If you run a personal care agency, you know the squeeze. Your caregivers need higher wages to stay in the workforce. Your clients need consistent, quality care. And the state Medicaid programs that pay you are caught between rising demand and tight budgets.
Personal care services, the non-skilled assistance with bathing, dressing, meal preparation, and other daily living activities, are the single largest outpatient spending category in Medicaid. HCPCS code T1019, which covers these services, represents one of the largest spending categories in the Medicaid claims data released by HHS in February 2026.
The 2026 reimbursement landscape is a patchwork of state-specific rate increases, minimum wage adjustments, and legislative reforms. This guide walks you through the rates that matter for your agency, organized by state, so you can plan your billing, staffing, and advocacy strategies for the year ahead.
The National Picture: T1019 Dominates Medicaid Spending
Before diving into state rates, understand the scale. HCPCS code T1019 is the single largest spending category in the Medicaid claims dataset spanning 2018 through 2024. The growth is staggering. Tempus Unlimited, Inc., a Massachusetts-based nonprofit that administers the state’s Personal Care Attendant (PCA) program, billed $34.1 million in T1019 claims in January 2018. By July 2024, that figure had reached $118.9 million per month—a 3.5x increase from a single organization billing a single HCPCS code.
However, the growth is not driven primarily by rate increases. Tempus Unlimited’s per-claim reimbursement rose from $88.29 in January 2018 to $98.60 in July 2024, an increase of just 12% over 6.5 years. The far larger driver is utilization expansion: the number of unique beneficiaries served grew from 17,200 to 39,765, more than doubling the population receiving services.
Modest rate increases combined with rapid utilization growth—is the defining dynamic of Medicaid personal care across the country.
State-by-State 2026 Reimbursement Rates
District of Columbia: $30.76 Per Hour (Effective January 1, 2026)
The District of Columbia Department of Health Care Finance updated PCA reimbursement rates effective January 1, 2026. The new rate structure incorporates enhanced wages for Direct Support Professionals calculated at 117.6% of the greater of the district’s minimum wage or its living wage.
| Code | Service Description | Reimbursement Rate |
| T1019-NP | State Plan | $30.76 Per Hour ($7.69 per 15 min) |
| T1019-UT | Personal Care Aide Services | $30.76 Per Hour ($7.69 per 15 min) |
| T1019-52 | Personal Care Service Per 15 Min | $30.76 Per Hour ($7.69 per 15 min) |
Texas: $17.13 Per Hour (Effective September 1, 2025)
Texas finalized a 9.9% increase in the base hourly reimbursement rate to $17.13 per hour, effective September 1, 2025. The rate increase is tied to the 2026-27 General Appropriations Act, which increases the wage for personal attendants to $13.00 per hour.
The affected programs include:
- Community Attendant Services Program (CASP)
- Personal Care Services (PCS)
- Primary Home Care, Community Attendant Services, and Family Care (PHC, CAS, FC)
- STAR Kids and STAR Health Medically Dependent Children’s Program (MDCP)
- STAR+PLUS Home and Community-Based Services
Illinois: $30.80 Per Hour (Effective January 1, 2026)
Illinois finalized a 3.9% increase in the base hourly reimbursement rate to $30.80 per hour, effective January 1, 2026 (subject to federal approval). This rate sustains a minimum wage of $18.75 per hour for direct in-home care service workers.
The affected programs include:
- Illinois Department on Aging, Community Care Program (CCP)
- Illinois Department of Human Services, Home Services Program (HSP)
- Illinois Department of HealthCare and Family Services, Managed Long-Term Service and Supports Program (MLTSS)
Massachusetts: Complex Care Differential and Union Wage Tiers
Massachusetts introduced significant changes effective January 1, 2026, driven by the collective bargaining agreement between the Commonwealth and the PCA union (1199SEIU) . The new rates include a PCA Complex Care Differential for PCAs working with high-need consumers.
Rate for Non-Exempt PCAs (Not Completed NHO)
| Service | Rate Effective Jan 1, 2026 | Unit |
| PCA Services | $5.43 | 15 min |
| Add-on for Premium Pay | $2.72 | 15 min |
| Earned Paid Time | $5.43 | 15 min |
Seniority Step Wages (Completed NHO or Exempt):
| Step | Hours Worked | PCA Services Rate (15 min) |
| Step 1 | 0 – 3,640 hours | $6.47 |
| Step 2 | 3,641 – 7,280 hours | $6.63 |
| Step 3 | 7,281 – 12,740 hours | $6.80 |
| Step 4 | 12,741 – 18,200 hours | $6.97 |
| Step 5 | 18,201+ hours | $7.14 |
The Massachusetts PCA Program also includes a complex care differential for PCAs working with consumers who have higher needs, as well as different rate structures for the Community Case Management (CCM) PCA Option.
California: $5.28 Per 15 Minutes ($21.12 Per Hour)
California’s 2026 HCBS reimbursement rates increased due to the statewide minimum wage rising from $16.50 to $16.90 effective January 1, 2026. The maximum payable rate for T1019 personal care services is $5.28 per 15 minutes, which translates to $21.12 per hour.
| Procedure Code | Provider Type | 2026 Maximum Payable Rate | Unit |
| T1019 | HHA (14) | $5.28 | 15 Minutes |
| T1019 | Personal Care Agency (66) | $5.28 | 15 Minutes |
| T1019 | HCBS Benefit Provider | $5.28 | 15 Minutes |
| T1019 | Employment Agency (64) | $5.28 | 15 Minutes |
| T1019 | Professional Corporation (95) | $5.28 | 15 Minutes |
North Carolina: PCS Rate Increase to $7.50 per 15 Minutes (Effective July 1, 2026)
North Carolina’s legislature passed a bill appropriating $120.8 million in recurring funds to increase the Medicaid rate for personal care services to $7.50 per 15-minute increment, effective July 1, 2026.
This applies to:
- State Plan Personal Care Services Program (PCS)
- Community Alternatives Program for Children (CAP/C)
- Community Alternatives Program for Disabled Adults (CAP/DA)
- Community Alternatives Program Choice (CAP/CO)
Colorado: Rate Rebalancing in FY 2025-26
Colorado’s Department of Health Care Policy & Financing is rebalancing rates across personal care, homemaker, In Home Services and Supports (IHSS) health maintenance, and Consumer Directed Attendant Support Services (CDASS) . The proposed changes are effective for FY 2025-26 and FY 2026-27.
Connecticut: Collective Bargaining Agreement Implementation
Connecticut’s Department of Social Services proposed SPA 25-AE to implement rate increases for the Community First Choice (CFC) benefit, driven by the collective bargaining agreement between the state’s PCA Workforce Council and the union representing self-directed PCAs. The rate methodology includes wage increases, additional holidays for holiday pay, increases in health care expense add-ons, and paid time off.
The CFC self-directed PCA rates use multiple billing methodologies:
- Hourly Rate: Quarter-hour billing for non-live-in care
- Per Diem Rate: For 24-hour continuous live-in care
- Pro-Rated Per Diem: For incomplete 24-hour shifts
- Overnight Rate: For 12-hour overnight shifts
- Pro-Rated Overnight: For incomplete 12-hour shifts
The Cross-State Rate Gap: Why New York Pays More Than Massachusetts
One of the most striking findings from the 2026 Medicaid claims data is the wide gap in reimbursement for the same service across states. HCPCS code T1019 is billed by providers in both New York and Massachusetts at high volume, but the per-claim rates are starkly different.
New York reimburses 54% to 113% more than Massachusetts for the same T1019 personal care service.
- Massachusetts: Approximately $98.60 per claim (Tempus Unlimited, July 2024)
- New York: $152 to $210 per claim (Freedom Care LLC and other top providers, July 2024)
This is not a difference in service scope. Both states use T1019 for non-skilled personal care in home settings. The difference is entirely in how each state’s Medicaid program sets its fee schedule.
Freedom Care LLC’s Growth Story: Freedom Care LLC, a New York-based fiscal intermediary that administers the state’s Consumer Directed Personal Assistance Program (CDPAP), grew from $5.7 million in monthly T1019 billing in January 2018 to $82.9 million by July 2024, a 14.5x increase. The per-claim rate stayed roughly in the $127–$152 range throughout, and each beneficiary averaged roughly 19 claims per month. What changed was the number of people enrolled: from 2,140 to 28,053.
This trajectory tracks the broader expansion of New York’s CDPAP program, which has been the subject of significant legislative scrutiny and reform efforts due to program costs exceeding $9 billion annually statewide.
Minimum Wage Increases
Several states’ rate increases are directly tied to minimum wage laws. California’s rate increase follows the statewide minimum wage rising from $16.50 to $16.90. Illinois’ $30.80 per hour rate sustains a $18.75 per hour caregiver minimum wage.
Collective Bargaining Agreements
Both Massachusetts and Connecticut have implemented rate increases driven by collective bargaining agreements with PCA unions. These agreements mandate wage increases, paid time off, health care add-ons, and other benefits that directly increase reimbursement rates.
Legislative Appropriations
States like North Carolina ($120.8 million) and Texas (9.9% increase) have passed legislation specifically appropriating funds for personal care rate increases. These are not tied to minimum wage laws but to legislative recognition of workforce shortages and the need to stabilize the caregiver workforce.
Attendant Compensation Reform
Texas is transitioning from the Attendant Compensation Rate Enhancement Program to a new rate methodology that incorporates a $13.00 per hour wage for personal attendants. The state’s total spending on personal attendant services under the new methodology is projected to reach $1.65 billion by SFY 2030.
Conclusion
Personal care reimbursement rates in 2026 are a state-by-state patchwork of legislative appropriations, minimum wage adjustments, and collective bargaining outcomes. The range is wide: from California’s $21.12 per hour to Illinois’ $30.80 per hour, with Massachusetts using tiered seniority rates and New York paying more than double Massachusetts for the same service.
What is consistent across states is the recognition that personal care services are essential, that the caregiver workforce is under pressure, and that reimbursement must increase to sustain quality care. North Carolina’s $7.50 per 15-minute rate, Texas’ $17.13 per hour, and Massachusetts’ complex care differentials all reflect this emerging consensus.
Ready to Optimize Your Personal Care Billing and Reimbursement Strategy?
Navigating changing Medicaid reimbursement rates, HCPCS T1019 billing requirements, and state-specific payment policies can be challenging without the right expertise. Whether you operate a personal care agency, home care organization, or consumer-directed services program, maximizing reimbursement starts with accurate billing, compliance, and revenue cycle management.
At RCM Xpert Medical Billing Services, we help personal care providers across New York and nationwide improve claim accuracy, reduce denials, accelerate reimbursements, and strengthen financial performance. Our experienced billing specialists stay current with Medicaid regulations, payer requirements, and reimbursement updates so your team can focus on delivering exceptional patient care.
Our Personal Care Billing Services Include:
✔ Medicaid Claims Submission & Management
✔ HCPCS T1019 Billing Support
✔ Revenue Cycle Management (RCM)
✔ Eligibility Verification
✔ Denial Management & Appeals Service
✔ Accounts Receivable (AR) Follow-Up
✔ Compliance & Documentation Review
✔ Reimbursement Analysis & Reporting
Looking to improve collections and streamline your personal care billing process?
Contact RCM Xpert Medical Billing Services today for a free consultation and discover how our specialized billing solutions can help your agency maximize revenue while remaining compliant with evolving Medicaid requirements.
