6.3 Georgia State Insurance Programs

Georgia Medicaid, Pathways to Coverage, and PeachCare

Medicaid is the joint federal-state program covering low-income residents, administered in Georgia by the Department of Community Health (DCH). Georgia did not adopt full ACA Medicaid expansion to 138% of the Federal Poverty Level (FPL). Instead, since July 1, 2023 it operates Georgia Pathways to Coverage — the only work-requirement-based coverage program in the country.

Adults earning 100%–138% FPL often fall into Georgia's coverage gap: too high for Medicaid/Pathways, but historically too low for the largest ACA subsidies.

PeachCare for Kids (CHIP)

PeachCare for Kids is Georgia's Children's Health Insurance Program (CHIP) for kids whose family income is above Medicaid but still modest.

Exam trap: PeachCare is CHIP, not Medicaid; families above the Medicaid limit but under the CHIP ceiling enroll children here.

Federal Marketplace and the Long-Term Care Partnership

Health Insurance Marketplace

Georgia uses the federally facilitated Marketplace at Healthcare.gov rather than a fully state-run exchange. The Marketplace offers Qualified Health Plans (QHPs) with income-based premium tax credits and, on Silver plans, cost-sharing reductions (CSRs).

Enrollment is limited to open enrollment unless a special enrollment period (SEP) applies — e.g., loss of job-based coverage, marriage, birth/adoption, or a permanent move.

Long-Term Care Partnership

Georgia participates in the Long-Term Care (LTC) Partnership Program, which links a qualified private LTC policy to Medicaid asset disregard.

1. The client buys a Partnership-qualified LTC policy (must include state-approved inflation protection).
2. As the policy pays benefits, the insured can later qualify for Medicaid while protecting assets dollar-for-dollar equal to the benefits the policy paid.
3. Normally Medicaid requires spending down to about $2,000 in countable assets; the Partnership lets the insured keep additional assets equal to LTC benefits used.

Example: a client buys a Partnership policy that pays out $200,000 of LTC benefits. When those benefits are exhausted and the client applies for Medicaid, Georgia disregards $200,000 of countable assets above the normal $2,000 limit, so the client can keep roughly $202,000 and still qualify. The disregarded assets are also shielded from Medicaid estate recovery after death.

Exam tip: The Partnership rewards buying private LTC coverage by protecting assets later — it does not raise the income limit, and the policy must include the state-mandated inflation protection to earn Partnership status.

Guaranty Association and GeorgiaCares

The Georgia Life and Health Insurance Guaranty Association protects Georgia residents when a licensed life or health insurer becomes insolvent. All admitted insurers must belong; assessments on solvent members fund claims. The following per-insured limits apply to insolvencies occurring after July 1, 2020:

Aggregate protection for any one life is capped (commonly $300,000 across all lines, except up to $500,000 for major medical). What is NOT covered: surplus lines insurers, unlicensed insurers, self-funded ERISA plans, the variable (separate-account) investment portion of variable products, and any amount above the statutory limits.

Producer advertising restriction

Georgia law prohibits producers and insurers from using the Guaranty Association in marketing. A producer may not:

• Use guaranty coverage as a sales inducement or selling point
• Advertise or reference the Association in solicitation
• Compare it to FDIC deposit insurance or imply the policy is "guaranteed"

GeorgiaCares (SHIP)

GeorgiaCares is Georgia's State Health Insurance Assistance Program (SHIP), offering free, unbiased Medicare counseling to beneficiaries — help comparing Medicare Advantage, Part D, and Medigap, screening for low-income subsidies, and reporting fraud.

Exam trap: A producer who tells a client "don't worry, the state guaranty fund backs this annuity like the FDIC" has committed a prohibited practice, even if the dollar figure quoted is accurate.