Does Florida Medicaid cover Pediatric Private Duty Nursing (PDN)?

Yes - Florida Medicaid can cover Pediatric Private Duty Nursing (PDN) when a child meets medical necessity and a physician orders skilled in-home RN/LPN care. Approved hours depend on diagnosis, stability, and the plan of care. Our team verifies benefits, manages prior authorization, and coordinates staffing so care can begin as soon as approvals and scheduling align.

Key Takeaways

• PDN = skilled nursing (RN/LPN) at home when medically necessary.

• Approval requires physician orders + documentation supporting need.

• We handle eligibility checks, authorizations, and nurse scheduling.

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What is PDN and who qualifies?

Pediatric Private Duty Nursing (PDN) provides clinically necessary, continuous nursing care from an RN or LPN in the home. Children with complex or fragile conditions—e.g., tracheostomy/ventilator, feeding tubes, seizures, or frequent monitoring—may qualify when skilled interventions are required beyond caregiver training.

• Physician establishes medical necessity.

• Plan determines coverage; documentation supports hour requests.

• Reassessments occur periodically or when the child’s condition changes.

How many hours are typically approved?

Hour approvals vary by condition, acuity, and safety risks. Plans may authorize day/night blocks or split schedules. Expect adjustments over time as the child stabilizes or needs shift.

• Common patterns: evenings/nights for monitoring; day hours for complex interventions.

• Hours can combine with therapies and Family Home Health Aide (FHHA) when appropriate.

Documents that speed up approvals

Having these ready reduces delays:

• MD orders and recent progress notes

• Current medication list & supply list

• Hospital discharge summary or specialty notes

• Plan of care with nursing tasks and goals

Check Medicaid Eligibility with a Care Coordinator

Start of care: realistic timeline

Once orders and authorization are approved, we move to staffing and orientation. Many families begin care within 24–72 hours post-approval, depending on nurse availability, competencies, and schedule preferences.

FAQs

• Which diagnoses commonly qualify for PDN?

  Conditions requiring ongoing skilled interventions—trach/vent, frequent suctioning, complex seizures, TPN/IV therapies, or intensive monitoring—often qualify when medically necessary.

• Can PDN hours be combined with school nursing or FHHA?

  Yes, depending on eligibility and plan rules. PDN may complement school-based services and FHHA for ADL support.

• How often are hours reviewed or changed?

  Plans revisit hours on a schedule (e.g., 60–180 days) or if the child’s status changes. We assist with updated documentation.

• What happens if authorization is denied?

  We review denial reasons, provide missing documents, and coordinate an appeal or resubmission with your physician.

• How quickly can services start after approval?

  With orders and authorization in place, many families start within 24–72 hours, subject to nurse matching and scheduling.