Pennsylvania presents significant challenges and opportunities for home health agencies. The state's 65+ population increased nearly 11% between 2020 and 2024, while the 18-and-younger population shrank by 3%. Pennsylvania is now among 11 states where adults aged 65 and older outnumber children, with projections showing the state moving from 1 in 4 people over 65 today to 1 in 3 by 2030.

However, the home care industry faces a severe crisis. More than 400,000 seniors and medically fragile individuals rely on home care, but caregivers and nurses are leaving the industry at an alarming rate. Pennsylvania reimburses home care agencies just $20.63 per hour on average, the lowest rate among its neighboring states. Nearly 80% of home care workers quit each year, according to the Pennsylvania Homecare Association. This guide covers everything agencies need to know about providing home health services in Pennsylvania.

Pennsylvania Home Health Agency Licensing Requirements

Home health agencies in Pennsylvania must obtain licensure from the Pennsylvania Department of Health (DOH). The regulatory framework distinguishes between home health care agencies (medical services) and home care agencies (non-medical services), with different requirements for each.

Defining home health care agency. Under Pennsylvania law, a home health care agency is "an organization staffed and equipped to provide skilled nursing care and at least one other therapeutic service - home health aides, physical therapy, speech therapy, occupational therapy, or medical social services - to persons on a part-time or intermittent basis in their place of residence" as defined in 28 Pa. Code Chapter 601.

License types. Pennsylvania categorizes agencies into two main types: Home Health Agencies (which provide skilled nursing, physical therapy, and other medical services) and Non-Medical Home Care Agencies (which offer personal care services such as assistance with daily living activities, meal preparation, and companionship under 28 Pa. Code Chapter 611).

Application process. To obtain licensure, agencies must complete the application document and submit it via email to [email protected]. The required license fee must be mailed separately. The application was most recently revised on February 4, 2025. Applications will be reviewed by the Division of Home Health for substantial compliance with the regulations at 28 Pa. Code Chapter 601, Subpart F.

License fees. The regular license fee is $250 per license. Checks or money orders should be made payable to "Commonwealth of Pennsylvania" and mailed to the Division of Home Health at 2525 N. 7th Street, Harrisburg, PA 17110. Hand delivery of applications is not accepted.

Required documentation. Agencies must submit documentation including a copy of the home health aide training program with clearly defined topics and hours per topic, Criminal Background Check (form SP-4-164) from the State Police, and documentation that criminal background checks have been completed for all employees.

Operational restrictions. Agencies cannot admit or treat any patients until approval is received from the Department of Health. The department enforces standards by conducting initial and periodic, unannounced state licensure surveys.

Medicare certification. State licensure is a prerequisite for federal Medicare certification. To become Medicare-certified, agencies must submit CMS Form 1572(a), CMS Form 690, CMS Form 1561 to the Division of Home Health, and CMS Form 855A Enrollment Application to the Fiscal Intermediary, along with Federal Civil Rights Information for Medicare Applicants.

Regulatory references. Primary regulations are found in 28 Pa. Code Chapter 601 (Home Health Care Agencies) and 28 Pa. Code Chapter 611 (Home Care Agencies and Home Care Registries).

Going deeper on the application package. For a section-by-section walkthrough of 28 Pa. Code Chapter 601 (Subparts A–G), the line-by-line document checklist a Division of Home Health reviewer expects, and the most common deficiency-letter issues new agencies hit, see our Pennsylvania 28 Pa. Code Chapter 601 application package guide. If your service model is non-medical personal care rather than skilled home health, the licensure pathway is different — see our 28 Pa. Code Chapter 611 walkthrough for the home care agency and home care registry licensure rules, the § 611.55 competency pathways, and the consumer-protection requirements that distinguish Chapter 611 from Chapter 601.

Home Health Aide Certification Requirements

Pennsylvania follows federal guidelines for home health aide training while maintaining specific state requirements. Understanding these requirements is essential for agencies to build a qualified workforce and maintain compliance.

Training hours. To become a home health aide in Pennsylvania, candidates must complete at least 75 hours of training that includes 16 hours of clinical instruction. A minimum of 16 hours of classroom training must precede a minimum of 16 hours of supervised practical training as part of the 75-hour total.

Competency evaluation. After training, candidates must pass a written and practical competency exam to become certified. Successful completion makes candidates eligible to be listed on the Pennsylvania Nurse Aide Registry.

Background check requirements. All candidates must pass a Pennsylvania State Police criminal background check and be listed on the Pennsylvania Nurse Aide Registry to obtain certification.

Continuing education. Pennsylvania requires HHAs to complete 12 hours of continuing education training for every 12 months of active service to maintain their certification and keep up with healthcare practices.

Alternative pathways. A person may qualify to provide direct care services through a Pennsylvania home care agency or registry in several ways: by meeting federal requirements for home health aides who work at Medicare-certified facilities, by meeting Certified Nurse Aide (CNA) requirements, by completing a state-approved training program, or by meeting requirements for a Medicaid waiver program or other federally funded program.

Program approval. Home health aide training programs must be approved by the Pennsylvania Department of Health to ensure they meet established standards.

Training costs. The cost of training programs varies, with many institutions charging between $450 and $650 for the complete program including materials and certification. Free HHA training is also available in Pennsylvania through some agencies offering training classes to address the demand for home health aides.

Salary expectations. The average hourly pay for a home health aide in Pennsylvania is $16.19 per hour, with salaries ranging from $9.64 to $22.41. The majority of HHA salaries fall between $13.99 (25th percentile) and $18.08 (75th percentile). Pennsylvania ranks 50th out of 50 states nationwide for home health aide salaries.

Certified Nursing Assistant (CNA) Requirements

Certified Nursing Assistants in Pennsylvania provide a higher level of care and are regulated through the Pennsylvania Nurse Aide Registry maintained by the Department of Health. Many home health agencies prefer or require CNA certification for skilled nursing support roles.

Training requirements. Pennsylvania requires completion of a state-approved Nurse Aide Training Program with at least 80 hours of training, including 42.5 classroom hours and 37.5 clinical hours.

Competency examination. To become a nurse aide, candidates must complete a training program and pass the NNAAP Nurse Aide Exam. The CNA test comprises two portions: a written (or oral) exam and a clinical skills evaluation, both administered on the same day. Candidates have up to 24 months after completing training to take the exam.

Exam registration. To register for the nurse aide exam, candidates must visit the Credentia website. After passing the exam, individuals are listed on the Pennsylvania Nurse Aide Registry.

Background check requirements. All applicants must pass a criminal background check. A nurse aide who is not enrolled or in good standing on the registry may not be employed in a nursing care facility that receives Medicare or Medicaid reimbursement.

Registry verification. Facilities must verify that aides they employ or are considering for employment are eligible for enrollment (or re-enrollment) as nurse aides and have no record of resident abuse, neglect, or misappropriation of residents' personal property.

Renewal requirements. To maintain certification, CNAs must renew every 24 months through the CNA365 portal. Renewal requires having worked at least eight consecutive hours as a CNA in an approved facility within the past 24 months. Credentia sends electronic renewal reminders approximately 90 days prior to expiration.

Reciprocity. If you hold an active CNA certification in active and good standing on another state's Nurse Aide Registry, you may submit an application through reciprocity to enroll on the Pennsylvania Nurse Aide Registry. There is no fee for reciprocity in Pennsylvania.

Contact information. For more information on how to become a nurse aide in Pennsylvania, contact Credentia at 888-204-6249.

Medicaid Reimbursement in Pennsylvania

Pennsylvania Medicaid provides coverage for eligible residents through both fee-for-service and managed care arrangements. The Department of Human Services (DHS) establishes Medicaid reimbursement rates for home health services.

Current reimbursement rates. Pennsylvania Medicaid Home & Community Based Services (HCBS) rates were updated effective January 1, 2025. The state reimburses home care agencies $20.63 per hour on average to cover all costs, including employee wages, benefits, and administrative costs. In Zone 4 (covering Philadelphia and the surrounding area) under the Community Health Choices waiver, the rate is $21.52 per hour.

Comparison to neighboring states. Pennsylvania's $20.63 per hour rate is significantly lower than its neighbors: Ohio pays $28.96 per hour, Maryland pays $25.58, and West Virginia pays $25.44. Neighboring states Delaware, Maryland, and New Jersey pay 25% to 75% more than Pennsylvania.

Recommended rate increase. In February 2025, the Department of Human Services released a rate study recommending the state invest more than $800 million in additional funding to raise the Medicaid reimbursement rate to $25.42 per hour. The Pennsylvania Homecare Association has called for a $550 million raise bringing the rate to $25.42 per hour, which would enable agencies to provide competitive wages.

Fee schedule access. The PROMISe Outpatient Fee Schedule is updated quarterly and available through the Pennsylvania Department of Human Services website. Providers can access fee information and rate tables for home health and other services.

Managed care considerations. Pennsylvania operates the Community HealthChoices (CHC) managed care program for dual-eligible and long-term care populations. Managed care organizations may have different reimbursement arrangements, and agencies should verify rates with each contracted MCO.

Industry impact. The low reimbursement rate directly affects worker wages. With agencies receiving $20.63 per hour to cover all costs, the average hourly wage for home care workers ranges from $14 to $18. This creates significant competition for workers from neighboring states and other industries that offer more competitive compensation.

Medicare Home Health Coverage

With Pennsylvania's large and growing elderly population, Medicare remains a crucial payer for home health services. Medicare certification allows agencies to serve beneficiaries and diversify their payer mix.

Eligibility requirements. To qualify for Medicare home health coverage, beneficiaries must be homebound (leaving home requires considerable effort due to illness or injury), need skilled nursing care on an intermittent basis or require physical therapy, speech-language pathology services, or continued occupational therapy, have a physician certify the need for home health care and establish a plan of care, and receive services from a Medicare-certified home health agency.

2025 rate updates. CMS's Calendar Year 2025 Home Health Prospective Payment System Final Rule includes a 2.7% home health payment update. This is offset by an estimated 1.8% decrease reflecting the permanent behavior adjustment and an estimated 0.4% decrease reflecting the updated fixed dollar loss ratio. CMS estimates that Medicare payments to home health agencies in CY 2025 would increase in the aggregate by 0.5%, or $85 million, compared to CY 2024.

PDGM adjustments. The CY 2025 rule finalized a permanent prospective adjustment of -1.975% to account for the impact of implementing the Patient-Driven Groupings Model (PDGM). The 2.7% market basket update is offset by productivity adjustments and PDGM budget neutrality requirements.

Certification process. New home health providers seeking Medicare certification should submit an application to the Division of Home Health. State licensure is a prerequisite for federal Medicare certification, and agencies must meet the federal Conditions of Participation in 42 CFR Part 484 and pass a state survey.

Plan of care requirements. Medicare requires a plan of care signed by a physician that specifies the services needed, frequency, and duration. The plan must be reviewed at least every 60 days.

Labor Laws and Wage Requirements

Pennsylvania follows the federal minimum wage while maintaining strong protections for home care workers employed by agencies. Understanding these requirements is essential for compliance and developing competitive compensation strategies.

Minimum wage. Pennsylvania's minimum wage is currently $7.25 per hour, matching the federal minimum wage. The Pennsylvania Minimum Wage Act establishes a fixed minimum wage and overtime rate for employees in the state.

Home care worker protections. Under the Pennsylvania Minimum Wage Act, domestic service employees of third-party providers (home care agencies) are covered by state minimum wage and overtime protections. In Pennsylvania, 94% of home care workers are employed by agencies and receive these protections, while the 6% directly employed by their clients do not have the same guarantees.

Overtime requirements. Most employees in Pennsylvania must be paid overtime compensation for any hours worked over 40 straight time hours per week. Overtime compensation is 1.5 times the employee's straight time rate of pay.

Healthcare "8 and 80" rule. Pennsylvania adopts the federal FLSA's "8 and 80" rule for individuals employed in hospitals or establishments primarily engaged in the care of the sick, aged, or mentally ill. Under this system, employers and employees can agree to calculate overtime on a 14-day, 80-hour work period. Overtime wages are required when an employee works more than 8 hours in any workday or more than 80 hours in a 14-day work period.

Wage theft enforcement. A recent review of DLI case assignments shows that from January 1, 2023, to present, at least 38% of all Minimum Wage Act complaints the Department received have involved companies in the home care industry. Wage theft is described as "rampant in the home care sector" by the state Department of Labor and Industry.

Federal enforcement actions. The U.S. Department of Labor has actively pursued wage violations in Pennsylvania. In November 2024, a federal court ordered a Pennsylvania home healthcare agency to pay $810,000 in back wages and damages to 196 workers denied minimum wage and overtime. Another judgment in September 2024 required a Pennsylvania in-home care agency to pay $1 million to 193 employees.

Federal regulatory developments. In 2025, the U.S. Department of Labor proposed reverting to outdated 1975 regulations that would remove federal minimum wage and overtime protections for domestic service employees. Pennsylvania's Shapiro Administration joined a multi-state coalition opposing this rollback, emphasizing that Pennsylvania home care workers employed by agencies remain protected by state law regardless of federal changes.

Pennsylvania Workforce Challenges

Pennsylvania faces one of the most severe direct care workforce crises in the nation, driven by its large and rapidly growing senior population, lowest-in-region wages, and systemic healthcare workforce gaps.

Unfilled shifts. More than 112,500 home care shifts go unfilled each month in Pennsylvania, primarily due to staffing shortages, according to the Pennsylvania Homecare Association. This represents a critical gap in care for the 400,000+ seniors and medically fragile individuals who rely on home care services.

Turnover crisis. Nearly 80% of home care workers quit each year in Pennsylvania, according to the Homecare Association. This extraordinarily high turnover rate creates constant recruitment pressure and disrupts continuity of care for clients.

Demographic pressures. Pennsylvania had 2.48 million senior citizens (aged 65 and older) in 2020, representing 19.07% of the population, making it the fifth state with the largest number of seniors. The 65+ population increased nearly 11% between 2020 and 2024. The state is projected to move from 1 in 4 people over 65 today to 1 in 3 by 2030.

Rural challenges. Rural Pennsylvania saw a 23% increase in senior citizens and an 11% decrease in youth from 2010 to 2020. In 2020, 24 Pennsylvania counties had more senior citizens than youth. Approximately 44,000 rural Pennsylvanians will turn 65 years old every year through 2028, while in urban Pennsylvania, more than 119,000 people will turn 65 annually.

Wage competition. Pennsylvania's $20.63 per hour Medicaid reimbursement rate, the lowest among neighboring states, means agencies cannot compete on wages. The average hourly wage for home care workers ranges from $14 to $18, while neighboring states pay 25% to 75% more. Workers are leaving for jobs in neighboring states or other industries that offer more competitive compensation.

Nursing facility shortages. The 2025 Workforce Survey found that in nursing facilities, there is a shortage of nearly 2,600 care providers to meet state staffing ratio requirements, with an additional shortage of over 20,000 per year projected through 2032. Among nursing home providers, 53% have had to limit or cap admissions, 38% have deferred facility upgrades, and 24% are putting admission referrals on wait lists.

Rate study recommendations. The Department of Human Services' rate study acknowledged Pennsylvania's home care agencies need a reimbursement increase of 23% to $25.42 per hour so agencies can offer competitive wages above the current $16.50 average. The industry is seeking a $370 million investment from the state to increase the reimbursement rate by 10%.

Strategies for Pennsylvania Agencies

Given Pennsylvania's specific market dynamics characterized by the nation's lowest regional wages, severe workforce shortages, and rapid demographic growth, agencies must adopt targeted strategies to recruit and retain caregivers.

Maximize compensation within constraints. With Pennsylvania's low Medicaid reimbursement rate of $20.63 per hour, agencies must be creative. Target paying at the higher end of the $14-$18 range where possible, and consider geographic differentials for areas competing with higher-paying neighboring states like New Jersey, Maryland, and Delaware.

Address training barriers. The 75-hour HHA training requirement creates a barrier to workforce entry. Partner with training programs to subsidize costs, offer paid training time, or provide signing bonuses that cover the $450-$650 training expense. Leverage the free training programs some agencies offer.

Build CNA career pathways. The 80-hour Pennsylvania CNA training program offers a clear career advancement path. Encourage HHAs to pursue CNA certification with tuition assistance tied to employment commitments. CNAs can command higher wages and take on more skilled care responsibilities.

Compete on benefits. Since wage competition is constrained by reimbursement rates, benefits can be a significant differentiator. Consider offering health insurance contributions, paid time off, retirement matching, or same-day pay options to address financial stress.

Focus on retention. With nearly 80% annual turnover statewide, every retained caregiver saves significant replacement costs. Invest in thorough onboarding, consistent scheduling, supervisor support, and recognition programs. Reducing turnover is often more cost-effective than continuous recruitment.

Navigate managed care. Pennsylvania operates Community HealthChoices for dual-eligible populations. Develop strong relationships with MCOs and understand their specific reimbursement rates and requirements. Diversify payer contracts to improve financial stability.

Pursue Medicare certification. Medicare certification diversifies payer mix and often provides higher reimbursement than Medicaid. This can support more competitive wages and improve agency financial sustainability. The state licensure process is a prerequisite for federal certification.

Target border regions strategically. Agencies near Delaware, Maryland, New Jersey, or Ohio borders face intense wage competition. Consider whether geographic expansion, premium pay zones, or travel reimbursement can help retain workers who might otherwise cross state lines for higher-paying positions.

Advocate for rate increases. The Pennsylvania Homecare Association actively advocates for reimbursement rate increases. Participate in advocacy efforts and rate study processes. The DHS rate study recommendation for $25.42 per hour demonstrates recognition of the problem at the policy level.

Ensure wage law compliance. With 38% of Minimum Wage Act complaints involving the home care industry and significant DOL enforcement actions, ensure rigorous overtime tracking, proper classification, and full payment of wages. Compliance failures carry substantial financial and reputational risks.

Key Resources and Contacts

Agencies operating in Pennsylvania should maintain relationships with these key regulatory and support organizations:

Pennsylvania Department of Health - Division of Home Health
Home health agency licensing under 28 Pa. Code Chapter 601
Address: 2525 N. 7th Street, Harrisburg, PA 17110
Phone: 717-783-1379
Email: [email protected]
Initial applications: [email protected]
Website: pa.gov/agencies/health/facilities/out-patient-healthcare-facilities/home-health

Pennsylvania Nurse Aide Registry
CNA certification and registry verification
Administered by Credentia
Phone: 888-204-6249
CNA365 renewal portal: cna365.examroom.ai/registry
Credentia testing: credentia.com/test-takers/pa

Pennsylvania Department of Human Services
Medicaid fee schedules and rate information
PROMISe Outpatient Fee Schedule (updated quarterly)
Website: pa.gov/agencies/dhs/resources/for-providers/ma-for-providers/ma-fee-schedule

Pennsylvania Department of Labor and Industry
Wage and labor law compliance
Minimum wage and overtime enforcement
Wage claim filing
Website: pa.gov/agencies/dli

Pennsylvania Homecare Association (PHA)
Industry association and advocacy
Regulatory information and resources
Website: pahomecare.org

Community HealthChoices (CHC)
Managed care program for dual-eligible populations
Information on MCO enrollment and provider participation
Website: pa.gov (search Community HealthChoices)

Complaints about home health agencies
Phone: 1-800-254-5164

The Bottom Line

Pennsylvania presents both significant challenges and substantial opportunities for home health agencies. The state's 2.48 million seniors today, growing 11% in just four years, ensure sustained and growing demand for home health services. The projection that 1 in 3 Pennsylvanians will be over 65 by 2030 underscores the long-term market opportunity.

However, the current workforce crisis is severe. With 112,500 shifts unfilled monthly, 80% annual turnover, and the lowest regional Medicaid reimbursement rate at $20.63 per hour, agencies face intense operational pressure. The state's Department of Human Services acknowledges a 23% rate increase to $25.42 per hour is needed, but budget allocations have not matched the scale of the crisis.

Navigating Pennsylvania requires careful attention to compliance. The DOH licensing process has specific requirements including training documentation, background checks, and state surveys. Medicare-certified agencies must meet additional federal Conditions of Participation. Wage law compliance is critical given that 38% of state Minimum Wage Act complaints involve the home care industry.

Success in Pennsylvania requires understanding the DOH licensing framework, navigating the low Medicaid reimbursement environment, maintaining wage law compliance, and investing creatively in compensation and retention. Agencies that can address training barriers, build career pathways, offer meaningful benefits, and reduce turnover will be best positioned to serve Pennsylvania's growing senior population while building sustainable operations in the Keystone State.