The Family CNA Model: Supporting Families and Improving Care for Children With Medical Complexity

Children with medical complexity (CMC) represent less than 1% of all children in the U.S., but account for one third of pediatric health care costs. Many CMC depend on support such as in-home nursing and medical devices. Without this support, CMC are at higher risk for emergency room visits, hospitalization, and even institutionalization. Many families struggle to access in-home support because of issues such as cost barriers and home care workforce shortages. Family members frequently leave their jobs to provide home health care without compensation. 

Several state Medicaid programs have adopted the Family Certified Nursing Assistant (CNA) Model. This model trains and reimburses family members to provide home care for CMC that would otherwise be provided by a registered nurse (RN), a licensed practical nurse (LPN), or a non-family CNA. The goal of this model is to keep CMC in their homes and out of hospital or institutional settings, while supporting families’ financial security. The model also has cost-saving potential for states, helping to prevent avoidable or prolonged hospitalizations.  

This report outlines the case for adopting the Family CNA Model and provides policy tools for legislators and Medicaid officials to implement the model in their own states. Our Foundation reviewed, provided guidance, and connected the author team to additional reviewers.