PDA Caregiver Support Program — Reimbursement Percentage Guide (Appendix F.2)
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This guide sets the percentage of benefits payable under the Pennsylvania Department of Aging (PDA) Caregiver Support Program based on household size and income ranges; it applies to administration of PDA caregiver reimbursement calculations. It is an informational appendix presenting income bands and corresponding reimbursement percentages effective 1/16/2026.
No material clinical or coverage changes in this revision.
Reimbursement Percentages by Income and Household Size
Reimbursement percentage criteria by income and household size
Reimbursement percent is assigned according to the household's income falling within the listed income range for the household size.
100% of benefits (<= 200% of poverty)
- Household size 1: $0 - $31,920
- Household size 2: $0 - (value omitted)
- Household size 3: $0 - $43,280
- Household size 4: $0 - $54,640
- Household size 5: $0 - $77,360
- Household size 6: $0 - $88,720
Percent of Benefits = 100%
90% of benefits (220% band)
- Household size 1: $31,921 - $35,112
- Household size 2: $43,281 - (value omitted)
- Household size 3: $47,608 - $54,641
- Household size 4: $54,641 - $60,104
- Household size 5: $66,001 - (value omitted)
- Household size 6: $88,721 - $97,592
Percent of Benefits = 90%
80% of benefits (240% band)
- Household size 1: $35,113 - $38,304
- Household size 2: $47,609 - $51,936
- Household size 3: $51,936 - $60,105
- Household size 4: $60,105 - $65,568
- Household size 5: $72,601 - $92,832
- Household size 6: $97,593 - $106,464
Percent of Benefits = 80%
70% of benefits (260% band)
- Household size 1: $38,305 - $41,496
- Household size 2: $51,937 - $56,264
- Household size 3: $56,264 - $65,569
- Household size 4: $65,569 - $71,032
- Household size 5: $79,201 - $100,568
- Household size 6: $106,465 - $115,336
Percent of Benefits = 70%
60% of benefits (280% band)
- Household size 1: $41,497 - $44,688
- Household size 2: $56,265 - $60,592
- Household size 3: $60,592 - $71,033
- Household size 4: $71,033 - $76,496
- Household size 5: $85,801 - $100,569
- Household size 6: $115,337 - $124,208
Percent of Benefits = 60%
50% of benefits (300% band)
- Household size 1: $44,689 - $47,880
- Household size 2: $60,593 - $64,920
- Household size 3: $64,920 - $76,497
- Household size 4: $76,497 - $81,960
- Household size 5: $92,401 - $108,305
- Household size 6: $124,209 - $133,080
Percent of Benefits = 50%
40% of benefits (320% band)
- Household size 1: $47,881 - $51,072
- Household size 2: $64,921 - $69,248
- Household size 3: $69,248 - $81,961
- Household size 4: $81,961 - $87,424
- Household size 5: $99,001 - $116,041
- Household size 6: $133,081 - $141,952
Percent of Benefits = 40%
30% of benefits (340% band)
- Household size 1: $51,073 - $54,264
- Household size 2: $69,249 - $73,576
- Household size 3: $73,576 - $87,425
- Household size 4: $87,425 - $92,888
- Household size 5: $105,601 - $123,777
- Household size 6: $141,953 - $150,824
Percent of Benefits = 30%
20% of benefits (360% band)
- Household size 1: $54,265 - $57,456
- Household size 2: $73,577 - $77,904
- Household size 3: $77,904 - $92,889
- Household size 4: $92,889 - $98,352
- Household size 5: $112,201 - $131,513
- Household size 6: $150,825 - $159,696
Percent of Benefits = 20%
10% of benefits (380% band)
- Household size 1: $57,457 - $60,648
- Household size 2: $77,905 - $82,232
- Household size 3: $82,232 - $98,353
- Household size 4: $98,353 - $103,816
- Household size 5: $118,801 - $139,249
- Household size 6: $159,697 - $168,568
Percent of Benefits = 10%
0% of benefits (above 380% of poverty)
- Household size 1: $60,649 and over
- Household size 2: $82,233 and over
- Household size 3: $103,817 and over
- Household size 4: $125,401 and over
- Household size 5: $146,985 and over
- Household size 6: $168,569 and over
Percent of Benefits = 0%
For households of seven or more, add $5,680 per additional member to the 100% poverty level when calculating income ranges (apply same percentage bands using adjusted poverty levels).
Coding and Percent Tiers
| No codes listed |
| Appendix F.2 | PDA Caregiver Support Program reimbursement percentage guide (no billing codes provided) |
Provider Guidance and Appendix Reference
Reference Appendix F.2 — Reimbursement percentage schedule by income and household size
See Appendix F.2: Reimbursement percentage schedule assigning the percent of benefits payable under the PDA Caregiver Support Program according to household size and the household’s income falling within the listed income range; the appendix presents tiers from 100% down to 0% mapped to income bands for household sizes 1–6 with guidance for households of seven or more.
- Appendix F.2 contains the full table of reimbursement percentages by income and household size (100%, 90%, 80%, 70%, 60%, 50%, 40%, 30%, 20%, 10%, 0%).
- Income bands are defined as percentages of the federal poverty level and are tabulated for household sizes 1 through 6; for households of seven or more, add $5,680 per additional member to the 100% poverty level when calculating ranges.
- Providers must reference Appendix F.2 when determining the applicable percent of benefits to apply based on the beneficiary’s household size and reported income.
Poverty Level and Household Adjustment Definitions
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