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

Childhood Cancer Lantern
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West Virginia program

Nurses and aides at home through Medicaid

Medicaid can pay for nursing and help with daily care at home after a care assessment.

What it is

Medicaid can pay for nursing and help with daily care at home after a care assessment.

Home care can become much harder during treatment. Skilled nursing and personal care are separate services, with separate assessments. The care team’s description of your child’s needs supports the request.

Eligibility rules
  • Nursing shifts at home are for children under 21 who need at least eight hours of skilled nursing a day. The diagnosis alone does not set the hours; the assessment does.
  • Personal care has its own assessment. The family or doctor can request it.
What you get
  • Approved nursing and personal care at no cost through Medicaid.
  • Help with daily tasks when the personal care assessment supports it.
What the coverage means
  • A personal-care assessment usually happens within 30 days of a complete request, or within two business days when your child is being discharged from hospital urgently.
  • EPSDT can support requests beyond ordinary service limits when the service meets Medicaid’s rules.
If you decide to apply
  1. Ask the hospital discharge team to review the nursing and daily care your child needs at home.
  2. Describe the hardest days and nights, then ask the doctor to send the supporting notes and orders.
  3. For personal care, ask Acentra about the assessment and whether an urgent discharge qualifies for the faster review.

Bureau for Medical Services through Acentra Health: 1-800-346-8272, extension 4401 for nursing; 1-866-385-8920 for personal care · Official page ↗

After you apply
  • Nursing requests go through Acentra Health at 1-800-346-8272, extension 4401. An approval sets the hours; finding an agency with a nurse free is a separate step.
Good to know

A parent of a minor child cannot be paid through this personal care service. An assessment deadline is not a promise that a nurse will start then.

Other details
  • A service denial notice identifies the authorizing agency and appeal route. Your social worker can check whether a plan appeal comes before a BMS hearing and whether existing services can continue during review.
  • Personal Care cannot pay a minor child’s parent, spouse, court-appointed guardian or conservator as the personal-care worker. BMS confirms any different paid-relative rules for licensed nursing or a separate waiver. The discharge team also checks actual staffing and a safe home-care plan.
Official sources
Ask your social worker

“Could nursing or an aide make home care safer, and what help could actually be arranged? If an assessment makes sense, could you help document the hours we need and plan for discharge?”

Why I’m asking: I want the care plan to reflect what we will manage at home, including overnight care.

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 what care looks like at home on the hardest day, and ask for the request to go in before discharge.

Your social worker

The hospital team writes the medical documentation and sends the request.

The care team

The doctor's orders and notes are the case. Ask for hours that match the nights, not just the days.

Who decides
Acentra Health authorises; the Bureau for Medical Services hears appeals.
Ask your social worker
“Can nursing hours be authorised before we go home, and can the personal care assessment be treated as an emergent discharge so it happens in two business days?”

How to apply

First step: Ask the oncology team to send the request to Acentra now, before the discharge date is set.

  1. Ask the oncology team to send the nursing request to Acentra before the discharge date.
  2. Say the assessment is needed for a discharge so the two-business-day clock applies.
  3. If a limit has been used up, ask the provider to send it as an EPSDT request with the medical notes.

Official application / program page ↗

Where it starts: The doctor or provider sends the request to Acentra. For personal care the request can come from you or your doctor.

What to gather

  • The doctor's orders
  • A list of what care takes at home over 24 hours
  • Your child's Medicaid number

How long: Personal care: 30 days from a complete request, or two business days when it is needed for a discharge. The nursing clock is not published.

What a yes looks like

A written authorisation with a number of hours and a start date, and an agency named to fill them.

What a no looks like, and the next move

Ask the provider to resubmit as an EPSDT request with fuller notes, and appeal to the Bureau for Medical Services by the date on the notice.

Watch out

  • A parent of a minor child cannot be paid for personal care in West Virginia.
  • Say the word discharge: the assessment clock drops to two business days.
  • The posted nursing manual is from 2020 and the decision clock is not published, so ask for a date in writing.

Dates that change this

2020-05-01: The nursing manual on the state site is from 2020 and is the newest posted version. Who authorises what between the health plan and the state was not settled. (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

Skilled nursing and personal care at home for a child under 21, with an assessment within 30 days, or two business days when it is needed for a discharge.

  • $30 — Personal care assessment after a complete request
  • $2 — Personal care assessment for an emergent hospital discharge

Covers: Private duty nursing for a member under 21 · Personal care for help with daily tasks · EPSDT requests for services beyond ordinary limits · An appeal to the Bureau for Medical Services after a denial

Legal protection: A member or provider can appeal a prior-authorisation denial

What it costs the family: Nothing on Medicaid.

The eligibility facts, as published

Age
under 21 for private duty nursing
Medicaid
required
Authorisation
prior authorisation by the utilisation management contractor, currently Acentra Health
Paid parent
not allowed for personal care by a parent of a minor child

Decisions this site cannot make: Prior authorisation by the utilisation management contractor · Pre-admission screening assessment for personal care

Expect friction on: The current decision clock for nursing is not published · A parent of a minor child cannot be paid for personal care

The trap: If a service is not covered, or the limit has already been used, the provider can send it in as an EPSDT request with medical documentation. That is the route that gets a child under 21 past an ordinary limit.

Where I read this

← Back to your options