S5199 Medicaid reimbursement rates by state
Personal care item, nos, each. 8 state Medicaid programs publish a fee-for-service rate for S5199 at the aide level. Rates run from $0.10 in Michigan to $5,000.00 in Minnesota, with a median of $15.00.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 8
- Median rate
- $15.00units vary by state
- Highest
- $5,000.00Minnesota
- Medicare (non-facility)
- —not on the physician fee schedule
S5199 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 |
|---|---|---|---|---|---|---|
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Brain Injury (BI) waiver | $5,000.00since 2026-01-01 | Decremental | — | Paid by the state, outside plans | — | Long-Term Services and Supports Service |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $500.00⚠ over 3× mediansince 2025-01-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| FloridaAny qualified provider (rate does not vary by provider) · Florida iBudget waiver for people with developmental disabilities (APD) | $276.63since 2026-07-01 | unit | — | Paid by the state, outside plans | — | Florida Medicaid Developmental Disabilit |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $15.00since 2007-09-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file hcpcmedical.csv |
| CaliforniaAide or attendant (HHA, CNA, PCA, home care aide) · California Medi-Cal (fee-for-service) | $14.99since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal Rates (Rates files zip: rates_d |
| North CarolinaAide or attendant (HHA, CNA, PCA, home care aide) · North Carolina Medicaid Direct (fee-for-service) | $1.40since 2025-10-01 | each | — | Plans negotiate; applies out of network | — | NC Medicaid fee schedule 'Home Health Se |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $1.12since 2026-07-01 | — | — | Not classified | — | Health First Colorado Physician Fee Sche |
| MichiganAide or attendant (HHA, CNA, PCA, home care aide) · Michigan Medicaid (fee-for-service) | $0.10since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Medical Suppliers/Orthotists/Prost |
Rates marked ⚠ are more than three times the median for the same unit; they are published as shown but often reflect an office (non-facility) fee or a different scope of service. 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 S5199?
It depends on the state. Of the 8 states with a published fee-for-service rate, the median is $15.00. Minnesota pays the most ($5,000.00 per Decremental) and Michigan the least ($0.10).
Which state pays the highest Medicaid rate for S5199?
Minnesota, at $5,000.00 per Decremental, effective 2026-01-01.
Do managed-care plans pay the same rate for S5199?
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.