North Dakota home care Medicaid rates follow a simple rule that few states use: one hourly price for most agency services. North Dakota Medicaid pays $9.59 per 15 minutes, or $38.36 an hour, for personal care on T1019. That ranks 6th of 27 states with a comparable rate and is 25.7% above the national median of $30.52.
The same $38.36 hourly rate applies to homemaker services on S5130 and hourly respite on S5150. Because the national medians for those services differ, the single rate lands in very different places in each ranking: 2nd of 9 for homemaker, 7th of 38 for respite. Companion care is the exception, paid at a lower rate. All rates are compiled from official state Medicaid publications and link to their source documents on the North Dakota Medicaid rates hub.
All of North Dakota's current home care rates took effect on July 1, 2026. They are published in the state's Medicaid home and community-based services fee schedule and in the Adults and Aging HCBS Qualified Service Provider (QSP) rates. North Dakota's program list also includes the HCBS Medicaid waiver for aged and physically disabled adults (ND.0273) and the state-funded Service Payments for the Elderly and Disabled (SPED and Expanded SPED) program, which is not Medicaid.
At $38.36, North Dakota sits just behind Missouri ($39.00) and Delaware ($39.35) on personal care, and ahead of most of the country. The highest rate is Utah at $84.84 an hour on S5125, followed by Oregon ($42.24) and Iowa ($42.00). The lowest are Pennsylvania ($19.48), Louisiana ($19.08) and Texas ($18.28).
North Dakota funds home care for older adults and adults with physical disabilities through several programs that share one provider system:
- The HCBS Medicaid Waiver for aged and physically disabled adults (ND.0273), for people who meet a nursing facility level of care.
- Medicaid state plan personal care, billed on T1019.
- Service Payments for the Elderly and Disabled (SPED) and Expanded SPED, state-funded programs that are not Medicaid but use the same Qualified Service Provider network.
Providers in these programs enroll as Qualified Service Providers (QSPs), either as agencies or as individuals. The ranked rates on this page are the agency provider rates; the full QSP rate list can carry different amounts for the same code depending on provider type, so an individual QSP should check the line that applies to them.
Developmental disability services run separately under the Traditional IID/DD waiver (ND.0037) and its own payment system; see the North Dakota IDD rates page.
North Dakota publishes rates for most of the home care lines we compare:
| Service | Code | North Dakota per hour | Rank | vs national median |
|---|---|---|---|---|
| Personal care | T1019 | $38.36 | 6 of 27 | +25.7% |
| Homemaker | S5130 | $38.36 | 2 of 9 | +24.5% |
| Respite (hourly) | S5150 | $38.36 | 7 of 38 | +51.6% |
| Companion care | S5135 (TF) | $27.04 | 9 of 20 | +4.2% |
Homemaker. Only Kentucky, at $39.00, pays more for S5130. Homemaker is the thinnest data set in home care nationally, with a $30.80 median, so North Dakota's rate is one of the few published benchmarks at the top of the range.
Respite. The 51.6% gap above the $25.30 national median is the largest of any North Dakota service. Virginia ($74.04), New York ($59.32) and South Dakota ($43.24) pay more per hour, but North Dakota is ahead of Maine ($39.48) and most other states. North Dakota has no comparable daily respite rate on file.
Companion care. S5135 with modifier TF pays $6.76 per 15 minutes, or $27.04 an hour, slightly above the $25.96 median. Its neighbor South Dakota pays $43.24 for the same code.
Adult day. North Dakota pays adult day on S5101 at $80.38 for a half-day maximum unit. Because the unit is a half day rather than a full day, it is not ranked against the $68.67 national daily median.
North Dakota home health and personal care aides earned a median of $18.96 an hour in May 2025, above the US median of $17.21. Registered nurses had a median of $38.81, well below the $46.90 national figure.
The single rate makes the margin math identical across three services. For personal care, homemaker and hourly respite alike, the aide wage takes 70.3% of the $38.36 rate, leaving a margin of $11.41 an hour after loaded wages. Companion care is a different story: the wage takes 99.7% of the $27.04 rate, leaving a margin of $0.09 an hour.
For an agency, that means North Dakota rewards hours billed as personal care, homemaker or respite, and treats companion hours as a near break-even service. The higher-than-average aide wage is covered comfortably by the shared rate but not by the companion rate.
Nursing costs work in the agency's favor. With registered nurses earning a state median of $38.81, well below the national $46.90, any nurse oversight an agency provides costs less here than in most states. Together with an aide wage that the shared rate covers with room to spare, that makes North Dakota one of the more forgiving states for an agency's cost structure, provided its hours are concentrated in personal care, homemaker and respite.
The main pressure point is rural distance. A strong hourly rate pays only for time spent with the client, so long drives between visits in a sparsely populated state come out of the $11.41 margin. Clustering clients and scheduling longer visits protects it.
North Dakota's coverage data shows no prior authorization rules on any home care code we track: S5100, S5101, S5115, S5130, S5135, S5150 and T1019 all show zero. Instead, three codes carry monthly limits: T1019, S5135 and S5150.
The practical effect is that billing risk shifts from getting approval to staying under the cap. An agency serving a client across personal care, companion and respite needs to track units against each monthly limit separately.
North Dakota adjusts home care rates every July 1 through its state plan public notices:
- Public Notice - Medicaid State Plan Changes for July 1, 2026, listed change 2.0%.
- Public Notice - Medicaid State Plan Changes for July 1, 2025, listed change 2.0%.
- Public Notice - Medicaid State Plan Changes for July 1, 2024, listed change 3.0%.
- Public Notice - Medicaid State Plan Changes for July 1, 2023, listed change 3.0%.
- SPA ND-23-0015, a 3.5% inflationary increase for Personal Care Services, effective July 1, 2023.
The pattern is steady annual steps rather than one-time jumps, and the result is a rate set that sits in the upper part of the national rankings.
The fee schedules for dates of service from July 1, 2026 were posted in a provider update on July 18, 2026, with the same 2.0% change. For an agency, the July cycle is predictable enough to build into the budget calendar: plan for a modest July increase and confirm the posted schedule before adjusting wages.
North Dakota's home care is paid from published fee schedules, outside any risk-based managed care program. We have 5 plans on file for the state, including Blue Cross Blue Shield of North Dakota, Northland PACE and Primary Care Case Management (PCCM). Our managed-care summary sets rules only for hospital inpatient and outpatient care, where the state sets the rate plans pay, and lists no plan rule for home and community-based services. Northland PACE, as a PACE program, arranges in-home care for its own enrollees under its own contracts. See the North Dakota managed care page for details.
For a home care agency, the practical result is one payer and one schedule: no plan negotiation, and every rate change reaches all providers on the same date.
North Dakota sits in a strong group of Upper Midwest home care states. South Dakota pays more for companion care and hourly respite; Minnesota leads the country on daily respite but pays $21.00 an hour for PCA personal care; Montana pays $36.92 for personal care, slightly below North Dakota. Compare North Dakota with Utah at the top of the personal care ranking, or see every state in the national home care overview.
Weight the mix toward the shared rate
Personal care, homemaker and respite all earn $11.41 an hour after loaded wages. Companion care earns $0.09. Where a client's needs can be met under more than one service, the authorization should reflect the service that matches the care actually delivered; agencies should not rely on companion hours to carry overhead.
Manage monthly caps
With monthly limits on T1019, S5135 and S5150, track units per client per month. Hours delivered after a cap is reached are unpaid.
Plan wages with the July step
With steady annual increases of 2.0% to 3.0% in recent years, wage increases can be planned on a July cycle that matches the rate updates.
Rates on this page are compiled from official state Medicaid publications, including the North Dakota Medicaid HCBS fee schedule, the Adults and Aging HCBS QSP rates and the state plan public notices named above. Each rate links to its source document on the North Dakota Medicaid rates hub, which covers all 19,715 current North Dakota Medicaid rates. Wage figures are state and US medians for May 2025.
Our methodology explains hourly conversions and ranks, and the pricing page describes access to the full dataset.