Providers, lawmakers urge $13 million state investment to shore up brain‑injury residential services

A coalition of providers, advocates and legislators told a joint House Human Services and Insurance Committee hearing in Harrisburg that Pennsylvania needs a near‑term infusion of state funding to keep residential habilitation services for people with brain injuries operating.

Richard Edgley, president and CEO of the Rehabilitation and Community Providers Association, told committee members that “there's a problem, and it's been going on for years without resolution, and that's the reason we're here.” He and other witnesses asked the Legislature to provide $13 million in state funds to support specialized residential habilitation providers; RCPA said that amount would trigger about $17 million in federal matching dollars.

Why it matters: witnesses said the specialized network that supports people with traumatic and acquired brain injuries has shrunk, workforce costs have risen and some providers have closed or stopped taking Medicaid, forcing people into nursing homes, hospitals, homelessness or corrections settings.

Providers and state officials described how policy changes in recent years moved brain‑injury services into the state’s Community Health Choices (CHC) managed‑care program. Juliette Marsala, deputy secretary for the Department of Human Services’ Office of Long Term Living, described CHC as “our largest managed long term services and supports program” and said it serves people across several eligibility categories. Marsala said CHC includes 33 services that can be used to build person‑centered plans and that approximately 1,600 individuals with brain injuries meet the nursing‑facility or higher clinical eligibility threshold and receive CHC long‑term services and supports.

Advocates said the funding mismatch is longstanding. Dr. Drew Nagel, co‑chair of the Pennsylvania Brain Injury Coalition, told committee members that specialized residential habilitation providers “have not received rate increases since 2012” and that rising labor costs have made it difficult for providers to hire and retain trained staff. Joanne Tangney, president and CEO of Success Rehabilitation, said that since the pandemic her organization has incurred steep new costs—“in 2024 alone, SUCCESS spent $850,000 on this one line item” for agency staffing—and that health‑care and compensation costs for staff have risen by double digits.

Providers and advocates gave more detail on access and capacity: Marsala said about 90% of the CHC participants with brain injury choose personal assistance services and that about 550 people receive cognitive rehabilitation therapy, a service now permitted to be delivered via telehealth as of January. Edgley said Pennsylvania had 18 brain‑injury providers in 2014 and about 14 today; he estimated several hundred people are effectively waiting for services because agencies will not initiate assessments until funds and provider capacity are available.

Funding proposals and context: witnesses asked for a $13 million state appropriation to residential habilitation providers that RCPA estimates would bring a $17 million federal match, for an immediate $30 million investment. Edgley acknowledged the figure would not fully restore providers to parity with other waiver populations but said it would be a critical step to preserve current capacity. Marsala described prior short‑term supports, including a 3% rate increase drawn from ARPA funds and a $525,000 CARES Act allocation, and said OLTL monitors network adequacy and has used targeted funding when available.

Workforce and rate drivers: witnesses pointed to higher private‑sector wages, pandemic‑era turnover and regulatory requirements such as the federal HCBS final settings rule as drivers of cost. Dr. Nagel said some specialized brain‑injury residential providers have closed because they “couldn't make the rates work,” and urged legislative action to prevent further erosion of the provider network.

Committee outcome and next steps: committee chairs thanked witnesses and said the committees would continue the topic in a follow‑up informational session. No formal funding decision or vote occurred at the hearing.