MedicaidCoverageHigh impact
[Georgia] Georgia Pathways Copays
CareSource·GA·Provider Bulletin
Effective date
Oct 1, 2025
We identified it
May 9, 2026
Summary
Effective October 1, 2025, CareSource Georgia Pathways members enrolled in CMOs must now pay copayments at point of service, with tiered amounts ranging from $0 for primary care to $12.50 for inpatient hospitalization. Members under age 21 are exempt from copayments, and providers cannot deny covered services if members are unable to pay.
Action Required
By October 1, 2025: Billing team must implement copayment collection at point of service for all Georgia Pathways CMO members. Update patient registration and billing system to: (1) Collect copayments per the tiered fee schedule (Primary Care $0, Specialist $2, Inpatient $12.50, Outpatient/ED $3, DME $3/$1, Pharmacy tiered $0.50–$3); (2) Add age verification to exempt members under 21 from copayment collection; (3) Train front desk and billing staff that inability to pay copayments cannot result in service denial for covered services. Update encounter forms and billing workflows to reflect new copayment amounts. Communicate policy changes to providers and clinical staff to ensure compliance with non-denial requirements.