(The Center Square) – As Gov. Josh Shapiro prepares to present his proposal for the coming budget year, which he’ll make before the Pennsylvania General Assembly in February, advocacy groups and legislators are making their priorities known.
A health care sector stretched especially thin has pressing demands, including, the Pennsylvania Homecare Association says, following through with recommendations laid out in the state’s own studies of the industry.
Last month, 69 of the state’s Democratic House members signed onto a letter urging Shapiro to include funding increases for the homecare industry in the next budget. While commending a $21 million investment made in participant-directed care in 2025, the lawmakers urged more attention to the industry as a whole.
“Your administration’s OLTL rate study found that agency PAS requires a 23% increase—nearly double the 12% needed for participant-directed PAS,” wrote the legislators. “Yet only participant-directed PAS received a 10% boost in the enacted budget. Aligning next year’s budget with these findings would send a clear, data-driven message that agency-employed caregivers are equally valued.”
Agency workers make up 94% of the state’s home health care workforce. In-home care, for many, means the difference between living independently and life in a nursing home or institution. Yet, even when home care is available to patients through Medicaid or insurance, the availability of home care workers often leaves them high and dry.
The industry has struggled to keep up with retail and service jobs that pay far higher wages, offer consistent hours, are often less emotionally taxing, and don’t require significant travel. Even those who are committed to their work within the industry have a hard time staying in their roles while earning enough to support their families.
“These caregivers are the heart of our home and community-based services, supporting hundreds of thousands of Pennsylvanians every day with compassion, skill, and dedication. Their work allows countless individuals to live safely and independently in their homes, and they deserve recognition and fair compensation for the vital role they play in our communities,” wrote the legislators.
Key to the home care crisis are Medicaid reimbursement rates, a figure set by the state. In Pennsylvania, the rate sits at $20.63, meaning that after overhead, most workers are taking home between $13 and $16 per hour. This figure sits well below every neighboring state, from Maryland’s $25.58 reimbursement to New York’s $36.31. West Virginia’s rate is now $26.96, up from about $19.
Advocates have called for incremental adjustments and ultimately tying reimbursement rates to the cost of living to avoid falling into the same funding gap in the future.
With Shapiro’s re-election this year and potential 2028 presidential candidacy in the balance, Pennsylvania Homecare Association CEO Mia Haney framed the issue as one of consequence for future elections in an interview with Axios.
“We know that Governor Shapiro has high aspirations, and we are supportive of those aspirations to the extent that he is prioritizing his responsibilities and the need … here in Pennsylvania,” Axios reported.
How Shapiro will navigate challenges like this one and other direct threats to his reputation as a leader will likely have an impact far beyond his gubernatorial future. With Pennsylvania often cast as the nation’s most decisive swing state, issues of health care, wages, and affordability are bound to carry considerable weight across elections in both the mid-terms and looking ahead to 2028.
