Pennsylvania’s HCBS Crisis

Advocates and service providers for people with intellectual disabilities and developmental disabilities urged the Pennsylvania General Assembly Wednesday to enhance state aid by $430 million to avoid the system from collapsing entirely. At a gathering in the Capitol rotunda, prominent health, and human services organizations expressed disappointment with continuing inadequate funding. Staffing shortages are forcing them to cut programs and turn away clients.

The $430 million budget request would lead to a government match, allowing providers to restart service to the 4,029 people denied care in previous years. Without the 15% increase, providers warn that 60,000 Pennsylvanians with intellectual and developmental disabilities risk losing or seeing a reduction in essential services.

In advocating for additional state funding, The Arc Pennsylvania was joined by the Rehabilitation and Community Providers Association (RCPA), Pennsylvania Advocacy and Resources for Autism and Intellectual Disability (PAR), The Provider Alliance, The Alliance of Community Service Providers, and the MAX Association. Years of underfunding, the COVID-19 pandemic, staffing shortages, and inflationary effects, they claim, have pushed the services to the edge of collapse. Providers have fought to maintain the same level of care with fewer resources, but advocates say they have reached a breaking point with little room to cut.

In a recent study of more than 130 providers conducted by RCPA, PAR, and The Provider Alliance, it was discovered that the number of people serviced decreased by 4,029, or 11%, from March 2020 to February of this year. Underfunding and staff shortages are causing program cancellation or downsizing, facility closures, or limitations on the number of individuals serviced.

Further stressing the network of care is the Pennsylvania waiting list backlog for services. More than 12,000 individuals remain on the list, and 5,400 are categorized as having emergency needs, indicating that they are at risk and require services immediately.

During the spring semester of 2022, Noah Spaulding was forced to complete college online. Spaulding has Cerebral Palsy and needs assistance with daily tasks. His plans to attend Messiah College classes on campus were derailed when he couldn’t find PCAs who could help him while living on campus.

PCAs can be tough to find because of low pay and few, if any, benefits. These jobs frequently don’t offer sick days, retirement plans, or health insurance. In Spaulding’s home state of Pennsylvania, the average hourly wage of $13.40 drives individuals to different occupations.

Disabled people in Pennsylvania require access to home and community-based services. Medicaid should be increased, and waiting lists should be removed. Wages must also rise for support staff. People are often forced into dangerous situations without access to home and community-based services, which can have catastrophic consequences.


Casey, Thom. “System for Individuals with Intellectual Disabilities, Autism Will …” Rehabilitation & Community Providers Association, Rehabilitation & Community Providers Association, 3 May 2023,

Wenner, David. “Caregiver Shortage Threatens College Dream of Messiah Student with Cerebral Palsy.” The Patriot-News, The Patriot-News, 27 July 2022,

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