Navigating the healthcare system for a child with complex medical needs can feel overwhelming. If you’ve heard about Prescribed Pediatric Extended Care (PPEC) and wonder whether your child qualifies, you’re in the right place. This comprehensive guide walks you through every step of the PPEC qualification and enrollment process in Florida.
Quick Answer: PPEC Eligibility Requirements
Your child may qualify for PPEC services in Florida if they meet ALL of these criteria:
✅ Age: Birth through 20 years old
✅ Medical Need: Require skilled nursing care due to a medically complex condition
✅ Insurance: Have Florida Medicaid or qualifying private insurance
✅ Physician Prescription: Doctor prescribes PPEC services as medically necessary
✅ Residency: Live in Florida (or receive care at a Florida PPEC)
The good news? If your child meets these requirements, PPEC services are fully covered by Medicaid with zero out-of-pocket costs to your family.
Understanding the Four Key Qualification Criteria
1. Age Requirements for PPEC
Florida PPEC centers serve children from birth through age 20. This wide age range reflects the understanding that medically complex children may need specialized care throughout their developmental years.
Infants and Toddlers (0-3 years): Many babies who were born prematurely or with congenital conditions qualify for PPEC. Early intervention combined with medical supervision can significantly improve outcomes.
Preschool and School-Age Children (3-12 years): Children in this age group benefit from the combination of medical care, therapy services, and socialization that PPEC provides. Many attend PPEC before or after school, or full-time if their medical needs require it.
Teenagers and Young Adults (13-20 years): Older youth with ongoing medical needs continue to benefit from PPEC services, including preparation for transition to adult services when they turn 21.
2. Medical Necessity: What Conditions Qualify?
The most important qualification factor is medical necessity. Your child must require skilled nursing care on an ongoing basis due to a medically complex condition.
Common Qualifying Conditions
Respiratory Conditions:
- Tracheostomy requiring frequent suctioning
- Ventilator dependence or BiPAP use
- Chronic lung disease (bronchopulmonary dysplasia)
- Oxygen therapy needs
- Apnea requiring monitoring
- Cystic fibrosis with complex care needs
Neurological Conditions:
- Cerebral palsy with medical complications
- Seizure disorders requiring frequent medication or monitoring
- Brain injuries or trauma
- Hydrocephalus with shunt
- Spina bifida with medical needs
- Progressive neurological conditions
Feeding and Nutritional Support:
- Gastrostomy tube (G-tube) feedings
- Jejunostomy tube (J-tube) needs
- Nasogastric tube (NG-tube) feedings
- Total parenteral nutrition (TPN)
- Severe feeding difficulties requiring skilled intervention
- Swallowing disorders with aspiration risk
Cardiac Conditions:
- Congenital heart defects requiring monitoring
- Heart failure needing medication management
- Arrhythmias requiring observation
- Post-surgical cardiac care
Genetic and Chromosomal Disorders:
- Down syndrome with complex medical needs
- Rare genetic syndromes
- Metabolic disorders
- Muscular dystrophy
Prematurity-Related Complications:
- Extreme prematurity with ongoing medical needs
- Failure to thrive requiring intervention
- Developmental delays with medical complexity
- Chronic conditions stemming from premature birth
Technology Dependence:
- Multiple medications throughout the day
- Medical equipment requiring nursing supervision
- IV medications or treatments
- Complex wound care
- Urinary catheterization
What “Skilled Nursing Care” Means
Skilled nursing care refers to medical services that can only be performed by or under the supervision of licensed nurses. This includes:
- Administering medications via multiple routes (oral, IV, inhaled, etc.)
- Managing medical equipment (ventilators, oxygen, suction machines)
- Performing tracheostomy care and suctioning
- Providing gastrostomy tube feedings and care
- Monitoring vital signs and responding to changes
- Assessing medical status and recognizing complications
- Providing complex wound care
- Managing seizures and administering rescue medications
- Implementing physician-ordered treatment plans
Important Note: The specific diagnosis matters less than the level of care required. A child with a “less severe” condition requiring constant medical supervision may qualify, while a child with a serious diagnosis who is medically stable may not need PPEC-level care.
3. Insurance Coverage: Medicaid and Private Insurance
Florida Medicaid Coverage
The majority of children in PPEC are covered by Florida Medicaid. PPEC is a covered benefit under Florida’s Medicaid program for children who meet medical necessity criteria.
Medicaid Eligibility for Children in Florida:
Florida Medicaid covers children based on age and family income:
- Infants (under 1 year): Families with income up to 211% of the federal poverty level (FPL)
- Children ages 1-5: Families with income up to 140-143% of FPL
- Children ages 6-18: Families with income up to 133% of FPL
- Children ages 19-20: More limited eligibility
Special Note: Many children with complex medical needs qualify for Medicaid regardless of family income through:
- SSI (Supplemental Security Income): Children receiving SSI automatically qualify for Medicaid
- Katie Beckett Waiver: Allows children with disabilities to qualify for Medicaid based on the child’s income alone, not family income
- Institutional Care Program (ICP): For children who would otherwise require institutional care
Don’t assume your child won’t qualify! Many middle-income families are surprised to learn their child is eligible for Medicaid due to their medical condition.
Applying for Florida Medicaid
If your child doesn’t currently have Medicaid:
- Apply Online: Visit ACCESS Florida to complete an application
- Call: Contact the Department of Children and Families at 1-866-762-2237
- In Person: Visit your local DCF office for assistance with the application
Required Documentation:
- Child’s birth certificate
- Social Security numbers for all household members
- Proof of income (pay stubs, tax returns)
- Medical documentation of your child’s condition
- Proof of Florida residency
Processing Time: Medicaid applications typically take 30-45 days to process. In urgent situations, expedited processing may be available.
Private Insurance Coverage
Some private insurance plans cover PPEC services, though it’s less common than Medicaid coverage. If your child has private insurance:
- Check Your Policy: Review your plan’s coverage for “medical daycare” or “pediatric day health” services
- Contact Your Insurance: Call the customer service number to ask specifically about PPEC coverage
- Request Prior Authorization: Most private insurance requires prior authorization before PPEC services begin
- Work with the PPEC Center: Amazing Kids PPEC can help verify your insurance benefits and assist with the authorization process
Dual Coverage: If your child has both Medicaid and private insurance, the private insurance is typically billed first, with Medicaid covering any remaining costs.
4. Physician Prescription and Medical Documentation
PPEC services require a prescription from your child’s physician. This isn’t like a medication prescription—it’s a comprehensive order for PPEC care that includes:
What the Physician Must Document:
- Medical Diagnosis: Your child’s specific condition(s)
- Medical Necessity: Why your child needs PPEC-level care
- Services Required: Specific nursing tasks, medications, treatments
- Frequency and Duration: How many days per week and hours per day
- Therapy Needs: PT, OT, speech therapy if appropriate
- Special Equipment: Ventilators, oxygen, feeding pumps, etc.
- Emergency Protocols: What to do in case of specific medical events
Which Physicians Can Prescribe PPEC?
- Pediatrician (most common)
- Pediatric specialist (neurologist, pulmonologist, etc.)
- Family medicine physician
- Nurse practitioner or physician assistant in some cases
Your child’s doctor must have personally examined your child and determined that PPEC services are medically necessary and appropriate.
Creating the Plan of Care (POC)
Once your physician prescribes PPEC, the PPEC center works with your doctor to create a detailed Plan of Care (POC). This document includes:
- All medical orders and nursing care instructions
- Medication schedule with exact dosages and times
- Feeding schedule and instructions
- Therapy goals and schedules
- Emergency contact information
- Parent/guardian preferences and concerns
- Individualized activity plans
The POC is reviewed and updated regularly (typically every 6-12 months) or whenever your child’s needs change.
The Step-by-Step PPEC Enrollment Process
Now that you understand the qualification criteria, here’s exactly how to enroll your child in PPEC services:
Step 1: Talk to Your Child’s Doctor
Schedule an appointment with your child’s pediatrician or specialist to discuss PPEC. Come prepared:
Questions to Ask:
- Does my child’s condition qualify them for PPEC?
- Would PPEC be beneficial for my child’s development and medical management?
- Can you provide a prescription for PPEC services?
- How many days per week and hours per day would you recommend?
- What specific services does my child need?
Information to Provide:
- Your child’s complete medical history
- Current medications and treatments
- Recent hospitalizations or medical events
- Therapy services your child currently receives
- Your concerns about caring for your child at home
If your doctor agrees that PPEC is appropriate, they’ll provide a written prescription and the necessary medical documentation.
Step 2: Verify or Apply for Insurance Coverage
If your child has Medicaid:
- Confirm their Medicaid coverage is active
- Ensure the PPEC center accepts their specific Medicaid plan (most do)
If your child doesn’t have Medicaid:
- Apply through ACCESS Florida (online, phone, or in person)
- Consider SSI or Katie Beckett Waiver if standard Medicaid eligibility isn’t met
- Provide all required documentation to speed the process
If you have private insurance only:
- Contact your insurance company to verify PPEC coverage
- Request information about prior authorization requirements
- Get a list of in-network PPEC providers if applicable
Step 3: Contact Amazing Kids PPEC
Once you have your physician’s prescription, contact us:
Call: (561) 355-8593
Visit: 11917 Southern Blvd, Suite 100, Royal Palm Beach, FL 33411
Email: Contact us through amazingkidsppec.com
During your initial call, we’ll:
- Discuss your child’s specific needs and medical condition
- Explain our services and daily schedule
- Answer your questions about PPEC
- Schedule a facility tour
- Begin gathering necessary information for enrollment
Step 4: Schedule and Complete a Facility Tour
Visiting Amazing Kids PPEC in person is an essential step. During your tour, you’ll:
- See our facility and meet our nursing staff
- Observe children engaged in activities
- Ask questions about daily routines and medical care
- Discuss your child’s specific needs and how we can meet them
- Review our safety protocols and emergency procedures
- Meet other parents (if available)
- Get a feel for whether our environment is right for your family
What to Bring to Your Tour:
- Your child (if possible, so they can see the environment)
- List of questions and concerns
- Your child’s current medication list
- Medical equipment information (types of pumps, oxygen requirements, etc.)
- Any special dietary needs or feeding instructions
Step 5: Complete Intake and Assessment
If you decide Amazing Kids PPEC is right for your family, we’ll begin the formal intake process:
Required Documentation:
- Physician’s PPEC prescription
- Complete medical history
- Current medication list with dosages
- Immunization records
- Emergency contact information
- Insurance information (Medicaid card or private insurance)
- Consent forms and enrollment paperwork
Assessment Components:
- Nursing assessment of your child’s medical status
- Review of care requirements and equipment needs
- Discussion of your child’s routine, preferences, and personality
- Therapy evaluations (if needed)
- Nutritional assessment
- Developmental assessment
This comprehensive assessment ensures we understand your child’s unique needs and can provide appropriate, individualized care.
Step 6: Prior Authorization (If Required)
For Florida Medicaid recipients, PPEC services require prior authorization from eQHealth Solutions, Florida’s Medicaid utilization management contractor.
The PPEC Center Handles This: Don’t worry—Amazing Kids PPEC submits the prior authorization request on your behalf. We’ll need:
- Your child’s Medicaid information
- Complete medical records from the physician
- The prescribed Plan of Care
- Any recent hospital discharge summaries
- Documentation of medical necessity
Authorization Timeline:
- Initial requests: Typically reviewed within 1-2 weeks
- Expedited requests: Available for urgent situations
- Continued stays: Must be renewed periodically (usually every 6-12 months)
We’ll keep you informed throughout the authorization process and let you know as soon as we receive approval.
Step 7: Create a Personalized Care Plan
Once authorized, our team works with you and your child’s physician to finalize a comprehensive care plan that includes:
Medical Care:
- Medication administration schedule
- Nursing procedures and monitoring
- Emergency protocols specific to your child
- Equipment management
- Communication plans with parents and physicians
Developmental Activities:
- Age-appropriate learning activities
- Socialization opportunities
- Therapy schedules (PT, OT, speech)
- Sensory experiences
- Play and recreation
Daily Routine:
- Arrival and departure procedures
- Meal and snack times
- Rest periods
- Activity schedule
- Parent communication methods
Step 8: Start Date and Transition
We’ll work with you to choose a start date that allows time for:
- Final paperwork completion
- Staff training on your child’s specific needs
- Delivery of any special equipment to the center
- Transportation arrangement (if needed)
Transition Tips:
- Start with shorter days initially if possible
- Bring comfort items from home
- Share photos of family members for security
- Communicate your child’s routine and preferences clearly
- Plan to stay for the first arrival if it helps your child (and you!)
First Week Expectations:
- Frequent communication from our staff
- Daily updates on how your child is adjusting
- Flexibility with schedule as needed
- Open door policy for parent visits
How Long Does the Entire Process Take?
Timeline Overview:
- Doctor Appointment: 1-2 weeks to schedule and complete
- Medicaid Application: 30-45 days if not currently enrolled
- PPEC Tour and Intake: 1-2 weeks
- Prior Authorization: 1-3 weeks for approval
- Start Date: Typically 4-8 weeks from initial inquiry
Total Time: Most families complete the process in 1-3 months. If your child already has Medicaid and medical documentation is readily available, it can be faster.
Expedited Process: In urgent situations (recent hospital discharge, parent returning to work, caregiver crisis), we can often expedite the process. Let us know if you’re facing time constraints.
Common Questions About PPEC Qualification
Q: My child has a serious condition but is medically stable. Will they still qualify?
A: Possibly. Even medically stable children may qualify if they require skilled nursing observation, medication administration, or ongoing monitoring that goes beyond what traditional daycare can provide. Discuss with your physician.
Q: We make too much money for Medicaid. Are there other options?
A: Children with disabilities may qualify for Medicaid through SSI or the Katie Beckett Waiver regardless of parental income. Also check your private insurance for PPEC coverage. We’re happy to help explore all options.
Q: Can my child attend PPEC part-time?
A: Yes! Children can attend anywhere from 2-5 days per week, and either partial days (up to 4 hours) or full days (5-12 hours), based on medical necessity and your physician’s prescription.
Q: What if we’re denied authorization?
A: You have the right to appeal. We’ll work with you and your physician to provide additional documentation and advocate for your child’s needs. Many denials are overturned on appeal with proper documentation.
Q: Does my child need to be potty trained?
A: No. We provide diapering and toileting assistance as part of our care services.
Q: Can siblings attend if only one qualifies for PPEC?
A: PPEC is specifically for children with qualifying medical conditions. Siblings without medical needs cannot attend. However, most parents find that the specialized care their medically complex child receives at PPEC allows more quality time with siblings at home.
Q: Will my child be with children who are healthier or sicker?
A: PPEC centers serve children with a range of medical conditions and abilities. We group children by age and developmental level when possible, and provide individualized care based on each child’s needs.
What Happens After Qualification?
Once your child is enrolled in PPEC, you can expect:
Ongoing Communication:
- Daily reports on your child’s activities, meals, and medical status
- Regular parent-teacher conferences
- Immediate contact for any medical concerns
- Collaboration with your child’s healthcare team
Continuous Assessment:
- Regular developmental evaluations
- Monitoring of medical status and progress
- Updates to the care plan as needs change
- Therapy progress reports
Family Support:
- Parent education and training
- Connection with other PPEC families
- Resources for additional community services
- Emotional support from our caring staff
Taking the Next Step
If you think your child might qualify for PPEC services, don’t wait to explore this option. The sooner you start the process, the sooner your child can benefit from the medical care, therapy services, and socialization that PPEC provides—and the sooner your family can experience the support and peace of mind that comes with professional care.
Ready to Find Out If Your Child Qualifies?
Contact Amazing Kids PPEC today:
- Call: (561) 355-8593
- Visit: 11917 Southern Blvd, Suite 100, Royal Palm Beach, FL 33411
- Website: amazingkidsppec.com
Our knowledgeable staff will answer your questions, help you understand the qualification process, and guide you through every step of enrollment. We’re here to support Palm Beach County families caring for children with complex medical needs.
Amazing Kids PPEC is proud to serve families throughout Royal Palm Beach, West Palm Beach, Wellington, and surrounding Palm Beach County communities. We accept Florida Medicaid and work with most private insurance plans. Our licensed PPEC center provides exceptional medical care in a nurturing environment where children can learn, play, and thrive.