Does FHHA Replace Private Duty Nursing in Florida?
Does FHHA Replace Private Duty Nursing in Florida?
Families often ask this when they are considering Florida's Family Home Health Aide program for a medically fragile child who already receives Private Duty Nursing. FHHA and PDN are connected, but they are different services with different roles in the child's care plan.
Does FHHA replace Private Duty Nursing?
No. FHHA does not turn family caregiving into Private Duty Nursing or replace the child's need for skilled nursing. However, approved FHHA services do affect the child's PDN schedule. Florida law requires services provided by a home health aide for medically fragile children to reduce the child's Private Duty Nursing service hours, and FHHA cannot be provided at the same time as PDN.
Private Duty Nursing is skilled nursing provided by a licensed RN or LPN. FHHA may allow an eligible and trained family caregiver to provide approved aide services through a participating home health agency. The mix of FHHA and PDN depends on the child's medical needs, physician orders, approved plan of care, payer requirements and authorization.
What Florida's Current Rules Say About FHHA and PDN
Florida Rule 59G-4.261, effective July 2, 2026, incorporates the February 2026 Florida Medicaid Private Duty Nursing and Family Home Health Aide Services Coverage Policy.
Florida Statute 400.4765 also addresses how services provided by a home health aide for medically fragile children affect Private Duty Nursing. The law requires those aide services to reduce the child's PDN service hours and does not allow FHHA and PDN services to occur at the same time.
FHHA vs. Private Duty Nursing: What's the Difference?
The simplest difference is who provides the care and what type of service is being provided. Private Duty Nursing is skilled nursing. FHHA is an aide service provided by an eligible family caregiver who meets program requirements and works through a participating home health agency.
| Care Question | Private Duty Nursing | Family Home Health Aide |
|---|---|---|
| Who provides the care? | A licensed RN or LPN who is qualified for the child's nursing needs. | An eligible family caregiver who completes required training and meets program requirements through a participating home health agency. |
| What type of service is it? | Skilled nursing care. | Approved home health aide services under the child's care plan. |
| Does the child need PDN first? | PDN eligibility is determined under the applicable Medicaid coverage requirements. | The child must already be receiving Private Duty Nursing before FHHA services can be considered under the Medicaid benefit. |
| Can they happen at the same time? | PDN may be scheduled according to the approved nursing plan. | No. FHHA cannot be provided during the same time period as PDN. |
| Does FHHA affect PDN hours? | PDN hours are authorized according to applicable medical necessity and coverage requirements. | Yes. Florida law requires FHHA services to reduce PDN service hours. |
| Who coordinates care? | Nursing services follow the child's physician orders, plan of care, authorization and applicable agency requirements. | FHHA services are provided through a participating home health agency and coordinated with the child's approved care plan. |
How FHHA and PDN Hours Work Together
FHHA should not be viewed as extra hours added on top of an unchanged Private Duty Nursing schedule. When FHHA is approved, the child's schedule must account for the fact that FHHA and PDN cannot be provided at the same time.
The child's nursing needs are identified
The child's medical condition, physician orders, required nursing care and existing Private Duty Nursing plan provide the starting point for the care schedule.
FHHA eligibility is reviewed
The child and family caregiver must meet the requirements of the FHHA benefit, including applicable physician order, training, background screening, agency and payer requirements.
The services are scheduled separately
FHHA hours and Private Duty Nursing hours cannot overlap. The approved schedule has to show which service is being provided during each period of care.
The care plan is followed
The final mix of services depends on the child's approved plan of care, authorization, medical need, payer requirements and the services the trained family caregiver is permitted to provide.
Does a Child Need Private Duty Nursing Before FHHA?
Yes. Under Florida Medicaid's current FHHA criteria, the child must be under 21 and receiving Private Duty Nursing. The child must also be under the care of a physician, and FHHA must be ordered as part of the applicable plan of care.
Meeting those basic conditions does not mean FHHA approval or payment is automatic. The child, family caregiver, home health agency and requested services must meet the requirements that apply to the benefit.
Child must be under 21
FHHA is a pediatric Medicaid benefit for eligible medically fragile children.
Child must be receiving PDN
FHHA is tied to the child's existing Private Duty Nursing benefit rather than operating as an unrelated home care service.
Physician involvement is required
The child must be under physician care, and the applicable services must be reflected in the plan of care.
Family caregiver requirements apply
The family caregiver must meet program requirements, including required training and background screening.
Agency participation matters
FHHA services are provided through a participating home health agency that meets applicable program requirements.
Authorization still matters
Training alone does not guarantee that FHHA services or a particular number of hours will be approved.
Can an FHHA Provide Skilled Nursing?
FHHA and Private Duty Nursing are not interchangeable. An RN or LPN provides skilled nursing within the nurse's professional scope and the child's nursing plan. An FHHA provides the services permitted under the FHHA program, the caregiver's training and the child's approved plan of care.
Families should ask the home health agency exactly which tasks are included in the FHHA portion of the care plan and which needs still require a licensed nurse.
Learn more about pediatric Private Duty Nursing and the Family Home Health Aide Program in Florida .
Questions Parents Should Ask Before Applying for FHHA
Families should understand how the child's schedule may change before beginning the FHHA process.
FHHA and Private Duty Nursing FAQs
These are some of the most common questions families have when comparing FHHA with pediatric Private Duty Nursing in Florida.
Does FHHA replace Private Duty Nursing?
No. FHHA is not the same as Private Duty Nursing and does not turn a family caregiver into an RN or LPN. However, approved FHHA services reduce the child's PDN service hours and cannot be provided during the same hours as PDN.
Does FHHA reduce my child's PDN hours?
Yes. Florida law requires services provided by a home health aide for medically fragile children to reduce the child's Private Duty Nursing service hours.
Can FHHA and PDN be provided at the same time?
No. FHHA and Private Duty Nursing cannot be provided during the same time period. The services must be scheduled separately under the child's approved care plan.
Does my child need PDN before FHHA?
Yes. Under the current Florida Medicaid criteria, the child must be under 21 and receiving Private Duty Nursing before FHHA services can be considered.
Can an FHHA perform the same work as a private duty nurse?
No. FHHA and Private Duty Nursing have different roles. A licensed RN or LPN provides skilled nursing. An FHHA provides services permitted under the FHHA program, the caregiver's training and the child's approved plan of care.
Who can become an FHHA in Florida?
Florida law allows an eligible family caregiver who meets the program requirements to complete approved training and, when all requirements are met, work through a participating home health agency as a home health aide for a medically fragile child.
Who decides how FHHA and PDN hours are scheduled?
The schedule depends on the child's physician orders, medical needs, approved plan of care, authorization, payer requirements and agency coordination. FHHA and PDN cannot overlap.
Can a parent be paid through FHHA?
An eligible family caregiver may be employed through a participating home health agency after meeting the applicable FHHA requirements. Eligibility, training, approval, employment and payment are not automatic.
Does FHHA change my child's Medicaid eligibility?
FHHA is a Medicaid home health benefit with its own eligibility and authorization requirements. Families should review their child's individual Medicaid or managed care plan requirements before making care schedule decisions.
Can my child still receive care from a private duty nurse if I become an FHHA?
A child may have both FHHA and Private Duty Nursing in the approved care plan, but the services cannot be delivered during the same hours. The final schedule depends on the child's approved plan of care and authorization.
Related FHHA and Pediatric Nursing Resources
Sources and current Florida guidance
- Florida Agency for Health Care Administration: Private Duty Nursing and Family Home Health Aide Services
- Florida Administrative Code Rule 59G-4.261
- Florida Medicaid Private Duty Nursing and Family Home Health Aide Services Coverage Policy, February 2026
- Florida Statute 400.4765: Home Health Aide for Medically Fragile Children Program
This page is for general educational purposes and does not determine Medicaid eligibility, authorization, approved hours or an individual child's plan of care. Coverage and service schedules depend on the child's medical needs, physician orders, current Medicaid or managed care requirements, authorization and participating provider availability.
Dolores Fishbein, MSN, RN
Trying to Understand How FHHA Will Affect Your Child's Nursing Schedule?
Talk with Dynamiks Home Care about your child's current Private Duty Nursing, physician orders, Medicaid or managed care plan, family caregiver situation and the FHHA services you are considering.
