Can a Spouse or POA Be a Paid Caregiver in Pennsylvania?
Can a Spouse or POA Be a Paid Caregiver in Pennsylvania?
Short answer: No. Under Pennsylvania’s Community HealthChoices (CHC) waiver, you cannot be paid to provide personal assistance services if you are the participant’s spouse, power of attorney (POA), legal guardian, or representative payee.
- Spouses, POAs, legal guardians, and representative payees are excluded from receiving wages as caregivers under the CHC waiver.
- Pandemic-era exceptions that temporarily allowed spouses to be paid ended on May 11, 2023.
- If you direct your own care through Services My Way, your designated representative also cannot be your paid caregiver.
- Families usually handle this by having a different adult relative become the paid caregiver or by utilizing respite services.
- Spouses may qualify for up to $600 a month in expense reimbursement through the PA Caregiver Support Program.
The rules for spouses, POAs, and guardians under the CHC waiver
Pennsylvania’s Community HealthChoices (CHC) program provides Medicaid managed care for adults 21 and older who need long-term services and supports. One of the primary services offered under the CHC waiver is Personal Assistance Services. This service pays for hands-on help with daily activities like eating, bathing, and dressing.
Many families want to get paid to care for a family member so they can afford to stay home and provide support. However, the state strictly limits who can receive these wages. The CHC waiver will not pay for services furnished by the participant’s spouse, legal guardian, representative payee, or Power of Attorney (POA).
These exclusions are enforced by the Office of Long Term Living (OLTL) and the CHC managed care plans. You can read the specific policy in the PA Health & Wellness bulletin. During the COVID-19 emergency, the state allowed temporary exceptions so spouses could be paid. Those pandemic-era exceptions ended on May 11, 2023. According to the PHLP, the OLTL does not expect to make future exceptions.
If you use the participant-directed option, your care is managed differently. Under this model, you or a designated representative act as the employer. The Services My Way manual explicitly states that the designated representative is also excluded from being the paid caregiver.
Payment eligibility by family role
Understanding exactly which roles are excluded helps families plan their care arrangements. The table below outlines who can and cannot receive wages under the CHC waiver.
| Role | Paid under CHC? | Rule |
|---|---|---|
| Spouse | No | Excluded by the CHC waiver |
| Power of attorney (POA) | No | Excluded by the CHC waiver |
| Legal guardian | No | Excluded by the CHC waiver |
| Representative payee | No | Excluded by the CHC waiver |
| Designated representative | No | Excluded in Services My Way |
| Adult child, grandchild, sibling, other relative | Yes | As long as they hold none of the roles above |
| Friend or neighbor | Yes | Same condition |
If you are a family caregiver who already has a client and needs an agency partner, New Century Home Care can help. Call us at 215-974-0000 or fill out our contact form and choose “I am a caregiver” followed by “I already have a client.”
If you hold POA for a parent or loved one
A Power of Attorney (POA) acts as the agent for the principal. In the CHC program, the participant has a person-centered service plan (PCSP) that dictates the care they receive and how often. If you hold POA, you help manage that plan and sign important documents.
Because the CHC plan will not pay a POA, families usually bring in a different adult relative to become the paid caregiver. You retain your role as POA to manage the finances and medical decisions, while the other relative earns the wages for providing hands-on care. You should discuss this arrangement with your CHC service coordinator.
Some caregivers consider changing or revoking their POA status so they can become the paid worker. This is a serious legal decision that affects your ability to make medical and financial choices for your loved one. Talk to an elder law attorney before changing a POA. You can also speak with an elder law attorney or call the Pennsylvania Health Law Project (PHLP) Helpline at 1-800-274-3258 for free legal help regarding OLTL waivers. You can also review our legal documents guide for general information.
How another relative can get paid
If a different family member steps up to provide care, your loved one must first be approved for the CHC waiver. PHLP says the process can take a few months but should not take more than 90 days. The application requires these specific steps:
- Call the Independent Enrollment Broker (IEB): Contact the IEB at 1-877-550-4227 to start the process.
- Physician Certification: The IEB sends a form to your loved one’s doctor, who should return it within 5 business days.
- First in-person visit: The IEB visits the home within 7 business days to help with the financial Medicaid application and explain the CHC plan choices (such as Keystone First CHC, UPMC, or PA Health & Wellness).
- Functional Eligibility Determination (FED): Within 10 business days, an assessor from the local Area Agency on Aging visits. In Philadelphia, this is the Philadelphia Corporation for Aging (PCA). They check whether your loved one is nursing facility clinically eligible, for example needing hands-on help with three or more activities of daily living such as bathing, dressing and toileting. Help with meal prep or shopping does not count.
- Financial review: The County Assistance Office (CAO) reviews income and resources. For 2026, the individual income limit is $2,982 per month. The CAO also looks at asset transfers over the past 5 years.
Once your loved one is approved, the alternate relative must meet state hiring standards. Our guide on caregiver requirements outlines the rules under 28 Pa. Code Chapter 611. The relative must pass a criminal history report and provide at least two satisfactory references from people they are not related to.
The relative must also complete a TB screening for active tuberculosis before having consumer contact. Finally, they must pass a competency exam covering topics like infection control, handling emergencies, and recognizing abuse. You can read more about expected wages in our guide to pay rate PA averages.
Options for a caregiving spouse in Pennsylvania
Spouses provide daily, intensive care but cannot receive CHC wages. If you are a caregiving spouse, you still have options to get physical relief and financial support.
First, you can request respite care through the CHC waiver. Respite is a waiver service designed to give primary caregivers a temporary break. A trained aide comes to the home to supervise and assist your spouse while you rest or run errands. Learn more about Philadelphia respite care.
Second, another relative or a professional agency caregiver can be hired through the CHC waiver to handle the Personal Assistance Services. This reduces your daily physical workload.
Third, you can apply for the PA Caregiver Support Program. This program is run by the PA Department of Aging and is delivered in Philadelphia by PCA. It provides education, care planning, and financial reimbursement for caregiving expenses.
The PA Caregiver Support Program can reimburse you up to $600 a month for caregiving expenses. It is reimbursement of expenses, not an hourly wage for your time.
Finally, consider joining local support groups. Connecting with other families helps you manage the stress of caregiving and learn how others handle the state rules.
Why home care agencies cannot take POA
Sometimes families ask if a home care agency owner or staff member can take over as the POA so the family member can be freed up to work. Pennsylvania home care law strictly forbids this practice.
Under 28 Pa. Code §611.57, no one affiliated with a home care agency may assume POA or guardianship over a consumer of that agency.
Dealing with these rules requires careful family planning. If you hold an excluded role, talk to your CHC service coordinator about your options and discuss whether another relative is available to complete the hiring process.
If you need an agency to help employ a qualified family member, contact New Century Home Care. Call us at 215-974-0000 or visit our contact us page and select “I am a caregiver” then “I already have a client.”
Frequently asked questions
Can my wife take care of me and get paid for it?
No. Under the Community HealthChoices (CHC) waiver, spouses are excluded from being paid for Personal Assistance Services. However, spouses can look into the PA Caregiver Support Program, which offers up to $600 a month in expense reimbursement.
Will Social Security pay a spouse to be a caregiver?
Pennsylvania’s Medicaid caregiver programs are run by the Department of Human Services, not Social Security. Ask the Social Security Administration directly about your specific benefits.
How much does a spouse caregiver get paid?
Nothing in wages under the CHC waiver. Instead of wages, spouses can apply for the PA Caregiver Support Program, which reimburses up to $600 a month for out-of-pocket caregiving expenses and supplies.
Can a POA be a paid caregiver in PA?
No. A person holding Power of Attorney for a CHC waiver participant cannot be paid to provide their personal assistance services.
Can a legal guardian be paid?
No. Legal guardians are excluded from receiving wages for caregiving under the CHC waiver.
Can my daughter be paid if I am her POA?
Yes. What matters is the role she holds over you, the participant. She can be paid as long as she is not your spouse, legal guardian, representative payee or POA. You being her POA does not affect this.
Who is taking care of the caregiver?
Caregivers can find support through CHC respite services, local support groups, and the PA Caregiver Support Program. In Philadelphia, this program is administered by the Philadelphia Corporation for Aging (PCA).
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