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Is Medicaid personal care work profitable for a private-pay agency?

It depends far more on visit length and travel than on the rate, which is what most people look at first. Short billing units mean per-visit costs recur more often against less revenue each time, and travel between short visits is frequently unpaid. Some agencies run it profitably. At least one owner we spoke to ran the numbers and exited. The arithmetic is below.

Last updated 28 July 2026. No figure on this page is a sector average. The arithmetic is yours to run on your own numbers.

01 · Why

Why you probably do not know

Because rate comparison is the natural way to evaluate a new payer and it is the wrong tool here. A per-hour rate that looks survivable can become unsurvivable once it is delivered in fifteen or thirty minute units, because the per-visit costs stay the same while the revenue per visit falls.

One agency owner described trying it and finding the scheduling alone made it unworkable: "You can only imagine the scheduling nightmare it is to try to have aides drive with gas prices to go from house to house to just do like thirty minutes here or an hour there." His conclusion was that he was close to losing money on it, and he stopped.

Whether that is your answer depends on your geography, your density and your state, and none of those are things a rate comparison shows you.

02 · The method

How to work it out for your agency

Model a realistic day, not a single visit.

revenue per day    = billable units per day × rate per unit
caregiver cost     = paid hours per day × hourly cost
                     (include travel time if you pay for it, and say so if you do not)
per-visit overhead = visits per day × per-visit office cost
                     (scheduling, documentation, billing minutes × office rate)
net per day        = revenue − caregiver cost − per-visit overhead

Then run it again at a realistic density. The version where six clients live within ten minutes of each other and the version where they are spread across forty minutes of driving are different businesses with the same rate card.

If travel time is unpaid in your model, note that explicitly. It is a real cost to somebody even when it is not a cost to you, and a model that leaves it out is describing a different job to the one you are asking someone to do.

03 · The figure

What a typical figure looks like

There is no meaningful national answer. Medicaid personal care rates, unit structures, travel rules and EVV requirements are set state by state and change, so a figure from one state tells you close to nothing about another.

What transfers is the structure: units, density and travel dominate the outcome, and rate alone will mislead you.

04 · The limits

What this is not

This is not advice on whether to take Medicaid work, and it is not a compliance guide. Programme rules, billing requirements and EVV mandates vary by state and change frequently. Check the current rules for your state and take advice on them.

05 · Next

What is a normal gross margin on a short shift covers the same per-visit overhead in a private-pay context, and the two together explain most of what makes short-visit work difficult.

Not sure this is your biggest one? Rank all eight against your own numbers — fourteen questions, no score, and it asks for nothing before showing you the result.

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