Purpose: The purpose of this study was to investigate how the amount of home language use between the primary caregiver and bilingual Spanish- and English-speaking children with hearing loss who use cochlear implants (CIs) versus their bilingual age-matched peers with normal hearing (NH) can impact speech outcomes in the home language. Method: Thirty-four bilingual Spanish- and English-speaking children (17 CI users and 17 with NH) between the ages of 5;3 and 7;9 (years;months) participated in this study. Independent variables were the amount of home language use with the primary caregiver and hearing status, and dependent variables were vowels and consonants correctly produced and occurrence of selected phonological processes. The amount of home language use was ascertained from surveys, and the dependent measures were based on a single-word picture elicitation task. Bilingual children with CIs who are exposed to Spanish for more than 80% of the time via their primary caregiver performed better on Spanish segmental accuracy measures than those who are exposed to Spanish from only 20% to 50% of the time, specifically on vowels (partial [eta-squared] = 0.31) and consonants (partial [eta-squared] = 0.025). Children with NH outperformed children with CIs on all accuracy measures in Spanish. Conclusions: Preliminary results suggest the importance of language exposure through interactions with the primary caregiver for speech development in bilingual children. Future studies should investigate strategies to facilitate home language development in bilingual children with CIs, enabling them to reach their full potential.