How Much Does Medicaid Pay for Home Care Per Hour? Rates by State (2026)
What Medicaid pays home care agencies per hour for personal care, by state: how rates are set, 15-minute units, fee-for-service vs managed care, what caregivers actually earn from it, and the 80/20 rule. With a state table and a margin calculator.
By Caregiver Scheduling Team ·
Short answer. Medicaid pays home care agencies anywhere from the high teens to the mid $40s an hour for personal care, depending on the state and the program. The rate is paid per 15-minute unit (four units an hour), it goes to the agency rather than the caregiver, and in many states a managed-care plan negotiates it from the state fee schedule. Of each hour, the caregiver typically earns 55 to 70 percent in wages; the federal 80/20 rule is set to require 80 percent of the payment to reach direct care workers as compensation from July 2030.
If you are a family or an individual caregiver asking what you would be paid: see paid family caregiver programs by state, because the number is the caregiver wage, not the agency rate.
Medicaid personal care rates: six examples
Rates are for agency-delivered personal care (HCPCS T1019 or the state’s equivalent, S5125 in many waivers), shown per hour (unit rate × 4). Each figure comes from the state’s own rate document. The caregiver median wage nationally was $17.21 an hour in May 2025 (BLS).
| State | Program and service | Hourly equivalent | Effective |
|---|---|---|---|
| South Dakota | Personal care agency (T1019), $11.17 per 15 minutes (fee schedule) | $44.68 | July 1, 2026 |
| Washington | Home care agency provider, in-home personal care (proposed, SPA 25-0023) | $42.92 | July 1, 2025 |
| Illinois | Community Care Program in-home service (FY26 budget) | $30.80 | Jan 1, 2026 |
| Colorado | Personal care (T1019), outside Denver, $6.96 per 15 minutes (fee schedule) | $27.84 | Oct 1, 2025 |
| Minnesota | Personal care assistance, 1:1, $6.22 per 15 minutes (SPA) | $24.88 | Jan 1, 2026 |
| Texas | Primary Home Care and Community Attendant Services, non-priority (rate table) | $17.13 | Sept. 1, 2025 |
For other states, see home care rates by state and the county reports.
Run your own numbers for any row in the Medicaid hour margin calculator.
How the rate is set
Each state writes a fee schedule for its Medicaid state plan services and for each HCBS waiver. The personal care rate is usually built from a cost model: an assumed caregiver wage, a payroll-burden percentage, an allowance for supervision, administration and travel, and a margin. Legislatures then fund (or do not fund) the result. That is why rates move in steps, often on July 1 or January 1 with the state budget, and why a state whose minimum wage rose last year may still be paying a rate built on the old wage.
Three things change the published number before it reaches you:
- Managed care. In the states that deliver long-term services through managed care plans (about half of them), the plan contracts with you at a rate “no less than” (or, in some states, “approximately”) the fee schedule. Plans add value-based bonuses, EVV compliance incentives and, increasingly, differentials for nights, weekends and rural counties.
- Program. The same hour can carry a different rate under the state plan, a 1915(c) waiver, Community First Choice, a self-directed program or a managed LTSS plan. Check which program the authorization names.
- Rate add-ons. Some states pay enhanced rates for specific populations (ventilator-dependent, behavioral needs), for live-in arrangements, or temporarily (workforce stabilization payments). These appear as modifiers on the claim.
Fifteen-minute units
Nearly every state bills personal care in 15-minute units. A published rate of $6.25 per unit is $25.00 an hour. Visits are rounded per visit; many states use an 8-minute rule (8 to 22 minutes is one unit, 23 to 37 is two), and some truncate. Check your state’s billing manual. A 50-minute visit is 3 units under the 8-minute rule, not 3.33. The authorization tracker converts minutes to units and tracks what each client has left.
Fee-for-service vs managed care
| Topic | Fee-for-service | Managed care (MLTSS) |
|---|---|---|
| Who pays | State Medicaid agency | The member’s health plan |
| Rate | Published fee schedule | Contracted; usually at or near the fee schedule |
| Authorization | State or its case-management contractor | Plan care coordinator |
| EVV | State aggregator | Plan or state aggregator (varies) |
| Payment speed | Set by state prompt-pay law | Contract; often 30 days clean claims |
| Negotiation | None | Terms, differentials, add-ons |
What the caregiver earns from the hour
The agency rate is not the caregiver’s wage. From a $25 hour a typical agency pays a $16 to $18 wage, $2 to $3 in payroll taxes, workers’ compensation and leave, $1 to $2 in unbilled time (travel, no-shows, training), and $3 to $5 in office cost. What is left is the margin, and in many states it is under $2. The calculator shows this for any rate and wage.
Families sometimes ask why Medicaid “pays $25 an hour” while the caregiver “only” earns $17. That gap is the cost of running a licensed agency: supervision, scheduling, EVV, insurance, training and the hours nobody bills.
The 80/20 rule
CMS’s Ensuring Access to Medicaid Services rule requires that, by July 9, 2030, at least 80 percent of Medicaid payments for homemaker, home health aide and personal care services go to direct care worker compensation (wages, benefits and the employer share of payroll taxes). States may set earlier dates and hardship exemptions, and CMS has signaled it may revisit the requirement. At a $25 rate that is $20 in compensation per hour. Agencies in states with low rates and market wages near the rate will not get there without a rate increase, which is the argument state associations are making to legislatures now. Status and dates are on the federal rule tracker.
How to find your county’s rate
- Open your state’s Medicaid fee schedule (search “[state] Medicaid HCBS fee schedule T1019”), or the waiver rate sheet for the program on the authorization.
- Multiply the unit rate by four.
- If the member is in a managed-care plan, ask the plan’s provider relations for the current contracted rate and any differentials; it may differ from the schedule.
- Check the county report for your county, which lists the published rate, the local caregiver median wage and the number of agencies.
Questions
How much does Medicaid pay caregivers per month? For an agency caregiver working 35 hours a week at a $17 wage, about $2,500 a month before taxes. Self-directed and paid family caregiver programs pay the caregiver directly, usually at a rate between the state minimum wage and the agency wage; the paid family caregiver pages list each state’s range.
Does Medicaid pay for 24-hour home care? Rarely as hourly personal care. States that cover it use per-diem codes (T1020, S5126) or live-in rates, and most cap hours per week by assessed need.
Why does the rate differ between two agencies in the same county? Different programs (state plan vs waiver), different plans, enhanced rates for specific populations, or value-based add-ons. The base rate for the same code under the same program and plan is the same.
How much does non-medical home care cost per hour privately? The national median was $35 an hour in 2025 (CareScout), higher in the Northeast and West Coast. Private-pay rates run 20 to 50 percent above Medicaid rates for the same hour, which is why many agencies keep a mix. See home care hourly rates by state.
Sources
- CMS, Ensuring Access to Medicaid Services, final rule, 89 FR 40542 (May 10, 2024).
- Bureau of Labor Statistics, Occupational Employment and Wage Statistics, May 2025, SOC 31-1120.
- State Medicaid fee schedules and HCBS waiver rate sheets, linked in the table above.
Last reviewed November 5, 2026. Rates change with state budgets.