The Florida Agency for Health Care Administration (AHCA) has finalized Rule 59A-8.0099, Florida Administrative Code (F.A.C.), formally establishing the minimum training requirements for the Family Home Health Aide for Medically Fragile Children Program (FHHA program), effective May 31, 2026.

Originally created through House Bill 391 during the 2023 Florida Legislative Session and later strengthened through Senate Bill 1156 in 2025, the FHHA program allows certain family caregivers to be trained and employed by licensed home health agencies to provide home health aide services to medically fragile children receiving Medicaid Private Duty Nursing (PDN) services.

In a significant related development, 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 addresses one of the largest concerns raised throughout implementation discussions: whether wages earned by family caregivers could unintentionally jeopardize Medicaid eligibility or waiver participation for medically fragile children and their families. HCAF strongly advocated for this change through passage of Senate Bill 1156 during the 2025 Session.

However, despite federal approval, the income disregard is not expected to become operational until at least the fourth quarter of 2026 while the Florida Department of Children and Families (DCF) implements necessary eligibility system and policy updates. Until then, providers and families should continue seeking individualized eligibility guidance before relying on the income exclusion.

Overview of the FHHA Program

The FHHA program allows a qualifying family member, legal guardian, or caretaker relative to become employed by a licensed home health agency to provide certain delegated home health aide services to an eligible medically fragile child in the home setting.

The program is designed to expand access to care for medically fragile children, help stabilize families facing nursing shortages, reduce unnecessary hospitalizations and institutionalization, supplement — not replace — authorized PDN services, and support continuity of care in the home.

Under the finalized rule, the family caregiver is considered an employee of the home health agency and must operate under the delegation and supervision of a registered nurse (RN).

Who May Participate?

To qualify for the program, the child must be under age 21, medically fragile, and eligible for and receiving Medicaid PDN services.

Eligible caregivers include family members, legal guardians, and caretaker relatives who:

• Are at least 18 years old
• Can read and write at a basic level
• Pass required Level 2 background screening
• Complete all required training and competency validations
• Are employed by a participating licensed home health agency

The rule also allows certain individuals awaiting nursing licensure after graduation from an accredited pre-licensure nursing program to qualify under specific circumstances.

Official Program Training Requirements

The finalized rule establishes a comprehensive minimum training curriculum totaling at least 76 hours. The curriculum consists of:

• 40 hours of basic home health aide training
• 20 hours of pediatric medically fragile skills training
• 16 hours of hands-on clinical competency validation

Basic Home Health Aide Training

The initial 40-hour component must comply with existing Florida home health aide training requirements under section 400.497, F.S., and Rule 59A-8.0095, F.A.C.

Training must be conducted by or under the supervision of a qualified RN with at least two years of nursing experience, including one year in home health care. The rule also clarifies that the Home Health Aide Competency Test alone may not substitute for the required training hours.

Caregivers must also complete a one-time HIV/AIDS educational course within 30 days of employment and maintain cardiopulmonary resuscitation (CPR) certification.

Pediatric Medically Fragile Skills Training

The rule requires an additional 20 hours of in-person pediatric nursing skills training tailored to the child’s individualized plan of care. This portion must be conducted by a qualified RN with at least two years of nursing experience, including one year in pediatric nursing.

Depending on the child’s needs, training may include:

• Tracheostomy care and suctioning
• Oxygen safety and respiratory management
• Enteral feeding and tube care
• Seizure recognition and rescue therapies
• Wound and skin care
• Ostomy and catheter care
• Intake and output monitoring
• Glucometer assistance
• Intravenous and total parenteral nutrition (TPN) assistive activities
• Rehabilitation support
• Emergency response procedures

Clinical Competency Validation

The rule also requires 16 hours of hands-on clinical competency validation conducted with an actual patient under the supervision of a qualified pediatric RN.

Caregivers must demonstrate all required skills in person and achieve 100% proficiency before independently providing services.

Competency validation must occur within 90 days of completing training. Validations expire annually and require revalidation to continue participating in the program.

Medication Administration Requirements

The finalized rule establishes additional medication administration requirements for family home health aides administering medications through expanded routes.

In addition to the standard six-hour medication administration course required under Rule 59A-8.0097, F.A.C., caregivers must complete an additional four hours of specialized pediatric medication administration training.

The additional training covers administration involving:

• Enteral feeding tubes
• Crushed medications
• Rectal medications
• Subcutaneous, intradermal, or intramuscular injections
• Inhaled medications administered through a tracheostomy

Supervision & Agency Responsibilities

Participating home health agencies will be responsible for ongoing supervision and documentation requirements.

A non-related RN employed or contracted by the agency must conduct supervisory visits at least every 60 days, although Medicare-certified agencies may be subject to more frequent federal supervision requirements.

Agencies must maintain written training curriculum documentation, policies governing delegated tasks, competency validation records, and documentation of supervisory visits.

While portions of the training may be conducted online or through hybrid models, in-person skills demonstrations remain mandatory.

Adverse Incident Reporting Requirements

The rule also establishes mandatory adverse incident reporting requirements for participating agencies.

Home health agencies must electronically report adverse incidents involving medically fragile child aides to AHCA within 48 hours using AHCA Form 3110-0011 OL through AHCA’s online reporting portal.

Key Takeaways for Providers

Home health agencies considering participation in the FHHA program should carefully review the finalized requirements before implementation.

Key compliance considerations include:

• Ensuring completion of all required training hours
• Maintaining detailed competency documentation
• Conducting timely annual revalidations
• Implementing appropriate RN supervision
• Developing policies for delegated tasks
• Monitoring medication administration compliance
• Maintaining adverse incident reporting protocols

The finalized rule provides substantially more operational clarity for providers and families while reinforcing AHCA’s emphasis on pediatric safety, competency validation, and RN oversight.

Advocacy in Action — and What Comes Next

This achievement underscores the impact of a unified home care voice in Tallahassee. HCAF’s ability to secure and implement meaningful policy reforms is driven by the engagement of its members and the support of the Home Care Political Action Committee (PAC).

With the 2026 elections approaching and the 2027 Legislative Session on the horizon, HCAF will continue advocating for reforms that reduce administrative burdens, strengthen the workforce pipeline, and support sustainable, high-quality care in the home.

This victory demonstrates what coordinated advocacy can accomplish — but continued progress depends on maintaining a strong presence at the Capitol.

To help support future legislative and regulatory victories, providers are encouraged to contribute to the Home Care PAC.

Click here to contribute today!