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Committee hears agency and family testimony on private duty nursing shortages and paid family-caregiver models

House Healthcare and Wellness Committee · February 4, 2026
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Summary

State agencies and family members told the House Healthcare and Wellness Committee that private duty nursing hours are often unfilled, parents commonly provide unpaid coverage, and other states (Montana, Massachusetts) use paid family-caregiver models (PCCA/CCA) with supervision and wage rules as partial solutions.

The House Healthcare and Wellness Committee heard a work session on private duty nursing (PDN) under the Medically Intensive Children's Program (MICP), receiving presentations from the Washington State Health Care Authority (HCA) and the Department of Social and Health Services (DSHS), and testimony from providers and family caregivers. Agencies and families described persistent staffing shortages, gaps between authorized and provided hours, and models other states use to compensate trained family members.

Heather Zager of the Washington State Health Care Authority summarized program structure: MICP serves children with complex medical needs through managed care organizations and a fee-for-service route administered by DSHS/DDCS; HCA provides program oversight and MCOs review prior authorizations using a standardized tool to determine medical necessity and hours. Zager said approved PDN hours range from four to 16 per day, and HCA estimated roughly 270 children receive MICP benefits across fee-for-service and…

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