Attendant Care Waiver in Pennsylvania | Paid Family Caregiving Guide

If the idea of directing your own care — choosing exactly who helps you, when they help, and how — appeals to you, the Attendant Care Waiver may be the most aligned program Pennsylvania offers. It’s built around a simple principle: the person receiving care knows best what they need, and they should have the power to manage it.

Among Pennsylvania’s Medicaid waiver programs, the Attendant Care Waiver offers the highest degree of participant control. That includes the ability to hire a family member as your paid attendant.

What the Attendant Care Waiver Is

The Attendant Care Waiver is a Pennsylvania Medicaid Home and Community-Based Services waiver administered by the Department of Human Services through the Office of Long-Term Living (OLTL). Like the OBRA Waiver and the services available through Community HealthChoices, it exists to keep people out of nursing facilities by funding care at home.

What distinguishes the Attendant Care Waiver from other programs is its emphasis on self-direction. The participant doesn’t just choose their caregiver — they hire them, train them, set their schedule, assign their tasks, and supervise their work. The participant is, in the fullest sense, the boss.

This level of control isn’t for every family. Some participants prefer to have an agency handle the logistics and just show up with a trained aide. But for individuals who want to run their own care — particularly those with physical disabilities who are cognitively sharp and have clear preferences about how their day should go — the Attendant Care Waiver is designed specifically for them.

Who Qualifies

The Attendant Care Waiver serves individuals who meet the following criteria. They must be a Pennsylvania resident enrolled in Medical Assistance (Medicaid). They must have a physical disability that creates a need for attendant care services. They must require a nursing-facility level of care — meaning their daily living needs are significant enough that, without home-based supports, institutional care would be the alternative. And they must be willing and able to direct their own care, or have a representative who can do so on their behalf.

That last point is key. The Attendant Care Waiver assumes the participant is actively managing the care relationship. If your loved one has significant cognitive impairment that prevents them from directing care, a representative can fill that role — but the self-directed philosophy remains central to how the program operates.

The program tends to serve a somewhat younger population than CHC’s broader enrollment — adults in their 20s through 50s with physical disabilities who are living independently or semi-independently in the community. These are often individuals who are working, attending school, or engaged in community life and who need attendant care woven around an active schedule rather than structured around a clinical framework.

What Services Are Covered

The core service under the Attendant Care Waiver is, as the name suggests, attendant care. This covers personal assistance with bathing, dressing, grooming, and hygiene, toileting and incontinence care, mobility support including transfers and positioning, meal preparation and feeding assistance, medication reminders, light housekeeping and laundry, and accompaniment to work, school, medical appointments, and community activities.

Beyond attendant care, the waiver may also cover personal emergency response systems, home modifications to improve accessibility (ramps, grab bars, widened doorways, accessible bathrooms), assistive technology and adaptive equipment, and respite care for the primary caregiver.

The specific services authorized for each participant are determined through a functional assessment and care planning process, similar to what occurs under Community HealthChoices.

How Family Members Get Paid

The Attendant Care Waiver supports self-directed attendant care, which means the participant hires and manages their own attendant. That attendant can be a qualifying family member.

The employment structure works through the same Agency with Choice (AWC) or Financial Management Service (FMS) model used in other Pennsylvania waiver programs. The participant selects their family member as their attendant. The family member completes background checks — Pennsylvania State Police, FBI fingerprinting, and ChildLine clearance. Employment paperwork is processed through the AWC/FMS organization, including W-4, I-9, and direct deposit enrollment. Once cleared, the attendant begins providing services and logging hours through the required timekeeping system. The AWC/FMS processes payroll biweekly, withholds taxes, and provides workers’ compensation coverage.

The family caregiver is a W-2 employee. Hourly rates are consistent with the general range across Pennsylvania’s PDS programs — approximately $13.50 to $18.00 per hour, depending on the rate structure applicable to the specific waiver and the AWC/FMS organization.

The same family relationship rules apply as in other Pennsylvania programs. Adult children, siblings, parents of adult participants, grandchildren, grandparents, aunts, uncles, nieces, nephews, and cousins are generally eligible. Spouses are typically not eligible to serve as paid attendants.

How the Attendant Care Waiver Differs from CHC

The most common question families ask is how the Attendant Care Waiver compares to the home care services available through Community HealthChoices. The differences are more about philosophy and structure than about the services themselves.

Degree of control. Under CHC with Participant-Directed Services, the participant chooses their caregiver and directs the day-to-day care, but the MCO and service coordinator play a significant role in developing the care plan and authorizing services. Under the Attendant Care Waiver, the self-direction is more pronounced — the participant takes on a larger management role, including training and supervising the attendant.

Population focus. CHC serves a broad population including older adults and individuals with various disabilities. The Attendant Care Waiver is specifically designed for individuals with physical disabilities who want to self-direct, which gives it a more targeted focus.

Administrative structure. CHC runs through MCOs (AmeriHealth Caritas, Keystone First, PA Health & Wellness). The Attendant Care Waiver is administered through OLTL, though participants may also be enrolled in CHC for their broader managed care benefits. The two can work in parallel.

Practical outcome. For the family caregiver, the day-to-day experience is largely the same — they provide care, log hours, and receive a biweekly paycheck. The differences are felt more by the participant, who has greater authority over how the care is structured and delivered under the Attendant Care Waiver.

For many families, the path they take depends on which program their loved one is assessed into and what the service coordinator recommends. CareChoice can help your family understand which option — or combination of options — makes the most sense.

How to Access the Attendant Care Waiver

Start with confirming your loved one’s Medicaid eligibility through COMPASS at compass.state.pa.us. Contact the Office of Long-Term Living or your local Area Agency on Aging to inquire about the Attendant Care Waiver specifically. In Philadelphia, the Philadelphia Corporation for Aging (PCA) at (215) 765-9040 can provide guidance and referrals.

A functional eligibility assessment will determine whether your loved one meets the nursing-facility level of care required for the waiver. If they qualify, a care plan is developed, attendant care hours are authorized, and the process of hiring and onboarding the family caregiver begins.

If your loved one is already enrolled in CHC and receiving PDS, it’s worth asking the service coordinator whether the Attendant Care Waiver might provide additional benefits or a better structural fit. The two aren’t mutually exclusive, and some participants benefit from services funded through both programs.

CareChoice Helps Families Navigate the Options

Whether your family’s path runs through CHC, the Attendant Care Waiver, the OBRA Waiver, or some combination, CareChoice helps Philadelphia families figure out which programs apply and how to activate them. The destination is the same — a family member gets hired and paid to provide the care your loved one needs at home. We help you get there through whichever door opens first.

Contact CareChoice → Philadelphia team

Attendant Care Waiver in PA: Everything You Need to Know