Idaho is a low-rate home care state on almost every line it publishes. Its home care Medicaid rate for personal care is $24.44 an hour on S5125, 22nd of 27 states and 19.9% below the national median of $30.52. Idaho also ranks 37th of 38 for hourly respite and 33rd of 34 for daily respite, and it appears on the national lowest-states list for homemaker services.
What makes Idaho distinctive is not just the level but the direction: a 4% Medicaid provider rate reduction took effect for dates of service from September 1, 2025. For personal care, attendant and homemaker agencies, that leaves very little room between the rate and the wage, and makes operating discipline the deciding factor.
| Service | Code | Idaho rate | Rank | vs national median |
|---|---|---|---|---|
| Personal care (hourly) | S5125 | $24.44 / hour | 22 of 27 | -19.9% |
| Homemaker (hourly) | S5130 | $21.04 / hour | 7 of 9 | -31.7% |
| Companion care (hourly) | S5135 | $22.16 / hour | 12 of 20 | -14.6% |
| Respite (hourly) | T1005 | $14.04 / hour | 37 of 38 | -44.5% |
| Respite (daily) | S9125 | $51.25 / day | 33 of 34 | -78.8% |
Companion care is Idaho's closest line to the national middle. At $5.54 per 15 minutes on S5135, effective July 1, 2026, it sits 12th of 20. Homemaker on S5130 pays $5.26 per 15 minutes and places Idaho among the three lowest homemaker states, alongside Nebraska and Texas.
Respite is where Idaho falls furthest. Hourly respite on T1005 pays $3.51 per 15 minutes, ahead of only Indiana. Daily respite on S9125 at $51.25 is ahead of only New Hampshire. Adult day services are paid on S5100 at $2.68 per 15 minutes, or $10.72 an hour, and are not ranked against the daily national median.
The full dataset holds all 23,716 current Idaho Medicaid rates, each linked to its source on the Idaho Medicaid rates hub.
Idaho pays nearly all home care in 15-minute units. A rate of $6.11 per unit becomes $24.44 for a full hour, but only when every unit is documented. In a state where the hourly margin is measured in cents, rounding and documentation practices matter.
Two personal care codes
Idaho uses two codes for hands-on personal care. S5125, attendant care under the Idaho Aged and Disabled waiver, carries the ranked rate in this article. T1019, the State Plan personal care code, has its own rules. Billing teams should confirm which code each member's plan of care uses, because authorization and limits differ between them.
Daily versus hourly respite
Daily respite on S9125 is billed per day, hourly respite on T1005 per 15 minutes. Both are among the lowest in the country, so the choice between them is less about price than about which fits the family's need and the agency's staffing.
Idaho's aide wages are slightly below the national level, but not by enough to offset the low rates. The state median wage for home health and personal care aides was $16.72 an hour in May 2025, against a US median of $17.21. Registered nurses had a state median of $44.45, compared with $46.90 nationally.
Set against the published rates, the margins are thin to negative on every line:
- Personal care at $24.44 an hour. Wages take 97.2% of the rate, leaving $0.68 an hour after a loaded wage.
- Companion care at $22.16. Wages equal 107.2% of the rate, a small negative margin.
- Homemaker at $21.04. Wages equal 112.9% of the rate.
- Hourly respite at $14.04. Wages equal 169.2% of the rate.
In practice, only personal care breaks even at the median wage, and only just. An Idaho agency's viability depends on paying close to the median, keeping overtime and travel time down, and holding a service mix weighted toward personal care.
A margin of $0.68 an hour leaves no room for inefficiency. The agencies that operate sustainably in low-rate states tend to share a few practices.
Minimize unpaid time
Travel between clients, gaps in the schedule and late cancellations are unpaid. Clustering clients by area, scheduling longer visits and keeping a short list of nearby fill-in clients all convert paid hours from a smaller share of total aide time into a larger one.
Limit services that lose money
Companion care, homemaker and hourly respite all lose money at the median wage. Agencies can offer them to existing personal care clients, scheduled adjacent to personal care visits, without taking on stand-alone referrals that require separate trips.
Watch overtime closely
Overtime at time and a half turns a thin positive margin into a loss on every overtime hour. Scheduling tools that flag hours approaching the overtime threshold are worth their cost in Idaho.
Diversify payers
Private-pay clients, priced independently of Medicaid, are the main way agencies in low-rate states build a cushion. A modest private-pay share can carry the overhead that Medicaid hours cannot.
Three recent changes shape Idaho home care billing:
- 4% Medicaid provider rate reduction for dates of service from 9/1/2025. Idaho's homemaker and hourly respite rates both carry a September 1, 2025 effective date, matching the reduction.
- MA25-13 Family Personal Care Services (FPCS) Program Sunsetting, effective August 1, 2025.
- MA26-11 Residential Habilitation Rates - Amended, published May 6, 2026 and effective July 1, 2026. The personal care, companion, daily respite and adult day rates share that July 1, 2026 effective date.
What the sequence means
The 2025 reduction lowered rates across the board, and the July 2026 schedule is the current baseline for most hourly home care codes. Homemaker and hourly respite still carry the September 2025 date, meaning they were not refreshed in July 2026. The FPCS sunset ended a program through which family members were paid for personal care, which may have shifted some of those clients toward agency providers.
The coverage rules attach a weekly limit to adult day services on S5100, and both a weekly limit and 1 prior authorization rule to personal care on T1019. S5125, the code that carries Idaho's ranked attendant care rate, has no prior authorization rules or unit limit.
Weekly limits change how scheduling works. A client whose weekly allowance is used early in the week cannot receive further paid hours until the next week begins, so schedules should spread hours evenly and track remaining units by week, not by month.
Idaho's rule for home and community-based services and personal care is clear: they are paid directly by the state, outside managed care. The same rule applies to intellectual and developmental disability services. Home care under the Idaho Aged and Disabled waiver is billed to Idaho Medicaid fee-for-service at the published rates, not negotiated with a health plan.
Idaho does have 7 plans in our home care data, including Molina Healthcare of Idaho and UnitedHealthcare Community Plan of Idaho, but for home care the published schedule is the rate. The Idaho managed care page shows which service lines run through plans and which do not.
Nationally, personal care runs from Utah at $84.84 an hour down to Texas at $18.28. Idaho sits in the lower group, though above the very bottom on personal care. On respite, Idaho is among the lowest-paying states on both the hourly and daily rates. Neighboring Washington home care rates and Montana home care rates offer regional comparisons. Compare every state on the home care Medicaid rates by state page.
Three things will shape Idaho home care economics over the next year.
- Whether the reduction is reversed. The 4% reduction from September 1, 2025 still sits in the homemaker and hourly respite rates. A restoration would matter most to those two lines, which already run negative margins at the median wage.
- The July fiscal-year update. Most hourly home care codes carry a July 1, 2026 effective date, which shows the state reissuing rates on a July cycle. Agencies should budget for the next update rather than assume rates will hold.
- Workforce supply after the FPCS sunset. With the Family Personal Care Services program ended, some caregivers who were previously paid as family members may move into agency employment, and some clients may move to agency care. Agencies with capacity to absorb both can grow, but only if they can do so without paying above the narrow wage ceiling the personal care rate allows.
Each of these is worth tracking through Idaho Medicaid's provider notices, since rate changes take effect on the stated date whether or not an agency has updated its billing system.
- Budgeting. Model each service at its unit rate and the wage you actually pay; at Idaho margins, the statewide median may not match your payroll.
- Service mix. Weight the business toward personal care and treat other lines as add-ons for existing clients.
- Scheduling. Track weekly limits for T1019 and adult day clients.
- Advocacy. Ranks of 37th of 38 and 33rd of 34 for respite are clear figures for public comment.
Rates are compiled from official Idaho Medicaid publications, including the Idaho Medicaid Numerical Fee Schedule for July to September 2026 and the Aged and Disabled Waiver Services 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.