Home health care advocates gather on the steps of the Capitol in Harrisburg, March 24, 2026. Despite a widening support base, the state has not prioritized reimbursement rates for these workers. (Photo courtesy of Becky Jacobs/Pennsylvania Homecare Association)
This story was updated 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, he urged Gov. Josh Shapiro to boost reimbursement rates for home health care workers in his proposed budget, which he refused to do. Also House Speaker Joanna McClinton (Philadelphia). presented her position.
On the other side of the industry, however, the industry hasn’t gained the same support, although a growing number of Republicans are joining the cause.
“It allows individuals to stay in their homes… (and) have personal caregivers who allow them to get out and be part of the community,” said Rep. David Rowe (R-Union). “It really just improves people’s quality of life.”
Rowe, whose mother was a home health nurse and has a sister-in-law who works in the field, tied his support for rate increases to increased accountability measures, particularly reducing waste and fraud.
“We know there are large numbers of fraudulent applicants in these programs. If we can remove these individuals from the program and save the state several billion dollars, we could easily use those savings to increase our reimbursement rates, making Pennsylvania competitive and ensuring that those caring for the most vulnerable in our communities can afford to live and work in Pennsylvania,” he said.
Pennsylvania has the lowest hourly reimbursement rate among neighboring states at $20.63, despite being the fifth oldest state in the nation. AND Medicaid fraud explained from health policy experts at KFF notes that “the majority of monetary losses from fraud are borne by providers.”
Mia Haney, CEO of the Pennsylvania Homecare Association, said the commonwealth’s fee rates are not regularly reviewed or adjusted. It placed responsibility in the hands of the legislature, which controls the budget and sets budgetary appropriations.
“Our booming population continues to grow, which means this problem is only going to get worse. So we really need to reflect on the adequacy of rates every year,” Haney said. “We saw Republican and Democratic leaders say, ‘We understand this is a serious problem.’”
The current state budget – passed in November, 135 days after the June 30 deadline – was included $21 million for some home health care workers employed directly by Pennsylvania residents.
However, increases were not included for 94% of carers employed by agencies. The latest proposed spending plan does not include any novel investments.
Skip the minimum wage boost
Democrats in the House of Representatives for the third time in four years adopted a bill increasing the minimum wage in the state from $7.25 per hour to $15.
According to A: Doing this for home health care workers would require a state investment of more than $800 million Commonwealth studywhich shows that it would cost the same to raise the wage to just $14.58. For employers to do this without state dollars would be unsustainable, Haney said.
Sen. Devlin Robinson (R-Allegheny) directly questioned Department of Human Services Secretary Val Arkoosh about the discrepancies during the February budget hearing, noting that the Shapiro administration publicly supports the boost to $15 and citing the report’s findings.
“We think the trend is that by January 2027 it will be $15 an hour,” Arkoosh said.
She continued by saying that the 2023 study looked at the costs of benefits and time off, not just wages.
“It was a much more holistic look at pay,” Arkoosh said. “So it’s some apples and oranges.”
DHS pointed to the U.S. Bureau of Labor Statistics, which determines the state’s home health and personal care advisor average hourly rate for 2024 at a price of $14.70. The agency added that DHS does not set wages but does set rates paid to Medicaid managed care organizations. They then negotiate rates with home care agencies, which set hourly rates with their employees.
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In a statement to the Capital-Star, Robinson said he supports the reimbursement rate boost.
“Pennsylvania’s population is aging, and as a result, there is an increasing need for home health care and nursing home workers to provide daily care to seniors, ensuring our loved ones can age in place and with dignity. Their role in the health care industry is absolutely critical, which is why, on behalf of the Pennsylvania Homecare Association, I advocated in the Senate to increase the reimbursement rate to promote stability in the industry,” he said.
Haney said wages have increased to keep pace with market forces, but “we have really stretched the agencies as far as we can.”
“If (agencies) continue to raise wages, something else comes into the system. And unfortunately it becomes a measure of quality and oversight,” she said. “Because there is literally nowhere to get the money. And we don’t want that to happen.”
High-quality agencies may also choose to opt out of Medicaid altogether due to low reimbursement rates, she continued. They can also opt for state disability programs, which pay almost double, at about $40 an hour compared to $20 for older Pennsylvanians.
“We have nannies under 16 who make more per hour than direct workers, and it’s hard work. It’s not easy,” Haney said. “It’s the kind of job that can seem thankless in many ways.”
Another budget cycle
Democratic budget leaders continue to make home health care agencies a priority, most recently under Appropriations Chairman Rep. Jordan Harris (R-Philadelphia). submitted the official version Shapiro’s spending plan.
He urged opposing Republicans to point to specific areas that should be cut, including nursing homes and school districts and home health agencies.
As for rate increases, Harris said he’s “happy to do it. We just need people to come to the table with us to finance it.”
“There are people (in home health care) who can work in other industries and make much more than they make now, and they also take care of the most vulnerable people in Pennsylvania,” he said. “I think they deserve a raise.”
Overseas, Republican-controlled West Virginia increased rates for home health care slow last year, giving a boost to an industry dedicated to helping people get out of bed, eat a meal or take a bath.
But not in Pennsylvania.
“Everyone right now is just looking at each other and saying, ‘Where are we going to get this funding?’ Because this is so significant — $800 million is a rock to climb this mountain,” Haney said. “But we have hundreds of thousands of jobs behind us. So this is a boulder worth pushing.”
Haney introduced home health care as preferred option for older people and is a way to keep aging Pennsylvanians well and secure.
“What will happen is that someone will be seriously injured or die because they don’t have access to these services… ignoring this issue is simply putting people at risk,” Haney said.
