Georgia Families, administered by DCH (Department of Community Health), is Georgia's mandatory Medicaid managed care program, covering Medicaid, PeachCare for Kids (CHIP), the Planning for Healthy Babies (P4HB) family planning waiver, and Georgia Families 360 (foster care). Per CMS's most recent managed care enrollment data, report year 2024, these programs covered a combined 1,657,892 members. Georgia has not adopted the ACA Medicaid expansion. Instead, Georgia Pathways to Coverage, a Section 1115 demonstration, covers adults 19 to 64 with incomes up to 100 percent of the federal poverty level who complete 80 hours a month of work or other qualifying activities; Pathways members enroll with the same three CMOs, and the demonstration's current term runs through December 31, 2026, with a further application pending at CMS. The program is in the middle of a major, currently-unresolved carrier transition: a re-procurement has selected four new plans to replace two of the three current incumbents, with the outcome still pending formal award as of mid-2026.
Three CMOs currently hold the Georgia Families contract: Amerigroup Community Care (Elevance), CareSource (nonprofit), and Peach State Health Plan (Centene). A competitive re-procurement concluded with DCH selecting four organizations to take over the program: CareSource (the only current incumbent retained), Humana, Molina Healthcare, and UnitedHealthcare; both Amerigroup and Peach State Health Plan were not selected and are set to exit the program. As of April 2026, the award remains in a formal protest phase pending a Notice of Award (NOA), and DCH has extended the current three CMOs' contracts through the end of state fiscal year 2027 (June 30, 2027) to bridge the gap until the new contracts take effect. This is a live, unresolved transition, not a settled outcome.
Long-term services and supports are not integrated into Georgia Families' MCO benefit package. Nursing facility care and most HCBS waivers are carved out and delivered fee-for-service rather than through the CMOs. This is consistent with Georgia's HCBS waiver portfolio operating largely outside the managed care structure entirely.
Not integrated into managed care
Behavioral health is generally carved into Georgia Families: each CMO manages behavioral health as part of its standard benefit package, not through a separate statewide behavioral health vendor. Specialty mental health services delivered by Community Service Boards (Georgia's public mental health provider network) operate alongside and coordinate with CMO-managed behavioral health rather than replacing it, making this a coordinated hybrid rather than a clean carve-in or carve-out.
Carved in
Dental is largely an in-plan CMO benefit, particularly for children under the EPSDT benefit. Certain dental services for adults are more limited and may be carved out or delivered under separate arrangements, consistent with Georgia's broader pattern of adult optional-benefit limitations. No single statewide dental administrator vendor was identified.
Pharmacy is fully carved out of Georgia Families to a single statewide State Pharmacy Benefits Manager (SPBM), Gainwell Technologies. Every Medicaid prescription claim in Georgia flows through Gainwell regardless of which CMO a member is enrolled in, and the state (not the individual CMOs) maintains the Preferred Drug List and prior authorization tiers centrally. This is a cleaner, fully carved-out model compared to the hybrid carve-in-with-shared-formulary structure seen in several other states.
Non-emergency medical transportation is carved out of Georgia Families to a statewide broker, Verida. Members and providers book NEMT directly through Verida rather than through their CMO. Notably, Georgia Pathways to Coverage (the state's 1115 work-requirement demonstration) enrollees do not receive NEMT as a covered benefit at all, except for members aged 19-20 accessing it through the EPSDT benefit, a distinctive limitation not seen in the state's standard Medicaid population.
Providers interact with the state's Medicaid claims and administrative functions through GAMMIS (Georgia Medicaid Management Information System, mmis.georgia.gov), the state's public-facing MMIS portal for provider manuals, fee schedules, and provider notices. Pharmacy claims route separately through Gainwell Technologies' own systems as the state's SPBM.
119 agency updates tracked for Georgia. Available with Pro.
See them with ProSpeaking to Georgia health advocates days after Keisha Lance Bottoms won the governor's race, Ryan Loke, senior vice president and chief health policy officer at Grady Health System and a former health policy adviser to Gov. Brian Kemp who helped design the Georgia Pathways to Coverage program, said he is confident the General Assembly will expand Medicaid in its 2027 session regardless of chamber makeup. Democrats won the governor's office and the state House, but Republicans retained the state Senate. Loke cautioned that expansion's impact depends heavily on whether federal work requirements and funding cuts under the One Big Beautiful Bill law remain in effect, and warned that Georgia's outdated Medicaid eligibility system would need state investment to handle an expanded caseload. A Center on Budget and Policy Priorities study using 2024 data estimated 347,000 uninsured Georgians could be eligible under full expansion, not counting those excluded by work requirements or enrollment barriers. Sen. Raphael Warnock has joined others pushing to delay the federal work-reporting requirements by two years.
Bacon County Health Services in Alma, Georgia, disclosed that an unauthorized party had access to its network for 17 days, gaining entry on July 10 and copying certain files around July 27, according to a notice posted on its website. The organization said patient care was not disrupted and only a limited segment of its internal network was affected. It reported the incident to law enforcement and HHS, estimating at least 501 affected individuals, a figure it says will be updated once its review is complete. Bacon County Health Services, which operates Bacon County Hospital, Twin Oaks Convalescent Center and a rural health clinic, said it is not aware of any identity fraud linked to the breach and plans to mail notification letters once the review concludes.
Piedmont Healthcare reported a 10.7% operating margin for fiscal year 2026, down from 11.4% in fiscal 2025, as expenses grew faster than revenue, according to financial documents published Nov. 6. Total revenue rose 7.9% to $9.5 billion and operating income reached $1.02 billion, while operating expenses climbed 8.8% to $8.5 billion. The Atlanta-based system ended the fiscal year, which closed June 30, with $3.8 billion in cash and continued investment in hospital expansion projects across Georgia expected to finish in fiscal 2027.
Keisha Lance Bottoms, former Atlanta mayor, defeated Republican Rick Jackson to become Georgia's next governor, making her the state's first Democratic governor in over two decades and the first Black woman elected governor in U.S. history. Medicaid expansion was a central plank of her campaign, which she framed as a way to fund more healthcare services and prevent further rural hospital closures in the state, one of ten that has not adopted full expansion. Bottoms ran a centrist campaign also focused on data center construction and grocery tax relief, overcoming heavy spending from Jackson, who was backed by outgoing Gov. Brian Kemp and President Trump. The race was called by the Associated Press Tuesday night; Bottoms takes office as governor of a state where Republicans have controlled government since 2003.
Grady Health System, an Atlanta-based safety-net system with 18 locations, has signed a revenue cycle management agreement with Ensemble Health Partners. Ensemble will operate Grady's end-to-end revenue cycle across hospital and physician services, while Grady retains control of revenue cycle strategy and patient financial policies. Grady's CFO framed the move as an effort to operate more efficiently and strengthen financial performance amid industry pressures. The deal was announced in an Oct. 29 Ensemble news release.
9 active waivers tracked for Georgia. Available with Pro.
See them with ProNo active solicitations currently tracked for Georgia.
1 managed care contracts tracked for Georgia. Available with Pro.
See them with Pro40 bills tracked for Georgia. Available with Pro.
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