80% of covered Medicaid home care payments must fund worker compensation by 2030

Medicaid pays for home care that helps older adults and people with disabilities live at home. Beginning July 9, 2030, states generally must ensure each covered provider spends at least 80% of the Medicaid payments it receives for homemaker, home health aide, and personal care services on direct care worker compensation. The rule covers specified Medicaid home- and community-based services programs, not every Medicaid home care payment. Required training, travel, and protective-equipment costs are excluded before the percentage is calculated. Compensation includes wages, benefits, and employer payroll taxes. States may set another level for small providers and grant hardship exemptions; some self-directed services and Indian Health Service and Tribal programs are exempt. Workers do not apply; states enforce the rule.

The rule also requires states to post Medicaid fee-for-service payment rates online and, at least every two years, publish average hourly fee-schedule rates for these home care services. Those are provider payment rates, not worker wages. States must also convene direct care workers, beneficiaries, and others to advise on rates.

CMS Administrator Chiquita Brooks-LaSure approved the rule, and HHS Secretary Xavier Becerra signed it.

The 80% requirement is phasing in. CMS issued guidance in October 2026 for annual compensation reporting that starts July 9, 2028. A separate CMS proposal has been under White House review since May 12, 2026; the agenda says it may revise or rescind unspecified parts of the 2024 rules, but public materials do not say whether the 80% minimum would change.