IDD Medicaid rates in Oklahoma sit at the very bottom of the country for residential care. Oklahoma pays $88.66 a day for residential habilitation, ranking 31st of 31 states and 68.4% below the national median of $280.27 a day. Its ICF/IID rate of $174.35 a day is also the lowest of 12 ranked states, 62.5% below the national median of $464.88.
That is the defining fact for Oklahoma IDD providers. Hourly in-home and employment services are below the median but within range of it; residential and facility care are the outliers, even after a 10% increase in October 2024.
Residential habilitation in Oklahoma pays $88.66 a day, effective October 1, 2024. The national range shows how far that sits from other states:
| State | Residential habilitation per day |
|---|---|
| Minnesota | $999.00 |
| District of Columbia | $567.62 |
| New York | $564.22 |
| Iowa | $140.81 |
| Illinois | $108.00 |
| Oklahoma | $88.66 |
New York pays $564.22 a day for the same service, and even the second- and third-lowest states, Illinois and Iowa, pay noticeably more. For an Oklahoma group home, a daily rate at this level makes 24-hour staffing very difficult to fund from the residential rate alone.
DDS Administrative Letter 25-02, issued February 24, 2025, gave Community Living Group Homes a 10% increase retroactive to October 1, 2024. Even with that adjustment, Oklahoma remains last among ranked states.
A daily rate is meant to cover everything a home needs in a day: staff on every shift, supervision, transportation, program supplies and administration. At $88.66, an Oklahoma residential provider cannot fund round-the-clock one-to-one staffing from the residential rate alone. In practice, providers rely on a combination of approaches:
- Shared staffing. Homes where several residents share staff on each shift spread the cost of a staffed hour across more daily rates.
- Layered services. People living in group homes often also receive day services or employment supports, each billed separately, which reduces the hours the residential rate must cover.
- Low wage base. Oklahoma's residential advisor median of $17.02 an hour, against $20.31 nationally, is what keeps homes operating at all.
The economics leave little room for vacancies. One empty bed removes a full daily rate while the staffing pattern stays the same, so occupancy management is the main operational priority for Oklahoma residential providers.
The facility side tells the same story. Oklahoma's ICF/IID daily rate is $174.35, effective July 1, 2026, the lowest of 12 ranked states. The District of Columbia pays $1,021.84, Maine $995.49 and South Dakota $926.97; Louisiana ($232.14) and Wisconsin ($201.04) join Oklahoma at the bottom.
For an ICF/IID operator, a rate this low against a licensed practical nurse wage of $28.04 an hour leaves little room for the nursing coverage these facilities require. ICF/IID facilities must provide active treatment and continuous oversight, so their cost base cannot be cut the way a community program's can. Facilities in Oklahoma operate on very tight margins and depend on high occupancy and efficient staffing schedules. The July 2026 effective date makes this the most recently updated IDD rate on Oklahoma's schedule.
Oklahoma's hourly IDD services are closer to national norms. All are agency-provider rates effective October 1, 2024:
- In-home and community living supports (T2017): $6.58 per 15 minutes, or $26.32 an hour. Ranks 18th of 29, 24.6% below the national median of $34.92.
- Prevocational services (T2015, modifier TG): $18.02 an hour. Ranks 17th of 28, only 3.5% below the national median of $18.67.
- Supported employment (T2019): $8.64 per 15 minutes, or $34.56 an hour. Ranks 24th of 39, 15.4% below the national median of $40.84.
- Day habilitation: $33.31 a day.
Prevocational services is Oklahoma's closest service to the national median. Supported employment sits in the lower-middle, well above the bottom of the range, where Tennessee ($14.96), West Virginia ($12.80) and Wyoming ($12.36) pay. Oklahoma has no community integration or behavior support rate in our ranked data.
Oklahoma pays day habilitation at $33.31 a day and prevocational services at $18.02 an hour with the TG modifier. The two rates point to different program designs. A daily rate pays the same amount whether a person attends for a short day or a full one, so day programs do best when attendance is consistent and the program day is planned around what the rate can fund. An hourly prevocational rate pays for time actually delivered, which rewards accurate attendance tracking and efficient group sizes.
Prevocational services are the clearest bright spot on Oklahoma's schedule relative to other states. At only 3.5% below the national median, they are priced close to the national norm in a state where wages are well below it, which gives prevocational programs more room than the state's other services. Programs that use prevocational time as a bridge into supported employment can combine two of Oklahoma's better-priced services, building work skills in a group setting and then moving people into individual job coaching, where the margin is wider still.
Federal occupational wage data for May 2025 places Oklahoma well below the national median on every IDD role:
- Direct support professional: $17.66 an hour, versus $22.08 nationally (based on the closest comparable occupation)
- Residential advisor: $17.02, versus $20.31
- Home health and personal care aide: $13.32, versus $17.21
- Licensed practical nurse: $28.04, versus $30.96
Those low wages are what allow Oklahoma's hourly rates to function. On T2017 community living supports, almost every dollar of the rate goes to the direct support hour, leaving very little for supervision, training or travel.
Supported employment does better. That makes job coaching one of the more sustainable IDD services in Oklahoma, in contrast with in-home supports, where travel time and short visits can turn the thin positive margin negative.
Oklahoma's current IDD rates trace back to a single round of increases:
- SPARC hearing, September 5, 2024. Developmental Disabilities Services increases of 10%.
- DDS Administrative Letter 24-02 (September 27, 2024). Put the 10% rate increases into effect for DDS providers on October 1, 2024.
- SPARC hearing, January 6, 2025. A further hearing on the Developmental Disabilities Services increases.
- DDS Administrative Letter 25-02 (February 24, 2025). A retroactive 10% increase for Community Living Group Homes, effective October 1, 2024.
OHCA also issued a public notice on December 15, 2025 and a notice on OK SPA 25-0003 for ABP updates effective March 1, 2025, along with notices on the ADvantage waiver and hospice.
What the 2024 increase did and did not change
A 10% increase is meaningful for services near the median, and it helped move prevocational services to within a few percent of the national figure. For residential and facility care, the starting point was so far below other states that a 10% increase did not change the ranking. Providers should treat the 2024 round as a floor, not a fix, and continue to document costs for the next review through the SPARC process.
In Oklahoma, intellectual and developmental disability services are paid directly by the state, outside managed care. Oklahoma's DDS 1915(c) waivers (Community, In-Home Supports for adults and children, and Homeward Bound) are billed through SoonerCare fee-for-service. Oklahoma also funds some DDS services with state-only money outside Medicaid.
SoonerSelect, the state's risk-based managed care program, includes plans such as Aetna Better Health of Oklahoma, Humana Healthy Horizons in Oklahoma and Oklahoma Complete Health; our IDD data counts 5 plan listings. For other home and community-based services, those plans must pay at least the published rate. The Oklahoma managed care page has each line's rule.
Oklahoma's neighbors in our data are Arkansas, Louisiana and Texas. Arkansas pays one of the highest supported employment rates in the country, while Texas and Louisiana sit near the bottom on several hourly services. Oklahoma is therefore not an outlier in its region on hourly services, but it is the national low point on residential and facility care. A regional provider would find Oklahoma's employment and prevocational rates competitive with neighbors, and its residential rates the hardest in the country.
- Lead with employment services. Supported employment carries the strongest margin on Oklahoma's schedule.
- Model residential homes per house. Build budgets on the full staffing pattern and every daily rate in the home, with vacancy scenarios.
- Engage in SPARC hearings. Rate changes in Oklahoma pass through public hearings, where documented costs carry weight.
Rates on this page are compiled from official state Medicaid publications, and each rate links to its source document, including the SoonerCare Title XIX Fee Schedule and the Vocational and Day Services Rates for the Web 2026-07-01. Hourly figures convert 15-minute units by multiplying by four. Our methodology explains how 15-minute and daily rates are compared.
The Oklahoma Medicaid rates hub covers the full SoonerCare schedule, drawn from all 29,954 current Oklahoma Medicaid rates, and IDD Medicaid rates by state compares every IDD service. The full dataset is described on our pricing page.