Alabama program
Nurses and aides at home through Medicaid
Medicaid can pay for nurses and personal care at home when your child needs them.
What it is
Medicaid can pay for nurses and personal care at home when your child needs them.
The nights and daily tasks at home matter when your team assesses care needs. A physician orders the care, and Alabama Medicaid decides the approved hours. Your child’s diagnosis alone does not tell the agency how much help is needed.
Eligibility rules
- Your child needs Medicaid. The broader children’s benefit applies under age 21.
- Home nursing needs at least four hours in a row of skilled nursing care; help with daily tasks (personal care) has its own test. Both need Medicaid approval. A parent who is a licensed nurse can be paid for up to 40 hours a week, but only as an employee of an enrolled nursing agency.
What you get
- Approved nursing and personal care at home through Medicaid.
- Up to 40 approved nursing hours weekly for a licensed parent employed by an enrolled nursing agency.
What the help includes
- Hours beyond the licensed parent’s 40-hour weekly limit need a different nurse.
- Under the Personal Choices handbook, a minor’s representative cannot also be the paid worker.
If you decide to apply
- Ask the discharge planner to review the care you give during the day and overnight.
- Have ready: the discharge plan, a daily care record and your nursing license number if applicable.
- Ask the doctor and nursing agency to prepare the care order and state paperwork.
Alabama Medicaid Agency · 1-800-362-1504 · Official page ↗
After you ask
- The doctor and the nursing agency send the care plan to Medicaid for approval. A decision is due within seven days, or 72 hours when the team marks it urgent. Before discharge, ask for the approved hours, a staffed schedule and what happens when a nurse misses a shift.
Good to know
A nursing license alone does not establish parent pay. The parent needs nursing-agency employment and specific Medicaid approval; ordinary parenting does not become paid aide work.
Other details
- Authorization and staffing are separate. The nursing provider must have a missed-visit policy, assess the need for substitute care and communicate about missed coverage; the discharge team should confirm a safe, actually staffed plan.
- EPSDT supports review of medically necessary services within Medicaid benefit categories, rather than every requested service.
Official sources
“Would home nursing fit the care our child needs, and how many hours could we realistically receive? If it would help, could you arrange the assessment and explain any parent-pay rules?”
Why I’m asking: I want a safe plan for the care we will need to manage at home.
More background and detailed requirements
Additional program information and published rules
Who does what
The three parts, side by side. The agency decides; nobody on this page does.
You
Say plainly what the nights look like, and ask for the order before discharge.
Your social worker
The discharge planner and the nursing provider prepare the authorisation paperwork.
The care team
A physician orders the service and signs the plan of care.
- Who decides
- The Alabama Medicaid Agency authorises the hours.
- Ask your social worker
- “Could we review the nursing care, approval and staffing needed for a safe discharge?”
How to apply
First step: Talk with the discharge team about clinical care needs, approval paperwork and a staffed home-care plan.
- Ask the inpatient team to start the nursing order before discharge, not after.
- Ask the discharge planner which nursing agencies have hours in your county.
- If a parent holds a nursing licence, ask about the licensed-parent option by name.
Where it starts: The hospital team writes the order and a nursing provider submits the authorisation paperwork before discharge.
What to gather
- The discharge plan
- A written note of what care at home takes each day and night
- A parent's nursing licence number, if there is one
How long: Applicable 2026 non-drug decision limits are seven calendar days standard and 72 hours expedited. Recertification submission at least 14 days before its due date is a separate requirement.
What a yes looks like
An authorisation naming the hours a week and a nursing agency that can staff them.
What a no looks like, and the next move
The notice and clinical team can identify whether the issue concerns medical criteria, paperwork or requested hours. EPSDT applies within federal Medicaid benefit categories.
Watch out
- Covered non-drug requests have seven-calendar-day standard and 72-hour expedited decision limits from 2026, subject to applicable request rules; staffing is separate.
- Parent nursing pay requires an Alabama RN or LPN license, enrolled-agency employment and legally liable nurse approval each certification period, for up to 40 hours weekly.
- The self-direction handbook says a minor's representative cannot also be the paid worker, so being paid as an ordinary aide is not open the way it is in some states.
Dates that change this
2026-08-14: The consolidated nursing rule took effect August 14, 2026. That is the rule's date, not the date the licensed-parent option began.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 11, 2026.
What it is worth
Medicaid must approve nursing and personal care. An Alabama-licensed parent employed by an enrolled nursing agency may receive approval for up to 40 nursing hours weekly under the legally liable nurse option.
- $40/week — Approved weekly hours for an Alabama-licensed parent employed by an enrolled nursing agency with legally liable nurse approval
Covers: Private duty nursing hours at home · Personal care after a physician's order · Medically necessary care for a child under 21 within federal Medicaid benefit categories, including eligible services beyond the ordinary state list
Legal protection: EPSDT covers medically necessary care within federal Medicaid benefit categories for a child under 21; the clinical test and required approval still apply.
What it costs the family: No charge on Medicaid.
The eligibility facts, as published
- Age
- under 21 for the wider children's rule
- Income
- none of its own: the child must have Medicaid
- Level of care
- Private-duty nursing and personal care have separate clinical tests. Private-duty nursing generally requires at least four consecutive hours of skilled nursing plus the rule’s medical criteria, physician assessment and Medicaid approval.
- Residency
- Alabama
- Processing standard
- From January 1, 2026, covered non-drug prior-authorization decisions have a seven-calendar-day standard and 72-hour expedited maximum under applicable federal request rules; approval does not establish available staffing.
Decisions this site cannot make: Alabama Medicaid prior authorisation of private duty nursing · Physician order after a screening exam
Expect friction on: Finding a nursing agency with hours to give is often harder than the approval
The trap: The 2026 non-drug decision clocks are seven calendar days standard and 72 hours expedited, subject to applicable rules. Nursing-agency staffing and a missed-visit safety plan are separate from approval.
Where I read this
- Alabama Administrative Code 560-X-11-.14 — EPSDT — Alabama Medicaid Agency, read September 10, 2026
- Alabama — Approved E&D Waiver Application AL.0068.R08.00 — Alabama Medicaid Agency / Alabama Department of Senior Services, read September 10, 2026
- ADSS — Personal Choices Participant Handbook — Alabama Department of Senior Services, read September 10, 2026
- Alabama Department of Senior Services — Medicaid Waiver Programs — Alabama Department of Senior Services, read September 10, 2026