Updated September 4, 2026. Quick answer: yes, through Community HealthChoices (CHC) Waiver, Services My Way (Budget Authority) / Participant-Directed Community Supports. Most adult family members can be hired and paid to provide the care. A spouse cannot be the paid caregiver; the federal rule against paying a “legally responsible relative” still applies here.
How Pennsylvania pays a family caregiver
| Program | Community HealthChoices (CHC) Waiver, Services My Way (Budget Authority) / Participant-Directed Community Supports |
|---|---|
| Can a family member be paid? | Yes. “Family members can provide Respite, Personal Assistance Services and Participant-Directed Community Supports; however, the following exclusions apply… Aside from the exceptions noted above, there are no restrictions on the types of family members who may provide Respite, Personal Assistance Services and Participant-Directed Community Supports.” |
| Can a spouse be paid? | No. “The CHC Waiver will not pay for services furnished by the participant’s spouse.” |
Why the spouse question is different
Federal Medicaid rule treats a spouse (and a parent paying for a minor child) as a “legally responsible relative”, someone already assumed to owe the care for free, so paying them is barred by default. A state has to build an explicit exception into its waiver or state-plan option to pay a spouse at all; the rule for any other relative (an adult child, a sibling, a grandchild) is looser and usually allowed. That is why the two rows above can carry different answers on the same page.
The going rate
Not published by the state in the materials reviewed this session.
How it works
Pennsylvania’s Community HealthChoices Medicaid waiver lets participants self-direct personal care either through Employer Authority (directly hiring a worker) or the Budget Authority model known as Services My Way, in which a certified Vendor Fiscal/Employer Agent handles enrollment, payroll, timesheets, and background checks while the participant recruits, hires, trains, and fires the direct care worker. Family members such as adult children, siblings, and in-laws may be paid Participant-Directed Community Supports or Personal Assistance Services workers, but the waiver categorically excludes the participant’s spouse, legal guardian, Representative Payee, and Power of Attorney.
What this doesn’t answer
No published statewide dollar wage rate for direct care workers was found in the waiver text; pay is set by the participant within Fiscal/Employer Agent-administered parameters, and the CHC-MCO must approve plans over 40 hours/week from one worker. The consumer-facing pa.gov Consumer Directed Services page does not itself restate the spouse exclusion; that language was confirmed directly in Appendix C-2-e of the waiver application (PA.0386.R05.01, effective July 1, 2026).
Sources
- Pennsylvania DHS, Office of Long-Term Living: Community HealthChoices 1915(c) HCBS Waiver Application PA.0386.R05.01 (effective July 1, 2026), Appendix C-2-e
- Pennsylvania DHS: Consumer Directed Services
Read September 4, 2026.
Same question, other states: Rhode Island · South Carolina.
Related: the private-pay caregiver-agreement rule · the household-employee tax rules once you’re being paid · what family caregiving actually costs unpaid.
General information drawn from each state’s own Medicaid agency and public program materials, not legal, tax or financial advice. Medicaid self-direction programs are administered state by state and change by budget cycle and waiver renewal; this page cannot see your own state’s current program status or your family’s eligibility. We are not a law firm, a benefits counselor, or a fiduciary, and this is not personalized advice. We sell nothing on this page and earn nothing from it.