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

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Maryland program

Nurses and aides at home through Medical Assistance

Medical Assistance can cover skilled nursing and help with daily activities at home. Each service has its own care assessment.

What it is

Medical Assistance can cover skilled nursing and help with daily activities at home. Each service has its own care assessment.

Some treatment tasks need skilled help at home. Medical Assistance can pay for nursing and personal assistance after review. The oncology team describes the tasks, hours and length of time needed.

Eligibility rules
  • EPSDT nursing applies to Medicaid participants under 21. Community First Choice and Community Personal Assistance Services have different care tests and are not limited to children. A HealthChoice card does not mean the plan decides every state-administered service.
  • There are three kinds of help: a nurse for skilled tasks; an attendant through Community First Choice for a child who would otherwise need hospital-level care; and an attendant for daily tasks without that test. Each has its own assessment, and a yes is not yet a nurse at the door.
What you get
  • Approved nursing and home health aide care at no family cost.
  • Personal assistance through an approved Community First Choice care plan.
What the help covers
  • Approval names the number of nursing hours and the period covered. An agency must also be arranged to provide the care.
If you decide to apply
  1. Ask the oncology team to describe the care needed at home, ideally as part of discharge planning.
  2. Have the discharge plan, Medical Assistance card and a list of daily care tasks ready.
  3. Ask for the written decision showing approved hours and dates; the HealthChoice Helpline can help with a stalled request.

Maryland Department of Health or its designated reviewer; HealthChoice Helpline, 800-284-4510, can identify the correct office. · Official page ↗

After you apply
  • A written decision helps identify whether a refusal came from the health plan or the state. The HealthChoice Helpline is 800-284-4510.
  • The plan or state must answer a nursing request within seven days, or 72 hours when urgent. The written decision says who said no and how to appeal; you generally have 90 days to ask for a state hearing. The HealthChoice Helpline (800-284-4510) can help.
Good to know

These rules do not let a parent become the paid nurse or aide for their own child.

Other details
  • Immediate family members and people who ordinarily live with the child cannot be the paid nurse, nursing assistant or home health aide under these rules. A parent representing a dependent minor cannot be assigned as that child's paid personal assistant.
  • EPSDT covers medically necessary services within Medicaid benefit categories. It does not guarantee every requested hour or service.
Official sources
Ask your social worker

“Which tasks at home need a nurse or aide, and what help could Medical Assistance approve? What would an assessment involve, and could you help request one if our child needs it?”

Why I’m asking: I want a safe care plan that does not leave our family doing skilled tasks without enough 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 request to go in before discharge and keep a copy of every decision.

Your social worker

The oncology team writes the medical justification with hours and duration.

The care team

The doctor or nurse practitioner states what care the child needs at home and for how long.

Who decides
The Maryland Department of Health or its designee approves the hours; the HealthChoice plan arranges them.
Ask your social worker
“Can the team put in a request for nursing hours at home before discharge, saying how many hours a day and for how long, and can I have the decision in writing?”

How to apply

First step: Ask the oncology team to request nursing hours before discharge, naming hours a day and duration.

  1. Ask the oncology team to write the request before discharge, naming hours a day and for how long.
  2. Ask for the decision in writing with a date on it.
  3. If the plan refuses, ask how to escalate under the child health rules and call the Helpline.

Official application / program page ↗

Where it starts: Ask the oncology team to request nursing hours, and call the HealthChoice Helpline on 800-284-4510 if nothing moves.

What to gather

  • The discharge plan
  • A list of what has to be done at home each day
  • The Medical Assistance card and plan name

How long: From January 1, 2026, affected Medicaid payers generally decide non-drug authorization in seven calendar days or 72 hours when expedited. This is not a complete CFC assessment, enrollment or staffing deadline. The actual decision-maker supplies a dated notice and the applicable review route.

What a yes looks like

A written approval names services, hours and dates. An available nurse or aide still must be arranged.

What a no looks like, and the next move

Ask whether the refusal came from the plan or the state, ask for it in writing, and call the Helpline on 800-284-4510.

Watch out

  • A parent cannot be the paid nurse or aide for their own child under these rules.
  • From January 1, 2026, affected Medicaid payers generally decide non-drug authorization in seven calendar days or 72 hours when expedited. This is not a complete CFC assessment, enrollment or staffing deadline. The actual decision-maker supplies a dated notice and the applicable review route.
  • Approval sits with the state or its designee, so a plan saying no is not always the last word.

Dates that change this

2026-09-10: From January 1, 2026, affected Medicaid payers generally decide non-drug authorization in seven calendar days or 72 hours when expedited. This is not a complete CFC assessment, enrollment or staffing deadline. The actual decision-maker supplies a dated notice and the applicable review route.

The numbers and the rules

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

What it is worth

Medical Assistance has separate routes for child EPSDT nursing, CFC institutional-level personal assistance and CPAS daily-activity help, with distinct assessments.

  • $21 — Upper age for nursing services under the child health programme

Covers: Nursing hours at home, once preauthorised on medical necessity, frequency and duration · Personal assistance under Community First Choice, once it is in the approved plan of service · Home health aide visits

Legal protection: EPSDT covers medically necessary care within federal Medicaid benefit categories for children under 21; it does not promise every requested service.

What it costs the family: None once approved.

The eligibility facts, as published

Age
EPSDT nursing under 21; CFC and CPAS are not limited to children.
Coverage
Medical Assistance
Authorisation
MDH or its designee approves EPSDT nursing by skilled need, frequency and duration. CFC requires institutional level of care and an approved plan of service. CPAS is a separate daily-activity assistance route below institutional care level.
Parent payment
Excluded. Immediate family and people who ordinarily live with the child cannot be the paid nurse, nursing assistant or home health aide; a parent of a dependent minor is a representative and cannot be assigned as the paid personal assistant.

The trap: A parent cannot be the paid nurse or aide. The nursing rule excludes services given by a member of the child's immediate family or anyone who ordinarily lives with the child, and the personal-assistance rule says an agency cannot assign a participant's representative to provide that participant's services, and the definition of representative includes the parent of a dependent minor child.

Where I read this

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