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

Childhood Cancer Lantern
Search Saved

South Carolina program

Nurses and aides at home

Healthy Connections can cover nurses and personal-care aides at home when your child needs them.

What it is

Healthy Connections can cover nurses and personal-care aides at home when your child needs them.

A child may need hands-on care between hospital visits, including overnight. Home nursing starts with what care is needed and who can safely give it. The plan reviews the team’s request.

Eligibility rules
  • Your child must have Healthy Connections and a medically necessary care need.
  • For children under 21, EPSDT covers care needed to correct or improve a condition within Medicaid benefit categories. It does not guarantee every requested service.
What you get
  • Nursing and aide hours at home with no child copay for covered care.
  • Home health visits and approved equipment or supplies.
What the help includes
  • The hospital team can identify whether the request goes to your Medicaid health plan or the state’s fee-for-service authorization route. Waiver services have a separate review; a waiver wait does not itself settle an EPSDT nursing request.
  • For children on the complex-children waiver, a nurse coordinator documents need using a checklist and nursing acuity scale.
If you decide to apply
  1. Ask the oncology team to describe the care needed at home and write the order.
  2. Keep a record of overnight tasks, equipment and how often someone must be awake.
  3. Ask the plan for its answer and any approved hours in writing.

Healthy Connections appeals · 800-763-9087 · plan complaints 877-552-4642 · Official page ↗

If you decide to go ahead
  • The plan should answer a nursing request within seven days, or three days when urgent. If it says no, you have 60 days to appeal and the plan has 30 days to decide; to keep hours already approved running during the appeal, you must ask sooner, so show the letter to your social worker straight away.
Good to know

A refusal or reduction can be appealed. The children’s benefit uses a broader medical-need test than adult Medicaid.

Other details
  • The written care request should explain the night as well as the day. Hours are assessed for the child rather than awarded by diagnosis.
Official sources
Ask your social worker

“Could our child qualify for nursing or an aide at home? What help and limits would that bring, and could the team help us describe the overnight care?”

Why I’m asking: I want to know which care could be shared with a nurse or aide.

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 night, not the average day: what happens at 2am and who does it.

Your social worker

The oncology team writes the order and the clinical picture behind it.

The care team

The team documents the nursing need; on the waiver, a nurse coordinator completes a medical-necessity checklist and nursing acuity scale.

Who decides
The child's Medicaid health plan, or department waiver staff.
Ask the care team
“Can you order nursing hours at home and write down what care is needed overnight? We would like the plan's decision in writing.”

How to apply

First step: Ask the oncology team to order home nursing, and ask the plan to answer in writing.

  1. Ask the oncology team to write the order with the hours it thinks are needed, not the hours it expects to get.
  2. Ask the plan for the decision in writing, with a date.
  3. If it is cut or refused, appeal to the plan, then ask for a state hearing.

Official application / program page ↗

Where it starts: Ask the oncology team to order it, then ask the plan for the decision in writing. Appeals: 800-763-9087. Help with a plan complaint: 877-552-4642.

What to gather

  • The order from the team
  • A night-by-night note of what care is needed
  • The plan's member number

How long: No South Carolina decision clock was published for these services.

What a yes looks like

An authorisation naming the hours a week and the agency that will staff them.

What a no looks like, and the next move

A letter cutting or refusing hours. Appeal to the plan and then ask the state hearings office on 800-763-9087.

Watch out

  • A refusal is appealable. Ask for it in writing, appeal to the plan, then ask for a state hearing.
  • For a child the test is what is needed to correct or improve the condition, which is wider than an adult's test.

The numbers and the rules

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

What it is worth

Nursing and aide hours at home, authorised through the child's Medicaid health plan or the waiver.

Covers: Private duty nursing hours · Children's personal care aide hours · Home health visits · Equipment and supplies the plan approves

Legal protection: For a child under 21, Medicaid must furnish all medically necessary care to correct or improve a condition · A denial or a cut can be appealed to the plan and then to the state hearings office

What it costs the family: No copay for a child on Healthy Connections.

The eligibility facts, as published

Coverage
the child must be on Healthy Connections
Medical
medically necessary to correct or improve the child's condition, under the children's benefit
Who authorises
the child's Medicaid health plan for medical services; department waiver staff for waiver services
Processing standard
NOT FOUND for South Carolina nursing decisions

The trap: A denial is not the end. Ask for the decision in writing, then use the plan's appeal and the state hearing route on 800-763-9087. For a child, the test is what is medically necessary to correct or improve the condition, which is a wider test than an adult's.

Where I read this

← Back to your options