Montana program
Nurses and aides at home through Medicaid
Medicaid can pay for nursing and personal care at home for children under 21.
What it is
Medicaid can pay for nursing and personal care at home for children under 21.
Going home can leave you managing a line, feeding tube or other skilled care. Medicaid reviews nursing and personal care as regular benefits. A waiver waiting list does not replace that review.
Eligibility rules
- Your child must have Montana Medicaid and be under 21.
- Mountain Pacific reviews requests for prior approval.
What you get
- Approved nursing hours, home health and personal care.
What it covers
- EPSDT requires consideration of medically necessary care within federal Medicaid benefit categories.
- It does not guarantee every requested service or number of hours.
If you decide to apply
- Ask the oncology team or discharge planner to request home-care review.
- Bring the doctor’s order, a description of daily care and the Medicaid number.
1-800-219-7035 — Mountain Pacific, for the state · Official page ↗
After you ask
- An approval names the services and hours. An agency still needs to arrange staff.
- Medicaid must answer a nursing request within seven days, or 72 hours when urgent. If it says no or cuts hours, you can ask for a hearing, and asking before the change date keeps the current hours running. Approval does not supply a nurse; if no agency can fill the hours, the discharge team has to make a safe plan.
Good to know
The diagnosis alone does not decide the hours. The request must describe the care and why it is necessary.
Other details
- Mountain Pacific began reviewing private-duty nursing requests February 23, 2026.
Official sources
“Could nursing or personal care make home treatment safer? What would assessment and staffing involve, and could you help request it if the team thinks it is needed?”
Why I’m asking: I want to understand which care we can safely manage and where trained help could make a difference.
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 and chase the review.
Your social worker
The discharge planner writes the order and the clinical justification.
The care team
Describes the hours of care the child needs and why a parent alone is not safe.
- Who decides
- Mountain Pacific reviews the request for the state.
- Ask your social worker
- “Before we go home, can we request private duty nursing hours, and have the under-21 medical-necessity review asked for by name?”
How to apply
First step: Ask the oncology team to order nursing hours before discharge.
- Ask the oncology team to order nursing hours before discharge, not after.
- Ask for the review request to be date-stamped, because no clock is published.
- If the request is refused, ask for the medical-necessity review for a child under 21 by name.
Official application / program page ↗
Where it starts: The oncology team sends the order and the clinical justification; you can call the review line to chase it.
What to gather
- The doctor’s order
- A written description of the daily care
- The Medicaid number
How long: No published deadline for nursing decisions; chase it weekly.
What a yes looks like
An authorisation with a number of hours and an agency named.
What a no looks like, and the next move
A denial on medical necessity. Ask for the under-21 review, and use the appeal date on the letter.
Watch out
- A waiver waiting list is not the answer to this request: ask for the under-21 review instead.
- No decision clock is published, so ask for the request to be date-stamped.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 11, 2026.
What it is worth
Shift nursing and personal care at home, authorised in advance, for a child under 21 on Montana Medicaid.
Covers: Private duty nursing hours at home · Personal care and home health · Any medically necessary service for a child under 21, on review
Legal protection: A child under 21 gets a medical-necessity review of anything the doctor orders
What it costs the family: None.
The eligibility facts, as published
- Coverage
- Montana Medicaid
- Age
- under 21
- Authorisation
- prior authorisation through Mountain Pacific and its portal
The trap: Do not let a waiver waiting list be offered as the answer to a state-plan request. The review for a child under 21 is a separate route and it is the one to ask for by name.
Where I read this
- EPSDT Private Duty Nursing Provider Manual — Montana DPHHS, read September 10, 2026
- Private duty nursing prior authorization provider notice — Montana DPHHS, read September 10, 2026
- EPSDT review and approval process through Mountain Pacific — Montana DPHHS, read September 10, 2026
- CFC/AB 404 — Service limitations — Montana DPHHS, read September 10, 2026
- Money Follows the Person — Montana DPHHS, read September 10, 2026