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

Childhood Cancer Lantern
Search Saved

New Mexico program

Nurses and aides at home (Medicaid)

Medicaid can cover nursing and personal care at home when your child’s assessed medical needs require it.

What it is

Medicaid can cover nursing and personal care at home when your child’s assessed medical needs require it.

A nurse or aide at home can help when care goes beyond what a family can safely manage. The plan reviews the actual medical tasks. Your child’s diagnosis alone does not establish nursing hours.

Eligibility rules
  • Your child must have New Mexico Medicaid. A primary care provider’s order and approved treatment plan are required.
  • Prior authorization is required before services begin. For children under 21, EPSDT applies within Medicaid benefit categories.
What you get
  • No charge for approved home nursing and personal care through Medicaid.
  • Help planning the move home from hospital.
What this includes
  • Personal care and private-duty nursing use different tests. Under-21 personal care requires assessed help with at least two age-appropriate daily activities and an approved plan. Private-duty nursing concerns qualifying continuous skilled care. The clinician and plan decide the service and hours. Intermittent home-health and waiver services are separate routes.
  • The health plan’s care coordination includes discharge planning.
If you decide to apply
  1. Ask the oncology team about a home-care assessment and a written order.
  2. Keep notes on hands-on tasks, overnight care and equipment. Ask the hospital care coordinator about the plan’s review before discharge.

Your Turquoise Care plan’s care coordinator. For Medicaid without a health plan, the state or its review contractor decides. Medicaid: 1-800-283-8415. · Official page ↗

After you apply
  • The Turquoise Care plan decides the hours. For fee-for-service coverage, the state or its review contractor decides.
  • A Turquoise Care plan appeal is generally due within 60 calendar days of the denial notice. The decision is due within 30 days, or 72 hours when delay risks health. A permitted extension can add up to 14 days. A missed deadline can open the state-hearing route. The social worker and HCA Fair Hearings confirm the hearing deadline because public instructions conflict.
  • Keeping an existing service needs both an appeal and a continuation request. They are due by the later of 10 calendar days after notice is sent or the proposed change date. The service must have been properly ordered and its authorization must still be running. After an unfavorable appeal, hearing and renewed continuation requests are due within 10 calendar days after that decision is sent. Repayment may be possible if the final decision is unfavorable.
  • For affected non-drug Medicaid requests from January 1, 2026, the federal initial-decision standard is seven calendar days or 72 hours urgently. Stricter New Mexico deadlines can apply. The plan confirms the request’s scope, complete-document date and decision deadline.
Good to know

Approval and staffing are separate steps. A doctor’s order alone does not mean a nurse is booked.

Other details
  • A written approval should identify the hours and agency. The care coordinator can help distinguish approved hours from available staffing.
Official sources
Ask your social worker

“Could our child’s care needs qualify for nursing or an aide at home? What are the benefits and drawbacks, and could you help us request an assessment if it would help?”

Why I’m asking: We want a safe plan for the care our child needs at home.

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 and the authorisation before discharge, and keep the dates.

Your social worker

The hospital care coordinator starts the request; the plan’s care coordinator has to help with the move home.

The care team

The doctor writes the order and the plan of care that the hours are built on.

Who decides
Your Turquoise Care health plan authorises the hours.
Ask the care team
“Can you write the order for nursing hours at home, and can the plan start the authorisation before we are discharged?”

How to apply

First step: Ask the oncology team for a written order and ask the care coordinator to start the authorisation today.

  1. Ask the doctor for a written order for nursing hours at home.
  2. Ask the plan’s care coordinator to start the authorisation before discharge.
  3. If it is refused, ask for the plan appeal in writing, then the state hearing.

Official application / program page ↗

Where it starts: Ask the oncology team for the order and the hospital care coordinator to start the authorisation before discharge.

What to gather

The diagnosis letter, the child’s insurance card, and the last two pay stubs cover most applications. The official page lists the rest.

How long: Unknown: New Mexico does not publish a first-decision deadline where we could read it. Ask for the date in writing.

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 refusal letter. Ask for the plan appeal, then the state hearing.

Watch out

  • Nothing starts without the order, the plan of care and the authorisation. Ask for all three before discharge.
  • If the plan says no, missing its own appeal deadlines still gets you to a state hearing.

The numbers and the rules

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

What it is worth

Nursing hours and personal care at home, with the plan required to provide them when they are medically necessary.

Covers: Private duty nursing at home · Personal care · Care coordination that includes hospital discharge planning

Legal protection: Coverage decisions for a child under 21 follow the rule for children · A plan appeal, then a state hearing; missing the plan’s own deadlines counts as exhausting the appeal

What it costs the family: Free with New Mexico Medicaid.

The eligibility facts, as published

Coverage
New Mexico Medicaid
Clinical
ordered by the primary care provider and included in an approved treatment plan
Authorization
prior authorization required before services begin

The trap: Nothing starts without the doctor’s order, an approved plan of care and the plan’s authorisation. Ask for all three before discharge day, not after.

Where I read this

← Back to your options