Effective Aug. 1, 2026, the Division of Health Benefits (DHB) is applying an 18% increase to the current rates for all applicable Personal Care Services (PCS) procedure codes designated by DHB. The increase applies to PCS delivered through NC Medicaid Direct and through the Community Alternatives Program for Children (CAP/C), the Community Alternatives Program for Disabled Adults (CAP/DA) and Community Alternatives Program Consumer Direction (CAP/CD).
The 2026 Appropriations Act (Senate Bill 257, Section 9E.15) appropriated $70.8 million in recurring State funding to raise PCS rates. The legislation does not set a rate or a percentage; therefore, DHB applied a uniform 18% increase across every applicable procedure code. That percentage distributes the full appropriation across the remaining 11 months of state fiscal year (SFY) 2027.
New Rates by Procedure Code
| Program | Procedure Code | Modifier / Setting | Current Fee Schedule Rate | New Rate at 18% Increase | Notes |
|---|---|---|---|---|---|
| State Plan PCS | 99509 | HA, HB | $5.96 | $7.03 |
|
| 99509 | HC, HH, HI, HQ, SC,TT | $5.96 | $7.03 | Daily Per diem rate is based on the fee schedule rate and the beneficiary's total pre-approved units for an authorized period. | |
| CAP/C | S5125 | $5.96 | $7.03 |
| |
| S5135 | $5.96 | $7.03 |
| ||
| S5150 | $5.96 | $7.03 |
| ||
| CAP/CD | S5125 | $5.96 | $7.03 |
| |
| S5150 | $5.96 | $7.03 |
| ||
| S9122 | TF | $5.44 | $6.42 |
| |
| S9122 | TG | $5.44 | $6.42 |
| |
| T1004 | $7.34 | $8.66 |
| ||
| T1019 | $7.34 | $8.66 |
| ||
| T2027 | $5.96 | $7.03 |
| ||
| T2027 | TF | $5.43 | $6.41 |
| |
| CAP/DA | S5125 | $5.96 | $7.03 |
| |
| S5150 | $5.96 | $7.03 |
|
NC Medicaid Managed Care
These rate increases also apply to PCS furnished by providers contracted with Standard Plans and Tailored Plans. Health plans have 45 calendar days from the date DHB notifies them to load the new rates, plus 30 additional days to reprocess claims with dates of service on or after Aug. 1, 2026.
Fee schedules
The applicable PCS codes are posted on the publicly posted fee schedule. NC Medicaid is revising the published fee schedules to reflect the rates shown above.