Pennsylvania’s Personal Care Assistance (PCA) Program: A Guide to Paid Family Caregiving

Providing care for a loved one is a profound commitment, and in Pennsylvania, various programs exist to support family caregivers in this vital role. While “Personal Care Assistance” (PCA) broadly refers to services that help individuals with daily living activities, it’s important to understand that paid family caregiving in Pennsylvania primarily operates through specific Medicaid waivers. These initiatives aim to support the invaluable work of caregivers while allowing loved ones to remain in the comfort and familiarity of their own homes or the homes of family members.

Understanding Personal Care Assistance (PCA) in Pennsylvania

In Pennsylvania, “Personal Care Assistance” (PCA) refers to the services that help individuals with daily living activities and household tasks, enabling them to live independently. It’s crucial to differentiate this from “Personal Care Homes (PCH),” which are residential facilities that provide housing, meals, supervision, and assistance, but typically do not offer third-party reimbursement for family caregivers providing care within them.

Instead, paid family caregiving for PCA services in Pennsylvania primarily operates through various Medicaid waivers, also known as Home and Community-Based Services (HCBS) waivers. These waivers are designed to provide direct assistance with Activities of Daily Living (ADLs) and household services for older adults or individuals with disabilities who live in their own homes or the homes of loved ones. The services provided under these waivers are what constitute “Personal Care Assistance” in the context of paid family caregiving.

Key Pennsylvania Medicaid Waivers for PCA

Pennsylvania offers several Medicaid waivers that facilitate paid family caregiving for Personal Care Assistance, each with specific eligibility criteria and rules regarding family members.

1. Community HealthChoices (CHC) Waiver: Getting Paid to Care for Loved Ones

The Community HealthChoices (CHC) waiver is Pennsylvania’s most common Medicaid managed care program that facilitates paid family caregiving for PCA. It is designed for individuals aged 21 or older who are eligible for both Medicaid and Medicare and require a nursing facility level of care. This program consolidates several former waivers into a single, comprehensive system and is administered by private healthcare insurance companies contracted by the state.

Recipient Eligibility for CHC: To qualify for the CHC program, the individual needing care must meet several criteria:

• Age: The recipient must be 21 years of age or older.
• Dual Eligibility: They must be eligible for both Medicaid and Medicare.
• Functional Eligibility: A physician must certify that the individual has a condition requiring long-term services and supports, specifically an inability to perform essential Activities of Daily Living (ADLs) such as bathing, toileting, or transferring. A trained assessor will also conduct a functional eligibility determination to confirm the level of care needed.
• Financial Eligibility: The individual must meet specific income and/or asset requirements, determined by the local County Assistance Office (CAO). For example, in 2023, the income limit to qualify for the Pennsylvania Medicaid waiver program under CHC was $2,742 per month.

Caregiver Eligibility (Who Can Be Paid, Spousal/Guardian Restrictions): Pennsylvania’s Medicaid waivers generally permit family members, such as adult children, siblings, and even friends, to be compensated for providing care. However, under the CHC waiver, spouses (husband or wife) are typically not eligible to be paid caregivers. Similarly, individuals holding Power of Attorney (POA) for the care recipient or legally responsible guardians (such as parents caring for children under 18) are also generally excluded from paid caregiver roles under this program.

Application Process: The process involves contacting the Pennsylvania Independent Enrollment Broker (IEB) at 1-877-550-4227, applying on the COMPASS website, and submitting necessary documentation, including physician certification and financial information. Once approved, the care recipient can select a state-licensed home care agency that employs family members, such as Avondale Care Group.

Services Covered & How Agencies Facilitate Payments: The CHC waiver covers a range of personal care and home care services. This includes direct assistance with Activities of Daily Living (ADLs) like bathing, dressing, meal preparation, and medication management, as well as various household services. Family caregivers are hired as regular employees of the licensed home care agency, which handles all administrative tasks, including payroll and compliance.

Payment Rates & Benefits for Family Caregivers: The compensation for family caregivers through Medicaid waiver programs in Pennsylvania typically ranges between $10 and $15 per hour. The number of hours approved depends on the care recipient’s health and needs, with a maximum of 35 hours of care per week often allowed. The maximum weekly pay rate for Pennsylvania is up to $700 per week, which aligns with or exceeds these hourly rates, potentially including overtime or other factors. Many agencies also offer additional benefits that significantly enhance the overall compensation package for family caregivers. These can include overtime pay, weekly pay, free Certified Nurse Aide (CNA) training for eligible caregivers, holiday pay (often 1.5 times the regular rate for specified holidays), 401k plans with company matching, company-sponsored healthcare insurance (with substantial premium coverage), flexible schedules, and paid time off.

2. OBRA Waiver

The OBRA Waiver is designed to support individuals aged 18-59 who have a severe developmental physical disability and require an Intermediate Care Facility/Other Related Conditions (ICF/ORC) level of care. This program helps these individuals live as independently as possible within their communities by providing assistance with activities of daily living (PCA services).

Family Member/Spouse Eligibility: Similar to the CHC waiver, the OBRA waiver excludes spouses or legal guardians from being paid caregivers.

Payment Rates: Compensation for caregivers under the OBRA waiver varies by geographic area, typically ranging from $13 to $15 per hour. The maximum weekly pay rate for Pennsylvania is up to $700 per week.

Application: The application process also begins by contacting the Independent Enrollment Broker (IEB) at 1-877-550-4227.

3. Consolidated Waiver

The Consolidated Waiver provides support and services to a broader population, including individuals of all ages with an intellectual disability (ID) or autism, as well as children under 22 with a developmental disability due to a medically complex condition. Recipients must be recommended for an intermediate care facility (ICF) level of care based on a medical evaluation.

Family Member/Spouse Eligibility: A significant difference with the Consolidated Waiver is that it explicitly allows a friend or family member, including a spouse or legal guardian, to receive payment for care provided.

Payment Rates: The average pay for Pennsylvania caregivers under the Consolidated Waiver typically falls between $11 and $14.50 per hour. The maximum weekly pay rate for Pennsylvania is up to $700 per week.

Application: To apply for the Consolidated Waiver, individuals should contact the Office of Developmental Programs (ODP) customer line at 1-888-565-9435.

Important Considerations: Medicaid Estate Recovery Program (MERP)

While Pennsylvania’s Medicaid programs offer crucial financial relief for family caregivers, it is essential for families to understand the long-term financial implications. The Medicaid Estate Recovery Program (MERP) is a federal requirement for all state Medicaid programs to seek repayment for long-term care costs after a recipient passes away. This recovery typically applies to individuals aged 55 and older who received Medicaid long-term care services, including those provided through Home and Community-Based Services (HCBS) waivers. Assets subject to recovery can include the deceased recipient’s primary home, even if it was exempt during their lifetime while receiving benefits. The state’s claim is generally delayed if there is a surviving spouse, a child under 21, or a child of any age who is blind or permanently disabled. Families may also be able to apply for undue hardship waivers in certain circumstances. Given these potential impacts on family inheritance and assets, it is highly advisable for families to consult with an elder law attorney or financial advisor for personalized guidance on MERP and comprehensive estate planning.