For families
GAPP, in plain English.
The Georgia Pediatric Program (GAPP) is a Georgia Medicaid program. It pays for skilled nursing at home, and in some cases personal care support, for medically fragile children under 21. Here is what it covers, who qualifies, and how the decision gets made.
Who qualifies
Your child is under 21.
GAPP serves children from birth until they turn 21.
Your child has Georgia Medicaid.
Any Georgia Medicaid coverage, whether your child is in a Georgia Families health plan (CMO) or in fee for service.
Your child’s doctor documents a need for skilled nursing.
The doctor signs a plan of treatment that says what nursing tasks your child needs and how often.
All three have to be true. If your child doesn’t have Medicaid yet, read the Katie Beckett section below before you give up.
What GAPP pays for
Covered
- Private duty nursing at home by an RN or LPN, for the hours Medicaid approves
- Nursing for ventilators, trachs, feeding tubes, oxygen, seizures and complex medications
- Personal care support services by an aide, in some cases including a trained parent
Not covered by GAPP
- Housekeeping and babysitting
- Therapy visits (PT, OT, speech)
- Medical equipment and supplies (those come through DME benefits)
- Care for other family members
Who decides, and what we control
Georgia Medicaid’s review team decides whether your child qualifies and how many hours are approved. They decide from the documents: the doctor’s plan of treatment, medical records, and the forms. We don’t decide, and no agency can promise you a number of hours before the review. What we control is the request. We make it complete, we make it clear, and we follow it until there is an answer.
What the request needs
- Proof of Georgia Medicaid
- Physician plan of treatment, signed and dated within the last 30 days
- Medicaid forms DMA-6A and DMA-80
- Recent hospital or specialist records
- Current medication list with doses
- Equipment list: vent, pump, oxygen, monitors
- A description of what caregivers do at home now and where the gaps are
We gather and fill out all of this with you. You sign.
How long it takes
Getting the packet together
Usually one to three weeks, mostly waiting on records and signatures.
Medicaid’s review
Georgia Medicaid says up to 30 days after a complete request.
Starting nursing
As soon as we have the approval and a matched nurse. Hospital discharges are staffed first when we can.
Renewals
GAPP approvals are time limited. Renewal needs updated orders, records and forms. We track your dates and start renewals 30 to 60 days early.
Appeals
If Medicaid denies the request or approves fewer hours than your doctor ordered, you have the right to appeal. We’ll help you and your doctor put the appeal together.
Katie Beckett
Georgia’s Katie Beckett program (also called the Deeming Waiver) lets a child with significant medical needs qualify for Medicaid based on the child’s own income and needs, not the parents’ income. If you’ve been told your family earns too much, ask us about it. Many GAPP families got there through Katie Beckett.
See if your child qualifies
Fill this out and a decision maker will call you.