This story was updated on March 25, 2026 at 5:05 p.m. with information from the state Department of Human Services.
Letters from 70 Democratic lawmakers earlier this year urged Gov. Josh Shapiro to raise reimbursement rates for home health care workers in his proposed budget — which he declined to do. State House Speaker Joanna McClinton (D-Philadelphia) also made her pitch.
But across the aisle, the industry hasn’t rallied the same amount of backing — though a growing number of Republicans are adding their voices to the cause.
“It’s allowing individuals to stay in their homes … (and) have personal caretakers that allow them to go out and be a part of the community,” said Rep. David Rowe (R-Union). “It really just improves the quality of life for people.”
Rowe, whose mother was a home health care nurse and has a sister-in-law in the field, tied his support for rate increases with enhanced accountability measures, specifically cutting down on waste or fraud.
“We know there’s a large number of fraudulent applicants on these programs. If we can remove those people from the program and save the state a couple billion dollars, we could very easily roll that savings into increasing our reimbursement rates, making Pennsylvania competitive and making sure that the people that take care of our most vulnerable in our communities can afford to live and work in Pennsylvania,” he said.
Pennsylvania has the lowest hourly reimbursement rate among its neighboring states at $20.63, despite being the fifth-oldest state in the nation. A Medicaid fraud explainer from health policy experts at KFF notes that “most monetary loss from fraud is by providers.”
Mia Haney, the CEO of the Pennsylvania Homecare Association, said that rate setting in the commonwealth isn’t reviewed or adjusted on a regular schedule. She placed the responsibility in the hands of the legislature, which holds the purse strings and determines budget appropriations.
“Our booming population is still booming, which means that this problem is going to get worse and worse. So we really need to be considering rate adequacy on an annual basis,” said Haney. “We have seen both Republican and Democratic leaders say, ‘We understand that this is a major issue.’”
The current state budget — signed into law in November, 135 days after its June 30 deadline — included $21 million for a sliver of home health care workers employed directly by Pennsylvanians.
But increases for the 94% of caregivers employed by agencies weren’t included. The latest proposed spending plan doesn’t call for any new investment.
Left out of minimum wage increase
For the third time in the four years, House Democrats passed a bill to increase the state’s minimum wage from $7.25 per hour to $15.
Doing that for home health care workers would require upwards of $800 million in state investment, according to a commonwealth study, which found it would cost that much to get wages up to just $14.58. For employers to do that without state dollars wouldn’t be sustainable, Haney said.
Sen. Devlin Robinson (R-Allegheny) questioned state Department of Human Services Secretary Val Arkoosh about the disparity directly during a February budget hearing, noting the Shapiro administration publicly endorses the increase to $15 and citing the report’s findings.
“We believe the trend is such that by January of 2027, they will be at $15 an hour,” said Arkoosh.
She continued by saying that the 2023 study included the cost of benefits and personal time off, not just wages.
“It was a much more holistic look at wages,” said Arkoosh. “So it’s a little bit of apples and oranges.”
DHS pointed to the U.S. Bureau of Labor Statistics, which puts the state’s home health and personal care aide average hourly wage for 2024 at $14.70. The agency added the DHS doesn’t set wages, but it does establish the rates paid to Medicaid Managed Care Organizations. Those then negotiate rates with home care agencies, who set hourly wages with their employees.
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In a statement to the Capital-Star, Robinson said he supported a reimbursement rate increase.
“Pennsylvania’s population is aging, and with that comes an increased need for home health care and nursing home workers to provide critical daily care for seniors, ensuring our loved ones can age in place and with dignity. Their role in the health care industry is absolutely critical, and as such, I’ve advocated in the Senate on behalf of the Pennsylvania Homecare Association for an increase in the reimbursement rate to promote stability within the industry,” he said.
Haney said that wages had increased to keep up with market forces, but, “we’ve really stretched agencies as far as they can go.”
“If (agencies) continue to raise wages, something else gives in the system. And, unfortunately, that becomes quality measures, oversight,” she said. “Because there’s literally nowhere to take funding from. And we don’t want that to happen.”
High-quality agencies may also decide to forgo Medicaid entirely because of the low reimbursement rates, she continued. Or they may opt into state programs for individuals with disabilities that pay nearly double at roughly $40 an hour, compared to $20 for elderly Pennsylvanians.
“We have babysitters under the age of 16 that are making more per hour than these direct care workers are — and this is hard work. This is not easy,” said Haney. “This is the type of work that can, in many ways, feel thankless.”
The next budget cycle
Democratic budget leaders still name home health care agencies as a priority, most recently when Appropriations Chair Rep. Jordan Harris (D-Philadelphia) filed a formal version of Shapiro’s spending plan.
He urged dissenting Republicans to identify specific areas to cut, including nursing homes and school districts alongside home health agencies.
When it came to rate increases, Harris said he would “love to do that. We just need people to meet us at the table to fund that.”
“There are folks (in home health care) who can work in other industries and make way more money than what they’re making now, and they’re taking care of the most vulnerable people in Pennsylvania,” he said. “I believe they deserve increases.”
Across the border, Republican-controlled West Virginia increased home health care rates late last year, giving a boost to an industry charged with helping people get out of bed, eat a meal or take a bath.
But not in Pennsylvania.
“Everyone is just kind of looking at each other now and saying, ‘Where do we get this funding?’ Because it’s so significant — $800 million is a boulder to try to move up this mountain,” said Haney. “But it is one that we have hundreds of thousands of jobs behind. So it’s a boulder worth pushing.”
Haney pitched home health care as the preferred option for elderly adults along with being a way to keep aging Pennsylvanians healthy and safe.
“What will happen is that somebody will be severely hurt or will die because of the lack of access to these services … ignoring this issue is just putting people at risk,” said Haney.
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