Delaware Medicaid private duty nursing rates sit comfortably above the national middle, and the state backs them with something most states do not have: a statute that sets a floor under managed-care payment. Delaware pays $63.67 an hour for RN private duty nursing on code S9123, rank 17 of 43 states and 16.1% above the national median of $54.84. The LPN rate on S9124 is $57.04, rank 11 of 39 and 29.4% above the median.
Under 29 Del. C. s.7931(d), enacted through HB 200, managed-care organizations must pay hourly home health care nursing at or above the DMMA rate. For a private duty nursing agency, that turns the published fee schedule into a minimum, not merely a reference point.
Delaware's three published nursing rates all took effect on January 1, 2024.
| Service | Code | Delaware | Rank | vs median |
|---|---|---|---|---|
| Private duty nursing, RN | S9123 | $63.67/hr | 17 of 43 | +16.1% |
| Private duty nursing, LPN | S9124 | $57.04/hr | 11 of 39 | +29.4% |
| Waiver nursing, RN | T1002 | $76.00/hr | 24 of 41 | -2.1% |
The state plan codes, S9123 and S9124, are billed by the hour. The waiver code, T1002, is billed at $19.00 per 15-minute unit. Delaware does not post a separate LPN waiver rate.
Two patterns stand out. First, Delaware's state plan rates rank higher than its waiver rate, the reverse of the national pattern, where waiver nursing pays more at the median. Second, Delaware's LPN rate ranks higher than its RN rate, because the gap between the two is narrower than in most states.
The provision most worth knowing for Delaware agencies is the statutory floor: 29 Del. C. s.7931(d) requires MCOs to pay hourly home health care nursing at or above the DMMA rate. It was enacted through HB 200 and took effect August 30, 2017. Delaware's managed-care rule for the private duty nursing line matches it: plans must pay at least the published rate.
Delaware's managed-care programs are the Diamond State Health Plan (DSHP) and Diamond State Health Plan Plus (DSHP Plus) for managed long-term services and supports. The state has 5 plans in its landscape, including AmeriHealth Caritas Delaware, Delaware First Health and Highmark Health Options.
In most states, private duty nursing paid through a plan is a negotiation, and the published rate only governs out-of-network claims. In Delaware, the DMMA rate is the minimum a plan must pay for hourly home health nursing. That makes the $63.67 and $57.04 figures a floor for contracting rather than a ceiling.
A floor changes the shape of every contract conversation. A plan cannot offer below the DMMA rate, so negotiation is only about how far above it the plan will go. Agencies should know their own cost per hour by nurse level and use it to argue for more where the floor does not cover it, which is the case for RN private duty nursing at the state's median wage.
The floor also protects agencies from a common risk in managed care: a plan cutting its contract rate while the state rate holds. In Delaware, any contract rate below the published rate would conflict with the statute. Agencies should check remittances against the DMMA rate for every plan and raise any underpayment promptly, since the law gives them a clear basis to do so. Keeping a copy of the statute with each contract file makes those conversations short.
Separately, Delaware's managed-care rules list home and community-based services as paid directly by the state, outside managed care. Waiver nursing hours billed on T1002 therefore follow the state's own rate, at $19.00 per 15-minute unit. Delaware's waivers include the DDDS Lifespan 1915(c) HCBS waiver for people with intellectual and developmental disabilities, which is also paid directly by the state.
CMS approved a renewal of Delaware's HCBS state directed payment for calendar year 2026. Directed payments require plans to pay designated providers in a set way, so agencies that serve DSHP Plus members should confirm with each plan whether any directed payment applies to their services. The Delaware managed-care page lists every plan and line rule.
Delaware nurse wages sit just above the national level. The state median wage is $47.85 an hour for registered nurses, against $46.90 nationally, and $33.03 for licensed practical nurses, against $30.96.
Here is how the rates hold up against a loaded median wage:
- RN private duty nursing: the loaded RN wage is 106.8% of the $63.67 rate, a margin of -$4.34 an hour.
- LPN private duty nursing: the loaded LPN wage is 82.3% of the $57.04 rate, leaving $10.09 an hour.
- RN waiver nursing: the loaded RN wage is 89.5% of the $76.00 rate, leaving $7.99 an hour.
The RN state plan rate comes close to covering a median-wage RN but falls just short once employer costs are loaded. The LPN state plan rate and the RN waiver rate both leave a positive margin.
For agencies, LPN staffing on the state plan is the strongest of the three lines, which matches Delaware's higher rank on LPN care. Cases where an LPN can cover routine shift care under RN supervision produce the best results, and RN time is most efficiently used for assessments, care plan updates and complex tasks.
RN-heavy state plan cases are the ones to price carefully. At -$4.34 an hour at the median wage, they are close to break-even, so modest differences in wages, overtime or travel decide whether they make or lose money. For those cases, the MCO floor is the agency's best tool: a plan that wants the case staffed may agree to pay above the DMMA rate.
Because of the floor, a Delaware nursing hour is worth at least the same amount whether the member is in fee-for-service Medicaid or a DSHP plan. What differs is the process. Fee-for-service claims go to DMMA under its rules; plan claims go to each plan under its contract, authorization and claims procedures. An agency serving members of all three plans plus fee-for-service is running four sets of administrative rules for one service.
The practical answer is standardization inside the agency. Use one intake checklist that captures the payer at referral, one authorization tracker that shows approved hours by payer, and one remittance review that compares each payment with the DMMA rate. That keeps the administrative cost of multiple payers from eroding the margin the floor protects, and it surfaces underpayments quickly.
Delaware's coverage listing attaches 1 prior authorization rule each to S9123 and S9124, and none to T1002. Private duty nursing is authorized in hours against a plan of care, so agencies should confirm approved hours before staffing a case, particularly on the state plan codes where a rule applies. For plan members, the plan's authorization process governs; for fee-for-service members, DMMA's does.
Delaware is a solid payer without being an outlier. On RN private duty nursing, Utah leads at $254.03, followed by Massachusetts at $130.64, Georgia at $95.36, Rhode Island at $94.40 and Hawaii at $94.04. At the bottom are Virginia at $25.86, New Jersey at $15.75 and Oklahoma at $8.92.
On LPN care, Delaware's $57.04 sits closer to the leaders. Massachusetts pays $90.96, South Dakota $77.36, Utah $75.10, Rhode Island $69.32 and Montana $63.44. The lowest are Mississippi at $14.95, New Jersey at $12.89 and Oklahoma at $8.92. On waiver nursing, Delaware's $76.00 RN rate sits just under the middle of the ranking, far behind Georgia at $146.72 but well above Arkansas at $19.08.
Among Mid-Atlantic neighbors, Maryland ranks among the top three states for waiver nursing, and Pennsylvania publishes its own nursing rates. New Jersey's state plan rates sit near the bottom of the country, which makes Delaware a markedly better payer than its northern neighbor.
Delaware's rates have held since January 1, 2024, and no newer nursing edition has followed. Other Delaware schedules have moved since: the DMAP 2026 physician, ASC and dental fee schedules were all reissued in 2026. With the MCO floor in place, any future DMMA nursing rate change would carry through to managed-care payment for hourly home health nursing as well, so a rate increase would benefit plan and fee-for-service hours alike.
- Contracts. Treat the DMMA rate as the floor and negotiate RN hours above it.
- Remittances. Check every plan payment against the published rate.
- Staffing. Lead with LPN state plan coverage under RN supervision where care plans allow it.
- Directed payments. Confirm whether the 2026 HCBS directed payment reaches your services.
The Delaware Medicaid rates page lists all 46,693 current Delaware Medicaid rates with their official source documents, and the private duty nursing rates by state overview ranks Delaware against the rest of the country.
Rates are compiled from official state Medicaid publications, including the DMAP fee schedules and the Delaware Code provision governing MCO payment for hourly home health nursing. Each rate links to its source document and carries its effective date. Hourly figures convert 15-minute units by four. National medians and ranks compare hourly rates for the same service and nurse level across the states that publish one. See our methodology.