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Home health aide program expanded; agencies await CMS approval while lawmakers press AHCA to help families who lost benefits
Summary
AHCA outlined implementation steps for the home health aide for medically fragile children program (SB1156): training hours were revised to 76 total, adverse-incident reporting within 48 hours was added, and AHCA has submitted a waiver amendment asking CMS to disregard program earnings for Medicaid eligibility; lawmakers raised that some families who enrolled early lost federal benefits and urged immediate outreach.
TALLAHASSEE — Agency for Health Care Administration officials told a House subcommittee on Nov. 6 that Florida's expanded home health aide program for medically fragile children is under active implementation but depends on federal approval for two policy components.
"As part of the bill, the agency was directed to pursue federal approval for two major components," Kim Smoak (Deputy Secretary for Health Quality Assurance, AHCA) said, identifying (1) an income disregard so earnings from the parental-care program do not count against Medicaid eligibility and (2) an expansion to include certain private-duty nursing specialties. AHCA submitted an 1115 waiver amendment in August and awaited final CMS approval following the federal public-comment period.
Smoak described program data collection and reporting requirements: AHCA reviewed encounter and managed-care data for the period Oct. 1, 2024–Sept. 30, 2025; about 300 recipients currently seek services; 199 licensed home health agencies reported participation (of roughly 2,728 statewide). SB1156 also added adverse-incident reporting for the program; AHCA must receive reports from home health agencies and managed-care plans within 48 hours for incidents including death, brain or spinal-cord injury, permanent disfigurement, fractures, or other serious events.
Training requirements were revised: total training was reduced to 76 hours composed of 40 hours of basic personal-care training, 20 hours of advanced nursing skills (reduced from 30), and 16 hours of on-site clinical competency validation supervised by an RN; an additional separate 10 hours is required before a caregiver administers medication.
Committee members raised immediate implementation problems. Representative Bartleman said she had been told that 10 families in Broward County lost federal benefits after enrolling early and being paid under the program; she urged AHCA to contact affected home health agencies, send plain-language notices to families and do proactive outreach. "These are people's lives we're messing with," Bartleman said.
AHCA officials acknowledged the concern, said some families had been affected before the eligibility fix was enacted (Representative Bartleman and others referenced a later legislative fix) and offered to work with legislators to identify affected households and coordinate outreach with the Department of Children and Families and health plans. Brian Meyer (AHCA deputy secretary for Medicaid) said DCF handles eligibility redeterminations and that AHCA and Medicaid will assist with targeted outreach and remediation where possible.
AHCA also described system and rule changes: modifications to the agency's adverse-incident reporting system (AIRS) are underway, with testing expected after build completion and a target to have the system updates and rule alignment in place early in the calendar year. AHCA said it had conducted multiple provider trainings in 2025 and will continue stakeholder engagement as it finalizes rules.
Lawmakers asked for written updates to the committee on how AHCA will prevent further eligibility losses and to confirm whether the program's $25-per-hour cap applies to family caregivers and how managed-care plan reimbursements will operate. AHCA pledged follow-up and to provide committee staff with specific outreach plans and status updates.
