Pennsylvania home-care agencies say low Medicaid rates leave more than 112,000 shifts unfilled each month, the Pennsylvania Homecare Association told the Philadelphia Tribune in an Oct. 4 feature.
PHA CEO Mia Haney said the average direct care worker earns about $14 to $15 an hour—only slightly above starting pay—and that many work more than 40 hours a week. The association says Pennsylvania reimbursement rates trail surrounding states by 25% to 75% and that several border states raised rates after the pandemic while Pennsylvania largely did not.
Agency rates vs. consumer-directed raises
Haney said last year's $21.4 million budget add-on went to workers who provide services without an agency, not to agency payrolls. Agencies sought about $800 million to close what PHA calls a roughly 23% structural deficit. Francina Chereisky, founder of Philadelphia's Tru Care, told the Tribune Medicaid pays her agency $21.52 an hour for certain personal assistance services and that reimbursements rose only $1.91 per hour over a decade, while 85%–90% of her business is Medicaid.
Why this matters for providers and DSPs
For Pennsylvania provider agency managers and DSPs, unfilled HCBS shifts mean canceled visits, overtime pressure, and clients left without bathing, meals, or medication support. Rate fights that lift only consumer-directed workers leave agency aides—and the people they support—stuck at the same pay floor.