Medicaid Benefits: Online Database

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Benefits by Service: Private Duty Nursing Services (October 2006) Definition/Notes

Note: Totals include 50 states and D.C.

"Benefits Covered" Totals

"Benefits Not Covered" Totals

Is the benefit covered?

Is there a co-payment requirement?

Yes: 2

No: 22

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Alabama
No
Alaska
No
Arizona
Yes		Yes		Fee for service	CN & MN
Arkansas
Yes		Yes	Limited to ventilator dependent beneficiaries and those with functioning tracheostomy requiring suctioning and oxygen supplementation, $80 maximum payment for medical supplies/month	Fee for service	CN & MN
California
No
Colorado
Yes		Yes	Limited to technology-dependent beneficiaries,16 hours/day	Fee for service	CN
Connecticut
No
Delaware
Yes		Yes	28 hours/week	Fee for service with capped payment/week	CN
District of Columbia
Yes		Yes		Fee for service using Medicare limits	CN & MN
Florida
No
Georgia
No
Hawaii
No
Idaho
No
Illinois
No
Indiana
Yes		Yes	Limited to ventilator dependent beneficiaries only	Fee for service	CN
Iowa
No
Kansas
No
Kentucky
No
Louisiana
No
Maine
Yes	$.50-$3/day, depending on payment, up to $50/month	Yes	Beneficiaries must meet specified level of care criteria	Fee for service with annual payment ceiling based on LOC	CN & MN
Maryland
No
Massachusetts
Yes		Yes	112 hours/week	Fee for service	CN & MN
Michigan
No
Minnesota
Yes		Yes		Fee for service	A - See state-specific FN
Mississippi
No
Missouri
No
Montana
Yes		Yes		Fee for service	A - See state-specific FN
Nebraska
Yes				Fee for service	CN & MN
Nevada
Yes		Yes	Approved hours of care dependent on medical necessity	Fee for service	CN
New Hampshire
Yes		Yes		Fee for service	CN & MN
New Jersey
No
New Mexico
No
New York
Yes		Yes	Limited to situations where home health agency care is not available or not cost effective	Fee for service	CN & MN
North Carolina
Yes		Yes	Not covered during same hours as home health or personal care	Fee for service	CN & MN
North Dakota
Yes				Fee for service	CN & MN
Ohio
Yes		Yes		Fee for service	CN
Oklahoma
No
Oregon
Yes		Yes		Fee for service	A - See state-specific FN
Pennsylvania
No
Rhode Island
No
South Carolina
No
South Dakota
Yes		Yes		Fee for service	CN
Tennessee
Yes					A & B - See state-specific FN
Texas
No
Utah
Yes			Limited to ventilator dependent beneficiaries only	Fee for service	A - See state-specific FN
Vermont
Yes			Limited to technology-dependent beneficiaries	Fee for service	A - See state-specific FN
Virginia
No
Washington
Yes			Must meet specified medical need criteria	Fee for service	CN & MN
West Virginia
No
Wisconsin
Yes	$.50/hour up to $2/day	Yes		2-tiered hourly rate based on level of care (RN or LPN)	CN & MN
Wyoming
No
American Samoa
Yes			Limited to post-hospital care only		See territory-specific FN
Guam
No
Northern Mariana Islands
No
Puerto Rico
No
Virgin Islands
No

Definition/Notes: Link to Private Duty Nursing Services Footnote


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