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

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Indiana program

Nurses and aides at home through Medicaid

Your child's Medicaid can pay for nursing, aide help and therapy at home when medically needed.

What it is

Your child's Medicaid can pay for nursing, aide help and therapy at home when medically needed.

Coming home can mean care that goes beyond what a parent can safely manage alone. Medicaid reviews the doctor's order and the child's needs. Approval of hours and finding an agency to cover them are separate steps.

Eligibility rules
  • Medicaid payment requires eligibility, medically necessary services, a physician's order and a care plan. Assessment and discharge planning can start while coverage is being checked.
  • A qualified parent employed by an enrolled home-health agency may provide approved aide, nursing or therapy services. That route does not require a waiver; credentials and the agency's arrangements still apply.
  • Paying a family member is a waiver service with its own assessment. The Health and Wellness waiver is the one a child with cancer could use; the two developmental-disability waivers need a separate finding that cancer does not supply.
  • A parent can be paid as an attendant on the waiver only for a child with very heavy needs: a tracheostomy, a ventilator, IV nutrition, or two of a short list such as monitored IV medicine and complex wounds. The doctor certifies this.
What you get
  • Approved nursing, aide care and therapy at home, paid by Medicaid.
  • Some children qualify for a discharge allowance; the care team checks which coverage rules apply.
  • A qualified parent may be paid through an agency or a separate waiver service.
What the help includes
  • In the first 30 days after discharge Medicaid can pay up to 120 hours of nursing and aide care, if the doctor's order is written before your child leaves. Finding an agency to staff those hours is a separate step.
  • The same fee-for-service provision allows up to 30 therapy units in that 30-day period under its order and medical-necessity conditions. A managed-care plan's coverage must be checked separately.
  • From January 1, 2026, the 40-hour weekly combined limit applies to legally responsible caregivers providing Health and Wellness attendant care or Family Supports participant assistance and care. The hours are combined across those caregivers, not granted separately to each parent.
If you decide to apply
  1. Ask the oncology team to describe your child's care tasks and the orders needed.
  2. Work with the discharge planner on an agency and the hours it can actually staff.
  3. Ask the care manager which paid-parent route fits the care, qualifications and agency arrangements.

Oncology discharge planner and the child's Medicaid plan; care outside a health plan, 866-725-9991 · Official page ↗

After you ask
  • For fee-for-service requests, a seven-day deemed-approval clock runs after complete documents arrive.
  • Medicaid health-plan requests follow applicable state and federal decision deadlines. The agency and plan identify the rule for the service and whether an urgent decision is needed.
  • The home-health agency submits the care request, and the discharge planner arranges the agency.
Good to know

Approved hours do not guarantee an available nurse. Ordinary family care does not automatically become paid work.

Other details
  • Your description of care at home is not a clinical assessment. An unchanged routine does not rule out nursing needs; the team assesses tasks, coverage and available staff.
  • The case manager can separate skilled nursing, aide services and waiver attendant care when explaining the care plan.
Official sources
Ask your social worker

“Could our child qualify for nursing or aide help at home? What would be covered, what limits should we expect, and could you help arrange the assessment and paperwork if it fits?”

Why I’m asking: I want a safe plan for care at home and a clear answer about who can provide each kind of help.

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 the order before discharge, keep the written decision, and ask the case manager about paying a parent if that is the plan.

Your social worker

The discharge planner arranges the agency; the agency files the prior authorisation.

The care team

The doctor writes the home-health order. Form 450B belongs to the specific extraordinary-care waiver route; it is not required for every paid-parent service.

Who decides
The child's Medicaid health plan, or the state contractor for fee-for-service members.
Ask your social worker
“Can we get the home health order signed before discharge so the 120-hour window starts at home, and can the case manager look at whether a parent can be paid for attendant hours?”

How to apply

First step: The discharge team can check whether the fee-for-service allowance applies from the discharge date and arrange the required order beforehand.

  1. Ask for the home health order before discharge, so the 120-hour window starts on day one.
  2. Ask the health plan for the prior-authorisation decision in writing, with a date.
  3. If a parent will be doing the care, ask the case manager about the extraordinary-care allowance and Form 450B.

Official application / program page ↗

Where it starts: Ask the oncology team for a home health order before discharge. Fee-for-service prior authorisation is on 866-725-9991.

What to gather

  • The doctor's written order
  • The health plan card and prior-authorisation contact
  • The case manager's name, if there is a waiver

How long: For fee-for-service requests, a seven-day deemed-approval clock runs after complete documents arrive. Medicaid health-plan requests follow applicable state and federal decision deadlines. The agency and plan identify the rule for the service and whether an urgent decision is needed.

What a yes looks like

A written authorisation naming hours a week and an end date, and an agency that confirms it has staff.

What a no looks like, and the next move

Ask for the reason in writing and appeal through the plan. The child health benefit reaches services outside the ordinary list when they are medically necessary.

Watch out

  • For fee-for-service requests, a seven-day deemed-approval clock runs after complete documents arrive. Medicaid health-plan requests follow applicable state and federal decision deadlines. The agency and plan identify the rule for the service and whether an urgent decision is needed.
  • From January 1, 2026, the 40-hour weekly combined limit applies to legally responsible caregivers providing Health and Wellness attendant care or Family Supports participant assistance and care. The hours are combined across those caregivers, not granted separately to each parent.
  • A rule that lets an agency employ a parent is not a promise an agency will have staff.

Dates that change this

2026-01-01: The extraordinary-care allowance letting a legally responsible parent be paid for attendant care sits in the waiver approved December 31, 2025, with January 1, 2026 dates of service. It is an approval route, not an entitlement, and agencies still have to have staff.

The numbers and the rules

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

What it is worth

Under the fee-for-service discharge rule, medically necessary nursing and aide care may total up to 120 hours in the first 30 calendar days after discharge. A physician's written order must be in place before discharge. This is not a guaranteed award, available staffing or blanket managed-care authorization.

  • $120 — Fee-for-service nursing/aide hours within 30 calendar days after discharge, with prior written order and medical necessity
  • $30 — Fee-for-service therapy units within 30 days after discharge under order and medical-necessity conditions
  • $40/month — Combined weekly cap for specified Health and Wellness attendant care and Family Supports PAC by legally responsible caregivers
  • $7 — Days after complete documents before a fee-for-service request is deemed granted

Covers: Skilled nursing at home · Home health aide hours · Physical, occupational and speech therapy · Attendant care through a waiver, which can be provided by a parent in extraordinary-care cases

Legal protection: The child health benefit covers services outside the ordinary benefit when they are medically necessary, subject to prior authorisation

What it costs the family: No cost when the child has Medicaid.

The eligibility facts, as published

Coverage
the child has Indiana Medicaid
Medical
a written physician order, and prior authorisation except in the discharge window
Paid parent
A qualified parent employed by an enrolled home-health agency may provide approved aide, nursing or therapy services. That route does not require a waiver; credentials and the agency's arrangements still apply.

Decisions this site cannot make: Prior authorisation by the health plan, or by the state contractor for fee-for-service members

Expect friction on: Finding an agency with staff · Prior authorisation for everything except the discharge window

The trap: From January 1, 2026, the 40-hour weekly combined limit applies to legally responsible caregivers providing Health and Wellness attendant care or Family Supports participant assistance and care. The hours are combined across those caregivers, not granted separately to each parent. The 40-hour limit is not a universal limit on home-health nursing, therapy or structured family caregiving. Health and Wellness/Traumatic Brain Injury structured family caregiving uses separate shared-home, agency and extraordinary-care rules; Community Integration and Habilitation has different caregiver exclusions.

Where I read this

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