By: Carolyn C. Foster, MD, MS, FAAP
Many children with complex health needs or disabilities can safely get care at home. But how do you know if your child is eligible for home health care services? How can you get home health care for your child? Who pays for home health care? And what's covered through public or private insurance?
Find the answers to these and other important questions here.
What the AAP recommends: home health care should be affordable
Home health care is when a child receives medical care and other services from trained professionals at home or in their community.
The American Academy of Pediatrics (AAP) advocates for families to have accessible, high quality home health care, which at times can be hard to find.
The AAP has called for
pediatric home health care regulations that clearly tell parents and caregivers who qualifies for home health care. The AAP strongly recommends that those regulations should also make it easier for families to get home medical services for their child.
How do I know if my child is eligible for care services at home?
If your child has a short-term, chronic or complex condition that would benefit from care outside the clinic or hospital, they may be able to get home care services.
Your child could receive longer or short-term services depending on their situation:
Longer-term services: They have a chronic condition or disability. For example, cerebral palsy, muscular dystrophy, chronic behavioral conditions or technology dependence (tracheostomy or feeding tubes, among others).
Short-term services: After a brief or serious illness or injury, such as surgery or an accident.
Financial assistance for child home care
There is no single insurance or government program that pays for home care. Depending on your child's needs, your family's income and the state you live in, your child may be eligible for Medicaid. There are other options as well, including:
States waivers or special health care programs for children with complex needs (even if they are not eligible for
Medicaid)
The Early and Periodic Screening and Diagnostic and Treatment (EPSDT) benefits through
Medicaid include
3 federally mandated services. They are necessary to "correct and ameliorate" a physical or mental condition.
Private Duty Nursing (PDN), Certified Nursing Assistant (CNA) and personal care services
Durable medical equipment (DME)
Case management
Challenges families face getting home care
Many families run into problems getting home care. Many times, their kids may not get all the services they need to be safe at home.
These are some of the most common challenges families face getting home care:
Uneven coverage: Different insurance plans don't cover the same services for the same amount of time.
Low payments: The plan might not pay the full cost for the service. This can make it harder to find people to provide care (private duty nurses, for example).
Finding care: There may only be a few providers where you live (it happens a lot in rural areas) or specific rules about who is qualified to provide services.
Those barriers put children at risk of life-threatening diseases, injuries and the need for hospital care. They also cause higher health care costs and more stress on family life.
The AAP believes children should get the medical care they need to allow families to have a healthy, functioning life. Your medical care team should be able to support you if you decide to submit an appeal for a denial.
How to get the home care your child needs
You will need a doctor's referral for home care services. Your pediatrician is part of your child's
care team and can write these orders.
Your child's pediatrician or specialist can work with your family on your child's care plan. They can also guide you on public and private insurance costs. If there are insurance coverage problems, they can usually speak up for your child.
Home care services should be affordable. Your pediatrician can work with your family to:
Check if your child's written care plan says they need care at home.
Ask your child's care team if any case manager or care coordinator can help you with the paperwork involved. It can be complicated.
Work with your child's care team to collect documentation, such as a
letter of medical necessity, to prove why your child needs home services.
Submit an appeal for a
denial of payment or service.
Remember
Home the ideal place for children to live even if they have a chronic or complex condition.
Home health care should be affordable, but many families run into problems when they try to get services their kids need at home.
Children enrolled in Medicaid have a right to medically necessary home health care services.
Your child's care team has the responsibility to help you access home health care services.
Your pediatrician can advocate on your child's behalf if there are problems with insurance coverage.
More information
About Dr. Foster
 Carolyn Foster, MD, MS, FAAP, is an Assistant Professor of Pediatrics at Northwestern University, Feinberg School of Medicine. She is also an attending physician in primary and complex care at Ann & Robert H. Lurie Children's Hospital of Chicago. As a primary investigator in the Foster Health Lab, she works to improve the health of children with disabling chronic conditions. Dr. Foster seeks to reduce health-care-related stress for their families through innovative healthcare design, research and policy change. She directs Lurie Children's Stanley Manne Research Institute's Health@Home Initiative, where she designs, develops and evaluates new digital tools and devices for care at home and in community settings.
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