Home health Medicaid rates in Hawaii sit near the bottom of the national ranking for the one discipline that can be compared. Hawaii's Med-QUEST program pays $20.00 per home health aide visit on code T1021, which ranks 13th of 14 ranked states and is 61.8% below the national median of $52.32.
What makes Hawaii distinctive is that the state has already acted on the problem. HB713 CD1 (2025), effective 2025-07-01, enacted a rate study for Medicaid home health services. The $20.00 aide rate has been in effect since 2024-03-04, so the study's results are the most important thing to watch for any Hawaii agency.
Hawaii Medicaid home health reimbursement in 2026
| Service | Code | Hawaii rate | Unit | Rank | vs national median |
|---|---|---|---|---|---|
| Home health aide visit | T1021 | $20.00 | visit | 13 of 14 | -61.8% |
Hawaii has no nurse visit, physical therapy, occupational therapy or speech therapy rate in this comparison. For reference, the national medians are $23.96 per 15 minutes for nursing, $120.52 an hour for physical therapy, $117.42 an hour for occupational therapy and $29.50 per 15 minutes for speech therapy. The full Hawaii schedule, with each rate linked to its source document, is on the Hawaii Medicaid rates page.
The T1021 Hawaii Medicaid rate against the national range
Hawaii's $20.00 per visit sits between North Dakota ($20.56) above it and Florida ($18.04) below it. Those three states form the bottom of the aide ranking.
At the top, Minnesota pays $80.62 per visit and Utah $79.96, followed by Mississippi ($75.48), New Jersey ($66.66) and Arkansas ($66.63). A Hawaii aide visit pays a fraction of those amounts for the same code.
Because T1021 is a flat per-visit rate, the effective hourly pay depends on visit length and drive time. On islands where travel between homes can be long, that structure puts more pressure on a low per-visit rate than it would in a dense urban market.
Wages: Hawaii's home health labor costs
Hawaii pays more for home health labor than most states, which makes the low aide rate harder to work with:
| Role | Hawaii median hourly wage | US median hourly wage |
|---|---|---|
| Registered nurse | $65.54 | $46.90 |
| Licensed practical nurse | $34.20 | $30.96 |
| Home health / personal care aide | $18.32 | $17.21 |
| Physical therapist | $48.90 | $49.40 |
| Occupational therapist | $49.46 | $48.24 |
| Speech-language pathologist | $46.90 | $47.05 |
The aide wage of $18.32 is above the US median, while the aide visit rate is 61.8% below the national median. That is the core tension in Hawaii home health. The registered nurse wage of $65.54 is far above the US median of $46.90, which makes any nursing service expensive to staff even though no nursing rate is compared here. Licensed practical nurses, at $34.20, are also paid above the national median of $30.96.
Therapist wages are close to national levels, so therapy staffing costs in Hawaii are not unusual.
The HB713 home health rate study
HB713 CD1 (2025) is the one recent change on file for Hawaii home health, and it is a study rather than a rate increase. It took effect on 2025-07-01. For providers, the practical point is that a study is the step that typically precedes a rate change, so the current $20.00 aide rate should be read as a rate under review.
For context, the states at the top of the aide ranking, Minnesota and Utah, pay $80.62 and $79.96 per visit, and the national median is $52.32. Agencies with a stake in the result should track the study's findings and any follow-up legislation, and benchmark their costs against the wage figures above. The gap between local wages and the per-visit rate is the strongest evidence any Hawaii agency has.
Managed care: QUEST Integration plans negotiate
Hawaii has 9 plans on file, and its programs include QUEST Integration and Community Care Services. The rules for the service lines closest to home health are:
- Home and community-based services: plans negotiate; the published rate applies out of network.
- Physical, occupational and speech therapy: plans negotiate; the published rate applies out of network.
That is a meaningful difference from states where plans must pay at least the published rate. In Hawaii, the $20.00 fee-for-service rate is the out-of-network benchmark, and an agency's in-network rate depends on what it negotiates with each plan. Agencies with strong local coverage can use that leverage; smaller agencies may find the fee schedule is effectively the ceiling. The Hawaii managed-care page lists the plans and every line's rule.
Prior authorization
No coverage or prior authorization rules are recorded for Hawaii home health codes in this comparison, and no unit limits are on file for T1021. For agencies, that means the fee-for-service aide visit carries little code-level administrative friction. The larger administrative task is contracting: because plans negotiate home and community-based rates, each plan relationship has its own terms to track.
All Hawaii rates are compiled from official state Medicaid publications and link to their source documents. See the methodology for how aide visit rates are ranked, and the home health hub for every state's figures.
Updated 2026-10-05