Home health Medicaid rates in Hawaii sit near the bottom of the national ranking for the one discipline that can be compared. Hawaii's Med-QUEST program pays $20.00 per home health aide visit on code T1021, which ranks 13th of 14 ranked states and is 61.8% below the national median of $52.32.
What makes Hawaii distinctive is that the state has already acted on the problem. HB713 CD1 (2025), effective 2025-07-01, enacted a rate study for Medicaid home health services. The $20.00 aide rate has been in effect since 2024-03-04, so the study's results are the most important thing to watch for any Hawaii agency.
| Service | Code | Hawaii rate | Unit | Rank | vs national median |
|---|---|---|---|---|---|
| Home health aide visit | T1021 | $20.00 | visit | 13 of 14 | -61.8% |
Hawaii has no nurse visit, physical therapy, occupational therapy or speech therapy rate in this comparison. For reference, the national medians are $23.96 per 15 minutes for nursing, $120.52 an hour for physical therapy, $117.42 an hour for occupational therapy and $29.50 per 15 minutes for speech therapy.
Hawaii's Medicaid program is Med-QUEST. Most members are enrolled in QUEST Integration managed-care plans, and the Med-QUEST fee-for-service schedule sets the published rate that applies outside those plans. Med-QUEST updates fee-for-service rates through numbered memos, such as the QI memos that carry its annual rate updates.
The per-visit aide rate
T1021 is a per-visit code. One payment covers the visit, whatever its length. That gives billing teams a simple claim, but it also means the agency carries all the risk of long visits and long drives.
Why only the aide visit is ranked
Hawaii publishes home health services in ways that do not map onto the national nurse and therapy comparisons. Only the aide visit can be placed on a common basis with other states, so it is the only Hawaii home health rate in the ranking.
Hawaii's $20.00 per visit sits between North Dakota ($20.56) above it and Florida ($18.04) below it. Those three states form the bottom of the aide ranking.
At the top, Minnesota pays $80.62 per visit and Utah $79.96, followed by Mississippi ($75.48), New Jersey ($66.66) and Arkansas ($66.63). A Hawaii aide visit pays a fraction of those amounts for the same code.
Because T1021 is a flat per-visit rate, the effective hourly pay depends on visit length and drive time. On islands where travel between homes can be long, that structure puts more pressure on a low per-visit rate than it would in a dense urban market.
Hawaii pays more for home health labor than most states, which makes the low aide rate harder to work with:
| Role | Hawaii median hourly wage | US median hourly wage |
|---|---|---|
| Registered nurse | $65.54 | $46.90 |
| Licensed practical nurse | $34.20 | $30.96 |
| Home health / personal care aide | $18.32 | $17.21 |
| Physical therapist | $48.90 | $49.40 |
| Occupational therapist | $49.46 | $48.24 |
| Speech-language pathologist | $46.90 | $47.05 |
The aide wage of $18.32 is above the US median, while the aide visit rate is 61.8% below the national median. That is the core tension in Hawaii home health. The registered nurse wage of $65.54 is far above the US median of $46.90, which makes any nursing service expensive to staff even though no nursing rate is compared here.
Therapist wages are close to national levels, so therapy staffing costs in Hawaii are not unusual. The pressure in Hawaii is concentrated on nurses and aides, the two roles that make up most home health visits.
At the Hawaii aide median wage of $18.32 an hour, the $20.00 visit payment leaves very little once the aide's time is paid. Everything else a visit carries has to fit into what is left: drive time between homes, payroll taxes, workers' compensation, nurse supervision of aides, scheduling and billing staff, and the agency's licensure costs.
What that means in practice
For most agencies, the answer is that the Medicaid aide visit cannot stand on its own in Hawaii. It works only as part of a broader mix, alongside Medicare skilled episodes, private-pay hours or negotiated plan rates above the fee schedule. Agencies that model the aide line in isolation will usually find it loses money per visit; agencies that model the whole caseload can decide how much Medicaid aide work their other lines can support.
HB713 CD1 (2025) is the one recent change on file for Hawaii home health, and it is a study rather than a rate increase. It took effect on 2025-07-01. For providers, the practical point is that a study is the step that typically precedes a rate change, so the current $20.00 aide rate should be read as a rate under review.
How agencies can prepare
Agencies with a stake in the result should track the study's findings and any follow-up legislation, and benchmark their own costs against the wage figures above. The gap between local wages and the per-visit rate is the strongest evidence any Hawaii agency has. Cost data by visit type, including travel time between islands and across rural areas, is exactly what a rate study needs to see.
Hawaii has 9 plans on file, including AlohaCare, the Hawaii Medical Service Association (HMSA), Kaiser Foundation Health Plan and UnitedHealthcare. Its programs include QUEST Integration and Community Care Services. The rule for home health is that plans negotiate their rates and the published rate applies out of network. The same rule applies to home and community-based services, personal care, private duty nursing and therapy.
That is a meaningful difference from states where plans must pay at least the published rate. In Hawaii, the $20.00 fee-for-service rate is the out-of-network benchmark, and an agency's in-network rate depends on what it negotiates with each plan. Agencies with strong local coverage, especially on neighbor islands where few agencies operate, can use that leverage; smaller agencies may find the fee schedule is effectively the ceiling.
The plan landscape is also changing. A Med-QUEST memo moves the Community Care Services program to AlohaCare effective November 1, 2026. Agencies serving CCS members should confirm their contracts with AlohaCare before that date. The Hawaii managed-care page lists the plans and every line's rule.
No coverage or prior authorization rules are recorded for Hawaii home health codes in this comparison, and no unit limits are on file for T1021. For agencies, that means the fee-for-service aide visit carries little code-level administrative friction.
The larger administrative task is contracting. Because plans negotiate home health rates, each plan relationship has its own authorization process, rate and billing terms to track. An agency with contracts across several plans effectively manages several fee schedules.
Hawaii's nearest comparison states pay very differently. Washington is in the top tier of the aide ranking at $66.48 per visit, more than three times Hawaii's rate. For a state whose wages are among the highest in the country, sitting next to Florida at the bottom of the ranking is the clearest sign of how far the aide rate lags.
Related lines in Hawaii may offer better economics. Agencies that also deliver personal care should compare the Hawaii home care rates, and those staffing extended shifts should see the Hawaii private duty nursing rates.
Three developments will shape Hawaii home health over the next year.
The first is the rate study. Its findings, and whether the Legislature funds a new rate, will decide whether the $20.00 aide visit changes at all. Agencies should watch for the study report and for any bill that follows it in the next legislative session.
The second is the annual Med-QUEST rate memo. Med-QUEST issued QI-2614 with fee-for-service rate updates effective July 1, 2026, which shows the state's usual cycle: a memo each summer that adjusts selected fee-for-service rates. Home health agencies should read each year's memo for any change to T1021, even when the headline update concerns other services.
The third is plan contracting. With the Community Care Services program moving to AlohaCare in November 2026, agencies that serve long-term care members will need to confirm that their authorizations and rates carry over. Because plans negotiate home health rates in Hawaii, a change of plan can mean a change of rate for the same patient.
Each of these can move an agency's revenue more than any routine fee schedule update, so they belong on the same calendar as payroll and licensure renewals.
For budgeting, treat $20.00 as the out-of-network floor and build plan-by-plan revenue on the rates you have negotiated. For planning, assume the rate study could change the figure, but do not budget for an increase until one is enacted. For advocacy and negotiation, the wage table above is the most persuasive evidence.
The Hawaii Medicaid rates page covers all 17,383 current Hawaii rates, and the pricing page explains full access with source documents and effective dates.
All Hawaii rates are compiled from official state Medicaid publications, including the Med-QUEST fee-for-service fee schedule and QI memos, and each rate links to its source document. See the methodology for how aide visit rates are ranked, and the home health hub for every state's figures.