The law does not require you, as a small employer, to provide medical coverage for your nanny. Under the Affordable Healthcare Act, an employer with 50 or fewer full time employees is not required to provide health coverage to its employees. Your nanny would be considered a full time employee but since you only employ one, you are exempt.The more practical question you should consider is whether you should use the Healthcare.gov marketplace to purchase medical coverage for your nanny. This option is worth investigating as employees who have medical coverage may be more likely to have routine medical checkups and be healthier than those without coverage. This is likely to ensure that you have the childcare coverage when needed and planned and that your kids are exposed to a healthy caregiver.