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

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District of Columbia program

Nursing hours at home

Medicaid can pay for nurses and home health aides when your child needs medical care at home.

What it is

Medicaid can pay for nurses and home health aides when your child needs medical care at home.

Nursing hours can make care at home more manageable. Your clinical team describes the needs, and the actual Medicaid reviewer decides covered services and hours. Home-care planning and coverage review can proceed together.

Eligibility rules
  • Your child must be under 21 for the children's health benefit.
  • Whatever opened the child's Medicaid.
  • Medical necessity, described by the child's clinician.
  • District of Columbia.
What you get
  • No family charge for covered nursing and home health aide services.
  • Approved equipment and supplies ordered by your child's doctor.
If you decide to apply
  1. Ask the hospital team to describe the care your child needs at home.
  2. Ask the team to send the nursing request to your Medicaid plan and identify the care manager.
  3. Describe the tasks, nights and care you cannot manage alone.

Your child’s Medicaid care manager, through the member-services number on the insurance card. If DHCF pays the bills directly, its office identifies the reviewer. · Official page ↗

Timing and who can be paid
  • The plan usually decides a request within about a week, or a day when urgent.
  • For a child under 18, nursing at home comes through ordinary Medicaid, not a waiver. At 18 to 20 the team can compare both routes.
  • A parent cannot be paid as their own child's personal-care aide. A parent who is a licensed nurse is a different question; ask the care manager in writing.
Good to know

The hospital's recommendation does not itself approve nursing hours. Your Medicaid plan makes that decision.

Other details
  • If your child moved from Wellpoint DC to AmeriHealth on August 1, 2026, ask the care manager about DHCF’s transition protection through October 31, 2026 for existing appointments and pre-transition approvals. New services have separate approval requirements.
Official sources
Ask your social worker

“Could nursing hours at home make our child’s care safer and more manageable? What care would still fall to us, and could you help us request an assessment if it fits?”

Why I’m asking: I want to understand the care we would still provide ourselves and the hours Medicaid might cover.

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 what you cannot do alone, and ask for the request before discharge.

Your social worker

The hospital team writes the order and sends it; the plan's care manager follows it.

The care team

The oncologist or nurse practitioner documents the medical need for nursing hours.

Who decides
The child's Medicaid health plan authorises the hours.
Ask your social worker
“We cannot manage the line care and the nights alone. Can the team request home nursing hours from the plan before discharge, and mark it urgent?”

How to apply

First step: Ask the discharge nurse or social worker today to start the home nursing request with the health plan.

  1. Ask the discharge nurse which health plan your child is in and who the care manager is.
  2. Get the nursing request submitted while the child is still an inpatient.
  3. If it is urgent, say so: the plan has a faster route for urgent requests.

Official application / program page ↗

Where it starts: Ask the child’s own plan for its care manager using member services on the insurance card. MedStar Family Choice DC’s care-management number is 855-798-4244; it is not a general nursing line for all plans. For fee-for-service Medicaid, DHCF can identify the reviewing office.

What to gather

  • The child's Medicaid card and plan name
  • A plain list of what the nights need

How long: No nursing-specific clock is published. The special-needs plan reported averaging 7 days standard and 26 hours urgent across all services in 2025.

What a yes looks like

An authorisation naming the hours per week and an agency that will staff them.

What a no looks like, and the next move

Ask for the denial in writing, then appeal through the plan and, if needed, to the Department of Health Care Finance.

Watch out

  • The plan authorises, not the hospital. Get the request in before discharge.
  • DC has no children's home-care waiver: every DC waiver starts at 18. The hours come from the ordinary children's benefit.
  • Whether a parent can be paid as the carer is unknown here. The only rule found bars paying a parent for respite, which is a different service.

The numbers and the rules

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

What it is worth

Nursing and aide hours at home, authorised by the health plan. The plan reported averaging 7 days for a standard decision and 26 hours for an urgent one in 2025.

  • $7 — Average time to a standard prior-authorization decision, all services, 2025
  • $26 — Average time to an urgent prior-authorization decision, all services, 2025

Covers: Skilled nursing hours at home · Home health aide hours · Equipment and supplies the doctor orders

Legal protection: A child under 21 on Medicaid is covered for medically necessary services ordered by the child's clinician

What it costs the family: No cost to the family for a covered service.

The eligibility facts, as published

Age
under 21 for the children's health benefit
Income
Whatever opened the child's Medicaid
Level of care
Medical necessity, described by the child's clinician
Residency
District of Columbia

The trap: The plan, not the hospital, authorises the hours. Ask for the care manager by name before discharge and get the request in while the child is still an inpatient.

Where I read this

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