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

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Virginia program

Nursing at home and pay for some parent care

Medicaid can cover approved nursing and personal care at home, including some care from a parent.

What it is

Medicaid can cover approved nursing and personal care at home, including some care from a parent.

The care team describes the help your child needs at home. The health plan decides which services it will cover. Approval and finding staff are separate steps.

Eligibility rules
  • Medicaid must cover the service dates, and the service needs approval. Care assessment and discharge planning can begin while the Medicaid application is reviewed.
  • There are three kinds of help: occasional nurse visits, nursing shifts, and attendant care for daily tasks. Paid parent care is only for approved extraordinary care under a waiver such as CCC Plus; it is not wages for ordinary parenting.
What you get
  • Approved nursing and attendant hours at home.
  • Under an applicable waiver, up to 40 paid hours weekly per child for approved extraordinary parent or guardian care.
What the rules cover
  • The health plan handles managed-care requests. The state review contractor handles fee-for-service requests.
If you decide to apply
  1. Ask the hospital care manager about a home-care request before discharge.
  2. Keep a note of overnight care, tasks and hours. Ask which agency can staff the approved hours.

Cardinal Care health plan, or the state review contractor for Medicaid paid directly by the state · Official page ↗

If you decide to apply
  • The ordering clinician explains the care needed and whether waiting would seriously jeopardize your child’s health or ability to function. The discharge team can ask which expedited or transition rule applies.
  • For managed-care rating periods beginning on or after January 1, 2026, the standard authorization ceiling is generally seven calendar days. Qualifying urgent requests are decided as fast as health requires, within 72 hours. A conditional extension can add up to 14 calendar days. The plan or state review contractor confirms any different fee-for-service or stricter transition deadline.
Good to know

Paid parent care excludes ordinary supervision, cooking and errands. Respite stops while a parent receives personal-care pay.

Other details
  • An approved number of hours does not guarantee an agency has staff available.
Official sources
Ask your social worker

“Which care could a nurse or attendant take over, and could either of us be paid for extraordinary care? Could you help weigh respite against parent pay and arrange an assessment?”

Why I’m asking: I need to understand how we can safely manage care at home and still meet our bills.

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

Say plainly what you are doing at home overnight and how many hours it takes.

Your social worker

The care manager or discharge planner files the request as an urgent transition and names an agency.

The care team

The nurse and doctor write the order and the clinical justification.

Who decides
The health plan, or the state review contractor on fee-for-service
Ask your social worker
“Can the home nursing request be filed as a hospital-to-home transition before discharge, and can one of us be the paid attendant for personal care?”

How to apply

First step: Ask the hospital care manager to file the request before discharge and to mark it a hospital-to-home transition.

  1. Ask the care manager to file the request before discharge, as an urgent transition.
  2. Ask whether a parent can be the paid attendant and who would be the employer of record.
  3. If the answer is no and your child is under 21 on Medicaid, ask for the second review by name.

Official application / program page ↗

Where it starts: The nursing or home-care provider files the request. Ask the hospital care manager to start it before discharge.

What to gather

  • The discharge plan and the nursing orders
  • A note of what you do overnight and how long it takes

How long: The health plan has seven calendar days to decide, or 72 hours when waiting would be dangerous. No measured wait for a nurse to start was published.

What a yes looks like

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

What a no looks like, and the next move

For a Medicaid child under 21 a refusal needs a second review under the children's benefit guarantee. Ask for that review by name, and ask the ombudsman line on 1-800-552-5019 if it does not happen.

Watch out

  • Approval is not staffing. Ask who will actually take the hours.
  • Respite stops while a parent is being paid for personal care; you pick one.
  • Paid parent hours cover extraordinary care only, not supervision, cooking or errands.

The numbers and the rules

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

What it is worth

Nursing and attendant hours at home, and up to 40 hours a week per child paid to a parent for extraordinary care. Plan decisions in seven days, 72 hours when waiting would be dangerous.

  • $40/week — Most hours a week a parent can be paid for one child
  • $7 — Health-plan decision on a standard service request
  • $72 — Health-plan decision when waiting would be dangerous

Covers: Private duty nursing · Personal care and attendant help · Respite care, when no parent is being paid for personal care · Care management through the health plan

Legal protection: A Medicaid child under 21 cannot be refused a service without a second review under the children's benefit guarantee

What it costs the family: None.

The eligibility facts, as published

Coverage
Virginia Medicaid; the waiver route carries the same services for an over-income child
Authorisation
the health plan for managed care, or the state review contractor on fee-for-service; approval is needed before the service
Paid parent
a parent or guardian of a minor, for extraordinary care only, up to 40 hours a week per child, from July 1, 2025
Decision clocks
seven calendar days standard with a conditional 14-day extension; 72 hours expedited; hospital-to-home transitions are urgent

Expect friction on: Finding a nurse or attendant to take the hours once they are approved

The trap: Approval is not staffing. An approved authorisation does not mean an agency has a nurse free. Ask the care manager who will actually take the hours, and by when.

Where I read this

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