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

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Pennsylvania program

Nurses and aides at home through Medical Assistance

Medical Assistance can provide nurses and aides at home when your child needs medically necessary care.

What it is

Medical Assistance can provide nurses and aides at home when your child needs medically necessary care.

MA can cover medically necessary nursing, personal care and home health aide services for a child under 21. The team needs a clear picture of care between appointments. An approval sets the services, but finding someone to staff the hours is another step.

Eligibility rules
  • Your child must have MA and be under 21. The plan reviews medical necessity under EPSDT; ordinary parenting tasks alone do not establish a nursing benefit.
  • MA may be through HealthChoices or fee-for-service. The approval route depends on which coverage your child has.
  • A paid parent must be qualified, trained and employed by the home health agency for the covered aide work.
What you get
  • Approved nursing and aide care at home with no family charge.
  • Help from a Pediatric Complex Care Resource Center.
  • HealthChoices may pay a qualified parent employed by a home health agency for approved aide hours.
What the help includes
  • Shift nursing uses agency RNs or LPNs under physician direction. Personal care and home health aide services have distinct payment rules.
  • A parent who is trained and employed by the home health agency can be paid for approved nursing or aide hours under a HealthChoices plan. Paying a parent for ordinary personal care uses different rules, and fee-for-service Medical Assistance has to confirm its own arrangement.
  • Resource centers can help the caregiver team organize complex pediatric care.
If you decide to apply
  1. Ask the oncologist to describe the care tasks, hours and medical need in a written order.
  2. Keep a care log and ask a home health agency to submit the request to your child's MA plan.
  3. Discuss parent employment with the agency if approved aide hours could fit your family.

Pediatric Complex Care Resource Centers: Advocacy Alliance 717-658-6609; Geisinger Central PA 570-271-5935; Milestone West 724-283-0990; Milestone Northwest 814-779-1629 · Official page ↗

After you ask
  • The plan should answer a nursing request within about seven days, or within three days when the need is urgent. Approval and finding an agency with staff are separate steps.
  • An approval should name the services and hours. The agency's actual start date is a separate question.
  • A denial must explain why the service is not medically necessary. The plan grievance process and a DHS fair hearing are review routes, with urgent review when delay could harm health.
Good to know

HealthChoices has specific rules for paid parent aide work. Other MA arrangements need a separate payment review. Approved hours still need an agency able to staff them.

Other details
  • A two-week log can show tasks, overnight care and the time each task takes. The oncologist's order explains why that care is medical.
  • If the plan turns down nursing hours, you have 60 days to appeal, and you must ask within ten days to keep existing hours running while the appeal is decided. The appeal steps are the same as on the Medical Assistance card.
Official sources
Ask your social worker

“Could nursing or aide help make care at home more manageable? Could you explain the benefits, parent-employment rules and staffing limits, then help us request a care review?”

Why I’m asking: I want our child's care needs assessed clearly and to understand what help can actually reach our 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

Keep a two-week log of every task, how often and how long. Ask the agency whether a parent can be hired as a home health aide.

Your social worker

The social worker lines up a home health agency and the plan's approval before discharge, and calls the Pediatric Complex Care Resource Center.

The care team

The oncologist writes the order with hours, tasks and why a nurse or aide is needed.

Who decides
The child's HealthChoices plan reviews medical necessity; the state Department of Human Services hears the appeal.
Ask your social worker
“Can you get shift-nursing or aide hours ordered and approved by our HealthChoices plan before discharge? And can you ask the agency whether I can be employed as the home health aide?”

How to apply

First step: Ask the oncologist for a written order and have a home health agency request approval from the HealthChoices plan. Call the Pediatric Complex Care Resource Center for your county for help with the care team.

  1. Ask the oncologist for a written order for shift nursing or aide hours.
  2. Have the agency file with the HealthChoices plan and ask for the decision date.
  3. If refused, ask for the written reasons and file the grievance and a fair hearing request.

Official application / program page ↗

Where it starts: The oncologist orders; a home health agency requests authorization from the plan.

What to gather

  • The oncologist's order (tasks, hours, why)
  • A two-week care log
  • HealthChoices plan ID
  • The agency's approval request and decision date

How long: For covered non-drug requests, the 2026 federal standard is generally seven calendar days or 72 hours urgent. Pennsylvania MA managed-care plans also have a two-business-day rule after required information arrives. The clinic confirms payer, request type and start point; the older 21-day exception FAQ is not a general nursing clock. Staffing follows separately.

What a yes looks like

An approval letter with hours per week and an agency start date. Ask the agency about employing a parent.

What a no looks like, and the next move

A letter with specific reasons. File the plan grievance and a state fair hearing request; ask for fast (expedited) review if delay could harm health.

Watch out

  • The paid-relative rule concerns approved HealthChoices nursing or home health aide services, not ordinary parenting or parent-provided personal care. Fee-for-service payment needs separate confirmation.
  • For covered non-drug requests, the 2026 federal standard is generally seven calendar days or 72 hours urgent. Pennsylvania MA managed-care plans also have a two-business-day rule after required information arrives. The clinic confirms payer, request type and start point; the older 21-day exception FAQ is not a general nursing clock. Staffing follows separately.
  • A written denial must give specific reasons. File a grievance, and ask for a fast (expedited) fair hearing if waiting could harm your child.

Dates that change this

2026-01-01: For covered non-drug requests, the 2026 federal standard is generally seven calendar days or 72 hours urgent. Pennsylvania MA managed-care plans also have a two-business-day rule after required information arrives. The clinic confirms payer, request type and start point; the older 21-day exception FAQ is not a general nursing clock. Staffing follows separately. (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

Shift nursing, personal care and home health aide hours approved by the HealthChoices plan for a child under 21; a parent hired and trained by the agency can be paid for home health aide hours.

Covers: Private-duty / shift nursing by an agency RN or LPN under physician direction · Personal care services · Home health aide services, including by a qualified legally responsible relative employed by the agency · Pediatric Complex Care Resource Center coaching for the caregiver team

Legal protection: The plan may not deny or limit authorized hours because the nurse or aide is a legally responsible relative · A denial must state the specific reasons the service is not medically necessary · Plan grievance, then a DHS fair hearing; expedited when waiting could harm health

What it costs the family: None.

The eligibility facts, as published

Age
under 21
Coverage
Medical Assistance (HealthChoices plan or fee-for-service)
Medical necessity
plan review; EPSDT standard
Paid parent
home health aide hours only, agency-employed, qualified and trained (MCS-05-2023-004); personal care excluded

The trap: The HealthChoices instruction does not authorize paying a legally responsible parent for personal care services. Fee-for-service arrangements need separate DHS confirmation.

Where I read this

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