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

Childhood Cancer Lantern
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Florida program

Nursing at home and a paid family aide

Medicaid can pay for skilled nursing at home. A trained parent can sometimes work as the paid aide.

What it is

Medicaid can pay for skilled nursing at home. A trained parent can sometimes work as the paid aide.

Home nursing depends on the tasks your child needs, not the cancer diagnosis alone. A doctor documents the skilled care and an agency requests hours. Family aide pay is a separate option while the child receives private duty nursing.

Eligibility rules
  • The child must be under 21, have Medicaid and need medically necessary skilled nursing. A diagnosis alone does not qualify.
  • The family aide must be at least 18, complete approved training and screening, and work through a home health agency. A physician’s order and care plan are required.
  • A related RN or LPN can provide paid nursing through the permitted agency arrangement for up to 40 hours weekly. Ordinary personal care has different paid-parent rules; the coordinator checks that separate service.
What you get
  • Approved nursing hours at home.
  • A trained family aide can receive pay through an agency for approved hours.
What the help covers
  • From July 2, 2026, family aide services ordinarily have a 12-hour daily and 40-hour weekly limit. An approved exception can exceed 40 hours when no other qualified worker is available. Nursing and aide hours cannot overlap or exceed 24 hours daily together. The same related person cannot fill both paid roles.
  • Orders describe tasks such as central-line care, IV nutrition, tube feeds or oxygen, with the risk if care is missed.
If you decide to apply
  1. Ask the discharge planner or plan care coordinator for a Medicaid home health agency referral.
  2. Keep a daily care log and ask the doctor to describe each skilled task and its frequency.
  3. Ask the agency about training and employment if you want to work as the family aide.

Your Medicaid care coordinator or hospital discharge planner · Official page ↗

What happens next
  • The Medicaid plan approves its members’ hours. For fee-for-service Medicaid, the state review organization reassesses at least every 180 days.
  • A Medicaid health plan has seven days to answer a request for nursing hours, or 72 hours when your child cannot safely wait.
  • An appeal after a denial is different from the first approval request. Sunshine CMS promises urgent appeal decisions within 48 hours; the federal appeal ceiling is 72 hours. The Medicaid children’s-care card explains appeal and continued-service deadlines.
Good to know

Approved hours and an available nurse are separate hurdles. Family aide pay depends on the child receiving private duty nursing.

Other details
  • The assessment can start before discharge, but hours are only paid once Medicaid is in place. If you become the paid aide, the agency sets your wage and that income counts for other benefits.
Official sources
Ask your social worker

“Would our child’s care qualify for home nursing, and what would the agency expect from us? Could a parent train as the paid aide, and could you help arrange the assessment?”

Why I’m asking: I want safe care at home and a realistic picture of staffing and possible parent pay.

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

Describe the daily tasks, ask the agency about being trained and paid as the aide, keep a care log.

Your social worker

The social worker or discharge planner finds a Medicaid home health agency, sends the referral and the doctor's orders, and follows the approval.

The care team

The doctor writes orders naming each skilled task, how often, and the risk without it.

Who decides
Your child's Medicaid health plan approves the hours for its members; the state's review company does it for children in Medicaid directly (fee-for-service).
Ask your social worker
“Which home health agency can assess our child, and can a parent be trained and paid as the family home health aide? Who authorizes the hours?”

How to apply

First step: Ask the discharge planner or oncology social worker this week for a referral to a Medicaid home health agency. The doctor's orders must name each skilled task. Ask the agency about the family aide training.

  1. Ask the discharge planner for a home health agency referral and physician orders naming each skilled task.
  2. Ask the agency about training a parent as the family home health aide.
  3. If the plan denies or cuts hours, appeal within 60 days and cite the under-21 medical-necessity rule.

Official application / program page ↗

Where it starts: Ask the plan's care coordinator or discharge planner for a home health agency referral; the agency requests authorization

What to gather

  • Medicaid number and plan name
  • Doctor's orders naming each skilled task and how often
  • Medication and equipment list
  • A daily care log

How long: The coordinator confirms the request type, rating period and applicable deadline. Covered managed-care non-drug requests use seven calendar days ordinary or 72 hours urgent, with a permitted extension up to 14 days. Fee-for-service reassessment is at least every 180 days. Clinical approval does not guarantee staffing.

What a yes looks like

A written approval with service type and hours, and an agency schedule. If a parent will be paid, get the hours, training and wage in writing first.

What a no looks like, and the next move

Ask for the written medical reason. Appeal to the plan within 60 days; a fair hearing can follow within 120 days of the plan's answer. Ask the doctor whether the order describes every task.

Watch out

  • Medicaid must cover the service date. Enrollment, the care assessment and staffing can be coordinated during discharge planning.
  • Leukemia alone gets no hours. The order has to name skilled tasks: central-line care, IV nutrition, tube feeds, oxygen.
  • Getting approval and finding a nurse are two different waits. The aide pay only exists while the child is getting private duty nursing.

Dates that change this

2026-07-02: The February 2026 private duty nursing and family aide policy took effect July 2, 2026 (12 aide hours a day); AHCA's web summary still says 8.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 8, 2026.

What it is worth

Approved nursing hours at home. From July 2, 2026, family aide services ordinarily allow up to 12 hours daily and 40 weekly, with a narrow approved weekly exception. A related agency-employed RN or LPN can provide up to 40 nursing hours weekly.

  • $12 — Family home health aide, hours per day (child under 21 receiving PDN)
  • $40/week — Family home health aide ordinary weekly limit; a narrow approved exception applies
  • $40/week — Related RN/LPN paid for PDN, hours per week

Covers: Private duty nursing hours · Family home health aide hours (a trained parent through the agency) · Nursing by a parent who is an RN or LPN, through the agency

What it costs the family: None. A Medicaid service delivered through an agency.

The eligibility facts, as published

Medicaid
required
Age max exclusive
21
Need
medically necessary skilled nursing (PDN); the aide needs a physician order and a child receiving PDN
Authorization
the managed-care plan for its members; fee-for-service through the Medicaid QIO at least every 180 days
Parent pay
family home health aide (trained, agency-employed); RN/LPN parent up to 40 hours a week; ordinary personal care excludes parents except CDC+
Decision deadlines federal
For managed-care non-drug requests in rating periods beginning January 1, 2026 or later: as quickly as needed, at most seven calendar days ordinary or 72 hours expedited; up to 14 additional days only under the regulatory conditions. Other requests and appeals have separate clocks.

The trap: The plan approves the hours, and then a nurse still has to be found. Ask the agency about staffing before you count on it. The state Medicaid agency's (AHCA) web page still says 8 aide hours a day; the July 2026 policy says 12.

Where I read this

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