UNDERSTANDING GAPP
Although GAPP can be difficult to understand and navigate, we can simplify the process for you, thanks to our partnership with GAPP.
What is GAPP?
Georgia Pediatric Program 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 the safety of their own home. Services are approved based on the child’s medical needs, and families who are eligible for Medicaid can apply for GAPP at any time. GAPP is managed by the Georgia Department of Community Health (DCH).
What is Katie Beckett?
Katie Beckett Waiver, or Deeming Waiver, is an eligibility category for Medicaid 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
MEET WITH YOUR CHOICE CAREGIVERS
Meet with YCC to sign consent paperwork and gather other required information such as letters of medical necessity from physicians, hospitalization discharges, and more.
YCC SENDS PAPERWORK TO GAPP
YCC prepares and submits paperwork to GAPP. GAPP may take up to 30 days to make a decision (approve or denial).
YCC RECIEVES DECISION
YCC receives decision from GAPP.
YCC CONTACTS YOU TO START CARE
YCC contacts you to schedule the start of care or to discuss the appeal process in case of denial.
How To Appeal GAPP's Decision
If the number of hours approved for your child is not what was requested or it has been reduced, you have the right to appeal — but you must respond quickly via mail by the deadlines indicated in your letter. Here’s how:
- You’ll receive a letter from GMCF (Georgia Medical Care Foundation), stating GAPP’s decision — and the clock starts from the date on the letter
- We’ll help you with the letters and acquire any other additional written correspondence from doctors, hospitals, or other required documentation.
- We’ll work with you to ensure that all documentation is mailed to the address on your letter within 30 days.
- GAPP has 30 days to accept or deny your appeal.
Your Choice Caregivers provides companion care, personal care, skilled and unskiled nursing care, Sitter/Nanny Services, Behavior/Intellectual Care and Alzheimer’s & dementia care services. Our affordable home care services are customized to allow your family member or adult to live at home in familiar surroundings while relieving you of stress and worry.
Services can begin as soon as 48 hours after contacting Your Choice Caregivers. All services begin with a free at-home assessment, meeting with the patient and family, to develop a Personal Care Plan customized to your needs and budget. The Personal Care Plan is followed by your caregiver and supervised by a registered nurse to be sure all needs are met.
With your approval, care can begin as soon as 48 hours after contacting Your Choice Caregivers.
To start, call us at (404) 479-1008 or send an email to [email protected]. We’ll discuss your needs and schedule to have our RN Director of Clinical Services come to your home to conduct a free, no obligation assessment with your loved one. We’ll answer all your questions such as types of services available and care costs. Then, we’ll create your Personal Care Plan and match your loved one with the perfect caregiver.
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.
