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

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New York program

Nursing and personal care at home through Medicaid

Medicaid can pay for nursing and personal care at home when your child's medical needs require it.

What it is

Medicaid can pay for nursing and personal care at home when your child's medical needs require it.

Care between appointments can be too much for a family to manage alone. Medicaid can cover approved skilled nursing, personal care and supplies. An assessment decides the care your child needs. An agency or qualified independent nurse must still be available.

Eligibility rules
  • Medicaid coverage and an assessment supporting the requested care are needed. Ordinary Medicaid, disability-related coverage and the Children’s Waiver have different enrollment tests. Private-duty nursing has no general age-21 cutoff; adult service rules apply when the under-21 EPSDT protection ends.
  • For fee-for-service private-duty nursing, a Medicaid-enrolled nursing agency or independently enrolled qualified nurse can seek prior approval for ordered, medically necessary skilled care. The child needs Medicaid coverage for Medicaid to pay for the service, but a pending application need not stop the discharge team from planning and identifying the correct enrollment route.
  • For a child under 18, your plan or local district can identify the current pediatric personal-care assessment route. Adult independent-assessor instructions should not simply be applied to your child. The approval date and first staffed shift are separate.
What you get
  • No family charge for approved Medicaid nursing and personal-care services.
  • Equipment and supplies when covered and approved.
What the help includes
  • Medicaid's under-21 benefit, C/THP or EPSDT, supports medically necessary services within Medicaid benefit categories.
  • The Children's Waiver can separately provide transitional care coordination.
If you decide to apply
  1. Ask the discharge planner or oncology social worker about a nursing or personal-care assessment and Medicaid coverage.
  2. Have the doctor's order, a two-week care log and your child's Medicaid plan information ready.
  3. Ask which agency or qualified independent nurse could cover the shifts, and discuss backup care with the discharge planner.

Medicaid plan or discharge planner; ICAN for long-term-care disputes: 844-614-8800 · Official page ↗

After you ask
  • The approval letter should give the hours and dates. The agency's staffing arrangements determine when those hours can actually be delivered.
  • A denial can be reviewed through the plan appeal and fair-hearing routes. ICAN helps with long-term-care disputes.
  • The plan should answer a nursing request within seven days, or 72 hours when urgent. An approval is not a nurse: staffing is the next conversation.
Good to know

An approval for nursing hours does not mean a nurse is available. Staffing is a separate conversation.

Other details
  • Medicaid does not pay a parent to nurse or care for their own child under 21. Some other relatives can be paid; get any arrangement in writing before counting on that income.
Official sources
Ask your social worker

“Could an assessment find nursing or personal-care hours for our child at home? What would the limits and staffing look like, and could you help us request it?”

Why I’m asking: We want to understand which daily care tasks Medicaid could help cover and what our family would still need to manage.

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

Keep a daily log of tasks and hours, ask for every decision in writing, and call ICAN if the plan stalls.

Your social worker

The discharge planner or social worker refers a Medicaid nursing agency and gets the order written.

The care team

Writes the order naming the skilled tasks, the hours and why a parent cannot safely do them alone.

Who decides
The managed-care plan (or the state's fee-for-service prior-approval unit through the nursing provider) decides the hours; the local district assesses personal care for a child under 18.
Ask your social worker
“Can you refer a Medicaid nursing agency this week and get the order written for the hours? If the plan says no, can we ask for an EPSDT review?”

How to apply

First step: Medicaid can cover assessed, approved nursing and personal care. A Medicaid-enrolled agency or independently enrolled qualified nurse can seek fee-for-service private-duty nursing approval. Coverage planning and discharge planning can proceed together; approval does not guarantee staffing.

  1. Ask the social worker for a Medicaid nursing agency and a written order for the hours.
  2. If the plan says no, ask in writing for an EPSDT (C/THP) medical-necessity review and appeal.
  3. Call ICAN (844-614-8800) if the plan stalls.

Official application / program page ↗

Where it starts: Medicaid can cover assessed, approved nursing and personal care. A Medicaid-enrolled agency or independently enrolled qualified nurse can seek fee-for-service private-duty nursing approval. Coverage planning and discharge planning can proceed together; approval does not guarantee staffing.

What to gather

  • The doctor's order naming skilled tasks and hours
  • A two-week log of daily care
  • The child's Medicaid ID and plan name

How long: Managed-care benchmark 72 hours urgent, seven days standard; the real staffing wait was not found.

What a yes looks like

An authorization letter with the hours and dates, and an agency that has assigned a nurse.

What a no looks like, and the next move

"Not medically necessary": ask for the EPSDT review, file the plan appeal, request a fair hearing, and call ICAN.

Watch out

  • A parent cannot be paid as the aide for their own child under 21 under the consumer-directed program (CDPAP). Do not plan the family budget around it.
  • An approval is not a nurse. Ask the agency about staffing before you leave the hospital, and ask the discharge planner for a backup.
  • The 72-hour and 7-day deadlines are published Medicaid managed-care benchmarks. Ask the plan in writing which one applies to your request, and call ICAN (844-614-8800) if it stalls.

Dates that change this

2026-07-01: The fee-for-service private-duty nursing manual dated July 1, 2026 requires prior approval before care starts, requested by a Medicaid-enrolled nursing provider. (not yet confirmed against the final rule)

The numbers and the rules

The arcane layer, kept on purpose. Checked September 9, 2026.

What it is worth

Private-duty nursing and personal-care hours, equipment and supplies through Medicaid, with prior approval. Managed-care benchmark: 72 hours for urgent requests, seven calendar days standard.

  • $72 (published NYSDOH benchmark; its reach to every pediatric nursing request was not verified) — Managed-care prior-authorization benchmark, urgent
  • $7 (published NYSDOH benchmark; its reach to every pediatric nursing request was not verified) — Managed-care prior-authorization benchmark, standard

Covers: Private-duty nursing (prior approval) · Personal care (local district assessment for under 18) · Durable medical equipment and supplies · Transitional care coordination through the Children's Waiver · ICAN ombudsman help with long-term-care disputes

Legal protection: EPSDT (C/THP): Medicaid must cover any coverable service medically necessary to treat, correct or reduce a child's condition

What it costs the family: None.

The eligibility facts, as published

Medicaid
required (the Children's Waiver counts)
Pdn ffs
prior approval before services start, requested by a Medicaid-enrolled PDN provider; the member must be fee-for-service eligible as determined by the local district
Pdn managed care
contact the plan
Personal care under 18
the local district performs the assessment (November 2022 guidance); the complete current workflow was not found
Paid parent
a parent cannot be hired as the CDPAP assistant for a child under 21 (GIS 16 MA/006); other legally-responsible-person exceptions NOT FOUND
Denial route
EPSDT medical-necessity request, plan appeal, fair hearing
Ombudsman
ICAN 844-614-8800

Decisions this site cannot make: Plan or fee-for-service prior approval · Local district personal-care assessment

Expect friction on: Provider must request approval · Staffing shortages · Approval clocks not verified for every request

The trap: A parent cannot be hired as the paid aide for their own child under 21 under the consumer-directed program (CDPAP). New York publishes approval benchmarks of 72 hours urgent and seven days standard for Medicaid managed care, but nobody verified they bind every pediatric nursing request. An approval is not a nurse.

Where I read this

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