S5100 Medicaid reimbursement rates by state
Day care services, adult; per 15 minutes. 10 state Medicaid programs publish a fee-for-service rate for S5100 at the clinical nurse specialist level. Rates run from $1.64 in Iowa to $16.84 in Illinois, with a median of $3.70.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 10
- Median rate
- $3.70units vary by state
- Highest
- $16.84Illinois
- Medicare (non-facility)
- —not on the physician fee schedule
S5100 rate in every state
One like-for-like fee-for-service rate per state, highest first. Units can differ between states; the per-hour column converts time-based units.
| State | Medicaid rate | Unit | Per hour | Managed-care plans | % of Medicare | Source |
|---|---|---|---|---|---|---|
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Persons with Brain Injury waiver (DHS-DRS Home Services Program, IL.0329) | $16.84since 2026-07-01 | hour | $16.84 | Plans must pay at least this | — | HSP Rates and Fees (Medicaid Waiver Serv |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Alternative Care (AC, state-funded program for people 65+) | $4.53since 2026-01-01 | 15 min | $18.12 | Not classified | — | Long-Term Services and Supports Service |
| ColoradoAny qualified provider (rate does not vary by provider) · Colorado HCBS waiver for persons who are elderly, blind or disabled (EBD) | $3.99since 2023-07-01 | 15 min | $15.96 | Paid by the state, outside plans | — | EBD CMHS BI CIH (effective January 1, 20 |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Home and Community Based (HCB) 1915(c) waiver | $3.82since 2025-01-01 | 15 min | $15.28 | Paid by the state, outside plans | — | DMS Home and Community Based Services Wa |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $3.81since 2026-10-01 | 15 min | $15.24 | Plans expected to pay at least this | — | AHCCCS Final FFS Home and Community Base |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Community Choices Waiver (OAAS 1915(c) waiver for older adults and adults with disabilities) | $3.58since 2026-10-01 | 15 min | $14.32 | Paid by the state, outside plans | — | Community Choices Waiver services proced |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington ALTSA adult day care and adult day health | $3.38since 2021-07-01 | 15 min | $13.52 | Paid by the state, outside plans | — | DSHS ORM Home & Community Based Rates Hi |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Money Follows the Person (Health & Wellness / A&D track) | $3.32since 2023-07-01 | 15 min | $13.28 | Paid by the state, outside plans | — | IHCP Professional Fee Schedule (Last Upd |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri Adult Day Care Waiver (DHSS, 1915(c)) | $3.32since 2023-07-01 | 15 min | $13.28 | Paid by the state, outside plans | — | MO HealthNet fee schedule: Adult Day Car |
| IowaAny qualified provider (rate does not vary by provider) · Iowa HCBS AIDS/HIV 1915(c) waiver | $1.64since 2025-08-01 | 15 min | $6.56 | Not classified | — | HCBS Habilitation and Waiver Upper Rate |
Rates are per the unit shown for each state; units can differ between states. Medicare amounts are computed from the CMS relative value file and locality cost indices with the CMS formula; states with several Medicare localities show a range. Confirm rates with the payer before billing.
Frequently asked questions
What does Medicaid pay for S5100?
It depends on the state. Of the 10 states with a published fee-for-service rate, the median is $3.70. Illinois pays the most ($16.84 per hour) and Iowa the least ($1.64 per 15 min).
Which state pays the highest Medicaid rate for S5100?
Illinois, at $16.84 per hour ($16.84 per hour), effective 2026-07-01.
Do managed-care plans pay the same rate for S5100?
Not necessarily. Each state's plan contracts decide whether plans must pay at least the fee-for-service rate, pay a state-set rate, or negotiate their own. The table shows the rule for each state, cited to the contract or statute.