Home health Medicaid rates in Iowa have risen sharply, and Iowa's managed-care plans have to follow them. Iowa Medicaid pays $98.87 per home health nurse visit on code T1030, effective 2025-08-01, after State Plan Amendment IA-25-0010 proposed a 45.0% change in payment rates for home health intermittent services from 2025-07-01. Because Iowa prices home health per visit, its rates are not placed in the national rankings, where the nurse visit median is $23.96 per 15 minutes.
Iowa's other defining feature is its floor. For home health, the state's rule is that IA Health Link plans must pay at least the published rate, so the fee schedule below is the minimum an agency should receive whether a member is in fee-for-service or managed care.
| Service | Code | Iowa rate | Effective since |
|---|---|---|---|
| Nurse visit | T1030 | $98.87 per visit | 2025-08-01 |
| Aide visit | 571 | $63.23 | 2025-07-01 |
| Physical therapy | 421 | $147.02 | 2025-07-01 |
| Occupational therapy | 431 | $148.02 | 2025-07-01 |
| Speech therapy | 441 | $159.81 | 2025-07-01 |
The aide and therapy rates are listed on revenue codes. Speech therapy carries the highest Iowa rate, and occupational therapy is slightly above physical therapy.
Iowa pays home health agencies for intermittent services, the short skilled visits that make up most home health care, and it prices them per visit.
Revenue codes for aides and therapy
The aide and therapy lines are listed on revenue codes: code 421 for physical therapy, code 431 for occupational therapy, 441 for speech therapy and code 571 for the aide. Revenue codes identify a type of service on an institutional claim, so Iowa home health claims look more like facility claims than physician claims.
Low Utilization Payment Adjustment rates
Iowa also publishes LUPA rates. A low-utilization adjustment applies when a patient needs only a few visits in a period, and it pays each visit at a set rate rather than as part of a larger episode. For agencies whose Medicaid patients typically need a handful of visits, the LUPA rates can matter as much as the standard schedule.
Iowa has an unusually active run of home health rate notices. Four changes are on file, each with a stated percentage:
- PUBLIC NOTICE: Medicaid Payment Rates for Home Health Low Utilization Payment Adjustment (LUPA) Rates, proposed for 2023-07-01: +21.0%.
- SPA IA-24-0006, Medicaid Payment Rates-Legislative Rate Increases, proposed for 2024-07-01: +9.32%.
- SPA IA-25-0010, Medicaid Payment Rates for Home Health Intermittent Services, proposed for 2025-07-01: +45.0%.
- SPA IA-25-0027, House File (HF) 1049 Rate Changes, proposed for 2025-07-01: +5.55%.
Taken together, the notices show Iowa raising home health payment in each of three consecutive years, with the largest step, 45.0% for intermittent services, landing on the same date as the current aide and therapy rates.
What the increases mean for an agency
For an agency planning staffing, a schedule that has moved upward three years running is a different proposition from one that has been flat for a decade. It supports wage increases, recruitment in rural counties and expansion into services that were marginal before. It also raises the question of durability: legislative increases depend on each year's budget, so agencies should plan on the current rates and treat further increases as possible rather than assumed.
A per-visit nurse rate of $98.87 is not directly comparable to the 15-minute rates in the national ranking, but the range is useful context. The District of Columbia pays $155.16 per 15 minutes, Texas $98.92 and Michigan $89.08, while Pennsylvania, Maine and California sit at $16.55, $16.48 and $15.21.
Iowa's aide visit rate of $63.23 is also off the ranking because it is on a revenue code without a stated unit. The national aide median is $52.32 per visit, with Minnesota at $80.62 and Florida at $18.04.
For therapy, the national hourly medians are $120.52 for PT and $117.42 for OT, with Michigan at $343.72 and $278.92 leading. Iowa's therapy visit rates of $147.02 and $148.02 sit above both medians if a visit lasts an hour.
Iowa's home health wages are mostly below US medians, which gives the higher per-visit rates more room:
- Registered nurses: $37.80 an hour (US $46.90).
- Licensed practical nurses: $30.11 (US $30.96).
- Home health and personal care aides: $17.34 (US $17.21).
- Physical therapists: $46.90 (US $49.40).
- Occupational therapists: $43.22 (US $48.24).
- Speech-language pathologists: $38.97 (US $47.05).
The combination is notable. Iowa's speech therapy visit rate is its highest home health rate, while its speech-language pathologist wage is the furthest below the national median of any role. Registered nurse wages are similarly low against a nurse visit rate of $98.87. For an Iowa agency, nursing and speech therapy are the service lines where rate and wage line up most favorably.
The aide line
The aide is the one role paid at the US median, $17.34 against $17.21. With an aide visit rate of $63.23, Iowa's aide line has more room than in most states, but it is the line most sensitive to wage growth, because aide wages are the ones moving toward national levels.
Iowa has 15 plans on file, including Iowa Total Care and Molina Healthcare of Iowa. Its program description states that the Iowa Medicaid fee-for-service schedules are the floor IA Health Link plans must pay, and the line-by-line rules match:
- Home health: plans must pay at least the published rate.
- Home and community-based services: plans must pay at least the published rate.
- Physical, occupational and speech therapy: plans must pay at least the published rate.
- Private duty nursing: plans must pay at least the published rate.
That makes Iowa one of the clearer states for home health contracting. Because the floor is tied to the published rate, the 45.0% intermittent-services change and the HF 1049 increase should be reflected in what plans pay as well. The Iowa managed-care page shows every plan and line.
Checking that plans pass increases through
A floor only helps if the agency checks it. When the state schedule rises, plan payments should rise with it from the same effective date. Agencies should compare remittances after each change against the new published rates and raise any shortfall with the plan promptly, citing the floor rule.
The coverage rules on file show no prior authorization rules for S9123, S9124, T1030 or T1031, and no unit limits. For nursing in particular, that is a light administrative load. Plans can still apply utilization review, so agencies should confirm each plan's process before starting care.
Iowa's next changes are arriving through its waivers rather than the home health schedule itself. The state issued an HCBS Waiver Rate Change Implementation Guide for SFY27, effective October 1, 2026, and a public notice covering several 1915(c) waivers, including the AIDS/HIV, Brain Injury, Children's Mental Health, Elderly and Health and Disability waivers. A separate implementation guide updated HCBS waiver service codes from January 1, 2026.
For a home health agency, these waiver changes matter in two ways. Many agencies deliver both intermittent home health visits and waiver services to the same households, so a waiver rate change can shift the overall economics of a caseload even when the home health rates stay put. And waiver service code updates change what is billed where: a service that moves to a new waiver code may move to a different rate.
The home health schedule itself follows the state fiscal year. Each of the last three increases took effect on July 1, so the spring legislative session and the SPA public notices that follow it in May and June are the window in which any further home health change will appear. Agencies should read those notices each year and update their budgets before July rather than after.
Finally, keep an eye on the LUPA rates. Because they apply to short episodes, they can change separately from the main schedule, as the 2023 notice did.
Iowa sits between two very different neighbors. Minnesota leads the national aide ranking at $80.62 per visit, while other Plains states pay much less. For agencies near the border, compare Missouri home health rates and Minnesota's. Agencies that also run shift nursing or personal care should see the Iowa private duty nursing rates.
For budgeting, build revenue by visit type, and include the LUPA rate for patients who need only a few visits.
For staffing, the gap between Iowa's rates and its below-median wages is the room an agency has to recruit. Nursing and speech therapy offer the most.
For plan contracting, cite the floor and audit remittances after every rate change. The Iowa Medicaid rates page covers all 105,138 current Iowa rates, and the pricing page explains full access with source documents and effective dates.
All Iowa rates are compiled from official state Medicaid publications, including the Iowa Medicaid fee-for-service schedules and the public notices named above, and each rate links to its source document. Per-visit rates are shown but not placed in rankings that compare hourly or 15-minute units. See the methodology and the home health hub for national comparisons.