Can I Get Paid to Care for My Disabled Child in Pennsylvania?

Yes, Pennsylvania will pay you to care for your disabled child in many cases, primarily through Medicaid Home and Community-Based Services waivers run by the state’s Office of Developmental Programs (ODP). Under a participant-directed model, your family controls the care budget, chooses the caregiver, and in most of these waivers that caregiver can be you. You become a formal employee on a payroll with taxes tracked and hours logged, but the compensation is real for work you may already be doing.

Which Waivers Let a Parent Be Paid

Three ODP waivers allow parents, including legal guardians, to serve as paid caregivers:

The Consolidated Waiver, which serves people of any age with an intellectual disability, developmental disability, or autism and explicitly permits family members to be paid.
The Community Living Waiver, which covers the same population and supports participant-directed services.
The Person/Family Directed Support (P/FDS) Waiver, built around family direction of services.

All three serve children and adults with intellectual disabilities, developmental disabilities, or autism, and all three let care happen at home instead of in an institution.¹

One boundary worth knowing up front: if your child has a physical or neurological disability but no intellectual disability or autism, the applicable program is usually the OBRA waiver, and OBRA generally does not allow legal guardians to be paid caregivers. Families often assume any Medicaid waiver will work and discover this distinction only after applying.

What the Job Actually Is

You’re paid for specific tasks written into your child’s care plan: hands-on help with bathing, dressing, eating, toileting, meal preparation, medication reminders, and similar activities of daily living. You are not paid for ordinary parenting you’d do anyway. The plan sets the services, the weekly hours, and the rate.

Pennsylvania’s participant-directed model runs through a Financial Management Services (FMS) provider that handles payroll, tax withholding, workers’ compensation, and insurance. Depending on the option your family picks, either your child (through a surrogate) is the common law employer with the FMS acting as fiscal agent, or the FMS is the employer of record under an “Agency with Choice” arrangement.² Either way, your hours and duties come from the Individual Support Plan and your paycheck comes from the FMS.

How Much You Can Earn

Pay rates for self-directed caregivers in Pennsylvania generally run $12 to $18 per hour, varying by waiver, service, and region. The waiver program sets the rate; it isn’t negotiated at the kitchen table.

Overtime can apply if you work more than 40 hours in a week, because federal rules generally require minimum wage and overtime for domestic care workers who spend more than 20 percent of their time on activities of daily living.³

Your total annual pay depends on authorized hours. A child with intensive needs might have 30 or 40 hours a week on the care plan; a child with lighter needs might have far fewer. The authorized hours are a ceiling tied to assessed functional need, not a floor set by family preference.

Who Qualifies

Your Child

Your child must clear a medical test and a financial test. Medically, the child needs a diagnosed intellectual disability, developmental disability, or autism that appeared before age 22, and a level of care equivalent to what an intermediate care facility would provide. Children under nine with a high probability of developing an intellectual disability or autism may also qualify.¹

Financially, only the child’s own income and assets are counted, not the parents’. That rule puts the program within reach of many middle- and upper-income families. For 2026, the child’s countable income must be below 300 percent of the SSI federal benefit rate; with the 2026 SSI rate at $994 per month for an individual, the cap works out to $2,982 per month.⁴ Countable resources cannot exceed $8,000.

You

You must be legally authorized to work in the United States, and you’ll go through a formal hiring process with the FMS provider. Pennsylvania requires a State Police criminal history check and a child abuse history clearance from the Department of Human Services before you start. If you haven’t lived in Pennsylvania for the past two consecutive years, you’ll also need an FBI criminal background check with fingerprints.² Certain convictions, especially those involving abuse, neglect, or other serious offenses, can disqualify you.

How to Apply

Start with your county’s Mental Health/Intellectual Disabilities (MH/ID) office. That office is the entry point to all ODP services, and an intake coordinator will walk you through registration.⁵ You can also begin online through COMPASS or by scheduling an in-person appointment.⁶

After registration, the county arranges one or more assessments to confirm the diagnosis, measure functional needs, and verify that your child requires an institutional level of care. That finding is a hard prerequisite for any of the three waivers.

Once approved, you’ll work with a supports coordinator to build an Individual Support Plan listing the services, authorized hours, and goals. You then choose an FMS provider from a state-approved list. From the moment that paperwork is complete, you are formally employed as your child’s caregiver.

Be Ready for a Waiting List

Eligibility does not mean immediate services. Pennsylvania’s ODP waivers carry substantial waiting lists, and the wait can stretch for years because funding slots are limited. Your child may be found eligible and still wait a long time to be enrolled.

While you wait, ask your county MH/ID office about base-funded county programs. These supports are less comprehensive than waiver services but can fill gaps. Getting on the waiting list early matters, even for young children whose needs are still taking shape.

How Caregiver Pay Is Taxed

Most families don’t learn this part until paychecks start arriving. Under IRS Notice 2014-7, Medicaid HCBS waiver payments made to a caregiver who provides nonmedical support services in the caregiver’s own home are treated as “difficulty of care” payments and excluded from federal gross income.⁷ Because most parents live with the child they’re caring for, the exclusion typically applies. It can cover both parents if two caregivers in the same household receive waiver payments for the same child. Care provided outside the caregiver’s home does not qualify.

If your FMS provider withholds federal income tax anyway, you can file an amended return or adjust your withholding going forward.⁸

Payroll taxes work differently. Under the common law employer model, where your child (through a surrogate) is technically your employer, wages paid to a parent are generally exempt from Social Security and Medicare taxes, and federal unemployment tax does not apply either.⁹ The tradeoff is that exempt wages won’t build Social Security credits, which can affect your own retirement benefits later. Ask a tax professional whether opting in makes sense for your situation.

Watch the Impact on Your Child’s SSI

If your child receives Supplemental Security Income, household income changes can reduce the monthly payment. Social Security uses “deeming” rules that count a portion of a parent’s income against a child’s SSI eligibility when the child lives at home.¹⁰ The maximum monthly SSI payment for 2026 is $994 for an individual.

Whether Medicaid waiver caregiver pay counts as deemed income is worth raising with both your supports coordinator and SSA before your first paycheck. If the payments are excluded from gross income under Notice 2014-7, there is an argument they should not count as earned income for SSI deeming either, but IRS and SSA rules don’t always line up. Getting a clear answer in advance can prevent a surprise cut to your child’s benefits.

Appealing a Denial

If the waiver application is denied or services are reduced, you have the right to a fair hearing. Federal Medicaid rules require the state to send written notice with the specific reasons, the regulations relied on, and instructions for requesting a hearing, and that notice must arrive at least 10 days before the action takes effect.¹¹

You can represent yourself or bring a lawyer, a relative, or anyone else to speak for you. Request the hearing before the effective date of a reduction or termination, and your child’s existing services generally continue until the hearing is decided. Initial decisions are sometimes wrong, and the appeal is the tool for correcting them.

1
Commonwealth of Pennsylvania. Apply for a Medicaid Consolidated Waiver
2
Pennsylvania Guide to Participant-Directed Services. Pennsylvania’s Guide to Participant-Directed Services
3
U.S. Department of Labor. Fact Sheet: Application of the Fair Labor Standards Act to Domestic Service, Final Rule
4
Social Security Administration. SSI Federal Payment Amounts for 2026
5
Commonwealth of Pennsylvania. Apply for Intellectual Disabilities Services
6
Commonwealth of Pennsylvania. Request a Medicaid Community Living Waiver
7
Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income
8
Internal Revenue Service. IRS Notice 2014-7
9
Internal Revenue Service. Household Employer’s Tax Guide
10
Social Security Administration. How Much You Could Get From SSI
11
eCFR. 42 CFR Part 431 Subpart E – Fair Hearings for Applicants and Beneficiaries