Pennsylvania's 2025-26 budget funds raises for only about 6% of the state's home-based care workers, according to the Pennsylvania Homecare Association, which said lawmakers abandoned the other 94%. Gov. Josh Shapiro signed the budget in November 2025 after a months-long impasse. It added about $21 million for caregivers in the participant-directed model and left rates for agency-employed caregivers unchanged.

The association laid out its figures in Nov. 10, 2025 testimony to the Senate Democratic Policy Committee and repeated them in a Nov. 26 letter to the governor. Home Health Care News reported the association's response to the budget on Nov. 17, 2025.

The rate at issue

As of November 2025, the statewide average Medicaid rate for agency-directed personal assistance services was $20.63 an hour, the association testified. It called that the lowest among Pennsylvania's neighbors, which it said pay 24% to 76% more; in its letter and press comments the group rounded that to 25% to 75%. Since 2013, according to the testimony, inflation rose 41% while the rate rose 12.1%.

The association said direct care worker turnover averages 79% a year. It reported more than 112,500 missed shifts of care a month, with managed care organizations saying 10% of authorized hours go unfilled. Its members serve more than 400,000 Pennsylvanians across home health, home care and hospice.

What the association wants

Two state-commissioned studies, the Legislative Budget and Finance Committee's 2025 HCBS study and the Department of Human Services' 2025 Mercer rate and wage study, found a reimbursement shortfall of at least 23%, the association said. It puts the cost of a 23% increase at about $800 million a year.

For 2026-27 it and the Pennsylvania Association of Home and Community-Based Service Providers asked for at least a 13% increase, to $23.31 an hour, on the way to an inflation-adjusted $25.38. Even that, the testimony noted, would trail New Jersey's $26.68 and Delaware's $31.

Why this matters for providers and DSPs

Home care agencies and I/DD providers often compete for the same workers, so low personal care rates ripple across the direct support labor market. Pennsylvania shows how quickly a gap can open between workers who get raises and those who don't, depending on how their services are paid for.