In-Home Care Costs by State: 2026 Southeast & National Guide

When families start exploring in-home care options, one of the first questions is always: “How much will this cost?” The answer, unfortunately, isn’t simple—because in-home care costs vary dramatically from state to state and even within regions.

Whether you’re in Alabama where costs are more affordable, or Florida where demand drives prices higher, understanding the pricing landscape in your state helps you plan realistically and explore all your payment options.

This comprehensive guide breaks down in-home care costs across all 50 states, with detailed focus on the Southeast region. You’ll learn what different types of care cost, why prices vary so much, and how Medicaid waivers can help make care more affordable in your state.

Quick Overview: National average for in-home care ranges from $28-35 per hour for personal care, with significant state variations. Southeast states generally run $22-30/hour, while high-cost states like Massachusetts and California can reach $35-40/hour. Most states offer Medicaid waiver programs to help eligible seniors afford care.

Understanding In-Home Care Cost Types

Before diving into state-by-state pricing, it’s important to understand that “in-home care” isn’t a single service—costs vary based on the type of care provided:

Homemaker/Companion Care ($22-30/hour average) – Light housekeeping, meal preparation – Companionship and conversation – Transportation to appointments – Medication reminders (no administration)

Personal Care/Home Health Aide ($28-35/hour average) – All companion care services, plus: – Assistance with bathing, dressing, grooming – Help with toileting and transfers – Hands-on support with activities of daily living (ADLs)

Skilled Nursing Care ($85-120/hour average) – Licensed nurse (RN or LPN) – Wound care, injections, IV therapy – Post-surgical care – Complex medication management

This article focuses primarily on personal care and companion care rates, as these are what most families need and budget for.

Southeast States: Detailed Cost Breakdown

These nine states represent our core coverage area. Here’s what families can expect to pay for in-home care services in 2026.

Monthly cost calculated at 44 hours per week (approximately 6 hours/day) of personal care. Rates based on Genworth Cost of Care Survey 2026 data.

What These Numbers Mean

Most Affordable: Mississippi offers the lowest rates in the Southeast at $26/hour for personal care—about 16% below the national average. For families on fixed incomes who find even these rates challenging, exploring low-income senior housing options alongside in-home care can provide additional affordability.

Highest in Region: Florida’s rates reflect higher demand from its large senior population and higher cost of living, particularly in metro areas like Miami and Tampa.

Mid-Range: Alabama, Georgia, Tennessee, and the Carolinas cluster around $28-30/hour—reasonable rates that make in-home care a viable option for many families.

Important Note: These are state averages. Major metropolitan areas (Atlanta, Charlotte, Nashville) typically run 10-15% higher than rural areas within the same state.

National Overview: All 50 States

For families considering relocating or comparing costs nationally, here’s the complete picture. States are grouped by region and listed with their average personal care hourly rate.

Northeast

Southeast (See detailed table above)

Alabama ($27), Arkansas ($28), Florida ($31), Georgia ($29), Louisiana ($28), Mississippi ($26), North Carolina ($30), South Carolina ($28), Tennessee ($29)

Midwest

Southwest

West

Key Regional Patterns

Most Expensive States: – Massachusetts: $38/hour – California: $35/hour
– Alaska: $35/hour – Rhode Island: $35/hour – Washington: $34/hour

Most Affordable States: – Mississippi: $26/hour – Missouri: $27/hour – Alabama: $27/hour – South Dakota: $27/hour – Oklahoma: $27/hour

National Average: $30/hour for personal care services

The spread between highest and lowest is significant—$12/hour, or about 46%. For someone needing 40 hours per week of care, that’s a difference of $1,920 per month ($480/week).

What Affects In-Home Care Costs in Your State?

Understanding why costs vary helps you anticipate pricing in your specific area:

1. Cost of Living

States with higher housing costs, gas prices, and overall living expenses naturally have higher care costs. Caregivers need wages that allow them to live in the same communities they serve.

2. Labor Market Competition

States with low unemployment and competitive job markets must pay caregivers more to attract workers. The national caregiver shortage has intensified this effect since 2024. According to the Bureau of Labor Statistics, demand for home health and personal care aides continues to outpace supply nationwide.

3. Population Density and Demand

States with large senior populations (Florida, Arizona) or major metropolitan areas face higher demand, which drives up prices. Rural areas within these states may still offer lower rates.

4. State Regulations and Licensing

States with more stringent training requirements, background check mandates, and licensing standards may have higher costs—but often higher quality care as well.

5. Minimum Wage Laws

States with higher minimum wages establish a floor for caregiver compensation. As of 2026, states with $15+ minimum wages typically see $30+ hourly care rates.

6. Insurance and Liability Requirements

States requiring higher insurance coverage and bonding for agencies pass these costs to consumers, but also provide more protection.

Medicaid Waiver Programs: Making Care Affordable

Most people don’t realize that Medicaid can pay for in-home care through Home and Community-Based Services (HCBS) waiver programs. These programs help eligible seniors receive care at home rather than in nursing facilities.

How Medicaid Waivers Work

Medicaid traditionally only covers nursing home care, not in-home care. HCBS waivers allow states to use Medicaid funds to pay for services delivered at home—which is often more cost-effective for the state and preferred by seniors.

Eligibility typically requires: – Meeting nursing home level of care criteria – Income below state limits (varies by state) – Asset limits (typically $2,000 for individuals, $3,000 for couples) – U.S. citizenship or qualified immigration status

Covered services often include: – Personal care assistance (bathing, dressing, toileting) – Homemaker services (light housekeeping, meal prep) – Respite care for family caregivers – Adult day care – Home modifications (ramps, grab bars) – Medical equipment

Southeast State Waiver Details

Here’s what you need to know about Medicaid waiver programs in our coverage states:

Alabama – Elderly and Disabled Waiver – Income limit: $2,829/month (2026) – Covers personal care, homemaker services, respite – Waiting list varies by region (3-12 months) – Contact: Alabama Medicaid Agency

Arkansas – Alternatives for Adults Waiver – Income limit: $2,829/month – Comprehensive services including personal care – Active enrollment, shorter waiting lists – Contact: Arkansas Department of Human Services

Florida – Managed Medical Assistance Long-Term Care – Income limit: $2,829/month – No waiting list in most regions – Services provided through managed care plans – Contact: Florida Agency for Health Care Administration

Georgia – Community Care Services Program (CCSP) – Income limit: $2,829/month – Waiting list of 6-18 months in most counties – Priority for those at immediate risk – Contact: Georgia Division of Aging Services

Louisiana – Elderly and Disabled Adult Waiver – Income limit: $2,829/month – Moderate waiting list (6-9 months) – Covers personal care and support services – Contact: Louisiana Department of Health

Mississippi – Elderly and Disabled Waiver – Income limit: $2,829/month – Limited slots, longer waiting lists (12+ months) – Apply early if anticipating need – Contact: Mississippi Division of Medicaid

North Carolina – Community Alternatives Program (CAP) – Income limit: $2,829/month – Relatively short waiting list (3-6 months) – Well-established program with good coverage – Contact: NC Department of Health and Human Services

South Carolina – Community Choices Waiver – Income limit: $2,829/month – Moderate waiting list (6-12 months) – Covers personal care and homemaker services – Contact: SC Department of Health and Human Services

Tennessee – Choices in Community Living – Income limit: $2,829/month – No waiting list for CHOICES program – Services coordinated through managed care – Contact: TennCare (Tennessee Medicaid)

Important Waiver Notes

Application Process: Even if income-eligible, there’s often a functional assessment to determine if you need nursing-home level care. Don’t assume you won’t qualify—many people who need daily assistance do qualify.

Waiting Lists: Some states have waiting lists ranging from months to over a year. Apply as soon as you anticipate needing care, even if you don’t need it immediately.

Income Limits: The $2,829/month figure is the 2026 federal limit, but some states have additional programs with higher limits. Check your specific state.

Spend Down: If income is slightly over the limit, you may be able to “spend down” to eligibility by deducting medical expenses. Consult with a Medicaid planner.

Learn more about Medicaid HCBS waivers nationwide

Other Ways to Pay for In-Home Care

Medicaid isn’t the only option. Many families use a combination of payment sources:

Long-Term Care Insurance Most policies cover in-home care, often at 50-100% of the daily benefit. Review your policy—some require care providers to be licensed or certified.

Veterans Benefits – Aid and Attendance Veterans and surviving spouses may qualify for up to $2,431/month (2026) to help pay for in-home care. This benefit has been increasingly utilized as more veterans reach ages requiring care support.

Life Insurance Conversions Some life insurance policies allow you to access a portion of the death benefit early to pay for long-term care. Check if your policy has an accelerated death benefit or chronic illness rider.

Reverse Mortgages Homeowners 62+ can tap home equity to fund care without monthly payments. The loan is repaid when the home is sold. This works best for those planning to age in place long-term.

Medicare (Limited Coverage) Medicare covers skilled nursing care and physical therapy at home, but only for short periods following hospitalization or for specific medical conditions. It does NOT cover ongoing personal care or companionship. Learn more about Medicare home health coverage from CMS.

Health Savings Accounts (HSA) If you have an HSA, funds can be used tax-free for qualified long-term care expenses, including in-home care services.

Explore all payment options for in-home care in detail

Estimating Your Monthly Costs

Use these calculations to budget realistically:

Part-Time Care (4-6 hours/day, 5 days/week) – 20-30 hours/week – At $28/hour average: $2,240-3,360/month – Good for: Someone needing morning or evening help

Full-Time Care (8-12 hours/day, 7 days/week) – 56-84 hours/week
– At $28/hour average: $6,272-9,408/month – Good for: Someone needing significant daily assistance

Around-the-Clock Care (24/7 coverage) – 168 hours/week – At $28/hour average: $18,816/month – Good for: Advanced dementia, high fall risk, end-of-life care – Note: Often more cost-effective to consider assisted living at this level

Money-Saving Strategies: – Share care with another family in your area (split caregiver time) – Supplement paid care with family caregiving – Use adult day care 2-3 days/week instead of in-home care – Hire independent caregivers (vs. agency) if comfortable managing – Apply for every assistance program you might qualify for

Regional Cost Trends to Watch

Based on industry data and state reports, here’s what to expect in the coming years:

Southeast Outlook: Costs expected to rise 4-6% annually through 2028 as demand increases and caregiver shortages persist. States investing in caregiver training programs (NC, TN) may see more moderate increases.

National Caregiver Shortage: The gap between caregivers needed and available continues to widen. This upward pressure on wages translates to higher hourly rates across all states.

Medicaid Expansion: More states are expanding waiver programs and increasing reimbursement rates to providers, which may improve availability even if costs rise slightly.

Technology Integration: Remote monitoring and telehealth are being integrated into some in-home care plans, potentially reducing hours needed and overall costs for some families.

Making the Right Decision for Your Family

State-by-state cost differences are just one factor in your decision. Also consider:

Quality vs. Cost: The cheapest option isn’t always the best. Licensed agencies with trained, background-checked caregivers cost more but offer security and reliability.

Your Specific Needs: Someone needing 4 hours of help daily might budget for in-home care. Someone needing 16+ hours might find assisted living more affordable and appropriate.

Family Availability: If family members can provide some care, paid care becomes more affordable. A blend of family and professional care works well for many.

Future Needs: Will care needs increase? Someone with progressing dementia might need significantly more hours in 6-12 months. Budget for potential increases.

Location Flexibility: If considering relocating, comparing state costs is valuable—but also factor in proximity to family, climate preferences, and quality of life.

Next Steps

To explore in-home care in your state:

1. Get cost estimates – Contact 2-3 local agencies for accurate quotes in your area. Rates can vary significantly even within the same state.
2. Check Medicaid eligibility – Even if you think you won’t qualify, it’s worth checking. Many people are surprised to learn they’re eligible or close to it.
3. Review your payment options – Look into long-term care insurance, VA benefits, and other funding sources before assuming you must pay privately.
4. Understand what you need – Be honest about care needs. Underpaying for insufficient care causes problems; overpaying for unneeded services wastes money.
5. Plan ahead – The earlier you explore options and apply for assistance programs, the more choices you’ll have when care becomes necessary.

Resources: – Complete guide to in-home care services – How to pay for in-home care: 7 options – Questions to ask before hiring a home care agency (coming soon)

For personalized help navigating in-home care options and costs in your state, consider speaking with a senior care placement advisor who can assess your situation and connect you with appropriate resources.

Cost data based on Genworth Cost of Care Survey 2026 and state Medicaid program documentation. Rates represent averages and may vary by region, provider, and specific services required. Last updated: February 2026