State healthcare programmes 2026: what has changed for patients, medicines and funding rules

What changed in 2026: a table with dates and sources

The table includes only changes that affect patients' rights, the scope of services or the application procedure, and that we have verified in the official texts. We have left out technical changes such as lists of providers, procurement rules and the budgets of individual budget lines. The “From” column gives the date from which the rule applies.

The comparison is based on the version of the 2025 programmes in force at the end of that year (No. 474, the last consolidated text on matsne for 2025) and the published text of the 2026 programmes, as well as on the amendments to Resolutions No. 655, No. 36 and No. 331 published up to 12 October 2026. The dates show when a rule took effect, not when it was adopted.

Paediatric cardiac surgery: the abroad component and new tariffs in Georgia

The most visible change in 2026 concerns children with congenital heart defects and works on two levels. The first is treatment abroad. A new component was added to the Referral Services Programme (No. 655, Annex 19): treatment of a child under 18 using a cardiac surgery method that is not performed in Georgia, on the terms of the “Paediatric Cardiac Surgery Convention”. Eligibility is determined by the referral commission, and children registered in Tbilisi, who are covered by the corresponding programme of Tbilisi Municipality, are excluded from this component.

In April, the commission's rules of procedure (No. 331) were brought into line. Resolution No. 169 added these children to the beneficiaries and recorded that the convention was concluded between the Geneva University Hospitals, Tbilisi City Hall and the Ministry of Health. The general requirements for treatment abroad, such as a doctor's recommendation in Form 100 and a breakdown of costs in the invoice, do not apply to these children: the service is funded on the terms of the convention. The order in which an application goes to the commission is described in our referral programme guide, and other sources of funding for a child's treatment are on the children's treatment funding page.

Surgery in Georgia: how much the ceiling tariffs have risen

The second level is treatment in Georgia. Annex 1.11 to Universal Healthcare (“Treatment of congenital heart defects”) was reworded in May and applies to cases occurring from 1 May 2026. The service is still reimbursed at actual cost, but no higher than the ceiling tariff for the category, and it is these ceilings that have risen:

Catheterisation tariffs were also revised: for example, the ceiling for a category IV intervention rose from GEL 10,406 to GEL 17,313. The co-payment rules stayed the same: in general the programme covers 70% of the actual cost, patients under 18 and beneficiaries in the socially vulnerable group pay nothing, other adult beneficiaries in protected groups pay 20%, and people of pensionable age pay 10%. There is also a new quality requirement: clinics must submit outcome indicators for the first time by 1 February 2027, and from 1 March 2028 only those that meet the conditions set by ministerial act will remain providers. For a family, a higher ceiling means that the programme's share of an expensive operation may increase; ask the clinic in writing how much the programme will cover in your particular case. In future, a clinic's outcome indicators will also become decisive when choosing where to have surgery.

Referral commission: what changed in the application and review rules?

The referral commission, which operates at the Solidarity Fund, reviews individual applications under Resolution No. 331. Resolution No. 169 of 27 April 2026, published on 29 April, dealt with three practical issues.

• Form IV-100/a will be checked more strictly. Every item in the certificate must be explained clearly and in detail, with ICD-10 and/or NCSP codes: the full diagnosis, concomitant diseases and complications, the medical history, the tests performed and the course of the disease. When treatment abroad is requested, a doctor's recommendation on this need is also required, again with codes.
• A foreign invoice must be broken down by cost. A translated and notarised invoice must show separately the non-medical costs (transfer, hotel, accompanying person) and the medical costs: surgery, conservative treatment, diagnostics, chemotherapy, radiotherapy.
• From 1 May, eye treatment abroad is first checked against what Georgia can offer. The commission sends the documents to every registered Georgian clinic licensed for eye surgery and waits for confirmation of whether they can provide the same service. Where necessary, the documents are also sent to the Ministry's specialist expert.

In practice, an incomplete certificate or a foreign invoice drawn up as a single lump sum will now hold up an application more often. Before you submit the documents, ask the doctor to enter the codes in Form 100 and the foreign clinic to break down the invoice. The figures and codes in the translated invoice and certificate must match the original exactly, so plan the financial document translation and the Form 100 translation together with notarisation as one package. For eye surgery, find out in advance which Georgian clinic performs the same procedure: if confirmation comes, the commission will probably refuse funding abroad. The detailed logic of funding for treatment abroad is set out in the guide to funding treatment abroad.

Rare diseases and medicines: the most dynamic area

The rare diseases programme (No. 655, Annex 17) changed three times in 2026, and this is also where the budget grew the most: from an initial GEL 70.0 million to GEL 84.9 million.

April: monitoring of neuromuscular diseases

A new component for people with Duchenne and Becker muscular dystrophy and spinal muscular atrophy took effect on 23 April. A beneficiary is entitled to one inpatient and two outpatient monitoring episodes a year, including consultations with a neurologist, cardiologist, pulmonologist, endocrinologist, gastroenterologist or nutritionist, and orthopaedist, as well as electrocardiography, echocardiography, Holter monitoring, spirometry, densitometry and laboratory tests. The service is reimbursed in full, with no co-payment, and the provider is a Universal Healthcare inpatient facility that confirms its participation in the programme.

July: an open list of medicines

From 30 July the programme text became “open” for three diseases: specific medicines for spinal muscular atrophy, medicines other than deflazacort for Duchenne muscular dystrophy, and medicines beyond the existing list for cystic fibrosis are determined by a legal act of the Minister. This matters: adding a new medicine no longer requires an amendment to the government resolution; a ministerial act is enough.

August-October: cystic fibrosis

According to a First Channel report of 11 August, after an agreement with Vertex Pharmaceuticals the Ministry of Health announced the procurement of Trikafta, an innovative cystic fibrosis medicine, for patients over the age of two with the relevant genetic mutation. Resolution No. 486, adopted in October and in force from 8 October, fully funded, with no co-payment, the outpatient services needed to provide the new medicine (consultations, laboratory and instrumental tests), and extended the same approach to new medicines for Duchenne muscular dystrophy. Prescribing a medicine for a particular patient and assessing the criteria is a matter for the treating doctor and the programme rules; a general picture of which medicine is covered by which programme is given in the guide to funding for medicines.

Universal Healthcare: the 2026 changes to Resolution No. 36

The Universal Healthcare Programme is not part of No. 655; it operates under Government Resolution No. 36 of 2013 and is implemented by the National Health Agency. Six changes were made to this resolution in 2026. None of them changed the main categories, the planned surgery limit or the co-payment shares, which are described in the Universal Healthcare guide. The changes concern specific services:

• Ruxolitinib for GVHD (from 1 July). Ruxolitinib procured under the list of oncology medicines is also provided to onco-haematology patients who develop steroid-refractory graft-versus-host disease (GVHD) after a bone marrow transplant. This also applies to children under 18.
• Bilateral cochlear implant (from 6 July). People with severe and profound sensorineural hearing loss who need a bilateral implant were added to the cochlear implant beneficiaries, provided the request reached the Agency before the age of 4. The detailed conditions are set by ministerial act, so bear in mind that the application deadline is the child's fourth birthday.
• Income deduction (from 21 September). The rule under which one-off assistance or compensation, including charitable assistance, is deducted from annual income now also covers a funded pension paid in for a person with disabilities. This matters for people who, because of this money, would exceed the GEL 40,000 threshold and lose part of the package. The deduction is not automatic: you must document the nature of the money to the Agency.
• Control of maternity hospitals (from 1 January). An amendment adopted in February applies retroactively: if, at a maternity facility working under a contract concluded from 2026, an analysis of the first three months shows that more than 70% of births ended in a caesarean section, the Agency suspends its provider status from the fifth month, and from 1 February 2027 providers will be selected on the basis of a 12-month analysis.
• Rabies post-exposure prophylaxis (from 1 July). High-risk employees of the National Food Agency are entitled to it with no co-payment, regardless of insurance and income.

The sixth change concerns the congenital heart defect tariffs described above. If your category depends on social status, check that it is accurate separately, using the social status guide.

Vaccination and screening: what was expanded in 2026?

Changes to the prevention programmes attract less attention, but they affect a large share of families.

Immunisation (Annex 2)

• HPV vaccine for men. In 2025 the “catch-up” rounds of human papillomavirus vaccination covered males aged 13-26; from 2026 they cover those aged 13-45, as was already the case for women. The schedule is the same: under 15, two doses at least six months apart; from 15, three doses.
• Free vaccination visit. If you take a child for vaccination to a facility where they are not registered for routine outpatient care, the facility may not charge you for the vaccine, nor for the vaccination visit or the doctor's consultation. In the 2025 text, only the vaccine was free.
• Invitations and follow-up. Parents receive invitations to their child's due vaccinations by SMS from the electronic immunisation system, and tracing zero-dose and incompletely vaccinated children has become a separate activity.

Early detection of disease (Annex 1)

Organised breast cancer screening is also carried out with a mammobile, that is, mobile mammography with ultrasound where needed, in locations planned by the Centre for Disease Control, including for women registered in Tbilisi. First and repeat screening invitations are sent as a personalised SMS to the registered mobile number. The pilot system for monitoring lead in children's blood, which in 2025 was limited to Tbilisi and several regions, covers the regions of Georgia in the 2026 text. The budget of this programme rose from GEL 3.4 million to GEL 4.6 million.

Dialysis, addiction treatment, mental health and budgets

In several programmes the change looks technical, but it affects the patient's path:

• Dialysis (Annex 15). Creating vascular access for haemodialysis and inserting or removing a peritoneal dialysis catheter were funded in 2025 through the Universal Healthcare DRG system; from 2026 they are a component of the dialysis programme and are reimbursed at tariffs set by ministerial act. The rules on the waiting list register and queue order have been removed from the programme text; the Agency sets the registration procedure in agreement with the Ministry. The requirement to connect a patient to dialysis immediately in a life-threatening condition is unchanged.
• Treatment of drug addiction (Annex 9). The minimum length of inpatient detoxification was set at 10 bed-days, and that of primary rehabilitation at a minimum of three sessions. From 1 March, substitution therapy providers, including those serving penitentiary facilities, must enrol patients who test positive for hepatitis C in diagnosis and treatment under the hepatitis management programme.
• Diabetes (Annex 13). From July, people held in penitentiary facilities also receive diabetes medicines, regardless of whether they have a document proving citizenship.
• Village doctor (Annex 18). A village doctor's monthly salary rose from GEL 1,362.50 to GEL 1,462.50, and a nurse's from GEL 1,118.75 to GEL 1,218.75.

How the budgets of the main programmes have changed

The figures come from the budget articles of Resolutions No. 474 and No. 655, are rounded to one decimal place and reflect the amendments published up to 12 October 2026. A budget is a programme's appropriation, not an individual entitlement: it often changes during the year, as happened with referral services in 2025.

What does all this mean for patients?

The changes are written in legal language, but they lead to five practical conclusions.

1. Check the date, not just the rule

   Every change has its own date of entry into force. The new heart defect tariffs do not apply to a case that occurred before 1 May, and the new check for eye treatment does not apply to an application submitted before 1 May. Write down the date of your case and ask the clinic or the commission which version they applied.

2. Review a 2025 refusal under the 2026 rules

   If last year you were refused HPV vaccination because of your age, monitoring for a neuromuscular disease or a bilateral cochlear implant, you may now be eligible under the new rules. A new application is often faster than appealing the old refusal.

3. Prepare documents to the new standard

   For the referral commission, Form 100 with codes and a foreign invoice with a cost breakdown are now the minimum requirement. Plan translation and notarisation in advance, so that your application is not returned over a technical defect.

4. Keep an eye on ministerial acts

   New rare disease medicines, the conditions for a bilateral implant and dialysis tariffs are set by ministerial acts. These acts change more often than the resolution, so check the specific condition with your doctor or on the Agency's hotline.

5. Ask for a refusal in writing

   If a clinic or agency says that the new rule does not apply to you, ask for a written response citing the provision. Appeal deadlines and routes are set out in the guide to appealing a refusal.

If you are not sure which component your case falls under according to the 2026 rules, a lawyer will check the version of the resolution in force as part of the funding search service, and if your rights as a patient have been violated, the patient rights protection service can help. Solidaroba.ge is not a state agency or fund and does not provide funding: we help with documents, translation and legal preparation.

Frequently asked questions about the 2026 changes