Private duty nursing Medicaid rates in Rhode Island are among the highest in the country, and they just went up again. Rhode Island Medicaid pays $23.60 per 15 minutes on code T1000 for RN private duty nursing, or $94.40 an hour, effective 2026-10-01. That ranks 4th of 43 states and sits 72.1% above the $54.84 national median. LPN care also ranks 4th, at $69.32 an hour.
In Rhode Island, every nursing line we track, state plan and waiver, RN and LPN, covers the loaded cost of a median-wage nurse with room to spare, even though those wages run above the national median. Every rate on this page is compiled from official state Medicaid publications and linked to its source document on the Rhode Island Medicaid rates page.
Rhode Island bills state plan private duty nursing on T1000 in 15-minute units, with modifiers separating the levels. All four nursing lines carry the same effective date, 2026-10-01.
| Service | Code | Per 15 min | Per hour | Rank | vs median |
|---|---|---|---|---|---|
| PDN, RN | T1000 UJ | $23.60 | $94.40 | 4 of 43 | +72.1% |
| PDN, LPN | T1000 UJ, TE | $17.33 | $69.32 | 4 of 39 | +57.3% |
| Waiver nursing, RN | T1002 L9 | $26.77 | $107.08 | 8 of 41 | +38.0% |
| Waiver nursing, LPN | T1003 L9 | $22.96 | $91.84 | 7 of 34 | +62.8% |
Only Utah, Massachusetts and Georgia pay more for RN private duty nursing; only Massachusetts, South Dakota and Utah pay more for LPN care. On the waiver side, Rhode Island sits in the top ten on both levels.
Rhode Island's rates depend on modifiers as much as codes. RN private duty nursing is T1000 with UJ; LPN private duty nursing is T1000 with UJ and TE; waiver nursing carries L9 on T1002 and T1003. A claim with the wrong modifier set may price at a different line, or not at all.
Three habits help. Set modifiers from the nurse's credential and the patient's program in the scheduling system, so billing staff are not choosing them by hand. Agree a rounding rule for partial 15-minute units at shift change. And review the first remittances after the 2026-10-01 update to confirm every line priced at the new figure, since claims straddling the change date are the most likely to price incorrectly.
Rhode Island publishes its home nursing rates as part of its Home Care Service Rates. The recent record shows sustained increases:
- Home Care Service Rates effective 2024-07-01, for eligible providers, published 2024-06-17, with a listed change of 0.14%.
- Home Care Service Rates effective 2024-10-01 (v2), published 2024-10-10, with a listed change of 68.0%.
- Home Care Service Rates effective 2026-10-01 (OHIC adj.), published 2026-09-24, with a listed change of 8.94%.
The October 2024 edition reset Rhode Island's home care rates substantially, and the October 2026 edition built on it. For agencies, the current figures are days old, so claims for dates of service on or after 2026-10-01 should reflect the new schedule.
Why the 2024 reset matters for planning
A large one-time reset followed by a smaller update suggests a schedule that is now reviewed on a regular cycle rather than left to drift. Agencies can plan wage reviews around October updates, while still budgeting conservatively: a listed change in one year is not a promise of the same change the next.
Rhode Island's FY2027 budget, Article 8, enacted a set of waiver rate changes pending CMS approval, alongside rate proposals from OHIC's Social and Human Service Programs Review:
- FY2027 Waiver Rates, 1915(c)-like non-DD: a listed change of 8.74%, effective 2026-10-01.
- FY2027 Waiver Rates, 1915(c)-like DD: a listed change of 10.64%, effective 2026-10-01.
- OHIC Rate SPAs for EPSDT, Early Intervention, Home Health, Hospice and Targeted Case Management: proposed with a listed change of 9.2%.
These actions are separate from the Home Care Service Rates but run on the same timetable. For a nursing agency that also delivers home health visits or serves children under EPSDT, the proposed home health and EPSDT SPA is the one to follow to final approval.
Rhode Island nurses earn above the national median. Federal wage data for May 2025 put the state median at $48.39 an hour for registered nurses (US: $46.90) and $38.51 for licensed practical nurses (US: $30.96).
Even so, every line leaves a positive margin after loaded wages:
- RN private duty nursing: loaded wage share 72.9%, margin $25.62 an hour.
- LPN private duty nursing: loaded wage share 79.0%, margin $14.59 an hour.
- RN waiver nursing: loaded wage share 64.2%, margin $38.30 an hour.
- LPN waiver nursing: loaded wage share 59.6%, margin $37.11 an hour.
Waiver nursing carries the widest margins, and the LPN waiver line is nearly as profitable per hour as the RN waiver line. On the state plan side, the RN shift leaves more than the LPN shift. That gives Rhode Island agencies room to pay above-median wages to recruit for complex pediatric and adult cases.
In many states, the choice between state plan and waiver work is a choice between a line that loses money and one that does not. In Rhode Island it is a choice between two lines that both work, and the trade-offs are different.
State plan private duty nursing on T1000 pays less per hour but carries no prior authorization rules at the code level, so cases can be staffed with less administrative effort. Waiver nursing pays more per hour and carries the widest margins, but each case sits behind twenty authorization rules and a daily cap. For a small agency with limited intake staff, a state plan caseload may produce steadier revenue per coordinator hour. For a larger agency with experienced intake and a team that knows the waiver process, the waiver codes return more per nursing hour.
The LPN waiver line deserves particular attention. Its margin is almost the same as the RN waiver line, while LPNs are typically easier to recruit than RNs for long home-based shifts. Where a waiver participant's plan of care allows LPN staffing, that line is the strongest combination of rate and recruitability in the state.
Rhode Island's coverage data show a sharp split between the state plan and waiver codes:
- T1000: no prior authorization rules listed.
- T1002 and T1003: 20 prior authorization rules each, and a daily limit on both codes.
The heavy authorization load on the waiver codes is the trade-off for their higher rates. Agencies should expect waiver nursing hours to be approved in advance and capped per day, and should build schedules and staffing from the authorization. With twenty rules per code, a written intake checklist is worth the effort: it lets a new coordinator confirm every requirement before the first waiver shift is staffed.
For private duty nursing, Rhode Island's rule is that it is paid directly by the state, outside managed care. Home and community-based services and intellectual and developmental disability services follow the same rule. Home health and personal care differ: plans must pay at least the published rate.
The state's home nursing programs appear as Rhode Island Medicaid home care and personal care (fee-for-service) and Rhode Island Medicaid long-term services and supports, home and community based, under the state's 1115 waiver. Children's services, including CEDARR, home-based therapeutic services and Katie Beckett, are also listed as fee-for-service.
Our records list 12 plan arrangements in Rhode Island, including Neighborhood Health Plan of Rhode Island, Tufts Health Public Plans and UnitedHealthcare Community Plan of Rhode Island. For home nursing, the state schedule above is the rate agencies bill, with no plan contract to negotiate. See the Rhode Island managed care page for every service line.
For RN private duty nursing, Rhode Island's $94.40 follows Utah ($254.03), Massachusetts ($130.64) and Georgia ($95.36), and sits just ahead of Hawaii ($94.04). At the bottom, Virginia pays $25.86, New Jersey $15.75 and Oklahoma $8.92.
For LPN care, Rhode Island's $69.32 sits just ahead of Montana ($63.44). Among New England neighbors, New Hampshire and Vermont price the same services very differently, which matters for agencies that recruit across state lines.
- Update billing for 2026-10-01. Confirm that every line reflects the new Home Care Service Rates from that date of service.
- Use the margin to recruit. Rhode Island's rates support above-median wages on every line.
- Invest in waiver intake. The waiver codes pay most but carry heavy authorization rules and daily limits.
- Follow the FY2027 actions pending CMS approval and the proposed home health and EPSDT SPA.
- Compare related lines, such as home health in Rhode Island, and the national private duty nursing hub.
All Rhode Island rates on this page are compiled from official Rhode Island Medicaid publications, including the Home Care Service Rates effective 10/1/2026. Each rate on the Rhode Island 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 how 15-minute units become hourly figures, and all 76,101 current Rhode Island Medicaid rates are available on our plans.