A Georgia child with spina bifida who has full Medicaid can receive care at home through GAPP, the Georgia Pediatric Program, when that care is medically necessary. Depending on your child’s needs, that can be skilled nursing, personal support with daily care, or both. The review looks at the care your child needs every day, such as catheterization, skin care and mobility, not at the diagnosis. At school, federal law requires the school to provide catheterization your child needs.
Spina bifida looks different in every child. This page explains how GAPP looks at a child with spina bifida, how surgeries and changes are handled, what the school must do, where a paid parent fits, and what to plan before 21.
How GAPP looks at a child with spina bifida
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 state’s nursing evaluation form, the DMA-6(A), asks the physician about the needs that often come with spina bifida:
- Bladder and bowel: catheterization, incontinence after age 3, and an ostomy.
- Skin: pressure sores, sterile dressings, and a child who is bedridden.
- Mobility: splints, a prosthesis, or a child over 18 months who cannot walk and uses a wheelchair.
- Neurological: paralysis and seizures.
- Surgeries and therapy: how many surgeries your child has had, and how often they have therapy visits and medical appointments.
The strongest application describes the care in practice: how often catheterization is done and by whom, how skin is checked and protected, and how your child is moved and positioned. The physician’s orders and statement of medical necessity should carry that detail. If your child also has seizures, our page on seizure care at home explains the seizure log GAPP requires.
Nursing and personal support
- Skilled nursing is the care in your child’s physician’s orders that needs a licensed nurse, 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). Personal support staff are trained in skin care, transfers, exercises and the use of adaptive aids and equipment (§909.3).
A child can be approved for personal support without skilled nursing (§601). Which tasks belong to which service, including catheterization, follows the physician’s orders and the plan of care, so ask your agency to walk you through it for your child.
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 spina bifida. Anyone who quotes one before the state’s review is guessing.
Surgeries and other changes
Surgery, a hospital stay, a new pressure sore or a change in how your child moves 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). An increase in hours needs documentation from the physician and updated orders.
School and catheterization
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).
For catheterization, the law is settled. In Irving Independent School District v. Tatro (1984), the U.S. Supreme Court held that clean intermittent catheterization is a related service a school must provide under federal special education law when a child needs it to attend school, because it is a school health service a school nurse or other qualified person can perform, not a physician’s service. If your child needs catheterization during the school day, it belongs in the IEP.
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). Our step-by-step guide covers the process, and Village Care is how ARZN supports families who qualify.
Planning for 21
GAPP ends on the 21st birthday. Georgia’s Independent Care Waiver Program (ICWP) serves a limited number of adults who apply between the ages of 21 and 64 with severe physical disabilities, at a nursing facility or hospital level of care (Georgia Medicaid). Before your child turns 21, the state assesses whether they meet its criteria. Start planning six months to a year ahead; our GAPP guide explains what happens at 21.
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. See our Katie Beckett guide and checklist.
What to ask an agency
- Which parts of my child’s care, including catheterization, would a nurse do, and which could personal support cover?
- Have your caregivers in my county worked with children who need skin checks, transfers and positioning?
- How will you handle my child’s hours around planned surgeries?
- Do you hire parents through the Family Caregiver Option?
In short
- GAPP looks at your child’s daily care, such as catheterization, skin and mobility, not the diagnosis.
- Surgeries and hospital stays are changes in condition, reported within five days.
- At school, catheterization your child needs is the school’s job under federal law, through the IEP.
- A parent can be paid for approved personal support, never for nursing.
If your child has spina bifida and needs care at home, tell us about your child and we will tell you honestly what GAPP may cover. The full program rules are in our GAPP guide.
Common questions
Can a child with spina bifida get care at home in Georgia?
Yes, if the child has full Georgia Medicaid and GAPP approves the care as medically necessary. Depending on the child's needs, that can be skilled nursing, personal support with daily care, or both. Catheterization, skin care and mobility needs are among the needs the physician records on the state's nursing evaluation form.
Does spina bifida qualify a child for GAPP?
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, so the answer depends on the child's daily care rather than on spina bifida itself.
Does the school have to do my child's catheterization?
In Irving Independent School District v. Tatro (1984), the U.S. Supreme Court held that clean intermittent catheterization is a related service a school must provide under federal special education law when a child needs it to attend school, because a school nurse or other qualified person can do it. GAPP hours cannot be used at school.
Can a parent be paid to care for a child with spina bifida in Georgia?
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 a GAPP agency. It does not cover skilled nursing, and foster parents are not eligible.
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.
- Supreme Court of the United States, Irving Independent School District v. Tatro, 468 U.S. 883, July 5, 1984.
- Georgia Medicaid, Long Term Services and Supports (Independent Care Waiver Program).
- 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.