How do I appeal My Georgia Access eligibility decision?

You have the right to file an appeal on any final eligibility determination from Georgia Access.  You can appeal, among other things, a decision to deny, terminate, or change:

• Your eligibility to buy health coverage through Georgia Access.
• The Advanced Premium Tax Credits (including the dollar amount of your tax credit) you are eligible to receive
• The cost-sharing reductions (including the dollar amount of your cost-sharing reductions) you are eligible to receive
• Your ability to enroll in or change plans through Georgia Access outside of an open enrollment period
• The insurance you can buy because Georgia Access told you that you did not submit documents proving that you were ineligible for other types of health coverage
• Georgia Access did not provide you with a timely eligibility determination after you applied for insurance coverage

Please note, only final Eligibility Determinations of Georgia Access are appealable.  At times, some notices from Georgia Access are not final Eligibility Determinations and cannot be appealed.  These include, but are not limited to the following:

• If you receive notice that says that someone in your application needs to submit documents, then you must follow instructions for sending them. Until you submit documents and your issue is resolved, your eligibility notice is not a final Eligibility Determination and cannot be appealed.
• If you are required to send more information to Division of Family and Children Services (DFCS) for Georgia Medicaid or PeachCare for Kids®, your eligibility notice is not a final determination of eligibility for Georgia Medicaid or PeachCare for Kids® coverage and it cannot be appealed.

You have 90 days from the mailing date of this notice to file an appeal. 

Please note:  If you have an immediate need for health services and a delay could seriously jeopardize your health, you can ask for an expedited (faster) appeal review. (See step 5)

Your appeal should be in writing and must include your name, address, and a detailed reason why you believe Georgia Access’s eligibility determination is in error.  If you are requesting an appeal for someone else (like your child), also include their name.

·       Any decision about your eligibility for benefits may also change the eligibility of other people in your household.

·       All appeals from actions of the Office are governed by 45 C.F.R. §§ 155.10, et seq. and the General Rules of Administrative Practice and Procedure, Ga. Comp. R. & Regs. Section 120-2-2.

To find more information on how to appeal a decision please visit www.Georgia Access.gov for more information and to download an appeal form.