Wisconsin home care Medicaid rates are built around a managed long-term care system rather than a single fee-for-service schedule. On the services we can rank, Wisconsin pays $203.44 a day for respite on S9125, 21st of 34 states and 16.0% below the national median of $242.21. Its monthly fee for self-direction administration, $36.75 on T2041, is the lowest of 14 ranked states.
For a home care agency, the most important Wisconsin fact is not either of those numbers. It is that Wisconsin runs Family Care and Family Care Partnership as managed long-term care programs, and publishes a minimum HCBS fee schedule those plans must pay. Every figure below is compiled from official Wisconsin Medicaid publications and linked to its source document.
Wisconsin lists two state-set managed long-term care programs: Wisconsin Family Care (managed long-term care, PIHP) and Wisconsin Family Care Partnership (integrated acute and long-term care, D-SNP aligned). Alongside them sits the Family Care and Partnership HCBS minimum fee schedule, described as state-set floors MCOs must pay.
That structure changes how an agency should read Wisconsin rates. A published floor is the least a plan may pay, not necessarily the rate an agency receives under contract. Plans on file for Wisconsin include Community Care Family Care, Anthem Blue Cross and Blue Shield Family Care and Community Care Health Plan - Partnership.
Wisconsin also runs the Children's Long-Term Support (CLTS) Waiver, which is fee-for-service with a statewide uniform rate schedule, and Wisconsin Medicaid and BadgerCare Plus, paid from ForwardHealth maximum allowable fees.
In a fee-for-service state, the published rate is the payment. In Wisconsin's Family Care system, it is the starting point. Three layers decide what a home care agency receives:
- The minimum fee schedule. The state sets floors that Family Care and Partnership MCOs must pay for covered HCBS.
- The MCO contract. Each plan negotiates its own rates with providers, at or above the floor.
- State directed payments. CMS-approved arrangements require plans to pay HCBS providers in specified ways for a calendar year.
For an agency, the practical work is comparing each MCO's contract rates against the floor, and understanding how directed payments flow through to its own claims. Two agencies in the same county can be paid differently for the same hour of care if they hold different plan contracts.
Wisconsin publishes several home care rates in 15-minute units:
- Personal care. S5108 pays $5.25 per 15-minute unit, effective January 1, 2025.
- Hourly respite. S5150 pays the same $5.25 per 15-minute unit, also effective January 1, 2025.
- Daily respite. S9125 pays $203.44 a day, 21st of 34 states.
- Adult day. S5105 with modifier U7 carries a published rate of $2.63, effective January 1, 2025.
Because the personal care and hourly respite rates are not published with an hourly conversion we can rank, they sit outside the national hourly comparisons. The national median for hourly personal care is $30.52, with Utah ($84.84) at the top and Texas ($18.28) at the bottom; for hourly respite the median is $25.30.
On daily respite, Wisconsin is in the lower middle of the ranking. Minnesota pays $938.09 a day and Pennsylvania $548.81; New Mexico ($73.09) and New Hampshire ($34.04) are lowest.
Units in Wisconsin home care
Personal care and hourly respite are published per 15-minute unit; daily respite per day; financial management per month. The U7 modifier on adult day and on T2041 identifies a specific program version of each code. Billing teams should set up each code-and-modifier pair as its own line, because the same code can carry a different rate in CLTS, fee-for-service and Family Care.
Not all Wisconsin home care runs through Family Care. The Children's Long-Term Support (CLTS) Waiver is paid fee-for-service on a statewide uniform rate schedule, and Wisconsin Medicaid and BadgerCare Plus pay from ForwardHealth maximum allowable fees.
That gives Wisconsin two very different payment environments inside one state:
- Family Care and Partnership for adults: plan contracts, minimum fee floors and directed payments.
- CLTS and fee-for-service: one published schedule, the same rate statewide, no plan negotiation.
An agency serving both children and adults works in both. The CLTS side offers rate certainty; the Family Care side offers room to negotiate above the floor. Agencies should price their services, and decide which programs to grow, with that difference in mind. A respite hour for a child under CLTS and a respite hour for an older adult under Family Care can carry different rates, different authorization processes and different payment timelines, even when the aide and the task are identical.
Wisconsin pays $36.75 a month for financial management services on T2041 with modifier U7, 67.8% below the $113.98 national median. It ranks 14th of 14 states. The next-lowest states are Alabama ($80.00) and Vermont ($89.00); the highest are California ($265.00), New York ($260.24) and Montana ($187.38).
For a fiscal agent weighing a Wisconsin contract, the published monthly fee is far below what most states pay, so volume and plan contract terms matter more than the base rate.
The median wage for home health and personal care aides in Wisconsin was $17.47 an hour in May 2025, just above the US median of $17.21. Registered nurses earned a median of $45.93, slightly below the national $46.90.
With the wage close to the national median, Wisconsin's home care economics depend heavily on what plans pay relative to the published floors. An agency comparing Wisconsin with other states should start from its MCO contract rates and treat the published minimum as the lower bound.
Wisconsin also allocated Direct Care Workforce payments for SFY 2025-2027, effective January 1, 2025. Payments of this kind are aimed at the direct care workforce, so agencies should account for them separately from base rates and follow any requirements on how the money reaches workers.
Several 2026 actions touch home care rates:
- ForwardHealth Update 2025-28: ForwardHealth Reimbursement Rate Increases, published October 31, 2025, effective January 1, 2026.
- Wis. Admin. Register 840A4: Public Notice: Notice of Personal Care Rate Increase, effective January 1, 2026.
- CMS approval of four Wisconsin HCBS state directed payment renewals (HCBS3, HCBS4, HCBS5 and HCBS9), approved March 30, 2026 and covering calendar year 2026.
The 2025-27 state budget, 2025 Wisconsin Act 15, includes a Personal Care Rate Increase as a DHS Medical Assistance item, which is the legislative basis for the January 2026 notice. The directed payment renewals matter for HCBS providers paid through plans. A state directed payment is an arrangement in which the state requires managed-care plans to pay providers in a specified way, and Wisconsin lists its managed care state directed payments as a program of their own.
We have 35 plans on file for Wisconsin, including BadgerCare Plus HMOs, SSI HMOs and the Family Care and Partnership MCOs. Our managed-care classification lists personal care and home and community-based services as paid directly by the state, outside the acute-care HMOs, while home health and private duty nursing follow a ceiling rule: plans may pay no more than the published rate. For the Family Care programs, the HCBS minimum fee schedule is the published reference. See the Wisconsin managed care page for each line.
In our coverage data, 99509, S5125 and T1019 carry no prior authorization rules and no unit limits. For agencies, that shifts the administrative work away from code-level approvals and toward the authorization and contract terms set by each plan, which is where Wisconsin home care billing is decided in practice.
Self-direction lets a person or family hire their own worker, with a fiscal agent handling payroll and employer paperwork. Wisconsin's $36.75 monthly fee for that service is far below every other ranked state.
For fiscal agents, that rate rewards scale and automation: a provider serving many self-directing families with efficient payroll systems can make it work, while one serving a few cannot. For families, the low administrative fee does not change the worker's pay, which is set separately. Agencies that offer both traditional agency care and self-direction support should account for them as different businesses with different cost structures.
- Minnesota home care rates lead the country on daily respite at $938.09.
- Illinois home care rates and Michigan home care rates are the closest regional comparisons.
- Vermont home care rates pay $89.00 a month for self-direction financial management.
The national home care overview compares every state.
Contracting. Compare each MCO's rates against the HCBS minimum fee schedule line by line, and ask how directed payments are applied to your claims.
Budgeting. Forecast by program: Family Care, Partnership, CLTS and fee-for-service each price the same code differently.
Wage planning. Use the January 2026 personal care increase and Direct Care Workforce payments to support aide pay in a market where wages sit at the national median.
Rates on this page are compiled from official Wisconsin publications, including ForwardHealth maximum fee schedules and the Family Care HCBS minimum fee schedule, and each links to its source document. Wisconsin's full dataset holds all 83,088 current Wisconsin Medicaid rates; the Wisconsin Medicaid rates hub has the full fee schedule. Our methodology explains how rates are converted and ranked.