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

Childhood Cancer Lantern
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Oklahoma program

Nurses and personal care at home (SoonerCare)

Help with nursing and daily care at home when your child’s medical assessment supports it.

What it is

Help with nursing and daily care at home when your child’s medical assessment supports it.

Care at home can become difficult to manage alongside treatment. SoonerCare can cover private duty nursing or personal care when assessed as needed. The state or health plan decides the hours.

Eligibility rules
  • SoonerCare must be in place for payment, and each service needs its own assessment and approval. Private duty nursing is skilled care for members under 21; personal care helps with assessed daily activities and is not limited to children. A doctor’s order, Medicaid enrollment or cancer diagnosis does not by itself establish the approved service or hours.
  • OHCA handles fee-for-service care, including the TEFRA route. SoonerSelect children use their plan.
  • OHCA's clinical review team decides whether your child qualifies for personal care.
What you get
  • Approved nursing and personal-care hours at home.
  • A decision within seven days of a complete request, or 72 hours when waiting would be risky.
What this covers
  • The assessment determines the services and hours. An order alone does not guarantee staffed hours.
  • For personal care, assessment is due within 10 business days when eligibility is already established, or 20 while eligibility is pending.
If you decide to apply
  1. Ask the oncology team or discharge nurse to help request home care through your child’s plan.
  2. Describe what days and nights at home involve, and have the doctor’s order and treatment plan ready.

OHCA Population Care Management: 877-252-6002 or 405-522-7650 · Official page ↗

What happens next
  • The social worker and discharge nurse can track the assessment and plan’s response.
  • A denial letter explains the decision and the route for challenging it.
  • The state or plan has seven days to decide a complete request, or 72 hours when the doctor says waiting is risky. Ask the care manager for the date it received everything. An approval is not a staffed nurse; the agency confirms that separately.
Good to know

Ordinary personal care does not pay a parent. Paid Family Caregiver is a separate benefit tied to approved nursing hours.

Other details
  • A daily care log helps the team describe what support is needed. Approved nursing and an agency able to staff it are separate questions.
Official sources
Ask your social worker

“Could home nursing or personal care help with our child’s needs? What would it cover, what are the limits, and if you recommend a request, could you help arrange the assessment?”

Why I’m asking: I want to understand how much of the care at home needs professional support.

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 and days look like at home, and keep the refusal letter if one comes.

Your social worker

The social worker and discharge nurse arrange the assessment and chase the authorization.

The care team

The doctor writes the order and the treatment plan that the authorization rests on.

Who decides
The Oklahoma Health Care Authority for fee-for-service care, or the child's SoonerSelect plan.
Ask your social worker
“Can we start a private duty nursing and personal care request before discharge, and can you tell me the date the plan must decide by?”

How to apply

First step: Ask the oncology team to write the nursing order before discharge, then call the health plan's care coordination line the same day.

  1. Ask the oncology team to write the nursing order and the treatment plan before discharge.
  2. Call the health plan's care coordination line and ask for the prior authorization to be started that day.
  3. If hours are refused, ask for a review under the child health benefit, then the plan appeal and a state fair hearing.

Where it starts: Ask the oncology team for the nursing order, then call the health plan's care coordination line. OHCA Population Care Management: 877-252-6002 or 405-522-7650.

What to gather

  • The treatment plan and nursing order
  • The SoonerCare or plan ID number
  • A plain description of the nights and days at home

How long: Seven calendar days standard and 72 hours urgent at the health plan, subject to the contract's extension provisions.

What a yes looks like

An authorization with a number of hours a week and an agency named.

What a no looks like, and the next move

A refusal or fewer hours than asked. Ask for the child health benefit review, then the plan appeal and a state fair hearing.

Watch out

  • The hours are authorized, not automatic: no order and no assessment means no hours.
  • The fee-for-service decision deadline was not published; the plan's clocks are seven days and 72 hours.
  • Ordinary personal care will not pay a parent. The Paid Family Caregiver benefit is the separate route.

The numbers and the rules

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

What it is worth

Nursing and personal-care hours at home, decided in seven calendar days standard or 72 hours urgent by the health plan; personal-care assessment in 10 business days when the child is already eligible.

  • $7 — Health plan standard prior-authorization deadline
  • $72 — Health plan expedited prior-authorization deadline
  • $10 — Personal-care assessment deadline when already eligible
  • $20 — Personal-care assessment deadline while eligibility is pending

Covers: Private duty nursing hours at home · Personal care help with daily living · Home health visits · Care coordination through the health plan

What it costs the family: None once approved.

The eligibility facts, as published

Coverage
SoonerCare, including TEFRA and certain other children
Route
OHCA for fee-for-service, or the child's SoonerSelect plan
Requirements
treatment plan, assessment and prior authorization
Decision maker
OHCA Clinical Review decides personal-care medical eligibility for the listed groups

The trap: There are two clocks. The health plan must decide a standard prior authorization within seven calendar days and an urgent one within 72 hours, subject to the contract's extensions. The personal-care assessment runs 10 business days when the child is already eligible for SoonerCare and 20 while eligibility is still being decided. The fee-for-service nursing decision deadline was not published.

Where I read this

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