1. What GAPP is
GAPP is a Georgia Medicaid program run by the Georgia Department of Community Health. It pays for medically necessary nursing care and personal care support services at home for medically fragile children under 21 who have Georgia Medicaid. The care is delivered by GAPP enrolled agencies like ours.
2. Who qualifies
Three things must be true: your child is under 21, has Georgia Medicaid, and has a documented need for skilled nursing or personal care support. The need is documented by your child’s physician on a plan of treatment. Common examples: ventilator dependence, tracheostomy, feeding tube dependence, seizure disorders needing rescue medication, and complex medication regimens. A diagnosis alone doesn’t qualify a child; the documented need does.
3. What it pays for and what it doesn’t
Pays for: skilled nursing by an RN or LPN at home; personal care support by an aide, in some cases including a trained parent. Doesn’t pay for: housekeeping, childcare, therapy sessions, medical equipment and supplies, or care for anyone but the child. Those may be covered by other Medicaid benefits.
4. Who decides
Georgia Medicaid’s medical review team (through its contractor, currently Alliant Health Solutions, or your child’s CMO plan) reviews the request and decides approval and hours. Agencies don’t decide. Doctors recommend; Medicaid approves.
5. The documents
- Proof of active Georgia Medicaid
- Physician plan of treatment, signed and dated within 30 days of submission
- Medicaid forms: DMA-6A (valid for one year) and DMA-80
- A caregiver and home information supplement, completed with the agency
- Letter of understanding and freedom of choice forms, signed yearly
- Recent hospital and specialist records, medication list, equipment list
- Optional: a letter of medical necessity from the physician, which helps
We prepare all of it with you.
6. The timeline
Assembling the packet usually takes one to three weeks, mostly waiting on records and signatures. Georgia Medicaid says the review can take up to 30 days after a complete request. Hospital discharges can move faster when the inpatient team and the agency work together. We can’t promise a date.
7. Hours
Medicaid approves hours based on documented medical necessity: what your child’s doctor says is needed and what the records support. No agency can promise a number of hours before the review. If the approved hours are fewer than your doctor ordered, you can appeal. See Denials and appeals.
8. Choosing and changing agencies
You choose the GAPP agency. You can change agencies without losing your child’s approval. If you’re unhappy with an agency, you don’t have to stay.
9. Renewals
GAPP approvals are time limited. Renewal needs an updated plan of treatment, records and forms, and the DMA-6A expires every year. We track your dates and start renewals 30 to 60 days early so hours don’t lapse.
10. Denials and appeals
If Medicaid denies or reduces hours, you get a written notice with the reason and your appeal rights. Appeals have deadlines. We help you and your doctor answer the reason in the notice with the right documents. Ask us the day you get a notice.
11. Paid parent caregivers
Georgia Medicaid allows parents and legal guardians to be paid for personal care support hours under GAPP. This covers daily living care, not skilled nursing. See our paid parent caregiver page.
12. Katie Beckett
If your family’s income is too high for regular Medicaid, the Katie Beckett program (Deeming Waiver) can qualify your child based on the child’s own income and level of need. Katie Beckett Medicaid can then be used for GAPP. Applications go through Georgia’s Division of Family and Children Services and a medical review. Start early; it takes months.
13. Turning 21
GAPP ends at 21. Adult Medicaid programs and waivers (such as the NOW and COMP waivers, or the Independent Care Waiver Program) have their own rules and waiting lists. We start the conversation with you a year ahead.