Credit: Bermix Studio / Unsplash.com
Some 135 days after its deadline, Gov. Josh Shapiro signed a bipartisan budget compromise into law and ended a monthslong impasse — but many Pennsylvanians working in home care were shut out of any additional funding, prompting a call for more investment in 2026.
The Pennsylvania Homecare Association seeks to raise Medicaid rates by 23% and invest upwards of $800 million into home care to “stabilize” the industry, citing studies commissioned by the Shapiro administration and a bipartisan legislative committee. But the 2025-2026 budget allotted just $21 million for Direct Care Workers, which the association said helps just 6% of the workforce.
“Pennsylvania’s in-home care crisis is both devastating and straightforward— the workforce is collapsing, and people are going without care,” Mia Haney, the association’s CEO, said in a release. “The Governor and Legislature have taxpayer-funded studies that spell out exactly what must be done. Families are missing hours they’re authorized for, medically fragile children are losing care, and seniors are being left without help. We don’t need more reports — we need leadership.”
PHA represents more than 700 homecare, home health and hospice providers across the commonwealth. The organization filed a formal Program Revision Request for a 13% increase in personal assistance services — at minimum — and a $59 per hour nursing rate in the next fiscal year, which starts on July 1.
According to PHA, the average hourly reimbursement rate for personal assistance services is “the lowest among neighboring states” at $20.63, a rate that ranges from $36.31 in New York to $25.58 in Maryland. The group added that managed care organizations report that 10% of personal assistance staff hours and 27% of nursing hours are unfilled each month.
Pennsylvania’s growing senior population is straining home care resources, especially in rural areas, as the Baby Boomer generation reaches retirement age. By 2030, rural Pennsylvanians aged 65 or older are expected to outnumber those under the age of 20.
“Raising rates isn’t an item on a wish list — it’s an absolute necessity for tens of thousands of vulnerable Pennsylvanians,” Haney continued. “This is both a moral and fiscal imperative. Every month of delay costs taxpayers millions and leaves more Pennsylvanians without care. The Commonwealth cannot keep balancing its budget on the backs of vulnerable families and underpaid caregivers.”
A little more about the budget process
When Shapiro signed the state’s budget into law last month, Pennsylvania’s Office of the Budget was already months into the process for developing the next fiscal year’s funding plan.
Instructions for state agencies submitting budget requests went out in August, amid the impasse. They directed each to submit “cost to carry budget requests,” or plans maintaining current levels of service. The 74-page document warns agencies that federal funds that are lost — or anticipated to be cut — should be incorporated into their requests.
However, “agencies should not request increased state resources to address these impacts in their agency submissions unless directed by the Office of the Budget.”
Agencies submitted their funding requests on Oct. 15. Program Revision Requests, which alter current programs outside of the submitted agency budgets, increase or decrease funding by more than 15% and have more than a $200,000 impact.
Sometime this month, the governor’s office typically meets with the General Assembly for a mid-year briefing on budget issues and “to apprise them of anticipated spending and revenue levels and to discuss major fiscal issues.”
The governor’s office then finalizes their budget proposal before a formal submission to the legislature in early February, kicking off negotiations before the June 30 budget deadline.
