By Jenna Dakroub, HeLP Fall 2017 Student Intern
The Georgia Pediatric Program (GAPP) is a resource provided by the state of Georgia to young children with medical illnesses. GAPP is a community-based service facilitated through the Georgia Department of Community Health and is one of several offered waiver programs. Each waiver program is designed to help individuals who qualify for institutional care remain in their community, or return to their community if they have already been institutionalized. Eligibility for the program is based on medical necessity and the need for skilled nursing and/or personal care support services. Additionally, children must be Medicaid eligible in order to be members of GAPP. More information on Medicaid, its eligibility requirements, and how to apply can be found here.
Medicaid is a health insurance program for low-income families. In Georgia, to be eligible for Medicaid you must have a low income, be a U.S. citizen or a lawfully admitted immigrant, and match one of the following: you think you are pregnant; are a child or teenager; are 65 or older, are legally blind; have a disability; or need a nursing home. Applications for GAPP, in turn, are completed by the individual Medicaid providers enrolled to offer services through the program.
GAPP provides services either in-home or in a medical day care as an alternative to full-time skilled nursing care at a facility or institutional setting such as a hospital. Medically Fragile Day Care is available to children who qualify as members from birth through the age of five. Skilled and non-skilled care is provided in a medically licensed day care facility five days a week. At the Day Care program, the goal is to improve the child’s independence. The following services are provided at Day Care: Skilled Nursing; Physical therapy; Speech therapy; Transportation; Social Service; Child life specialist; and Registered dietitian services.In-home Nursing services are provided to members who are under the age of 21 and have a medical necessity for skilled nursing. To be eligible for in-home nursing, children must be medically fragile, require skilled nursing care, and currently be receiving physician-ordered services.
The Georgia Medical Care Foundation (GMCF) is under contract with the Department of Community Health to review applications for admission and continued stay in the GAPP Program. While the child’s primary care physician develops the child’s initial plan, GMCF has the discretion to determine what services are necessary and may approve or deny determinations.
The primary care physician develops the child’s initial plan of care.
If a client with a child is interested in applying for GAPP, specifically for in-home nursing services, I recommend informing the client that the program aims to reduce the hours of in-home skilled nursing services the child receives over time. The GAPP manual suggests that the child’s primary caregiver should aid in the offered care, and eventually even take over that care. At first glance, there may not appear to be an issue if the primary caregiver were to take over the child’s care. However, it is unrealistic in the long term for a caregiver to assume all or most of the child’s care, as such care is time consuming, especially for individuals not trained as skilled nurses. These nurses’ tasks include assisting with daily living activities; monitoring vital signs such as blood pressure, pulse, respiration and temperature; assisting with ambulation and transfers; and providing care and assistance related to IV therapies, wound care, tube feedings, and gastrointestinal disorders. It is unlikely that an untrained caregiver would be able to take on most of these tasks. While this would only be a problem for clients with children with severe health issues, it is something all clients should be aware of before becoming GAPP members.