
Medicaid Managed Care
The Medicaid and CHIP Managed Care Final Rule improves transparency by requiring states and managed care plans to provide and maintain specific content on a public website that is accessible to Medicaid and CHIP managed care members. Specifically, the Medicaid and CHIP Managed Care Rule requires states and managed care plans to provide the following information:

Network Adequacy
Accreditation Status of Care Management Organizations
The State of Georgia introduced the Georgia Families managed care program in 2006 and contracts with private Care Management Organizations to deliver services to enrolled members. The Department of Community Health is responsible for administering the Medicaid program and CHIP in the State of Georgia. The State refers to its CHIP as PeachCare for Kids®. Both programs include fee-for-service and managed care components. The Department of Community Health is the single State agency for Medicaid.
The Department of Community Health employs a care management approach to organize its system of care, enhance access, achieve budget predictability, explore possible cost containment opportunities, and focus on systemwide performance improvements. The Department of Community Health uses managed care to continuously improve the quality of healthcare and services provided to eligible members and improve efficiency by using both human and material resources more efficiently and effectively.
The Care Management Organizations that contracted with Department of Community Health during SFY 2022–2023 are displayed in Table 2-1.
CMO | Year Operations Began in Georgia as a Medicaid CMO | Profile Description | CMO NCQA Accreditation Status |
---|---|---|---|
Amerigroup | 2006 | Amerigroup Community Care is a subsidiary of Amerigroup Corporation. Amerigroup is a wholly owned subsidiary of Anthem, Inc., founded in 2004 with the merger of Anthem and WellPoint Health Networks. Product lines include Medicaid, Medicare commercial, federal employees, and specialty services. | Accredited* through 9/22/2025 Health Equity Accredited* through 11/15/2025 |
Amerigroup 360** | 2014 | Amerigroup 360° is a subsidiary of Amerigroup Corporation. Amerigroup is a wholly owned subsidiary of Anthem, Inc., founded in 2004 with the merger of Anthem and WellPoint Health Networks. Product lines include Medicaid, Medicare commercial, federal employees, and specialty services. | Accredited* through 9/22/2025 Health Equity Accredited* through 11/15/2025 |
CareSource | 2017 | CareSource was founded in 1989 and is a nonprofit model of managed care. CareSource product lines include Medicaid, Marketplace, and Medicare Advantage programs. | Accredited* through 12/21/2024 |
Peach State | 2006 | Peach State Health Plan is a subsidiary of the Centene Corporation. Centene was founded in 1984. Product lines include Medicaid, Medicare, and the Exchange plans in some states. | Accredited* through 5/22/2023 |
WellCare | 2006 | WellCare of Georgia, Inc., is a subsidiary of WellCare Health Plans, Inc. WellCare was founded in 1985. Product lines include Medicaid, Medicare Advantage, Medicare Prescription Drug Plans, State Children's Health Insurance Programs, and others. On January 23, 2020, WellCare Health Plans, Inc. became a wholly owned subsidiary of Centene Corporation. The merger with Peach State Health Plan was completed on April 30, 2021. | Accredited* Accredited through 9/18/2023 |
*Accredited: NCQA has awarded an accreditation status of Accredited for service and clinical quality that meet the basic requirements of NCQA’s rigorous standards for consumer protection and QI.
**Amerigroup 360° is not separately accredited from Amerigroup.
Table 2-2 displays the Department of Community Health annual enrollment by program.
Program | April 2023 |
---|---|
Medicaid CMO | 2,184,084 |
Medicaid FFS | 642,561 |
Medicaid Total Enrollment | 2,826,645 |
PeachCare for Kids® | 207,162 |
Source: Advantage Suite, 6/1/2023, HD; This report is based on Medicaid and Peachcare for Kids® members in April 2023.
Agreed‐Upon Procedures Reports
These reports are conducted by an independent auditor to evaluate the Care Management Organizations (CMOs) contract compliance, program integrity (PI) oversight, subcontractor oversight, and encounter submissions.
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Amerigroup AUP Report - Posted 03/24/23
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CareSource AUP Report - Posted 08/12/22
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Peach State Health Plan AUP Report - Posted 08/12/22
Managed Care Periodic Audit Reports
Per federal regulations, the Department of Community Health must periodically, but no less frequently than once every three years, conduct or contract for an independent audit of the accuracy, truthfulness, and completeness of the encounter and financial data submitted by, or on behalf of each Care Management Organization and post the results of these audits on our website. 42 CFR§ 438.602(e) and (g).
Medical Loss Ratio (MLR) Reports
The Department of Community Health must ensure, through its contracts starting on or after July 1, 2017, that each Care Management Organization calculate and report a MLR in accordance with 42 CFR 438.8.
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Amerigroup 2020 MLR Final Signed Report - Posted 12/08/22
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CareSource 2020 MLR Final Signed Report - Posted 12/08/22
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Peach State 2020 MLR Final Signed Report - Posted 12/20/22
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WellCare 2020 MLR Final Signed Report - Posted 12/08/22
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Amerigroup 2019 MLR - Final Report - Posted 11/09/22
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CareSource MLR - Final Report - Posted 11/09/22
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PeachState 2019 MLR - Final Report - Posted 11/09/22
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WellCare MLR - Final Report - Posted 11/09/22
Encounter Data Reports
“Encounter data” are claims that have been paid by Care Management Organizations or delegated vendors (e.g., dental, vision, and pharmacy) to health care providers that have rendered health care services to members enrolled with the Care Management Organization (CMO).
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GA CMO Encounter Report - Amerigroup February 2021 thru January 2023 - Posted 04/19/23
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GA CMO Encounter Report - Amerigroup December 2020 thru November 2022 - Posted 02/07/23
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GA CMO Encounter Report - Amerigroup October 2020 thru September 2022 - Posted 12/13/22
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GA CMO Encounter Report - Amerigroup August 2020 thru July 2022 - Posted 12/09/22
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GA CMO Encounter Report - CareSource February 2021 thru January 2023 - Posted 04/19/23
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GA CMO Encounter Report - CareSource December 2020 thru November 2022 - Posted 02/07/23
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GA CMO Encounter Report - CareSource October 2020 thru September 2022 - Posted 12/13/22
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GA CMO Encounter Report - CareSource August 2020 thru July 2022 - Posted 12/09/22
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GA CMO Encounter Report - Peach State February 2021 thru January 2023 - Posted 04/19/23
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GA CMO Encounter Report - Peach State December 2020 thru November 2022 - Posted 02/07/23
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GA CMO Encounter Report - Peach State October 2020 thru September 2022 - Posted 12/13/22
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GA CMO Encounter Report - Peach State August 2020 thru July 2022 - Posted 12/09/22
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GA CMO Encounter Report - Wellcare October 2020 thru September 2022 - Posted 12/13/22
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GA CMO Encounter Report - Wellcare August 2020 thru July 2022 - Posted 12/09/22
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Care Management Organization Hospital Statistical and Reimbursement (HS&R) Reports
Care Management Organizations must provide the Hospital Statistical and Reimbursement (HS&R) report for a specific fiscal year as requested by the hospital provider within 30 days of the hospital's request. GA. Code § 33-21-A-11.
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Amerigroup HS&R Quarter 4 2022 Report
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Amerigroup HS&R Quarter 3, 2022 Report
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Amerigroup HS&R Quarter 2, 2022 Report
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Amerigroup HS&R Quarter 1, 2022 Report
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Amerigroup HS&R Quarter 4, 2021 Report
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Amerigroup HS&R Quarter 3, 2021 Report
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Amerigroup HS&R Validation Report Q2 2021
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Amerigroup - HS&R Quarter 1, 2021 Report
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Amerigroup - HS&R Quarter 4, 2020 Report
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CareSource HS&R Quarter 4 2022 Report
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CareSource HS&R Quarter 3, 2022 Report
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CareSource HS&R Quarter 2, 2022 Report
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CareSource HS&R Quarter 1, 2022 Report
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CareSource HS&R Quarter 4, 2021 Report
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CareSource HS&R Quarter 3, 2021 Report
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CareSource HS&R Validation Report Q2 2021
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CareSource - HS&R Quarter 1, 2021 Report
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CareSource - HS&R Quarter 4, 2020 Report
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Peach State Health Plan HS&R Quarter 4 2022 Report
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Peach State Health Plan HS&R Quarter 3, 2022 Report
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Peach State Health Plan HS&R Quarter 2, 2022 Report
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Peach State Health Plan HS&R Quarter 1, 2022
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Peach State Health Plan HS&R Quarter 4, 2021 Report
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Peach State Health Plan HS&R Quarter 3, 2021 Report
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Peach State HS&R Validation Report Q2 2021
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Peach State Health Plan - HS&R Quarter 1, 2021 Report
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Peach State Health Plan - HS&R Quarter 4, 2020 Report
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WellCare HS&R Validation Report Q2 2021
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WellCare - HS&R Quarter 1, 2021 Report
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WellCare - HS&R Quarter 4, 2020 Report
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HS&R Quarter 3 2020 Report
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HS&R Quarter 2 2020 Report
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HS&R Quarter 1 2020 Report
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hsr_quarter_4_2019_final
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hsr_report_q3_2019_final
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hsr_report_q2_2019_final
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hsr_report_q1_2019_final
Ownership and Control Interest and Criminal Conviction Information Reports
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Amerigroup-Disclosure of Ownership and Control Interest and Criminal Conviction Information - Posted 08/12/22
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CareSource-Disclosure of Ownership Control Interest Criminal Conviction Information - Posted 08/12/22
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Peach State-Disclosure of Ownership and Control Interest and Criminal Conviction Information - Posted 08/12/22
Medicaid Quality Reports
Review the Medicaid Quality reports page for Quality Strategic Plans, Quality Performance Dashboards, and External Quality Review Organization Reports.
Georgia Families and Georgia Families 360° Contracts
Review current Georgia Families and Georgia Families 360° contracts on the Georgia Families webpage.
Care Management Organization Resources
Amerigroup
- Drug Formulary
- Provider Directory
- Georgia Families Member Handbook
- Georgia Families 360° Member Handbook
- PeachCare for Kids® Member Handbook
- Planning for Healthy Babies Member Handbook
CareSource
- Drug Formulary
- Georgia Families Member Handbook
- Planning for Healthy Babies Member Handbook
- Provider Directory