Private duty nursing Medicaid rates in West Virginia sit almost exactly at the national middle for LPN care and below it for RNs, because the state pays both levels the same. West Virginia Medicaid pays $11.02 per 15 minutes on code T1000, or $44.08 an hour, effective 2026-04-01. For RN private duty nursing that ranks 29th of 43 states, 19.6% below the $54.84 national median. For LPN care, the same rate ranks 20th of 39 and matches the $44.08 national median exactly.
The waiver side is split in the other direction: RN waiver nursing pays above the median, LPN waiver nursing far below it. Every rate here is compiled from official state Medicaid publications and links to its source document on the West Virginia Medicaid rates page.
| Service | Code | Per 15 min | Per hour | Rank | vs median |
|---|---|---|---|---|---|
| PDN, RN | T1000 | $11.02 | $44.08 | 29 of 43 | -19.6% |
| PDN, LPN | T1000 | $11.02 | $44.08 | 20 of 39 | 0.0% |
| Waiver nursing, RN | T1002 HI | $20.70 | $82.80 | 15 of 41 | +6.7% |
| Waiver nursing, LPN | T1003 U3 | $6.82 | $27.28 | 31 of 34 | -51.6% |
The state plan rate does not distinguish RN from LPN time. On the waiver side, the RN rate of $82.80 an hour sits far above the LPN rate of $27.28, which pushes agencies toward RN staffing on waiver cases. The waiver rates, with HI and U3 modifiers, have been in effect since 2025-10-01.
Most states pay a higher hourly rate for a registered nurse than for a licensed practical nurse. West Virginia's state plan does not: an hour on T1000 pays $44.08 whichever level of nurse delivers it.
That single rate produces two very different national positions. Measured against other states' RN rates, $44.08 ranks 29th of 43 and sits 19.6% below the median. Measured against other states' LPN rates, the same figure ranks 20th of 39 and lands exactly on the median. Neither reading is wrong; they simply compare against different peer groups.
For an agency, the single rate is a strong signal about staffing. Since the payer does not reward RN time on state plan cases, the extra cost of an RN is not recovered. Where a patient's plan of care allows LPN-level care, the state plan line is built for LPNs. Where the physician orders require an RN, the agency is staffing at a rate set without regard to RN cost.
West Virginia nurse wages sit well below the national median. Federal wage data for May 2025 put the state median at $38.52 an hour for registered nurses (US: $46.90) and $26.61 for licensed practical nurses (US: $30.96).
The four lines split two and two:
- RN private duty nursing: loaded wage share 124.2%, a loss of $10.67 an hour at the median wage.
- LPN private duty nursing: loaded wage share 85.8%, leaving $6.26 an hour after loaded wages.
- RN waiver nursing: loaded wage share 66.1%, leaving $28.05 an hour.
- LPN waiver nursing: loaded wage share 138.6%, a loss of $10.54 an hour.
"Loaded" means the wage plus employer costs such as payroll taxes and benefits. The margin left after that has to pay for supervision, scheduling, training, insurance and mileage, so a thin positive margin is not the same as a profitable line.
The staffing logic is the mirror image across programs. Under the state plan, an LPN shift works and an RN shift does not, because both are paid the same. Under the waiver, an RN shift carries a wide margin and an LPN shift loses money.
At intake
Check each referral's funding source before assigning staff. A state plan case authorized for LPN-level care is the natural fit for an LPN. A waiver case is the natural fit for an RN.
When the order and the economics disagree
Some cases will not fit the pattern: a state plan patient whose orders require an RN, or a waiver patient whose plan specifies LPN care. Those cases are clinically necessary and should be staffed as ordered, but they are worth tracking separately so the agency knows how much of its book runs below cost.
Across the caseload
An agency with a balanced mix of state plan LPN hours and waiver RN hours can carry the loss-making lines. An agency concentrated in one of the losing combinations cannot.
West Virginia's Bureau for Medical Services (BMS) has raised home and community-based rates twice in two years:
- HCBS rate increases effective October 1, 2024, announced in a BMS memo dated August 22, 2024, with a listed change of 27.2%.
- HCBS and Personal Care rate increases effective October 1, 2025, announced in a BMS letter dated October 10, 2025, with a listed change of 6.12%.
Both followed an HCBS rate-setting brief with proposed rates published in December 2023, which carried a listed change of 29.27%. The current waiver nursing rates carry the 2025-10-01 date, and the state plan T1000 rate the 2026-04-01 date.
What this means in practice: West Virginia has moved HCBS rates on a roughly annual October cycle since the rate study. Agencies should expect the next waiver adjustment to arrive the same way, through a BMS letter, and should check each new letter for changes to T1002 and T1003 before the effective date.
West Virginia's coverage data list:
- Two prior authorization rules on T1000.
- One rule on T1002, with a monthly limit.
- One rule on T1003.
The monthly cap on RN waiver nursing means agencies should track units against the authorization across the month, not only per visit. A case that runs heavy early in the month can exhaust its authorized units before the month ends, leaving the agency to choose between unpaid shifts and gaps in care. Scheduling against the monthly total from the first week avoids that problem.
On the state plan side, two authorization rules on T1000 mean a case needs approved hours before services start, and renewals need to be filed before the current approval lapses. A simple calendar of authorization end dates, reviewed weekly, prevents most unpaid hours.
West Virginia's home-based waivers include the Aged and Disabled Waiver (ADW), the Intellectual/Developmental Disabilities Waiver (IDDW), the Traumatic Brain Injury Waiver (TBIW) and the Children with Serious Emotional Disorder Waiver (CSEDW). The waiver nursing rates on T1002 and T1003 are published under the IDDW. West Virginia Medicaid's fee-for-service program, run by the Bureau for Medical Services, carries the state plan T1000 rate.
Each waiver has its own service plan and authorization process, so the same nurse may bill different codes for different patients. The West Virginia IDD rates page covers other IDDW services, and the West Virginia home health rates page covers the visit-based nursing many PDN agencies also provide.
Our records list 5 plan arrangements in West Virginia: Aetna Better Health of West Virginia, Highmark Health Options West Virginia, The Health Plan of West Virginia, UniCare Health Plan of West Virginia and Wellpoint West Virginia.
For private duty nursing, West Virginia's rule is that services are paid directly by the state, outside managed care. The same rule covers home and community-based services, personal care and intellectual and developmental disability services. Home health is different: there, plans negotiate and the published rate applies out of network.
For a PDN agency, this means the BMS rate is the rate. There is no plan contract to negotiate on nursing hours, and a state rate change applies to every case at once. Agencies that also bill home health visits, however, need plan contracts for that line. The West Virginia managed care page lists each rule.
For RN private duty nursing, Utah pays $254.03 an hour and Massachusetts $130.64, while Virginia ($25.86), New Jersey ($15.75) and Oklahoma ($8.92) are lowest. For LPN waiver nursing, West Virginia's $27.28 sits just above California ($24.72), North Carolina ($13.92) and Arkansas ($12.68).
West Virginia's picture is mixed rather than low: a mid-table state plan rate, an above-median RN waiver rate and a near-bottom LPN waiver rate. The private duty nursing hub shows the full national ranking.
- Budget by line, not by agency average. The four lines run from a $28.05 margin to a $10.67 loss per hour, so an average hides the real picture.
- Forecast with the effective dates. The state plan rate changed on 2026-04-01 and the waiver rates on 2025-10-01; bill each date of service at the rate in effect.
- Use the LPN waiver gap in comments. A rate 51.6% below the national median, with a loaded wage share of 138.6%, is a clear, documented case for an increase when BMS takes comment on HCBS rates.
- Benchmark wage offers. Wages below the state median improve each line's margin, but recruiting in a market already below national pay levels has limits.
The full West Virginia dataset includes all 88,707 current Medicaid rates, with every nursing code, modifier and waiver variant, through a MedicaidRate plan.
Rates on this page are compiled from official state Medicaid publications from the West Virginia Bureau for Medical Services, including the state plan fee schedule and the waiver rate tables, and each rate links to its source document. Hourly figures are four 15-minute units. National ranks compare each state's published rate for the same service and provider level, and wages are May 2025 federal occupational medians. Our methodology explains how rates are matched and compared.