Private Duty Nursing (PDN)

Case Status: In Progress

Initiated: March 2024

Main Concern

Medicaid recipients under age 21 not receiving adequate access to medically necessary community-based  PDN services.

Summary

Michigan’s Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Private Duty Nursing service provides life-sustaining nursing care to individuals under 21. Until late last year, Michigan imposed a cap of sixteen hours of PDN per day and required family caregivers to provide at least eight hours of skilled nursing care per day. Many recipients were consequently unable to receive sufficient medically necessary PDN, resulting in increased hospitalizations and medical complications.

As a result of advocacy and threatened litigation during the summer of 2025, the Michigan Department of Health & Human Services (“MDHHS”) committed to removing the caps and eight-hour caregiving requirement. New statewide policies formalizing the changes took effect on November 1, 2025, and the medical necessity of each PDN request is now evaluated on an individual basis as required by federal law. MDHHS also appears to have begun providing notice of hearing rights when requests for increased authorizations are denied (DRM continues to monitor this issue).

DRM continues to help other recipients receive increased authorizations under the new policies, and it continues to work with Michigan’s primary nursing agencies to help recipients request and maintain sufficient PDN authorizations. DRM’s investigation into additional PDN issues (including restrictive eligibility criteria) continues.

Outcome

Recipients are more able to receive medically necessary PDN based on individual need.

Bulletin: Michigan Medicaid Policy (Distributed to Private Duty Nursing Providers)