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

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Oregon program

Nurses and aides at home through the Oregon Health Plan

OHP can pay for nurses and personal-care help in your home when your child's needs support it.

What it is

OHP can pay for nurses and personal-care help in your home when your child's needs support it.

Care at home can involve far more than an ordinary parenting routine. The oncology team can describe the skilled tasks and hours your child needs. OHP reviews those needs before approving nursing or personal-care support.

Eligibility rules
  • Your child must have OHP. All private duty nursing needs a written order and prior authorization.
  • For an OHP member under 21, EPSDT reviews the child’s individual medical need within Medicaid benefit categories. Private-duty nursing, home health and personal care have different assessment and authorization routes. A CIIS waiver place is not a prerequisite for every OHP nursing request; ask the social worker which route applies and whether any parent-employment option is allowed.
What you get
  • Approved nursing and personal-care hours at no cost to your family.
  • For a CCO non-drug request, a decision within 7 calendar days, or 72 hours when urgent. Permitted extensions can change this.
What the help includes
  • Requests go to the coordinated care organization, or Oregon Health Authority for Open Card members.
  • A CCO extension of up to 14 calendar days requires your or the clinician’s request, or a justified need for information in your child’s interest. Required notice applies; an extension is not automatic. These non-drug authorization clocks apply under the 2026 CCO guidance.
If you decide to apply
  1. Ask the oncologist for a written order describing the tasks and hours of care.
  2. With the social worker, send the request to your child's OHP plan and keep its submission date.

Open Card coordination, Acentra Health: 800-562-4620. OHP ombuds: 1-877-642-0450. · Official page ↗

After you ask
  • An approval identifies the allowed hours and agency.
  • For a CCO denial, an appeal is due within 60 calendar days of the adverse-benefit notice. The CCO normally decides within 16 calendar days after receiving the appeal, or within 72 hours for an approved urgent appeal. An extension of up to 14 calendar days needs the member’s request or a justified need for more information that is in the member’s interest; the CCO must give the required notice. A state hearing is normally available within 120 calendar days of the appeal-resolution notice, or after the CCO fails required appeal timing or notice rules. Open Card members request an OHA hearing directly, normally within 60 calendar days of OHA’s denial; they do not first appeal to a CCO.
  • The denial notice identifies the hearing route. Continued services have earlier deadlines described below.
Good to know

An approval does not guarantee a nurse is available. The home-care agency confirms which approved hours it can staff.

Other details
  • For a CCO decision to reduce, suspend or end an existing service, ask the social worker to check the notice immediately. To keep qualifying services during review, both the appeal and a request to continue services must be timely: request continuation by the later of 10 calendar days after the adverse notice is sent or the proposed action date. The service must have been ordered by an authorized provider and its original authorization must not have expired. After an appeal denial, request both a state hearing and continued services within 10 calendar days of the appeal-resolution notice—not the ordinary 120-day hearing window. If the final decision goes against you, repayment may be sought for services provided only because of continuation; ask about the written repayment terms before agreeing. Open Card uses OHA’s direct-hearing process, not the CCO appeal sequence.
  • Turning 21 ends the child EPSDT framework. The social worker can check adult nursing or other home-care benefits; it does not necessarily end every route to support.
Official sources
Ask your social worker

“Could nursing or personal-care help at home make our child's care safer? What would it cover, what limits should we expect, and could you help request an assessment if it would help?”

Why I’m asking: I want to understand which parts of care at home could be shared with trained help.

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

Describe the daily and night care in plain terms and keep the date you asked.

Your social worker

The social worker sends the request and chases the seven-day clock.

The care team

The oncologist writes the order and the hours the child needs.

Who decides
The coordinated care organization, or the Oregon Health Authority for a member on Open Card.
Ask the care team
“Can you write an order for nursing hours at home, saying what has to be done and how often, so we can send it for authorisation?”

How to apply

First step: With the social worker and clinician, discuss the care tasks, written order and appropriate OHP assessment or approval route.

  1. Ask the oncologist for a written order describing the hours and tasks.
  2. Send the prior-authorisation request and note the date; the plan owes an answer in seven days.
  3. If it is refused, file the plan appeal within 60 days and ask for it to be expedited if waiting would harm your child.

Official application / program page ↗

Where it starts: Ask the oncologist for a written order, then ask the plan for prior authorisation. Open Card coordination: Acentra Health, 800-562-4620. The Oregon Health Authority ombuds line is 1-877-642-0450.

What to gather

  • The oncologist's written order
  • A list of the tasks and times care is needed
  • Your plan card and member number

How long: For applicable CCO service requests in 2026, standard review is seven calendar days and urgent review 72 hours, with a justified extension up to 14 days. Open Card and specific nursing programs need their own route and deadline check.

What a yes looks like

An authorisation naming the hours a week and the agency.

What a no looks like, and the next move

A denial notice identifies the route. For qualifying CCO existing-service continuation, request the appeal and continuation by the later of notice plus 10 calendar days or the proposed action date, with an authorized order and unexpired approval. After an adverse appeal, request the hearing and continuation within 10 days. Repayment can apply after a final adverse result; Open Card uses separate rules.

Watch out

  • Every hour needs authorisation before it starts.
  • Who decides depends on enrolment: your plan, or the state if you are on Open Card. Ask which.
  • An approval is not staffing. Ask the agency what hours it can actually fill.

The numbers and the rules

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

What it is worth

Assessed nursing and personal care may be covered at home. The service and OHP route determine who decides and which clock applies.

  • $7 — Standard authorisation answer by the coordinated care organization
  • $72 — Expedited authorisation answer
  • $14 — Maximum extension, with written reasons
  • $21 — Upper age for children’s EPSDT review within Medicaid benefit categories

Covers: Private duty nursing hours at home · Personal care services · Home health · Care coordination through the plan, or Open Card coordination on 800-562-4620

Legal protection: Under 21, medical necessity is decided case by case on the child's own needs · A plan appeal, then a state hearing, when hours are refused

What it costs the family: No cost to the family.

The eligibility facts, as published

Coverage
enrolled in the Oregon Health Plan
Age
under 21 for the medical-necessity rule
Medical
a written order and prior authorisation for all private duty nursing

Decisions this site cannot make: Prior authorisation by the coordinated care organization, or by the Oregon Health Authority for a member not in a plan

Expect friction on: All private duty nursing needs prior authorisation, and agency staffing is often the real limit

The trap: Every hour needs prior authorisation before it starts, and who authorises it depends on how your child is enrolled: the plan for a plan member, the Oregon Health Authority for a member on Open Card. Ask which one your request went to.

Where I read this

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