OBRA Waiver in PA | Paid Family Caregiving for Physical Disabilities

If your loved one has a physical disability and needs daily help at home, the OBRA Waiver may be the program that makes paid family caregiving possible for your family. It’s one of the lesser-known pathways in Pennsylvania’s Medicaid system — overshadowed by Community HealthChoices, which handles the bulk of home care services — but for families who qualify, it provides the same powerful benefit: a family member can be hired and paid to provide care.

Here’s what the OBRA Waiver covers, who it serves, and how it connects to getting a family member on payroll.

What Is the OBRA Waiver?

The OBRA Waiver — named after the federal Omnibus Budget Reconciliation Act — is a Pennsylvania Medicaid waiver program administered by the Department of Human Services through the Office of Long-Term Living (OLTL). It was designed specifically for individuals with physical disabilities who need long-term care services but want to receive those services at home rather than in a nursing facility.

The word “waiver” is important. Normally, Medicaid would cover long-term care only in a nursing home. A waiver literally waives that restriction, allowing Medicaid funds to be used for home and community-based services instead. The OBRA Waiver is one of several such programs in Pennsylvania, and its specific focus on physical disabilities sets it apart.

Who the OBRA Waiver Serves

The OBRA Waiver is designed for individuals who meet all of the following criteria. They must be a Pennsylvania resident. They must be enrolled in Medical Assistance (Medicaid). They must have a physical disability — this is the defining characteristic that distinguishes OBRA from other waivers. They must require a nursing-facility level of care, meaning their daily needs are significant enough that institutional care would be the alternative without home-based supports. And they must be able to live safely in a home or community setting with appropriate services in place.

One of the features that makes the OBRA Waiver particularly relevant is its focus on younger adults. While Community HealthChoices serves a broad population including older adults, the OBRA Waiver has historically been a key program for working-age adults with physical disabilities — people in their 20s, 30s, 40s, and 50s who have significant care needs but are otherwise living active, community-integrated lives. For these individuals, having a trusted family member provide daily care instead of rotating agency staff can be especially important for maintaining independence and dignity.

Services Available Under the OBRA Waiver

The OBRA Waiver covers a comprehensive set of home and community-based services. Personal care assistance is the core service — help with bathing, dressing, grooming, eating, toileting, and mobility. Homemaker services cover meal preparation, light housekeeping, and laundry. The waiver also includes assistive technology and specialized medical equipment, home modifications such as ramp installation, doorway widening, and bathroom accessibility upgrades, personal emergency response systems, community integration services that help participants engage in work, education, and social activities, respite care for primary caregivers, and service coordination to manage the overall care plan.

The breadth of services is similar to what’s available through Community HealthChoices, and in many cases OBRA participants may also be enrolled in CHC for their managed care coverage. The two programs can work together — CHC handling the managed care structure while the OBRA Waiver funds specific home and community-based services.

How Family Members Get Paid Through the OBRA Waiver

The OBRA Waiver uses the same Participant-Directed Services (PDS) model that operates under Community HealthChoices. This means the participant — the person with the physical disability— has the right to choose their own caregiver. If they choose a family member, that person is hired through the Agency with Choice (AWC) model.

The mechanics are identical to what families experience through CHC. The participant names their chosen family caregiver. The family member completes background checks —Pennsylvania State Police criminal history, FBI fingerprint check, and ChildLine child abuse clearance. They complete employment paperwork through the AWC organization, including W-4, I-9, and direct deposit setup. Once cleared, the caregiver begins providing services and logging hours. Payment is processed by the AWC organization and deposited biweekly.

The family caregiver is a W-2 employee with tax withholdings, workers’ compensation coverage, and the same employment protections as any other employee. Hourly rates fall within the same general range as other PDS programs in Pennsylvania.

The same family relationship rules apply. Adult children, siblings, parents of adult participants, grandchildren, grandparents, aunts, uncles, nieces, nephews, and cousins are generally eligible. Spouses are typically not eligible to be paid caregivers under the OBRA Waiver, consistent with most Pennsylvania Medicaid programs.

How to Access the OBRA Waiver

The enrollment path starts with confirming Medicaid eligibility through COMPASS atcompass.state.pa.us. If your loved one is already on Medicaid, the next step is connecting with the appropriate intake entity.

For the OBRA Waiver specifically, contact the Office of Long-Term Living (OLTL) or your local Area Agency on Aging. In the Philadelphia area, the Philadelphia Corporation for Aging (PCA) at(215) 765-9040 can help with referrals and initial guidance. If your loved one is already enrolled in Community HealthChoices, their MCO service coordinator can also help determine whether the OBRA Waiver applies to their situation.

A functional eligibility assessment will be conducted to confirm that your loved one requires a nursing-facility level of care. This assessment evaluates their ability to perform daily activities independently and determines what services and hours are authorized.
During care planning, request Participant-Directed Services and name the family member who will serve as the caregiver. From there, the AWC onboarding process begins, and services can typically start within a few weeks of the caregiver clearing background checks.

OBRA Waiver vs. Community HealthChoices: What’s the Difference?

Many families wonder whether the OBRA Waiver or CHC is the right program. In reality, they’re not always an either/or choice — they can complement each other. CHC is the broader managed care framework that most Medicaid recipients with long-term care needs are enrolled in. The OBRA Waiver provides an additional layer of home and community-based services specifically tailored to individuals with physical disabilities.

If your loved one has a physical disability and is enrolled in CHC, they may also qualify for OBRA Waiver services. The service coordinator or OLTL can help determine which combination of programs best fits your family’s situation.

The key overlap that matters most for families exploring paid caregiving: both programs support Participant-Directed Services and the Agency with Choice model. Whether the services are funded through CHC, the OBRA Waiver, or a combination, the family caregiver pathway works the same way.

CareChoice Can Help Your Family Navigate This

The relationship between multiple waiver programs, CHC, and the various eligibility pathways
can be genuinely confusing. CareChoice helps Philadelphia-area families understand which programs apply to their situation, how to access them, and how to get a family member enrolled as a paid caregiver through whichever pathway fits.

If your loved one has a physical disability and you’ve been providing care without compensation, there’s a strong chance a program exists to change that. Let us help you find out.
Contact CareChoice →Pennsylvania team

OBRA Waiver in Pennsylvania: How It Pays Family Members to Provide Home Care

What Is the OBRA Waiver?