GAPP

• 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

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)

Provide non-skilled care, such as:

• Assistance with daily activities
• Supervision and safety monitoring
• Daily care and support
• Skilled nursing is separate from caregiver services
• Parents who are nurses cannot perform skilled nursing tasks for their own child
• Payment is based on approved PSS hours through Medicaid

• GAPP typically does not directly impact SSI benefits
• It provides medical services, not income
• Changes in caregiver pay or household status may require review
• Always confirm with Social Security or your provider