T1005 Medicaid reimbursement rates by state
Respite care services, up to 15 minutes. 17 state Medicaid programs publish a fee-for-service rate for T1005 at the agency level. Rates run from $2.63 in California to $290.45 in New Jersey, with a median of $6.25.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 17
- Median rate
- $6.25units vary by state
- Highest
- $290.45New Jersey
- Medicare (non-facility)
- —not on the physician fee schedule
T1005 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 |
|---|---|---|---|---|---|---|
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $290.45⚠ over 3× mediansince 2026-01-01 | 15 min | $1,161.80 | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| IllinoisAgency provider · Illinois Persons with Brain Injury waiver (DHS-DRS Home Services Program, IL.0329) | $25.00since 2026-07-01 | hour | $25.00 | Plans must pay at least this | — | HSP Rates and Fees (Medicaid Waiver Serv |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia developmental disability waivers (Building Independence, Family and Individual Supports, Community Living) | $20.23since 2025-07-01 | hour | $20.23 | Paid by the state, outside plans | — | DMAS Developmental Disabilities Waiver S |
| North CarolinaNurse (RN or LPN, same rate) · North Carolina Community Alternatives Program for Children (CAP/C) | $13.00since 2025-10-01 | 15 min | $52.00 | Paid by the state, outside plans | — | NC Medicaid fee schedule 'CAP for Childr |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri DD Community Support Waiver (DMH Division of DD, 1915(c)) | $10.34since 2024-07-01 | 15 min | $41.36 | Paid by the state, outside plans | — | MO HealthNet fee schedule: Community Sup |
| WashingtonAgency provider · Washington DDA waiver and state plan services (Basic Plus, Core, IFS, CIIBS, CP) | $10.12since 2023-07-01 | OF | — | Paid by the state, outside plans | — | DSHS ORM Home & Community Based Rates Hi |
| ColoradoAide or attendant (HHA, CNA, PCA, home care aide) · Colorado HCBS waiver for children with a life-limiting illness (CLLI) | $8.34since 2023-07-01 | 15 min | $33.36 | Paid by the state, outside plans | — | CLLI, CHCBS, CHRP (effective January 1, |
| WisconsinAgency provider · Wisconsin Children's Long-Term Support (CLTS) Waiver (fee-for-service, statewide uniform rate schedule) | $7.35since 2025-01-01 | 15-min. | — | Paid by the state, outside plans | — | CLTS Waiver Statewide Uniform Rate Sched |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Intellectual Disability and Related Disabilities (ID/RD) Waiver (SC.0237, DDSN-operated) | $6.25since 2025-11-01 | 15 min | $25.00 | Paid by the state, outside plans | — | SCDHHS HCBS Waivers Fee Schedule (Effect |
| KentuckyAgency provider · Kentucky Acquired Brain Injury Long Term Care 1915(c) waiver | $6.00since 2025-01-01 | 15 min | $24.00 | Paid by the state, outside plans | — | DMS 1915(c) HCBS LTSS RISE Services Summ |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Public Behavioral Health System (specialty mental health, SUD and ABA, paid fee-for-service through the Carelon ASO) | $5.52since 2024-07-01 | 15 min | $22.08 | Paid by the state, outside plans | — | FY2025 PBHS Fee Schedule – PRP and Speci |
| FloridaLicensed practical / vocational nurse (LPN / LVN) · Florida iBudget waiver for people with developmental disabilities (APD) | $4.72since 2026-07-01 | 15 min | $18.88 | Paid by the state, outside plans | — | Florida Medicaid Developmental Disabilit |
| PennsylvaniaAgency provider · Pennsylvania Act 150 attendant care program (state-funded) | $4.49since 2026-07-01 | 15 min | $17.96 | Not classified | — | OLTL Home and Community Based Waiver Ser |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Community Choices Waiver (OAAS 1915(c) waiver for older adults and adults with disabilities) | $4.02since 2026-10-01 | 15 min | $16.08 | Paid by the state, outside plans | — | Community Choices Waiver services proced |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana PRTF Transition Waiver (youth leaving psychiatric residential treatment) | $4.00since 2012-10-01 | unit | — | Paid by the state, outside plans | — | IHCP Professional Fee Schedule (Last Upd |
| TexasAgency provider · Texas Home and Community-Based Services - Adult Mental Health (HCBS-AMH, 1915(i)) | $3.40since 2025-09-01 | 15 min | $13.60 | Not classified | — | HHSC PFD HCBS-AMH payment rates (9-1-202 |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $2.63since 2026-10-01 | 15 min | $10.52 | Plans negotiate; applies out of network | — | Medi-Cal Rates (Rates files zip: rates_d |
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 T1005?
It depends on the state. Of the 17 states with a published fee-for-service rate, the median is $6.25. New Jersey pays the most ($290.45 per 15 min) and California the least ($2.63 per 15 min).
Which state pays the highest Medicaid rate for T1005?
New Jersey, at $290.45 per 15 min ($1,161.80 per hour), effective 2026-01-01.
Do managed-care plans pay the same rate for T1005?
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.