North Carolina home care Medicaid rates moved sharply in 2026. The state published a Rate Increase for Personal Care Services and the Community Alternatives Program effective August 1, 2026, with a listed change of 17.95%, and matching CAP postings list 17.98%. Of the home care services we rank nationally, North Carolina's comparable published rate is for self-direction: it pays $107.42 a month for financial management services on T2040, 8th of 14 states and 5.8% below the national median of $113.98.
For a personal care agency, those two facts frame the North Carolina market. The state's hourly personal care, companion and respite rates are not in a form we can rank against other states, so the most useful benchmarks are the size of the August 2026 increase and the national ranges below. Each rate is compiled from official state Medicaid publications and links to its source document on the North Carolina Medicaid rates hub.
North Carolina's home care rates are published under two names: Personal Care Services, and the Community Alternatives Program, which has three parts: CAP for Disabled Adults (CAP/DA), CAP for Children (CAP/C), and the consumer-directed option, CAP/CD. Each has its own published rate set, and all of them were reissued for August 1, 2026.
Because the August 2026 increase covers both Personal Care Services and CAP, it lifts the agency side and the waiver side of home care at the same time. That matters for agencies that serve a mix of state plan and waiver clients: the gap between the two funding streams did not widen.
Our North Carolina data also includes a legacy CAP-MR/DD and TBI waiver fee schedule from before the Innovations waiver, kept separate from the current CAP rate sets.
On the fee schedule, T1019 personal care pays $8.66 per 15 minutes, or $34.64 an hour, effective August 1, 2026. That figure reflects the August increase. It sits above the $30.52 national median for agency personal care, though North Carolina's rate is not part of the national ranking, so it has no rank of its own.
For an agency, the practical comparison is with its own cost per hour. At a state median aide wage of $15.02, the post-increase rate leaves noticeably more room than before for wages, travel, supervision and overhead. All 143,093 current North Carolina Medicaid rates, including every PCS and CAP code, are available in the full dataset.
The North Carolina home care changes on file all share the same effective date:
- Rate Increase for Personal Care Services and the Community Alternatives Program, published July 31, 2026, effective August 1, 2026, listed change 17.95%.
- Updates to Rate Increase for Personal Care Services and the Community Alternatives Program, published August 4, 2026, with the same effective date and the same 17.95%.
- CAP for Disabled Adults (CAP/DA)+: new rates, effective August 1, 2026, listed change 17.98%.
- CAP for Children (CAP/C)+: new rates, posted August 3, 2026 and again September 1, 2026, listed change 17.98%.
- CAP- Consumer Directed (CAP/CD)+: new rates, effective August 1, 2026, listed change 17.98%.
An increase of this size resets the economics of every home care hour in the state. The follow-up notice and the second CAP/C posting suggest providers should confirm they are billing against the latest posted schedule rather than the first one published in August.
The legislative and federal steps behind it
The increase has a legislative basis: S.L. 2026-41 (Senate Bill 257) Sec. 9E.15, Medicaid Personal Care Services Rate, enacted July 7, 2026. The state then posted NC SPA 26-0007 for Personal Care Services on September 18, 2026, the 10-day public posting before submission to CMS, with an effective date of August 1, 2026. Until CMS approves the amendment, the federal side of the change is still in progress, though the rates are in effect.
From cuts to increases
The 2026 increase followed a difficult year for CAP/C. Postings recorded rate reductions for CAP for Children effective October 1, 2025. For CAP/C providers, the August 2026 rate set partly reverses that ground rather than adding to an unchanged base, which is worth keeping in mind when comparing year-over-year revenue.
Separately, a North Carolina Innovations Waiver Direct Care Worker Wage Increase took effect October 1, 2026, for the state's developmental disability waiver.
The median wage for home health and personal care aides in North Carolina was $15.02 an hour in May 2025, below the US median of $17.21. Registered nurses, whose time counts wherever a program requires nurse supervision of aides, had a state median of $40.56 against $46.90 nationally.
A below-median wage base has two sides for an agency. It lowers the cost of each hour of care, but it also means the labor market has been tight at the pay levels Medicaid rates could support. A 17.95% rate increase gives agencies room to raise aide pay toward the national median without cutting into the margin per hour.
Nurse costs move the other way for agencies whose programs require RN supervision visits. With registered nurses earning a state median of $40.56, below the national $46.90, supervision is cheaper in North Carolina than in most states, which helps agencies that serve CAP participants with more complex needs. The combination of lower labor costs and a freshly raised rate makes 2026 a better year to plan growth in North Carolina than the years before it.
North Carolina's ranked home care rate is the monthly fee for financial management services under self-direction, the service that handles payroll and tax filing when a person or family hires their own worker. North Carolina pays $107.42 a month on T2040, effective since October 1, 2025.
That ranks 8th of 14 states. The top of the range is California ($265.00), New York ($260.24) and Montana ($187.38). The bottom is Vermont ($89.00), Alabama ($80.00) and Wisconsin ($36.75). North Carolina sits near the middle, 5.8% under the median.
Because North Carolina's hourly personal care and respite rates are not ranked, the national ranges are the reference point for comparing the post-increase rates:
| Service | National median | Highest | Lowest |
|---|---|---|---|
| Personal care (hour) | $30.52 | Utah $84.84 | Texas $18.28 |
| Companion care (hour) | $25.96 | Vermont $51.92 | Arkansas $6.72 |
| Respite (hour) | $25.30 | Virginia $74.04 | Indiana $14.00 |
| Respite (day) | $242.21 | Minnesota $938.09 | New Hampshire $34.04 |
| Adult day (day) | $68.67 | Maine $124.44 | Virginia $10.70 |
Among neighbors and nearby states, Virginia stands out for the highest hourly respite rate in the country, $74.04 on T1005, and the lowest adult day rate, $10.70. South Carolina pays $80.00 a day for adult day, fourth-highest nationally. For personal care, Oregon ($42.24), Iowa ($42.00), Delaware ($39.35) and Missouri ($39.00) follow Utah at the top, while Pennsylvania ($19.48) and Louisiana ($19.08) join Texas at the bottom.
For agencies weighing expansion within the Southeast, Georgia and Tennessee are the other large markets to compare code by code. North Carolina's August 2026 increase moved it ahead of where it stood a year earlier, so comparisons made before August are out of date.
Prior authorization is part of North Carolina home care billing. In our coverage data, code 99509 carries 3 prior authorization rules, so each authorized episode needs to match the code and units on the approved plan of care. For CAP services, the participant's service plan sets what can be billed, so hours delivered beyond it are not payable.
North Carolina has 15 plans on file, including the Medicaid Managed Care Standard Plans, the Healthy Blue Care Together children and families specialty plan, and plans such as Alliance Health, Partners Health Management, Trillium Health Resources and Vaya Health. North Carolina Medicaid Direct remains the fee-for-service program.
The rules on file are clear for home care: personal care and home and community-based services are paid directly by the state, outside managed care. PCS and CAP providers bill North Carolina Medicaid at the published rate, so the August 2026 increase reached every provider at once without plan contract renegotiation. For home health and private duty nursing, by contrast, plans negotiate and the published rate applies out of network. See the North Carolina managed care page for each line's rule and the plans on file.
Re-run the budget on the new rates
An increase of 17.95% changes every revenue assumption. Rebuild the budget on the August 2026 schedule, service by service, and confirm claims since August 1 have paid at the new rates.
Decide how much goes to wages
With aide wages below the national median, the increase is an opportunity to recruit and retain. Agencies that pass part of it through to aides are better placed to staff authorized hours, which is where revenue comes from.
Watch the SPA
Track NC SPA 26-0007 through CMS review. Approval confirms the federal share behind the increase.
Rates on this page are compiled from official state Medicaid publications, including NC Medicaid fee schedule postings for Personal Care Services and CAP, state law and SPA notices. Each rate links to its source document on the North Carolina Medicaid rates hub. Wage figures are state and US medians for May 2025.
The national home care overview compares every state, our methodology explains how rates are converted and ranked, and the pricing page describes access to the full dataset.