District of Columbia Medicaid private duty nursing rates run on two clocks. The state plan rates are among the oldest in the country: DC pays $28.00 an hour for RN private duty nursing on code S9123, a rate effective since September 1, 2003. That ranks 39 of 43 states and sits 48.9% below the national median of $54.84. The waiver nursing rates, by contrast, were reset on October 1, 2026, and the RN waiver rate of $77.60 an hour lands exactly on the national median.
For a home nursing agency in the District, those two numbers describe nearly different businesses. Which program authorizes a patient's hours decides whether a shift is paid at a 2003 rate or a 2026 rate, and that one fact shapes staffing, intake and cash flow more than any other line on the fee schedule.
DC's state plan private duty nursing rates are flat hourly amounts:
- RN private duty nursing, S9123: $28.00 an hour, rank 39 of 43, 48.9% below the median.
- LPN private duty nursing, S9124: $20.00 an hour, rank 35 of 39, 54.6% below the median of $44.08.
Both carry the same September 1, 2003 effective date. In practical terms, these rates have not moved in more than two decades while nurse wages, insurance and travel costs have. That is why the District sits near the bottom of both rankings even though it is a high-wage labor market.
Only a handful of states pay less. On RN care, Virginia pays $25.86, New Jersey $15.75 and Oklahoma $8.92. On LPN care, Mississippi pays $14.95, New Jersey $12.89 and Oklahoma $8.92. Being near that group is a signal for agencies: state plan private duty hours in DC are best treated as a service obligation to existing patients rather than a growth line.
DHCF issued Transmittal 26-25, Skilled Nursing Rate Changes Effective October 1, 2026, which set the current waiver nursing rates. It follows Transmittal 23-42, the skilled nursing rate change effective October 1, 2023.
| Service | Code | Per 15 min | Per hour | Rank | vs median |
|---|---|---|---|---|---|
| Waiver nursing, RN | T1002 U4 | $19.40 | $77.60 | 22 of 41 | 0.0% |
| Waiver nursing, LPN | T1003 U4 | $16.15 | $64.60 | 13 of 34 | +14.5% |
The RN rate sits precisely at the $77.60 national median. The LPN rate does better, ranking in the upper half and 14.5% above the $56.42 median. For an agency deciding where to put scarce nursing hours, the waiver side of the District's schedule is now competitive with the country as a whole, while the state plan side is not.
Waiver nursing in the District is paid through home and community-based services waivers. The fee-for-service programs listed for DC include the Elderly and Persons with Physical Disabilities (EPD) 1915(c) waiver, the Intellectual and Developmental Disabilities (IDD) 1915(c) waiver operated with DDS, and the Individual and Family Support (IFS) 1915(c) waiver, also operated with DDS. State plan private duty nursing sits under DC Medicaid (DHCF) fee-for-service.
Why the program matters more than the code
The same nurse doing similar work can be paid at very different rates depending on the authorization. A child or adult whose nursing hours come through the EPD or IDD waiver is billed on T1002 or T1003 with the U4 modifier at the 2026 rates. A patient whose hours come through the state plan is billed on S9123 or S9124 at the 2003 rates. Intake staff should confirm the funding source before a case is accepted, not after the first claim.
Waiver rules are moving in 2026
Several 2026 actions touch the DDS waivers. Transmittal 26-21 introduced new IDD waiver service rates effective August 1, 2026, alongside a CMS-approved IDD waiver amendment with the same date. Final rulemaking amending 29 DCMR Chapter 90 for the Individual and Family Support waiver was published in the DC Register. Agencies serving DDS clients should read each notice for service definitions and documentation rules, not only rates.
DC's waiver nursing codes are billed in 15-minute units, while the state plan codes are hourly. Four units make an hour, so the $19.40 RN unit becomes $77.60 and the $16.15 LPN unit becomes $64.60. All rankings on this page are compared per hour so that states using different units line up fairly.
Unit billing has operational consequences. Visit times must be documented to the minute, partial units follow the state's rounding rules, and a missed quarter-hour on a long shift is lost revenue that adds up over a month. Agencies that move between S9123 hourly claims and T1002 unit claims for different patients should keep the two billing workflows clearly separated in their scheduling system.
DC nurse wages run above the national level: the median is $49.30 an hour for registered nurses against $46.90 nationally, and $36.42 for licensed practical nurses against $30.96.
Those wages make the gap between the two programs concrete:
- State plan RN: a loaded median RN wage equals 250.2% of the $28.00 rate, a margin of -$42.07 an hour.
- State plan LPN: the loaded LPN wage equals 258.8% of the $20.00 rate, a margin of -$31.76 an hour.
- Waiver RN: the loaded RN wage equals 90.3% of the $77.60 rate, leaving $7.53 an hour.
- Waiver LPN: the loaded LPN wage equals 80.1% of the $64.60 rate, leaving $12.84 an hour.
On the state plan, the hourly rate does not cover a median-wage nurse on either tier. On the waiver, both tiers clear the wage line, though the margin still has to fund scheduling, supervision, training, insurance and the cost of travel between homes.
The margins above point to a clear staffing pattern. On waiver cases, LPN hours leave more per hour than RN hours, because the LPN rate ranks higher nationally and the LPN wage is lower. Where a care plan allows LPN delivery under RN supervision, an LPN-led model is the more sustainable one in DC.
RN hours are still required for assessments, supervisory visits and higher-acuity patients. The practical approach is to reserve RN time for the tasks that require it and to staff routine shift hours with LPNs where the plan of care permits. On state plan cases, neither tier covers its wage, so the staffing question becomes how many such cases an agency can carry alongside its waiver census.
DC lists prior authorization rules on more nursing codes than most jurisdictions. We count 11 rules on T1000, 13 on G0299, 9 on G0300, and 5 each on T1001, T1002 and T1003. S9123 and S9124 carry none.
That spread reflects the range of codes DC uses for in-home nursing. Agencies billing T1002 and T1003 under the waiver should expect authorization checks on every case, and the codes with the most rules, G0299 and T1000, deserve particular attention before the first visit is scheduled.
A workable routine: verify the authorized code, modifier, unit count and date span before staffing; track units used against units authorized weekly; and request extensions well before an authorization lapses so that shifts are not delivered unpaid.
DC does not publish a line-specific managed-care rule for home health or home and community-based services. For other lines, its rules vary: physician services, behavioral health, transportation and nursing facilities are paid directly by the state outside managed care, while hospital, laboratory and clinic services carry a rule that plans must pay at least the published rate.
We track 6 plans in the District, including AmeriHealth Caritas District of Columbia, MedStar Family Choice DC and Health Services for Children with Special Needs (HSCSN). Transmittal 26-19 records that Wellpoint DC exited and its enrollees were auto-assigned to AmeriHealth Caritas DC effective August 1, 2026. Agencies with patients who moved should confirm that authorizations and plan contracts carried over. The DC managed-care page shows each plan and rule.
The District has now reset its skilled nursing rates on October 1 twice in three years, through Transmittal 23-42 in 2023 and Transmittal 26-25 in 2026. That pattern suggests waiver nursing rates are reviewed on a fiscal-year cycle, while the state plan S9123 and S9124 rates have stayed on their 2003 footing.
For planning, the useful takeaway is timing. DC's fiscal-year rate actions land on October 1, so budgets, payroll adjustments and payer-mix decisions for waiver nursing are best revisited each autumn. Other 2026 home care actions, such as Transmittal 26-16 for home health aide services and Transmittal 26-17 for PCA services, both effective July 1, 2026, show that the District updates adjacent in-home services on a different date, which matters for agencies that offer both aide and nursing care.
At the top of the private duty nursing rankings, Utah pays $254.03 an hour for RN care, Massachusetts $130.64 and Georgia $95.36. On waiver nursing, Georgia leads RN care at $146.72, with Maryland at $123.08 for both RN and LPN waiver nursing.
Regionally, the contrast is sharp. Maryland's waiver nursing rate sits well above DC's, while Virginia is one of the few states paying less than DC for state plan RN care, at $25.86. Agencies operating across the region should expect nurses to compare pay across jurisdiction lines, and should price District waiver work against Maryland's rate when recruiting.
The District's waiver rates now sit in the national middle, while its state plan rates sit near the bottom. The October 2026 transmittal improved the waiver side without touching the 2003 state plan figures.
- Build the budget by program, not by code. Project waiver hours and state plan hours separately, because one tier carries a positive margin and the other does not.
- Price recruitment against the waiver rate. With a median RN wage of $49.30, the waiver RN rate is the realistic ceiling for what an agency can offer and still cover overhead.
- Use the national rank in conversations with plans. Where a plan contracts for nursing, a published rate at the national median, or 14.5% above it for LPNs, is a clear reference point.
- Watch October 1. Rate actions for skilled nursing have arrived on that date, so check the DC Medicaid rates page each autumn.
Rates on this page are compiled from official state Medicaid publications, and every rate links to its source document. For the District, those include the DC Medicaid MMIS Medical Fee Schedule Report and DHCF transmittals such as Transmittal 26-25 and Transmittal 23-42. The DC rates page lists all 87,654 current District Medicaid rates across 7 programs, with history back to 1978.
Rankings compare each state's rate per hour for the same service and provider level; our methodology explains how 15-minute units become hourly comparisons. The private duty nursing rates by state overview ranks DC against every other state, and plans and pricing covers full access to rate history and source links.