The Home Care Association of Florida (HCAF) is seeking input from home health providers serving medically fragile Medicaid children ahead of mediation in United States v. Florida, a federal disability rights case addressing access to care at home and unnecessary institutionalization.

HCAF reached out to Disability Rights Florida (DRF) to request a meeting and offer the provider perspective after hearing families describe difficulties accessing private duty nursing (PDN). HCAF is meeting with Caitlyn Clibbon, DRF’s Director of Litigation, to discuss those concerns and how agencies’ experiences can inform advocacy for children and families.

In October 15 correspondence with HCAF, Clibbon confirmed that mediation is scheduled for the first week of November. Providers are encouraged to share their experiences with HCAF before that mediation.

The discussions come as the U.S. Department of Justice (DOJ) retreats from legal positions it previously advanced in the case. That shift raises questions about future federal enforcement, but it does not overturn the Supreme Court’s Olmstead decision, repeal the Americans with Disabilities Act (ADA), or automatically cancel court orders.

What is at Stake?

In Olmstead v. L.C., the Supreme Court recognized that unjustified institutionalization of people with disabilities can constitute discrimination under Title II of the ADA.

That principle underlies United States v. Florida, which DOJ filed in 2013 over Florida’s administration of services for medically complex children. The case addresses children unnecessarily living in nursing facilities and children living at home whose inadequate access to services places them at serious risk of institutionalization.

Following a 2023 trial, the district court ordered Florida to address deficiencies in nursing access, care coordination, and transition planning. A central provision required the state to ensure children receive at least 90% of their authorized and desired PDN hours. In March 2026, the Eleventh Circuit Court of Appeals largely upheld the liability findings and injunction, including the PDN delivery requirement, while vacating certain other provisions. Click here to read the appellate decision.

The distinction between authorizing care and actually delivering it is central to the dispute. For families, an approval for nursing hours offers limited relief when those hours remain unfilled.

DOJ Changes Its Position; Court Directs Mediation

In June, DOJ’s Office of Legal Counsel issued an opinion rejecting the broader interpretation of an integration mandate under the ADA and Section 504 of the Rehabilitation Act. In July, DOJ announced that it would no longer rely on its longstanding Olmstead guidance in enforcement. Click here to read the DOJ opinion and here to read the Federal Register notice.

According to DRF, DOJ’s August 13 filings in the Florida case declined to defend protections for children living at home or in community settings who face a substantial risk of institutionalization. DOJ also asked the appeals court to vacate its opinion and return the case to the district court.

On September 15, the appeals court directed the parties to mediation and called for counsel representing at-risk children to be invited. DRF’s September update reported that rehearing proceedings were paused pending mediation and that the request to vacate was dismissed without prejudice, allowing it to be renewed. Click here to read DRF's case update.

DOJ’s changed position does not itself erase judicial decisions. Changes to the injunction require court action, and its operative requirements must be understood in light of applicable court orders and stays. The executive branch’s legal interpretation also does not bind courts or overturn Supreme Court precedent. Click here to read an American Bar Association analysis.

Potential Effects on Home Health Providers

For providers, the principal concern is whether the case will continue to support systemic accountability for gaps in home-based care. A narrower injunction or reduced federal enforcement could weaken a mechanism for addressing service delivery failures before children enter institutions.

That possibility does not itself change a child’s Medicaid eligibility, authorization, or an agency’s reimbursement rate. Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements remain a separate basis for coverage of appropriate, medically necessary Medicaid-coverable services for eligible children under age 21.

HCAF members report concerns involving both reductions in authorized nursing hours and difficulty staffing hours that have already been approved. Those problems should be documented separately: one concerns whether sufficient care is authorized, while the other concerns whether the delivery system can provide it.

Reimbursement and workforce capacity remain important provider concerns. The injunction identified increased reimbursement, managed care payment requirements, and stronger network adequacy standards among possible tools Florida could consider to improve nursing access. It did not mandate a particular rate increase.

Share Your Experience With HCAF Before Mediation

HCAF Executive Director Denise Bellville, RN, BS, and Senior Director of Policy, Advocacy & Communications Kyle Simon attended DRF’s October listening session and subsequently requested a meeting to contribute the home health provider perspective.

This outreach builds on HCAF’s longstanding advocacy, including its support for House Bill 391 in 2023 and Senate Bill 1156 in 2025, which created and strengthened Florida’s Family Home Health Aide for Medically Fragile Children (FHHA) Program. Family caregiver services offer additional support alongside the licensed nursing care children need. Click here to read HCAF's recent program update.

Providers are encouraged to contact HCAF before the early November mediation with examples involving:

• Reductions or denials of medically necessary PDN hours
• Authorized hours that remain unfilled despite documented staffing efforts
• Reimbursement barriers affecting nurse recruitment and retention
• Delayed hospital or nursing facility discharges because home nursing is unavailable
• Care coordination difficulties and the effects of service gaps on families

Please distinguish the hours requested, authorized, and actually delivered, and explain the steps taken to resolve the issue.

To share input, contact Kyle Simon, HCAF’s Senior Director of Policy, Advocacy & Communications, at ksimon@homecarefla.org, (850) 222-8967, or (202) 830-4080. Please omit patient-identifying information from initial correspondence.

Providers’ experiences can help HCAF explain what families and agencies need to make care at home reliably available to medically fragile children.