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How to Get Paid as a Family Caregiver

for a Loved One with a Disability

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The Pennsylvania waiver is the general term for the 10 support service waivers provided by the state. In this guide, we will refer specifically to the Community HealthChoices waiver, known as CHC. This particular waiver is new and is the combination of three former waiver programs: aging waiver,  attendant care/ act 150 waiver, and independence waiver.

The reason we want to focus on the Community HealthChoices waiver is because that is by far the most common program that provides home care services in PA to seniors and disabled adults in need.

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Community Health Choices (CHC) Medicaid waiver health plans

CHC is a Medicaid managed care program. It exists for individuals that are 21 years of age or older and are eligible for both Medicaid and Medicare. Plus, these individuals must require a certain level of assistance that we discuss below.

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In the state of Pennsylvania, managed care Medicaid is administered by one of four private healthcare insurance companies. These companies are contracted by the state to manage the CHC services provided to program participants.  These include Amerihealth Caritas (called Keystone First in Philadelphia and the surrounding PA counties), UPMC, and PA Health and Wellness.

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Does Pennsylvania allow family members to be caregivers and get paid through Medicaid?

Yes. Every state has different regulations, and some will not allow paid family caregivers through the Medical Assistance program. Luckily, Pennsylvania recognizes the economic and health benefits that can come with having a loved one be a caregiver to a family member or a friend. Advantages include the potential for improved care and support through increased familiarity and comfort that come with a loved one providing care directly.

 

These programs, often referred to as Medicaid waivers or home and community-based services (HCBS) waivers, allow for family members to be compensated for providing care, particularly when the care recipient is eligible for Medicaid and requires assistance with daily living activities.

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What Caregivers Need to Know

1. Determine Eligibility

  • Care Recipient: Must usually qualify for Medicaid or a state-funded program for people with disabilities.

  • Caregiver: Often must be a family member other than a spouse (though some programs allow spouses or parents).

 

How It Works

Option 1: Medicaid Programs (Most Common)

Paid Caregiving for Adult Children in PA (Click here for the step by step guide for applying for the waiver)

Medicaid Waiver Programs & Rules

  • Community HealthChoices (CHC) is the main waiver for adults aged 21 and older (or those with physical disabilities aged 21–64) who meet nursing‑facility level of care. Family members, including parents (but generally not spouses or legal guardians), may be employed via state‑contracted agencies to provide care Pennsylvania.gov

  • Person/Family Directed Support (P/FDS) Waiver allows self-directed care: the person with ID/DD (or their representative) chooses caregivers—this model often permits parents to be paid, even for adult children. It has a cost limit of $41,000 per person per fiscal year. It also offers self-directed service models and traditional, agency-based service models.

  • Adult Autism Waiver

  • Community Living Waiver

  • Consolidated Waiver

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How to Find an Agency

Steps:

  1. Contact your state's Medicaid office or Department of Health and Human Services.

  2. Ask about:

    • Self-directed care programs

    • Home and community-based services (HCBS) waivers

  3. Once enrolled, you'll often be asked to choose from a list of approved agencies or Fiscal Intermediary (FI) providers who:

    • Handle payroll and taxes

    • Provide training

    • Ensure compliance

 

Parent-as-Caregiver: Legal Landscape in PA

  • Parents of adult children with disabilities can be paid under the self-directed or agency-based models in CHC or P/FDS waivers

  • Parents of minor children cannot be paid caregiver aides under Medicaid once the child is under 18—the state has ended that practice

  • Spouses, legal guardians, or POAs are typically excluded from receiving care giving pay, except perhaps for limited “extraordinary care” roles—but Pennsylvania’s waivers don’t broadly authorize those roles for parents of adult children

 

How It Typically Works in PA

  1. Care recipient must qualify for Medicaid and meet financial and functional eligibility for a waiver (e.g. CHC, OBRA, or P/FDS)

  2. Apply via the Pennsylvania Independent Enrollment Broker (IEB) at 1‑877‑550‑4227 or through the County Assistance Office or MH/ID office

  3. Choose the care model: either self-directed (recipient chooses the caregiver) or agency-based (caregiver is hired through a contracting provider).

  4. Agency handles payroll, compliance, training, and background checks.

  5. Maintain documentation: time sheets, service logs, physician documentation of needs, and training records

 

Can You Invest the Money on Behalf of Your Loved One?

 

Short Answer: It depends — proceed carefully.

  • If the money is paid to you as income, it's yours and taxed as such. You can invest your earnings as you see fit.

  • If your loved one is receiving SSI or Medicaid, investing their money could put their benefits at risk due to asset/income limits. 

 

Safer Ways to Invest Caregiver Pay:

  • Special Needs Trust (SNT):

    • Protects eligibility for benefits.

    • Funds can be used for care and quality-of-life items.

  • ABLE Account (Achieving a Better Life Experience):

    • Tax-advantaged savings account for individuals with disabilities.

    • Doesn’t affect Medicaid or SSI (up to certain limits).

    • Money can be used for qualified disability expenses, including caregiving support.

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For more information about caregiver pay in the state of Pennsylvania, click here. 

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