Delaware is one of the best-paying states for home care Medicaid rates. Delaware Medicaid pays $39.35 an hour for personal care on T1019 with the PC modifier, which ranks 4th of 27 states and is 28.9% above the national median of $30.52.
What sets Delaware apart is the combination of that rate with a below-average local wage. The state median aide wage is lower than the US median, so Delaware's personal care rate leaves an unusually wide margin over wages. Delaware also has a statute requiring managed care organizations to pay home care at or above the state rate, plus a CMS-approved directed payment for home and community-based services.
| Service | Code | Delaware rate | Rank | vs national median |
|---|---|---|---|---|
| Personal care | T1019 PC | $39.35 / hour | 4 of 27 | +28.9% |
| Respite (hourly) | T1005 U1 | $29.51 / hour | 13 of 38 | +16.6% |
| Respite (daily) | T2033 HK | $262.69 / day | 15 of 34 | +8.5% |
All three ranked services sit above the national median, with personal care furthest ahead. The full dataset holds all 46,693 current Delaware Medicaid rates, each linked to its source on the Delaware Medicaid rates hub.
The $39.35 hourly rate has been effective since July 1, 2024. Only three states pay more for comparable personal care: Utah at $84.84 an hour, Oregon at $42.24 and Iowa at $42.00. Missouri, at $39.00, is just behind Delaware.
At the other end, Texas pays $18.28. In a market where most states cluster close to the $30.52 median, Delaware is clearly in the top group.
Modifiers matter
Delaware publishes T1019 with a modifier that identifies the service context. The PC modifier marks the agency personal care rate used in this ranking. Billing the code without the right modifier, or with a modifier from a different program, can change the rate paid or lead to a denial. Set up modifiers by program and client in the billing system rather than leaving them to individual staff.
Delaware's labor numbers run the opposite way from its rate. The state median wage for home health and personal care aides was $16.50 an hour in May 2025, below the US median of $17.21. Registered nurses had a state median of $47.85, slightly above the $46.90 national median.
| Service | Delaware rate | Wage share of rate | Margin after loaded wage |
|---|---|---|---|
| Personal care (T1019) | $39.35 / hour | 59.6% | $15.90 / hour |
| Hourly respite (T1005) | $29.51 / hour | 79.5% | $6.06 / hour |
A 59.6% wage share is unusually low for home care, where wages usually consume most of the rate. The $15.90 hourly margin on personal care leaves room for supervision, training, travel and overtime that thinner-margin states cannot absorb. Hourly respite is more typical, with wages at 79.5% of the rate.
What to do with the margin
A wide margin is an opportunity to compete on wages. Because Delaware's median aide wage sits below the national median, an agency that pays above the local median can recruit more easily and still keep a healthy margin. Agencies that invest part of the margin in wages, training and nurse supervision tend to have lower turnover, which in home care is the single largest hidden cost.
The margin figures above compare the rate with an aide's wage alone. A real agency carries other labor costs that the margin has to cover.
Nurse supervision
Personal care agencies typically need registered nurses for assessments, care plan updates and periodic supervision visits. Delaware RNs earn a median of $47.85 an hour, so each supervision hour costs close to three aide hours. An agency should budget nurse time per client per month and divide it across that client's billed aide hours to see the true cost per hour.
Travel and scheduling
Delaware is compact, which helps. Shorter drives between clients mean less unpaid time between visits than in large rural states, and that is part of why the personal care margin holds up in practice, not just on paper.
Turnover
Recruiting, onboarding and training a replacement aide is costly. Because Delaware's rate leaves room above the local wage, agencies can treat retention as an investment: modest raises, guaranteed hours and paid training time tend to pay for themselves by reducing turnover.
Delaware pays above the national median for both hourly and daily respite, though by smaller margins than for personal care.
- Hourly respite. T1005 with the U1 modifier pays $29.51 an hour, effective July 1, 2024. That is 13th of 38 states and 16.6% above the national median of $25.30.
- Daily respite. T2033 with the HK modifier pays $262.69 a day, effective since March 25, 2022. That is 15th of 34 states and 8.5% above the national median of $242.21.
The daily respite rate is the oldest of the three ranked rates. Agencies providing daily respite have absorbed wage growth since 2022 without a rate change, which narrows a margin that was never as wide as personal care's.
Delaware attaches both prior authorization rules and dollar caps to its core home care codes:
- T1019 personal care: 6 prior authorization rules, limited by a waiver-year dollar amount.
- T1005 respite: 3 prior authorization rules, with a waiver-year dollar limit.
- H0045 respite: 4 prior authorization rules, with a waiver-year dollar limit.
- S5150 and T2033: no prior authorization rules and no stated limit.
How dollar caps work in practice
Waiver-year dollar caps mean the number of hours a person can receive depends on the rate. When rates rise, the same dollar budget buys fewer hours unless the cap rises with it. For agencies, that has two consequences. First, a client's hours can run out before the waiver year ends, so track spending against the cap through the year rather than discovering it in the final months. Second, a rate increase without a cap increase can reduce hours, not raise revenue.
Delaware runs managed care through the Diamond State Health Plan (DSHP) and managed long-term services and supports through Diamond State Health Plan Plus (DSHP Plus). The 5 plans and programs include AmeriHealth Caritas Delaware, Delaware First Health and Highmark Health Options.
Two rules shape how home care is paid:
- In the state's managed-care classification, home and community-based services and personal care are paid directly by the state, outside managed care.
- Where MCOs do pay home care for LTSS providers, 29 Del. C. s.7931(f), enacted through SB 109 on September 30, 2021, requires them to pay home health and home care at or above the DMMA rate.
Together, those rules mean the published Delaware rate acts as the floor for home care whichever payer handles the claim. When negotiating with a DSHP Plus plan, the question is not whether the plan will match the state rate, but what it will pay above it. The Delaware managed care page shows how this compares with other service lines.
CMS has approved a Delaware state directed payment for HCBS two years running:
- DE_Fee_HCBS_New_20250101-20251231, approved May 9, 2025, effective January 1, 2025, with a 5.0% change.
- DE_Fee_HCBS_Renewal_20260101-20261231, approved November 25, 2025, effective January 1, 2026, again at 5.0%.
A renewed directed payment signals that the state is using managed-care payments to add to HCBS reimbursement on top of the fee schedule. For home care agencies contracting with DSHP Plus plans, it is worth checking how the 5.0% is applied to their claims and whether it appears as a separate payment or within the claim rate.
What to watch
Directed payments are approved one year at a time. The next renewal decision, for 2027, will determine whether the extra 5.0% continues. Agencies should not build it into permanent wage commitments until it is renewed.
Delaware is 4th for personal care, above the median for both respite lines, and has a statutory floor for MCO payments. Only Utah's outlier rate, Oregon and Iowa pay more per hour of personal care. Paired with a below-median wage, Delaware is among the most favorable home care Medicaid markets in the country. For regional context, compare Maryland home care rates and the full home care Medicaid rates by state page.
- Budgeting. Personal care carries the margin; budget respite as a supporting line.
- Contracting. Use the statutory floor as the starting point with DSHP Plus plans and negotiate above it.
- Client planning. Track each client's waiver-year dollar budget so hours do not run out late in the year.
- Workforce. Use part of the personal care margin to pay above the local median and cut turnover.
Rates are compiled from official Delaware Medicaid publications, including the DMAP fee schedules and the DDDS Lifespan Waiver provider rates. Each rate links to its source document. Rankings compare the rate for the same service across states that publish one, using the per-hour figure where a service is billed in time units. Wages are May 2025 medians. Rankings follow our methodology; access to the full dataset is described on our pricing page.