Program Purpose and Goals

This program allows family caregivers to:

• Become employed by licensed home health agencies
• Provide delegated home health aide services
• Support medically fragile children receiving Medicaid PDN services

This program is intended to:

• Expand access to care for medically fragile children
• Help stabilize families facing nursing shortages
• Reduce unnecessary hospitalizations
• Reduce institutionalization
• Improve continuity of care in the home
• Supplement authorized PDN services

Child Eligibility Requirements

To participate the child must:

• Be under age 21
• Be medically fragile
• Be eligible for Medicaid
• Be receiving Medicaid PDN services

This program specifically targets high-acuity pediatric Medicaid recipients, children requiring substantial home-based nursing support.

Family Caregiver Eligibility

Eligible caregivers include:

• Family members
• Legal guardians
• Caretaker relatives

Participants must:

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

Training Requirements Overview

AHCA has finalized the Medicaid Family Home Health Aide for Medically Fragile Children program minimum training requirements. They were filed on 5/11/26 and made effective on 5/31/26. They were originally created through HB 391 in 2023, expanded and strengthened through SB 1156 in 2025, and then implemented through Rule 59A-8.0099, F.A.C.

The finalized rule requires:

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

Emphasis on:

• Pediatric safety
• Competency validation
• RN oversight
• Standardized statewide requirements

Caregivers must also complete a one-time HIV education within 30 days of employment and CPR certification.

The 20 Hours of Pediatric Medically Fragile Skills Training

Training must be:

• In person
• Tailored to the child’s individualized plan of care
• Conducted by qualified pediatric RN

The 16 Hours of Clinical Competency Validation

Requirements:

• Hands on validation
• Conducted with an actual patient
• Direct supervision by qualified pediatric RN
• In-person demonstration of all required skills

Caregivers must achieve 100% proficiency before independently providing services. Ongoing competency validation must occur within 90 days of training completion and renewed annually.

Any change in physician orders may require new delegation, additional competency review, and updated validation documentation.

Medication Administration Requirements

In addition to the standard 6 hours of medication administration training is required under Rule 59A-8.0097, caregivers must complete 4 additional hours of specialized pediatric medication administration training. 

Training includes administration involving:

• Enteral feeding tubes
• Crushed medications
• Rectal medications
• Subcutaneous injections
• Intradermal injections
• Intramuscular injections
• Inhaled medications administered through a tracheostomy

Medicaid Eligibility Development

CMS has approved State Plan Amendment FL-25-0011 effective 2/9/26. This allows Florida to disregard wages earned through the AMFC program, preventing caregiver income from negatively impacting Medicaid eligibility and protecting waiver participation eligibility. Despite federal approval, the income exclusion is not expected to become operational until the fall of 2026. DCF must still complete eligibility system updates, policy changes, and operational implementation. Providers and families should continue seeking individualized Medicaid eligibility guidance before relying on the income disregard. We are keeping an eye on this development and will inform you as soon as we receive any further updates.