Caring for a child with complex medical needs can feel overwhelming, especially when families must balance work, daily responsibilities, and specialized healthcare at home. The Georgia Pediatric Program (GAPP) is a Medicaid-funded initiative that provides in-home skilled nursing and support services for children and young adults under 21. By covering medical and non-medical care, GAPP ensures children can remain safely at home instead of long-term hospital or facility care.

To benefit from this program, families must understand the eligibility criteria and how to successfully apply. Below is a detailed breakdown of the requirements, documentation, and steps involved in accessing GAPP services.

1. Age Requirement

GAPP is strictly for children and young adults under the age of 21. The program is designed to serve infants, toddlers, school-age children, and teens who have ongoing medical needs that require support at home.

Once the individual turns 21, they may transition to other Medicaid waiver programs or adult in-home care services. Therefore, families are encouraged to plan ahead if their child is nearing the age limit.

2. Residency Requirement

The child must be a legal resident of Georgia. This means the family must live within the state and provide proof of residency, such as:

• A driver’s license or state ID showing a Georgia address

• A recent utility bill in the guardian’s name

• Lease agreement or mortgage statement

Residency ensures that the child qualifies for state-funded Medicaid programs like GAPP.

3. Medicaid Coverage

Since GAPP is fully funded by Georgia Medicaid, the child must first be eligible for Medicaid. Families who do not currently have Medicaid will need to apply before seeking GAPP services.

Who qualifies for Medicaid in Georgia?

• Children under 19 with limited family income (per federal poverty level)

• Children or young adults under 21 with significant medical needs

• Families meeting income or disability-based criteria

Medicaid enrollment can be completed online through Georgia Gateway, by phone, or at a local Division of Family and Children Services (DFCS) office.

4. Medical Necessity Requirement

One of the most important eligibility criteria for GAPP is medical necessity. The program is not open to every child on Medicaid—it specifically serves those who require skilled nursing care or unskilled personal care assistance at home.

Medical necessity is determined by a physician’s assessment and medical documentation. Typically, children may qualify if they have:

• Trach dependency

• Gastrostomy tube (G-tube) feeding needs

• Ventilator dependency

• Neurological disorders (e.g., cerebral palsy, muscular dystrophy, seizure disorders)

• Chronic respiratory conditions requiring CPAP, BiPAP, or oxygen therapy

• Diabetes management needs

• Paralysis or mobility limitations

The child’s doctor must certify that in-home care is essential for safety, health, and quality of life. Without such care, hospitalization or facility placement might be required.

5. Functional Limitations

In addition to medical needs, the child’s ability to perform activities of daily living (ADLs) is also considered. For example, children may qualify if they need help with:

• Bathing, dressing, or feeding

• Mobility (wheelchair use, transfers, positioning)

• Medication administration and monitoring

• Respiratory treatments or suctioning

• Observation for seizures or other life-threatening conditions

The greater the level of daily care required, the more likely a child will meet eligibility standards.

6. Documentation Required for GAPP Application

To prove eligibility, families must provide several types of documentation:

• Physician’s Statement – A doctor must complete a form verifying the child’s medical needs.

• Current Treatment Plan – Outlines ongoing care, medications, therapies, and goals.

• Medical Records – Hospital discharge papers, diagnosis reports, or therapy notes.

• Medicaid Information – Proof of active Medicaid coverage.

• Residency Proof – Georgia address confirmation.

The more thorough and updated the documentation, the smoother the approval process.

7. The GAPP Application Process: Step by Step

Step 1: Contact a GAPP Provider

Families typically begin by reaching out to a Medicaid-approved home health provider who participates in GAPP. The provider guides the family through paperwork and submits the application to Medicaid on their behalf.

Step 2: Physician Referral

The child’s primary care physician or specialist must complete a medical necessity referral stating why the child requires GAPP services.

Step 3: Submit Documentation

Families submit all required documents, including treatment plans and medical history, to the provider.

Step 4: Medicaid Review

Georgia Medicaid reviews the application, verifying both medical necessity and Medicaid eligibility.

Step 5: Approval and Service Plan

Once approved, a plan of care is developed, outlining the number of nursing or support hours provided each week. Families collaborate with providers to create a personalized schedule.

8. How Long Does Approval Take?

Approval timelines vary, but most families receive a decision within 30–45 days after submitting a complete application. Delays often occur if documentation is missing, so families should ensure all paperwork is accurate and current.

9. Renewal and Recertification

Eligibility for GAPP is not permanent. Families must undergo recertification every six months. This ensures that services remain aligned with the child’s needs as they grow and develop.

• Every 6 months – Physician reassessment required

• Updated treatment plan – Must reflect current care needs

• New documentation – Any recent hospitalizations, diagnosis changes, or therapy adjustments

If the child’s condition improves and no longer requires in-home care, services may be reduced or discontinued.

10. Common Challenges and Tips

Many families face obstacles when applying for GAPP. Here are some tips:

• Work with a provider early – Providers know the system and can prevent delays.

• Keep records organized – Store all hospital notes, therapy evaluations, and doctor’s orders.

• Communicate with your doctor – Ensure they understand the level of daily care your child requires.

• Follow up with Medicaid – If you haven’t heard back after 30 days, call to check status.

11. Benefits of Meeting Eligibility

Families who qualify for GAPP gain access to:

• Skilled nursing in the comfort of home

• Daily living support for hygiene, feeding, and mobility

• Reduced hospital visits and medical complications

• More time for parents to work or rest

• Peace of mind knowing trained professionals are caring for their child

Conclusion

The Georgia Pediatric Program (GAPP) is a lifeline for families raising children with complex medical needs. By offering Medicaid-funded in-home nursing and unskilled care, the program helps children remain safe, comfortable, and supported within their families.

To qualify, families must meet age, residency, Medicaid eligibility, and medical necessity requirements, and provide thorough documentation. With proper preparation and physician support, the GAPP application process can be smooth, ensuring children receive the care they deserve.