Everyday care, explained
What Counts as Extraordinary Care for a Child?
Extraordinary care is a Medicaid term for support beyond what a parent would ordinarily provide to a child of the same age. It is assessed individually.
Virginia guidance · Reviewed
Begin with the actual hands-on help.
Virginia’s extraordinary-care guide considers bathing, dressing and grooming, toileting, transferring and eating. The type of help and the child’s age both matter. Needing assistance with an ADL is a starting point for assessment, not an automatic approval.
The provider considers what your child does independently, what you physically help with, how long the tasks take and how the need differs from age-typical care. DMAS allows individualized documentation to explain needs beyond the examples in its guide.
Separate ADLs from supervision and household tasks.
- Helping someone physically eat is different from preparing the family meal.
- Physically assisting with dressing is different from giving a routine reminder to get dressed.
- Providing a transfer is different from generally watching for safety.
- Ordinary age-appropriate parenting, general supervision and instrumental tasks such as shopping or housekeeping do not qualify as extraordinary paid LRI care.
Make the care conversation specific.
Instead of only saying “my child needs help all day,” describe the daily activities and the assistance involved. Explain variability honestly, including tasks your child can complete independently on some days. This helps the assessor understand the person rather than only a diagnosis.
You do not need to describe intimate care details in the public eligibility checker. Select the broad ADL categories that apply. Save detailed discussion and records for the appropriate assessment and approved private process.
The assessment shapes what can be paid.
Extraordinary ADL needs, Medicaid and waiver requirements, a care plan and service authorization all matter. The paid caregiver must meet the role’s requirements. A diagnosis alone does not qualify a child, and the LRI limit does not guarantee a particular number of hours.
Needs outside paid LRI personal care can still be discussed with the child’s care team. Ask what other supports are appropriate without assuming those needs can be billed as LRI care.
Official sources
These Virginia and local government resources explain the rules and the public programs described here.
This guidance and our preliminary screening do not guarantee Medicaid eligibility, paid caregiver employment or service authorization. First Choice Home Care does not make the final Medicaid or authorization decision. Your program and care plan determine which services may be approved.
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