T1019 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. A like-for-like rank only counts states that use the same unit: 41 of the 42 states publish T1019 per 15 min, enough to rank them against each other.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 30 of the 42 states list more than one rate for T1019, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
• Unit. Of the 42 states, 41 publish T1019 per 15 min and 1 per unit.
• Per hour. Time-based units are converted to an hour of service (four 15-minute units make an hour). 39 of the 42 states bill T1019 by time, with a median of $28.60 per hour.
• Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
• % of Medicare. No Medicare physician fee schedule amount is on file for T1019, so there is no percentage.
• Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.

Published rates for T1019 run from $2.10 in Connecticut to $25.00 in Illinois, a 11.9x gap in the same unit. Half the states pay more than the median of $7.07 and half pay less. The usual reasons for a spread like this in personal care & attendant rates:

• Some states require a share of the rate to go to direct-care wages, and minimum wage changes push personal care rates up.
• The same service can be paid under the state plan, under one or more waivers or under a separate state program, each with its own rate.
• Agency-delivered and self-directed (consumer-directed) care are usually paid at different rates.

Timing matters too. 16 states set the current rate for T1019 in 2026 or later, while 11 states still pay a rate that took effect in 2022 or earlier. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

What a plan pays for T1019 is negotiated privately, but the state decides how much room there is to negotiate. Here is how the rules break down across the 42 states.

In 4 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 11 states, plans negotiate and the published rate is a benchmark or out-of-network default (or a ceiling). In 14 states, the service is paid outside the plans or through a state-directed payment. The rule for the remaining 13 states is not classified yet.

• Paid by the state, outside the plans (14 states). Bill the state's Medicaid program, not the plan, at the published rate. There is no plan contract to negotiate for this service.
• Plans negotiate; the published rate applies out of network (9 states). In-network rates can be above or below the published rate. The published rate is the benchmark both sides know, and the fallback if no contract is signed.
• Plans must pay at least the published rate (4 states). The published rate is your floor. Negotiate up from it, and if a plan pays less, the contract provision is the basis for a payment dispute.
• Suggested schedule for plans (1 state). Use the schedule as a public benchmark in negotiations; the actual rate is whatever you and the plan agree.
• Plans may pay no more than the published rate (1 state). Expect offers at or below the published rate. Higher payment would have to come from something other than the base rate, such as a quality or value-based arrangement.

Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example Illinois managed care.

T1019 is a HCPCS Level II state Medicaid agency code in the personal care & attendant line, billed mostly by home care and personal care agencies and self-directed attendants. T codes were created for state Medicaid agencies, for services such as personal care, private duty nursing, case management and waiver services. Each state defines how the code is used and paid, so units vary from 15 minutes to a month.

Personal care is commonly billed in 15-minute units, though some states pay per hour or per day. Modifiers distinguish agency from self-directed care and, in some states, the number of people served at once.

Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.