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

Childhood Cancer Lantern
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Tennessee program

Nurses and aides at home through your health plan

TennCare can cover nursing shifts and hands-on personal care at home for a child.

What it is

TennCare can cover nursing shifts and hands-on personal care at home for a child.

Some care at home needs a nurse or aide, beyond what a parent can safely manage alone. The oncology team describes the tasks and hours. Your child’s TennCare plan decides whether the requested care is medically necessary.

Eligibility rules
  • The children’s medical-necessity route applies under age 21 with TennCare coverage.
  • A physician prescription and prior authorization from the health plan are required.
What you get
  • Covered nursing shifts and personal care at home after the plan approves them.
What the help covers
  • EPSDT permits review of medically necessary services within Medicaid benefit categories. A missing benefit-list entry does not by itself settle a child’s request.
  • TennCare allows an agency to hire qualified relatives for certain approved home services. These include private-duty nursing, home health nursing, home health aide services and some community services. This pays for approved care, not simply for being a parent. Birth or adoptive parents of minors do not need court approval under the agency guidance. Legal guardians and conservators do. You must meet the service’s training, licensing and employment requirements. Your child’s program and approved care plan control paid tasks and hours. The plan and agency confirm whether this route fits your child.
  • TennCare nursing and personal care are health-plan benefits. Katie Beckett has separate eligibility rules and home-service budgets. Part B is not full Medicaid coverage.
If you decide to apply
  1. Ask the oncology team or discharge planner to discuss the home tasks and request the needed hours.
  2. Bring a description of daily care and ask which local agencies have children’s nurses available.

Your TennCare health plan or discharge planner. Medical appeals: 1-800-878-3192. · Official page ↗

After you ask
  • A denial can go through TennCare’s medical appeal process. Member medical appeals: 1-800-878-3192.
  • The plan should answer a nursing request within seven days, or within three days when urgent. If it says no, the appeal steps and deadlines are the same as on the TennCare card.
Good to know

Approval does not mean a nurse is available. Staffing and payment approval are separate questions.

Other details
  • The request should describe what care is needed at home, who can perform it safely, and how many hours it takes.
Official sources
Ask your social worker

“Would nursing or an aide at home help with our child’s care? What would the assessment and staffing involve, and could you help the team make a request if appropriate?”

Why I’m asking: I want to know which care tasks need professional help and how we can manage safely at 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

Ask for the request to go in before discharge, keep every letter, and appeal by the date on a denial.

Your social worker

The discharge planner sends the request and names the agencies with pediatric nurses free.

The care team

The oncologist prescribes the hours and writes why the care has to happen at home.

Who decides
The TennCare health plan decides; the oncology team writes the medical case.
Ask your social worker
“Can the home nursing request go to the plan before discharge? What is their deadline to answer, and what do we do the day a denial arrives?”

How to apply

First step: Ask the discharge planner to send the request to your TennCare plan before discharge, and ask the plan in writing for its decision deadline.

  1. Ask the discharge planner to send the nursing request to the plan before discharge, not after.
  2. Ask the plan in writing what its decision deadline is for this request.
  3. If it is denied, ask for the children’s medical-necessity review and call 1-800-878-3192.

Official application / program page ↗

Where it starts: The oncology team or the discharge planner sends the request to the plan. If it is denied, ask for the children’s medical-necessity review and call member medical appeals.

What to gather

  • The health plan card and member number
  • The oncologist’s prescription and letter
  • A written list of what the care at home needs

How long: The state contract sets seven calendar days for a standard decision and 72 hours for an urgent one, but the version in force today could not be confirmed. Ask the plan.

What a yes looks like

An authorization naming the hours and the dates, and an agency that can actually staff them.

What a no looks like, and the next move

Ask for the children’s medical-necessity review, then call free member medical appeals on 1-800-878-3192 by the date on the letter.

Watch out

  • A service missing from the benefit list is not a no for a child under 21. Ask for the individual medical-necessity review by name.
  • Approval and staffing are different problems. Ask which agencies have pediatric nurses free in your county.
  • Whether a parent can be paid for these hours is unsettled in Tennessee right now. Ask the plan and get the answer in writing.

If they say no, quote this: The state’s managed-care contract requires an individual medical-necessity review for a child under 21 regardless of whether the required service is a covered benefit.

Dates that change this

2026-01-01: The state’s managed-care contract sets a deadline of seven calendar days for a standard decision and 72 hours for an urgent one. The published file shows two different contract versions, so the deadline in force today could not be confirmed. Ask the plan for its current one in writing. (not yet confirmed against the final rule)

2025-07-01: Under a 2025 state law, TennCare says a parent of a minor child can be employed by a provider agency as a family caregiver without going to court. The same guidance says the restrictions on ordinary home nursing are only proposed for removal, and the contract still excludes a close relative from ordinary private-duty nursing. Ask the plan what applies to your child now. (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

Nursing shifts and personal care at home for a child under 21, authorized by the TennCare health plan.

Covers: Private-duty nursing shifts at home · Personal care services · Home health visits and equipment · An individual medical-necessity review for a child under 21, even for a service not on the benefit list

Legal protection: A standard request that the plan means to deny in whole or in part carries a decision deadline, and an urgent one is faster · Free member medical appeals on 1-800-878-3192

What it costs the family: None through TennCare.

The eligibility facts, as published

Age
under 21 for the children’s medical-necessity route
Coverage
TennCare
Authorization
prior authorization by the health plan, on a physician prescription and a finding of medical necessity

Decisions this site cannot make: Prior authorization by the TennCare health plan · Physician prescription and a finding of medical necessity

Expect friction on: Hours are authorized in blocks and have to be asked for again · Agency staffing, not the approval, is often what limits the hours that actually arrive

The trap: A denial is not the end. Tennessee’s contract requires an individual medical-necessity review for a child under 21 even when the service is not listed as covered. Ask for that review by name, and call TennCare member medical appeals on 1-800-878-3192.

Where I read this

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