Title 49, Chapter 5, Section 273
(a) There is created the PeachCare for Kids Program to provide
health care benefits for children in families with income below 235
percent of the federal poverty level. Children from birth through
18 years of age in families with family incomes below 235 percent of
the federal poverty level and who are not eligible for medical
assistance under Medicaid shall be eligible for the program, to be
administered by the department pursuant to federal law and subject
to availability of funding.
(b) No entitlement to benefits for the children covered under the
program or this article shall be created by the program, nor shall
this article or any rules or regulations adopted pursuant to this
article be interpreted to entitle any person to receive any health
services or insurance available under this program. The program
shall be established subject to the availability of funds
specifically appropriated by the General Assembly for this purpose
and federal matching funds as set forth in federal law. The
department shall operate the program consistent with administrative
efficiency and the best interests of children.
(c) The program shall offer substantially the same health care
services available to children under Georgia's Medicaid plan, but
coverage for such services shall not be provided by an expansion of
eligibility for medical assistance under Medicaid. However, the
program shall exclude nonemergency transportation and targeted case
management services. The department shall utilize appropriate
medical management and utilization control procedures necessary to
manage care effectively and shall prospectively limit enrollment in
the program and modify the health care services benefits when the
department has reason to believe the cost of such enrollment or
services may exceed the availability of funding.
(d) The department may require copayments for services consistent
with federal law; provided, however, that no copayment shall be
charged for preventive services and no copayments or premiums shall
be charged for any child under six years of age. Preventive
services include but are not limited to medically necessary
maintenance medication and monitoring for chronic conditions such as
asthma and diabetes.
(e) The department shall require payment of premiums for
participation in the program. The premiums shall not exceed the
amounts permitted under Section 1916(b)(1) of the Social Security
Act or federal law.
(f) The department may provide for presumptive eligibility for all
applicant children as allowed by federal law and in a manner
consistent with the provisions of this article.
(g) The department shall provide for outreach for the purpose of
enrolling children in the program. Applications shall be accepted
by mail or in person. All necessary and appropriate steps shall be
taken to achieve administrative cost efficiency, reduce
administrative barriers to application for and receipt of services
under the program, and ensure that enrollment in the program does
not substitute for coverage under a group health insurance plan.
(h) Any health care provider who is enrolled in the Medicaid program
shall be deemed to be enrolled in the program.
(i) The department shall file a Title XXI plan to carry out the
program with the United States Department of Health and Human
Services Health Care Financing Administration by June 1, 1998. The
department shall have the authority and flexibility to make such
decisions as are necessary to secure approval of that plan
consistent with this article. The department shall provide a copy
of the plan to the General Assembly. The department shall operate
this program consistent with federal law.
(j) The department shall publish an annual report, copies of which
shall be provided to the Governor and the General Assembly setting
forth the number of participants in the program, the health services
provided, the amount of money paid to providers, and other pertinent
information with respect to the administration of the program.
(k) All state agencies shall cooperate with the department and its
designated agents by providing requested information to assist in
the administration of the program.
(l) The department, through the Department of Administrative
Services or any other appropriate entity, may contract for any or
all of the following: the collection of premiums, processing of
applications, outreach, data services, and evaluation, if such
contracting achieves administrative or service cost efficiency. The
department, and other state agencies as appropriate, shall provide
necessary information to any entity which has contracted with the
department for services related to the administration of the
(m) Nothing in this article shall be interpreted in a manner so as
to preclude the department from contracting with licensed health
maintenance organizations (HMO) or provider sponsored health care
corporations (PSHCC) for coverage of program services and eligible
children in a metropolitan statistical area; provided, however, that
such contracts shall require payment of premiums and copayments in a
manner consistent with this article. The department may not require
enrollment in a health maintenance organization (HMO) or provider
sponsored health care corporation (PSHCC) as a condition of
receiving coverage under the program.
(n) There shall be created a separate budget unit "C" and a separate
appropriation in the department for the purpose of carrying out the
provisions of this article.
(o) The Department of Education and local boards of education shall
cooperate with and provide assistance to the department and its
designated agents for the purposes of identifying and enrolling
eligible children in the program.