PA’s Bipartisan Budget Deal Is a Bipartisan Failure

Plenty of ink has been spilled and plenty of congratulatory statements have been issued about this year’s budget agreement in Harrisburg. But on one of the most urgent issues facing our Commonwealth, the reality hasn’t changed: Pennsylvania’s home care system is in crisis, the governor and legislative leaders know it, and they did just about nothing in this budget to fix it.

More than 400,000 Pennsylvanians rely on in-home care to live safely and independently. They are seniors, adults with disabilities, and medically fragile children who depend on reliable, consistent support to stay out of hospitals and nursing homes. Yet every month more than 112,500 authorized shifts of care go unfilled. Families wait for help that never arrives. Older adults go hours or days without basic support. Children who could be home with their families remain stuck in hospitals because they can’t arrange for care at home. These are not rare or extreme situations — this is now the everyday reality. The in-home care system in Pennsylvania is collapsing.

The reason behind this crisis is straightforward. States set the reimbursement rates that determine what in-home care workers are paid. But while every state surrounding Pennsylvania has steadily raised its rates to keep their home care systems functioning — West Virginia has raised rates twice in the past year alone — Pennsylvania’s rates have barely moved in a decade. As neighboring states acted to protect their home care workforces, Pennsylvania stood still. The consequences were predictable and are now unavoidable: home care workers here earn dramatically less than workers in nearby states, in some cases 50 to 75% less. Many can make more at Wawa or Sheetz than they can providing hands-on care to seniors and children. No workforce can survive under those conditions. Agencies across the state are struggling to provide care for all the people who need it.

The governor is well aware of this. He commissioned a taxpayer-funded study to determine exactly how far behind Pennsylvania is and what would be required to stop the collapse. The findings were unequivocal: Pennsylvania must invest more than $800 million in the state budget to raise reimbursement rates enough to stabilize the workforce and restore access to care. A second independent study — commissioned directly by the legislature for its own members, both Republicans and Democrats — reached the same conclusion.

Despite knowing exactly how bad the issue is and despite acknowledging the severity of the crisis, the final budget passed by the legislature and signed by Gov. Shapiro included just $21 million for in-home care.

Twenty-one million dollars for a crisis that demands more than $800 million. Twenty-one million dollars when providers and advocates have urged lawmakers to at least approve a $370 million down payment to begin closing the gap.

To make matters worse, those limited funds were directed only to a small segment of the workforce: roughly six percent of in-home care workers in the participant-directed model. Ninety-four percent of workers employed by licensed, regulated, and reliable agencies — the ones most families depend on — were left out entirely. Agencies were already struggling to hang on; now, with no support at all in this year’s budget, the consequences will continue to get worse.

This budget failure is also irresponsible from a fiscal standpoint. When people cannot access care at home, they end up in far more expensive settings, often for far longer than necessary. State leaders had a choice: make the investments now to stabilize the workforce and improve access, or do almost nothing and guarantee that the problem grows more severe — and far more expensive — in the years ahead. They chose the latter.

Every state surrounding Pennsylvania has taken serious steps to stabilize home and community-based care. We are the outlier, and our residents are paying the price: more missed shifts, more exhausted families, more children and seniors going without the care they are authorized to receive.

It is good that, after months of delay, the Commonwealth finally has a budget. But let’s not buy the spin. On the issue that affects hundreds of thousands of Pennsylvanians and determines whether they can safely remain in their homes, this budget is a failure — and state leaders must address this crisis in the 2026-2027 budget.