How Are GAPP Nursing Hours Determined, and Can You Request More?
If your child has a disability or complex medical needs, in-home nursing care through Georgia’s GAPP (Georgia Pediatric Program) can be life-changing. But many families are left wondering:
1. How are my child’s nursing hours determined?
2. What if the hours approved aren’t enough?
We hope that this article in our resource center will help families like yours across Georgia understand and advocate for the right level of care, including navigating Medicaid reviews, appeals, and requests for increased hours. Here's what families need to know:
How GAPP Nursing Hours Are Determined
Once your child is approved for GAPP (usually through Medicaid directly or the Katie Beckett waiver), your selected home care agency will work with you and your physician to submit a Plan of Care (POC) to obtain a Prior Authorization (PA) from Georgia Medicaid. These documents form the foundation of your child’s nursing hours approval.
The number of nursing hours your child receives depends on:
The severity and complexity of their medical condition
Whether they require skilled interventions (e.g., trach suctioning, G-tube feedings, oxygen support, seizure monitoring)
The level of supervision and care needed throughout the day
Any nighttime care needs, such as apnea monitoring or seizure support
Whether a caregiver (such as a parent or family member) is available and trained to provide care when a nurse is not present
All of this is reviewed by the Georgia Medical Review Team, which makes the final decision on the number of weekly nursing hours your child will receive under Medicaid.
What Is the Role of the Child’s Doctor?
Your child’s physician plays a critical role in the process. As part of the PPOT (Physician Plan of Treatment), they must:
Provide a Letter of Medical Necessity (LMN)
Sign off on the Plan of Care
Provide detailed medical documentation supporting the need for skilled nursing
Agencies like Miralta often collaborate closely with your child’s pediatrician or specialist to ensure this documentation is complete, specific, and timely, which can greatly improve the likelihood of a fair and accurate approval.
How Your Home Care Agency Can Help
A knowledgeable, experienced GAPP provider can make a significant difference in how your child’s case is presented to Medicaid. At Miralta, we:
Help families complete and organize medical documentation
Coordinate directly with your physician to ensure medical necessity is clearly documented
Advocate for your child during initial authorization and renewal periods
Monitor whether the assigned hours are actually meeting your family's needs and submit a request for more if needed
We’ve seen firsthand how the quality of documentation and advocacy can influence outcomes
Can You Request More Nursing Hours?
Yes. If the number of hours approved does not meet your child’s care needs, you can request a re-evaluation or file an appeal.
You may be able to:
Submit updated or additional documentation, such as a new LMN from your child’s physician
Revise the Plan of Care with updated information on your child’s condition, needs, or family circumstances
Request an increase in nursing hours if the child’s health has worsened or if new care tasks have been added
If a request is denied, you also have the right to a Medicaid fair hearing, which is a formal appeal process.
We’ll Guide You Through the Process
At Miralta Home Care, we’ve helped hundreds of families across Georgia secure the right level of nursing support. We handle:
Initial GAPP intake and enrollment
Development and submission of the Plan of Care
Communication with doctors and Medicaid
Advocacy for increased hours and appeals when needed
All of this is provided at no cost to the family.
Serving Metro Atlanta and Surrounding Counties
Miralta proudly serves families in Fulton, DeKalb, Gwinnett, Cobb, Forsyth, Clayton, Cherokee, Henry, Hall, Fayette and Paulding counties. We specialize in pediatric home nursing for children with complex or chronic conditions. We are committed to getting you the care you need.
Schedule a Free Consultation Today
You don’t have to figure this out on your own. We’re here to make the process easier, faster, and more successful.
Book your free consultation now. Let’s talk about how we can help your child get the care they deserve.
