Private duty nursing Medicaid rates in North Dakota come from a different place than in most states. North Dakota's in-home nursing rates in our data are waiver nursing rates, not state plan private duty nursing. The state pays $19.34 per 15 minutes on code T1002, or $77.36 an hour for RN nursing, which ranks 23rd of 41 states and sits just 0.3% below the $77.60 national median for RN waiver nursing.
That puts North Dakota almost exactly at the middle of the country for RN home nursing. The LPN side is weaker, and because the state's nurse wages run below the national median, the RN line carries most of the margin. Every rate here is compiled from official state Medicaid publications, and each links to its source document on the North Dakota Medicaid rates page.
North Dakota publishes both nursing rates in 15-minute units, effective 2026-07-01:
| Service | Code | Per 15 min | Per hour | Rank | vs national median |
|---|---|---|---|---|---|
| Waiver nursing, RN | T1002 | $19.34 | $77.36 | 23 of 41 | -0.3% |
| Waiver nursing, LPN | G0300 | $11.32 | $45.28 | 21 of 34 | -19.7% |
Two details stand out. First, the LPN rate is billed on G0300 rather than the T1003 code most states use for LPN waiver nursing. Billing staff coming from other states need to set up claims accordingly. Second, both rates carry a 2026-07-01 effective date, so they are among the most recently updated nursing rates in our national data.
For an agency, the RN rate is the stronger of the two. It is close to the national middle, while the LPN rate sits nearly a fifth below its national median.
Quarter-hour billing ties revenue directly to documented time. Four units make an hour, and every unit claimed must be supported by the nurse's visit record. A few habits keep North Dakota claims clean:
- Use the right code for the credential. RN time goes on T1002; LPN time goes on G0300 under the North Dakota schedule. Set the code by credential in the scheduling system so it does not depend on manual entry.
- Agree a rounding rule. Decide how partial units at the start and end of a visit are counted, and apply the rule consistently.
- Match the service plan. Units billed must fall within the hours written into each client's plan.
- Check effective dates. Claims are priced by date of service. Visits before 2026-07-01 price at the earlier schedule.
Most states publish a separate state plan private duty nursing rate on S9123, S9124 or T1000, usually for medically complex children and adults who need long shifts at home. Our data do not include a ranked North Dakota rate for those state plan lines, so North Dakota does not appear in the national RN or LPN private duty nursing rankings described on the private duty nursing hub.
That makes the waiver schedule the reference point for North Dakota agencies. When comparing North Dakota with other states, the fair comparison is with their waiver nursing rates, not their state plan PDN rates.
The structure also affects how an agency grows. In a state where most home nursing runs through waivers, referral volume depends on how many people are enrolled in each program and how many nursing hours their service plans include. Relationships with case managers and the agencies that write service plans matter as much as rate levels. An agency planning to add nurses in North Dakota should look at waiver enrollment in its service area, not only at the hourly rate.
The state's home and community-based programs include:
- The North Dakota Medicaid home and community-based services fee schedule, which covers waiver and state plan HCBS codes.
- The HCBS Medicaid Waiver for aged and physically disabled adults.
- The Traditional IID/DD HCBS Waiver, which uses the state's DD payment system.
- The Adults and Aging HCBS Qualified Service Provider (QSP) rates.
- A 1915(i) state plan option for home and community-based behavioral health services.
The state-funded Service Payments for the Elderly and Disabled (SPED) program also pays for in-home services but is not Medicaid. Each program has its own eligibility and enrollment path, and the program a client is enrolled in decides which schedule an agency bills.
North Dakota's nurse wages run below the national median. Federal wage data for May 2025 put the state's median at $38.81 an hour for registered nurses, against $46.90 nationally, and $29.95 for licensed practical nurses, against $30.96.
Those lower wages help the RN line considerably:
- RN waiver nursing: the loaded median RN wage is 71.3% of the $77.36 rate, leaving a margin of $22.20 an hour after loaded wages.
- LPN waiver nursing: the loaded median LPN wage is 94.0% of the $45.28 rate, leaving a margin of $2.71 an hour.
Why RN staffing carries the business here
The difference is stark. An RN hour leaves room for supervision, travel, training and on-call coverage; an LPN hour barely covers the nurse. In practice, this pushes North Dakota agencies toward RN staffing where cases allow it, the opposite of the pattern in many states where LPN shifts carry the better margin. In a rural state where travel between clients takes time, the RN margin is also what pays for the drive.
North Dakota's coverage data list no prior authorization rules on any of the nursing-related codes we track: G0300, S5115, T1002 and T1003. No unit limits are listed either.
That does not mean services are unlimited. Waiver services are delivered under an individual service plan, and the number of hours a client may receive is set there. But at the code level, North Dakota adds fewer authorization steps than most states. For an agency, the service plan is the control document: schedules should be built from it, and any change in a client's needs should go back through the plan before hours increase.
North Dakota Medicaid runs mainly as a fee-for-service program. Our records show 5 plan arrangements in the state, including Blue Cross Blue Shield of North Dakota, Northland PACE and Primary Care Case Management (PCCM). The managed-care rules on file cover hospital services, where the state sets the rate plans pay; home nursing is not classified under a managed-care rule, and the waiver schedule is the rate agencies bill against.
For a nursing agency, that simplifies contracting. There is no plan-by-plan nursing fee schedule to negotiate, and the published rate is the reference for every claim. The North Dakota managed care page shows the rules for each service line.
North Dakota updates its fee schedules on a regular cycle. A provider update posted 2026-07-18 announced that fee schedules for dates of service from July 1, 2026, had been posted, with a listed change of 2.0%, and a public notice of Medicaid state plan changes for July 1, 2026 carried the same figure. The January 2026 cycle carried a listed change of 3.2%.
The nursing rates above share the 2026-07-01 effective date. For billing teams, the key point is that a regular annual update means rates on older claims may differ from current ones, so reconciliations should always use the schedule in force on the date of service. For budgeting, a predictable update cycle makes it easier to plan wage increases in step with rate changes.
At the top of RN waiver nursing, Georgia pays $146.72 an hour, Vermont $125.84, Maryland $123.08, Utah $120.00 and New Mexico $119.04. At the bottom, North Carolina pays $34.88, Florida $32.64 and Arkansas $19.08. North Dakota's $77.36 sits almost exactly between those groups.
For LPN waiver nursing, the top runs from Utah at $345.48 to Connecticut at $96.32; the bottom includes California ($24.72), North Carolina ($13.92) and Arkansas ($12.68). North Dakota's $45.28 places it in the lower-middle. For a regional comparison, see Montana private duty nursing rates and South Dakota, where state plan nursing pays well above the median.
A middle ranking is not a weak position when wages are low. North Dakota's RN rate is close to the national median, but its RN wage is well below the national figure, so the RN margin compares well with states that rank higher on rate alone. The useful comparison is always rate against local cost, not rate against rate.
- Staff to the margin. RN hours carry most of the margin; LPN hours barely cover the nurse at median wages.
- Budget for travel. In a rural market, drive time is a real cost that the hourly rate has to absorb.
- Plan around the annual cycle. Rates update on a regular schedule; align wage reviews with it.
- Use the service plan as the authorization. With no code-level prior authorization, the plan sets the hours.
- Compare related lines, such as home health in North Dakota, before adding service lines.
All North Dakota rates on this page are compiled from official North Dakota Medicaid publications, including the home and community-based services fee schedule. Each rate on the North Dakota Medicaid rates page links to its source document and effective date. Per-hour figures convert 15-minute units to an hour, national ranks compare published rates for the same service and provider level, and wages are federal May 2025 state medians. Our methodology explains each step, and all 19,715 current North Dakota Medicaid rates are available on our plans.