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

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Washington program

Skilled nursing at home (Medically Intensive Children’s Program)

Apple Health pays for approved skilled nursing hours at home for children 17 or younger with complex needs.

What it is

Apple Health pays for approved skilled nursing hours at home for children 17 or younger with complex needs.

This program needs at least four continuous hours a day of active skilled nursing plus two complex nursing tasks, decided by a clinical assessment, and Apple Health in place for the benefit itself. If you or the care team think your child needs nursing-level care at home, ask for the assessment before discharge, and do not wait for the Apple Health decision to raise it.

Rules
  • Age 17 or younger.
  • At least four continuous hours of skilled nursing that is not delegable at first and is safe outside hospital, plus at least two complex skilled nursing tasks.
  • Apple Health eligibility must already be established; this is not a way around its income rules.
What you get
  • Approved nursing hours at home from a contracted agency.
What it is not
  • It does not pay a parent’s wages.
If you decide to apply
  1. Talk with the social worker and discharge team about a nursing assessment and which plan handles it. If it is pursued, ask about approved hours, agency availability and the safe plan at home.

Discharge planner

If it becomes relevant
  • A note of skilled tasks and how long they take can support the assessment; provide any insurance denial letters.
Good to know

Equipment alone does not establish that your child meets the requirements.

Other details
  • Ask how approved hours will be staffed and what the backup plan is.

Federal background: Check the right program for care at home.

Official sources
Ask your social worker

“Given the care our child needs at home, should the team assess home nursing now, and what information would help?”

Why I’m asking: We want a safe plan at home and to know which plan or program would handle nursing if it is needed.

More background and detailed requirements

How this could help

A nurse at home can help a child leave the hospital safely when their care requires nursing skills. The program assesses the tasks, time and medical needs; it does not award hours just because a child has cancer or uses a feeding tube.

This is care provided by a qualified nursing provider, not wages for a parent. Ask the discharge team to start the assessment early so that an approval and an available provider can be considered before discharge.

What to know before you apply

  • Apple Health eligibility must already be in place. This program alone is not a way around its financial eligibility rules.
  • The published criteria include at least four continuous hours of skilled nursing and at least two complex nursing tasks, with additional safety and assessment requirements.
  • Insurance coverage or denial information may be needed when another plan could pay.

Your next steps

  1. Ask the discharge planner for a medically intensive nursing assessment.
  2. Keep a short record of nursing tasks and how long they take, and provide any insurance denial letters.
  3. Ask how approved hours will be staffed and what the backup plan is if a nurse is unavailable.

17 and younger

no separate income test: the child must already be eligible for Apple Health under the categorically needy, medically needy or alternative benefit plan rules

at least four continuous hours of skilled nursing, not delegable at first and safe outside hospital, plus at least two complex skilled nursing tasks

Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Keep a two-week log of every nursing task, when it happens and how long it takes.

Your social worker

The discharge planner or oncology nurse starts form DSHS 15-398 and describes the hours in the record.

The care team

The doctor and nurse write the skilled tasks and the hours they take.

Who decides
The Department of Social and Health Services after a nursing care consultant's assessment, or the Apple Health plan for its own members.
Ask your social worker
“Does my child need the level of skilled nursing this program covers, and can the discharge team start an assessment?”

How to apply

First step: Ask the discharge planner for a medically intensive nursing assessment.

  1. Ask the oncology team to write down the nursing tasks, how long each takes and how often.
  2. Ask the discharge planner to start form DSHS 15-398 before your child goes home.
  3. If a plan or insurer says no to the nursing, keep that letter: the application needs it.

Official application / program page ↗

Where it starts: Form DSHS 15-398. If your child is in an Apple Health managed-care plan or has other insurance, the application needs that plan's letter refusing the nursing.

What to gather

  • A two-week log of nursing tasks and how long each takes
  • Any letter from a plan or insurer refusing the nursing

How long: The published rule gives fifteen days for the first review and five business days after extra information; that text predates 2024.

What a yes looks like

A number of authorised nursing hours a week and an agency to provide them.

What a no looks like, and the next move

If the no is about the hours, ask what the assessment recorded and ask the team to add the tasks it left out, then appeal by the date on the notice.

Watch out

  • It is not a way into Apple Health: coverage has to be in place first.
  • A parent cannot be the paid provider of a waiver service for their own child under eighteen.
  • If a plan or insurer refuses the nursing, keep the refusal letter; the application needs it.

Dates that change this

2026-09-10: The fifteen-day review figure comes from rule text predating 2024 and the current authorisation timetable was not retrievable; treat it as the published rule, not a promise.

2026-09-10: A parent cannot be the paid provider of a waiver service for their own minor child. Whether the personal-care programmes allow it was not settled; ask rather than assume.

The numbers and the rules

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

What it is worth

Paid nursing hours at home for a child of seventeen or younger who needs at least four continuous hours of skilled nursing and two complex nursing tasks.

  • $4 — Continuous hours of skilled nursing in the clinical test
  • $2 — Complex skilled nursing tasks required
  • $17 — Oldest age served

Covers: Private duty nursing hours in your home · Assessment by a nursing care consultant · A route to ask for medically necessary services that are not on the ordinary covered list

What it costs the family: Nothing once approved.

The eligibility facts, as published

Age
17 and younger
Age max exclusive
18
Income
no separate income test: the child must already be eligible for Apple Health under the categorically needy, medically needy or alternative benefit plan rules
Level of care
at least four continuous hours of skilled nursing, not delegable at first and safe outside hospital, plus at least two complex skilled nursing tasks
Residency
Washington

Decisions this site cannot make: Nursing care consultant assessment · Prior authorisation

Expect friction on: Finding an agency with staff free · Getting a refusal letter from the plan

The trap: This is not a door into Apple Health. Washington's research shows the programme needs Apple Health eligibility first, so a family over the income line has to get in another way before asking for nursing. If your child has other insurance or a managed-care plan, the application needs that plan's letter refusing to cover the nursing.

Where I read this

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