Can I Get Paid to Care for My Disabled Child in Pennsylvania?

Yes, you can get paid to care for a disabled child in Pennsylvania. The money comes through Medicaid Home and Community-Based Services waivers run by the state’s Office of Developmental Programs (ODP), which let families direct their child’s care budget and hire the caregiver themselves. In many cases, that caregiver can be you.

It’s more formal than most parents expect. You go on a payroll, your hours are set by a care plan, and background checks come before any paycheck. But the work you’re already doing can become paid work.

Which Waivers Let a Parent Be Paid

Three ODP waivers use a participant-directed model that allows a parent to serve as the paid caregiver:

The Consolidated Waiver, which covers people of any age with an intellectual disability, developmental disability, or autism and explicitly allows family members, including parents and legal guardians, to be paid.
The Community Living Waiver, which serves the same population and supports participant-directed services.
The Person/Family Directed Support (P/FDS) Waiver, built around family direction of services.

All three deliver care at home instead of in an institution.¹

One boundary matters here. If your child has a physical or neurological disability but not an intellectual disability or autism, the OBRA waiver may cover them, but it generally excludes legal guardians from serving as the paid caregiver. Many parents assume any Medicaid waiver will do; it won’t.

Who Qualifies

Your Child

Your child needs both a medical and a financial qualifier. Medically, they need a diagnosed intellectual disability, developmental disability, or autism that appeared before age 22 and a level of need equivalent to what an intermediate care facility provides. Children under nine who have a high probability of developing an intellectual disability or autism can also qualify.¹

Financially, eligibility looks only at the child’s own income and assets. Your household income does not disqualify them. For 2026, the child’s countable income must fall below 300 percent of the SSI federal benefit rate. With the 2026 SSI rate at $994 per month, that cap works out to $2,982 per month, and countable resources cannot exceed $8,000.²

You

You must be legally authorized to work in the United States. Before you start, Pennsylvania requires a State Police criminal history check and a child abuse history clearance from the Department of Human Services. If you haven’t lived in Pennsylvania for the past two consecutive years, add an FBI criminal background check with fingerprints, which costs $24.95.³ Convictions involving abuse, neglect, or other serious offenses can disqualify you.⁴

What You’re Paid to Do, and How Much

You’re paid for specific tasks the care plan lists: hands-on help with bathing, dressing, eating, toileting, meal preparation, medication reminders. Not general parenting. The Individual Support Plan spells out which services you provide, how many hours per week, and at what rate.

Hourly rates for self-directed caregivers in Pennsylvania generally run between $12 and $18, depending on the waiver, the service, and your region. The waiver program sets the rate; families don’t negotiate it. Overtime rules apply if you cross 40 hours in a week, since federal labor rules require minimum wage and overtime for domestic care workers who spend more than 20 percent of their time on daily-living assistance.⁵

Annual income depends on authorized hours. A child with intensive needs might have 30 or 40 hours per week; a child with moderate needs, far fewer. The authorized number is a ceiling, tied to your child’s assessed functional needs.

A Financial Management Services (FMS) provider handles the payroll mechanics — either as your fiscal agent while you (or a surrogate for your child) serve as the common-law employer, or as the employer of record itself under the “Agency with Choice” option.⁴ Either way, the FMS provider cuts your check, withholds taxes, and handles workers’ compensation.

How to Apply

Start with your county’s Mental Health/Intellectual Disabilities (MH/ID) office. This is the entry point for every ODP service, and an intake coordinator will register your child and explain what documents to send in.⁶ You can start online through Pennsylvania’s COMPASS system or schedule an in-person appointment.⁷

The county then arranges assessments to confirm the diagnosis, gauge functional needs, and verify that the level of care matches what an institution would provide. That institutional-level-of-care finding is a hard prerequisite for all three waivers. Once approved, a supports coordinator builds the Individual Support Plan with you, and you pick an FMS provider from a state-approved list. From that point, you are formally employed as your child’s caregiver.

Expect a Waiting List

This is where many families get stuck. Pennsylvania’s ODP waivers carry long waiting lists, and the wait can stretch for years. Your child can be found eligible and still not receive services for a long time, because funded slots are limited.

While you wait, ask the county MH/ID office about base-funded county programs. Those services are narrower than waiver services, but they can provide something. Get on the waiting list as early as you can, even if your child is young and their needs are still coming into focus.

How Caregiver Pay Is Taxed

Most families don’t learn this until after the first paycheck: the IRS may let you exclude the payments from taxable income. Under IRS Notice 2014-7, Medicaid HCBS waiver payments to a caregiver who provides nonmedical support services in the caregiver’s own home are treated as “difficulty of care” payments and excluded from federal gross income.⁸ Because parents caring for a disabled child almost always share a home with that child, the exclusion typically applies. It covers both parents if two caregivers in the same household are paid for the same child. Care provided outside your home does not qualify.⁹

Payroll taxes work differently. Under the common-law employer setup where your child (through a surrogate) is technically your employer, wages paid to a parent are generally exempt from Social Security and Medicare taxes, and federal unemployment tax does not apply.¹⁰ The tradeoff: exempt wages don’t build Social Security credits, which can affect your retirement benefits later. A tax professional can tell you whether opting in makes sense.

Watch the Effect on Your Child’s SSI

If your child receives Supplemental Security Income, household income changes can reduce their monthly payment. The Social Security Administration uses “deeming” rules that count a portion of a parent’s income against a child’s SSI when the child lives at home.¹¹ The 2026 maximum SSI payment for an individual is $994.

Whether your waiver caregiver payments count as deemed income is worth raising with both your supports coordinator and the Social Security Administration before you finalize anything. Payments excluded from gross income under IRS Notice 2014-7 arguably should not count as earned income for SSI deeming, but SSA and IRS rules don’t always match. Get an answer in writing before your first paycheck lands so a benefit reduction doesn’t blindside you.

If You’re Denied, You Can Appeal

A denial or a reduction is not the end. Federal Medicaid rules require the state to send written notice with the specific reasons for the action, the regulations behind it, and instructions for requesting a fair hearing, and that notice must arrive at least 10 days before the action takes effect.¹²

You can represent yourself or bring a lawyer, relative, or anyone else to speak for you. If you request the hearing before the effective date of a reduction or termination, existing services generally continue until the hearing is resolved. Initial decisions are sometimes wrong, and this is the tool for fixing them.

1
Commonwealth of Pennsylvania. Apply for a Medicaid Consolidated Waiver
2
Social Security Administration. SSI Federal Payment Amounts for 2026
3
Commonwealth of Pennsylvania. Apply for an FBI Criminal History Background Check
4
Pennsylvania Guide to Participant-Directed Services. Pennsylvania’s Guide to Participant-Directed Services
5
U.S. Department of Labor. Fact Sheet: Application of the Fair Labor Standards Act to Domestic Service, Final Rule
6
Commonwealth of Pennsylvania. Apply for Intellectual Disabilities Services
7
Commonwealth of Pennsylvania. Request a Medicaid Community Living Waiver
8
Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income
9
Internal Revenue Service. IRS Notice 2014-7
10
Internal Revenue Service. Household Employer’s Tax Guide
11
Social Security Administration. How Much You Could Get From SSI
12
eCFR. 42 CFR Part 431 Subpart E – Fair Hearings for Applicants and Beneficiaries