Family caregivers provide incredibly valuable support to their loved ones, often incurring personal expenses related to their caregiving role. Understanding the available programs for compensation through Pennsylvania’s Medicaid program and other support systems is crucial for those providing this essential care.
What is a Caregiver?
Caregivers are people who help elderly, ill, injured, and/or disabled patients with attaining their needs and completing day-to-day tasks. A paid caregiver could work with a patient who requires long-term assistance at the sick or elderly person’s residence. Although many caregivers fill this role as professional and paid employees, family caregivers are those who take care of their own family and/or one that they’re friends with or close to.
Does Pennsylvania allow family members to be caregivers and get paid through Medicaid?
Simply put, the answer is yes. Medicaid in Pennsylvania participates in Personal Assistant Services (PAS). This program provides PAS services to family members and pays them to assist with the services related to ADL and IADL care. These services include meal preparation, mobility, housework, shopping, grooming, eating, bathing, toileting, laundry, and more. Almost anyone can be a paid family caregiver as long as they meet certain requirements.
Medicaid Programs
Medicaid is a joint federal and state program that provides health coverage to eligible low-income individuals, including families, seniors, and people with disabilities. Medicaid waivers allow states to offer additional services and benefits not typically covered under Medicaid by “waiving” certain federal requirements to provide more tailored support to specific populations, such as those needing long-term care.
In Pennsylvania, the following Medicaid waivers are available with an option for caregiver pay:
Person/Family Directed Support (P/FDS) Waiver
This waiver is similar to the Consolidated Waiver but has a lower individual cost limit of $41,000 per person per fiscal year. It also offers self-directed service models and traditional, agency-based service models.
OBRA Program
This program provides services to individuals with developmental disabilities ages 18-59 years who meet an ICF/IID level of care.
Community HealthChoices Program
This program provides services to individuals ages 65 or older and individuals with physical disabilities ages 21-64 years who meet a nursing facility level of care.
How Medicaid Waivers Work
Medicaid waivers allow family caregivers to get paid through self-direction programs (also known as consumer direction, participant direction, or other similar names), giving care recipients more control over their care by enabling them to choose who provides it, including family members. To get paid, the care recipient must be evaluated and approved for in-home care, after which the caregiver may need to complete training, acquire credentials, and be “employed” by an agency that processes payments. Once enrolled and hired, caregivers must document and verify their work according to the program’s procedures.
Payment Details for Family Caregivers
Pay rates for family caregivers vary based on several factors:
- Program guidelines: Each waiver program may have specific rules and regulations regarding caregiver compensation. These guidelines often outline the maximum hourly rate allowed.
- Local wage rates: Hourly rates are determined at the local zip code level based on a variety of factors.
- Qualifications and experience: Your qualifications and experience as a caregiver can impact your hourly rate. If you have specialized training or certifications relevant to caregiving, it may justify a higher rate. Additionally, your years of experience in caregiving can also influence your compensation.
- Level of care required: The level of care needed by the individual you are caring for can impact your hourly rate. Higher levels of care, such as providing medical assistance or supporting individuals with complex needs, may justify a higher rate compared to basic caregiving tasks.
- Time commitment: The number of hours you dedicate to caregiving can influence your hourly rate. If you are providing care full-time or have a significant time commitment, it may justify a higher rate compared to part-time caregivers.
- Market demand: The demand for caregivers in your area can also affect your hourly rate. If there is a shortage of caregivers or a high demand for specific types of care, it may drive up the hourly rates.
Average Pay Rate for Pennsylvania Caregivers: On average, the amount could range between $11 and $14.50 per hour.
Support Systems
Every state is mandated by the federal government to create support systems for family caregivers. They often reach local communities through Area Agencies on Aging (AAAs).
Area Agencies on Aging are crucial in supporting family caregivers caring for older adults. These agencies typically offer various services, resources, and programs to assist family caregivers in their caregiving responsibilities. Some of the most common ways in which state Agencies on Aging support family caregivers include:
- Information and referrals: AAAs provide guidance on local resources, support groups, caregiver training, and respite care options.
- Caregiver education and training: They organize programs on caregiving techniques, stress management, healthcare navigation, and legal/financial aspects.
- Respite care: They offer temporary relief for caregivers, enabling them to take breaks and attend to their well-being.
- Support groups: They facilitate caregiver support groups for sharing experiences, concerns, and learning from others.
- Caregiver assessments: AAAs evaluate caregivers’ needs and provide tailored support and recommendations.
- Counseling and consultation: They offer professional guidance and emotional support for caregivers.
- Advocacy and policy development: They advocate for caregiver-friendly policies and programs.
Access to benefits and services: They assist caregivers in accessing benefits and programs like Medicaid, home-based services, and transportation assistance.
Eligibility and Restrictions
To become a family caregiver and qualify for PAS, you must meet certain requirements:
- Age: At least 18 years old
- Training: Complete caregiver training requirements
- Health: TB tested
Key Statistics
Source: AARP
- Family caregivers: 1.6 million in Pennsylvania
- Hours spent per year: 1.39 billion
- Annual unpaid care value: $22.0 billion
Pennsylvania Family Caregiver FAQs
Who cannot be a family caregiver in Pennsylvania?
- Spouses cannot be paid to be family caregivers for each other.
- Parents cannot be the family caregiver of their non-adult children.
- Elderly family caregivers cannot be a Power of Attorney (POA) or Payee for the patient or spouse.
Who can be a caregiver?
- Any family member or friend over 18 that is not a spouse, POA, or payee.
- Caregivers must fulfill training and certification rules.
What do I do if I don’t have Medicaid and/or a Waiver?
If you don’t have Medicaid, you can apply for Medicaid services directly through the state. Once enrolled, FreedomCare can assist you in contacting Maximus, the facilitator for the HCBS enrollment process.
To start, you’ll submit a Community Referral Form to Maximus. Your doctor will then need to complete a Physician’s Certification Form to help determine your eligibility. Submit this form promptly to avoid delays.
After the forms are submitted, you’ll schedule an initial intake meeting with a state representative. This meeting, which can take place at your home or another public location, will assess your ability to manage daily tasks like cleaning, cooking, and grocery shopping.
A second intake meeting will be conducted in person by the Area Agency on Aging (AAA), where an assessor will perform a Functional Eligibility Determination to confirm whether you qualify for HCBS. After both assessments, you will receive your final eligibility results.
If approved, you’ll be enrolled in the HCBS program. Your Managed Care Organization (MCO), or health plan, will determine the number of care hours you are eligible for. The entire process typically takes about 90 days.
What Medicaid plans and HCBS waivers do FreedomCare work with?
Depending on your county of residence we typically work with the following Medicaid plans:
- AmeriHealth
- Keystone First
- UPMC
- Pennsylvania Health & Wellness
Depending on your county of residence we typically accept the following HCBS waivers:
Why Should I Choose FreedomCare?
At FreedomCare, we empower families by making caregiving easier and more rewarding. Our streamlined process ensures that eligible family members can get paid to care for their loved ones, all while providing top-notch support every step of the way. As the trusted leader in Medicaid home care, FreedomCare offers unmatched flexibility by allowing you to choose who provides care, whether it’s a parent, sibling, adult child, or close friend. Our dedicated team is here to handle the complexities of enrollment, payroll, and compliance, so you can focus on what matters most: delivering compassionate, high-quality care in the comfort of your home. Join the thousands of families who trust FreedomCare to make caregiving a sustainable and fulfilling experience.
Conclusion
As a family caregiver, you provide invaluable support to your loved one. Exploring the options for getting paid through Pennsylvania’s Medicaid program, veteran programs, and other support systems can help you manage the financial burden and continue to provide high-quality care. By understanding the requirements and opportunities available, you can make informed decisions that benefit both you and your loved one.