The best states to open a home health agency, judged by the Medicaid rate for a home health nurse visit, are Delaware, Nevada and Arizona. Delaware ranks 1st of the 11 states compared, paying $49.07 per 15 minutes ($196.28 an hour), 104.8% above the national median of $23.96. Nevada ranks 2nd at $28.46 ($113.84 an hour) and Arizona 3rd at $24.73 ($98.92 an hour).
Delaware is the standout by a wide gap: after a loaded nurse wage it leaves $128.27 an hour, while no other state in the ranking keeps more than $44.10. This guide explains where Medicaid pays most for home health nursing, how that compares with local nurse wages, and how managed-care plans treat the published rate. Reimbursement is one input to a location decision. Licensing, staffing, payer mix and competition need your own local research.
The table ranks the ten states that pay the most for a home health nurse visit, per 15 minutes. Margin per hour is the hourly rate minus the median nurse wage after employer costs such as payroll taxes and benefits.
| State | Rate (per 15 min) | Rank | Margin per hour |
|---|---|---|---|
| Delaware | $49.07 | 1 of 11 | $128.27 |
| Nevada | $28.46 | 2 of 11 | $43.00 |
| Arizona | $24.73 | 3 of 11 | $30.93 |
| Louisiana | $24.73 | 4 of 11 | $44.10 |
| South Dakota | $23.20 | 5 of 11 | $39.46 |
| Oklahoma | $21.45 | 6 of 11 | $29.13 |
| Kansas | $20.00 | 7 of 11 | $25.79 |
| Rhode Island | $18.36 | 8 of 11 | $4.66 |
| Pennsylvania | $16.55 | 9 of 11 | $0.31 |
| Maine | $16.48 | 10 of 11 | $6.48 |
After Delaware, rates cluster close to the national median, and margins depend mostly on local nurse wages. Louisiana ranks 4th but keeps slightly more per hour than Nevada, and South Dakota, 5th, keeps more than Arizona.
Delaware pays $49.07 per 15 minutes for a home health nurse visit, or $196.28 an hour. It ranks 1st of the 11 states compared and is 104.8% above the national median.
The median nurse wage in Delaware is $47.85 an hour, only 34.6% of the rate. After a loaded wage, the margin is $128.27 an hour, the largest in the ranking by a wide gap.
The caveat is managed care. Delaware's plans negotiate their own rates, and the published rate applies out of network. If most of your patients are in plans, your contracts set your rate, and the published figure becomes your negotiating anchor. Even so, with a published rate this far above every other state, Delaware gives a new agency more room than anywhere else in the ranking to absorb travel, documentation and missed visits. Research the state's licensing requirements for home health agencies and how competitive nurse hiring is in your target area.
See every code on the Delaware home health Medicaid rates page.
Nevada pays $28.46 per 15 minutes, or $113.84 an hour, ranking 2nd of the 11 states compared and 18.8% above the national median.
The median nurse wage is $49.84 an hour, the highest among the top six, and takes 62.2% of the rate. After a loaded wage, the margin is $43.00 an hour.
Nevada's plans negotiate their own rates and the published rate applies out of network. That makes your plan contracts as important as the fee schedule. Research how many home health agencies already serve your target area and how competitive nurse hiring is; with a high wage, a small difference in what you must pay nurses moves the margin a lot.
See the Nevada home health rates page.
Arizona pays $24.73 per 15 minutes, or $98.92 an hour, ranking 3rd of the 11 states compared and 3.2% above the national median.
The median nurse wage is $47.84 an hour, 68.7% of the rate, leaving $30.93 an hour after a loaded wage.
Arizona's plans are expected to pay at least the published rate. That gives a new agency a reasonable revenue floor without heavy negotiation. The margin is thinner than in Louisiana at the same rate, so the decision turns on whether you can control costs other than wages: travel, documentation time and missed visits. Research licensing, the number of agencies already operating in your area, and nurse recruitment.
Details are on the Arizona home health Medicaid rates page.
Louisiana pays $24.73 per 15 minutes, or $98.92 an hour, ranking 4th of the 11 states compared and 3.2% above the national median, the same rate as Arizona.
The difference is the wage. Louisiana's median nurse wage is $38.57 an hour, 55.4% of the rate, leaving $44.10 an hour after a loaded wage, the second-best margin in the ranking.
Plans in Louisiana must pay at least the published rate, so the fee schedule is a floor in plan contracts. A strong margin combined with a binding floor makes Louisiana one of the more predictable states on the list. Research licensing, local competition and how easily you can recruit nurses at the local wage.
See the Louisiana home health rates.
South Dakota pays $23.20 per 15 minutes, or $92.80 an hour, ranking 5th of the 11 states compared and 3.2% below the national median.
Its median nurse wage is $37.53 an hour, the lowest in the ranking, at 57.5% of the rate. That leaves $39.46 an hour after a loaded wage, more than Arizona despite a lower rate.
We have no managed-care rule on file for home health in South Dakota, so ask the state how claims are paid. The open questions are local: travel distances between patients, which add unpaid time to every visit, and how many patients in your area need home health.
See the South Dakota home health rates page.
Oklahoma pays $21.45 per 15 minutes, or $85.80 an hour, ranking 6th of the 11 states compared and 10.5% below the national median.
The median nurse wage is $39.87 an hour, 66.0% of the rate, leaving $29.13 an hour after a loaded wage, close to Arizona's margin on a lower rate.
Oklahoma's distinguishing feature is how it pays: home health is paid directly by the state, outside managed care, so the published rate is the rate you collect. It is the only state in the top 10 with that arrangement for home health. For a new agency without contracting leverage, that certainty can be worth more than a few dollars of rate. Research local competition and nurse hiring before committing.
See the Oklahoma home health rates.
California ranks 11th of the 11 states compared, paying $15.21 per 15 minutes ($60.84 an hour), 36.5% below the national median. Its median nurse wage is $67.44 an hour, which takes 157.5% of the rate, a margin of -$35.01 an hour.
Maine pays $16.48 ($65.92 an hour), with a margin of $6.48. Pennsylvania pays $16.55 ($66.20 an hour), where the wage takes 99.5% of the rate and the margin is $0.31. Rhode Island pays $18.36 ($73.44 an hour), a margin of $4.66.
In these states, a Medicaid home health nurse visit barely covers the nurse, or does not. An agency there would rely on Medicare, commercial payers or plan contracts that pay above the published rate. Pennsylvania and California both let plans negotiate, so a contract above the fee schedule is possible; Rhode Island requires plans to pay at least the published rate, which here is a low floor.
States are ordered by their Medicaid rate for a home health nurse visit by an RN or LPN, ranked among the 11 states compared. Rates are compared per 15 minutes and converted to an hourly figure for the margin.
Nurse wages are median hourly wages from Bureau of Labor Statistics data, where available. The margin takes the hourly rate and subtracts that wage after employer costs. It is a gross figure before travel, documentation and administration. Because the margin uses the hourly equivalent of a 15-minute rate, a visit that runs longer or shorter than planned changes what you actually keep per visit, so build your own visit-length assumptions into any budget.
Every rate is compiled from official state Medicaid publications, and each one on the site links to its source document. The methodology page explains how units and services are matched.
Home health agencies can be paid by Medicare, Medicaid and commercial insurers. A high Medicaid rate matters most if Medicaid will be a large share of your visits, so research your expected payer mix first.
The margin figure also leaves out the costs that make home health hard:
- travel time between patients, which is paid but not billed;
- documentation and care coordination;
- missed or cancelled visits;
- clinical supervision, scheduling and compliance.
And it says nothing about licensing, which varies by state, or about how many agencies already compete for the same patients and nurses. Treat the ranking as a shortlist and the margin as a screen.
Home health shows the full range of managed-care rules:
- Plans must pay at least the published rate (Louisiana, Kansas, Rhode Island): the fee schedule is a floor.
- Plans are expected to pay at least the published rate (Arizona): a softer floor; ask plans how it works in practice.
- Plans negotiate; the published rate applies out of network (Delaware, Nevada, Pennsylvania, California): contracts set your rate.
- Paid directly by the state, outside managed care (Oklahoma): you collect the published rate.
South Dakota and Maine have no rule on file for home health. For Delaware in particular, what plans actually pay will decide how much of its headline margin an agency keeps.
Home health agencies bill more than nursing. National medians:
- Home health aide visit: $52.32 per visit.
- Home health physical therapy: $120.52 an hour.
- Home health occupational therapy: $117.42 an hour.
The best state for nursing is not always the best for the rest of your service mix, so compare each line you plan to offer on the state pages.
Start with the home health Medicaid rates by state hub to compare nursing, aide and therapy rates everywhere. Then check the state pages for your shortlist, including Delaware, Louisiana, Nevada and Arizona, for every rate with its source.
For full access while you build a budget, see pricing. The methodology page explains how rates are compared.