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

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Utah program

Nursing and personal care at home

Utah Medicaid can pay for skilled nursing and personal care your child needs at home.

What it is

Utah Medicaid can pay for skilled nursing and personal care your child needs at home.

Some care needs more help than a parent can safely provide alone. Your child’s team explains the tasks and hours needed. The health plan or Medicaid decides which services to approve.

Eligibility rules
  • Your child must have Utah Medicaid and meet medical-necessity requirements.
  • The EPSDT route applies under age 21, within covered Medicaid benefit categories.
What you get
  • Approved nursing and personal care at home, at no charge under Medicaid.
  • A treatment plan with registered-nurse supervision.
What the help includes
  • Services can include private-duty nursing, home personal care and home health. Waiver case management has its own eligibility rules.
If you decide to apply
  1. Ask the oncology or discharge team whether nursing or personal care at home fits your child’s needs.
  2. Describe the daily tasks and hours, and have the Medicaid card, plan name and discharge date ready.
  3. Ask the team to send the medical-need letter and give you the request date.

Health plan: number on the Medicaid card. Utah Medicaid: 801-538-6155 or 800-662-9651. · Official page ↗

After you ask
  • An approval names the hours and service agency. A denial must include appeal and hearing information.
  • In affected 2026 Medicaid coverage periods, non-drug prior approval decisions have a seven-calendar-day standard maximum or 72 hours for urgent review. Medical-plan appeals generally allow 60 days to file, 30 days for a standard answer or 72 hours for urgent review. A permitted extension is at most 14 days. These are separate clocks; a clinic’s reconsideration request does not replace your appeal.
  • After an adverse medical-plan appeal, the state-hearing window is 120 days. Keeping already approved services has a shorter deadline: generally the later of ten days after notice is sent or the intended action date, with all continuation conditions met. After the appeal decision is sent, a hearing and continued-services request generally must follow within ten days. The social worker can check those conditions, possible repayment, and the separate fee-for-service hearing route on your notice. These medical-plan appeal rules do not automatically apply to a transport-only plan.
Good to know

A clinical assessment comes before approved hours. The team can assess needs while you explore existing insurance, Medicaid or a waiver.

Other details
  • A parent is not automatically paid for care. The MCCW or TDW case manager confirms whether an approved service can employ a legally responsible parent. That includes training, employer, timekeeping, wage and hour rules. DSPD caregiver rules alone do not answer this question for these two waivers.
Official sources
Ask your social worker

“Which care tasks could a nurse help with at home, and what would still fall to us? Could you help request an assessment if it would make care safer?”

Why I’m asking: I want to understand what help is available before we try to manage everything 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 the team to request it, and keep the date of the request.

Your social worker

The provider submits the request with a medical-necessity letter.

The care team

The letter is the whole case: hours a day, tasks, and why a parent alone cannot do it.

Who decides
The child's health plan, or Utah Medicaid for fee-for-service members.
Ask the care team
“Can you request private-duty nursing hours for home, and say in the letter how many hours a day and why?”

How to apply

First step: Ask the discharge team to request prior authorisation now, and to name the discharge date in the request.

  1. Ask the discharge team to request nursing hours before the discharge date, not after.
  2. Ask for the medical-necessity letter to name the hours a day and the tasks.
  3. If it is refused, read the notice for the appeal route and use it.

Official application / program page ↗

Where it starts: The provider asks for prior authorisation. Fee-for-service: 801-538-6155 or 800-662-9651, then 3, 3 and the programme. Managed care: the number on the Medicaid card.

What to gather

  • The Medicaid card and plan name
  • The discharge date
  • A list of what care at home actually involves

How long: Utah publishes no state decision clock for private-duty nursing. Ask the plan for its own.

What a yes looks like

An authorisation with a number of hours and an agency named.

What a no looks like, and the next move

A written denial with appeal information. Ask the team for a fuller letter and appeal by the date on the notice.

Watch out

  • Nobody gets hours without a request. Ask the team to make it before the discharge date.
  • A parent can be paid as a caregiver on the disability agency's waivers, but Utah did not publish that permission for the two children's waivers. Ask; do not assume.
  • A denial must carry appeal information. Read it the day it arrives.

The numbers and the rules

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

What it is worth

Nursing hours and personal care at home, authorised once Utah Medicaid is in place.

Covers: Private-duty nursing · Home personal care under a nurse-supervised treatment plan · Home health · Nurse case management on the medically complex children's waiver

Legal protection: A denial must give appeal and hearing information

What it costs the family: No charge under Medicaid.

The eligibility facts, as published

Age
under 21 for the EPSDT route
Income
Utah Medicaid eligibility is the gate
Level of care
medical necessity under a treatment plan with registered-nurse supervision
Residency
Utah
Processing standard
unknown

Decisions this site cannot make: Prior authorisation by the health plan or by Utah Medicaid

Expect friction on: The split between plan and state authorisation is not published · Nurse staffing shortages are not something a decision fixes

The trap: Nobody gets hours without a request. The provider submits it, with a letter saying why it is medically necessary. A denial has to carry appeal and hearing information; read it rather than filing it.

Where I read this

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