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State budget targets pay boost for participant‑directed direct care workers
Summary
In the governor—s proposed budget, Pennsylvania would increase Medicaid rates for participant‑directed direct care workers—an effort the Department of Human Services says will send more money directly to those 8,500 workers who are hired and managed by the people they care for.
HARRISBURG — The Department of Human Services told lawmakers that the governor—s budget focuses a wage increase this year on direct care workers in participant‑directed programs so the pay reaches workers who are hired and managed directly by people receiving services.
Secretary Acush described participant direction as a model in which "the employer is actually the individual receiving services," and said the administration proposed a rate increase that applies to the roughly 8,500 workers in that program.
The department says the state cost to fund the participant‑directed increase is about $21 million, with roughly $40 million in total funds reaching the worker pool. "That money, that increase will really, almost in its entirety, go directly into their pockets," Acush said. Officials told lawmakers the change should allow workers to take limited paid time off and make employer‑sourced insurance more affordable for those who purchase it themselves.
Nut graf: The administration framed the targeted approach as a budget‑driven choice to prioritize a smaller group of workers who lack employer benefits, rather than raising rates across agency‑employed direct care workers, which officials said would cost substantially more.
Lawmakers pressed for detail on how the participant‑directed model differs from agency employment. Acush explained that agency workers are employed by provider organizations and may have access to employer benefits such as health insurance and paid time off, while participant‑directed workers do not. "That individual can hire a trusted family member or friend if they wish in that program," she said, emphasizing the flexibility the model provides to participants.
Department staff and committee members also discussed the scale of a comparable pay increase for agency‑employed direct care staff, which the department estimated would cost in the order of $800 million—an amount the administration said made a statewide expansion impractical in a tight budget year.
Ending: DHS officials said they are open to legislative changes that could widen the increase later, but that budget constraints drove the administration—s decision to focus on participant‑directed workers for 2025–26.
