A lack of access to in-home care in Pennsylvania has reached a crisis point, according to professionals in the field, leaving thousands of residents without essential services.

More than 400,000 Pennsylvanians rely on in-home care for daily support.

Mia Haney, CEO of the Pennsylvania Homecare Association, said Gov. Shapiro's budget puts seniors at risk, as it only includes $21 million for direct care workers and only for what's known as the directed model, which employs just 6% of them, leaving 94% without funding.

"We do not have enough workers to meet the need for folks who are looking for services and every single month, 112,000-plus shifts go unfilled," Haney pointed out. "That could be an eight-hour shift, it could be a six-hour shift, but a caregiver is not coming and someone is waiting for services."

Haney emphasized legislators control budget priorities and insisted they must support the direct care workforce this year. Without funding increases, she argued, many will go without care, leading to harm and unnecessary nursing facility placements for those who could receive services at home.

The General Assembly must vote on the budget by June 30.

Haney notes by 2030, one in three Pennsylvania residents will be over 65, increasing the demand for caregivers. Meanwhile, the number of potential caregivers remains steady, creating a growing shortage as the elderly population rises.

"We just this year had a study released that showed that the rates here in Pennsylvania are insufficient, meaning that you cannot possibly recruit and retain quality workers with the Medicaid reimbursement rate that we have today," Haney reported. "In fact, (it) indicated that we are 23% below where we should be."

Pennsylvania's average reimbursement rate for in-home care is just $20.63 cents per hour, which some feel is insufficient to maintain a stable workforce.

In comparison, neighboring states -- such as Delaware, Maryland, New Jersey and West Virginia -- offer rates that are 25% to 75% higher for the same services.


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As Congress pushes for Medicaid cuts and new work requirements for the program, experts have warned more Tennesseans could lose their health coverage through TennCare.

The U.S. House reconciliation bill would slash federal Medicaid spending by at least $700 billion to fund a tax-cut extension and other Trump administration priorities.

Jane Dimnwaobi, attorney and Equal Justice Works fellow at the Tennessee Justice Center, said tying Medicaid eligibility to work requirements is the biggest potential threat for Tennesseans. She added most would have to work or volunteer at least 80 hours a month to stay covered.

"We know there are about 1.4 million people on Medicaid, on TennCare here in Tennessee, and 300,000 of them are the kind of adults that would be affected by the work requirements provision in the bill," Dimnwaobi explained.

According to KFF in one recent year, nearly two-thirds of working-age adults on Medicaid were employed, and close to three in 10 were not working due to caregiving duties, health conditions, disabilities or school attendance, circumstances which have qualified as exemptions from Medicaid work requirements.

Dimnwaobi noted Tennessee attempted to add work requirements to Medicaid in 2018 but the waiver was not approved by federal officials. She added today, it is essentially "lying in wait" and could be approved if the big budget bill passes in the Senate. She pointed out the proposed work rule targets able-bodied adults without young children and it ignores caregiving duties and barriers like job access or transportation.

"For Tennessee, there was a projection that about 68,000 people would lose coverage under the state work requirements proposal," Dimnwaobi underscored. "We have a state that's already wanting to implement work requirements at a very strict level and now the federal budget reconciliation bill has opened the door to our state doing that."

She noted similar work requirement policies in Georgia and Arkansas dropped eligible workers, putting them and their families at risk. If the bill passes, the policy would take effect in December 2026, just after the November midterm elections.


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Pennsylvanians will rally in Harrisburg today to call attention to the urgent child care teacher shortage across the state.

The Pennsylvania Child Care Association is urging lawmakers to support the $55 million proposed in the state budget for early child care educators.

Diane Barber, executive director of the Pennsylvania Child Care Association, said it is important for lawmakers to prioritize early childhood education funding and take action to ensure child care educators are paid fairly and supported professionally.

"In the last three weeks, I know of six child care programs that have closed, and basically it has to do with they can't staff the class," Barber reported. "We have lots of empty classrooms. We have waiting lists for families, and it's really hard to fill those slots when what you're offering is $15.15 an hour."

Barber noted they have several speakers including Rep. Jeannie McNeil, D-Lehigh, who has introduced House Bill 506, which would actually create the recruitment and retention funding. The state House and Senate must pass the budget by June 30.

Barber explained they are in Harrisburg at the Capitol to urge lawmakers to see this not just as an investment in child care teachers but in the families across Pennsylvania who rely on child care.

"The governor and the General Assembly actually passed some bills around tax credits, both for families and for businesses who helped pay for child care," Barber acknowledged. "But if there's no child care to pay for because child care can't find teachers, tax credits don't go very far, so they only work for families who actually have child care."

Barber added The Pennsylvania Child Care Association is a nonprofit and part of the Start Strong PA campaign. A survey found more than 3,000 child care teacher vacancies across Pennsylvania, based on responses from just 1,100 programs. Advocates will meet with lawmakers and hold a news conference. The rally is to start at 1:30 p.m.


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Ukrainians who fled the war in their home country for temporary roots in North Dakota are waiting with worry about their ability to keep working in the U.S., as the future of a key support program is up in the air.

Separate from refugees or asylum-seekers, humanitarian parole gives people escaping a global conflict a chance to work and live temporarily in an American community. As reported by North Dakota News Cooperative, several hundred Ukrainians in North Dakota fall under that status, taking on a range of local jobs the past two years.

Yaroslav Riazanov is one of them, and with the Trump administration trying to roll back immigration relief, he is living day-to-day.

"My work permit expires in a couple of days," Riazanov explained. "I need to work because I have a lot of bills to pay, you know, it's a big stress for me."

Legal wrangling continues over humanitarian parole, with the U.S. Supreme Court recently allowing programs with four other countries to be suspended. Supporters of the Ukrainian designation said there is still too much uncertainty about applications for those folks, renewing concerns they will be forced back to a war-torn region. The White House insists the programs do not have strong enough vetting.

Michael Southam, cofounder of FM Volunteers for Ukraine, a volunteer group in North Dakota sponsoring Ukrainians approved for work status, said although it is not meant as a pathway to citizenship, some participants want to stay in stable settings longer, seeing the opportunity to better their own lives and those around them.

"They've come here at the expense of their sponsor or themselves, not the government," Southam pointed out. "They work, they contribute locally; they have their children going to our schools, they contribute through volunteer activities."

He hopes elected leaders realize the local effects and see the benefit of maintaining the programs.
While a humanitarian parolee cannot apply for a green card, they could qualify for another visa, which potentially opens doors to longer-term residency.


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