How do I fund my child's in-home nursing?

In some cases, Medi-Cal pays directly for nursing through managed care plans. In other cases, CCS pays for nursing if the need for nursing is related to the child’s CCS-qualifying condition. Medi-Cal is the only program that reliably covers home nursing.

In the rare cases where private insurance covers home nursing, there are usually strict limits on how many hours are covered. Additionally, the definition of medical necessity for private duty nursing is usually far more restrictive in private insurance policies, so nursing can be denied for medical necessity under private insurance but still be medically necessary under Medi-Cal’s pediatric standards.

Full-scope Medi-Cal includes the private duty nursing benefit for children under age 21 through the EPSDT benefit (services that are available for children but not adults), so any child who has Medi-Cal based on family income can access home nursing without enrolling in any extra programs. There are three waiver programs that can provide a child with Medi-Cal eligibility in order to access home nursing if their family income is over the limit.

For more information, see our full article How to Navigate In-Home Nursing for Your Child.