Who’s Paying for That Nurse? A Nassau County Family’s Guide to Covering Private Duty Nursing Costs

When a loved one comes home from the hospital with complex medical needs — or when a chronic condition requires skilled nursing care around the clock — the question families in Nassau County ask first isn’t always “who will help?” It’s “how will we pay for it?” Private duty nursing is a lifeline for many families, but navigating the payment landscape can feel overwhelming. The good news: there are more options than most people realize. This guide breaks down every major path to covering the cost of private duty nursing nassau county families depend on.

What Is Private Duty Nursing — and Who Needs It?

Private duty nursing (PDN) refers to specialized nursing services provided to patients in their homes, particularly for individuals who require more individual and continuous nursing care than a certified home health agency (CHHA) can offer. In typical scenarios, CHHAs provide care for less than two hours per service, making PDN essential for those needing more extensive assistance. Unlike other home care services that may include non-medical assistance such as bathing and household chores, PDN focuses exclusively on skilled nursing tasks.

For Nassau County residents managing conditions like COPD, cardiac disease, Parkinson’s, or recovering from major surgery, private duty nursing can be the difference between staying safely at home and entering a costly facility. Studies show PDN may be less expensive than a facility stay, costing up to half as much as a single hospital day.

Option 1: New York State Medicaid

Medicaid is one of the most significant sources of funding for private duty nursing in New York. Private duty nursing services are available for NYS Medicaid fee-for-service members who require continuous skilled nursing care in a non-institutional setting. Medicaid can pay for approved licensed personal care and home health care services for people financially eligible for Medicaid.

However, getting Medicaid to cover PDN requires following a specific process. The first step in the prior approval process is that the client’s physician, or a certified nurse practitioner, must provide a written order describing why private duty nursing services are medically necessary, including the client’s need for skilled services, frequency, whether RN or LPN services are recommended, and the number of hours of nursing services needed.

It’s also critical to understand the order in which payers are used. Under federal law, the Medicaid program is the payer of last resort. All third-party obligations must be exhausted before claims can be submitted to Medicaid, and it is the responsibility of the member (family) and provider to investigate and exhaust all other insurance sources first.

New York State’s Medicaid program covers private duty nursing in Nassau County, and as of April 1, 2022, the PDN Medically Fragile Children’s Program expanded to the Medically Fragile Children and Adult Program, broadening access to more individuals in need.

Option 2: Medicare

Many Nassau County residents assume Medicare will cover private duty nursing in the same way Medicaid does — but the rules are quite different. Clients enrolled in Medicare (often those age 65+ or persons with disabilities) may have portions of their nursing care paid through traditional Medicare or managed Medicare plans. However, this coverage is limited. Medicare will cover part-time skilled nursing care and physical, occupational, and speech therapy if you are homebound and meet medical necessity requirements, but Medicare typically does not cover 24-hour in-home care, custodial care, or transportation services.

In short, if your loved one needs continuous, around-the-clock skilled nursing at home, Medicare alone will likely not be enough. It is best used as a bridge or supplement alongside other payment sources.

Option 3: Private Health Insurance and Managed Care Organizations

Many families use their private health insurance or employer-sponsored coverage to pay for private duty nursing services. Coverage varies widely by plan, so it’s essential to contact your insurer directly to ask about home nursing benefits, prior authorization requirements, and any limits on hours or duration of care.

Managed Care Organizations (MCOs) may also provide coverage, requiring authorization through the appropriate MCO and adherence to the plan’s billing guidelines. If your loved one is enrolled in a Medicaid Managed Long Term Care (MLTC) plan, that plan may coordinate PDN benefits on their behalf.

Option 4: Long-Term Care Insurance

Long-term care insurance often provides coverage for private duty nursing, helping to alleviate financial burdens. A long-term care insurance policy pays for long-term care expenses and can help an individual protect their resources, expand care options, and maintain independence and financial control.

New York State even offers a special program to incentivize planning ahead. The New York State Partnership for Long-Term Care combines private long-term care insurance and Medicaid to help New Yorkers prepare for nursing home care or home care. This means that purchasing a qualifying long-term care policy can protect your assets while also giving you a pathway to Medicaid if your benefits run out.

The cost of care in New York makes this option worth serious consideration. In New York, just one year of care in a nursing home costs on average approximately $159,000 per person, and even receiving care at home costs an average of approximately $66,000 per person annually.

Option 5: Veterans Benefits

Eligible veterans can access specific benefits that may help with the costs of nursing care. Nassau County has a significant veteran population, and programs through the U.S. Department of Veterans Affairs — including the Aid and Attendance benefit — can help cover in-home skilled nursing for those who qualify. Families should contact the Nassau County Veterans Service Agency to explore eligibility.

Option 6: Out-of-Pocket and Private Pay

Some families may elect to pay privately for services if they do not meet insurance or program eligibility. While this provides the most flexibility in choosing a provider and scheduling care, it also carries the highest financial burden. Homeowners can also explore options such as reverse mortgages or selling property to secure funds for nursing services. Savings, retirement accounts, and family contributions are other common private-pay strategies.

Getting Started: What to Do First

• Talk to your physician. A doctor’s written order establishing medical necessity is the foundation of any PDN approval process, whether through Medicaid or private insurance.
• Review all your insurance coverage. Check Medicare, private health insurance, and any long-term care policies before assuming you must pay out of pocket.
• Apply for Medicaid if eligible. The New York State of Health Marketplace provides access to all insurance programs, including Medicaid, Child Health Plus, and private health plans.
• Consult a free counselor. New York State’s HIICAP program provides free, confidential, and unbiased health insurance information, with trained counselors who explain coverage, costs, and options for Medicare, Medicaid, and private insurance, including long-term care insurance.
• Choose an accredited provider. Work with a licensed, reputable agency that understands the full range of payment options available to Nassau County families.

How Axzons Home Care Can Help

Axzons Home Care provides professional, compassionate home care services across New York, New Jersey, Georgia, Alabama, Massachusetts, and Pennsylvania, specializing in delivering personalized, high-quality care directly to patients’ homes, ensuring comfort, safety, and support. Axzons is a NYS licensed homecare agency serving all 47 counties across New York, including Nassau, Suffolk, Queens, and Westchester.

Axzons is a licensed home care services agency that has earned The Gold Seal of Approval® from The Joint Commission® — a mark of excellence that gives families confidence in the quality and safety of care their loved ones receive. Their core values include innovation, excellence, compassion, respect, integrity, healing, teamwork, and leadership.

Axzons accepts all types of payments and insurances, making it easier for Nassau County families to access the care they need regardless of their financial situation. Their mission is to provide patients with compassionate and quality care that embraces dedication and professionalism of the highest standard, while pledging to honor all patients’ rights and work closely with their families to achieve the patient’s maximum functional independence in the home setting.

Paying for private duty nursing doesn’t have to be a solo journey. With the right information, the right agency, and the right support system, Nassau County families can find a path to skilled, compassionate care that fits both their medical needs and their budget.