Medicaid Spending on Home- and Community-Based Services and the Economic Status of Home Care Workers

Abstract

The long-term care industry is one of the fastest growing sectors of the economy but also creates some of the lowest-paid and lowest-quality jobs. The precarious working conditions of long-term care workers – who are disproportionately women and women of color – are costly for both the workers and the patients they care for. Existing research has examined several factors undermining the pay and working conditions in this sector, but it has insufficiently examined the role of government policy. This project leverages over-time and cross-state variation in Medicaid policy in the United States to examine the role of government policy, focusing particularly on the impact of the expansion of Medicaid home- and community-based services (HCBS) on home-care workers’ wages and job quality. We use the Current Population Survey and original Medicaid HCBS investment measures to examine how policies shape long-term home care workers’ economic position. Our preliminary analyses show that the expansion of Medicaid HCBS investment has not translated into substantial wage or job quality improvements for the workers.