Home health Medicaid rates in Rhode Island changed on October 1, 2026, and the new schedule puts the state near the top of the country for therapy. Rhode Island Medicaid now pays $44.27 per 15 minutes for physical therapy on G0151, or $177.08 an hour, ranking 5th of 19 states and sitting 46.9% above the national median of $120.52. The same rate applies to occupational and speech therapy, which both rank 4th.
The October update followed the OHIC rate review, and the published home care service rates carry an 8.94% change.
Several actions came together around the October 1, 2026 effective date:
- Home Care Service Rates effective October 1, 2026 (OHIC adj.). Published on September 24, 2026, with an 8.94% change. All of Rhode Island's home health rates in this comparison carry this effective date.
- OHIC Rate SPAs for EPSDT, Early Intervention, Home Health, Hospice and Targeted Case Management. Proposed on September 1, 2026 with a 9.2% change, effective October 1, 2026.
- SPA 26-00XX, OHIC rate review updates. The companion state plan amendment, also proposed on September 1, 2026.
The update reverses the direction set the year before. Rhode Island's FY2026 enacted budget eliminated annual rate increases for home care, effective July 1, 2025, and CMS approved the related RI SPA 25-0012 on August 31, 2026. Agencies that budgeted for flat rates in 2026 should revisit those figures.
A separate change, the MCO contract A21 State Directed Payments table, took effect on July 1, 2026 with a 3.22% change.
Rhode Island's home health rates are tied to a recurring review by the Office of the Health Insurance Commissioner (OHIC), the Social and Human Service Programs Review. The review recommends rates, the legislature funds them through the budget, and the Medicaid program carries them into state plan amendments and published rate tables.
Why this matters to agencies
The process gives Rhode Island agencies a predictable place to watch. Rate changes do not arrive unannounced; they appear first as OHIC recommendations, then in the enacted budget, then in SPA notices and finally in the home care service rate table. An agency that follows the review cycle sees changes months before they take effect.
A history of large steps
The October 2024 home care update carried a 68.0% change. That followed the FY2025 enacted budget, which funded 100% of the OHIC review recommendations from October 1, 2024, plus 30% for home care skilled professional services. The 2025 freeze and the 2026 increase both sit on top of that higher base.
The new rates split cleanly into strong therapy rates and below-median nursing:
| Discipline | Code | Per 15 min | Per hour | Rank | vs national median |
|---|---|---|---|---|---|
| Physical therapy | G0151 | $44.27 | $177.08 | 5 of 19 | +46.9% |
| Occupational therapy | G0152 | $44.27 | $177.08 | 4 of 18 | +50.8% |
| Speech therapy | G0153 | $44.27 | $177.08 | 4 of 16 | +50.0% |
| Nurse visit | G0299 | $18.36 | $73.44 | 11 of 14 | -23.4% |
| Aide | G0156 | $11.33 | $45.32 | not ranked | n/a |
On nursing, Rhode Island ranks 11th of 14, just above Pennsylvania at $16.55 per 15 minutes. The aide rate is priced per 15 minutes rather than per visit, so it is not placed in the national aide ranking.
Against wages, Rhode Island's therapy rates leave room. The median physical therapist wage in Rhode Island was $47.79 an hour in May 2025, which is 38.4% of the $177.08 hourly rate. Occupational therapists earned $48.10 (38.6% of the rate) and speech-language pathologists $50.00 (40.1%).
After a loaded wage, the margin per billed hour is $109.16 for physical therapy, $108.72 for occupational therapy and $106.02 for speech. Those figures still have to pay for drive time, documentation and overhead, but they give a Rhode Island agency a real reason to grow its therapy line.
Rhode Island's small size helps. Short drives between homes mean more of each therapist's paid day is billable, which protects the margin better than in large rural states with similar rates.
Nursing is the opposite case. Rhode Island's median registered nurse wage of $48.39 an hour, above the US median of $46.90, is 93.7% of the $73.44 hourly rate. After loaded wages, the margin is $4.66 per billed hour. Licensed practical nurses earn a median $38.51 in Rhode Island against $30.96 nationally, so using LPNs helps less here than in lower-wage states.
Aides earn a median $21.00 an hour in Rhode Island, above the US median of $17.21. That is 65.9% of the $45.32 hourly aide rate, leaving $15.47 per hour after a loaded wage.
For an agency, the takeaway is to keep skilled nursing visits efficient and let therapy carry margin. A plan of care that is nursing-heavy is harder to staff profitably in Rhode Island than one with substantial therapy.
Rhode Island lists no prior authorization rules on its main home health codes. The limits it does set are structural: the therapy codes G0151, G0152 and G0153 and the aide code G0156 each carry a limit per claim line, and the nursing code G0299 carries a daily limit.
In practice, a claim-line limit caps how many units a single line can carry, and a daily limit caps nursing units per day. Agencies should check how many units each line can carry before billing long visits, and split services across lines or dates only where the documentation supports it. Billing more units than a line allows usually results in the excess being cut rather than the whole claim being denied, which makes the loss easy to miss without careful remittance review.
Rhode Island counts 12 plans, including Neighborhood Health Plan of Rhode Island, Tufts Health Public Plans and UnitedHealthcare Community Plan of Rhode Island.
Home health: a floor
For home health, Rhode Island's rule is that plans must pay at least the published rate. The October 2026 schedule is the minimum a plan can pay, which means the 8.94% increase reaches managed-care claims as well as fee-for-service ones. Personal care follows the same floor rule.
Therapy, waiver services and private duty nursing: paid by the state
For physical, occupational and speech therapy as a service line, Rhode Island's rule is that these services are paid directly by the state, outside managed care. Home and community-based services and private duty nursing follow the same rule, which fits the state's Medicaid home care and personal care program being paid fee-for-service. The Rhode Island managed care page lists the rule for each service line.
Rhode Island's FY2027 budget also set new waiver rates under the OHIC review, several of them pending CMS approval. For home health agencies that also serve waiver members, those changes will reach adjacent lines in the coming months. CMS approval of SPA 26-0002 (Attachment 4.19B), effective October 1, 2026, is another notice to read alongside the home care rate table.
Three practical steps follow. Load the October 1, 2026 rates into billing systems for dates of service from that day. Check that plan payments for home health have moved up to at least the new schedule. And follow the next OHIC review cycle, since that is where the next change will start. See Rhode Island private duty nursing rates and Rhode Island home care rates for the adjacent lines.
On therapy, the states ahead of Rhode Island are a short list. Michigan pays $343.72 an hour for physical therapy and $278.92 for occupational therapy. Utah pays $330.48 for physical therapy, New Mexico $198.64 across all three disciplines, and Delaware $197.00 for physical therapy. Missouri leads speech therapy at $137.61 per 15 minutes.
Rhode Island's $177.08 matches or beats every state below those leaders, including Washington ($145.52 for occupational therapy), the fifth-ranked state on that line. Within New England, New Hampshire pays far less for the same three therapy codes.
- Grow the therapy line. At $177.08 an hour against median therapist wages of $47.79 to $50.00, therapy carries the margin in Rhode Island.
- Keep nursing visits focused. With a $4.66 hourly margin after loaded wages, nursing time that is not billable quickly turns a visit into a loss.
- Check plan payments against the floor. Plans must pay at least the published home health rate, so any payment below the October 2026 schedule is worth disputing.
- Respect the unit limits. Claim-line and daily limits cap what each line can carry; build them into billing edits.
- Follow the OHIC cycle. Rhode Island's rate changes start as OHIC recommendations, so the review is the earliest warning of the next change.
These steps matter more in Rhode Island than in most states because the gap between disciplines is so wide. The same agency can earn a strong margin on a therapy visit and almost nothing on a nursing visit to the same patient on the same day.
Every rate here is compiled from official Rhode Island Medicaid publications, including the Home Care Service Rates table effective October 1, 2026, and links to its source document. Rhode Island publishes all 76,101 current Medicaid rates across 91 service categories. Rankings compare nursing and speech therapy per 15 minutes and physical and occupational therapy per hour. Wages are May 2025 medians, and margins subtract a loaded wage from the hourly rate.
The Rhode Island Medicaid rates page shows the full schedule, the national home health page compares every state, and our methodology explains how 15-minute units become hourly rates.