For a child under 21 with full Georgia Medicaid, private duty nursing is usually paid for by Medicaid through GAPP, and approved hours cost the family nothing. Georgia Medicaid pays the nursing agency $95.36 an hour for a registered nurse and $63.40 an hour for a licensed practical nurse. If your child also has private health insurance, that plan is asked first, because Medicaid pays last.
Private duty nursing means a licensed nurse stays with your child through a shift at home, rather than visiting for a single task. This page covers what it costs, who pays and in what order, and how many hours Medicaid has to cover. For what the nurse does and how care starts with us, see our pediatric skilled nursing page.
What private duty nursing costs in Georgia
GAPP pays agencies a fixed rate for each 15 minutes of approved care. The Department of Community Health publishes the rates in the GAPP manual (Appendix C, revised April 2025):
| Care | What Medicaid pays the agency | Per hour |
|---|---|---|
| Registered nurse (RN) | $23.84 per 15 minutes | $95.36 |
| Licensed practical nurse (LPN) | $15.85 per 15 minutes | $63.40 |
These are payments to the agency, not bills to you. Families whose child is approved for GAPP pay nothing for the approved hours. To put the numbers in perspective, 40 hours a week of RN care comes to $3,814.40 a week at Medicaid’s own rate, which is why the question of who pays matters so much.
Families who pay privately agree a rate with the agency directly. A GAPP agency may not charge Medicaid more than it charges private-pay patients for the same service, and Medicaid pays the lowest of the agency’s charge, its private-pay rate and the Medicaid rate (§1002, §1003).
Who pays, and in what order
- Private health insurance, if your child has it. GAPP requires every other source of payment to be considered before Medicaid is asked, because Medicaid is the payer of last resort (§1001.4). Ask your plan whether it covers private duty or shift nursing at home, for how many hours, and whether it needs approval in advance. Whatever the plan does not cover can still go to GAPP.
- Georgia Medicaid, through GAPP. For children under 21 with full Georgia Medicaid whose nursing is medically necessary and backed by physician’s orders (§601, §701, §702.1.1). Children on PeachCare for Kids are not eligible (§925.11). You apply through a GAPP agency, not the state. Our step-by-step guide covers how.
- Katie Beckett, if your income is too high for Medicaid. 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. Once your child has Medicaid, GAPP is requested as usual. See our Katie Beckett guide.
- Paying privately. If none of these apply, the cost falls to the family, at a rate agreed with the agency.
GAPP ends on the 21st birthday, and the state assesses young adults for Georgia’s adult program before then. Our GAPP guide explains what happens at 21.
How many hours Medicaid has to pay for
There is no fixed number of hours for a diagnosis. GAPP approves hours as a monthly maximum, based on your child’s medical treatment needs and on what the primary caregiver still needs to learn, for up to six months at a time (§702.1.4, §819.4, §804.2).
Federal law sets the floor. Children under 21 on Medicaid are covered by EPSDT, the Early and Periodic Screening, Diagnostic and Treatment benefit, which requires states to provide private nursing services sufficient to correct or ameliorate the child’s condition (42 U.S.C. § 1396d(r)(5)).
A 2026 ruling about a Georgia child. In L.W. v. Commissioner of the Georgia Department of Community Health, decided May 18, 2026, the U.S. Court of Appeals for the Eleventh Circuit, which covers Georgia, upheld a court order requiring Georgia Medicaid to provide at least 100 hours a week of private nursing to a three-year-old who had been approved for 21. The state had refused more hours, citing a policy against increases without a change in his medical condition. The court held that Georgia cannot deny medically necessary care by relying on a policy, even a reasonable one. The case was about one child, but the federal standard it applies covers every child under 21 on Medicaid.
If your child’s hours were denied or cut, you have 30 calendar days from the decision letter to ask Alliant Health Solutions to reconsider. Our guide to GAPP appeals covers what to send.
What GAPP does not pay for
- Nursing at school. Skilled care during the school day is arranged through the school, usually through your child’s IEP (§604).
- Care in the hospital or outside Georgia (§703.2.3).
- Respite care. GAPP does not fund respite (§925.7). The NOW and COMP waivers do; see how Georgia’s programs compare.
- A parent as the nurse. Parents cannot be paid for skilled nursing. A parent who lives with the child can be paid for approved personal support hours through GAPP’s Family Caregiver Option, which is our Village Care Program (§604.2, §604.3).
In short
- Georgia Medicaid pays GAPP agencies $95.36 an hour for an RN and $63.40 for an LPN. Approved care costs eligible families nothing.
- Private insurance is asked first. Medicaid pays last.
- No diagnosis sets the hours. Federal law requires enough care to correct or ameliorate your child’s condition.
- If your income is too high for Medicaid, Katie Beckett may be the way in.
Want to know whether your child could qualify? Tell us about your child.
Common questions
How much does private duty nursing cost per hour in Georgia?
Georgia Medicaid pays GAPP agencies $23.84 per 15 minutes for a registered nurse, which is $95.36 an hour, and $15.85 per 15 minutes for a licensed practical nurse, which is $63.40 an hour (GAPP manual, Appendix C, revised April 2025). Families whose child is approved for GAPP pay nothing for the approved hours. Private-pay rates are set by each agency.
Does private insurance pay before Medicaid for private duty nursing?
Yes. GAPP requires every other source of payment to be considered first, because Medicaid is the payer of last resort. If your child has private insurance, ask whether the plan covers private duty or shift nursing at home, and for how many hours. What the plan does not cover can still be requested through GAPP.
How many hours of private duty nursing will Georgia Medicaid cover?
There is no fixed number for a diagnosis. GAPP approves a monthly maximum based on your child's medical needs and the caregiver's training needs. Under the federal EPSDT rule, Medicaid must provide private nursing sufficient to correct or ameliorate a child's condition, and in 2026 the Eleventh Circuit held that Georgia cannot deny medically necessary care by relying on a policy, even a reasonable one.
Can my child get private duty nursing without Medicaid?
Yes, through private insurance if the plan covers it, or by paying an agency privately. GAPP itself requires full Georgia Medicaid. If your family's income is too high for Medicaid, Katie Beckett (TEFRA) can provide Medicaid for children 18 and under based on the level of care they need.
What does GAPP not pay for?
GAPP does not pay for care at school, in the hospital or outside Georgia, and it does not fund respite care. Parents cannot be paid for skilled nursing, though a parent who lives with the child can be paid for approved personal support hours through the Family Caregiver Option.
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.
- U.S. Court of Appeals for the Eleventh Circuit, L.W. v. Commissioner of the Georgia Department of Community Health, No. 24-12774, May 18, 2026.
- 42 U.S.C. § 1396d(r)(5), early and periodic screening, diagnostic and treatment services.
- Georgia Medicaid, TEFRA/Katie Beckett.
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.