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If you are reapplying for Food Stamps or Medicaid, or renewing your TANF or Medicaid benefits, you can file this application/renewal form with only your name, address and signature.
If you are reapplying for Food Stamps or renewing your TANF or Medicaid benefits, you can file this renewal/application form with only your name, address and signature. However, it will help us to process your application, recertification and/or renewal more quickly if you complete the entire form and provide verification of
. If you are reapplying for Food Stamps (SNAP) or renewing your TANF or Medicaid benefits, you can file this renewal/application form with only your name, address, and signature.
To improve efficiency and timeliness of the revalidation process, DCH will require all providers to revalidate online only using the Georgia Medicaid Management Information System (GAMMIS) at www.mmis.georgia.gov. Providers may not revalidate using a paper application.
P roviders should prepare a Change of Information form that can be found on the Georgia Web Portal homepage at www.mmis.georgia.gov. Click on Provider Information and scroll down to Forms at the bottom of the page and click on the Medicaid -- PeachCare for Kids® Provider
Please click the 'New Application' to start a new Provider Enrollment application or click 'Continue Application' to continue with an existing application. 42 CFR 455.460 requires that certain prospective (new), re-enrolling, or revalidating providers pay an application fee.
Download and print the Medicaid renewal form. Bring the completed form to your local DFCS office. You will receive a notice when your renewal has been completed by DFCS, your case will remain open until then.
