Pennsylvania ยท Act 150 and the OBRA waiver
Get paid to care for a family member
If you are already helping someone bathe, dress, eat and get through the day, you are doing the work of a home care aide. In Pennsylvania there are programs that can pay you for it — whatever age the person you care for is.
Most families find out about this years too late, or never. There is no advertising budget behind these programs and nobody is knocking on doors to explain them. So here is the whole thing, plainly, including the parts that might rule you out.
How it actually works
Two Pennsylvania programs — Act 150 and the OBRA waiver — pay for attendant care at home. The person receiving care enrolls in the program. A licensed home care agency then employs the caregiver and bills the state.
Nothing in those rules says the caregiver has to be a stranger. If the family member who is already doing the work meets the same standards as any employee, the agency can hire them.
That is the whole mechanism. You become our employee. We handle the clearances, the orientation, the payroll, the taxes and the paperwork with the state. The person you love keeps the caregiver they already trust.
Who can be paid
Under Act 150, the rules place no restriction on which family members may provide personal assistance services, apart from the three exclusions below. In practice that means:
- Adult sons and daughters
- Parents
- Brothers and sisters
- Nieces, nephews, cousins, in-laws, grandchildren
- Close friends and neighbours — you do not have to be related at all
Who cannot be paid
We would rather tell you now than after you have filled out forms. The program does not pay for services provided by:
- The participant's spouse
- The participant's legal guardian
- Someone acting as the participant's Power of Attorney
If that rules you out, it may not rule out your family. A wife cannot be paid to care for her husband — but their daughter can. So can his sister, his nephew, or the neighbour who has been coming over three times a week for two years. It is worth asking who else in the picture could take the role.
Who the care recipient has to be
This is the part that surprises people most: these two programs are for adults aged 18 through 59. Not seniors.
Act 150 is a state-funded program — not Medicaid — for people with a physical disability, diagnosed by a doctor and expected to last at least twelve months, whose income is too high to qualify for Medicaid. There is a weekly fee based on income; it slides with what you earn and can never exceed the cost of the services themselves.
The OBRA waiver is a Medicaid waiver for adults with a severe developmental physical disability requiring an intermediate care level of support, with substantial limitations in three or more major life activities.
If someone is enrolled before turning 60, they can continue after 60. New applicants aged 60 or over are directed to other programs — and there are other routes for that age group, which we are happy to walk you through even though these two are not among them.
What if the person is 60 or over?
Act 150 and the OBRA waiver stop at 59 — but the idea does not. Under Community HealthChoices, Pennsylvania's Medicaid program for people 60 and over and for adults on both Medicare and Medicaid, a family member can also be paid to provide the care.
The exclusions there are slightly wider: not a spouse, not a legal guardian, not a Representative Payee, and not someone holding Power of Attorney. Everyone else — adult children, parents, siblings, nieces, nephews, in-laws, friends, neighbours — can be.
One practical difference worth knowing before you start. Under Community HealthChoices this usually runs through participant-directed services: the person receiving care becomes the employer of their own caregiver, and a financial management service handles the payroll and taxes. An agency is not in the middle of it the way we are under Act 150 and OBRA.
That means for a family over 60 we are often not the ones who would pay you — and we will tell you that plainly rather than take your details and waste your time. Call us anyway: sorting out which door you are actually standing in front of takes about fifteen minutes and costs nothing.
What the caregiver has to do
Family members have to meet the same qualification standards as anyone else working for an agency. That means:
- Pennsylvania State Police criminal background clearance
- Orientation and training — we provide it and document the hours
- Standard employment paperwork and work authorization
- Recording visits electronically, which the state requires
If you do not have your clearances yet, that is normal and we walk people through getting them. It is not a barrier, it is a form.
How to start
- Enrollment. The person needing care contacts Pennsylvania's Independent Enrollment Broker at 1-877-550-4227. That is the front door for both programs.
- Assessment. Someone determines the level of care needed and whether they qualify. The state decides this, not us.
- Service coordinator. If eligible, one is assigned. They help arrange services.
- Choosing the agency. The participant picks the home care agency — and can ask for one by name. This is the step most families do not realise they control.
You can call us at any point in that sequence, including before it starts. We will tell you what to expect, what to ask, and whether it looks like a fit — and we will tell you honestly if it does not.
One thing we will never say: that you are definitely going to qualify. Eligibility is determined by the Commonwealth, not by any agency, and any agency that promises you otherwise is telling you what you want to hear.
Talk to us
Call 484-705-2418. It is a conversation, not a sales call — and if the answer turns out to be a program we cannot bill, we will point you at the one you actually need.
We serve Lehigh, Northampton and Monroe counties, and our caregivers speak English, Spanish, Russian, Ukrainian and Farsi.
¿Cuida usted a un familiar? En Pensilvania es posible que le paguen por el cuidado que ya está brindando. No puede ser el cónyuge, ni el tutor legal, ni quien tenga poder notarial — pero sí un hijo o hija adulta, un padre, una hermana, un sobrino, un amigo o un vecino. Llámenos al 484-705-2418 y podemos hablar en español.
About us: Bright Future Home Care is licensed by the Pennsylvania Department of Health as a Home Care Agency, License #85343601, and is an enrolled Pennsylvania Medical Assistance provider for Personal Assistance Services under the Act 150 Program and the OBRA Waiver.