CareSource and Peach State Health Plan, two Georgia Medicaid managed care organizations, are cutting therapy reimbursement rates to 80% of the Medicaid fee schedule. CareSource's cuts take effect May 11, 2026. Peach State's follow on May 15.

When reimbursement drops 20%, therapists face a choice: absorb the loss or exit the network. Many will leave. A physical therapist quoted in the Moultrie Observer put it plainly: "I don't know any business who could roll the clock back that far."

If your child receives speech, occupational, or physical therapy through either MCO, your provider may drop out of the network this month. Here's what to do.

Why Providers Leave When Rates Drop

Therapists aren't choosing to exit networks out of principle. They're choosing to stay solvent. When reimbursement doesn't cover the cost of providing care, the decision makes itself.

Medicaid fee schedules already reimburse below commercial rates. An 80% cut means therapists are paid less than what it costs to deliver a session when overhead, credentialing, documentation time, and liability insurance are factored in. Small practices and solo providers can't absorb that gap indefinitely. Larger clinics may continue accepting Medicaid patients selectively, but capacity shrinks fast.

In rural Georgia, the impact is immediate. One Statesboro clinic serves 900 Medicaid-enrolled children and is one of only two providers within 50 miles. If it drops out of CareSource or Peach State's network, families in that region lose local access.

What Network Adequacy Rules Require

Georgia's managed care contracts with CareSource and Peach State include network adequacy standards. MCOs must maintain enough providers to deliver medically necessary services without unreasonable delay or travel.

On paper, those rules protect access. In practice, enforcement is weak. An MCO can claim adequate networks by counting providers who are technically in-network but not accepting new patients, or by defining "reasonable travel" broadly enough to include providers two counties away.

Families whose therapists exit the network don't automatically get reassigned. The MCO will provide a list of remaining in-network providers, but whether those providers have openings, accept the child's age group, or offer the specific service your child needs is not guaranteed.

Four Steps to Take This Week

1. Contact Your MCO Directly

Call the member services number on your insurance card. Ask three questions:

• Has my child's current therapy provider confirmed participation in the network after the May rate change?
• If they've exited, which in-network providers in my county accept new pediatric patients for [speech/OT/PT]?
• What is the process for requesting an out-of-network exception if no in-network provider is available within reasonable distance?

Document the call: date, time, representative name, and what they told you. If they can't answer, ask when you'll receive written confirmation.

2. Request an Out-of-Network Exception in Writing

If your current provider exits the network and the MCO can't identify an available in-network replacement within a reasonable distance, you can request an out-of-network exception. This allows your child to continue seeing the original provider at in-network cost-sharing rates while the MCO pays the provider at a negotiated rate.

Submit the request in writing to the MCO. Include:

• Your child's name, member ID, and current diagnosis
• The exiting provider's name and specialty
• A statement that no in-network provider in your county is accepting new patients for this service
• A physician's statement that continuity of care is medically necessary (if applicable)

Send via certified mail or through the MCO's online portal with confirmation of receipt.

3. File a Grievance With the State Medicaid Agency

If the MCO denies your out-of-network exception or can't provide an available in-network provider, file a grievance with the Georgia Department of Community Health, which administers the state's Medicaid program.

Georgia Medicaid members can file grievances online at Georgia Gateway or by calling 1-877-423-4746. The grievance should state:

• Your MCO denied access to medically necessary therapy services
• The rate cut caused your provider to exit the network
• No in-network provider is available within reasonable distance
• Your out-of-network exception request was denied or not responded to

Georgia Medicaid has 90 days to resolve grievances, but families can request an expedited review if the delay poses serious risk to the child's health.

4. Begin Identifying Alternative Providers Now

While you work through the exception and grievance process, start calling other providers. Even if they're out-of-network or not currently accepting Medicaid, ask if they'd consider seeing your child if you can secure an out-of-network exception or if network participation changes.

Keep a log of every provider you contact, whether they're accepting patients, and what they told you. This documentation strengthens your case if you need to escalate to a fair hearing.

What Protections Exist for Children With Severe Chronic Conditions

Georgia's managed care contracts include continuity-of-care protections for children with severe chronic conditions like cerebral palsy. If your child qualifies, the MCO must allow continued access to the exiting provider for up to 90 days while a transition plan is developed.

Ask your pediatrician or specialist to submit documentation that your child meets continuity-of-care criteria. This buys time but doesn't solve the underlying problem if no replacement provider exists.

When the MCO Can't Meet Network Adequacy Standards

Network adequacy requirements are only as strong as their enforcement. If the state determines an MCO has failed to maintain adequate provider networks, it can impose corrective action plans or financial penalties. But those remedies don't help the family whose child lost access to therapy last week.

Georgia's Medicaid ombudsman can intervene in cases where MCOs fail to provide required services. Contact the ombudsman at 1-866-229-4392 if you've exhausted the MCO's internal grievance process and still don't have a solution.

What This Means for Therapy Access Statewide

CareSource and Peach State cover hundreds of thousands of Georgia Medicaid enrollees. A 20% rate cut affects every therapist who treats children in those plans. The therapists who stay in-network will see increased demand as others exit. Wait times will grow.

Georgia isn't the only state facing this pattern. Medicaid MCOs nationwide face budget pressure as federal matching funds decline and enrollment surges. Rate cuts are one lever MCOs use to close gaps. Provider exits are the predictable result.

For families, the action items remain the same regardless of the state: contact the MCO, request exceptions in writing, document every interaction, and file grievances when access is denied. The bureaucratic process is slow, but it creates a record that state regulators can act on.

What Happens After May 15

Once the rate cuts take effect, the MCOs will publish updated provider directories. Check your child's provider against the new directory within two weeks of the effective date. If they're no longer listed, don't wait for a notification letter. Start the exception and grievance process immediately.

Medicaid MCOs are required to notify members if their provider exits the network, but notices can arrive weeks after the change takes effect. Families who wait for the notice lose time they could have used to secure continuity of care.