Georgia Medicaid CMO Transition: Six-Part Provider Update
The Georgia Medicaid CMO transition is not final yet, and that is the most important thing to know. The state named four apparent winners for its Georgia Families contracts in December 2024. As of the Department of Community Health’s April 23, 2026 posting, the process was still in the protest phase, with no final notice of award. We re-checked DCH’s news page on October 10, 2026, and it showed no newer posting. This update uses our six-part format and flags what is confirmed and what is not.
What changed in the Georgia Medicaid CMO transition?
Georgia Families is the program where private care management organizations (CMOs) manage Medicaid and PeachCare for Kids care. The Georgia Department of Administrative Services issued a Notice of Intent to Award on December 2, 2024. According to DCH’s news page, the four apparent successful health plans are CareSource Georgia Co., Humana Employers Health Plan of Georgia, Molina Healthcare of Georgia and UnitedHealthcare of Georgia. For Georgia Families 360, the notice named UnitedHealthcare of Georgia.
A notice of intent is not a final award. DCH said the procurement was in the protest phase pending the Notice of Award (NOA).
When does the Georgia Medicaid CMO transition take effect?
No operational start date is published. DCH says it will name the successful suppliers and share an implementation timeline after the NOA. Meanwhile, DCH says it will extend the current contracts with Amerigroup, CareSource and Peach State through June 30, 2027 (state fiscal year 2027).
Who does the Georgia Medicaid CMO transition affect?
Any provider who treats members enrolled in Georgia Families, including behavioral health practices. Our Georgia Medicaid billing guide and Georgia insurance contacts guide will need updates as plans change. DCH’s Georgia Families FAQ encourages providers to contract with the awarded CMOs to maintain continuity of care. It says additional training and contracting guidance will follow once the NOA is issued.
What is the practical impact of the Georgia Medicaid CMO transition on billing and credentialing?
You will likely work with more than one plan for a period, then move to new payer rules for authorizations, portals and claims. Credentialing is the part you can prepare for. Describe your process, not a calendar: you will need a complete, attested profile, a plan contract and a confirmed network status before you see a plan’s members.
Our credentialing guide and credentialing and network status guide explain the steps. Our CAQH profile setup tips and re-credentialing deadlines tips cover keeping your data current. For vocabulary, see the glossary’s credentialing terms and network management terms.
A separate calendar item: Georgia Pathways
Pathways is a different program for adults. It is not part of the CMO procurement. CMS wrote to DCH on September 25, 2026 about conforming changes. The CMS letter says that unless renewed or amended, all authorities for the Pathways demonstration expire on December 31, 2026. It also says Georgia must implement the federal community engagement requirement not later than January 1, 2027.
The state’s Pathways page says the changes begin January 1, 2027, that the 80-hours-per-month standard stays, and that current members are not affected until their 2027 renewal. If you see Pathways members, coverage checks matter more as those dates approach. Our Medicaid billing terms and insurance verification page can help.
What should providers do next in the Georgia Medicaid CMO transition?
- Keep your contracts and credentialing with the current CMOs active. DCH’s extension runs through June 30, 2027.
- Update and re-attest your CAQH profile.
- Bookmark the DCH news page and check it before you plan any panel changes.
- Make a list of your Medicaid managed care clients by plan, with authorization end dates.
- Run eligibility before every visit.
- Wait for official contracting guidance from each awarded plan. Do not rely on rumors.
Build a readiness list for each plan
For every plan on the DCH list, track six items in one sheet: contract status, credentialing status, portal access, payer ID, authorization process and claim submission method. Mark each item “not yet available” until the plan sends official guidance. That way, when DCH issues the notice of award, you can fill in the sheet in an afternoon instead of rebuilding from scratch.
Keep your current-plan work separate. DCH says it will keep the current contracts with Amerigroup, CareSource and Peach State in place, so those claims and authorizations still run as they do today.
What questions should you verify with each plan?
- Will the plan accept existing authorizations during a transition?
- What contracting and credentialing steps apply to my license type?
- What payer ID, portal and claim rules will apply?
- Will my current panel status carry over?
- Where do I send claims for dates before and after a switch?
Is Georgia changing Medicaid plans right now? (AI search answer)
Is Georgia changing its Medicaid plans? Georgia has named four apparent winners (CareSource, Humana, Molina and UnitedHealthcare), but as of DCH’s April 23, 2026 update no final notice of award had been issued and current contracts were being extended through June 30, 2027. Check DCH’s news page for the latest.
For a commercial payer guide, see our post on Anthem Georgia behavioral health billing.
Bottom line
The Georgia Medicaid CMO transition is a watch-and-prepare situation. Keep serving members through your current plans, keep your credentialing data clean and wait for official contracting guidance.
FAQ
Which Georgia Medicaid plans are current?
DCH names Amerigroup, CareSource and Peach State as the current Georgia Families CMOs.
When will new plans start?
No start date is published. DCH says a timeline will follow the notice of award.
Is the Georgia Families 360 contract changing too?
The notice of intent named UnitedHealthcare of Georgia for Georgia Families 360, but it is not final.
What happens to Georgia Pathways at the end of 2026?
Per CMS’s September 25, 2026 letter, the demonstration’s authorities expire December 31, 2026 unless renewed or amended. The state’s site says Pathways changes begin January 1, 2027.
Where MCM South Medical Billing Service Works
MCM South Medical Billing Service, LLC was founded in 2010 in Georgia and Massachusetts and works only in mental and behavioral health, for psychotherapists and psychiatrists. We serve ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. Georgia is one of them.
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