In Georgia, a child with a tracheostomy who has full Medicaid can receive skilled nursing at home through GAPP, the Georgia Pediatric Program. A licensed nurse provides the trach-related care your child’s physician orders, while you learn the care alongside them. Hours are set from your child’s medical needs and your own training needs, and they change as both change.
Bringing a child home with a trach is one of the biggest steps a family takes. This page covers how GAPP nursing works for trach care, how the state decides hours, and the questions worth asking any agency before you choose one.
How GAPP looks at a tracheostomy
GAPP does not approve care by diagnosis. It approves care that is medically necessary, judged on your child’s overall 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 to record exactly these needs, and its list includes the trach itself, suctioning, oxygen, pulse oximetry, nebulizer treatments and chest physical therapy.
So the strongest application describes the care in practice: how often your child needs suctioning, what the oxygen needs are, what happens at night. The physician’s orders form and statement of medical necessity carry that detail.
What a home nurse does
A GAPP nurse provides the skilled care in your child’s physician’s orders. For a child with a trach that usually means monitoring breathing and oxygen, trach and site care, suctioning, responding to changes in your child’s condition according to the plan of care, keeping records, and teaching the family. The orders decide the care, not the agency and not this page.
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, and renewed. The renewal is due 30 days before the approval ends (§819.4, §804.2, §817).
- There is no published number of hours for a trach. Anyone who quotes one before the state’s review is guessing.
Your training
One of GAPP’s stated goals is to teach parents and caregivers to care for their child safely when a nurse is not there (§825.5). Your agency keeps a teaching plan and a caregiver skills checklist that records what you have learned (§918). Expect hours to be reviewed as your confidence grows. If there are tasks you cannot yet do safely on your own, make sure the checklist says so.
When things change
An improvement such as decannulation, or a setback such as a new infection, is a change in condition. The agency must submit a change request within five days of the change, and the state’s medical review team expedites these when necessary (§827). An increase in hours needs a letter or other documentation from the physician and updated orders.
Getting to appointments
Medicaid’s non-emergency transportation system is available to GAPP members, and ambulance transport can be requested, with precertification, for children who are extremely medically fragile with multiple needs. An agency may also allow its nurse to travel with you, if its own policies cover it (§902).
Can a parent be paid for trach care?
No. Trach care is skilled nursing, and GAPP’s Family Caregiver Option is for personal support only (§604.2). A parent who lives with the child can be paid for approved personal support hours, such as bathing and dressing, while a nurse provides the nursing. Our Village Care page explains how that works.
What to ask an agency
- How many of your nurses in my county have cared for a child with a trach at home?
- What happens when my child’s nurse calls out? Agencies must have provisions for back-up staffing (§609.4).
- How will you train me, and who signs off my caregiver skills checklist?
- Will you coordinate with the hospital’s discharge team so nursing starts when my child comes home?
There are more in our guide to choosing a GAPP provider.
In short
- A child with a trach and full Georgia Medicaid can get skilled nursing at home through GAPP.
- Hours come from your child’s needs and your training needs, not from the diagnosis.
- Changes such as decannulation go to the state within five days.
- Parents cannot be paid for trach care, only for approved personal support.
If your child is coming home with a trach, tell us about your child and we will tell you honestly whether we can staff the care in your county. The full program rules are in our GAPP guide.
Common questions
Can my child with a tracheostomy get nursing at home in Georgia?
Yes, if your child has full Georgia Medicaid and GAPP approves skilled nursing as medically necessary. A tracheostomy, suctioning and oxygen are among the nursing needs the physician records on the state's nursing evaluation form. You apply through a GAPP-approved agency.
How many nursing hours does a child with a trach get?
There is no fixed number for a trach. GAPP sets hours from your child's specific medical treatment needs and from the training needs of the primary caregiver, approves them as a monthly maximum for up to six months, and renews them.
Can I get paid to do my child's trach care?
No. Trach care is skilled nursing, and GAPP's Family Caregiver Option covers personal support only. A parent who lives with the child can be paid for approved personal support hours, while a licensed nurse provides the nursing.
What happens to GAPP hours after decannulation?
An improvement such as decannulation is a change in condition. The agency submits a change request within five days, the state's reviewers expedite it when necessary, and hours are adjusted to your child's needs.
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.
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.