Ventilator care at home for children in Georgia: nursing through GAPP

A Georgia child on a home ventilator who has full Medicaid can receive skilled nursing at home through GAPP, the Georgia Pediatric Program. A licensed nurse provides the respiratory care in the physician’s orders, hours are set from your child’s needs and your training needs, and weaning or other changes are reviewed quickly.

For families of ventilator-dependent children, the question is rarely whether care is approved. It is whether a nurse with the right experience is actually there, every shift. This page covers how GAPP handles ventilator care and what to ask an agency about staffing before you sign.

How GAPP looks at ventilator care

GAPP approves care that is medically necessary, judged on your child’s overall condition, equipment 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 these needs, including a home ventilator, CPAP or BiPAP, trach, oxygen, suctioning, pulse oximetry, nebulizer treatments and chest physical therapy. The more precisely the physician’s orders describe the day-to-day care, the better the review can see it.

What a home nurse does

A GAPP nurse provides the skilled care in your child’s physician’s orders. For a child on a ventilator that typically includes monitoring breathing, oxygen and equipment, airway and trach care, suctioning, responding to changes according to the plan of care, keeping records, and teaching the family. The orders decide the care.

How hours are decided

• Hours are based on your child’s 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 and renewed, with renewals due 30 days before the approval ends (§819.4, §804.2, §817).
• If no single agency can staff every shift, skilled nursing hours can be shared between two GAPP agencies under one set of physician’s orders (§823).

Staffing and backup

Ventilator care needs nurses with ventilator experience, and parents in Georgia say finding them is the hardest part. Every GAPP agency must have provisions for back-up staffing coverage (§609.4), and an agency that cannot staff your child’s approved hours must tell you and refer you to agencies that can (§822). Ask for specifics before you choose.

Your training

GAPP aims to teach parents and caregivers to care for their child safely when a nurse is not there (§825.5), recorded in a teaching plan and caregiver skills checklist (§918). Being trained does not mean being left alone with tasks you are not ready for. Make sure the checklist reflects what you can and cannot yet do safely.

Weaning and other changes

Weaning off the ventilator, or a setback that increases your child’s needs, is a change in condition. The agency submits a change request within five days, and the state’s medical review team expedites it when necessary (§827). An increase in hours needs documentation from the physician and updated orders.

Transport

GAPP members can use Medicaid’s non-emergency transportation system. Ambulance transport can be requested, with precertification, for children who are extremely medically fragile with multiple needs, such as children on a ventilator. An agency may let its nurse travel with you if its own policies allow it (§902).

What to ask an agency

• How many of your nurses in my county have cared for a ventilator-dependent child at home, and for how long?
• What is your backup plan when my child’s nurse calls out at night?
• Will you share hours with another agency if you can staff only part of them?
• How will you coordinate with the hospital so nursing is in place on discharge day?

If your child needs ventilator care at home, tell us about your child. We will tell you honestly whether we can staff the care in your county, and if we cannot, we will say so before you sign anything. More on the program in our GAPP guide.

Common questions

Can a child on a ventilator get nursing at home in Georgia?

Yes, if the child has full Georgia Medicaid and GAPP approves skilled nursing as medically necessary. A home ventilator, trach, oxygen and suctioning are among the nursing needs recorded on the state's nursing evaluation form.

Who decides how many nursing hours a ventilator-dependent child gets?

Alliant Health Solutions reviews each GAPP request for the Department of Community Health. Hours are based on the child's specific medical treatment needs and the primary caregiver's training needs, approved as a monthly maximum for up to six months at a time.

What happens to GAPP hours when my child weans off the ventilator?

Weaning off the ventilator 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 current needs.

Can GAPP help with transport for a child on a ventilator?

GAPP members can use Medicaid's non-emergency transportation system, and ambulance transport can be requested with precertification for children who are extremely medically fragile, such as children on a ventilator.

Sources

1. 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.
2. Georgia Department of Community Health, Georgia Pediatric Program (GAPP) provider presentation, June 2023, published on the Georgia Medicaid Management Information System portal.
3. Georgia Medicaid, Waiver Programs.
4. 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.