Home Care Medicaid Rates in the District of Columbia (2026)

DC Medicaid home care reimbursement is led by respite. The District pays $496.96 a day for respite on S9125, which ranks 6th of 34 states and is 105.2% above the national median of $242.21. Hourly respite and companion care also sit in the top quarter of their national rankings.

The District of Columbia does not have a comparable hourly agency personal care rate in our national ranking, so the comparison here runs through the services it does rank: daily respite, hourly respite and companion care. For a personal care or attendant agency in the District, that profile means above-median rates on every ranked line, set against an aide wage well above the US median and a heavy layer of prior authorization.

Every ranked line sits above its national median. The hourly lines were set on January 1, 2026; the daily respite rate dates from January 1, 2024. The full dataset holds all 87,654 current DC Medicaid rates, each linked to its source on the DC Medicaid rates hub.

At $496.96 a day, DC's daily respite rate is in the same tier as the national leaders. Minnesota leads at $938.09, followed by Missouri, Pennsylvania, Maryland and New York. The District sits just below that group and far above the bottom, where New Hampshire pays $34.04.

For an agency able to staff full-day or overnight blocks, daily respite is the District's most generous home care line relative to the rest of the country. It is also the line where the rate has the most headroom over DC's high wages, because a single caregiver covering a long block spreads fixed costs across many hours.

Modifiers on DC respite codes

DC publishes respite rates with stacked modifiers that identify the waiver, the provider and the service variant. A claim with the wrong modifier combination is likely to be denied or paid at a different rate. Agencies should map modifiers to each client's program at intake and lock them into the billing system.

Companion care on S5135 pays $7.89 per 15 minutes with the U1 modifier, or $31.56 an hour, effective January 1, 2026. Among 20 ranked states only four pay more, led by Vermont at $51.92. The national median is $25.96.

Hourly respite on T1005 pays $8.49 per 15 minutes, or $33.96 an hour, also effective January 1, 2026. That is 9th of 38 states. Virginia leads at $74.04.

Both rates were refreshed on the same date, which suggests the District reviews companion and respite rates together. For an agency, that is useful: when one line changes, check the other.

The District has a high-wage home care workforce. The DC median wage for home health and personal care aides was $20.53 an hour in May 2025, against a US median of $17.21. Registered nurses had a DC median of $49.30 against $46.90 nationally.

That wage level absorbs most of the above-median rates:

• Companion care at $31.56 an hour. Wages take 92.5% of the rate, leaving $2.38 an hour after a loaded wage.
• Hourly respite at $33.96. Wages take 85.9% of the rate, leaving $4.78 an hour.

So even where DC ranks near the top nationally, the hourly margin is narrow. Agencies relying on companion hours have little room for overtime, travel time or supervision costs. Daily respite, priced far above the national median, is where the rate has the most headroom over wages.

Why wages run high in the District

The District's direct care workers are paid under local wage requirements that sit above most states, and the DCSP supplemental payment for enhanced direct care, whose reporting requirements were updated in Transmittal 25-38, is tied to direct care pay. Agencies should treat wage levels as largely set by policy rather than by their own choice, and manage margin through scheduling and mix instead.

DC stands out for how many prior authorization rules attach to home care codes:

• T1019 personal care carries 57 prior authorization rules.
• Code 99509 carries 37.
• T1005 hourly respite carries 30.
• S5135 companion care carries 17.
• S9125 daily respite and S5199 each carry 13.
• S5100 adult day services carries 9, and S5120 and S5130 carry 5 each.
• S5125 attendant care carries none.

None of these codes has a stated unit limit, so authorization, not a published cap, controls volume.

Building authorization into operations

For billing teams, authorization tracking is a core part of getting paid on almost every DC home care line. A workable approach: record each authorization's start date, end date and approved units in the scheduling system; block scheduling beyond authorized units; and start renewals well before expiry. Denials for missing or expired authorizations are the most avoidable revenue loss in a high-rule market.

The District's home care services run through DC Medicaid (DHCF) fee-for-service and its waivers, including the EPD waiver, the DC Intellectual and Developmental Disabilities waiver and the DC Individual and Family Support waiver. Among the 6 plans and programs are AmeriHealth Caritas District of Columbia, MedStar Family Choice DC, Health Services for Children with Special Needs (HSCSN), Edenbridge PACE and UnitedHealthcare of the Mid-Atlantic D-SNP.

The rates in this article are the published DHCF fee schedule rates. Agencies that also serve PACE or D-SNP members should expect those organizations to contract separately, and can use the DHCF rate as a reference point in those talks. The DC managed care page covers how plans in the District pay across service lines.

2026 has been an active year for DC home care rules and rates:

• Transmittal 25-35 set rate changes for PCA services effective January 1, 2026, alongside DC Register notices updating the PCA and EPD waiver fee schedules from the same date. Transmittal 25-32 changed adult day health program rates on the same date.
• DC Register Vol 73/7 N144101, a proposed rulemaking amending 29 DCMR Chapters 50 and 97 on personal care aide services and adult day health program services, was published February 13, 2026, and N145130 finalized it on May 15, 2026.
• DC Register Vol 73/21 N145277 and N145276 published PCA and EPD waiver fee schedule updates effective July 1, 2026.
• Transmittal 26-17 changed PCA rates effective July 1, 2026, alongside Transmittal 26-15 updating assisted living residence rates.

What to watch

PCA rates changed twice in one calendar year, in January and July. Billing staff should confirm claims for dates of service from July 1, 2026 use the new schedule, and that any claims paid at the old rate after that date are corrected. The amended PCA rules finalized in May 2026 may also change documentation or service requirements, so review them against current practice.

The District's schedule rewards some business models more than others.

• Agencies with respite capacity. Daily respite is priced 105.2% above the national median and is the one line with real headroom over DC wages. Agencies that can staff overnight and full-day blocks have the strongest economics in the District.
• Companion-focused agencies. A top-five companion rate sounds attractive, but at DC wage levels it leaves only a few dollars an hour. These agencies need dense scheduling and very low missed-visit rates to stay viable.
• Small agencies. The density of prior authorization rules falls hardest on small agencies, which often lack dedicated authorization staff. A single expired authorization on a high-hour client can wipe out a month's margin on that client.
• Multi-state operators. Agencies that already serve Maryland and Virginia can share authorization and billing staff across jurisdictions, which spreads the administrative cost that DC's rules impose.

For any of these, the deciding factor is less the rate than the ability to run tight operations around it.

Nationally, home care rates are compressed, and the median hourly personal care rate is $30.52. The District's ranked services all sit above their national medians, from 21.6% above on companion care to 105.2% above on daily respite. It does not approach outliers like Utah, but it is consistently in the upper tier, with neighboring Maryland also near the top for respite and Virginia leading on hourly respite. Compare every state on the home care Medicaid rates by state page.

• Budgeting. Treat daily respite as the margin line; companion care and hourly respite run close to break-even at DC wages.
• Billing. Load the July 1, 2026 PCA schedule and confirm modifier combinations for each program.
• Authorizations. Make authorization tracking a scheduling control, not a billing afterthought.
• Benchmarking. Compare with Maryland and Virginia, where many DC agencies also operate.

Rates are compiled from official DC Medicaid publications, including the DC Medicaid MMIS fee schedule reports and DHCF transmittals such as Transmittal 25-35 on PCA rates. Each rate links to its source document. Rankings compare the rate for the same service across states that publish one, using the per-hour figure where a service is billed in time units. Wages are May 2025 medians. Rankings follow our methodology; access to the full dataset is described on our pricing page.