FAQ

• Have skilled medical needs requiring hands-on care
• Require continuous supervision for safety due to a medical condition
• Diagnosed with medical complexity (not diagnosis alone, but care needs)
• Need assistance with activities of daily living (ADLs) such as feeding, toileting, and mobility
• Require ongoing medical interventions, such as:
  • Seizure monitoring/intervention
  • Oxygen use
  • G-tube feedings
  • Tracheostomy care
    • More
• Have a clear need for in-home care beyond what the school provides
• Are enrolled in Medicaid
• Have strong medical documentation supporting medical necessity from physicians and home health agencies

• No skilled medical needs (only developmental or behavioral concerns)
• Diagnoses such as autism or ADHD alone (without medical complexity or safety needs)
• Independent with daily activities (feeding, toileting, mobility)
• No need for continuous supervision for safety
• No ongoing medical interventions (e.g., oxygen, seizures requiring intervention, G-tube, trach)
• Needs are fully met at school or through other programs (no in-home need)
• Not enrolled in Medicaid
• Insufficient or weak medical documentation to support the need

Hours are determined based on a combination of medical documentation and the child’s daily care needs:

• Physician Plan of Treatment (PPOT)

  A detailed document completed by the physician outlining the child’s diagnoses, medical needs, required treatments, and the level of care needed in the home

• Nursing Assessments

  A comprehensive in-home evaluation completed by a nurse that identifies the child’s condition, safety risks, and the amount of hands-on care and supervision required each day

• Medical Records

  Recent office visit notes, hospital records, and specialist reports that support the child’s condition and demonstrate the need for ongoing care

• Functional Limitations

  The child’s ability (or inability) to perform daily activities such as feeding, mobility, toileting, and communication, as well as the level of supervision needed to ensure safety

• Insufficient medical documentation

  Physician notes, PPOT, or records do not clearly support the level of care requested

• The medical need is not clearly demonstrated

  Diagnosis is present, but there is no evidence of ongoing hands-on care or skilled need

• The child is too independent

  Able to perform ADLs (feeding, toileting, mobility) without significant assistance

• Lack of skilled or continuous care needs

  No need for interventions such as seizure management, oxygen, G-tube, trach, or close monitoring

• Needs are considered non-medical

  Primarily behavioral, developmental, or educational (e.g., autism or ADHD without medical complexity)

• Services overlap with school (IEP)

  Care needs are already being met during school hours, with no clear need at home

• Incomplete or incorrect paperwork

  Errors, missing signatures, or vague physician responses on the PPOT

• Inconsistent or limited use of previously approved hours

  Can impact renewals and future approvals

• Not enrolled in Medicaid

  GAPP is a Medicaid-based program

• Failure to demonstrate safety risks

  Documentation does not clearly show why the child requires supervision to prevent harm

A skilled nurse provides medically necessary care and supervision based on the child’s condition and physician orders.

• Medication administration and monitoring for side effects
• Seizure monitoring and intervention per care plan
• Respiratory care (oxygen management, suctioning, monitoring)
• Tracheostomy (trach) care and emergency response
• G-tube care and feedings (administration, flushing, site care)
• Clinical monitoring (vital signs, condition changes, complication prevention)
• Medically-related personal care (bathing, feeding, positioning for safety)
• Mobility and transfer assistance related to medical needs
• Care coordination with physicians, specialists, and DME providers
• Skilled documentation (nursing notes, care compliance)

All services must be medically necessary and physician-ordered.

Yes — parents can be paid under Personal Support Services (PSS)

Parent caregivers provide non-skilled care, such as:

• Assistance with ADLs (bathing, feeding, toileting)
• Supervision and safety monitoring
• Daily care and support
• Skilled nursing is separate from caregiver services

If a parent is a nurse, they cannot perform skilled nursing tasks for their own child under GAPP. Payment is based on approved PSS hours through Medicaid.

No, parents are not required to use all approved hours each week Hours can vary based on:

• Illness
• Scheduling needs
• Family circumstances
• Consistently not using hours may impact renewals or future approvals
• May indicate to reviewers that the full level of care is not needed
• Best practice: use hours as consistently as possible
• Document reasons when hours are not used

• Yes — typically, a parent or responsible adult must be present, especially for minor children
• GAPP services are designed to support the family, not replace parental responsibility
• Parents remain the primary decision-makers and caregivers
• The nurse provides medical care and supervision, but does not assume full custody of the child
• In some cases (older teens or specific approvals), requirements may vary — always confirm with your provider

Skilled medical care, including:

• Medication administration
• Seizure monitoring and intervention
• Oxygen, trach, or G-tube care (if applicable)

Clinical monitoring, such as:

• Vital signs
• Observing changes in condition
• Preventing complications

Medically-related ADLs, including:

• Bathing, grooming, and hygiene
• Diapering and toileting (when medically necessary)
• Feeding support with safety precautions (aspiration risk, positioning)

Daily care routines tied to medical needs, including:

• Positioning and mobility support
• Maintaining a safe environment
• Structured activities based on the care plan

Care coordination, such as:

• Communicating with physicians
• Supporting implementation of the care plan (PPOT)

Possibly — but limited and case-specific

Must align with:

• The child’s safety needs
• The approved plan of care
• Agency and program guidelines

Generally:

• Short, necessary outings may be allowed
• Extended absences are typically not permitted without approval

Always: discuss with your provider in advance

• Ensure expectations are clearly documented

Typically, GAPP does not directly impact SSI benefits

• GAPP provides medical services, not income to the child
• However:
  • Changes in caregiver pay (PSS) or household circumstances may require review
• Always:
  • Confirm with Social Security or your provider for your specific case

Yes — school services can impact GAPP hours. GAPP and school services cannot overlap (no duplication of services)

Nursing hours may be adjusted based on:

• The child’s school schedule
• Nursing or support services provided at school

Documentation must clearly show:

• What care is needed at home
• What care is already provided at school

Strong coordination between:

• Parents
• School (IEP team)
• Medical providers are essential to support approvals

• How the approval process works
• Understanding Medicaid requirements and rules
• How nursing hours are determined
• The difference between:
  • Skilled nursing (RN/LPN)
  • Caregiver/PSS services
• Why:
  • Approved hours sometimes do not match physician recommendations
  • Appeals are often needed