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 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 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.
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.
The Appeal Itself
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: Tube feedings, Central lines for medication and IV fluids, tracheostomy and ventilator, 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: increased risk for infection, risk of injury, or potential for increased hospitalizations.
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.
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.