Pediatric Home Care Services
What is GAPP?
Georgia Pediatric Program is a Medicaid program that provides services to medically fragile children under the age of 21 in need of skilled nursing care and personal care support, in the safety of their own home. Services are approved based on the child’s medical needs, and families who are eligible for Medicaid can apply for GAPP at any time. GAPP is managed by the Georgia Department of Community Health (DCH).
What is Katie Beckett?
Katie Beckett Waiver, or Deeming Waiver, is an eligibility category for Medicaid for children under the age of 18. The Katie Beckett Waiver takes parents’ income out of the picture and bases the decision on the child’s needs. If the child qualifies for the Katie Beckett Waiver, they become eligible for services available under the regular state Medicaid plan.
Home Care Services Included With GAPP
Skilled nursing and personal care services provided under GAPP include:
Medication Administration
Hygiene Care
Bathing
Dressing
Take Vital Signs
Wheelchair assistance
Collect Treatment Plan Information
Turn or Reposition assistance
Change Sheets and Bed Linens
Observation
Communicate issues to Nurse or Doctor
Assistance with Daily Living Activities
Trach Care
(Including changing and cleaning)
Gastrostomy Tube Care (Including Tube Feeding, Cleaning, Changing)
Bagging via Trach or Mouth
Respiratory Treatment
Suctioning
And More
What is the GAPP Approval Process?
Skilled nursing and personal care services provided under GAPP include:
A Capstone Quality Care coordinator comes out to your home to complete initial paper work.
Sign Consent to obtain medical records
Gather Initial qualifying criteria
Qualifying documents are sent to GAPP for approval
The GAPP Decision Team determines eligibility
GAPP and Capstone Quality Care contacts family with decision
It takes 30 to 60 days to go through the approval process. Once approved, your loved one will start receiving care immediately.
How To Appeal GAPP's Decision?
If the number of hours approved for your child is not what was requested or it has been reduced, you have the right to appeal — but you must respond quickly via mail by the deadlines indicated in your letter. Here’s how:
You’ll receive a letter from GMCF (Georgia Medical Care Foundation), stating GAPP’s decision — and the clock starts from the date on the letter
We’ll help you with the letters and acquire any other additional written correspondence from doctors, hospitals, or other required documentation.
We’ll work with you to ensure that all documentation is mailed to the address on your letter within 30 days.
GAPP has 30 days to accept or deny your appeal.
Writing the Appeal Letter
This letter should be written by the primary caregiver of the patient. It should be in your own words, describing your child’s needs and any special considerations that you feel should make your child eligible to receive the requested hours of care. Describe any equipment he or she depends on, such as tube feedings, central lines for medication and IV fluids, tracheostomy and ventilators, among others. Explain any recent changes in your child’s condition, medication, hospitalizations, etc. Explain how the care of your child impacts your family (are there any other children who also need care?). Explain in detail how your child could be negatively affected by decreasing the in-home nursing/personal care support hours, such as an increased risk for infection, risk of injury, or potential for increased hospitalizations.
Gathering Doctor’s Letters & Additional Documentation
They may be able to add additional documents, such as clinical notes, to support your arguments, and may also write a letter in support of your request. Letters from multiple doctors can be submitted, and should include detailed information and support for your request. Additional documentation (such as hospitalization discharge paperwork, nursing progress notes, etc.) can also be submitted.
Submitting Your Appeal
You’re entirely responsible for submitting the appeal. If you don’t follow the instructions and meet the deadlines they’ve given you, the decision cannot be appealed. You’re also responsible for mailing in the appeal, although we can help you along the way.