The best states to start a home care agency, judged by what Medicaid pays for agency personal care, are Utah, Oregon and Iowa. Utah ranks 1st of the 27 states compared at $21.21 per 15 minutes, or $84.84 an hour, 178.0% above the national median of $30.52. Oregon ranks 2nd at $42.24 an hour and Iowa 3rd at $10.50 per 15 minutes ($42.00 an hour).
Home care runs on thin margins, and the wage picture matters more here than in almost any other Medicaid service. Outside Utah, no state in the top 10 keeps more than $17.35 an hour after paying an aide's loaded wage. This guide ranks states on the personal care rate, shows what is left after the local aide wage, and explains whether managed-care plans are bound by the published rate. It is one input to a location decision; licensing, staffing, payer mix and competition need your own local research.
The table ranks the ten states that pay the most for agency personal care and attendant care. States publish the rate per 15 minutes or per hour; the hourly figure is shown for comparison. Margin per hour is the hourly rate minus the median aide wage after employer costs.
| State | Rate | Rank | Margin per hour |
|---|---|---|---|
| Utah | $21.21 per 15 min ($84.84/hr) | 1 of 27 | $60.32 |
| Oregon | $42.24 per hour | 2 of 27 | $11.90 |
| Iowa | $10.50 per 15 min ($42.00/hr) | 3 of 27 | $17.35 |
| Delaware | $39.35 per hour | 4 of 27 | $15.90 |
| Missouri | $9.75 per 15 min ($39.00/hr) | 5 of 27 | $16.40 |
| North Dakota | $9.59 per 15 min ($38.36/hr) | 6 of 27 | $11.41 |
| Alaska | $9.30 per 15 min ($37.20/hr) | 7 of 27 | $10.04 |
| Montana | $9.23 per 15 min ($36.92/hr) | 8 of 27 | $11.89 |
| Kentucky | $9.00 per 15 min ($36.00/hr) | 9 of 27 | $11.10 |
| New York | $35.36 per hour | 10 of 27 | $8.28 |
Notice how flat the margin column is. Oregon ranks 2nd but keeps less per hour than Iowa, Delaware or Missouri, because its aide wage is higher. In home care, a state's wage level can wipe out most of its rate advantage.
Utah Medicaid pays $21.21 per 15 minutes for agency personal care, or $84.84 an hour. That ranks 1st of the 27 states compared and is 178.0% above the national median. Oregon, in 2nd place, pays $42.24 an hour.
The median aide wage in Utah is $17.25 an hour, only 28.9% of the rate, leaving $60.32 an hour after a loaded wage. No other state comes close on margin.
Personal care in Utah is paid directly by the state, outside managed care, so the published rate is the rate you are paid. That combination, the highest rate, the widest margin and no plan contracts to negotiate, puts Utah at the top of any shortlist built on Medicaid economics. The remaining questions are the ones the rate cannot answer: the program requirements an agency must meet to bill this service, how many clients in your area qualify, how far aides would travel between them, and how many agencies already compete for the same workers.
See the details on the Utah home care Medicaid rates page.
Oregon pays $42.24 an hour for agency personal care, ranking 2nd of the 27 states compared and 38.4% above the national median.
The catch is the wage. Oregon's median aide wage is $21.35 an hour, the highest in the top 10, and it takes 71.8% of the rate. After a loaded wage, the margin is $11.90 an hour.
That margin has to fund scheduling, supervision, travel between clients, insurance, training and the office. Oregon pays personal care directly, outside managed care, which removes plan-contract uncertainty. For a home care agency, the decision rests on whether you can run lean enough at that wage level to live on the margin.
See the Oregon home care rates page.
Iowa pays $10.50 per 15 minutes, or $42.00 an hour, ranking 3rd of the 27 states compared and 37.6% above the national median.
Iowa's median aide wage is $17.34 an hour, 58.7% of the rate. That leaves $17.35 an hour after a loaded wage, the largest margin in the top 10 after Utah.
Personal care is paid directly by the state, outside managed care, so the published rate is the rate you collect. For a new agency without negotiating leverage, that combination of a top-three rate, a moderate wage and a predictable payment route makes Iowa one of the clearest cases on the list. The open questions are local ones: where clients are, how far aides would travel, and how hard it is to recruit in your area.
Details are on the Iowa home care Medicaid rates page.
Delaware pays $39.35 an hour for agency personal care, ranking 4th of the 27 states compared and 28.9% above the national median.
Its median aide wage is $16.50 an hour, 59.6% of the rate. The margin after a loaded wage is $15.90 an hour, better than Oregon's despite a lower rate.
Delaware pays personal care directly by the state, outside managed care. That gives a clear revenue figure per hour. As with every state on this list, research licensing for home care agencies, the size of the Medicaid population in your area, and how many agencies already compete for clients and aides.
See the Delaware home care rates.
Missouri pays $9.75 per 15 minutes, or $39.00 an hour, ranking 5th of the 27 states compared and 27.8% above the national median.
Missouri's median aide wage is $15.90 an hour, the lowest in the top 10, at 57.9% of the rate. That leaves $16.40 an hour after a loaded wage, the third-best margin on the list.
Like most leaders, Missouri pays personal care directly, outside managed care. A low wage helps the margin, but it can also make recruiting harder if nearby employers pay more. Find out what aides in your target area are actually being offered before you plan on the median.
Read more on Missouri home care Medicaid rates.
North Dakota pays $9.59 per 15 minutes, or $38.36 an hour, ranking 6th of the 27 states compared and 25.7% above the national median.
Its median aide wage is $18.96 an hour, which takes 70.3% of the rate. After a loaded wage, the margin is $11.41 an hour, close to Oregon's and below every state ranked 3rd to 5th.
North Dakota shows why the rank alone can mislead in home care. Its rate is only a little below Missouri's, but its higher wage leaves it $11.41 an hour against Missouri's $16.40. We have no managed-care rule on file for personal care in North Dakota, so ask the state how claims are paid. If you are weighing it, look closely at travel distances between clients and at what local employers pay aides, both of which the margin figure leaves out.
See the North Dakota home care rates page.
At the bottom of the ranking, Medicaid barely covers the aide.
Texas ranks 27th of the 27 states compared at $4.57 per 15 minutes ($18.28 an hour), 40.1% below the national median. Its aide wage takes 90.6% of the rate, leaving $1.72 an hour after a loaded wage. Louisiana pays $4.77 ($19.08 an hour), with a margin of $3.69.
In three states the margin is negative. Pennsylvania pays $4.87 ($19.48 an hour), a margin of -$0.62. Kansas pays $4.98 ($19.92 an hour), a margin of -$1.44. Minnesota pays $5.25 ($21.00 an hour), where the wage takes 124.9% of the rate and the margin is -$5.22. Idaho pays $6.11 ($24.44 an hour) and keeps $0.68.
An agency can operate in these states, but Medicaid personal care alone will not sustain it at the median wage. Private-pay clients, other programs, or a different service mix would have to carry the business.
States are ordered by their Medicaid rate for agency personal care and attendant care, ranked among the 27 states compared. Rates published per 15 minutes are converted to an hourly figure so they can be compared with states that publish an hourly rate.
Aide wages are median hourly wages from Bureau of Labor Statistics data for the closest comparable occupation, where available. The margin takes the hourly rate and subtracts that wage after employer costs. It is a gross figure, before overhead.
Every rate is compiled from official state Medicaid publications, and each one on the site links to its source document. The methodology page explains how services and units are matched.
In home care, the rate matters less than the gap between the rate and what it costs to put an aide in a client's home. Several costs the margin figure does not include:
- travel time and mileage between clients;
- scheduling, supervision and training;
- insurance, payroll processing and visit verification;
- hours an aide is paid but not billing, such as cancellations.
A high rate also says nothing about demand. Research how many people in your target area qualify for Medicaid personal care, how many agencies already serve them, and what private-pay clients will pay. Licensing requirements for home care agencies differ by state; check them early. And staffing is the hardest part of home care almost everywhere, so look at what competing employers pay aides locally.
Most of the top home care states pay personal care directly, outside managed care: Utah, Oregon, Iowa, Delaware, Missouri, Kentucky and Indiana. In those states the published rate is the rate you collect, which makes budgeting simpler for a new agency.
New York is the exception in the top 10. There, plans negotiate; the published rate applies out of network, so your contracts with plans set your real rate. Among the lowest states, Kansas and Pennsylvania require that plans must pay at least the published rate, but at under $20 an hour that floor is low.
North Dakota, Alaska, Montana and Wyoming have no managed-care rule on file for this service. Ask the state how personal care claims are paid in those states before you budget.
Most agencies bill more than one service, and the leaders differ for each. National medians:
- Homemaker and housekeeping help: $30.80 an hour.
- Companion care: $25.96 an hour.
- Respite care (hourly): $25.30 an hour.
Homemaker rates are published in 10 states, while 48 publish a respite rate. If you plan to offer respite or companion care alongside personal care, compare those lines too.
Start with the home care Medicaid rates by state hub to compare personal care, homemaker, companion and respite rates everywhere. Then review the state pages for your shortlist, such as Utah, Iowa, Delaware and Missouri, for each rate with its source.
For full access while you build a budget, see pricing. The methodology page explains how rates are compared.