The Georgia Pediatric Program (GAPP), explained for parents.

Last updated October 7, 2026. Every rule on this page is checked against the Georgia Department of Community Health sources listed at the end, and cited by section as you go.

GAPP, the Georgia Pediatric Program, is a Georgia Medicaid program that pays for skilled nursing, personal support and behavioral support aide services at home for medically fragile children under 21. Families apply through a GAPP-approved nursing agency, not to the state. Alliant Health Solutions reviews each request for the Department of Community Health, and approved hours are renewed at least every six months.

What GAPP is

The Georgia Pediatric Program, almost always called GAPP, is a Georgia Medicaid program run by the Georgia Department of Community Health (DCH). It pays for care at home for medically fragile children and young people under 21, so that a child who needs nursing or hands-on support every day can live at home rather than in a hospital or a facility. It started in August 2002. (manual §601)

DCH runs the program, and a company under contract to DCH, Alliant Health Solutions, reviews every request for services and every renewal. (§603) You will not deal with Alliant directly very often. Your nursing agency does that, but the decision letters you receive will usually come from that review.

What GAPP covers

Skilled nursing

Nursing care by a registered nurse or licensed practical nurse in your home, provided in shifts. (§604.1, §838) This is the clinical side: medications, tube feedings, tracheostomy and ventilator care, seizure management, assessments. It always needs a licensed nurse.

Personal support services

Help with the everyday care your child cannot do alone: feeding, bathing, dressing, personal hygiene, preparing meals, light housekeeping around your child's space, and help with moving and walking, all following your child's plan of care. (§604.2) A child can be approved for personal support without skilled nursing. (§601, §918) This is also the only service a parent can be paid to provide (see Getting paid to care for your child).

Behavioral support aide

Added to GAPP on April 1, 2023, with its own rules in Appendix W of the manual. Like the other services, it cannot be delivered at school. (§602, Appendix W)

What GAPP does not cover

• Care while your child is in the hospital, at school, or outside Georgia. GAPP pays only for care in Georgia, outside hospital and school. (§703.2.3)
• Respite care. The manual says plainly that respite is not a covered service, and other resources have to be found for it. (§925.7)

Who qualifies

The manual sets out what has to be true. Your child must:

• Be under 21. Children age out of GAPP on their 21st birthday. (§601)
• Have full Georgia Medicaid. Medicaid has to be decided before GAPP can be approved, and GAPP cannot be approved while a Medicaid application is still pending. (§701; DFCS Medicaid manual §2933) Children on PeachCare for Kids are not eligible for GAPP. (§925.11)
• Need care that is medically necessary. That means skilled nursing, personal support and/or a behavioral support aide, judged on your child's overall medical condition, the equipment they use, and the level and frequency of care they need. (§702.1.1)
• Have physician's orders. Every service must be backed by the physician's orders form, called the PPOT. Since April 1, 2024, a nurse practitioner or physician assistant can complete it too, and the agency is not allowed to fill it out for your doctor to sign. (§602.2, §805, §913.3)
• Have a primary caregiver who takes part. The family member who is the main caregiver must help with care at home and stay in regular contact with the agency. (§702.1.2)

What about a diagnosis?

There is no list of qualifying diagnoses. GAPP looks at the care a child needs every day, so two children with the same diagnosis can get different answers. One note matters for many families: the manual directs members with autism to Georgia Medicaid's Autism Spectrum Disorder program. (§602) If your child is autistic and also has medical or personal care needs, ask an agency to look at those needs specifically. We have written more about this in Can I get paid to take care of my autistic child in Georgia?

Getting Medicaid first

Medicaid eligibility is decided by the Division of Family and Children Services (DFCS), not by GAPP or by an agency. DFCS looks for the best category your child qualifies under, such as SSI, Family Medicaid or Aged, Blind and Disabled Medicaid. (DFCS §2933)

If your family's income is too high: Katie Beckett

Katie Beckett, also called TEFRA, is a route into Medicaid for children with disabilities who live at home. It lets the state ignore family income and bases eligibility on the level of care the child would need in an institution. It covers children 18 and under. DFCS uses it when a child does not qualify under another category. (Georgia Medicaid, TEFRA/Katie Beckett; DFCS §2933)

Katie Beckett gives your child Medicaid. It is not a GAPP application. Once Medicaid is in place, GAPP is still requested separately through an agency. Our Katie Beckett guide covers who qualifies, every form and the appeal deadlines, and there is a printable Katie Beckett checklist.

You can apply to the Centralized Katie Beckett Medicaid Team or any local DFCS office, by mail, phone or fax, or online at gateway.ga.gov. The Katie Beckett team's phone number is 678-248-7449. (Georgia Medicaid, TEFRA/Katie Beckett)

How to apply

You do not apply to the state. Families apply through a nursing agency approved for GAPP, and the agency submits the request. If your child is in the hospital, the hospital's discharge planning or social work team can start it. (§703.1, §703.2)

1. Medicaid in place. Full Georgia Medicaid, not PeachCare, decided by DFCS.
2. Choose a GAPP-approved agency. The state keeps a list of approved agencies, and you can choose any of them. If you need help, the GAPP Program Specialist at DCH can be reached at (404) 683-5113 or GAPP.inquiries@dch.ga.gov. (§703.1) Our guide to choosing a GAPP provider has the questions to ask.
3. Your doctor completes the orders. The physician's orders form (PPOT) and a statement of medical necessity, backed by recent office visit notes. (§602.2, Appendix H, Appendix N)
4. The agency submits the request. It goes to Alliant Health Solutions through the state's online medical review portal, with the forms you sign each year, including a Letter of Understanding, a Freedom of Choice form and a caregiver skills checklist, plus your child's IEP if they have one. (§801, Appendix N)
5. The review. Alliant has 30 days to review a complete request. A request that is still incomplete after 30 days is denied, so missing paperwork costs real time. (§703.2.5)
6. Care begins. If your child is approved, care must start within 60 days. (§703.3)

For a fuller walk through, with what to have ready before you call, read How to apply for GAPP in Georgia, step by step.

How hours are decided and renewed

There is no fixed number of hours for a diagnosis, and no published cap. Hours are based on your child's specific medical treatment needs, confirmed by their medical records, and on the training needs of the primary caregiver shown in the caregiver skills checklist. (§702.1.4)

• Hours are approved as a monthly maximum. You, your agency and your nurses can arrange them across the month to suit your family, rather than as a fixed amount each day. (§819.4)
• Approvals last up to six months. Your child is re-evaluated at least every three to six months. (§703.3, §804.2)
• Renewals are due 30 days before the approval ends. If a renewal goes in late, the new approval starts from the date it was received, and care in the gap is not paid. (§817.1, §817.2) A good agency tracks this for you. It is still worth knowing your own renewal date.
• Changes go in quickly. If your child's condition changes, the agency must submit a change request within five days. Hospital stays must be reported too. (§827, §818.11)

Be ready for hours to change in both directions. One of GAPP's stated goals is to teach parents and caregivers to care for their child safely when a nurse is not there, so as you become more confident, and as your child's needs change, the hours can be adjusted. (§702.1.5, §825.5)

Your part as a parent

GAPP is built around the family, not around replacing it. The manual expects the primary caregiver to:

• help with your child's care at home and keep in regular contact with the agency (§702.1.2)
• name an emergency contact (§702.1.3)
• learn the care your child needs over time, recorded in the caregiver skills checklist (§702.1.5, §918)
• sign a Letter of Understanding and a Freedom of Choice form each year (Appendix N)

School

GAPP hours cannot be used at school. If your child needs skilled care during the school day, it is arranged through the school, usually through their IEP, and billed through the school rather than GAPP. If your child is school age and not in school, the agency has to give the reason. (§604, §703.2.3)

Hospital stays

GAPP does not pay for care while your child is in the hospital, and the agency must report hospital stays. A stay longer than 30 days needs a discharge summary before care restarts. (§703.2.3, §818.11, §818.12)

Your mail

Decision letters go to the parent or guardian by certified mail, at the address the state has on file. Keep your address current with DFCS, because the time limits for challenging a decision start from the date on the letter. (§703.3)

Getting paid to care for your child

GAPP has a Family Caregiver Option. It lets a legally responsible adult family member who lives with the child, usually a parent, be paid for providing the child's approved personal support hours. (§604.2) The federal government approved Georgia paying parents this way on November 15, 2024, and the approval runs through December 31, 2029. (CMS approval, November 15, 2024)

• Personal support only. The option is not available for skilled nursing or for behavioral support aide services. (§604.2, §604.3)
• You are hired by the agency. The agency must employ you like any other caregiver, including fingerprinting, a background check, CPR certification and the agency's training, and it supervises the care. (§604.2, §604.3, §919)
• The hours still have to be approved. Personal support must be medically necessary and go through the same prior approval as any other GAPP service. (CMS approval)
• Foster parents are not eligible for the Family Caregiver Option. (§604.3)

Not every family who searches for this will qualify, and we would rather say so plainly. Our Village Care Program is how ARZN supports families who do.

Changing or sharing agencies

You choose your agency, and you can change it. The manual says parents and guardians have a right to choose or transfer agencies without consequences from the current agency. (§808)

• Care continues while you move. If you decide to change, your current agency must keep providing service for at least 30 days if you want it to. (§808)
• Transfers start on the first of a month, and the hours that move are the ones currently approved. Care with the new agency begins once Alliant has approved the transfer, and transfers are not processed in the last two business days of a month, so start early. (§820, §822)
• An agency that cannot staff your hours must tell you and refer you to agencies that can. (§822)
• An agency that wants to stop serving your child must give at least 30 calendar days' written notice. (§840)

Sharing hours between two agencies

If no single agency can staff all of your child's nursing, the skilled nursing hours can be shared between two GAPP agencies, under one set of physician's orders. Personal support hours cannot be split between two agencies. (§823)

The whole process, step by step: How to switch your GAPP nursing agency.

If GAPP is denied or hours are cut

If requested hours are not approved, you receive a certified letter. (§825.4) The clock starts on the date of that letter, so read it the day it arrives.

1. Ask for a reconsideration within 30 calendar days. Write to Alliant Health Solutions, PO Box 105406, Atlanta, GA 30348, Attn: GAPP Review Nurse, or submit it online through your agency, with supporting documentation from your child's physician. If no reconsideration is requested in time, the decision becomes final. (§831)
2. Ask for a fair hearing within 30 calendar days of the final letter. If the reconsideration does not resolve it, you can request a hearing before an Administrative Law Judge within 30 calendar days of the Final Adverse Action Determination Letter. Send it to the Georgia Department of Community Health, DCH Legal, Floor 18, 2 Martin Luther King Jr. Dr., Atlanta, GA 30334, with a copy of the letter and your specific reasons. Ask about continuing services during the appeal when you make the request. (§833)

What to send, and how to build the strongest case: GAPP hours denied or cut? How appeals work in Georgia.

Children under 21 on Medicaid are covered by a federal rule known as EPSDT, which requires states to cover care that is medically necessary. If you believe hours were reduced for a reason other than your child's needs, the Georgia Advocacy Office advises families on disability rights, and Parent to Parent of Georgia can connect you with other parents who have been through it.

When your child turns 21

GAPP ends on your child's 21st birthday. (§601) Before then, Alliant's review nurse assesses whether your child meets the criteria for the Independent Care Waiver Program (ICWP), Georgia's adult program, and sends the family an ICWP packet ahead of time. ICWP services cannot begin before the 21st birthday. (§836) The Letter of Understanding asks families to start looking into adult programs six months to a year before, and that advice is worth taking. Adult waivers have their own rules and their own timelines.

Common questions

If you are trying to work out whether GAPP fits your child, tell us about your child. We will tell you honestly what we think, including when the answer is that another program is the better fit.

Sources

1. Georgia Department of Community Health, Part II Policies and Procedures for Georgia Pediatric Program (GAPP) In-Home Nursing, July 1, 2025 edition. Section numbers on this page (§) refer to this manual. Current editions are published on GAMMIS, Provider Manuals.
2. Georgia Department of Community Health, Georgia Pediatric Program (GAPP) presentation, June 2023.
3. Division of Family and Children Services, Medicaid Policy Manual, section 2933, Georgia Pediatric Program.
4. Centers for Medicare & Medicaid Services, approval for Georgia to pay legally responsible individuals for personal care services, November 15, 2024.
5. Georgia Medicaid, TEFRA/Katie Beckett.
6. Georgia Medicaid, Autism Spectrum Disorder program.
7. Georgia Department of Community Health, GAPP fact sheet.

Please read. This page is general information about a public program, written by ARZN Care, a GAPP provider agency. It is not medical, legal or financial advice and it is not a decision about your child. The state updates the GAPP manual every quarter, so confirm anything that matters with the Department of Community Health, your agency or your child's physician before you rely on it.