Florida Medicaid covers several ways for a medically fragile child to get skilled care outside a hospital, and the names alone can be confusing: PPEC, PDN, FHHA. They are not three versions of the same thing. Each one is a different kind of care, delivered in a different place, by a different person, and they can often work together. This guide compares them side by side so you can walk into conversations with your child's doctor and health plan knowing what to ask about.
| Private Duty Nursing (PDN) | Family Home Health Aide (FHHA) | PPEC | |
|---|---|---|---|
| Who provides care | A licensed nurse (RN or LPN) employed by a home health agency | A trained family member or caretaker relative employed by a home health agency | Nurses and staff at a licensed pediatric center |
| Where | Your home or the community | Your home | A non-residential center |
| Maximum hours | Up to 24 hours per day may be reimbursed | Up to 12 hours per day, no more than 40 hours per week | Up to 12 hours per day |
| Age | Under 21 | Under 21 | Birth through age 20 |
| Key requirement | Physician order; needs more extensive, continual care than a home health visit | Child must also be eligible for PDN/require skilled nursing care; physician order for FHHA | Medically complex and medically stable; prior authorization |
1. Private Duty Nursing (PDN)
PDN is skilled, hands-on nursing for a child whose condition requires more continual care than a periodic home health visit can provide, such as help with a ventilator, tracheostomy care, or complex medication or seizure management. To qualify, a child must be under 21, be under a physician's care with a PDN order in the plan of care, and require care that can be provided safely at home or in the community. Florida Medicaid may reimburse up to 24 hours of PDN per day, though the hours actually authorized for your child depend on medical necessity. For a deeper look at what skilled nursing offers, see our post on the value of skilled nursing for medically fragile children.
2. The Family Home Health Aide (FHHA) Program
FHHA lets an eligible family member become a trained, paid caregiver for a medically fragile child at home. The child must be under 21, eligible for PDN services, and have a physician order for PDN in their plan of care. The family member is employed by a home health agency, completes the required training (see our Glitch Bill update for the current training requirements), and is supervised by a registered nurse. For the legislative background, see our post on HB 391.
Two rules trip up families. First, FHHA hours are capped at 12 per day. Second, FHHA and PDN can both be authorized, but they cannot be provided at the same time, and FHHA is intended to offset authorized PDN hours rather than add to them. For the full story on how paid family caregiving works, see our guide on how to get paid for taking care of your child in Florida.
3. Prescribed Pediatric Extended Care (PPEC)
PPEC centers are licensed, non-residential medical daycare facilities where medically complex children from birth through age 20 receive continual medical care, with up to 12 hours a day of nursing, personal care, developmental therapies, and caregiver training. To qualify, a child needs complex medical needs and must be medically stable. PPEC services require prior authorization. PPEC works well for families who want skilled care plus a structured, social setting outside the home, or who need daytime coverage so a parent can work.
4. How the Options Fit Together
This is rarely an either-or choice. Many families use PDN for skilled care at home, and some add FHHA so a parent can be paid for part of the authorized care, or use PPEC for daytime hours. What gets authorized depends on medical necessity as determined through your child's plan of care and your Medicaid health plan. If you're considering combining services, ask your plan how hours are counted, since the same hour of the day generally can't be covered by two services at once. If you're lining these up before a hospital discharge, our NICU discharge checklist walks through what to arrange and when.
5. Who Decides What Your Child Qualifies For?
It starts with your child's physician, who writes the orders that go into the plan of care. A Medicaid health plan then reviews requests for medical necessity. Children under 21 are covered by Medicaid's EPSDT benefit, which is why age 21 matters so much. If your child is enrolled in the CMS Plan, see our post on the CMS Plan transition to Molina.
6. Questions to Ask Your Care Team
Ask your child's physician and health plan: Which of these services support my child's condition? How many hours are likely to be authorized? How do PDN and FHHA hours work together in our case? Is a PPEC center available near us, and does my child meet the criteria? Which agency can staff the care we need? Our guide to choosing a pediatric home health agency has a full list of questions for agencies.
Find Out What Your Child May Qualify For
Home Heart Florida provides private duty nursing and FHHA family caregiving for children across Florida. Learn more about our Private Duty Nursing and Family Caregiving (FHHA) services, call 844-721-1433, or fill out our Caregiver Inquiry Form to see if your child is eligible for FHHA/PDN services.
Clinically reviewed by Christina Viamontes, MSN, RN
Sources
Florida Agency for Health Care Administration, Private Duty Nursing Services
Florida Agency for Health Care Administration, PDN and FHHA Frequently Asked Questions (PDF)
Florida Agency for Health Care Administration, Prescribed Pediatric Extended Care (PPEC)
Florida Statutes, Section 400.4765, Home Health Aide for Medically Fragile Children Program
Disclaimer
This article is for general informational and educational purposes only and is not intended as medical, legal, or professional advice. It does not replace consultation with your child's physician, care team, or other qualified healthcare provider, and reading it does not create a provider-patient relationship with Home Heart Florida. Always follow the specific instructions and care plan provided by your child's medical team, and consult your child's doctor with any questions about your child's individual condition.