To get paid to take care of a family member in Pennsylvania, the most common route is Community HealthChoices, a Medicaid waiver that lets an eligible adult hire a relative as their personal care aide through a participant-directed services model. A fiscal employer agent handles payroll, taxes, and workers’ compensation, so you’re paid an hourly wage for the hours in your relative’s approved care plan. Veterans have separate VA pathways, and a narrower state program called Act 150 helps people who need this level of care but don’t qualify for Medicaid.
Which Programs Actually Pay a Family Caregiver
Community HealthChoices (CHC)
CHC is the primary route for most families. It’s a Medicaid program authorized under a federal 1915(c) waiver, serving adults 21 and older with physical disabilities or age-related needs who would otherwise require a nursing facility.1Medicaid.gov. PA Community HealthChoices Waiver Under the participant-directed services option, your relative is the employer of record. They choose you as the aide, set the schedule, and sign off on your hours. A fiscal employer agent runs payroll, withholds taxes, and covers workers’ comp so nobody has to build a payroll system from scratch.
Act 150 Attendant Care
Act 150 is worth looking at when your relative needs nursing-facility-level care but has too much income or too many assets for Medicaid. It serves adults aged 18 to 59 with a physical disability who can hire, supervise, and fire their own attendant, and who can manage their own financial and legal affairs. A co-payment based on income may apply.2Pennsylvania Department of Human Services. Act 150 – Attendant Care Waiver
VA Programs for Veterans
If your family member is a veteran, two federal options may pay more than the state programs. The Program of Comprehensive Assistance for Family Caregivers (PCAFC) pays a monthly stipend to the primary family caregiver of a veteran with a service-connected disability rated 70% or higher who needs in-person personal care for at least six continuous months and receives care at home from a VA primary care team.3U.S. Department of Veterans Affairs. Monthly Stipend for Primary Family Caregivers Fact Sheet The stipend is tied to the GS-4, Step 1 federal pay rate for the veteran’s locality: Level One caregivers receive 62.5% of the monthly rate, Level Two caregivers 100%. Depending on location, the range runs from roughly $1,500 to over $3,000 per month. Primary caregivers also get CHAMPVA health coverage, mental health counseling, and respite.
Veteran Directed Care lets a veteran manage a care budget and hire family members directly. In Pennsylvania, it runs through select Area Agencies on Aging, with ARIS Solutions currently serving as the fiscal employer agent. To start, call the VA Caregiver Support Line at 1-855-260-3274 or ask your VA social worker for a referral.
What Doesn’t Pay a Relative
Two programs come up often but won’t put a wage in your pocket. The Pennsylvania Caregiver Support Program reimburses primary caregivers for out-of-pocket costs like respite, supplies, and home modifications, but by rule it cannot reimburse you for paying a relative to provide care.4Pennsylvania Code and Bulletin. 6 Pa Code 20.41 – General Reimbursement The OPTIONS program, a state-funded option for Pennsylvanians 60 and older, delivers services rather than paying family caregivers a wage.5Commonwealth of Pennsylvania. Apply for the OPTIONS Program
Which Family Members Can Be Paid
You must be at least 18. Adult children, siblings, parents, and other relatives can be paid through CHC. Spouses and legal guardians cannot be paid caregivers under Medicaid waiver programs. That’s a federal Medicaid rule, not a Pennsylvania one, and it catches a lot of families by surprise.
Every caregiver must pass a criminal background check. Pennsylvania requires a State Police check for anyone who has lived in the state for at least two years. If you’ve been a resident for less than two years, you’ll also need a federal (FBI) record and a determination letter from the Department of Aging.6Pennsylvania Code and Bulletin. 28 Pa Code 611.52 – Criminal Background Checks Certain convictions are permanent disqualifiers.
Training depends on the role. Home health aides complete at least 75 hours, including a minimum of 16 clinical hours. Personal care aides have training obligations too, though the specific hour requirement varies by employer and by the managed care organization’s policies. Expect an orientation covering safety, infection control, and the participant’s care plan before your first paid shift.
Whether Your Relative Qualifies for CHC
Two hurdles: clinical need and finances.
Clinical Eligibility
Your relative must be found “nursing facility clinically eligible,” certified by a physician. In practice, the functional assessment looks at hands-on help with bathing, dressing, eating, toileting, and moving around. Needing hands-on assistance with three or more of those activities, or being bedbound or frequently incontinent, meets the threshold outright. Someone with fewer physical limitations can still qualify if cognitive impairment, memory problems, behavioral symptoms, or medication management needs push them over the line on a secondary checklist.
Financial Eligibility
For CHC and other Medicaid HCBS waivers, your relative’s monthly income cannot exceed $2,901 as of 2025, and countable assets must stay at or below $8,000 for a single applicant. These limits adjust annually. Only the applicant’s own income counts, and married couples may benefit from spousal impoverishment rules that shield part of the healthy spouse’s assets. Countable assets include bank accounts, investments, and non-primary real estate. The primary home, personal belongings, one vehicle, and certain prepaid burial arrangements are generally excluded.
If assets exceed $8,000, your relative will need to spend down before qualifying. Legitimate spend-down options include paying off debts, making accessibility modifications to the home, buying medical equipment, prepaying funeral expenses, and covering medical bills. Pennsylvania enforces a 60-month look-back: Medicaid reviews the previous five years of financial transactions, and gifts or below-market transfers within that window trigger a penalty period. The penalty is calculated by dividing the total value of improper transfers by $421.20 (the 2026 daily penalty divisor), and the result is the number of days the applicant must wait before coverage begins. Talk to an elder law attorney before moving any significant assets.
How to Apply
Most applications take several weeks and involve more than one agency.
Step 1: Call the Independent Enrollment Broker
Start with the Pennsylvania Independent Enrollment Broker (PA IEB) at 1-877-550-4227. The IEB coordinates HCBS enrollment statewide and will schedule an in-person intake visit.7Pennsylvania Department of Human Services. Independent Enrollment Broker Applicants 60 and older go through their local Area Agency on Aging instead of the IEB.
Step 2: Gather Documentation
Have these ready for the intake visit:
- Social Security numbers for the care recipient, a driver’s license or state ID, and proof of Pennsylvania residency (a utility bill or lease works).
- Bank statements going back 24 months, investment account statements, proof of all income (Social Security award letters, pension statements, pay stubs), and the most recent federal tax return.
- A physician’s statement covering diagnoses and functional limitations. The Medical Evaluation Form (MA 51), completed by the doctor, documents clinical need.
The financial eligibility application itself is the PA 600 L, “Medical Assistance Financial Eligibility Application for Long Term Care, Supports and Services.”8Pennsylvania Department of Human Services. PA 600 L – Medical Assistance Financial Eligibility Application for Long Term Care, Supports and Services You can get it through the Department of Human Services website or a local County Assistance Office.
Step 3: Submit the Application
Submit the PA 600 L in person at a County Assistance Office, by mail, or by phone. The COMPASS portal can send a referral to the right program office, but the HCBS enrollment itself runs through the IEB and your County Assistance Office rather than through COMPASS directly.9Commonwealth of Pennsylvania. COMPASS Homepage
Step 4: Assessments and Enrollment
After submission, two reviews happen in parallel: a functional assessment for clinical eligibility, and a County Assistance Office review of the financials. Regular Medical Assistance decisions are supposed to come within 30 days, but long-term care applications involving disability determinations can take up to 90. If nothing has moved at 45 days, call both the IEB and the County Assistance Office. Applications often stall on a single missing document nobody flagged.
Once approved, your relative picks one of the three managed care organizations that run CHC statewide.10Pennsylvania Department of Human Services. Community HealthChoices The MCO assigns a service coordinator who builds a person-centered care plan setting the types and hours of services authorized. If your relative chooses participant-directed services, you then enroll with the fiscal employer agent, complete background checks and training, and start providing paid care under the plan.
What You’ll Be Paid
Family caregivers paid through CHC’s participant-directed model earn an hourly wage, not a salary. Pennsylvania’s Office of Long-Term Living rate study puts the direct-care wage component for participant-directed personal assistance at a statewide lower bound of roughly $14.58 per hour, with actual unit rates closer to $16 per hour depending on region.11Pennsylvania Department of Human Services. CY 2025 HCBS Rate and Wage Study Rates vary by geography and by MCO.
Weekly hours come from the care plan. Some participants have 10 authorized hours a week; others with heavier needs get 40 or more. You’re responsible for accurate timesheets. Fiscal agents typically offer electronic submission, some still accept paper, and late or incomplete timesheets delay pay. Keep your own copies. Disputes over hours worked do happen, and documentation ends them fast.
Taxes: The Rule Many Caregivers Miss
Under IRS Notice 2014-7, Medicaid waiver payments you receive for caring for someone who lives in your home can be excluded from your gross income entirely as “difficulty of care” payments under Section 131 of the Internal Revenue Code. The key requirement is that your relative actually lives in your home, meaning the place where you reside and carry on your normal private life. Two households, no exclusion.12Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income
When the exclusion applies, the payor ideally wouldn’t issue a W-2 or 1099. In practice, many fiscal agents issue them anyway. If you get a W-2 with the payments in Box 1, the nontaxable amount should also appear in Box 12 with Code II; report the Box 1 amount on your 1040 and subtract it on Schedule 1, Line 8s, so it zeros out. If you receive a 1099-NEC or 1099-MISC for payments that should be excluded, take the same approach: report the income, then back it out on Schedule 1. If a form is clearly wrong, ask the payor for a corrected one.12Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income
Payments from state programs that aren’t Medicaid waivers are generally taxable. Employees receive a W-2 and report wages on the 1040; independent contractors receive a 1099-NEC and report on Schedule C, where business expenses are deductible. Whatever the program, keep timesheets, payment records, and contracts.
If the Application Is Denied
You have 30 days from the date of the written denial notice to file an appeal for a fair hearing.13Pennsylvania Code and Bulletin. 55 Pa Code Chapter 275 – Appeal and Fair Hearing and Administrative Disqualification Hearings Miss it and you’re generally starting over with a fresh application. File the appeal in writing with the program office that issued the denial; it goes on to the Bureau of Hearings and Appeals, and most hearings are held by phone.14Commonwealth of Pennsylvania Department of Human Services. Hearings and Appeals Process
Most denials come down to finances: assets over the limit, or a bank statement showing a transfer inside the 60-month look-back. If the denial is clinical, a more detailed physician’s statement documenting functional limitations often carries the appeal. Pennsylvania’s legal aid organizations offer free help with Medicaid appeals, and the denial notice itself will spell out the specific reason and your appeal rights.