Home health Medicaid rates in North Dakota sit near the bottom of the national ranking for aide visits. North Dakota Medicaid pays $20.56 per home health aide visit on code T1021, which ranks 12th of 14 ranked states and is 60.7% below the national median of $52.32. Only Hawaii ($20.00) and Florida ($18.04) pay less.
What makes North Dakota unusual is the labor market behind that rate. The state's median home health aide wage is $18.96 an hour, above the $17.21 national median. North Dakota is one of the few states where a low aide visit rate meets an above-average aide wage, and that combination shapes how agencies here staff and schedule.
The aide visit on code T1021 is North Dakota's only ranked home health rate. At $20.56 per visit, effective July 1, 2026, it compares with:
- the national median of $52.32 per visit;
- the top-paying states, Minnesota at $80.62 and Utah at $79.96, both on T1021;
- Mississippi ($75.48), New Jersey ($66.66) and Arkansas ($66.63) in the rest of the top five;
- Hawaii at $20.00 and Florida at $18.04, the two states below North Dakota.
North Dakota's neighbor Minnesota pays the highest aide visit rate in the country on the same code. For an agency operating near the border, the same service is paid at very different levels depending on which state's Medicaid program covers the member.
A per-visit rate pays the same amount whether the aide stays 30 minutes or two hours. At North Dakota's level, that design matters more than the headline number.
Visit length is the deciding factor
An aide visit paid at $20.56 against a median wage of $18.96 an hour barely covers one hour of the aide's paid time before anything else. Payroll taxes, travel, supervision, scheduling and documentation all come on top. Short, focused visits are the only way the rate covers its costs; long visits lose money on every occurrence.
Travel is the hidden cost
North Dakota is large and sparsely populated. A visit that requires a long drive each way can consume more paid aide time than the visit itself. Agencies that succeed with aide services here tend to build routes around clusters of patients in the same town and avoid isolated single visits wherever possible.
When a different service line fits better
Some patients who need long hours of hands-on help are better served under personal care or home and community-based services rather than the home health aide visit. Those lines are paid on time-based units under separate schedules. See North Dakota home care rates for personal care.
North Dakota pays home health nursing on code T1030 at $77.36 per day, also effective July 1, 2026. Because it is a daily rate, it is not placed in the national nurse visit ranking, which compares states per 15 minutes. For context, the national median there is $23.96 per 15 minutes, with the District of Columbia highest at $155.16 and California lowest at $15.21. Our methodology explains why per-day and per-visit rates are not converted.
A daily rate fits short, routine nursing contacts well. A registered nurse at North Dakota's median wage of $38.81 who completes a one-hour visit leaves room in $77.36 for travel and overhead. A nurse who spends much longer does not. Agencies should plan which patients fit the daily structure and which need continuous hourly nursing under the state's separate private duty nursing benefit; see North Dakota private duty nursing rates.
No home health physical, occupational or speech therapy rates appear in North Dakota's home health data. Therapy delivered by a North Dakota agency is billed under the state's therapy schedules rather than as a home health visit.
That has two practical effects. First, therapy revenue follows the time-based therapy codes rather than a flat home health visit rate, so documentation of treatment time matters. Second, policy changes to therapy reach home-based therapists directly: North Dakota Medicaid updated its physical, occupational and speech therapy policies effective February 1, 2026, with a clarification posted January 28, 2026. Agencies should read those updates alongside the North Dakota therapy rates.
Median hourly wages for home health roles in North Dakota in May 2025, against the national medians:
| Role | North Dakota | United States |
|---|---|---|
| Registered nurse | $38.81 | $46.90 |
| Licensed practical nurse | $29.95 | $30.96 |
| Home health / personal care aide | $18.96 | $17.21 |
| Physical therapist | $41.02 | $49.40 |
| Occupational therapist | $40.00 | $48.24 |
| Speech-language pathologist | $36.17 | $47.05 |
The aide row is the only one where North Dakota is above the national figure, and it is the role with the lowest-ranked rate. Agencies in this position keep aide visits short and routes tight, or they focus on service lines where the rate and wage relationship is easier.
Nursing looks different. North Dakota's registered nurse median of $38.81 is below the national $46.90, and the licensed practical nurse median of $29.95 is close to the national $30.96. The daily T1030 rate of $77.36 is paid per day of service rather than per visit length, so its value to an agency depends on how much nursing time each day involves. Therapist wages are well below the national medians across all three disciplines, which helps agencies that bill therapy under the state's therapy schedules.
North Dakota's recent changes point to small, regular increases rather than large resets:
- July 1, 2026: a public notice of Medicaid state plan changes proposed a 2.0% change, and the fee schedules for dates of service from July 1, 2026 were posted on July 18, 2026.
- July 1, 2025: a state plan notice proposed a 2.0% change, and CMS approved SPA ND-25-0018, a rate increase for home health services, on October 14, 2025.
- July 1, 2024 and July 1, 2023: state plan notices each proposed a 3.0% change.
The current T1021 and T1030 rates carry July 1, 2026 effective dates, in line with that annual cycle. Even with steady increases of this size, the aide visit remains far from the national median, so agencies should plan around the current level rather than expect North Dakota to close the gap quickly.
The approval timing is worth noting too. SPA ND-25-0018 took effect July 1, 2025 but was approved in October 2025. When approval lags the effective date, the new rates may be paid retroactively, so billing teams should watch for adjustments to claims from the gap period.
The coverage data for North Dakota's home health codes is simple: T1021, T1030 and T1031 each show 0 prior authorization rules. That keeps the administrative load on aide and nursing visits lighter than in states that attach authorization rules to every home health code.
Lighter authorization is a genuine cost saving. In states with heavy authorization rules, intake staff time is a large part of the cost of each case. In North Dakota, that time can go to scheduling and routing instead, which is where the aide rate needs the most help. Agencies should still keep physician orders and plans of care current, since a missing order is a common reason for denial even where authorization is not required.
The rates above are the North Dakota Medicaid fee-for-service rates. The state has 5 plans in its home health data, including Blue Cross Blue Shield of North Dakota, Northland PACE and the Primary Care Case Management (PCCM) program.
North Dakota's managed-care rules cover hospital inpatient and outpatient services, where the state sets the rate plans pay; no separate rule is recorded for home health. In practice, most North Dakota home health is billed against the published fee-for-service schedule, and agencies dealing with a plan or PACE program should confirm in writing how that plan pays home health visits. The North Dakota managed care page shows those rules in full.
North Dakota sits in the West North Central region alongside Minnesota, the top-paying aide state, and Nebraska, which ranks 7th. South Dakota is the other close neighbor to compare. The spread inside the region is wider than in most of the country, which makes the border a real business consideration for agencies in eastern North Dakota.
- Cap aide visit length. At $20.56 per visit, short visits are the only ones that cover their costs.
- Route by geography. Group aide and nursing visits by town to limit unpaid drive time.
- Match patients to the right benefit. Long-hour needs may fit personal care or private duty nursing better than home health.
- Budget the July update. Model each July at the recent 2.0% to 3.0% range, then replace the estimate when schedules are posted.
- Use the light authorization rules. Redirect intake time to scheduling and documentation quality.
All rates are compiled from official state Medicaid publications, including North Dakota Medicaid's fee schedules for dates of service from July 1, 2026, with a link to each source document. North Dakota publishes all 19,715 current Medicaid rates across 101 service categories. Rankings compare states on a common unit; daily rates are shown but not ranked. Wages are May 2025 medians.
For how North Dakota compares across every state and discipline, see home health Medicaid reimbursement rates by state, or the full North Dakota Medicaid fee schedule.