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

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South Dakota program

A nurse at home (Medicaid private duty nursing)

Medicaid can pay for skilled nursing at home when your child’s doctor says it is needed.

What it is

Medicaid can pay for skilled nursing at home when your child’s doctor says it is needed.

Some children need a nurse’s skills at home during treatment. The discharge team and nursing agency document the care before Medicaid decides on hours. Having a line or pump does not by itself guarantee approval.

Eligibility rules
  • Your child needs full South Dakota Medicaid or qualifying full-benefit CHIP and a physician-ordered plan showing skilled nursing needs. Private duty nursing is different from intermittent home health or personal-care help; the discharge team can identify the right assessment.
  • The well-child exception route (EPSDT) applies through age 20. The nursing agency submits clinical records.
What you get
  • Paid skilled nursing hours at home for approved care.
  • A children’s Medicaid review route for medically needed care under age 21.
What the help includes
  • The private duty nursing manual generally excludes paying a parent or household member. It also names a temporary exemption form.
  • Medicaid does not normally pay a parent or someone in the household to be the nurse. There is a temporary exception; ask the agency whether it is open, what training it needs and to get any approval in writing.
  • Help with daily tasks such as bathing and feeding is a separate service with its own assessment, and it does not pay a parent for a child under 18. The discharge team can say which service fits.
If you decide to apply
  1. If you want a review, ask the discharge planner which nursing agency will send the request.
  2. Ask the doctor to describe each skilled task and how often your child needs it.
  3. Ask the discharge team how care will work while Medicaid decides and while nurses are being found.

South Dakota Medicaid, Division of Medical Services: 800-597-1603 · Official page ↗

After you ask
  • Medicaid should answer a nursing request within seven days, or within three days when the need is urgent.
  • The nursing agency sends the private duty nursing form to DSSMedicaidPA@state.sd.us.
Good to know

Approved hours do not guarantee an available nurse. Each approval lasts at most two months, so renewal dates matter.

Other details
  • Staffing can be especially difficult west of the river. A discharge plan needs to account for the hours a nurse can actually cover.
Official sources
Ask your social worker

“Would nursing at home help our child, and what are the benefits and drawbacks? If you think it fits, could you help the discharge team request it?”

Why I’m asking: I want a workable care plan at home and clarity about who can cover the skilled care.

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

Ask who is sending the request and by when, and chase the renewal before the two months run out.

Your social worker

The discharge planner and the nursing agency put the request together.

The care team

The doctor orders the nursing and writes why a nurse's skills are needed.

Who decides
South Dakota Medicaid, Division of Medical Services
Ask your social worker
“Who is sending the private duty nursing request to South Dakota Medicaid, on what date, and what happens if it is not back before discharge?”

How to apply

First step: Ask the discharge planner who is sending the request and on what date.

  1. Ask the discharge planner this week who is sending the nursing request and on what date.
  2. If a service you need is outside the ordinary limits, ask for it through the well-child route with the clinical notes attached.
  3. Put the two-month renewal date in the diary the day the first approval lands.

Official application / program page ↗

Where it starts: The home health or nursing provider sends the request to DSSMedicaidPA@state.sd.us using the private duty nursing form. You ask the discharge planner to start it.

What to gather

  • The doctor's order for home nursing
  • Your child's Medicaid number

How long: Covered non-drug requests generally have a seven-calendar-day or expedited 72-hour decision clock from January 1, 2026. Drug requests and emergency exceptions differ.

What a yes looks like

An approval naming the hours a week and the end date, at most two months out.

What a no looks like, and the next move

Ask whether it was the hours or the level of care, and ask for the well-child route if the refusal was about an ordinary coverage limit.

Watch out

  • Each approval lasts at most two months; the renewal has to be sent before it runs out.
  • Approved hours are not the same as a nurse being available to work them, especially west of the river.
  • The manual does not pay a parent or household member for nursing, though it names a temporary exemption form. Ask about that by name.

Dates that change this

2026-09-11: The August 2025 nursing manual mentions a temporary family-member exemption. Medicaid must confirm its current availability, operative form, nurse qualifications and payment limits before a family relies on it. (not yet confirmed against the final rule)

The numbers and the rules

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

What it is worth

Skilled nursing hours at home require Medicaid approval and an assessment of the child’s needs.

  • $2 — Maximum length of one private duty nursing authorisation
  • $7 — Federal standard decision time for covered non-drug requests from January 1, 2026; expedited requests generally 72 hours

Covers: Private duty nursing hours at home · Home health visits · Anything medically necessary for a child aged 20 or younger, through the well-child exception route · A personal care needs assessment by the Division of Long Term Services and Supports

Legal protection: Urgent or emergency care is exempt from prior authorisation altogether · A coverage limit is not the end of the request for a child aged 20 or younger

What it costs the family: No charge to the family on Medicaid.

The eligibility facts, as published

Age
the well-child exception route applies to a child aged 20 or younger enrolled in Medicaid
Medical
physician-ordered skilled nursing; the provider submits the request with clinical records
Coverage condition
South Dakota Medicaid
Processing standard
Covered non-drug requests: generally seven calendar days standard or 72 hours expedited from January 1, 2026. Medicaid confirms the applicable route; the older state manual says 30 days.

Decisions this site cannot make: Division of Medical Services prior authorisation for the nursing hours

Expect friction on: Every authorisation lasts at most two months, so the paperwork comes round again while the child is still in treatment · Finding a nurse to fill approved hours is a separate problem from getting the hours approved, especially west of the river

The trap: Do not treat a coverage limit as the end of the conversation. The well-child rule says a service that is medically necessary for a child but falls outside ordinary limits still goes to the state as a prior authorisation request, with the clinical notes attached.

Where I read this

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