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

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Vermont program

A nurse at home (high-technology nursing)

A nurse can provide skilled care at home through Vermont's pediatric high-technology nursing program.

What it is

A nurse can provide skilled care at home through Vermont's pediatric high-technology nursing program.

Some care after discharge needs a nurse rather than a family member alone. Medicaid can cover home nursing after a clinical review. The team must also find a nurse who can staff the approved hours.

Eligibility rules
  • Your child needs Vermont Medicaid, a medical referral and state approval of skilled nursing care.
  • A parent cannot make the clinical referral.
  • Pediatric High-Tech Nursing serves Medicaid-enrolled children under 21 who need complex, ongoing skilled nursing assessment or intervention beyond ordinary intermittent home care. A medical referral, records and a nursing assessment determine necessary tasks and authorized hours; reassessment is generally annual or sooner if needs change.
What you get
  • Approved nursing hours at home, with no charge through Vermont Medicaid.
What the help includes
  • A Vermont registered nurse who is the child's parent may be able to provide the nursing.
  • A parent who is a Vermont registered nurse can be paid for up to 12 hours a day and 40 hours a week of the approved nursing, once enrolled with Medicaid. Other hours need other nurses.
If you decide to apply
  1. Ask the oncology doctor whether a pediatric high-technology nursing referral fits your child's discharge plan.
  2. Have a daily care list ready and ask the discharge team who can staff the hours.

Family questions: 800-660-4427. Clinical referrals: ahs.vdhcshnhightechnursing@vermont.gov; fax 802-863-6344. · Official page ↗

After you ask
  • The standard decision time is 7 calendar days, with up to 14 additional days in allowed circumstances. An expedited request has a 72-hour standard.
Good to know

Approval of hours does not mean a nurse is available. Staffing is part of the discharge conversation.

Other details
  • The referring doctor describes the skilled tasks and how often your child needs them.
Official sources
Ask your social worker

“Would nursing at home make our child's care safer, and what would it involve for us? Could you help with the referral and a realistic staffing plan?”

Why I’m asking: I want to know which care needs a nurse before we are managing it 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 doctor to refer before discharge and ask for the decision date in writing.

Your social worker

The hospital social worker chases the referral and the discharge plan together.

The care team

The doctor makes the referral and describes the skilled care needed each day. A parent cannot refer.

Who decides
The state authorises the hours; the health department's team runs the programme.
Ask the care team
“Can you refer for pediatric high-tech nursing now, before discharge, and ask for an expedited decision so the hours are in place when we go home?”

How to apply

First step: Ask the oncology doctor this week to refer to pediatric high-tech nursing, and ask for an expedited decision if discharge depends on it.

  1. Ask the oncology doctor to refer before discharge, not after.
  2. Ask for an expedited decision if discharge is being held up: the standard is 72 hours.
  3. If a parent is a registered nurse, ask about family-managed nursing on the same call.

Official application / program page ↗

Where it starts: Ask the oncology doctor to refer to pediatric high-tech nursing. Referrals go to ahs.vdhcshnhightechnursing@vermont.gov or fax 802-863-6344. Family questions: 800-660-4427.

What to gather

  • The discharge date being planned
  • The list of skilled tasks needed each day
  • A parent's nursing licence, if that route applies

How long: The state decides a standard request in 7 calendar days, with up to 14 more if extended, and an expedited request in 72 hours.

What a yes looks like

Authorised hours with dates, and a named agency to staff them.

What a no looks like, and the next move

Ask whether the no was the level of care or the paperwork, and ask about the child's right to a medically necessary service even where adults do not get it. The Health Care Advocate helps free on 1-800-917-7787.

Watch out

  • A parent cannot refer. The doctor has to, and the referral can go in before discharge.
  • The caps on a parent being the nurse come from a 2019 policy. Ask whether they still stand.
  • Paper approval is not a nurse. Ask who is actually available in your part of the state.

Dates that change this

2019-10-01: The parent-as-nurse caps of 12 hours a day and 40 hours a week come from a 2019 policy. The option is corroborated by the 2025 manual, but a newer cap was not published, so ask whether the caps still stand. (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 hours at home, authorised by the state within 7 calendar days, or 72 hours when expedited. A parent who is a Vermont registered nurse can be the nurse.

  • $7 — Standard prior authorisation decision
  • $72 — Expedited prior authorisation decision
  • $12 — Cap on nursing by a parent or guardian, 2019 policy
  • $40/week — Weekly cap on nursing by a parent or guardian, 2019 policy

Covers: Nursing hours at home · Family-managed nursing where a parent is a Vermont-licensed registered nurse enrolled with Vermont Medicaid · A referral route that can start before discharge

Legal protection: A child's medically necessary service must be covered even where it is not covered for adults

What it costs the family: None on Vermont Medicaid.

The eligibility facts, as published

Coverage
Vermont Medicaid
Referral
a medical provider must make the referral
Authorisation
prior authorised by the State

Expect friction on: Vermont publishes no measured waiting time for a nurse to be found, and a rural state can take a while

The trap: A parent cannot refer. The health department's page says the medical provider must be the one to refer, and the referral can go in before discharge.

Where I read this

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