Medicaid Denied Your Child's Nursing Hours? Here's What to Do

Being denied — or having your child's nursing hours cut — is one of the most stressful moments a family can face. Here is the honest truth: a denial is not always the end of the road, and many families successfully get decisions changed. This page explains your options.

First, do not miss the deadline. Medicaid denial and reduction notices come with a limited window to appeal (often about 30 days from the date on the notice). If you believe the decision is wrong, act quickly — even while you are still gathering documents.

Why nursing hours get denied or reduced

The most common reasons are about documentation, not about whether your child truly needs care:

• The medical documentation did not fully capture how much care your child actually needs.

• A reassessment concluded your child's needs had changed.

• Physician forms or paperwork were incomplete.

• The request went in as standard Medicaid without the right pathway (see below).

That distinction matters — because documentation can be strengthened, and a stronger record often changes the result.

What you can do

1. Read the notice carefully. It states the reason for the decision and your appeal deadline.

2. Request an appeal / fair hearing in writing before the deadline. You have the right to one.

3. Ask your child's physician for stronger documentation — a detailed letter describing the condition, the skilled tasks required, and what would happen without in-home nursing. This is often what changes the outcome.

4. Get an experienced agency involved. An approved GAPP agency handles these assessments constantly and can help ensure your child's needs are documented the way the state needs to see them.

If you were denied “regular” Medicaid on income

This is a different situation with a different fix. If you were denied children's Medicaid because your household income was too high, the answer may not be an appeal at all — it may be the Katie Beckett pathway, which ignores parents' income entirely. Many families denied on income qualify through Katie Beckett and never knew to ask.

Read about Katie Beckett →

You do not have to do this alone

Denials feel personal, but they are often a documentation problem with a documentation solution. HeartPath helps Georgia families navigate assessments, appeals, and the paperwork that determines nursing hours.

See where you stand — try the Path Finder →

Clinically reviewed by the Director of Nursing, HeartPath Home Care. Last reviewed July 2026.

Sources: Georgia Department of Community Health (dch.georgia.gov); Georgia Medicaid (medicaid.georgia.gov). This page is educational and does not determine eligibility; eligibility is decided by Georgia Medicaid.