Parents’ Ability to be Paid Caregivers in Jeopardy after Public Health Emergency Ends

Currently, over 400 parents are paid by Pennsylvania’s Medicaid program to provide home health aide services for their own child, according to state Medicaid officials.  This practice has increased significantly during the pandemic, as the workforce shortage for direct care workers has intensified and families have sought to protect medically complex children by minimizing exposure to non-family members. 

State Medicaid officials reported in early December that allowing parents to be paid caregivers is in jeopardy following the future expiration of the federal Public Health Emergency (PHE). Federal law prohibits payment to parents or other legally responsible relatives to provide personal care services.  This prohibition has not been enforced during the PHE because of flexibilities the federal government granted to Pennsylvania under its COVID-19 1135 Waiver.  State officials state that they are in ongoing conversations with federal partners and that Department of Human Services (DHS) leadership is committed to finding both short-term and long-term solutions to this issue.  The shortage of direct care workers has already become more acute during the pandemic; removing the ability of parents to be paid caregivers will only exacerbate the workforce shortage.  DHS also cautioned that a solution may not be in place by mid-April, which is the current best estimate for when the federal PHE could expire. 

Members of the Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) encouraged DHS to contest the federal government’s interpretation, noting that the federal prohibition pertains to personal care services and that Pennsylvania’s practice instead involves home health aide (HHA) services being provided through home health agencies.  Unlike with other services provided through the Medicaid home health benefit, nothing in federal law requires HHA services to be provided on a part-time or intermittent basis. 

PHLP will keep readers informed as additional information and updates are released.