Georgia Medicaid managed care: what plans must pay
Managed-care plans don't publish their provider fee schedules. What is public is the rule each plan must follow, set in Georgia's plan contracts, statutes and notices. For 0 of 19 service lines, plans must follow a rule tied to the state's published rates.
- Lines with a binding rule
- 0of 19
- Plans on record
- 14
- Directed payments
- 0
- Capitation cells
- 178$19.76–$8,978.43 PMPM
Who sets the rate, by service line
| Service line | Main rule for plans | Rates | Also applies |
|---|---|---|---|
| Physician & professional | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 10,097 | |
| Hospital inpatient | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 2,928 | |
| Radiology | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 1,906 | |
| Equipment & supplies | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 1,734 | |
| Lab & pathology | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 1,694 | |
| Pharmacy | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 810 | |
| Nursing facility | Paid by the state, outside plansPaid directly by the state, outside managed care | 712 | |
| Therapy (PT/OT/speech) | Paid by the state, outside plansPaid directly by the state, outside managed care | 214 | Plans negotiate; applies out of network |
| Dental | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 154 | |
| Hospice | Paid by the state, outside plansPaid directly by the state, outside managed care | 154 | |
| IDD services | Paid by the state, outside plansPaid directly by the state, outside managed care | 149 | |
| ABA / autism services | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 120 | |
| Other home & community services | Paid by the state, outside plansPaid directly by the state, outside managed care | 108 | Plans negotiate; applies out of network |
| Vision & hearing | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 39 | |
| Behavioral health | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 29 | Paid by the state, outside plans |
| Personal care & attendant | Paid by the state, outside plansPaid directly by the state, outside managed care | 20 | |
| Private duty nursing | Paid by the state, outside plansPaid directly by the state, outside managed care | 13 | Plans negotiate; applies out of network |
| Home health | Paid by the state, outside plansPaid directly by the state, outside managed care | 9 | Plans negotiate; applies out of network |
| Transportation | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 9 |
Frequently asked questions
Do Georgia Medicaid plans have to pay the state fee schedule?
The plan contracts we reviewed do not tie plan payment to the state's rates for most lines; plans negotiate rates with providers.
Where do these rules come from?
From Georgia's managed-care plan contracts, state statutes and regulations, provider notices and CMS-approved directed-payment filings. Each rate in the workspace carries its citation.
Can I see what each plan actually pays?
No plan publishes its provider fee schedule. The closest public signals are the binding rules above, state-set rates, directed payments and the state's own payment-level estimates in its directed-payment filings.