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

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Colorado program

Nursing at home, paid by the state

Health First Colorado can pay for skilled nursing at home when your child needs medical care there.

What it is

Health First Colorado can pay for skilled nursing at home when your child needs medical care there.

The nursing team describes the skilled tasks and hours your child needs. Medicaid reviews the medical request. A regional care team can help coordinate care without deciding every nursing request.

Eligibility rules
  • Your child needs Health First Colorado and medically necessary nursing care.
  • Private Duty Nursing and Home Health are not limited to children under 21. EPSDT adds protections before age 21 for medically necessary services within federal Medicaid benefit categories.
What you get
  • Approved nursing hours at home at no cost to the family.
What the help includes
  • The clinician documents the medical tasks and the hours needed. Approval depends on those needs, not the cancer diagnosis alone.
  • Equipment and supplies are part of the benefit. EPSDT applies to medically necessary services within Medicaid benefit categories before age 21.
  • The child benefit can allow up to 24 hours a day, but the medical review sets approved hours. That limit does not promise a staffed shift.
If you decide to apply
  1. Ask the hospital discharge team to discuss nursing needs with you and submit the medical request.
  2. Describe the care you do each day and ask the team how many hours it requested.

Hospital discharge planner and enrolled nursing agency · Official page ↗

After you ask
  • The hospital or nursing team submits the request. A parent cannot complete the medical request alone.
  • A denial notice identifies the service and review route. Existing services may stop unless continuation is requested by a shorter deadline; the social worker can help check the notice promptly.
  • The Medicaid managed-care ombudsman's complaint number is 877-435-7123.
Good to know

Approved hours depend on the clinical review. An approval and an available nurse are different questions.

Other details
  • The nursing agency confirms the initial and renewal request dates and asks Medicaid about urgent handling when appropriate. The discharge planner can help arrange backup care if an agency cannot staff the approved hours.
  • If no agency has staff for the approved hours, that is not a Medicaid denial; ask the discharge planner for a backup plan.
Official sources
Ask your social worker

“What nursing help could our child qualify for at home, and what would it change for our family? If you recommend a request, could you help the team describe the hours needed?”

Why I’m asking: I want to know which medical tasks we will be expected to manage at home and where nursing help could fit.

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 for it before discharge and keep the refusal letter if one comes.

Your social worker

The hospital team writes and submits the request.

The care team

The doctor writes what the child needs and for how many hours.

Who decides
Health First Colorado or the regional plan.
Ask the care team
“Can you request private duty nursing hours before we are discharged, and tell us how many hours you asked for?”

How to apply

First step: Ask the hospital team to submit the request before you are discharged.

  1. Ask the hospital to make the nursing request before you go home.
  2. If it is refused, call the managed-care ombudsman on 877-435-7123.

Where it starts: The provider asks. Ask the hospital to start it before discharge.

What to gather

  • The discharge plan and the list of equipment going home with you

How long: Unknown. Colorado's decision clock for this was not published where it could be read.

What a yes looks like

An approval identifies covered tasks and hours. The agency and discharge planner separately arrange staffing and any backup plan.

What a no looks like, and the next move

Ask for the refusal in writing, appeal by the date on it, and call the ombudsman on 877-435-7123.

Watch out

  • The 24-hour figure is the benefit limit, not what is approved.
  • The provider has to ask; a parent cannot file this alone.
  • Ask before discharge. It is much harder to arrange once you are home.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Medically necessary nursing at home after assessment, order and approval. Benefits are not limited to children under 21; an available nurse must be arranged separately.

  • $24 — Published maximum private duty nursing for a child

Covers: Private duty nursing at home · Medically necessary services within Medicaid benefit categories before age 21 under EPSDT, with the applicable assessment and authorization. · Equipment and supplies

Legal protection: The managed-care ombudsman takes complaints on 877-435-7123

What it costs the family: Nothing.

The eligibility facts, as published

Coverage
Health First Colorado
Age
Private Duty Nursing and Home Health can cover eligible members across ages. EPSDT adds protection before age 21.
Level of care
Medical necessity, described by the provider

The trap: The 24-hour figure is the limit of the benefit, not what gets approved. The provider has to ask, and the decision clock for Colorado was not published where it could be read.

Where I read this

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