A Georgia child with Down syndrome can get skilled nursing, personal support or both at home through GAPP, the Georgia Pediatric Program, when they have full Medicaid and the care is medically necessary. Down syndrome on its own does not qualify a child: the review looks at the care your child needs every day, such as heart, breathing or feeding care. A parent who lives with the child can be paid for approved personal support hours, never for nursing.
Many children with Down syndrome never need nursing at home, and other Georgia programs may fit them better. This page explains when GAPP fits, where a paid parent fits, and the programs that help children with Down syndrome whatever their medical needs.
How GAPP looks at a child with Down syndrome
GAPP does not approve care by diagnosis. It approves care that is medically necessary, judged on your child’s overall medical condition, the equipment they use and the level and frequency of care they need (GAPP manual §702.1.1). The CDC lists congenital heart defects, hearing loss and obstructive sleep apnea among the health problems that are more common in people with Down syndrome. On the state’s nursing evaluation form, the DMA-6(A), the physician records needs such as:
- Heart and breathing: a cardiopulmonary monitor or pulse oximetry, oxygen, CPAP or BiPAP, suctioning and nebulizer treatments.
- Feeding: slow feeding, tube feeding and medications given through the tube.
- Surgery and appointments: the number of surgeries, and how often your child has therapy visits and medical appointments.
A child recovering from heart surgery, on oxygen or CPAP, or fed by tube is reviewed on those needs, like any other child. Our pages on feeding tubes, trach care and what counts as a medically fragile child go further.
Nursing and personal support
- Skilled nursing is the care in your child’s physician’s orders that needs a licensed nurse, such as oxygen and breathing support, tube feeding or medications, depending on the orders.
- Personal support is hands-on help with feeding, bathing, dressing, hygiene, meals, help with moving and walking, and light housekeeping around your child’s space (§604.2).
A child can be approved for personal support without skilled nursing (§601). Which tasks belong to which service follows the physician’s orders and the plan of care.
How hours are decided
- Hours are based on your child’s specific medical treatment needs and on the training needs of the primary caregiver (§702.1.4).
- They are approved as a monthly maximum for up to six months at a time, then renewed. The renewal is due 30 days before the approval ends (§819.4, §804.2, §817).
- There is no published number of hours for Down syndrome. Anyone who quotes one before the state’s review is guessing.
When needs change
Heart surgery, a new feeding plan, new breathing support or a hospital stay can all change the care your child needs. A change in condition goes to the state as a change request within five days, and the review team expedites these when necessary (§827). Hospital stays must be reported too (§818.11).
Can a parent be paid?
Through GAPP’s Family Caregiver Option, a parent or other legally responsible adult who lives with the child can be paid for approved personal support hours, as an employee of the agency. It does not cover skilled nursing, and foster parents are not eligible (§604.2, §604.3). Your child must first be approved for GAPP personal support, which depends on their care needs. Our step-by-step guide covers the process, and Village Care is how ARZN supports families who qualify.
Other programs for children with Down syndrome
- Babies Can’t Wait is Georgia’s early intervention program for children from birth to 3 with disabilities or significant developmental delays, run by the Department of Public Health.
- Katie Beckett, also called TEFRA, can give a child 18 and under Georgia Medicaid without counting the parents’ income, based on the level of care the child needs. For a child with Down syndrome, the application includes a psychological or developmental evaluation. See our Katie Beckett guide and checklist.
- NOW and COMP serve people with an intellectual disability or a closely related condition who meet an ICF-ID level of care, with long-term supports such as respite, specialized equipment and home and vehicle adaptations. You apply through DBHDD, and people found pre-eligible go onto a planning list prioritized by need, so it is worth applying early.
Our programs comparison sets them side by side.
School
GAPP hours cannot be used at school. Care during the school day is arranged through the school, usually through your child’s IEP (§604, §703.2.3).
What to ask an agency
- Have your nurses cared for children recovering from heart surgery, or on oxygen or CPAP, at home?
- What is your backup plan when my child’s nurse calls out?
- Do you hire parents through the Family Caregiver Option for personal support?
In short
- Down syndrome alone does not qualify a child for GAPP; heart, breathing and feeding needs can.
- A parent can be paid for approved personal support, never for nursing.
- Babies Can’t Wait, Katie Beckett, and NOW and COMP help whatever your child’s medical needs.
- Apply for NOW and COMP early: the planning list goes by need.
If your child has Down syndrome and medical needs at home, tell us about your child and we will tell you honestly whether GAPP fits and whether we can staff the care in your county. The full program rules are in our GAPP guide.
Common questions
Can I get paid to take care of my child with Down syndrome in Georgia?
Through GAPP's Family Caregiver Option, a parent or other legally responsible adult who lives with the child can be paid for the child's approved personal support hours, as an employee of the GAPP agency. Your child needs full Georgia Medicaid and GAPP approval for personal support, which depends on their care needs, not the diagnosis. It never covers skilled nursing.
Does Down syndrome qualify a child for GAPP?
Not on its own. GAPP does not approve care by diagnosis. It looks at the child's overall medical condition, the equipment they use and the level and frequency of care they need, such as recovery from heart surgery, oxygen, CPAP or tube feeding.
Can a child with Down syndrome get Katie Beckett in Georgia?
Katie Beckett can give a child 18 and under Georgia Medicaid without counting the parents' income, when the child needs the level of care of a hospital, a nursing facility or a facility for people with intellectual disabilities. For a child with Down syndrome, the application includes a psychological or developmental evaluation.
What other Georgia programs help children with Down syndrome?
Babies Can't Wait provides early intervention for children under 3. The NOW and COMP waivers serve people with intellectual disabilities with long-term supports such as respite, equipment and home adaptations, from a planning list prioritized by need, so it is worth applying early through DBHDD.
Sources
- Georgia Department of Community Health, Part II Policies and Procedures for Georgia Pediatric Program (GAPP) In-Home Nursing, July 1, 2025 edition, published on GAMMIS under Provider Manuals.
- Georgia Department of Community Health, Georgia Pediatric Program (GAPP) provider presentation, June 2023, published on the Georgia Medicaid Management Information System portal.
- Georgia Medicaid, Waiver Programs.
- Georgia Department of Community Health, Community Based Services.
- Centers for Disease Control and Prevention, About Down Syndrome.
- Georgia Medicaid, TEFRA/Katie Beckett.
- Georgia Medicaid, New Options Waiver (NOW) and Comprehensive Supports Waiver (COMP).
- Georgia Department of Public Health, Babies Can’t Wait.
Please read. This article is general information about a public program, not medical, legal or financial advice, and it is not a decision about your child. Program rules change. Confirm anything that matters with the Georgia Department of Community Health or with a GAPP participating agency before you rely on it.