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

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Wisconsin program

Nursing and personal care at home (Wisconsin Medicaid)

Help with nursing and personal care at home for a child enrolled in Wisconsin Medicaid.

What it is

Help with nursing and personal care at home for a child enrolled in Wisconsin Medicaid.

Hands-on care at home can take more than one parent can manage alone. Medicaid can cover nursing or personal care when your child meets the clinical requirements; approval and finding a worker are separate steps.

Eligibility rules
  • Your child needs Wisconsin Medicaid coverage for the service. Depending on the service and who covers it, an enrolled home health agency, personal-care provider or independent nurse submits the required records and authorization request; the hospital social worker can help identify the correct payer and provider.
  • The September 2026 ForwardHealth personal-care update adds clinical-record requirements. The requesting provider should check the update and the child’s health-plan instructions rather than assume that one submission process fits every payer.
  • HealthCheck Other Services is available for members under 21 for medically necessary services within Medicaid benefit categories.
What you get
  • Approved nursing and personal care hours at no cost to the family.
  • A separate review of other medically necessary services through HealthCheck for children under 21.
If you decide to apply
  1. Ask your social worker and oncology team which agency or nurse can assess your child’s needs and request care.
  2. Bring your child's ForwardHealth number, health-plan name and notes about daytime and nighttime care.

Your oncology team and home care agency; Medicaid plan ombudsperson: 800-760-0001 · Official page ↗

Good to know

Coverage approval and finding a nurse are separate steps. The request needs clinical records from the care team.

Other details
  • The state’s published averages cover many kinds of prior authorization, not the time needed to find a children’s nurse. The care team can track the request date, urgency, decision deadline and separate staffing arrangements.
  • For non-drug prior authorization, Medicaid decision rules generally require a standard decision within seven calendar days and an urgent decision within 72 hours from January 1, 2026, sooner when the child’s health requires it. These are decision requirements, not merely reporting measures. An approval still does not guarantee that a nurse is available.
  • Medicaid does not pay a parent to nurse their own child under 21 or to give personal care, even if the parent is a nurse. The county waiver has its own family-provider rules.
  • Home health covers medically necessary intermittent skilled visits; private-duty nursing covers more continuous skilled care; personal care covers assessed help with daily activities under nursing supervision. The provider documents the tasks, frequency and medical need and obtains any required approval. Coverage and staffing are separate, and a written denial or reduction has appeal rights; ask the social worker to help check the notice and any deadline to keep existing care during review.
  • All nursing shifts need approval in advance, and so does personal care beyond 50 hours a year or home-health visits beyond 30 a year.
Official sources
Ask your social worker

“Could nursing or personal care help at home, what would arranging it involve, and would you help us request an assessment if appropriate?”

Why I’m asking: I want the care plan to reflect what our child needs throughout the day and night.

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 for the referral before discharge and say plainly what the nights look like.

Your social worker

The oncology team refers, and the home care agency sends the request with the clinical records.

The care team

The clinical records are now required with every personal-care request.

Who decides
Wisconsin Medicaid or the child's health plan, on the provider's request.
Ask your social worker
“Can we get a home care referral before discharge, and can the agency send the clinical records with the authorisation request?”

How to apply

First step: Ask the oncology team before discharge to refer your child to a home care agency, and ask the agency to send the records with the request.

  1. Ask the oncology team for a referral to a home care agency before discharge.
  2. Ask the agency to send the clinical records with the request, which is now required.
  3. If something is refused and your child is in a health plan, ring the ombudsperson on 800-760-0001.

Official application / program page ↗

Where it starts: Ask the oncology team to refer to a home care agency; the agency submits the authorisation with the clinical records.

What to gather

  • Your child's ForwardHealth number
  • The health plan name, if there is one
  • A note of what the nights involve

How long: From January 1, 2026, non-drug authorization decisions generally require seven calendar days, or 72 hours when urgent, sooner if health requires. Staffing takes a separate review.

What a yes looks like

An approval with a number of hours and an agency named to provide them.

What a no looks like, and the next move

A refusal or fewer hours than asked for. Ask what the records showed, and ring the plan ombudsperson on 800-760-0001.

Watch out

  • The request comes from the agency, not from you, so pick one that will do the paperwork.
  • Clinical records must now go with every personal-care request.
  • Payment to a parent depends on the service. Home health excludes a parent caring for their child under 18; private-duty nursing excludes a parent caring for their child under 21; personal care excludes legally responsible relatives. Other relatives must meet the service’s qualifications and restrictions.

The numbers and the rules

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

What it is worth

Personal care and nursing hours at home for a child on Wisconsin Medicaid, approved in advance on the clinical records.

  • $3.1 — Average days a standard authorisation decision took in 2025, all services
  • $1 — Middle number of days a standard authorisation decision took in 2025
  • $6.3 — Average days an expedited authorisation decision took in 2025

Covers: Personal care hours at home · Skilled nursing at home when approved · Items and services outside the usual benefit for a member under 21, through HealthCheck Other Services

Legal protection: For a member under 21, a route to medically necessary items the ordinary benefit leaves out

What it costs the family: None, once approved.

The eligibility facts, as published

Coverage
Wisconsin Medicaid, in fee-for-service or a health plan
Approval
prior authorisation from the provider, with the clinical records attached
Age route
HealthCheck Other Services for members under 21
Paid parent
Payment to a parent depends on the service. Home health excludes a parent caring for their child under 18; private-duty nursing excludes a parent caring for their child under 21; personal care excludes legally responsible relatives. Other relatives must meet the service’s qualifications and restrictions.

The trap: An eligible agency or independent provider handles the request, depending on the service. Approval and finding an available worker are separate steps.

Where I read this

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