Medicaid Self-Directed Care in Pennsylvania: Can You Hire a Family Caregiver?

Main programs and routes in Pennsylvania

What self-directed care means

Self-directed care means the person getting care has more control over who provides the care and how approved care is scheduled. In Pennsylvania CHC, the person is called the participant.

The participant still needs an approved Person-Centered Service Plan. This plan says what help is approved, how often it is approved, and what goals the services support.

Under Employer Authority, the participant or chosen Common Law Employer handles many employer duties. That can include recruiting, hiring, training, scheduling, supervising, and ending a worker’s job if needed.

Under Services My Way, the participant may also manage an individual budget. That budget is tied to the approved care plan. It may cover Participant-Directed Community Supports and approved goods or services that meet the plan rules.

The participant does not just receive cash to spend freely. Medicaid money must follow the care plan, approved hours, worker rules, spending plan rules, and payroll rules.

Program name in Pennsylvania

The main Medicaid long-term care program for many Pennsylvania adults is Community HealthChoices, or CHC.

The self-directed route may be described in several ways:

• participant-directed services
• self-directed services
• Self-Directed Personal Assistance Services
• Employer Authority
• Services My Way
• Budget Authority
• Participant-Directed Community Supports

When you call, use more than one phrase. Some workers may know "Services My Way." Others may know "participant-directed services."

Who can be hired

Pennsylvania CHC rules allow some family members to provide certain waiver services when they are qualified and approved. The services named in the CHC waiver include Respite, Personal Assistance Services, and Participant-Directed Community Supports.

A worker may need to complete enrollment forms, background checks, training, tax paperwork, and Electronic Visit Verification steps. Electronic Visit Verification, or EVV, is the system used to record and approve work time.

The family caregiver must do the work in the approved plan. They cannot bill for unapproved tasks, extra hours, or time when the participant did not receive the service.

The CHC plan and service coordinator must authorize the service. The fiscal/employer agent must finish the worker setup before pay can happen.

Spouse and adult child rules

The CHC Waiver rules reviewed for this guide say the waiver will not pay for services furnished by the participant’s spouse. It also will not pay for services furnished by a legal guardian, representative payee, or power of attorney.

An adult child may be allowed if they are not also in one of the barred roles and meet all worker rules. The same may be true for a sibling, cousin, grandchild, friend, neighbor, or other trusted person.

Do not guess based on family relationship alone. A caregiver may be barred because of a legal role, even if the family relationship would otherwise be allowed.

Payroll and timesheets

In CHC participant direction, the participant or Common Law Employer is not expected to run payroll alone. Pennsylvania uses a fiscal/employer agent for CHC participant-directed services. The current CHC materials name Tempus Unlimited as the fiscal/employer agent.

The fiscal/employer agent helps with payroll and tax withholding. It also helps process worker enrollment, timesheets, payments, and worker tax forms.

The Common Law Employer still has duties. They may need to recruit, hire, train, schedule, supervise, and dismiss the direct care worker. They also approve time and make sure the work matches the approved Person-Centered Service Plan.

Tempus materials say direct care workers and Common Law Employers must attend EVV and timesheet training. The training explains how to clock in and out, submit time, edit a shift, approve or reject time, and view payment information.

How to switch from agency care

You do not have to cancel agency care before asking about self-direction. Ask first. A gap in care can put the person at risk.

Pennsylvania CHC materials say participants may choose self-directed care during service plan development, at reassessment, or at any time. They also say participants may use a mix of service models to meet their needs.

What to do if the first answer is no

A "no" on the phone may mean several things. It may mean the family member is barred. It may mean the worker is not enrolled yet. It may mean the service plan does not include the needed hours. It may also mean the person you reached used the wrong program name.

For help with call notes, use the CaregiverBenefits.org phone scripts and caregiver checklists.

How this connects to other caregiver benefit paths

Medicaid self-directed care is only one route. It is not the same as a family leave program, a tax break, or a VA benefit.

Start with Can I get paid to be a caregiver? if you want a broader view. Use the paid caregiver quiz if you are not sure which path fits.

If the person may need long-term services through Medicaid, read Medicaid HCBS waivers explained. If income or assets may be an issue, review Medicaid spend-down and Medicaid look-back period.

Veterans and surviving spouses may also want to check VA Aid and Attendance. Caregivers who pay out of pocket can review caregiver tax deductions. If the family needs a break from care, see respite care for caregivers. To compare care costs, use the care cost calculator.