Need help navigating GAPP? Our partnership with the Medicaid program means we can help make the process easier to understand.
What is GAPP?
Georgia Pediatric Program (GAPP) is a Medicaid program that provides services to medically fragile children under the age of 21 in need of skilled nursing care and personal care support in their homes and in the community. Services are approved based on the child’s medical needs, and families who are eligible for Medicaid can apply for GAPP at any time.
What is the Katie Beckett Waiver?
The Katie Beckett Waiver, or Deeming Waiver, is an eligibility Medicaid category for children under the age of 18. The Katie Beckett Waiver takes parents’ income out of the picture and bases the decision on the child’s needs. If the child qualifies for the Katie Beckett Waiver, they become eligible for services available under the regular state Medicaid plan.
Getting Approved for In-Home Services
How to Appeal GAPP’s Decision
The Appeal Itself
Step 1: Writing the Appeal Letter
This letter should be written by the primary caregiver of the patient. It should be in your own words, describing your child’s needs and any special considerations that you feel should make your child eligible to receive the requested hours of care.
- Describe any equipment he or she depends on, such as tube feedings, central lines for medication and IV fluids, tracheostomy and ventilators, among others.
- Explain any recent changes in your child’s condition, medication, hospitalizations, etc.
- Explain how the care of your child impacts your family (are there any other children who also need care?).
- Explain in detail how your child could be negatively affected by decreasing the in-home nursing/personal care support hours, such as an increased risk for infection, risk of injury, or potential for increased hospitalizations.
Step 2: Gathering Doctor’s Letters & Additional Documentation
Your doctor should help you make a case for your appeal. They may be able to add additional documents, such as clinical notes, to support your arguments, and may also write a letter in support of your request. Letters from multiple doctors can be submitted, and should include detailed information and support for your request. Additional documentation (such as hospitalization discharge paperwork, nursing progress notes, etc.) can also be submitted.
Step 3: Submitting Your Appeal
You’re entirely responsible for submitting the appeal. If you don’t follow the instructions and meet the deadlines they’ve given you, the decision cannot be appealed. You’re also responsible for mailing in the appeal, although we can help you along the way.
