Allegheny County Proposes Paid Leave Regulations; Implications for Adult Home-Based Care Providers

On May 13, 2026, the Allegheny County Health Department (ACHD) introduced proposed amendments to the County’s Paid Sick Leave regulations, along with a new Paid Parental Leave mandate. The proposal would significantly expand Article XXIV of the Allegheny County Health Code by requiring employers to provide extensive paid parental leave benefits directly funded by employers.

For providers delivering adult home and community-based services (HCBS), personal assistance services, and other Medicaid-funded in-home supports throughout Allegheny County, the proposal could create substantial operational and financial pressures. RCPA is closely monitoring the proposal and evaluating the implications for the broader home-based care system, workforce stability, and continuity of care for vulnerable adults.

Key Components of the Proposal:

Paid Parental Leave Requirement
The proposed regulation would require all employers operating within Allegheny County, regardless of size, to provide up to 18 weeks of paid parental leave at an employee’s full regular rate of pay.

Employees would become eligible after only 30 days of employment. Qualifying events would include childbirth, legal adoption, or permanent legal placement of a child, including foster placement. Eligible employees could use the leave at any point during the first 12 months following the qualifying event.

Unlike state-administered paid leave programs funded through payroll contributions or social insurance models, this proposal places the financial obligation directly on employers, potentially requiring providers to absorb the costs themselves or purchase supplemental private insurance coverage.

Expansion of Paid Sick Leave Requirements
The ACHD proposal also expands existing paid sick leave requirements by increasing the accrual rate from one hour earned for every 35 hours worked to one hour for every 30 hours worked. In addition, the maximum accrual cap would increase from 40 hours to 72 hours annually.

Collectively, these changes would materially increase labor costs for providers operating within an already constrained Medicaid reimbursement environment.

Public Health Rationale
ACHD has framed the proposal as a prevention-focused public health initiative intended to improve maternal and infant health outcomes and address disparities in access to paid leave benefits. County officials cited goals including reductions in postpartum depression, improved infant wellness outcomes, increased immunization compliance, and broader equity for lower-wage workers who often lack employer-sponsored leave benefits.

Status of the Proposal
The regulations are currently in the proposal stage and have not yet been adopted.

• A 30-day public comment period began on May 13, 2026.
• A public hearing is scheduled for June 2, 2026, at 5:30 pm in the Gold Room of the Allegheny County Courthouse.
• Following the comment period, the Allegheny County Board of Health may vote on a final version before forwarding it to Allegheny County Council for approval.

Implications for Adult Home-Based Care Providers
RCPA recognizes the importance of workforce supports and family-friendly employment policies. However, the association remains deeply concerned about the impact of imposing significant new unfunded mandates on Medicaid-funded adult home-based care providers without corresponding reimbursement adjustments.

Providers delivering personal assistance services, attendant care, waiver services, and other in-home supports already operate under severe workforce shortages and historically inadequate reimbursement structures. Allegheny County continues to have some of the lowest Medicaid-funded personal assistance reimbursement rates in Pennsylvania, creating limited financial flexibility for providers to absorb substantial new labor-related costs.

Without parallel Medicaid rate increases or supplemental funding mechanisms, the proposal could accelerate provider instability, reduce service capacity, increase caregiver shortages, and ultimately jeopardize access to care for older adults and individuals with disabilities who rely on in-home services to remain safely in the community.

RCPA will be preparing formal comments regarding the proposal and continue engaging policymakers, advocates, and stakeholders to highlight the potential consequences for the adult home- and community-based care sector and the Medicaid populations it serves.

If you have any questions or comments, please contact Fady Sahhar.