West Virginia home care Medicaid rates rank below the national middle, but they sit on top of an aide wage far below the national median. West Virginia Medicaid pays $6.75 per 15 minutes for personal care on S5125 with modifier UB, or $27.00 an hour. That ranks 18th of 27 states with a comparable rate and is 11.5% below the national median of $30.52.
The low rank hides a better margin than the number suggests. West Virginia aides earn a median of $13.47 an hour, so even a below-median rate leaves a positive margin on personal care. And the current rate is the product of two recent increases: 27.2% in October 2024 and 6.12% in October 2025. Every figure below is compiled from official West Virginia Medicaid publications and linked to its source document.
The current S5125 rate took effect on October 1, 2025. West Virginia's home care programs include the Aged and Disabled Waiver (ADW), the Traumatic Brain Injury Waiver (TBIW) and the Intellectual/Developmental Disabilities Waiver (IDDW), alongside West Virginia Medicaid fee-for-service, administered by the Bureau for Medical Services.
Nationally, hourly personal care runs from Utah's $84.84 on S5125 down to Texas at $18.28. Oregon ($42.24), Iowa ($42.00), Delaware ($39.35) and Missouri ($39.00) round out the top five; Pennsylvania ($19.48) and Louisiana ($19.08) join Texas at the bottom. West Virginia is in the lower half but well clear of the bottom three.
West Virginia bills in-home services in 15-minute units on national codes, and it uses modifiers to identify the program and provider version of each service. The UB modifier marks the personal care rate on S5125 compared here, and the HA modifier marks the hourly respite rate on T1005.
For billing staff, two practical points follow:
- Four units make an hour. The $27.00 hourly figure is four units of $6.75. Partial units that are not documented are not paid, so visit records should capture exact start and end times.
- Program decides the row. An agency serving the Aged and Disabled Waiver and the Traumatic Brain Injury Waiver should set up separate rate rows for each, rather than assuming one personal care rate applies everywhere.
West Virginia's recent changes are large by any measure:
- HCBS rate increases effective October 1, 2024 (BMS memo August 22, 2024), with a listed change of 27.2%.
- HCBS and Personal Care rate increases effective October 1, 2025 (BMS letter October 10, 2025), with a listed change of 6.12%.
- An HCBS rate setting brief from December 2023 proposed rates with a listed change of 29.27%.
- State Plan Amendment (SPA) 22-0009, Personal Care Services, a public notice published March 23, 2022, with a proposed effective date of April 1, 2022.
The 2025 increase names personal care alongside HCBS, while the 2024 increase names HCBS alone. For agencies, the sequence means the current rates are recent, and both increases took effect on October 1, the date to watch for the next West Virginia rate change.
What two increases in two years mean
Large increases close together usually reflect a rate study catching up with costs, and West Virginia's December 2023 rate setting brief preceded the 2024 increase. The practical lesson for an agency is that rates which had fallen behind wages have been reset, but the next movement is less certain. Budgets for the coming year should assume the current rates hold until a new BMS letter says otherwise.
West Virginia's rate set is narrower than most. It has ranked rates for personal care and hourly respite only:
| Service | Code | West Virginia per hour | Rank | vs national median |
|---|---|---|---|---|
| Personal care | S5125 (UB) | $27.00 | 18 of 27 | -11.5% |
| Respite (hourly) | T1005 (HA) | $20.04 | 28 of 38 | -20.8% |
Hourly respite on T1005 pays $5.01 per 15 minutes, effective October 1, 2024. The national median is $25.30; Virginia pays $74.04, New York $59.32 and South Dakota $43.24, while Nebraska ($14.95), Idaho ($14.04) and Indiana ($14.00) are lowest.
West Virginia has no comparable rate on file for homemaker, companion care, daily respite, adult day or self-direction fees, so agencies cannot benchmark those services against other states.
The median wage for home health and personal care aides in West Virginia was $13.47 an hour in May 2025, against a US median of $17.21. Registered nurses earned a median of $38.52, compared with $46.90 nationally.
That wage gap is what makes the West Virginia numbers work:
- Personal care. The aide wage takes 70.9% of the $27.00 rate, leaving a margin of $7.86 an hour after loaded wages.
- Hourly respite. The wage takes 95.5% of the $20.04 rate, leaving $0.90 an hour.
A personal care hour in West Virginia earns a positive margin even though the rate is below the national median. Respite is close to break-even and works only as part of a mix weighted toward personal care. The 2024 and 2025 increases give agencies room to pay aides above the state median, which matters when the state median sits at $13.47 against $17.21 nationally.
West Virginia's margin on personal care is one of its main advantages for agencies. With $7.86 an hour left after a loaded median wage, an agency has real choices:
- Pay above the state median. Recruiting is often the limit on growth. An agency that pays above $13.47 can fill more authorized hours, and each filled hour earns the margin.
- Fund supervision and training. Registered nurses in West Virginia earn a median of $38.52, below the national level, so nurse oversight costs less than in most states.
- Keep respite as a supporting line. At $0.90 an hour, hourly respite does little more than cover the aide. It works best for families already receiving personal care, where it strengthens the relationship without adding much overhead.
The trade-off is that any wage increase spends margin directly. An agency should decide how much of the $7.86 it will spend on wages before committing to a pay scale.
West Virginia attaches prior authorization rules to its main home care codes. S5125 and T1019 carry 4 rules each, and T1019 also carries a monthly limit. T1005 carries 2 rules. S5130 carries none.
Agencies billing both S5125 and T1019 need to track authorization separately for each and manage T1019 units against the monthly cap.
Home care in West Virginia is funded through fee-for-service West Virginia Medicaid and four 1915(c) waivers:
- Aged and Disabled Waiver (ADW), for older adults and adults with physical disabilities. It carries homemaker and personal care lines.
- Traumatic Brain Injury Waiver (TBIW), which publishes its own attendant care rate.
- Intellectual/Developmental Disabilities Waiver (IDDW), the largest of the four by number of rates.
- Children with Serious Emotional Disorder Waiver (CSEDW), which includes respite for families of children with serious emotional disorders.
Each waiver has its own eligibility, service definitions and authorization path. A West Virginia agency that serves more than one waiver should tag every client to a waiver at intake, keep rate tables per waiver and check that the modifier on each claim matches the waiver that authorized the hours. That discipline matters more when margins on some lines, such as respite, are under a dollar an hour, because a single mispriced claim can wipe out the contribution of many correctly billed ones.
West Virginia has 5 plans on file, including Aetna Better Health of West Virginia, Highmark Health Options West Virginia, The Health Plan of West Virginia, UniCare Health Plan of West Virginia and Wellpoint West Virginia.
For home care, those plans are not the payer. Personal care, home and community-based services and private duty nursing are all paid directly by the state, outside managed care. Home health is different: plans negotiate, and the published rate applies out of network. See the West Virginia managed care page for every line.
For an agency, the state-paid model means one schedule, one payer and no plan-by-plan rate negotiation for personal care. Rate changes arrive through BMS letters and memos, not through contract renewals.
- Virginia home care rates lead the country on hourly respite at $74.04.
- North Carolina home care rates are the closest southern comparison.
- Pennsylvania home care rates sit near the bottom for personal care at $19.48.
The national home care overview compares every state.
Budgeting. Forecast personal care and respite separately; their margins differ by a factor that a blended rate hides.
Authorization tracking. Track T1019 units against the monthly cap and keep S5125 and T1019 authorizations apart.
Wage planning. Decide how much of the personal care margin to invest in pay before the next October 1 rate date.
Watching changes. Follow BMS letters and memos in late summer and early autumn, when West Virginia's recent increases were announced. Update billing systems before October 1 so new rates apply from the first date of service.
Each rate is compiled from official West Virginia Medicaid publications from the Bureau for Medical Services and links to its source document. West Virginia's full dataset holds all 88,707 current West Virginia Medicaid rates, with history back to 2017; the West Virginia Medicaid rates hub has the full fee schedule. Our methodology explains how hourly conversions and ranks work.