North Carolina Hospice Medicaid Rates (2026)

Hospice Medicaid rates in North Carolina track the national median closely. North Carolina Medicaid pays $186.00 a day for routine home care, against a national median of $186.66 across 35 states, and $66.94 an hour for continuous home care, against a median of $66.11. Its two ranked rates sit in the middle of the field: inpatient respite is 8th of 19 states and general inpatient care 9th of 18, at 0.1% above the median.

North Carolina's distinctive feature is its track record. Its hospice rates have risen every October for four straight years, most recently by 4.14% effective October 1, 2026. Combined with wages that sit below the national median for every hospice role, that makes North Carolina one of the more workable median-rate states for a hospice. This page explains each level of care, the annual update cycle, and how NC Medicaid Managed Care plans fit in.

All four rates are effective October 1, 2026. For a hospice that operates in several states, North Carolina is close to a benchmark state: its rates track the national medians across all four levels of care, so it is a useful yardstick when judging whether another state pays well or poorly.

North Carolina bills hospice on institutional revenue codes, one per level of care: 0651 for routine home care, 0652 for continuous home care, 0655 for inpatient respite and 0656 for general inpatient care. In many other states the same levels are billed on HCPCS codes such as T2042 through T2045.

Daily and hourly units

Three levels are paid per day. A routine day pays the same whether the team visits once or several times. Continuous home care is the exception: it is paid by the hour, for crisis periods when a patient needs predominantly nursing care at home.

Program structure

Fee-for-service hospice claims run through NC Medicaid Direct. Members enrolled in NC Medicaid Managed Care are paid by their plan, under the contract terms described below.

North Carolina's hospice rate postings show a steady run of annual updates, each effective October 1:

1. Rates effective October 1, 2026. Posted October 1, 2026, with a 4.14% change.
2. Rates effective October 1, 2025. Posted October 1, 2025, with a 3.36% change; a later posting dated October 1, 2026 for the same effective date recorded 3.54%.
3. Rates effective October 1, 2024. Posted October 1, 2024, with a 3.39% change.
4. Rates effective October 1, 2023. Posted October 3, 2023, with a 2.42% change.

Before that, Special Bulletin COVID-19 #267 announced that temporary COVID-19 rate increases would end on June 30, 2023.

Two points stand out for providers. First, the increases have been consistent and sizable, from 2.42% to 4.14% a year. Second, the 2025 rates were revised in a later posting, so a hospice reconciling 2025 claims should check which version of the rate table it billed against.

The regularity of North Carolina's updates is useful. A hospice can set its fiscal planning around an October rate change with some confidence that one will arrive, because four have arrived in a row on schedule.

What it cannot do is assume the size. The increases have varied by more than a percentage point and a half from year to year. A sound approach is to budget on the current rate, then treat the next increase as a revision once it is posted. Hospices with managed care contracts should check whether each contract moves with the state's October posting or holds its rates until renegotiated, because that determines whether an increase reaches plan-paid days at all.

The end of the temporary COVID-19 increases in 2023 is a reminder that not every rise is permanent. Add-ons tied to an emergency or a budget year can lapse, while base-rate increases carry forward.

Routine home care is paid for each day a patient is enrolled and at home, whether or not a visit occurs. North Carolina's $186.00 is effectively the national median. Above it, New York pays $317.60 and Massachusetts $231.13; below it, Missouri pays $178.98, South Carolina $173.92 and Arkansas $80.36.

The daily rate funds the full interdisciplinary team, plus drugs, equipment and supplies related to the terminal illness. Because it covers most hospice days, a median-level rate means a North Carolina hospice's margin depends mostly on its own cost structure rather than on an unusually generous or tight rate. Length of stay, visit frequency in the first and last days of a stay, and travel time between patients are the levers that decide the result.

Continuous home care pays hourly for crisis periods when a patient needs predominantly nursing care at home. North Carolina's $66.94 an hour sits just above the $66.11 median, within a national range that runs from $59.29 in West Virginia to $80.47 in Oregon.

This level is where North Carolina's wage market matters most, because continuous care is mostly nursing time. A rate at the national median combined with a nurse wage below it gives a North Carolina hospice more room on each hour than most states. That room pays for the parts of crisis care the hourly rate must also cover: short-notice scheduling, travel and overnight coverage.

North Carolina's two ranked rates are its inpatient levels:

• Inpatient respite. $542.16 a day, 8th of 19 states and 2.3% above the $530.15 median. Oregon ($629.83), New Jersey ($585.40), New York ($571.19), Massachusetts ($560.76) and Utah ($557.97) lead.
• General inpatient care. $1,159.02 a day, 9th of 18 and 0.1% above the $1,157.99 median. Oregon ($1,354.60), New York ($1,299.97) and New Jersey ($1,253.17) lead; Kansas ($1,057.76), Missouri ($1,048.85) and Arkansas ($449.54) trail.

Respite is the one level where North Carolina pays a little more than a typical state. For hospices that contract inpatient beds rather than run their own, these rates set the ceiling on what they can pay a hospital or nursing facility per day while still covering their own oversight.

Federal occupational wage data for May 2025 shows North Carolina below the national median for every hospice role:

• Registered nurse: $40.56 an hour, against $46.90 nationally
• Home health / personal care aide: $15.02, against $17.21
• Healthcare social worker: $30.42, against $32.63
• Chaplain: $28.65, against $29.24

This is where North Carolina's position becomes favorable. Its rates sit at the national median, but its wages sit below it. On continuous home care, North Carolina pays $66.94 an hour while the median North Carolina RN earns $40.56 rather than $46.90, so a North Carolina hospice keeps more of each crisis-care hour than a hospice paying national-median wages at the median rate.

The same applies to routine home care. Nurse and aide visits make up much of a hospice's daily cost, and both cost less in North Carolina than nationally, while the daily rate is effectively the same.

North Carolina Medicaid runs both NC Medicaid Direct and NC Medicaid Managed Care, with plans including AmeriHealth Caritas North Carolina, Healthy Blue, UnitedHealthcare Community Plan of North Carolina and the Healthy Blue Care Together specialty plan, plus the EBCI Tribal Option. The state lists 15 plans.

For hospice, the state's rule is that plans negotiate their own rates, and the published rate applies out of network. Home health follows the same rule. Nursing facilities are different: there, plans must pay at least the published rate, which matters for hospices serving facility residents.

In practice, the published hospice rates are the reference point for every plan negotiation, not a guaranteed floor. A hospice should compare each plan's offer with the out-of-network rate and confirm whether the plan follows the October update. The North Carolina managed care page lists the plans and the rules for each service line.

1. Use North Carolina as a benchmark. Because its rates sit at the median, compare other markets against it.
2. Reconcile 2025 claims. Check which of the two postings for October 1, 2025 your claims were paid on.
3. Negotiate from the out-of-network rate. A plan rate below the published rate gives you less than an out-of-network claim.
4. Lean on wage advantage carefully. Below-median wages help margins, but recruitment in rural counties can still limit continuous care capacity.

Rates on this page are compiled from official state Medicaid publications, and each rate links to its source document. The hospice figures come from North Carolina's annual hospice rate postings for October 2023 through October 2026, with Special Bulletin COVID-19 #267 for the end of the temporary increases.

These hospice rates are part of all 143,093 current North Carolina Medicaid rates across 89 service categories. For every other service line, see the North Carolina Medicaid rates hub. The national hospice rates comparison covers every state, our methodology explains how hospice rates are compared, and pricing covers access to the full dataset.