T1019 — "personal care services per 15 minutes" — is the most-billed code in the entire Medicaid dataset. At $122.7 billion, it accounts for more than 11% of all Medicaid provider spending between 2018 and 2024. No other code comes close. The #2 code is T1015 (clinic-based services) at $47 billion.

Nearly 9,800 providers across 39 states bill T1019. But the spending is extraordinarily concentrated:

#	State	T1019 Spending	Providers	Per Provider Avg
1	New York	$74.6B	912	$81.8M
2	Massachusetts	$8.4B	137	$61.6M
3	Missouri	$6.2B	1,335	$4.6M
4	New Jersey	$4.2B	274	$15.5M
5	Virginia	$4.2B	760	$5.5M
6	Ohio	$2.6B	830	$3.1M
7	Minnesota	$1.9B	225	$8.6M
8	Texas	$1.9B	1,050	$1.8M
9	Florida	$1.9B	763	$2.5M
10	Colorado	$1.7B	475	$3.5M
11	DC	$1.4B	29	$47.5M
12	New Mexico	$1.2B	89	$13.3M

New York alone accounts for 61% of all T1019 spending nationally, with only 9% of the providers. The per-provider average in New York is $81.8 million — 18 times the national average excluding New York. For more on why, see How One Program Drives Half of New York's Medicaid Spending.

What T1019 Pays For

Personal care services cover help with activities of daily living: bathing, dressing, grooming, meal preparation, light housekeeping, mobility assistance, and medication reminders. The beneficiaries are people who can't fully care for themselves — the elderly, people with physical and intellectual disabilities, those with chronic illness or brain injuries.

Every state delivers these services differently. Some use T1019 exclusively; others use different HCPCS codes (California uses T1015 and S5102; many states use H2015 or state-specific codes). The total amount spent on personal care nationally is likely much higher than $122 billion once equivalent codes are included.

The programs that authorize T1019 vary by state but share a common structure: Medicaid Home and Community-Based Services (HCBS) waivers. These waivers were created to keep people out of institutions — nursing homes, group homes, state hospitals — by funding care in their own homes and communities. The logic is both humanitarian and economic: home-based care is cheaper than institutional placement, and most people prefer to live at home.

New Mexico: Waivers and Vulnerability

New Mexico's $1.2 billion in T1019 spending comes through several Medicaid waiver programs: the Mi Via self-directed waiver, the Medically Fragile waiver, the Developmental Disabilities waiver, and others administered through Centennial Care (the state's managed care program). With 89 providers billing an average of $13.3 million each, the spending is concentrated but not as extreme as New York.

#	Provider	City	T1019 Paid
1	Ambercare Home Health Care	Albuquerque	$235M
2	Basin Coordinated Healthcare	Farmington	$69M
3	Heritage Home Healthcare	Albuquerque	$65M
4	Clovis Homecare	Clovis	$53M
5	Links II Inc	Farmington	$38M

The populations served by these programs are among the most vulnerable Medicaid beneficiaries. People with developmental disabilities, traumatic brain injuries, and severe chronic conditions depend on personal care services for basic survival. They often cannot advocate for themselves when care is inadequate, and they may not recognize when billing is being inflated in their name.

This vulnerability creates a structural problem. The people who most need these services are the least equipped to report abuse. A caregiver who bills for hours not worked, a provider who signs off on services never delivered, an agency that churns through aides while billing full rates — the beneficiary may not know, may not have the capacity to report it, or may fear losing the care they do receive if they complain.

The Oversight Challenge

Personal care services are inherently difficult to audit. Unlike a hospital procedure with imaging and lab results, personal care happens in private homes with no objective record of what was delivered. Did the aide spend four hours or two? Was the meal prepared? Was the bath given? The billing says yes. There's often no one to say otherwise.

This doesn't mean the spending is fraudulent. The vast majority of personal care billing is almost certainly legitimate — people genuinely need help, aides genuinely provide it, and the programs genuinely keep people out of more expensive institutional settings. But the structure of the service makes it uniquely susceptible to fraud, and the populations it serves make that fraud uniquely difficult to detect.

At $122.7 billion, T1019 is larger than the GDP of most countries. The question is not whether to fund personal care — the alternative is worse in every way. The question is whether the systems for delivering and overseeing $122 billion in personal care spending are adequate to the scale of money involved and the vulnerability of the people it's meant to serve.

Explore the data: T1019 national page · New Mexico billing codes · New York billing codes