24-Hour Home Care: Is It Available Through Medicaid in Pennsylvania?

The question comes up constantly: can Medicaid provide 24-hour home care? The honest answer is that true around-the-clock, 24/7 Medicaid-funded care is rare — but the number of hours Medicaid can authorize is often more generous than families expect, and creative combinations of services can get families close to full coverage.

What Medicaid Realistically Covers

Through Community HealthChoices, Pennsylvania Medicaid authorizes home care hours based on the functional assessment and resulting care plan. There’s no fixed statewide cap on hours, but authorizations are tied to documented need. In our experience at CareChoice, the most intensive care plans we see in Philadelphia authorize 40 to 60 hours per week of personal care — which covers most waking hours but not 24/7 coverage.

Individuals with extreme care needs — those who require overnight assistance, continuous supervision for safety (severe dementia with wandering), or round-the-clock physical care — may receive higher authorizations, but true 168-hour-per-week coverage through a single Medicaid program is uncommon.

How to Maximize Hours

Prepare thoroughly for the assessment.  The functional assessment determines everything.  Describe the full scope of needs including overnight toileting, early morning assistance, evening medication management, and weekend care. If you only describe weekday daytime needs, the authorization will reflect that limited picture.

Document overnight and safety needs specifically.  If your loved one wanders at night, falls when getting up for the bathroom, or needs repositioning while sleeping, these needs should be explicitly documented during the assessment and in any supporting medical records.

Request a reassessment if needs increase.  Care plans aren’t static. If your loved one’s condition worsens, contact the MCO service coordinator and request an updated assessment. More intensive needs can result in more authorized hours.

Combining Programs for Greater Coverage

The most effective approach for families who need near-24-hour coverage is combining multiple services.

Personal care hours (PDS) cover the primary caregiver’s shifts — morning routine, daytime care, evening routine. A family caregiver through Agency with Choice handles these hours and gets paid.

Respite care covers periodic relief — allowing a second caregiver to step in so the primary caregiver can rest or handle personal obligations.

Adult day services through programs like SarahCare cover structured daytime hours (typically 8AM–6 PM), freeing the family caregiver for other responsibilities during the day and providing the care recipient with social engagement and health monitoring.

Personal emergency response systems (PERS) provide overnight safety monitoring — a wearable alert button that connects your loved one to emergency help 24/7.

Multiple family caregivers.  In some cases, two family members can share the authorized hours.  One covers mornings and evenings; the other covers midday. Both are paid through PDS.

In our experience, families who combine a paid family caregiver with adult day and PERS often achieve effective near-24-hour coverage at no out-of-pocket cost — all funded through Medicaid.

When 24-Hour Care at Home Isn’t Feasible

In some cases — continuous skilled nursing needs, severe behavioral safety concerns, or care needs that exceed what home-based services can safely provide — a nursing facility may be the more appropriate setting. This isn’t a failure. It’s a recognition that some care needs genuinely require institutional-level resources.

But that decision should be made with full information about what’s available at home first. Many families default to facility placement without exploring how far home-based services can stretch.

Explore your family’s options →Contact CareChoice

Written by Gary Murray, Chief Marketing Officer | CareChoice