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

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North Carolina program

Nurses and aides at home

Medicaid-paid nurses and aides can help care for your child at home after a separate assessment.

What it is

Medicaid-paid nurses and aides can help care for your child at home after a separate assessment.

Line care, feeding and other medical tasks can make home care much more than supervision. Medicaid nursing and personal care have separate assessments. Approval of hours does not mean an agency has staff available.

Eligibility rules
  • There are three kinds of help at home: shift nursing for ongoing skilled care (under 21), an aide for daily tasks beyond what a child that age normally needs, and occasional nurse visits. Each has its own assessment, and all need Medicaid first.
  • NCLIFTSS assesses personal care. NCTracks handles nursing approval in Medicaid Direct; other children use their health plan.
What you get
  • No-cost approved nursing and personal care through Medicaid.
  • Hands-on help with washing, dressing, feeding and moving.
  • A care review before a planned hospital discharge.
What the help covers
  • For a child under 21, medical-necessity documentation can support an exception to a policy’s service limit. Approval is still required.
  • A nursing agency may choose to employ a licensed nurse who is the child’s legally responsible person. CAP/C separately allows up to 40 weekly hours of extraordinary care.
If you decide to apply
  1. Ask the discharge team to request the nursing hours and any expedited personal-care assessment.
  2. Describe a full day and night, including tasks, frequency and what happens without help.
  3. Have the orders, discharge date and Medicaid plan name ready.

NC Medicaid through NCTracks, or the child’s health plan: 800-688-6696 · Official page ↗

If you decide to apply
  • A planned discharge can receive an assessment within two business days. Initial personal-care results are due within 14 business days after a completed assessment.
  • Medicaid or the health plan must answer a nursing request within seven days, or 72 hours when urgent. Approval does not supply a nurse; the agency has to find staff for the hours.
  • These decision clocks apply to Medicaid Direct and health plans. Personal-care assessment milestones are separate and do not extend an applicable approval deadline. Your discharge team and nursing agency confirm which approved shifts can actually be staffed.
Good to know

Ordinary personal care does not pay a parent or someone living in the home. CAP/C has separate paid-caregiving rules.

Other details
  • GDIT nursing questions: 800-688-6696. NCLIFTSS assessments and CAP: 833-522-5429. The agency separately confirms which approved hours it can staff.
  • Ordinary personal care excludes payment to parents, co-residents and other listed close relatives. An agency may separately employ a properly licensed parent as a nurse under the nursing policy. That is agency employment, not a general payment for family caregiving.
Official sources
Ask your social worker

“Would home nursing or aide help make our child’s care safer, and what would our family still need to cover? Could you help assess the hours and find an agency that can staff them?”

Why I’m asking: I need to understand the care we can safely manage at home and where trained help fits.

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 what the day and night look like at home and keep a copy of every order.

Your social worker

The discharge planner requests the expedited assessment and the nursing prior approval, and chases the decision.

The care team

The oncology team writes the orders: hours, tasks, and what happens without them.

Who decides
NC Medicaid through NCTracks, or the child’s health plan.
Ask your social worker
“Can you request an expedited personal-care assessment today because discharge is planned, and ask the plan in writing for a decision date on the nursing hours?”

How to apply

First step: Ask the discharge team to request an expedited assessment today and name the planned discharge.

  1. Ask the discharge team to request the expedited assessment now, naming the planned discharge.
  2. Ask the plan, in writing, for a decision date on the nursing request.
  3. If the hours approved are short of what is ordered, ask for the exception for a child under 21.

Official application / program page ↗

Where it starts: Ask the hospital discharge team to request an expedited personal-care assessment and to send the nursing prior approval. Nursing questions: GDIT on 800-688-6696. Assessment and CAP line: 833-522-5429.

What to gather

  • The nursing and aide orders
  • The discharge date
  • The Medicaid card and the health plan name

How long: Personal-care assessment milestones are separate from approval. From January 1, 2026, the non-drug decision standard is seven calendar days or 72 hours expedited, with permitted extensions. The agency confirms actual staffed shifts.

What a yes looks like

A prior approval with hours and an agency named. Then ask the agency what it can staff.

What a no looks like, and the next move

Ask whether the no was medical necessity or a policy limit. For a policy limit, ask for the exception for a child under 21 and appeal.

Watch out

  • An approval is not a nurse. Ask the agency how many hours it can actually staff.
  • Ordinary personal care does not pay a parent or anyone living in the home.
  • If the hours fall short of the order, ask for the exception for a child under 21 and send the documentation.

The numbers and the rules

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

What it is worth

Skilled nursing and aide hours at home. A planned discharge gets an assessment within two business days.

  • $14 — Business days for personal-care results after a completed first assessment
  • $2 — Business days for an assessment when a hospital discharge is planned
  • $7 — Calendar days for a standard Medicaid non-drug prior-authorization decision from January 1, 2026, subject to permitted extensions

Covers: Skilled nurse hours at home for a child under 21 · Hands-on help with washing, dressing, feeding and moving · Exceptions to a policy limit for a child under 21 with documentation

Legal protection: A service limit in a coverage policy can be exceeded for a child under 21 when medical necessity is documented

What it costs the family: No cost once Medicaid is in place.

The eligibility facts, as published

Requirement
North Carolina Medicaid, plus a nursing or personal-care need
Age
Private duty nursing policy 3G-2 covers children under 21; personal care policy 3L has no general age-21 cutoff and requires help beyond age-appropriate parenting.
Assessor
NCLIFTSS (Acentra Health) for personal care; NCTracks and GDIT for nursing prior approval in Medicaid Direct; the health plan for everyone else

Expect friction on: Approval and staffing are separate problems: an approval does not find a nurse · Parents are not paid under ordinary personal care

The trap: Ordinary personal care does not pay a parent, a legally responsible person, or anyone whose home address is the same as the child’s. There are two narrow exceptions: a nursing agency may, at its own discretion, employ a licensed nurse who is the child’s legally responsible person, and the Community Alternatives Program for Children pays a legally responsible individual for extraordinary care up to 40 hours a week.

Where I read this

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