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

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Massachusetts program

Nursing hours at home (continuous skilled nursing)

Nursing help at home through MassHealth [Continuous Skilled Nursing] when care takes more than two continuous hours a day.

What it is

Nursing help at home through MassHealth [Continuous Skilled Nursing] when care takes more than two continuous hours a day.

Some children need more nursing at home than a parent can safely manage alone. A discharge planner can help describe that care and request hours. MassHealth or the child’s plan decides what services are covered.

Eligibility rules
  • Your child needs MassHealth coverage and an assessment showing more than two continuous hours of skilled nursing a day.
  • A doctor or ordering practitioner must sign the care plan before services begin. Prior authorization is required.
  • Members of a managed-care or accountable-care partnership plan request the service through that plan.
  • A complex care assistant must meet the nursing agency’s employment, training and task-competency rules and work under nurse supervision. The parent of a minor child cannot be that child’s ordinary PCA. The separate CCA role needs an individual agency and MassHealth review; a family relationship alone does not establish eligibility or payment.
  • A complex care assistant must be 18 or over, pass the agency's screening and training, and work under a nurse. Ask the agency whether a parent can take the role for your child.
What you get
  • Covered nursing hours at home have no charge through MassHealth.
  • A trained complex care assistant can work alongside the nurse on approved tasks.
What the help covers
  • Children under 21 can also request medically necessary care through the child screening and treatment rules (EPSDT).
  • An agency must pay a complex care assistant at least 65% of the rate it receives for that service. That is not a promise that a particular family member qualifies.
  • A nurse checks in on the complex care assistant every two weeks and visits at least every two months.
If you decide to apply
  1. Ask the oncology team and discharge planner to request Continuous Skilled Nursing and a signed care plan.
  2. Bring the medicine and equipment list, MassHealth card, and a written picture of a day and night at home.
  3. Ask the nursing agency whether a family member can train for the separate complex care assistant role.

MassHealth or its designee, or the child’s MassHealth health plan: 855-781-9898 · Official page ↗

After you ask
  • An approval names the nursing hours and the agency expected to fill them. Approved hours and available staff are separate discharge-planning questions.
  • A denial identifies refused hours. The team can support an appeal and explain when a delay puts the child at risk.
  • From January 1, 2026, covered non-drug prior-approval requests generally have outer limits of seven calendar days, or 72 hours when urgent. Your child’s condition may require an earlier answer. The clinical team confirms the responsible payer, completeness, urgency and any permitted extension.
Good to know

An ordinary personal care attendant cannot be a minor child’s parent. The complex care assistant role has different rules.

Other details
  • Nursing and CCA are state-plan services. Coverage review and service assessment can proceed together during discharge planning; an under-21 EPSDT rule is not a general CSN or PCA age ceiling.
  • The member-help number supplied for this service is 855-781-9898.
Official sources
Ask your social worker

“Would nursing hours make care at home safer for our child, and could a family member qualify as a complex care assistant? What would each involve, and could you help request an assessment?”

Why I’m asking: I want to understand what help could make the daily and overnight care manageable.

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 ask about the complex care assistant role by name.

Your social worker

The discharge planner and the nursing agency write and submit the request with the signed plan of care.

The care team

The doctor signs the plan of care before services start.

Who decides
MassHealth or its designee assesses and authorises the hours; the child’s health plan authorises for its own members.
Ask the care team
“We need nursing hours at home. Can you request continuous skilled nursing and sign the plan of care, and can the agency tell me whether I can be trained and approved as a complex care assistant?”

How to apply

First step: Ask the discharge planner to request continuous skilled nursing now, before your child goes home.

  1. Ask the discharge planner to request continuous skilled nursing before discharge.
  2. Ask the nursing agency whether a parent can be trained and approved as a complex care assistant.
  3. If the plan is slow, call the MassHealth member helpline on 855-781-9898.

Official application / program page ↗

Where it starts: Ask the oncology team and the discharge planner to request continuous skilled nursing, and ask the agency about the complex care assistant role for a trained family member.

What to gather

  • The medication and equipment list
  • A written picture of what a night at home involves
  • The MassHealth plan card

How long: No current clock was published. An older rule gave 14 days for independent nurse services and 21 days for other services.

What a yes looks like

An authorisation with a number of hours and an agency named to fill them.

What a no looks like, and the next move

A denial names the hours refused. Appeal it, and ask the plan for an expedited review while your child is still an inpatient.

Watch out

  • Ordinary personal care attendant rules exclude a minor’s parent. The complex care assistant role is a different service; ask for it by that name.
  • Nursing has to be authorised before it starts, and a doctor has to sign the plan of care.
  • The current decision clock was not published. Ask for a date, and call the member helpline on 855-781-9898 if the plan stalls.

The numbers and the rules

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

What it is worth

Licensed nursing at home above two continuous hours a day, authorised by MassHealth or its designee, with a complex care assistant able to work alongside. An agency must pay a complex care assistant at least 65% of the rate it is paid.

  • $2 — Nursing hours a day above which the service is continuous skilled nursing
  • $65 — Share of the service rate an agency must pay a complex care assistant
  • $14 — Older authorisation standard for independent nurse services
  • $21 — Older authorisation standard for all other services

Covers: Continuous skilled nursing at home · Complex care assistant hours alongside the nurse · Care a child under 21 needs, requested through the child health screening and treatment rule

Legal protection: MassHealth or its designee assesses the need and coordinates the other long-term services · A doctor or ordering practitioner signs the plan of care before services start

What it costs the family: No charge on MassHealth.

The eligibility facts, as published

Age
under 21 for the child health screening and treatment route
Medical
more than two continuous hours of skilled nursing a day, assessed by MassHealth or its designee
Coverage
a MassHealth coverage type first
Residency
Massachusetts
Authorisation
prior authorisation before services; members in a managed care or accountable care partnership plan go through that plan

The trap: Ordinary personal care attendant work excludes a minor’s parent and legally responsible relatives. The complex care assistant role is a different service, and providers describe approved family members doing it, so ask by that name rather than arguing about personal care.

Where I read this

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