Written by a parent, not a doctor. Nothing here is medical advice.

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California program

Skilled nursing at home through Medi-Cal

Medi-Cal nursing at home for children under 21 who need skilled care, after a medical assessment.

What it is

Medi-Cal nursing at home for children under 21 who need skilled care, after a medical assessment.

A discharge plan may leave your child needing skilled nursing at home. You do not have to wait for HCBA enrollment for this separate Medi-Cal benefit. The plan or other responsible payer must help arrange the approved care.

Who can get it
  • Your child must have Medi-Cal and be under 21 for this EPSDT route.
  • A Medi-Cal member under 21 can have medically necessary private-duty nursing reviewed under EPSDT without HCBA. Your child needs an assessment and an approved nursing plan. The nurse must be properly licensed and enrolled. You do not need to wait for an HCBA place. Approval still does not guarantee a nurse is available.
What you get
  • No charge with Medi-Cal that has no Share of Cost.
  • Approved private-duty nursing hours for medically necessary skilled tasks.
  • Help arranging nursing staff and tracking unfilled hours.
If you decide to apply
  1. Ask the discharge planner to send the doctor’s nursing orders to the right Medi-Cal plan, CCS office or direct Medi-Cal payer.
  2. Have ready: orders listing tasks, frequency and hours, the discharge plan, agencies contacted and a record of unfilled shifts.

(855) 347-9227 DHCS Pediatric Day Health Care / Private Duty Nursing · Official page ↗

What happens next
  • The payer reviews medical necessity and identifies approved hours. The discharge team can obtain a written staffing plan.
  • The plan must help find nurses, including contacting agencies and individual nurses. Unstaffed approved hours remain a care gap.
Good to know

An approval letter does not mean a nurse is available. Staffing gaps need a documented search and follow-up.

What else to know
  • The federal EPSDT rule covers medically necessary services within Medicaid benefit categories. It does not guarantee every requested service or hour.
  • DHCS receives reports of unfilled hours at EPSDT@dhcs.ca.gov or 855-347-9227. A record of agencies contacted and missed shifts helps explain the gap.
Official sources
Ask your social worker

“Does our child need skilled nursing at home, and what could Medi-Cal cover? What limits or staffing gaps should we expect? Would you recommend requesting an assessment, and could you help us arrange approved care while other programs are pending?”

Why I’m asking: I want to understand whether skilled care at home could be covered and how nursing shifts would be staffed.

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

Ask who the payer is, keep the unstaffed-hours log, and report any gap to DHCS at (855) 347-9227 or EPSDT@dhcs.ca.gov the same week.

Your social worker

The discharge planner and social worker send the request to the right payer and hold the plan's case manager to its duty to find agencies.

The care team

The physician writes the nursing orders with tasks, frequency and hours.

Who decides
The responsible Medi-Cal payer: the managed-care plan, CCS, or fee-for-service Medi-Cal
Ask your social worker
“Who pays for home nursing for my child? Has the request gone to them with the ordered hours, and who is arranging the agency?”

How to apply

First step: Ask the discharge planner who pays: your Medi-Cal plan, CCS, or Medi-Cal directly. Ask them to request the nursing hours the doctor ordered. Write down every unfilled shift and report it to DHCS at (855) 347-9227 or EPSDT@dhcs.ca.gov.

  1. Ask the discharge team to send the nursing request to the actual payer.
  2. If hours are approved but no nurse comes, email EPSDT@dhcs.ca.gov with the child's name, Medi-Cal number and your phone, or call (855) 347-9227.
  3. Keep an unstaffed-hours log.

Where it starts: Discharge planner sends the nursing request to the payer

What to gather

  • Nursing orders with tasks, frequency and hours
  • The discharge plan
  • Agencies contacted and unfilled shifts

How long: Clinical urgency sets the pace. Ask for the approval date and the staffing plan in writing.

What a yes looks like

An approval with hours and a named agency actually scheduling shifts.

What a no looks like, and the next move

A medical-necessity denial (appeal through the plan or CCS with the physician's orders), or an approval with no nurse (report the gap to DHCS at (855) 347-9227 and ask the plan's case manager for its search log).

Watch out

  • An approval letter is not a nurse. The Medi-Cal plan must document every effort to find one and track the gap. Report unstaffed hours to EPSDT@dhcs.ca.gov or (855) 347-9227 with the child's name, Medi-Cal number and your phone.
  • Do not relabel ordinary care as skilled nursing. The orders must name skilled tasks.
  • The plan must help arrange the nursing hours it authorized, including contacting agencies and individual nurses. If approved hours remain unstaffed, ask the plan to document its search and contact EPSDT@dhcs.ca.gov.

Dates that change this

2026-06-01: APL 26-009 (June 1, 2026) replaces APL 20-012 on private-duty nursing case management: plans must document efforts to find providers and manage staffing gaps. The DHCS EPSDT page still links the old letter.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 10, 2026.

What it is worth

Authorized private-duty nursing hours at home for skilled needs, with a duty on the payer to help find the nurse.

Covers: Private-duty nursing hours · Case management to arrange staffing

Legal protection: EPSDT: medically necessary services for a child under 21 must be covered

What it costs the family: None with no-share Medi-Cal.

The eligibility facts, as published

Medi cal
required (EPSDT, under 21)
Need
medically necessary skilled nursing ordered by the physician

Decisions this site cannot make: Medical necessity by the responsible payer

Expect friction on: Nursing-agency staffing · Identifying the responsible payer (plan, CCS or FFS)

The trap: An approval letter is not a nurse. The plan must document its search for one. Keep an unstaffed-hours log and report gaps to DHCS.

Where I read this

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