IDD Medicaid rates in North Dakota land above the national median on the service that matters most to in-home providers. North Dakota pays $10.43 per 15 minutes for in-home and community living supports on code S5125, or $41.72 an hour, effective July 1, 2026. That ranks 10th of 29 states and is 19.5% above the national median of $34.92 an hour.
North Dakota's schedule is also one of the few where the economics of a direct support hour clearly work. An above-median rate paired with a direct support wage close to the national figure gives North Dakota providers more room per hour than most of their peers.
The S5125 rate is paid in 15-minute units under North Dakota's 1915(c) Traditional IID/DD HCBS Waiver (ND.0037) and its DD payment system. At $41.72 an hour, North Dakota sits in the upper third of the 29 ranked states.
For context, the top of the national range is South Carolina at $85.96 an hour on T2017, followed by South Dakota at $69.28, Massachusetts at $68.04, Alaska at $61.84 and Maryland at $61.32. The bottom is Idaho ($15.44), West Virginia ($13.52 on S5125) and Louisiana ($12.40 on S5125).
North Dakota's neighbor to the south pays substantially more per hour on this service, but North Dakota's rate is still well clear of the national median, which places in-home supports on a reasonably stable footing.
North Dakota builds its DD rates from a rate matrix that converts cost components into a fully loaded hourly value, published as the DD Rate Matrix - Fully Loaded Hour Value. The approach starts from the cost of an hour of direct support, including wages, benefits and payroll taxes, and adds the indirect costs that make the hour possible: supervision, training, program support and administration.
For providers, the practical value of a matrix approach is transparency. When the legislature changes a component, such as the $1-an-hour direct care adjustment in 2023, the effect on the rate can be traced through the matrix. It also gives providers a framework for comparing their own costs against the assumptions built into the rate.
The labor economics are the strongest part of North Dakota's picture.
| Service | Rate per hour | DSP median wage | Wage share of rate | Margin per hour after loaded wage |
|---|---|---|---|---|
| Community living supports (S5125) | $41.72 | $22.24 | 73.7% | $10.97 |
| Supported employment (T2019) | $38.36 | $22.24 | 80.2% | $7.61 |
A wage share of 73.7% means the median direct support professional's wage, once payroll taxes and benefits are loaded on, takes up a little under three-quarters of the hourly rate. The remaining $10.97 an hour has to cover supervision, training, travel, administration and any profit. That is a workable margin by IDD standards, and a contrast with states where the rate does not even cover the loaded wage.
Where the margin goes
In a rural state, travel is the largest hidden cost in in-home services. A worker who drives between clients in different towns spends paid time that does not produce billable units. North Dakota agencies that schedule clients in clusters, stagger visits to minimize backtracking, and use longer visits where plans allow keep more of the $10.97 margin. Supervision is the second major cost: new staff need more oversight, so turnover directly erodes the margin.
North Dakota pays $9.59 per 15 minutes on T2019 for supported employment, or $38.36 an hour. That ranks 21st of 39 ranked states, 6.1% below the national median of $40.84.
Supported employment has the broadest coverage of any IDD service nationally, with 47 states publishing a rate. New York pays $141.64 an hour, Arkansas $102.36 and the District of Columbia $97.08. At the bottom are Tennessee ($14.96), West Virginia ($12.80) and Wyoming ($12.36), all on T2019. North Dakota is in the middle of the field, closer to the median than to either extreme.
Supported employment is tighter at $7.61 an hour, but still positive. Job coaching often involves travel between employer sites, so the narrower margin matters more than the headline rate suggests. H2023, the other employment code on North Dakota's schedule, carries a daily limit, so programs using it should track units per person per day.
Federal occupational wage data for May 2025 puts North Dakota at or above the national median on most IDD roles:
- Direct support professional: $22.24 an hour, versus $22.08 nationally (based on the closest comparable occupation)
- Residential advisor: $23.36, versus $20.31
- Home health and personal care aide: $18.96, versus $17.21
- Licensed practical nurse: $29.95, versus $30.96
North Dakota is a market where direct care wages are not a discount. Residential advisors and personal care aides both earn noticeably more than the national median, so providers compete for staff at national-level wages. The above-median S5125 rate is what keeps that sustainable.
The competition for workers also comes from outside Medicaid. Personal care aides earning $18.96, above the national median, signal a tight labor market for entry-level care work. IDD agencies that want to recruit and keep staff need to position their wages against both other care employers and other local industries.
North Dakota sets IDD rate increases through the legislature's biennial budget. Two provisions of 2023 SB 2012, both effective July 1, 2023, shaped the current rates:
- Direct care adjustment. A developmental disability provider rate adjustment equivalent to $1 an hour for direct care and indirect support staff.
- Inflation increases. A provider inflation increase of 3% in each year of the 2023-25 biennium, with DD service payments rising 2% each year.
The $1-an-hour adjustment is a targeted wage measure: it was expressed in hourly terms tied to direct care. Combined with the annual DD increases, it helps explain why North Dakota's S5125 rate now sits above the national median while its direct support wage is also above the national figure.
What the biennial cycle means for planning
Because rate growth runs through the legislature, the budget session is the moment that matters for North Dakota providers. Inflation increases are set for both years of a biennium at once, which makes the second year predictable but leaves providers waiting for the next session if costs rise faster than expected. Agencies should build two-year budgets that match the biennium and take part in the budget process with cost data before the session begins.
North Dakota's coverage listing shows no prior authorization rules on S5125, S5120, T2019 or H2023. H2023 carries a daily limit. For billing teams, the practical control on these services is the authorized waiver plan and the unit limits, not a code-level authorization step.
The absence of code-level prior authorization reduces administrative work compared with states that require approval for each service, but it does not remove the need for discipline. Services must still match the person's plan, and units billed must stay within what the plan authorizes. An internal check that compares each month's billed units with the plan is the simplest safeguard.
North Dakota's IDD services run fee-for-service through the Traditional IID/DD HCBS Waiver and the DD payment system, with rates published by the state. North Dakota's Medicaid program has 5 plan listings in our IDD data, including Blue Cross Blue Shield of North Dakota and Northland PACE, alongside primary care case management. Those arrangements do not set DD waiver rates. The North Dakota managed care page shows the rule for each service line that plans cover.
In the West North Central region, North Dakota's in-home rate trails South Dakota's but sits well above Nebraska, where the same service ranks 24th of 29. Minnesota runs a framework-based system with very high reference rates for day and residential services. For an in-home agency weighing the region, North Dakota offers a combination of above-median rates, positive margins at median wages and light code-level authorization. The trade-off is geography: long distances between clients raise travel costs, so the rate advantage is largest for agencies serving people in and around the state's towns, where visits can be grouped efficiently and staff spend more of each paid hour with the people they support.
- Budget on fully loaded costs. Compare your actual cost per hour, including supervision and travel, with the $41.72 S5125 rate.
- Plan on the biennium. Rate changes arrive through the legislature; build two-year budgets that match. Revisit them when each session ends.
- Benchmark employment services. At $38.36 an hour, T2019 margins depend on keeping coaches in billable contact.
Rates on this page are compiled from official state Medicaid publications, and each rate links to its source document, including the DD Rate Matrix - Fully Loaded Hour Value. Hourly figures convert 15-minute units by multiplying by four. Our methodology explains how 15-minute units are converted to hourly rates.
For the national view of every IDD service, see IDD Medicaid rates by state. The North Dakota Medicaid rates hub covers the rest of the state's schedule, drawn from all 19,715 current North Dakota Medicaid rates. The full dataset is described on our pricing page.