Getting Paid to Care for a Family Member in Pennsylvania Through Medicaid

You've been caring for your aging parent for months — maybe years — without pay. You've heard that Pennsylvania Medicaid can actually compensate family caregivers through the Community HealthChoices program. That's true — but there's a critical rule that disqualifies many families before they even apply.

How Paid Family Caregiving Works Under CHC

Pennsylvania's Community HealthChoices program allows certain family members to be hired as Direct Care Workers (DCWs) through home care agencies contracted with the parent's managed care organization. Adult children, siblings, and grandchildren can all qualify as paid caregivers.

The program works through the MCO's provider network. Your parent's service coordinator authorizes a certain number of home care hours per week. A participating home care agency hires you as an employee, handles payroll and tax withholding, and bills the MCO. You get paid for the care you're already providing.

Compensation rates vary by agency and region, but typically range from $12 to $18 per hour for personal care services. For a family caregiver providing 20 to 30 hours of care per week, this can mean $12,000 to $28,000 per year — money that's especially meaningful for adult children who've reduced their own work hours to care for a parent.

The POA Disqualification Rule

Here's where families get caught: under Pennsylvania's post-pandemic Community HealthChoices rules (since May 11, 2023, when pre-emergency standard operations resumed), anyone who holds power of attorney, legal guardianship, or representative payee status for the Medicaid recipient is disqualified from receiving payment as a Direct Care Worker.

The logic behind the rule is conflict-of-interest prevention. The person making financial and care decisions for the parent should not be the same person receiving a paycheck for providing that care. Pennsylvania considers this an inherent conflict that could lead to self-dealing — authorizing more care hours than necessary to increase your own compensation.

This creates a trap for families who didn't plan ahead. The adult child who stepped up to handle Dad's legal and financial affairs — signing the POA, managing the bank accounts, filing the Medicaid application — is the same person most likely to be providing daily hands-on care. And that same person is now locked out of caregiver compensation.

How to Structure Around the Conflict

The solution is structural, not legal. You separate the decision-making authority from the caregiving role:

Option 1: Name a different primary agent. If two adult children are involved, one takes the POA (handles finances, Medicaid paperwork, medical decisions) and the other serves as the paid caregiver. This is the cleanest separation.

Option 2: Use co-agents with defined roles. Pennsylvania allows multiple agents under a single POA. Structure the document so one co-agent handles financial authority and the other handles healthcare decisions. The sibling who isn't named on the financial authority side can then serve as the paid caregiver.

Option 3: Name a successor agent. If only one adult child is involved, they can serve as the paid caregiver and name a trusted family friend, aunt, uncle, or professional fiduciary as the primary POA agent. The caregiver becomes the successor agent — stepping into decision-making authority only if the primary agent can no longer serve.

The key principle: whoever will provide hands-on care and receive Medicaid payment must not hold POA or guardianship status at the time they're working as a paid caregiver.

What If You Already Hold POA?

If you already signed as your parent's agent and now want to become a paid caregiver, the options are more limited:

• Resign as agent and have the successor agent step in (if one is named in the original POA)
• Execute a new POA naming a different primary agent — but only if your parent still has cognitive capacity to sign
• Accept the conflict and continue providing unpaid care while maintaining legal authority

Revoking or restructuring a POA after the fact is much harder than getting the structure right from the start. This is one of the strongest arguments for thinking through the caregiving and legal authority relationship before any documents are signed.

The Pandemic Flexibility Is Gone

During the COVID-19 public health emergency, Pennsylvania temporarily relaxed restrictions on who could serve as a paid caregiver under Medicaid waivers. Family members with POA status could receive compensation. Those flexibilities expired on May 11, 2023, and the pre-emergency conflict-of-interest rules are back in full force.

Families who relied on the temporary rules and didn't restructure their legal documents when the emergency ended are now in violation — and risk repayment demands from the MCO.

Plan the Structure Before You Sign

The Pennsylvania Power of Attorney & Guardianship Kit includes a caregiver conflict guide that walks you through structuring your POA to preserve paid caregiver eligibility — before the documents are executed and the options narrow.

See more Pennsylvania guides →