Georgia is one of 10 states that has not expanded Medicaid under the ACA, meaning the standard expansion threshold of 138% of the Federal Poverty Level does not apply here. Instead, Georgia runs the Pathways to Coverage program, a limited 1115 demonstration waiver offering Medicaid to adults ages 19 to 64 at incomes up to 100% FPL who document at least 80 qualifying activity hours per month. When Pathways or traditional Georgia Medicaid ends, the coverage gap between 100% FPL and the ACA subsidy floor at 100% FPL creates a narrow but real risk: some Georgians who lose Pathways for activity-reporting failures may not immediately qualify for subsidized marketplace coverage either, depending on their exact income. Knowing which pathway applies to you in 2026 is the first decision this page helps you make.
Georgia Access is Georgia's state-based marketplace for ACA plans, operating at georgiaaccess.gov rather than healthcare.gov. Georgians who lose Medicaid or Pathways coverage qualify for a 90-day Special Enrollment Period, which is longer than the standard 60-day SEP that applies to most other coverage losses. The One Big Beautiful Bill Act (OBBBA), signed July 4, 2025, added new work requirements for Medicaid expansion populations nationally and requires redeterminations every six months starting December 31, 2026. Georgia's Pathways waiver is extended through December 31, 2026, but the program will be restructured after that date to align with new federal rules. This guide covers the six steps to take after losing Georgia Medicaid, how to calculate whether you qualify for Georgia Access subsidies or re-qualify for Medicaid, and what happens to your children's coverage under PeachCare for Kids. Check the Medicaid income limits and ACA income limits for 2026 to understand your options before your 90-day clock expires.
6 Steps to Get Coverage
Common Mistakes That Cost People Thousands
The most costly mistakes Georgians make after losing Medicaid or Pathways coverage in 2026:
- Waiting to act because you filed a Georgia Pathways appeal. Appeals through OSAH can take weeks. Apply for Georgia Access marketplace coverage at the same time as your appeal. If the appeal succeeds, you can cancel the marketplace plan without penalty.
- Missing the 90-day SEP window. Most people assume the standard 60-day window applies, but loss of Medicaid or CHIP triggers a longer 90-day window. Even so, the clock starts on the termination DATE on your notice, not the date you read the notice or the date coverage actually stopped.
- Enrolling on healthcare.gov instead of georgiaaccess.gov. Georgia runs its own state-based marketplace. Starting your application at healthcare.gov with a Georgia ZIP code should redirect you, but going directly to georgiaaccess.gov avoids confusion and is faster.
- Assuming children lose coverage when adults do. PeachCare for Kids (Georgia CHIP) is evaluated separately. Children in your household may still qualify at incomes up to 247% FPL even if you as an adult no longer qualify for Medicaid. Apply through gateway.ga.gov immediately.
- Reporting last year's income instead of projected current income. Georgia Access and Medicaid both use Modified Adjusted Gross Income (MAGI) based on projected CURRENT-year income. If your income dropped since your last tax return (due to job change, Pathways activity-hour failure, or other reason), report your new projected income to maximize your subsidy.
Georgia's Coverage Gap in 2026: What It Means If You Earn Below 100% FPL
Georgia's decision not to expand Medicaid creates a situation unique among the 40 states and DC that did expand: adults earning below 100% FPL ($15,960 for a single person in 2026) who do not qualify for Georgia Pathways have no subsidized coverage option. ACA premium tax credits start at 100% FPL, not below it. Pathways requires 80 qualifying activity hours per month, meaning adults who cannot meet that requirement because of illness, irregular work, or caregiving responsibilities may fall into this coverage gap. Adults who lost Pathways specifically because they could not document activity hours are most at risk of landing in the gap rather than in the ACA subsidy zone. The KFF 2026 analysis estimates approximately 200,000 to 240,000 Georgians are affected by this gap.
Georgians in the coverage gap have limited options in 2026: (1) attempt to re-qualify for Georgia Pathways by resuming qualifying activities and documenting them through gateway.ga.gov; (2) access care through Federally Qualified Health Centers (FQHCs) that offer sliding-scale fees based on income; (3) apply for coverage under a different Medicaid category if your circumstances changed, such as pregnancy (covered up to 225% FPL), a new disability determination, or reaching age 65 for Medicare eligibility. The OBBBA, signed July 4, 2025, restructures Pathways after December 31, 2026, but the gap is not expected to close unless Georgia enacts full expansion separately.
Documents Deep-Dive: Why Each Document Matters for Your Georgia SEP Application
Georgia Access requires proof of the qualifying life event within 30 days of selecting a plan. The Georgia DCH or DFCS termination letter is the primary document that establishes both the qualifying life event (loss of Medicaid/Pathways coverage) and the termination date that starts your 90-day SEP clock. Without it, Georgia Access may place your SEP application on hold or reject it. Keep a copy of the letter the moment you receive it. If you lost the letter, call the Georgia DFCS Customer Contact Center at 877-423-4746 and request a duplicate termination notice.
Proof of current income is used to calculate your Modified Adjusted Gross Income (MAGI) for 2026 ACA premium tax credit eligibility through Georgia Access. Report your projected CURRENT-year income, not your prior-year tax return figure. If your income is irregular (gig work, seasonal employment, self-employment), use your best estimate for the remainder of 2026. Under-reporting income risks a reconciliation bill at tax time via Form 1095-A; over-reporting costs you subsidy dollars during the year. If your income changes significantly after you enroll, update your application on georgiaaccess.gov within 30 days to keep your subsidy accurate.
Georgia Pathways Work Requirements in 2026 and What Changes After December 31
Georgia Pathways to Coverage covers adults ages 19 to 64 at or below 100% FPL ($15,960 for a single person in 2026) who document at least 80 qualifying activity hours per month. Qualifying activities include: paid employment, job search or training, enrollment in an educational program, vocational rehabilitation services, caregiving for a child under age 6 (new for 2026), and approved community service. Documentation must be submitted through the Georgia Gateway portal at gateway.ga.gov at annual renewal; the program moved from monthly to annual documentation reporting in 2026. Caregiving for a child under 6 was added as a qualifying activity in 2026, allowing stay-at-home parents who previously fell out of Pathways for activity failures to re-qualify without meeting a traditional employment or training requirement.
After December 31, 2026, Georgia Pathways will be restructured under the OBBBA national framework. The federal law requires all states to implement community engagement requirements for Medicaid expansion populations by January 1, 2027, with standard work, training, education, or community service documentation. Georgia's waiver framework positions it ahead of most states because work requirements are already in effect. The bi-annual (every 6 months) redetermination schedule for Medicaid expansion adults also takes effect December 31, 2026 under OBBBA, though Georgia's non-expansion status means the exact application to Pathways enrollees is subject to CMS guidance. If you are enrolled in Pathways, expect a renewal or redetermination contact from Georgia DCH in late 2026 or early 2027 under the new rules.
Frequently Asked Questions
How long do I have to enroll in Georgia Access after losing Georgia Medicaid or Pathways?
You have 90 days from the date your Georgia Medicaid or Pathways coverage ended to enroll in a Georgia Access marketplace plan using the loss-of-coverage Special Enrollment Period (SEP). This is longer than the standard 60-day SEP that applies to most other qualifying life events. Your 90-day clock starts from the termination date on your DCH or DFCS notice, not the date you received the letter. Visit georgiaaccess.gov, select 'I lost qualifying health coverage,' choose Medicaid/CHIP as the coverage type, and enter your termination date. Upload your termination letter within 30 days of selecting a plan.
Can I appeal my Georgia Pathways termination in 2026?
Yes. Every Medicaid recipient has the right to a fair hearing. Submit your appeal request to Georgia's Office of State Administrative Hearings (OSAH) before the deadline stated in your termination notice, which is typically 30 days from the notice date. Visit pathways.georgia.gov/eligibility/appeal-eligibility-decision to file online or call the Georgia DCH at 877-423-4746. If you appeal before your coverage ends and request continuation of benefits within 10 days of the notice date, Georgia may continue your Medicaid benefits while the hearing is decided. Common grounds for successful appeals include procedural errors where documentation was submitted but not processed, and disputed income calculations.
Why does Georgia Access not show up on healthcare.gov for Georgia residents?
Georgia operates its own state-based ACA marketplace at georgiaaccess.gov rather than using the federal healthcare.gov platform. If you enter a Georgia ZIP code on healthcare.gov, the site should redirect you to Georgia Access, but starting directly at georgiaaccess.gov is faster and avoids confusion. Georgia Access launched for the 2024 plan year and has operated independently since. Seven carriers competed statewide for 2026 plans. If you are a Georgia resident, all ACA marketplace enrollment, plan comparisons, and subsidy applications must be completed on georgiaaccess.gov.
Do I qualify for Georgia Access subsidies after losing Medicaid?
Yes, if your 2026 projected household income is between 100% and 400% FPL. For a single person in 2026, that is $15,960 to $63,840. For a family of 4, that is $33,000 to $132,000. Between 100% and 250% FPL, Silver plans on Georgia Access also qualify for cost-sharing reductions (CSRs) that dramatically lower your deductible and out-of-pocket maximum. The enhanced ACA premium tax credits from the American Rescue Plan Act expired January 1, 2026, so the 2026 subsidy cliff at 400% FPL is in effect. If your income is above 400% FPL, you pay full premium with no ACA subsidy.
What if my income is below 100% FPL and I don't qualify for Georgia Pathways?
Adults below 100% FPL who cannot meet the Georgia Pathways activity requirement, and who are not pregnant, elderly, disabled, or a child, fall into Georgia's coverage gap. ACA marketplace premium tax credits start at 100% FPL, so you do not qualify for Georgia Access subsidies. Options include: attempting to re-qualify for Pathways by resuming qualifying activities, accessing care at Federally Qualified Health Centers (FQHCs) that use sliding-scale fees, or checking whether your circumstances have changed enough to qualify for another Medicaid category such as pregnancy (up to 225% FPL) or a disability determination. Georgia has not enacted full Medicaid expansion, so the gap is not expected to close in 2026.
What happens to my children's coverage when I lose Georgia Medicaid?
Children's coverage is evaluated separately. PeachCare for Kids is Georgia's CHIP program and covers uninsured children under age 19 at household incomes up to 247% FPL (roughly $81,510 for a family of 4 in 2026). The standard two-month uninsured waiting period is waived when coverage was involuntarily lost, which includes a Medicaid or Pathways termination. Premiums are $0 to $35 per month and include dental and vision. Apply through gateway.ga.gov year-round. Children do not face the same 90-day SEP window as adults and can be enrolled at any time if income-eligible.
What is Georgia Pathways to Coverage and how does it differ from regular Medicaid?
Georgia Pathways to Coverage is a limited Medicaid program authorized under a federal 1115 demonstration waiver. It covers non-disabled adults ages 19 to 64 at or below 100% FPL who complete at least 80 qualifying activity hours per month through employment, job training, education, caregiving for a child under 6, or community service. Regular Medicaid in Georgia covers pregnant women (up to 225% FPL), children under PeachCare for Kids (up to 247% FPL), and adults who are aged, blind, or disabled. Georgia Pathways is the only pathway for healthy non-disabled working-age adults in Georgia to access Medicaid, and it covers roughly 5,000 to 7,000 enrollees, far fewer than full expansion would cover.
What changed with Georgia Medicaid in 2026 under the One Big Beautiful Bill Act?
The One Big Beautiful Bill Act (OBBBA), signed July 4, 2025, made two changes relevant to Georgia: (1) states with Medicaid expansion must conduct eligibility redeterminations every six months starting December 31, 2026, instead of annually. Georgia does not have full expansion, but CMS guidance will clarify how this applies to Pathways enrollees. (2) All states must implement community engagement requirements for Medicaid working-age adults by January 1, 2027. Georgia Pathways already has work requirements, but the Pathways waiver will be restructured to align with the new federal framework after December 31, 2026. If you are in Pathways, expect a renewal communication from Georgia DCH in late 2026 or early 2027.
