Your State Now Has to Publish What It Pays for Home Care

As of July 2026, a federal Medicaid rule requires states to publish the hourly rates they pay for home health aide and personal care services. Here is how to find your state's number and what it does and does not tell you.

There's a question almost every home health aide eventually asks and almost none can answer: how much is Medicaid actually paying for my work, and how much of it is reaching me?

As of this month, that first half got a lot easier to answer.

A federal rule that took effect in July 2026 requires state Medicaid programs to publish the hourly rates they pay for home care. Not in an internal spreadsheet. On a public website, where you can read it.

What the rule requires

The Medicaid Access Rule requires states to report and publish their average hourly payment rates for four service categories:

Home health aide services
Personal care services
Homemaker services
Habilitation services

The number you'll see is what the state pays a provider per hour of service. It is not your wage. The gap between those two figures is the interesting part, and until now it was mostly invisible from the outside.

How to find your state's rate

There's no single national dashboard, which is the frustrating part. The rates are published state by state.

Search for your state's Medicaid agency website. It's usually a department of health, human services, or health care policy.
Look for a section on payment rates, fee schedules, or home and community based services (HCBS).
Find the hourly rate for home health aide or personal care services.

If you can't locate it, your state Medicaid office can point you to it directly. So can your agency, and it's a reasonable thing to ask.

The honest caveat

This rule is newer than the compliance behind it.

According to an analysis by KFF, only 15 states were able to report all of the required payment rate data. So depending on where you live, your state's published figures may be incomplete, hard to find, or slow to appear. The requirement exists. Uniform, easy-to-read compliance does not, at least not yet.

If your state hasn't published anything usable, that isn't your failure to find it.

What this is actually building toward

The transparency requirement is the first step of a much larger change.

Starting in July 2030, states will have to ensure that at least 80% of Medicaid payments for home health aide, personal care, and homemaker services goes to direct care worker compensation. That's the rule people refer to as the 80/20 rule.

The order is deliberate. Publishing the rates first creates a baseline that the 80% requirement can eventually be measured against. You can't enforce a pass-through percentage on a number nobody has written down.

Four years is a long runway, and the rule has been contested within the industry. But the direction is set: more of each Medicaid dollar is supposed to end up in the paycheck of the person doing the work.

What to do with the number

Once you find your state's published rate, it's useful in a few concrete ways.

Compare it to your hourly wage. The difference covers your agency's overhead, scheduling, supervision, training, insurance, and profit. Some of that is legitimate cost. You can now see the size of the pool it comes out of.

Compare agencies. The state rate is the same regardless of who employs you. If two agencies are billing the same rate and paying different wages, that's a real difference between them.

Use it when you negotiate. Knowing the rate doesn't obligate anyone to pay you more. It does mean you're having the conversation with actual information.

One thing worth being clear about: a high state rate does not automatically mean you're being underpaid. Agencies carry real costs. But you're better off knowing the number than not.

If you're not certified yet

None of this applies until you're working. Medicaid-funded home health aide work requires certification and registry placement, which means passing your state's competency exam first.

You can practice real HHA exam questions free right now, no signup required.