Under 21 years old
GAPP serves children and young adults under the age of 21. As that birthday approaches, care transitions to adult Medicaid services — start that conversation early.
GAPP & Eligibility
The Georgia Pediatric Program (GAPP), explained
GAPP is the Georgia Medicaid program that pays for skilled nursing at home for medically fragile children under 21. This is the complete guide: who qualifies, what it covers, how hours are decided, how a parent can be paid, and exactly how to apply.
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Days to typical approval
What GAPP is
A Medicaid benefit, not a waiting list you have to win
The Georgia Pediatric Program is a Georgia Medicaid program that pays for skilled nursing care in the home for medically fragile children under the age of 21. It is administered by the Georgia Department of Community Health.
The reasoning behind it is simple. Children with complex medical needs do better at home than in a hospital. They sleep better, they develop faster, they get sick less often, and they grow up with their families instead of visiting them. What makes home safe is skilled nursing, and skilled nursing has to be paid for.
For families who qualify, GAPP covers that nursing at no out-of-pocket cost. It is a benefit your child either medically qualifies for or does not — not a grant you compete for, and not something an agency can talk you into.
Who this page is for: Georgia parents of a child under 21 with complex medical needs — including families still being told they earn too much for Medicaid, and families already approved who want to change agencies.
Eligibility
Who qualifies for GAPP
Three things have to be true at the same time. Two out of three is a no — but two out of three is also usually fixable, which is why the free review is worth the phone call.
A Georgia Medicaid member
Your child must be enrolled in Georgia Medicaid. If household income is the barrier, ask about the Katie Beckett pathway — it qualifies many children on their own need instead.
Documented medical necessity
Your child’s physician documents a genuine need for skilled nursing at home. The documentation, not the diagnosis alone, is what the reviewer decides on.
Qualifying conditions
Conditions we commonly see approved
This list is not exhaustive and it is not a guarantee. GAPP approves a documented need for skilled nursing, not a diagnosis — what matters is the tasks your child’s care actually requires.
- Ventilator dependence, full-time or overnight
- Tracheostomy, with or without ventilator support
- Chronic respiratory failure and chronic lung disease
- Spina bifida
- Cerebral palsy
- Paraplegia and quadriplegia
- Seizure disorders requiring skilled monitoring or rescue medication
- Feeding tube dependence — NG, G-tube, GJ or J-tube
- Genetic and metabolic disorders with skilled nursing needs
- Complex airway conditions requiring suctioning or oxygen
- Neuromuscular conditions affecting breathing or swallowing
- Medically fragile infants transitioning home from a NICU or PICU
Not sure whether your child’s condition qualifies? The eligibility review is free and takes one conversation. Call (201) 696-8934.
What GAPP covers
Skilled nursing hours, in your home
GAPP pays for private duty nursing — continuous, one-to-one care measured in shifts rather than fifteen-minute visits.
Skilled nursing hours in your home
Continuous, one-to-one private duty nursing measured in shifts, not in fifteen-minute visits. The nurse stays for the full authorised period.
RN and LPN care
Registered nurses and licensed practical nurses, with an RN supervising the plan of care regardless of who is on shift.
Care for high-acuity needs
Ventilator management, tracheostomy care, suctioning, oxygen, tube feeding, complex medication regimens and seizure response.
Nights, weekends and around the clock
Authorised hours can fall at any hour. Overnight coverage is common, and for many families it is the hours that matter most.
The paid parent caregiver provision
Qualifying parents and guardians can be trained, employed and paid to provide approved hours of their own child’s care.
Care coordination
Plan of care, physician communication and the authorisation paperwork that keeps the hours flowing without a gap.
What it does not cover
Worth knowing before you are surprised by it
- Housekeeping, laundry, errands or care for your other children
- Babysitting or childcare with no skilled nursing need
- Durable medical equipment and supplies — these are covered by Medicaid separately, through your DME provider
- Therapies such as physical, occupational or speech therapy, which are authorised under different Medicaid benefits
- Care for anyone in the household other than the approved child
Equipment and therapies are covered by Georgia Medicaid under separate benefits. They still have to work together — coordinating them is part of what our care coordinators do. See comprehensive care at home.
How hours are determined
Medical necessity decides. Not us, and not how well you argue.
Authorised hours are set by your child’s documented medical necessity, as written by their physician and reviewed by Georgia Medicaid. Reviewers are asking a specific question: what skilled tasks does this child need, how often, at what hours of the day, and what happens if nobody qualified is there to do them.
Most families we serve are approved for 25 to 40 hours per week. Children with higher acuity, such as ventilator dependence, are frequently approved for substantially more, including overnight coverage.
Two things worth saying plainly. First, no agency decides your hours — if one promises you a number before the review, they are telling you something they cannot know. Second, hours follow the child. If your child’s condition changes, the documentation should change with it, and the hours can be reassessed.
- Skilled tasks, documented. Suctioning, ventilator management, tube feeds, rescue medication, skilled assessment.
- Frequency and timing. A child who needs care at 3am has a different case from one who needs it at 3pm.
- The consequence of no nurse. The reviewer is weighing risk, so the record has to be honest about it.
Paid parent caregiver
You may be able to be paid to care for your own child
One of the most important things about GAPP, and one of the least known.
Georgia allows qualifying parents and guardians to be trained, employed and paid to provide approved hours of their own child’s care. You do not need to already be a nurse to ask about it.
The provision exists for a practical reason rather than a sentimental one. Some children need skilled care at hours no agency can reliably staff, in counties where nurses are thin on the ground. Meanwhile the person already doing that care at 3am, competently, every night, is the parent. Paying that parent is often the safest and most stable answer available.
What it means in practice: you are trained to a documented competency standard, you are employed, you are paid for approved hours, and you are supported by an RN supervisor like any other caregiver on the case. It is a job, with a standard, not a stipend.
Whether your family qualifies depends on your child’s approved hours and your household circumstances. We handle the training, the credentialing and the employment side — ask us during your consultation.
Ask about it by name. Many families are never told this exists. If you are on this page and you are already the one doing the 3am care, raise it on your first call.
How to apply
The GAPP application, step by step
This is the whole process. We do steps one through three with you, and most of step two for you — because that is where applications stall.
Confirm Medicaid and get a physician’s order
Your child must be a Georgia Medicaid member. If they are not, that application comes first — the Katie Beckett pathway is how many children with significant disabilities qualify regardless of household income. In parallel, your child’s physician documents the need for skilled nursing in the home and signs the order.
- Georgia Medicaid membership confirmed
- Physician order for skilled nursing
- Katie Beckett route if income is the barrier
Assemble the clinical documentation
This is where most applications stall, and it is the part we take off you. Current clinical notes, hospital records, the medication list, equipment details and a plan of care all have to tell one consistent story about what your child needs and why a nurse is the person who has to provide it.
- We collect the records
- We build the plan of care
- We chase the signatures
Submit, review and approval
The completed request goes to Georgia Medicaid for a medical necessity review. Reviewers decide both whether your child qualifies and how many weekly hours the documentation supports. Most families we serve have an answer within about 30 days.
- Medical necessity review
- Hours determined from documentation
- Typically approved within 30 days
Meet your team and start care
Once hours are authorised, you meet the nurses who will actually be in your home, and you have a say. If a parent qualifies for the paid caregiver provision, we start the training and credentialing. Then care begins on your schedule.
- You meet your nurses
- Parent caregiver training if you qualify
- Care starts on your schedule
Required documentation
What the reviewer needs to see
Applications rarely fail because a child does not need care. They fail because the paperwork is incomplete, out of date, or tells two different stories. Here is the checklist.
- Proof of Georgia Medicaid membership for your child
- A signed physician order for skilled nursing in the home
- A current history and physical, plus recent clinical notes
- Recent hospital or specialist records, including discharge summaries
- The current medication list with doses and routes
- Equipment details — ventilator model and settings, trach size, feeding pump and formula
- A plan of care describing the skilled tasks required and their frequency
- Documentation of the caregiving already happening at home, and where the gaps are
You do not have to assemble this alone. Collecting the records, building the plan of care and chasing physician signatures is the work we take off families. Bring us what you have and we will find the rest.
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Days to typical approval
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Average hrs approved weekly
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Years old — who GAPP serves
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Out-of-pocket cost when approved
Timelines and renewal
What happens after approval
Approval typically lands within about 30 days. The clock is driven almost entirely by how quickly complete, consistent documentation reaches the reviewer. Applications stall for boring reasons — a missing signature, a clinical note from eight months ago, a plan of care that does not match the physician order. For urgent hospital discharges we move faster; call and say the word “discharge”.
Authorisations are time-limited. Nothing renews automatically. Renewal requires current documentation that the medical necessity continues: updated physician orders, current clinical notes and an updated plan of care. A lapsed authorisation means a gap in your child’s care, and gaps are exactly what this program exists to prevent.
We track your renewal dates and start early. That is our job, not yours. Renewal is also the right moment to have hours reassessed if your child’s condition has changed since the last review — in either direction.
If hours are denied or reduced, you can appeal. You have appeal rights including a Medicaid fair hearing, and there is a deadline printed on the letter. Do not miss it. A denial is frequently a documentation problem rather than a judgement that your child does not need care.
GAPP vs Katie Beckett vs private insurance
Three different things families are told are the same thing
They are not alternatives to each other. Understanding which one you are talking about saves months.
GAPP
A Georgia Medicaid benefit that pays for skilled nursing hours at home for medically fragile children under 21. Your child must already be a Medicaid member and must meet medical necessity. No out-of-pocket cost. Most of our families are approved for 25 to 40 hours per week.
This is the program that puts a nurse in your home.
Katie Beckett / Deeming Waiver
A pathway onto Medicaid, not a nursing benefit. It lets some children with significant disabilities qualify for Georgia Medicaid based on their own income and level of need rather than their parents’ income. Families are often told they “earn too much” — this is the answer to that.
Katie Beckett gets you Medicaid. GAPP then gets you nursing.
Private insurance
Some commercial plans cover private duty nursing, but authorised hours are typically far more limited than GAPP, with annual caps and repeated re-authorisation. Many children with private insurance also qualify for Medicaid as a secondary payer based on disability.
Having private insurance does not disqualify your child from GAPP.
GAPP questions, answered
Everything else families ask about GAPP
GAPP is a Georgia Medicaid program that pays for skilled nursing care delivered in the home to medically fragile children under 21. It exists because children with complex medical needs do better at home than in a hospital or an institution — they sleep better, develop faster and get sick less often — and because the nursing that makes home safe has to be paid for by someone.
For families who qualify, GAPP covers that nursing at no out-of-pocket cost.
Three things must be true: your child is under 21, your child is a Georgia Medicaid member, and your child has a documented medical need for skilled nursing, signed by their physician. All three, together. Two out of three is a no.
Qualifying is about medical necessity, not about diagnosis alone. Two children with the same diagnosis can receive very different answers depending on what their care actually requires day to day.
The conditions we most often see approved include ventilator dependence, tracheostomy, chronic respiratory failure, spina bifida, cerebral palsy, paraplegia, seizure disorders, feeding tube dependence and genetic or metabolic disorders.
But the program does not approve a diagnosis — it approves a documented need for a skilled nurse. What matters is the tasks: suctioning, ventilator management, tube feeds, rescue medications, skilled assessment. If those tasks are real and documented, the diagnosis behind them matters less than parents expect.
By medical necessity, as documented by your child’s physician and reviewed by Georgia Medicaid. Reviewers look at what skilled tasks your child needs, how often, at what hours, and what happens if nobody qualified is there.
Most families we serve are approved for 25 to 40 hours per week. Children with higher acuity, such as ventilator dependence, are frequently approved for substantially more. Nobody at HomeCare Roots decides your hours, and any agency that promises you a specific number before the review is telling you something they cannot know.
In many cases, yes. Georgia allows qualifying parents and guardians to be trained, employed and paid to provide approved hours of their child’s care. You do not have to already be a nurse to ask about it.
The provision exists for a practical reason: some children need care at hours no agency can reliably staff, and the person already doing it at 3am is the parent. We handle the training, the credentialing and the employment side. Whether your family qualifies depends on your child’s approved hours and your household circumstances — ask us during your consultation.
Most families we work with have an answer within about 30 days of their consultation. The clock is driven almost entirely by how fast complete, consistent documentation reaches the reviewer.
Applications stall for boring reasons: a missing signature, an old clinical note, a plan of care that does not match the physician order. That is precisely the part we take over. For urgent hospital discharges we move faster — call and say the word “discharge”.
No. For eligible children, GAPP-covered nursing has no out-of-pocket cost — no copay for the nursing hours, no deductible, no bill after the fact. We also do not charge families to apply, to be assessed, or to have their eligibility reviewed.
If any agency asks you to pay a fee to apply for GAPP, stop and call someone else.
Ask about Katie Beckett, also called the Deeming Waiver or TEFRA. It lets some children with significant disabilities qualify for Georgia Medicaid based on the child’s own income and level of need rather than their parents’ income.
This is the single most common thing families are never told. Household income disqualifying you from ordinary Medicaid does not necessarily disqualify your child. Katie Beckett gets your child onto Medicaid; GAPP is then what pays for the nursing.
GAPP authorisations are time-limited. Renewal requires current documentation that the medical necessity continues — updated physician orders, current clinical notes and an updated plan of care. Nothing renews automatically, and a lapsed authorisation means a gap in your child’s care.
We track renewal dates and start the paperwork ahead of the deadline. If your child’s condition has changed since the last review, renewal is also the moment to have the hours reassessed.
You have appeal rights, including a Medicaid fair hearing, and there is a deadline printed on the letter you received. Do not miss it. A denial is frequently a documentation problem rather than a judgement that your child does not need care.
We help families assemble the clinical documentation for an appeal and work with the physician to make the record say what is actually true about your child’s needs.
Yes. You choose your provider, and you can change providers. Your approval belongs to your child, not to the agency currently holding the case. Switching does not mean reapplying from zero or losing your approved hours.
Families switch most often for one reason: shifts that keep going unstaffed. Approved hours that nobody shows up for are not care. If that is your situation, call us — we handle the transfer paperwork and coordinate timing so there is no gap.
No. GAPP covers skilled nursing hours. Durable medical equipment, supplies and therapies such as physical, occupational and speech therapy are covered by Georgia Medicaid under separate benefits, through different providers.
They do all have to work together, though, and coordinating them is normally what eats a parent alive. Our care coordinators handle that as part of the service.
GAPP serves children under 21. As that birthday approaches, care has to transition to adult Medicaid services, which work differently and are authorised differently.
Start the conversation early — well before the birthday, not after it. Your care coordinator should be raising this with you, and we do.
One phone call. We confirm your child’s eligibility at no cost and with no obligation, then we file the paperwork. Most families are approved for funding within 30 days, and then you meet your nurses.
This page is a guide, not a guarantee. Eligibility, authorised hours and covered services are determined by Georgia Medicaid based on documented medical necessity. Nothing here is medical advice — always consult your child’s physician. If this is a medical emergency, call 911.
Find out if your child qualifies
A free eligibility review, an honest answer, and a team that files the paperwork. We serve Fulton, Cobb, Gwinnett, DeKalb, Clayton and counties across Georgia. A clinician answers, day or night.