Key takeaway
Pennsylvania pays family caregivers primarily through Community HealthChoices (CHC). The Services My Way option lets the participant self-direct care and hire family members.
- Community HealthChoices (CHC) is PA’s managed long-term services and supports program for adults 21+ at nursing-facility level of care.
- Services My Way is the participant-directed option inside CHC; family members can be hired (spouses excluded under Medicaid).
- The OBRA Waiver serves adults 18–59 with severe physical disabilities.
- Veterans can use Aid & Attendance or Veteran Directed Care (VDC can pay a spouse).
Overview
Pennsylvania consolidated most of its long-term services and supports into a single managed care program called Community HealthChoices (CHC), launched statewide in 2020. CHC serves Medicaid-eligible adults 21+ who need a nursing-facility level of care, including dually eligible adults (Medicare and Medicaid). Family members can be paid as caregivers either through an enrolled home care agency or through the Services My Way participant-directed option.
For adults 18–59 with severe physical disabilities who don’t need a full nursing-facility level of care, Pennsylvania uses the OBRA Waiver. Older adults who don’t qualify for Medicaid can access limited state-funded services through Area Agencies on Aging and the OPTIONS program. Veterans can layer in VA Aid & Attendance or Veteran Directed Care on top of any of these paths.
Programs that pay family caregivers in Pennsylvania
| Program (Type) | Care recipient eligibility | Paid family caregiver provisions |
|---|---|---|
| Community HealthChoices (CHC) (Medicaid managed long-term care) | Age 21+, Pennsylvania Medicaid-eligible, and needs a nursing-facility level of care (or already in a nursing facility). Dually eligible adults are also enrolled. | Funds personal care, home health, adult day, and home modifications through a CHC managed care organization (Keystone First, AmeriHealth Caritas, or UPMC). Family members can be hired through agencies; Services My Way allows participant-direction. |
| Services My Way (within CHC) (Medicaid self-directed) | CHC participants who want to direct their own care; participant or authorized representative manages the plan. | Participant hires and supervises their own caregiver — including most family members (spouse and legal guardian excluded). A Financial Management Services agency handles payroll. |
| OBRA Waiver (Medicaid HCBS waiver) | Age 18–59 with a severe physical disability or developmental physical disability; meets ICF/ORC level of care; Medicaid-eligible. | Funds personal assistance, respite, home modifications, and assistive technology. Services My Way self-direction is available; family caregivers (other than spouse) can be paid. |
| Act 150 Attendant Care (State-funded) | Pennsylvania residents 18–59 with a severe physical disability who do not qualify for Medicaid; income and cost-share rules apply. | Funds attendant care services delivered by an enrolled provider; family members can be hired by the agency (spouse excluded). |
| OPTIONS Program (State / lottery-funded) | Pennsylvania residents 60+ who need help with daily living and do not qualify for Medicaid. | Provides personal care, home-delivered meals, and respite through Area Agencies on Aging; pay-to-family is limited. |
| Aid & Attendance / Veteran Directed Care (VA benefits) | A&A: wartime veteran or surviving spouse needing help with ADLs. VDC: veteran in VA care needing nursing-facility level of care at a participating VAMC. | A&A increases pension to pay family caregivers (not the spouse). VDC pays family, including a spouse, through a fiscal management service. |
Pennsylvania Medicaid programs
Pennsylvania Medicaid (Medical Assistance) funds family caregivers primarily through Community HealthChoices (CHC) and the OBRA Waiver. Both programs include the Services My Way participant-directed option for families that want to manage their own caregivers.
Community HealthChoices (CHC)
CHC is PA’s managed long-term services and supports program. Three CHC-MCOs (Keystone First CHC, AmeriHealth Caritas Pennsylvania CHC, and UPMC Community HealthChoices) coordinate all long-term care for enrolled members.
- Eligibility: 21+, Medicaid-eligible, and nursing-facility level of care (or already in a nursing facility).
- Services include personal care, home health, adult day, respite, home modifications, and behavioral health.
- Family members — except spouses and legal guardians — can be hired through CHC-approved agencies.
Services My Way
Services My Way is the participant-directed option inside CHC and the OBRA Waiver. Instead of an agency, the participant hires and supervises their own caregiver, with payroll handled by a Financial Management Services (FMS) agency.
- Available to CHC and OBRA Waiver participants.
- Participant designs the service plan with their CHC service coordinator.
- Family caregivers can be paid (spouse and legal guardian excluded).
OBRA Waiver
The OBRA Waiver serves adults 18–59 with severe physical or developmental physical disabilities who meet an ICF/ORC (Intermediate Care Facility/Other Related Conditions) level of care.
- Funds personal assistance, respite, home modifications, and behavioral supports.
- Services My Way self-direction available; family members other than spouse can be paid.
State-funded options: Act 150 and OPTIONS
Pennsylvania offers two main state-funded paths for people who don’t qualify for Medicaid: Act 150 Attendant Care (for adults 18–59 with severe physical disabilities) and the OPTIONS program (for adults 60+ administered by Area Agencies on Aging).
Funds attendant care for non-Medicaid-eligible adults with severe physical disabilities. Services delivered through enrolled providers, with a cost-share for participants above the income threshold.
Lottery-funded program administered by AAAs that provides personal care, home-delivered meals, respite, and care management for older Pennsylvanians not on Medicaid.
Who qualifies
- Act 150: PA residents 18–59 with a severe physical disability who don’t qualify for Medicaid.
- OPTIONS: PA residents 60+ with functional needs who don’t qualify for Medicaid.
- Cost share may apply; subject to available funding.
Veterans’ programs
Pennsylvania veterans and surviving spouses can fund in-home care through two VA pathways: Aid & Attendance and Veteran Directed Care.
Aid & Attendance Pension
A&A increases the monthly VA pension for qualifying wartime veterans (or surviving spouses) who need help with daily living. The veteran can use the increase to pay an adult child or other family caregiver.
- Wartime service, limited income/assets, and documented need for daily care are required.
- Spouses cannot be paid directly through A&A because household income is jointly counted.
Veteran Directed Care (VDC)
VDC provides a VA-funded monthly budget that the veteran self-directs. Family — including spouses — can be paid through a fiscal management service. Pittsburgh, Philadelphia, and Wilkes-Barre VAMCs typically participate.
- Requires veteran to be in VA care and need nursing-facility level of care.
- Spouses, adult children, and other relatives can be paid caregivers.
Long-term care insurance
A long-term care insurance policy can pay a family caregiver if it covers in-home personal care and allows direct payment to the policyholder.
What to check in the policy
- Confirm in-home personal care is a covered service.
- Cash or indemnity policies let the policyholder pay any caregiver, including family.
- Reimbursement-only policies typically require a licensed home care agency to bill.
If the policy reimburses only licensed agencies, a Pennsylvania-licensed home care agency can employ the family caregiver and bill the insurer for services rendered.
How to apply in Pennsylvania (step-by-step)
- Identify the most likely path: Community HealthChoices (CHC) with Services My Way, the OBRA Waiver, Act 150, OPTIONS, VA benefits, or LTC insurance.
- Gather documents: photo ID, Social Security card, proof of income/assets, medical records, medication list, and DD-214 (if applicable).
- Start with the right agency:
- CHC: contact the Independent Enrollment Broker (1-877-550-4227) to begin the application and assessment.
- OBRA Waiver: contact the PA Office of Long-Term Living or the Independent Enrollment Broker.
- Act 150: contact PA Department of Human Services or your local Service Coordinator.
- OPTIONS: contact your Area Agency on Aging (PA Link, 1-800-753-8827).
- VA paths: connect with a VA social worker at your nearest VAMC.
- Complete the level-of-care assessment (Functional Eligibility Determination) and financial review.
- Select your CHC-MCO (Keystone First, AmeriHealth Caritas, or UPMC) and choose Services My Way if you want self-direction.
- Enroll your family caregiver with the Financial Management Services agency, submit timesheets, and complete annual reassessments.
Pennsylvania paid caregiver FAQs
How do I become a paid caregiver for a family member in Pennsylvania?
The most common path is Community HealthChoices (CHC) with Services My Way. Your loved one applies through the Independent Enrollment Broker, completes a Functional Eligibility Determination, and chooses a CHC-MCO. With Services My Way, they hire you directly and a Financial Management Services agency processes payroll.
What is Services My Way?
Services My Way is the participant-directed option inside Pennsylvania’s Community HealthChoices and the OBRA Waiver. It lets the Medicaid participant — or an authorized representative — hire, train, and supervise their own caregivers, including most family members (spouse and legal guardian excluded).
Can a spouse be paid as a caregiver in Pennsylvania?
Not under Community HealthChoices, the OBRA Waiver, or Act 150. Spouses can be paid through VA Veteran Directed Care (VDC) at participating Pennsylvania VAMCs.
What is the difference between CHC and the OBRA Waiver?
CHC serves adults 21+ at a nursing-facility level of care, including dually eligible older adults. The OBRA Waiver is specifically for adults 18–59 with severe physical or developmental physical disabilities who meet an ICF/ORC level of care.
How long does it take to be approved for CHC?
Approval typically takes 45–90 days from the initial application and assessment to authorization and Services My Way enrollment, depending on documentation and CHC-MCO onboarding.
