Municipal medical assistance: how City Hall healthcare programmes work and how to apply

How does a municipal healthcare programme work?

A municipal healthcare programme is not a copy of a state programme. Its legal basis is the Local Self-Government Code, and the specific rules are approved by the municipal council every year together with the budget. The resolution is published in the Legislative Herald and sets out who the beneficiaries are, what is funded and up to what limit, which documents are needed and who makes the decision.

The rules differ widely from one municipality to another, but a few elements recur almost everywhere:

• Registration requirement. The beneficiary is someone registered in the municipality. Some sub-programmes also check how long you have been registered.
• Annual restriction. The same type of assistance is usually given once a year and up to a fixed limit.
• State comes first. The municipality fills the gaps the state does not cover, so it often asks for the decision of the Universal Healthcare Programme or the Ministry.
• Prior approval. Funding is provided through a guarantee letter or voucher, and services provided before it is issued are generally not reimbursed.

Tbilisi 2026: what sub-programmes exist and how do you get into them?

The 2026 rules for the Tbilisi Municipality healthcare sub-programmes were approved by City Council Resolution No. 6-18 of 26 December 2025 and have applied since 1 January 2026. The resolution brings together nine sub-programmes:

• disease screening (early detection of breast, cervical, prostate and colorectal cancer);
• epidemiological control of communicable and non-communicable diseases;
• habilitation of children with autism spectrum disorder;
• transplantation (bone marrow transplantation for listed diagnoses and liver transplantation in Georgia);
• medicines for breast cancer, multiple sclerosis and rheumatoid arthritis;
• community mental health services;
• joint replacement surgery.

All of them are run by City Hall's Healthcare and Social Services Department, but the entry conditions differ. For example, the transplantation sub-programme requires one year of continuous registration before you apply to City Hall, and joint replacement requires the last two years; in both cases people who have registered in Tbilisi for the first time and were never registered in another municipality before are also eligible.

Joint replacement as an example

This sub-programme shows clearly how the municipality fills the state's gaps: the Universal Healthcare Programme does not cover orthopaedic joint replacement, with minor exceptions, whereas Tbilisi City Hall funds hip and knee replacement. The mechanism works as follows:

1. Contact a clinic

   The patient or their legal representative chooses a participating clinic and the type of prosthesis. The clinic submits the request through the electronic module.

2. The clinic uploads the documents

   The module receives the patient's details, Form IV-100/a, issued no more than 3 months before the request is registered, and a preliminary cost estimate.

3. You submit an insurance statement

   If you have private insurance, after the request you must give the department a statement from your insurance company about its funding.

4. Receive a code by SMS

   If the decision is positive, you automatically receive a unique request code, which you present to the clinic.

5. Activate it within 60 days

   The decision must be activated within 60 days of issue. The period can be extended once, and only before it expires.

Funding is capped at GEL 6,000, the patient's co-payment is set according to the actual cost, and the same service is funded once per budget year. The sub-programme is not available to beneficiaries under Annex 1.3 of the Universal Healthcare Programme or to anyone who turned down joint replacement offered by the Ministry.

Zugdidi 2026: the classic model with a commission and a guarantee letter

Zugdidi Municipal Council Resolution No. 4 of 16 January 2026 (amended on 6 March) is a good illustration of the more common model, in which you apply directly to City Hall. The application is reviewed by the healthcare commission, which sets the amount of funding for each beneficiary, and a guarantee letter is issued on the basis of its decision.

Co-funding of an operation once a year is available to socially vulnerable people with a score below 65,001, persons with disabilities, cancer patients, pensioners, children under 18 and students. An operation covered neither by universal healthcare nor by private insurance may receive up to GEL 1,000 by decision of the commission.

The same rules also fund other services: CT and MRI scans up to GEL 250 once a year, coronary angiography up to GEL 1,000, co-funding of PET/CT up to GEL 1,000, expensive medicines (unit price of GEL 50 or more) up to GEL 150, and up to GEL 400 for cancer patients. The guarantee letter has a validity period: 45 calendar days for medicines and tests, 60 days for an operation, 90 days for a hearing aid and 180 days for rehabilitation. An ordinary beneficiary may use one sub-programme a year, while socially vulnerable people, persons with disabilities and cancer patients may use each service once.

What documents does City Hall need?

The exact list is set by your municipality's rules, but both models discussed above ask for almost the same core set. Under the Zugdidi rules, the beneficiary or an adult family member submits to City Hall:

• an application;
• copies of the ID cards of the beneficiary and the applicant and, where needed, a birth certificate, an IDP certificate and proof of registration;
• Form IV-100/a and an invoice;
• where applicable, an extract from the database of socially vulnerable families and a document confirming disability status;
• for co-funding of an operation, the referral or decision of the Universal Healthcare Programme or the Ministry, or, if funding was not granted, the refusal of the relevant body;
• for an emergency operation, additionally, a debt acknowledgement agreement;
• for cash assistance (specialised nutrition, palliative care), a bank account number and monthly proof of expenses.

Two practical notes. First, the rules limit how "fresh" Form IV-100/a must be (3 months for joint replacement in Tbilisi, 5 months for the autism programme in Zugdidi), so do not turn up with an old certificate. How to get a certificate that will not be sent back is explained in the Form 100 guide. Second, if the operation is planned abroad, you will need a Georgian translation of the foreign invoice; we prepare this through our financial document translation service.

Where and when should you apply?

The main rule is simple: you apply to the municipality where you are registered, not the one where the clinic is or where you actually live. The application route depends on the type of sub-programme:

1. Through the clinic. If the sub-programme works through an electronic module (like joint replacement in Tbilisi), the clinic starts the process and you provide the code received by SMS and the required statements.
2. By application to City Hall. If the rules provide for review by a commission (as in Zugdidi), you submit the document package to City Hall and wait for the guarantee letter.
3. Directly with the provider. Screening and similar preventive sub-programmes are usually used at a facility registered as a provider under the sub-programme.

Most time is lost when you apply to the municipality too early: many rules need the state programme's decision to work out how much they will fund. So first get the Universal Healthcare Programme letter (how it works is explained in the universal healthcare guide), and then go to City Hall. The full sequence of funding sources is described in the guide to funding for surgery.

How do you find your municipality's current rules?

Almost every municipality's rules are in the Legislative Herald, but finding them is not always easy, because titles vary and amendments are added during the year. Proceed as follows:

1. On matsne.gov.ge, search for the name of the municipality together with the words "healthcare" or "medical" and the current year (the search works in Georgian).
2. Choose the council's main resolution and check whether it has later amendments; some amendments change who is eligible, as happened with the Tbilisi screening sub-programme in May 2026.
3. Look for five things in the document: who the beneficiaries are (including the registration period), what the limit is, which documents are needed, who makes the decision and how long the guarantee letter is valid.
4. If anything is unclear, ask City Hall in writing and keep the reply.

One word of warning: the municipal budget is annual, and a sub-programme's allocation may run out towards the end of the year. If you can choose the date of treatment, apply at the beginning or in the middle of the year.

What to do if you are refused, and where we can help

A refusal by City Hall or its commission is a decision of an administrative body, which must be issued in writing with reasons and can be appealed within the statutory deadline. Before you write a complaint, compare the reason for refusal with the text of the rules: often it is enough to submit a missing document or bring the state programme's letter. Deadlines and the structure of a complaint are covered in the guide to appealing a refusal, and the role of social status in municipal limits in the social status guide.

If you would rather not find the rules, assemble the package or correspond with City Hall yourself, Advocat.Ge lawyers do this as part of the funding search service: they find the current version of your municipality's rules, check which sub-programme you qualify for and prepare the application.

Frequently asked questions about municipal assistance