S5101 Medicaid reimbursement rates by state
Day care services, adult; per half day. 7 state Medicaid programs publish a fee-for-service rate for S5101 at the clinical nurse specialist level. Rates run from $26.37 in Iowa to $61.53 in Georgia, with a median of $46.15.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 7
- Median rate
- $46.15units vary by state
- Highest
- $61.53Georgia
- Medicare (non-facility)
- —not on the physician fee schedule
S5101 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 |
|---|---|---|---|---|---|---|
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Independent Care Waiver Program (adults with physical disabilities or brain injury) | $61.53since 2024-07-01 | per half day | — | Paid by the state, outside plans | — | Part II Policies and Procedures: Indepen |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Home Care Waiver (ODM) | $53.11since 2026-04-17 | Per half day | — | Plans negotiate; applies out of network | — | OAC 5160-46-06 (Register of Ohio final f |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $49.75since 2025-07-01 | — | — | Paid by the state, outside plans | — | Rates for Adult Day Health Services (eff |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $46.15since 2026-10-01 | Half Day (12 – 23 units) | — | Plans expected to pay at least this | — | AHCCCS Final FFS Home and Community Base |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $44.00since 2025-01-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Money Follows the Person (Family Supports track) | $43.75since 2023-07-01 | half day | — | Paid by the state, outside plans | — | IHCP Professional Fee Schedule (Last Upd |
| IowaAny qualified provider (rate does not vary by provider) · Iowa HCBS AIDS/HIV 1915(c) waiver | $26.37since 2025-08-01 | Half Day | — | 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 S5101?
It depends on the state. Of the 7 states with a published fee-for-service rate, the median is $46.15. Georgia pays the most ($61.53 per per half day) and Iowa the least ($26.37 per Half Day).
Which state pays the highest Medicaid rate for S5101?
Georgia, at $61.53 per per half day, effective 2024-07-01.
Do managed-care plans pay the same rate for S5101?
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.