How to Get Approved for the Georgia Pediatric Program (GAPP)

A step-by-step guide to navigating the GAPP approval process, avoiding common delays, and finding providers who are actually accepting new patients.

This guide is for:

Parents of medically fragile childrenCase managersFoster parentsHospital discharge planners

GAPP Approval Requirements

Before starting the approval process, confirm your child meets these requirements:

  • Child is under 21 years old
  • Georgia Medicaid is active (not pending)(critical)
  • Physician has ordered skilled nursing care(critical)
  • Child has a medically fragile diagnosis requiring home nursing
  • Home care is appropriate and cost-effective vs. facility care

The GAPP Approval Path

Follow these steps in order. Skipping steps or doing them out of sequence causes most delays.

1

Confirm Medicaid Status

This step stops 60% of applications. Your child must have active Georgia Medicaid—not pending, not applied for, but active with a Medicaid ID number.

Common mistake: Families contact GAPP agencies while Medicaid is still pending. Agencies cannot submit prior authorization without active Medicaid. Wait until you have your Medicaid card.

How to check: Call Georgia Medicaid at 1-866-211-0950 or check your Georgia Gateway account. You need the Medicaid ID number, not just approval.

2

Get the Physician Order (The Right Way)

Your child's physician must document that skilled nursing care is medically necessary. This isn't a simple referral—it must clearly state:

  • The specific type of care needed (RN, LPN, or PCS)
  • Why home nursing is medically necessary
  • The diagnosis requiring skilled care
  • Recommended hours of care

Pro tip: Many GAPP agencies will help your doctor complete the order correctly. Choose your agency first (Step 3), then have them send the physician order form to your doctor.

3

Choose a Medicaid-Approved GAPP Agency

This is where most families get stuck. Not all agencies are accepting new patients, and availability varies by county. When choosing an agency, verify:

  • They serve your county
  • They're currently accepting new patients
  • They have nurses available for your needed shifts
  • They offer the service type you need (RN, LPN, or PCS)

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4

Agency Submits Prior Authorization

Once you've chosen an agency and they have the physician order, they submit the prior authorization to Georgia Medicaid. This is the formal approval request.

You don't do this step—your agency does. But you should:

  • Confirm with the agency that they've submitted
  • Ask for the submission date and expected timeline
  • Provide any additional documentation they request promptly
5

Approval & Care Begins

Once Medicaid approves the prior authorization, your agency will:

  • Schedule an intake assessment at your home
  • Create a care plan based on your child's needs
  • Assign nurses to your case
  • Begin scheduled care shifts

Timeline: From prior authorization approval to care starting is typically 1-2 weeks, depending on nurse availability in your area.

Why GAPP Applications Get Delayed or Denied

Understanding these common problems helps you avoid them:

Medicaid is pending, not active

Solution: Wait until you have your Medicaid ID. Agencies cannot submit prior auth without it.

Physician order doesn't document medical necessity clearly

Solution: Have your agency send the correct form to your doctor. They know what Medicaid requires.

Agency is not responding or following up

Solution: If an agency isn't responsive during intake, they likely won't be responsive during care. Choose a different provider.

No nurses available in your county

Solution: This is a real problem in rural areas. Contact multiple agencies and ask specifically about nurse availability before committing.

Missing or incomplete documentation

Solution: Respond to documentation requests within 24-48 hours. Delays on your end delay the whole process.

Child doesn't meet "institutional level of care" requirement

Solution: This is a clinical determination. If denied, request an appeal and have your physician provide additional documentation.

Read the full guide on avoiding GAPP denials →

Find GAPP Providers by County

Provider availability varies by county. Browse providers in Georgia's major areas:

FultonGwinnettCobbDeKalbClaytonHenryChathamRichmond
View all Georgia counties →

Related Resources

GAPP Approval Timeline

How long each step takes and what to expect.

Medicaid Requirements

What "active Medicaid" means and how to check your status.

Why Applications Get Denied

Common denial reasons and how to avoid them.

GAPP vs Katie Beckett

Compare GAPP with other Georgia Medicaid waivers.

GAPP Approval FAQs

How long does GAPP approval take?
GAPP approval typically takes 2-6 weeks once you have active Medicaid and a physician order. The timeline depends on how quickly your chosen agency submits the prior authorization and whether all documentation is complete.
Can I apply for GAPP while my Medicaid is pending?
No. You must have active Georgia Medicaid before a GAPP agency can submit a prior authorization. Pending Medicaid does not count. If your Medicaid application is in process, wait until you receive your Medicaid card before contacting GAPP providers.
What if my GAPP application is denied?
You have the right to appeal any denial. Common reasons include incomplete documentation, Medicaid not being active, or the physician order not clearly documenting medical necessity. Your GAPP agency can help you understand the denial reason and resubmit.
Do I need a referral from my doctor for GAPP?
Yes. You need a physician order documenting that your child requires skilled nursing care at home. This is different from a referral—it must specifically state the type of care needed (RN, LPN, or PCS) and the medical necessity.
Can I choose any GAPP provider in Georgia?
You can choose any Medicaid-enrolled GAPP provider that serves your county. Not all providers serve all counties, so check that the agency you want covers your area and has nurses available.
What happens after GAPP approves my child?
Once approved, your chosen agency will schedule an intake visit to assess your child's needs, then assign nurses and begin care. The agency handles scheduling and will work with you on shift times.
Can my child receive GAPP services at school?
GAPP services are typically for in-home care. School nursing is usually handled through your child's IEP or 504 plan. However, some families use GAPP hours for before/after school or transport.

Who uses this resource:

Georgia case managersHospital discharge plannersFoster care coordinatorsHome health agencies

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