Minnesota Proposed Compromise on In-Home Nursing Limits
State officials aim to extend daily care hours for patients affected by new insurer benefit caps.
Updated on Oct. 6, 2026 in Nursing Jobs
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Minnesota officials have proposed a compromise to address coverage limits for in-home nursing care that restricted patients to 120 visits annually. The plan would allow those 120 visits to span 24 hours each, shifting the administrative interpretation of how covered care is measured.
Why it matters
The change seeks to mitigate the impact of benefit adjustments implemented by insurers like Medica, which cited the need to align coverage with state dual-enrollment laws. This regulatory tension highlights the ongoing friction between private insurance administration and the medical requirements of families relying on consistent, long-term home nursing.
The proposal focuses on a cap of 120 nursing visits per year. Officials are evaluating whether these visits can be extended to cover 24-hour periods, a shift intended to maintain care levels for families previously capped under narrower insurer definitions.
The players
Medica
A health insurance provider that manages benefits by aligning with state laws and other insurance carriers.
Tim Walz
The Governor of Minnesota who directed state departments to find administrative solutions for health coverage gaps.
Minnesota Department of Commerce
A state agency responsible for overseeing insurance regulation and implementing administrative policy updates.
The details
Medica, which began notifying members of the new benefit administration rules in May 2025, implemented the changes in 2026 to synchronize its policies with state Medical Assistance requirements. Families have argued for protections based on a 2010 statute, prompting the Governor’s office to instruct the Department of Commerce to seek administrative solutions rather than legislative ones. The proposed adjustment shifts the definition of a visit, allowing for longer durations of care within the existing annual count.
Timeline
2010: Statute identified for potential coverage protection.
May 2025: Medica notified impacted members of benefit changes.
2026: Medica implemented changes to benefit administration.
Market Landscape
The proposed administrative adjustment marks a shift in how state regulators interpret the 2010 statute regarding nursing coverage protections. It follows a pattern of state-level intervention as insurance providers tighten administrative policies to meet complex dual-enrollment requirements.
Operators in the home health sector should monitor whether these administrative changes set a precedent for how 'visit' hours are audited by commercial payers. Review your agency’s billing protocols to ensure compliance if state regulators finalize the 24-hour definition for existing annual caps.
The takeaway
This dispute illustrates the critical need to align private benefit definitions with state-level administrative guidelines to avoid patient care gaps. Monitor the Minnesota Department of Commerce for formal updates on the 24-hour visit ruling, as this will define billing capacity for the coming fiscal year.
Further reading
For broader trends in industry staffing and coverage, visit Nursing Jobs.
Source note: This article includes information reported by CBS News.
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Should the state government require private insurers to provide unlimited in-home nursing care for children?
