A parent, sibling or other relative caring for an adult in Pennsylvania whose developmental disability began before age 22 can often be paid to provide personal care at home., The OBRA Waiver, a Medicaid program that enrolls these adults from 18 through 59, pays family members to provide respite and, for participants 21 and over, personal assistance., Act 150 funds attendant care for adults 18 to 59 with a physical disability who don't qualify financially for Medicaid.

In This Guide

Which Program Fits: Pennsylvania's OBRA Waiver or Act 150

Pennsylvania's OBRA Waiver and Act 150 split on two tests: the type of disability, and Medicaid's money test. OBRA needs a developmental disability that began before age 22 plus Medicaid eligibility; Act 150 needs a physical impairment plus a Medicaid finding of financial ineligibility.,

OBRA Waiver Act 150
Who it's for A developmental disability that began before 22 and needs an Intermediate Care Facility for Other Related Conditions (ICF/ORC) level of care A physical impairment expected to last at least 12 months (or, per the Department of Human Services (DHS), that may result in death)
Age Enroll through 59; can stay after turning 60 18 through 59
Other conditions Three or more substantial functional limitations Mentally alert; able to hire, supervise and fire a worker and manage own money and legal affairs
Money test Medicaid's, set by the County Assistance Office Must go through Medicaid and be found financially ineligible
Paid by Medicaid State funds, plus a sliding fee from some families

The OBRA Waiver's own examples of qualifying conditions include "cerebral palsy; spina bifida; epilepsy; severe physical disabilities, and autism." A disability that began at 22 or later doesn't fit OBRA's definition. If it's a physical impairment and Medicaid finds your family member financially ineligible, Act 150 may fit; Act 150 also requires a nursing facility level of care. If your family member is 21 or older and qualifies for Medicaid long-term care both financially and medically, ask about Pennsylvania Community HealthChoices instead.

Act 150 also requires Pennsylvania residence and, per the Act 150 Guidelines of the Office of Long-Term Living (OLTL), which runs both programs, U.S. citizenship or lawful permanent residence., Someone already in Act 150 before 60 may stay or ask to move to an Area Agency on Aging program, but that move depends on the agency's funds and the person's priority of need, and isn't guaranteed.

Who Can Be Paid Under Pennsylvania's OBRA Waiver and Act 150

Program Parent, sibling or adult child Spouse Live-in relative Guardian or POA
OBRA Waiver Yes No Yes for personal assistance, not respite No (nor a Representative Payee)
Act 150 Only if the program confirms No Ask the program No (guardian or active POA)

Pennsylvania's OBRA Waiver lets family members provide personal assistance and respite. The OBRA Waiver won't pay the participant's spouse, a legal guardian, a POA or a Representative Payee, and "aside from the exceptions noted above, there are no restrictions on the types of family members who may provide Personal Assistance or Respite Services." The participant's representative can't be a paid attendant either.

OLTL's Act 150 Guidelines say Act 150 doesn't pay a spouse, a legal guardian or an active POA, and that aside from those limits, "there are no restrictions on the types of family members who may provide PAS" (personal assistance services). But the 1986 Act 150 law, the Attendant Care Services Act, defines a "personal care attendant" as "an individual other than a family member.", No source we found reconciles the two, so before a parent, sibling or adult child counts on Act 150 pay, get OLTL's answer in writing. The Act 150 Guidelines also hold family workers to the same qualification standards as workers serving non-relatives.

If you're married to the person you care for, our guide to getting paid to care for your spouse in Pennsylvania covers the routes that remain.

If You Live With Your Family Member

Sharing a home doesn't stop you being paid under OBRA, but two limits apply.

  • Respite: no. A relative can provide OBRA respite only if they don't live in the home.
  • No overtime premium. OBRA's participant-directed overtime rate "is only paid to participant-employed direct care workers who do not live in the same residence as the participant and for hours worked over 40 hours per week."

Act 150's sources don't address a live-in relative, so ask the program before you plan around it.

Hours and Pay

Hours come from your family member's service plan, not a fixed number. Under OBRA, a plan giving one person more than 40 hours a week of personal assistance is reviewed and approved by OLTL. If someone plans to cut back other work for this, describe the full daily care when the plan is written and get the approved hours in writing first.

Act 150's 40-hour figure is a limit on each provider agency's average across all its consumers, not a cap on your family. The Department can also limit services to match available funding.

The typical pay figure above, about $14.14 an hour, is a Bureau of Labor Statistics wage estimate for home care aides in Pennsylvania (May 2025), not a rate any program pays a family caregiver.

For both Pennsylvania's OBRA Waiver and Act 150, DHS pays $4.00 to $4.90 per 15 minutes, depending on region, for participant-directed personal assistance (W1792), effective January 1, 2026. That's what the program pays, not your wage.

Region Standard rate Overtime rate
Region 1 $4.18 $6.27
Region 2 $4.00 $6.00
Region 3 $4.37 $6.56
Region 4 $4.90 $7.35

Ask your service coordinator which region your county is in and what hourly wage that supports.

What Act 150 Costs Your Family

Act 150 isn't always free. OLTL's Act 150 Guidelines say a family whose monthly gross income is above 300 percent of the Federal Benefit Rate pays a weekly fee on the Department's sliding scale, based on household size, income, and medical and disability expenses. For 2026, 300 percent of the Federal Benefit Rate is $2,982 a month. DHS says the Act 150 co-payment "will not be more than the total costs of services." We didn't find a current published fee table, and not knowing the fee is hard when money is already tight, so ask OLTL for your estimated weekly fee in writing before enrollment.

You can hire and manage your own workers in Act 150, but its budget option, Services My Way, isn't available.

How to Start in Pennsylvania

1
Step 1

Call the PA Independent Enrollment Broker at 1-877-550-4227

It handles enrollment for both programs.,

2
Step 2

Complete the Medicaid financial check

OBRA uses the County Assistance Office's decision; Act 150 needs you to go through it and be found ineligible. Our guide on how to apply for Medicaid in Pennsylvania walks through it.,

3
Step 3

Ask to self-direct and name the family member you want hired

Both programs let the participant act as employer.,

4
Step 4

Set up payroll with Public Partnerships (PPL)

, which runs payroll for both programs: 1-877-908-1750.

5
Step 5

Questions or problems

the OLTL Participant Helpline, 1-800-757-5042.

Frequently Asked Questions

Can a parent be paid to care for an adult child in Pennsylvania?

Under Pennsylvania's OBRA Waiver, a parent can be paid to care for an adult child unless the parent is also the guardian, POA, Representative Payee or the participant's representative. A parent who is an adult child's legal guardian can't be the paid worker under either the OBRA Waiver or Act 150., Under Act 150, confirm with OLTL first.

My family member is 18 to 20. Does the OBRA Waiver pay for personal care?

The OBRA Waiver's personal assistance is only for participants 21 and over. For 18- to 20-year-olds, medically necessary personal assistance is covered through Pennsylvania Medicaid's Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit instead.

My family member is over 21 but doesn't fit either program. What else is there?

Adults 21 and over who qualify for Medicaid financially and need a nursing facility level of care may qualify for Community HealthChoices waiver services, which can also pay relatives other than a spouse, guardian, POA or Representative Payee., CHC covers personal assistance only when neither the participant nor anyone else in the household, relative or informal caregiver, is available, willing and able to help, and a relative who lives in the home can't be paid to provide respite. Being enrolled in CHC because someone has both Medicare and Medicaid isn't enough on its own to get a relative paid. If your family member directs their own care, the person acting as their employer or designated representative can't also be the paid worker.

Learn More

CaregiverHow to Get Paid to Care for a Family Member in PennsylvaniaPennsylvania's Community HealthChoices can pay most relatives, but not a spouse, guardian, POA or rep payee, to give care at home. Start at 1-877-550-4227. CaregiverHow to Get Paid to Care for Your Spouse in PennsylvaniaCan you get paid to care for your spouse in Pennsylvania? Medicaid waivers say no, but a VA caregiver stipend pays a husband or wife in 2026. Here is how. CaregiverPennsylvania Caregiver Programs2026 directory of Pennsylvania caregiver programs: FCSP $600/mo, OPTIONS, CHC, VA PCAFC, Aid & Attendance, PA MEDI, PACE/PACENET, LIHEAP, and PTRR pathways. MedicaidCommunity HealthChoices PennsylvaniaHow Community HealthChoices works in Pennsylvania in 2026: the three CHC plans, who must enroll, the carve-outs, Services My Way, and how to choose a plan. CaregiverPennsylvania Respite CarePennsylvania respite care runs on eight funding rails in 2026: FCSP up to $600/month, CHC, OBRA, OPTIONS, Medicare hospice, VA, and GUIDE. See which combine. MedicaidHow to Apply for Medicaid in PennsylvaniaHow to apply for Medicaid in Pennsylvania in 2026: online via COMPASS, at your County Assistance Office, by phone, or by mailing the PA 600, plus timelines.

Find personalized help choosing between Pennsylvania's OBRA Waiver and Act 150 for your family member at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

Still have questions?

Brevy answers from this guide and every other guide here, and can check what you qualify for.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.