Get ready to apply
Georgia Medicaid
CHIPRA Premium Assistance
What you get
Help reimbursing health-insurance premiums through a parent's or child's job while Medicaid coverage continues. Ask whether requests are open.
- Who starts it
- You
- How it’s sent
- Online, on their website
- Your time
- About 15 minutes
- Last checked
- Aug 27, 2026
Before you start, check you fit
- Your child is 18 or under.
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What their form asksA preview, so you can gather things first. Fill it in on their site.
Open their application ↗ Checked Aug 27, 2026What the form asks for
CHIPRA application questionsHead of HouseholdPolicyholder’s NamePolicy NumberGroup NumberPolicyholder’s Social Security NumberPolicyholder’s Date of BirthIs the policy referenced in #1 the primary policyIs there a secondary policy with another employerComplete the following information regarding the employer offering the policy referenced in #1List all Medicaid eligible persons covered under this policyHave any of the persons in #5 been diagnosed with a medical condition? If yes, please list all medical conditions or diagnosisIf known, how much are the premiums for this policyHow often is the premium amount paidCan we contact your employer and/or insurance carrier to verify this informationDo you authorize the GA CHIPRA Unit to send communication via electronic mail to the policyholder’s email address provided aboveHave ready
- Copy of COBRA enrollment packet, only if COBRA benefits may be available and forms were received.
After you send
Call CHIPRA Unit at (678) 564-1162, option 2, for application and eligibility questions. If you have not heard back in two weeks, write and ask whether it arrived.