 1932(b)(2) of the Social Security Act, your plan must cover and pay for emergency services regardless of whether the provider has a contract with the plan, and without requiring prior authorization. You do not need to check whether an emergency room is in-network before going. That protection covers the services needed to evaluate or stabilize the emergency; care after you are stabilized is a separate category, covered under 42 CFR 438.114(e) rather than the emergency-services rule.5

New appointment wait time standards are phasing in

The CMS Medicaid and CHIP Managed Care Access, Finance, and Quality Final Rule (CMS-2439-F), published in the Federal Register on May 10, 2024 (89 FR 41002) and effective July 9, 2024, requires states to set and enforce maximum appointment wait time standards.3 Under 42 CFR 438.68(e), the routine-appointment maximums are no longer than 10 business days from the date of request for outpatient mental health and substance use disorder care (adult and pediatric), 15 business days for primary care (adult and pediatric), and 15 business days for obstetric and gynecological services, each applying where your plan's contract covers that service.6 A plan is deemed compliant when secret shopper results show appointment availability meeting these standards at least 90 percent of the time.6

These appointment wait time standards apply to the first managed care rating period beginning on or after July 9, 2027.3 The revised network adequacy standard applies to the first rating period beginning on or after July 9, 2026, and the secret shopper survey requirement to the first rating period beginning on or after July 9, 2028.3 Until your plan's contract reaches these dates, Georgia's own contract access standards, set out in the next two sections, still apply.

How Georgia sets its own distance standards

Federal rule 42 CFR 438.68 sets the framework but requires the state, not CMS, to develop and enforce the specific quantitative network adequacy standards.7 In Georgia, DCH publishes the time-and-distance standards in Figure 1 of the Georgia Families Contract, and each CMO must conduct a geographic access analysis of its network utilizing those standards.7 DCH publishes that Figure 1 grid on its Network Adequacy page, and the standard depends on the provider type and on whether DCH classifies your county as urban or rural on the county map published alongside it.8

In a rural county only, a pharmacy can meet that last standard instead with an after-hours emergency phone number and a pharmacist on call.8 Georgia requires that at least 90% of the members in each county have access to a provider when the contractual access standards are applied.8 So a plan can be compliant statewide while your county is the gap. A standard can also be waived: under 42 CFR 438.68(d) a state may permit an exception to any network standard it sets, and must then monitor enrollee access to that provider type on an ongoing basis.7 Ask DCH or your CMO to confirm the standard, and any exception, for the service and county you need.

Georgia's own appointment wait time standards

Figure 2 of the Georgia Families Contract already sets maximum waits by provider type, without waiting on the federal rule above. Routine primary care visits are not to exceed fourteen (14) calendar days, and adult and pediatric sick visits are not to exceed twenty-four (24) clock hours. Specialist appointments are not to exceed thirty (30) calendar days, routine dental visits twenty-one (21) calendar days, and mental health providers fourteen (14) calendar days. Urgent care is not to exceed twenty-four (24) clock hours, and emergency care must be available immediately, 24 hours a day, seven days a week.8

A different standard covers the wait once you are in the office, and it is not in Figure 2. Figure 3 of the Georgia Families model contract, Waiting Times by Appointment Type, caps the office wait at sixty (60) minutes for a scheduled appointment and ninety (90) minutes for a work-in or walk-in visit, and requires that after thirty (30) minutes (forty-five (45) for a work-in or walk-in) you be given an update with the option of waiting or rescheduling. DCH does not republish Figure 3, and it is confirmable only against a 2016 to 2017 model contract generation, not against any current DCH publication, so check it with your CMO or DCH before relying on it.8

If the earliest appointment offered falls past the standard for that visit type, note the date and who told you, and use it when you request out-of-network authorization or file a complaint.

Provider directories: useful, but verify

A listing can be wrong in several ways: the practice has closed, the doctor is not taking new patients, or the number no longer works.

CMS-2439-F expands network adequacy oversight and adds independent secret shopper surveys.3 That secret shopper requirement applies to the first managed care rating period beginning on or after July 9, 2028, a protection arriving, not one you can invoke today.3

Until then, treat the directory as a list of candidates, not confirmed appointments.

Continuity of care: keeping your current provider

Continuity of care keeps treatment already underway from being cut off when you enroll, switch plans, or your provider leaves the network. The specifics sit in your CMO's member handbook, so ask your plan in writing for its transition-of-care policy.

Ask for three things: permission to keep your current provider while the transition is arranged, the names of in-network alternatives, and confirmation that an approved prior authorization will still be honored. Name the treatment in progress (pregnancy, cancer treatment, a transplant, an active behavioral health episode), because that is where an interruption does the most damage.

If the plan denies your request, file a complaint with the plan and with DCH, and see our Georgia Medicaid appeals and fair hearings guide for how a plan decision gets appealed.

Behavioral health access and mental health parity

A thin behavioral health network can be both a network adequacy problem and a mental health parity problem. The federal Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 does not require a plan to cover mental health and substance use disorder care; it governs the terms when a plan does. A limit on those benefits (including a nonquantitative one such as a network-composition standard) cannot be applied more stringently than the plan applies comparable limits to medical and surgical benefits.9 MHPAEA does not reach Medicaid by its own terms: a member's parity rights run through the 2016 Medicaid and CHIP parity final rule, codified at 42 CFR Part 438 Subpart K, which CMS says does not reach members not enrolled with an MCO.10 Getting those rules into contracts took years: in a 2024 report, the HHS Office of Inspector General (OIG) found that in all eight states it reviewed, contracts with Medicaid managed care organizations did not contain the required parity provisions by the October 2, 2017 compliance date. OIG recommended that CMS improve its oversight, and CMS concurred.11

If you or your child cannot get a timely behavioral health appointment in-network, raise a parity complaint with DCH and CMS as well as requesting out-of-network care. See our Georgia Medicaid mental health parity guide.

Dental care and transportation: where to ask

A dentist and a ride to the appointment are arranged differently from an ordinary office visit.

• Dental. Georgia Medicaid covers dental services for recipients age 21 and over, effective July 1, 2024, under State Plan Amendment GA-24-0005, which expanded the scope of covered adult dental services and removed the covered-procedure limitations that had applied to adults 21 and older.12 All adult dental services except emergency services require prior authorization, so ask about that before you schedule.12
• Non-emergency medical transportation (NEMT). Effective April 1, 2026, Verida (formerly Southeastrans) is Georgia's statewide Medicaid Transportation Broker, providing NEMT in all five Georgia regions: North, Atlanta, Central, East, and Southwest. Modivcare no longer provides Georgia Medicaid NEMT.13 DCH defines NEMT as medically necessary, cost-effective transportation for an eligible Medicaid member, and an escort if one is required, who has no other means of transportation to a Medicaid-reimbursable service, at no cost to the member.13 Call the broker between 7 a.m. and 6 p.m., Monday through Friday, at least three workdays before a non-urgent scheduled appointment, a window that counts the day you call but not the day of the appointment. Urgent trips are the exception: DCH says a valid urgent-care request is honored within three hours.13

Georgia network gaps: check your own county

Rather than rely on a general picture of which specialties are short, check the county you actually live in. The CMOs submit quarterly Network Adequacy Reports giving member access data by county, and where a county falls below the 90% access bar the CMO must give DCH a corrective action plan. DCH says what that plan has to deliver: recruiting additional providers where they are available, contracting with providers in nearby counties, or coordinating non-emergency transportation, as necessary, so members receive care.8 Ask DCH or your CMO what the most recent report shows for your county and the provider type you need, and use the answer when you request out-of-network care.

Federally Qualified Health Centers (FQHCs) and Rural Health Clinics anchor the safety net in many rural areas, and our Georgia FQHC and RHC coverage guide shows how to find one.

Worked example: no in-network specialist within range

Marcus, 45, lives in Albany and is enrolled in CareSource. His doctor at a Federally Qualified Health Center refers him to an endocrinologist, but the plan's directory shows none near Albany.

His path:

1. Confirm the gap. He calls the listed distant providers and documents that none is reachable within a reasonable distance and timeframe.
2. Ask for an alternative. He asks CareSource to arrange a telehealth endocrinology consultation.
3. Request out-of-network care. If telehealth is not appropriate, he asks CareSource to authorize an out-of-network endocrinologist and to confirm in writing what he will owe.
4. Arrange transportation. If he must travel, he books an NEMT ride at least three workdays ahead.
5. Escalate. If access remains inadequate, he files a complaint with CareSource, then with DCH at 1-866-211-0950.4

Where to get help

Start with your plan's member services line; if it does not resolve the problem, escalate to DCH. For how the plans themselves work, see our Georgia Medicaid managed care plans guide.

Learn More

Find personalized help navigating Georgia Medicaid provider networks 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.