North Dakota home care Medicaid rates follow a simple rule that few states use: one hourly price for most agency services. North Dakota Medicaid pays $9.59 per 15 minutes, or $38.36 an hour, for personal care on T1019. That ranks 6th of 27 states with a comparable rate and is 25.7% above the national median of $30.52.
The same $38.36 hourly rate applies to homemaker services on S5130 and hourly respite on S5150. Because the national medians for those services differ, the single rate lands in very different places in each ranking: 2nd of 9 for homemaker, 7th of 38 for respite. Companion care is the exception, paid at a lower rate.
North Dakota personal care Medicaid rate: T1019 at $38.36 an hour
All of North Dakota's current home care rates took effect on July 1, 2026. They are published in the state's Medicaid home and community-based services fee schedule and in the Adults and Aging HCBS Qualified Service Provider (QSP) rates. North Dakota's program list also includes the HCBS Medicaid waiver for aged and physically disabled adults (ND.0273) and the state-funded Service Payments for the Elderly and Disabled (SPED and Expanded SPED) program, which is not Medicaid.
At $38.36, North Dakota sits just behind Missouri ($39.00) and Delaware ($39.35) on personal care, and ahead of most of the country. The highest rate is Utah at $84.84 an hour on S5125, followed by Oregon ($42.24) and Iowa ($42.00). The lowest are Pennsylvania ($19.48), Louisiana ($19.08) and Texas ($18.28).
Homemaker, respite and companion rates
North Dakota publishes rates for most of the home care lines we compare:
| Service | Code | North Dakota per hour | Rank | vs national median |
|---|---|---|---|---|
| Personal care | T1019 | $38.36 | 6 of 27 | +25.7% |
| Homemaker | S5130 | $38.36 | 2 of 9 | +24.5% |
| Respite (hourly) | S5150 | $38.36 | 7 of 38 | +51.6% |
| Companion care | S5135 (TF) | $27.04 | 9 of 20 | +4.2% |
Homemaker. Only Kentucky, at $39.00, pays more for S5130. Homemaker is the thinnest data set in home care nationally, with a $30.80 median, so North Dakota's rate is one of the few published benchmarks at the top of the range.
Respite. The 51.6% gap above the $25.30 national median is the largest of any North Dakota service. Virginia ($74.04), New York ($59.32) and South Dakota ($43.24) pay more per hour, but North Dakota is ahead of Maine ($39.48) and most other states. North Dakota has no comparable daily respite rate on file.
Companion care. S5135 with modifier TF pays $6.76 per 15 minutes, or $27.04 an hour, slightly above the $25.96 median. Its neighbor South Dakota pays $43.24 for the same code.
Adult day. North Dakota pays adult day on S5101 at $80.38 for a half-day maximum unit. Because the unit is a half day rather than a full day, it is not ranked against the $68.67 national daily median.
Aide wages and margins in North Dakota
North Dakota home health and personal care aides earned a median of $18.96 an hour in May 2025, above the US median of $17.21. Registered nurses had a median of $38.81, well below the $46.90 national figure.
The single rate makes the margin math identical across three services. For personal care, homemaker and hourly respite alike, the aide wage takes 70.3% of the $38.36 rate, leaving a margin of $11.41 an hour after loaded wages. Companion care is a different story: the wage takes 99.7% of the $27.04 rate, leaving a margin of $0.09 an hour.
For an agency, that means North Dakota rewards hours billed as personal care, homemaker or respite, and treats companion hours as a near break-even service. The higher-than-average aide wage is covered comfortably by the shared rate but not by the companion rate.
Prior authorization and service limits
North Dakota's coverage data shows no prior authorization rules on any home care code we track: S5100, S5101, S5115, S5130, S5135, S5150 and T1019 all show zero. Instead, three codes carry monthly limits: T1019, S5135 and S5150.
The practical effect is that billing risk shifts from getting approval to staying under the cap. An agency serving a client across personal care, companion and respite needs to track units against each monthly limit separately.
Recent North Dakota rate changes
North Dakota adjusts home care rates every July 1 through its state plan public notices:
- Public Notice - Medicaid State Plan Changes for July 1, 2026, listed change 2.0%.
- Public Notice - Medicaid State Plan Changes for July 1, 2025, listed change 2.0%.
- Public Notice - Medicaid State Plan Changes for July 1, 2024, listed change 3.0%.
- Public Notice - Medicaid State Plan Changes for July 1, 2023, listed change 3.0%.
- SPA ND-23-0015, a 3.5% inflationary increase for Personal Care Services, effective July 1, 2023.
The pattern is steady annual steps rather than one-time jumps, and the result is a rate set that sits in the upper part of the national rankings.
Managed care and North Dakota home care
North Dakota's home care is paid from published fee schedules. We have 5 plans on file for the state, including Blue Cross Blue Shield of North Dakota, Northland PACE and Primary Care Case Management (PCCM). Our managed-care summary sets rules only for hospital inpatient and outpatient care, where the state sets the rate plans pay, and lists no plan rule for home and community-based services. See the North Dakota managed care page for details.
For the full fee schedule, visit the North Dakota Medicaid rates hub. Compare North Dakota with Utah at the top of the personal care ranking, or see every state in the national home care overview. Our methodology explains hourly conversions and ranks.
Updated 2026-10-05