The Florida Agency for Health Care Administration (AHCA) has finalized revisions to the Florida Medicaid Private Duty Nursing (PDN) and Family Home Health Aide (FHHA) Services Coverage Policy, implementing key changes resulting from HCAF-led reforms enacted in 2025. Effective July 2, 2026, the updated policy expands access to family-delivered care for medically fragile children while aligning Medicaid coverage requirements with recent statutory and regulatory changes.

The revisions represent another significant milestone in the ongoing implementation and evolution of Florida’s FHHA program, which allows qualified family members to be trained and employed by licensed home health agencies to provide home health aide services to medically fragile children who qualify for PDN services.

Recent Program Developments

The coverage policy revisions follow several significant developments in the FHHA program over the past year.

In 2025, Governor Ron DeSantis signed SB 1156, legislation championed by HCAF that expanded utilization limits, strengthened oversight requirements, authorized participation by Medicaid pediatric specialty providers, and directed Florida to pursue federal approval to disregard FHHA earnings when determining Medicaid eligibility.

Earlier this year, the Centers for Medicare & Medicaid Services (CMS) approved Florida State Plan Amendment FL-25-0011, effective February 9, 2026, authorizing Florida to disregard income earned through the FHHA program when determining Medicaid eligibility. The approval implements one of the key provisions championed by HCAF through SB 1156 and helps ensure that family caregivers can participate in the program without jeopardizing Medicaid eligibility for their medically fragile child. Although CMS approval is now in place, the income disregard is not expected to become operational until the Florida Department of Children and Families (DCF) completes necessary eligibility system and policy updates.

In addition, AHCA recently finalized Rule 59A-8.0099, F.A.C., establishing the minimum training and competency requirements for Family Home Health Aides. HCAF previously published a detailed summary of those requirements, which became effective May 31, 2026.

Coverage Limits Expanded

The most significant change in the revised policy is the expansion of covered FHHA service hours.

Under the previous coverage policy, Florida Medicaid covered up to eight (8) hours of FHHA services per day for eligible recipients receiving PDN services.

The revised policy increases coverage for eligible recipients receiving PDN services from eight hours per day to up to 12 hours per day and 40 hours per week, with exceptions permitted when medically necessary.

The policy also recognizes the statutory exception process allowing services to exceed 40 hours per week when medically necessary.

These expanded limits provide greater flexibility for families and providers while helping address persistent workforce shortages affecting medically fragile children throughout Florida.

Eligibility and Care Coordination Clarified

The revised policy expressly states that children receiving medically necessary PDN services may also receive medically necessary FHHA services.

While FHHA services continue to supplement — not replace — PDN services, the updated language provides additional clarity regarding how the two services work together to support children with complex medical needs.

As under the previous policy, FHHA services:

• May not duplicate authorized PDN services
• May not occur concurrently with PDN services
• Must be supervised by a non-related registered nurse employed by a participating home health agency

Additional Policy Revisions

In addition to the FHHA-specific changes, AHCA made several technical and conforming updates throughout the coverage policy, including:

• Updating federal legal authority references
• Adding a definition for “Private Duty Nursing Services”
• Updating terminology to reference “Family Home Health Aide or Home Health Aide for Medically Fragile Children”
• Clarifying that recipients receiving medically necessary PDN services may also receive medically necessary FHHA services

The policy otherwise retains existing requirements related to authorization, physician orders, care plans, documentation, and Quality Improvement Organization (QIO) review processes.

What Providers Should Do Now

Providers participating in the FHHA program should review both the updated coverage policy and AHCA’s finalized training rule to ensure compliance with current program requirements.

Particular attention should be paid to:

• Updated hourly utilization limits
• Requests for services exceeding 40 hours per week
• Training and competency requirements
• Registered nurse supervision requirements
• Documentation supporting medical necessity and coordination with PDN services

HCAF will continue monitoring implementation of the FHHA program and advocating for policies that expand access to safe, high-quality home-based care for Florida’s medically fragile children and their families.