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Get Qualified

Get Qualified

One short form. You do not need paperwork, and you do not need to know whether your child qualifies — that is what the conversation is for.

This form needs JavaScript turned on. You can also call us at (470) 645-9079 and we will take your details by phone.

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Fields marked * are required.

Parent / Guardian

First name*

Last name*

Phone*

Email*

City*

ZIP code*

Child Information

Child's first name*

Child's last name*

Date of birth*

Gender (optional)

Primary Diagnosis / Medical Condition

Choose all that apply — or Not Sure if you are not certain.

Tracheostomy / VentilatorG-tube / Feeding PumpSeizure Disorder / EpilepsyCerebral PalsySpina BifidaHydrocephalusMuscular DystrophySpinal Muscular Atrophy (SMA)Brain InjurySpinal Cord InjuryGenetic / Chromosomal DisorderMetabolic DisorderChronic Lung Disease / Respiratory FailureDevelopmental DisabilityComplex Medical NeedsOtherNot Sure

Medicaid Status

Is your child currently enrolled in Medicaid?

Yes — Active MedicaidYes — Application / PendingNo — Need Help ApplyingNot Sure

Anything else you’d like us to know? (optional)

0 / 600

I agree to be contacted by WeLIVE Healthcare Services about services for my child by phone, text, or email.*

This is not a Medicaid application. Georgia Medicaid determines eligibility and service hours.

This is not a Medicaid application. Georgia Medicaid determines eligibility and service hours.

What happens after you send this

1.A member of our team reviews what you have told us.
2.We call, text or email you to talk it through.
3.If we may be able to help, we explain what the next steps would involve.

This is not an eligibility decision

WeLIVE Healthcare does not determine Medicaid eligibility and cannot approve Georgia Pediatric Program services or hours. Those decisions are made by Georgia Medicaid based on medical necessity, physician orders and clinical documentation.

Would you rather just talk?

Plenty of families prefer the phone. That is completely fine.

Call (470) 645-9079

If your child is having a medical emergency, call 911. Please do not use this form to report an emergency. See our privacy policy.

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(470) 645-9079Fax (678) 884-0561 care@welivehealthcare.com

650 Ponce De Leon Ave NE STE 300, Atlanta, GA 30308

Pediatric Skilled Nursing
Personal Care & Support Services
Respiratory & Airway Care
Enteral Feeding Support
Medication Management
Seizure Monitoring & Response
Complex Pediatric Care

The Georgia Pediatric Program (GAPP) is administered by the Georgia Department of Community Health, Division of Medical Assistance Plans. WeLIVE Healthcare Services does not determine Medicaid eligibility or approve program services. Information on this site is general and educational, is not medical advice, and does not guarantee eligibility, approval, service hours or coverage. Approval decisions are based on medical necessity, physician orders and clinical documentation reviewed by Georgia Medicaid.

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