By Ben Castle
If you are new to the Affordable Care Act Marketplace, you are probably confused. Not only is health insurance confusing on its own, but the Marketplace also introduces you to a set of confusing terminology and programs. One of those is CHIP aka PeachCare aka Medicaid. This article will help clear up the confusion. Your agents at Georgia Health Insurance wade the murky waters of insurance, so you don’t have to. Here is what we’ve found.
CHIP, PeachCare, and Medicaid
CHIP, PeachCare, and Medicaid are related to each other. CHIP is a federal program created in 1997. At that time Congress created Title XXI of the Social Security Act to provide health care for the growing number of uninsured children in the United States. CHIP stands for Children’s Health Insurance Program. This federal level program is managed by the states. In Georgia, CHIP is known as PeachCare for Kids. So, in Georgia, CHIP is PeachCare.
Medicaid is another government assistance program that provides health care for low-income individuals. But that’s for another article. For now, simply know that PeachCare for Kids falls under the Georgia Medicaid administrative umbrella.
When your agent helped you apply for a health insurance plan on the ACA Marketplace, you had the option to seek government assistance to help pay for your health insurance premiums. If you choose to seek government assistance, the Marketplace checked to see if your children qualified for Georgia’s CHIP, that is PeachCare for Kids. They do this to avoid double dipping into the government’s pocket. If your household income is below a certain threshold, CHIP coverage takes precedence over ACA assistance.
So, you’ve enrolled in health insurance and gotten an effective date. Great! But what about your kids? They were kicked over to CHIP. When you submitted your application for government assistance, your information was sent over to the Georgia Medicaid department. The Georgia Medicaid department then began the process to determine if your children are eligible for PeachCare for Kids, otherwise known as the “determination period.”
Alternatively, you can apply directly here: https://dch.georgia.gov/peachcare-kids
Determination Period
The determination period for PeachCare for Kids is 45 days from your application submission. When your agent helped you apply for health insurance, you filled out an application. That application included all the information about your family that the Georgia Medicaid program needs to determine your children’s eligibility for PeachCare for Kids (CHIP) coverage. As soon as that application was submitted, if your income was below a certain threshold (we’ll talk about those in a minute) your household information was sent to Georgia Medicaid.
Federal Regulations and State Regulations
To determine eligibility for CHIP there is a combination of federal and state regulations that must be met to qualify.
According to federal regulations, to be eligible for CHIP a child must be:
- Under 19 years old,
- Uninsured,
- A citizen or meet the immigration requirements,
- A resident of the state in which they are applying for medical coverage,
According to Georgia’s regulations (in addition to the requirement above), a child must be a member of a family who meet the following income criteria noted here: https://dch.georgia.gov/peachcare-kids/eligibility-criteria
If your child meets the federal and state level requirements, they will be enrolled in PeachCare for Kids. It is critical that you wait on the Georgia Medicaid program to finish their determination period. There is no need to enter a new application for your children as this will initiate a new 45 business day determination window.
Determination Results
After your 45 business day window has passed, you should contact the Georgia Medicaid department to find out if you child has been determined eligible.
PeachCare for Kids Contact information:
- Phone: 1-877-427-3224
- Email Contact Form: https://dch.georgia.gov/programs/peachcare-kids/contact-us
The phone number will take you to an automated system. This is where you can find out the status of your children’s coverage. Select option “2” and enter the Social Security number and birthday for the head of household. The system will tell you if you have been denied or if you are still in process. If there is no information the system will say that they cannot find your social and birthday in the system. Try it again the next day until you get a response. It takes about 3 mins to get the info from the automated phone system. If your children have been denied coverage under PeachCare for Kids, not to worry. Call your Georgia Health Insurance agent and we can enroll your child into your health plan.
If you child has been approved for coverage under PeachCare for kids, they will send id cards and other coverage information to you about 14-20 business days after they have been approved.
Using PeachCare for Kids
Now that you have been approved for PeachCare you will need to find a Primary Care Provider that will work with you to make sure your children get care they need. PeachCare for kids offers comprehensive healthcare services but there are coverage limits and doctors orders/prior approvals may be required. You can find participating providers here: https://www.pshpgeorgia.com/find-a-doctor.html and if you need help choosing a doctor, call customer service at 1-800-704-1484
You can view more information about the plan details in the Member Handbook: https://www.pshpgeorgia.com/members/medicaid/resources/handbooks-forms.html
Be sure to check out the Value Added Benefit offerings here: https://www.pshpgeorgia.com/value-added-services.html
