The best states to start a private duty nursing agency, judged by the Medicaid rate for RN private duty nursing, are Massachusetts, Georgia and Rhode Island. Massachusetts ranks 1st of the 40 states compared, paying $32.66 per 15 minutes ($130.64 an hour), 138.2% above the national median of $54.84. Georgia ranks 2nd at $23.84 ($95.36 an hour) and Rhode Island 3rd at $23.60 ($94.40 an hour).
Private duty nursing is the hardest Medicaid service to make work on paper, because registered nurses are expensive. In Hawaii, a top-five state, the RN wage takes 99.1% of the rate. This guide ranks states on the RN private duty nursing rate, sets each against the local RN wage, and notes whether managed-care plans must honor the published rate. Medicaid reimbursement is one input to a location decision; licensing, nurse staffing, payer mix and competition need local research.
The table ranks the ten states that pay the most for RN private duty nursing, shown as an hourly figure. Margin per hour is the hourly rate minus the median RN wage after employer costs such as payroll taxes and benefits.
| State | Rate per hour | Rank | Margin per hour |
|---|---|---|---|
| Massachusetts | $130.64 | 1 of 40 | $59.19 |
| Georgia | $95.36 | 2 of 40 | $31.43 |
| Rhode Island | $94.40 | 3 of 40 | $25.62 |
| Hawaii | $94.04 | 4 of 40 | $0.89 |
| South Dakota | $92.80 | 5 of 40 | $39.46 |
| Montana | $87.44 | 6 of 40 | $29.17 |
| Iowa | $80.00 | 7 of 40 | $26.27 |
| Idaho | $78.24 | 8 of 40 | $15.06 |
| New Hampshire | $75.84 | 9 of 40 | $7.72 |
| Michigan | $72.32 | 10 of 40 | $7.88 |
Massachusetts stands alone at the top. Ranks 2 to 5 are bunched within a few dollars of each other, but their margins range from $0.89 to $39.46. In private duty nursing, the local RN wage decides more than the rate does.
Massachusetts pays $32.66 per 15 minutes for RN private duty nursing, or $130.64 an hour. That ranks 1st of the 40 states compared and is 138.2% above the national median.
The median RN wage in Massachusetts is $50.27 an hour, 54.7% of the rate. After a loaded wage, the margin is $59.19 an hour, the largest in the ranking.
Private duty nursing in Massachusetts is paid directly by the state, outside managed care, so the published rate is the rate you collect. For a new agency without contracting leverage, that is the strongest combination on the list: the highest rate, the widest margin and no plan negotiation. The margin still has to cover clinical supervision, scheduling, insurance, recruitment and the shifts you cannot staff. Research the state's licensing requirements for a nursing agency, and how hard it is to recruit nurses for long home shifts locally.
See the Massachusetts private duty nursing rates page.
Georgia pays $23.84 per 15 minutes, or $95.36 an hour, ranking 2nd of the 40 states compared and 73.9% above the national median.
The median RN wage in Georgia is $44.98 an hour, 67.0% of the rate, leaving $31.43 an hour after a loaded wage.
Georgia pays private duty nursing directly, outside managed care, so the published rate is the rate you are paid. Its margin is well below Massachusetts's but still among the better figures in the ranking, and its wage is lower than in most top-five states. The questions to research are local: how many families need home nursing in your area, how many agencies already serve them, and what nurses there expect to be paid for home shifts.
Details are on the Georgia private duty nursing rates page.
Rhode Island pays $23.60 per 15 minutes, or $94.40 an hour, ranking 3rd of the 40 states compared and 72.1% above the national median.
The median RN wage is $48.39 an hour, 72.9% of the rate. The margin after a loaded wage is $25.62 an hour, below Georgia's even though the rates are almost the same.
Rhode Island pays private duty nursing directly, outside managed care. That makes the published rate a dependable revenue figure. Rhode Island shows the pattern that runs through this whole ranking: two states with nearly identical rates can differ by several dollars an hour of margin once the local RN wage is counted. If your model mixes RN and LPN shifts, compare both rates on the state page.
See the Rhode Island private duty nursing rates.
Hawaii pays $23.51 per 15 minutes, or $94.04 an hour, ranking 4th of the 40 states compared and 71.5% above the national median.
Hawaii is the clearest example of why rate alone misleads. The median RN wage is $65.54 an hour, which takes 99.1% of the rate. After employer costs, the margin is $0.89 an hour.
In Hawaii, plans negotiate their own rates and the published rate applies out of network. A plan contract could pay more than the published rate, and an agency staffed partly by LPNs would face lower wage costs. But on the published RN rate and the median RN wage, there is almost nothing left for overhead.
Read more on Hawaii private duty nursing rates.
South Dakota pays $92.80 an hour, ranking 5th of the 40 states compared and 69.2% above the national median.
Its median RN wage is $37.53 an hour, the lowest in the top 10, at 57.5% of the rate. That leaves $39.46 an hour after a loaded wage, second only to Massachusetts.
We have no managed-care rule on file for private duty nursing in South Dakota, so ask the state how claims are paid. A low wage helps the margin but can make recruiting harder; find out how quickly local employers fill nursing positions and how far nurses would travel to patients' homes.
See the South Dakota private duty nursing rates page.
Montana pays $21.86 per 15 minutes, or $87.44 an hour, ranking 6th of the 40 states compared and 59.4% above the national median.
The median RN wage in Montana is $41.00 an hour, 66.6% of the rate, leaving $29.17 an hour after a loaded wage. That is close to Georgia's margin on a lower rate, because Montana's nurses earn less at the median.
We have no managed-care rule on file for private duty nursing in Montana. The local questions matter more here than the rate: distances between patients, which add unpaid travel to every shift, and whether you can recruit enough nurses to cover long home shifts in your area.
See the Montana private duty nursing rates.
At the bottom of the ranking, the RN rate covers only a fraction of the nurse.
Virginia ranks 40th of the 40 states compared at $25.86 an hour, 52.8% below the national median; the RN wage takes 247.3% of the rate, a margin of -$38.10 an hour. Kansas pays $26.00, a margin of -$28.21. The District of Columbia and Arkansas each pay $28.00, with margins of -$42.07 and -$25.94; in the District the wage takes 250.2% of the rate. Mississippi pays $29.33, a margin of -$23.34, and New York $31.21, where the wage takes 239.6% of the rate and the margin is -$43.58.
An agency in these states would need LPN staffing, plan contracts above the published rate, or other nursing lines to make the numbers work. The published RN rate alone will not cover an RN. Virginia and Mississippi require plans to pay at least the published rate, but at this level that floor is low.
States are ordered by their Medicaid rate for private duty nursing delivered by a registered nurse, ranked among the 40 states compared. Rates published per 15 minutes are converted to an hourly figure so they can be compared with hourly rates.
RN 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 supervision, scheduling, insurance and administration.
Every rate is compiled from official state Medicaid publications, and each one on the site links to its source document. See the methodology for how units and provider levels are matched.
Private duty nursing is shift work, often long shifts in a patient's home. A high hourly rate only becomes revenue if you can staff those shifts. The rate does not tell you:
- whether nurses in your area will take home shifts at the wage you can offer;
- how many patients need home nursing and how authorizations are approved;
- the share of your patients on Medicaid versus other coverage;
- how many agencies already compete for the same nurses and families.
It also leaves out what licensing and accreditation a nursing agency needs in the state. Research those before you choose. The margin figure is a screening tool, not a forecast.
One practical test: take the published rate for your shortlisted state, subtract what you would actually have to offer a nurse locally, and ask whether the remainder covers a clinical supervisor, a scheduler and the shifts that go unfilled. If it does not at the published rate, the state only works with better plan contracts or a different staffing mix.
Many of the strongest states pay private duty nursing directly, outside managed care: Massachusetts, Georgia, Rhode Island, Idaho, Michigan and Washington. There, the published rate is what you collect.
In Iowa and New Hampshire, plans must pay at least the published rate, so the fee schedule is a floor. In Hawaii and Ohio, plans negotiate; the published rate applies out of network, and your contracts decide your real rate. For Hawaii, a negotiated rate above the published one is the difference between a viable and a non-viable agency.
South Dakota and Montana have no managed-care rule on file. Ask the state how claims are paid before you budget. Where plans negotiate, ask them early what they pay for private duty nursing; the published rate is a useful anchor in that conversation.
Most agencies staff both RNs and LPNs, and many also bill waiver nursing. National medians:
- Private duty nursing (LPN): $44.08 an hour.
- Waiver nursing (RN): $77.60 an hour.
- Waiver nursing (LPN): $56.42 an hour.
Waiver nursing pays more than private duty nursing at the median, so an agency able to serve waiver patients as well may find its overall rate picture stronger than the private duty ranking alone suggests. Compare each line you plan to offer on the state pages.
Start with the private duty nursing Medicaid rates by state hub to compare RN, LPN and waiver nursing everywhere. Then review the state pages for your shortlist, such as Massachusetts, Georgia and South Dakota, for each rate with its source.
For full access while you build a budget, see pricing. The methodology page explains how rates are compared.