As policymakers tackle strategies to strengthen the direct care workforce, addressing benefits cliffs could be a transformative solution.
We witness firsthand the daily challenges caregivers face through our myCNAjobs caregiver network and the insights shared in our 2024 Direct Care Workforce Report. The findings are striking: America’s caregiving system is at a tipping point. This workforce—primarily composed of minority women within seven key personas—is grappling with not only the surging demand for care but also the daily struggle to achieve financial stability. A staggering 32% of caregivers rely on Medicaid as they provide essential care to Medicaid beneficiaries. This statistic highlights the precarious nature of their economic reality and underscores the urgent need for systemic change.
A Workforce in Crisis
The direct care workforce is facing an unprecedented crisis. Too few individuals are entering the profession, turnover rates are alarmingly high, and the demand for care continues to escalate. Care deserts—regions with little or no access to professional caregivers—are becoming increasingly common as agencies shrink their territories and service areas. This scarcity not only affects individuals in need of care but also places immense pressure on caregivers and agencies alike.
Compounding this issue is the concept of the benefits cliff. Many caregivers hesitate to take on additional hours out of fear of losing vital benefits such as Medicaid and SNAP. This hesitation is further magnified by the inherent unpredictability of home care work, where hours can fluctuate unpredictably. The result is a catch-22: many caregivers want to earn more, but doing so risks jeopardizing the very benefits that keep them afloat.
Raising Medicaid Income Thresholds for Direct Care Workers
What if direct care workers could earn more without the fear of losing their benefits? Raising Medicaid income thresholds presents a compelling opportunity to alleviate workforce shortages. By allowing caregivers to increase their income without disqualifying them from essential programs, we can unlock significant workforce capacity. This policy adjustment could empower caregivers to work additional hours, providing more consistent care to patients and enhancing the efficiency of the care system.
The Ripple Effects of Change
The potential benefits of raising income thresholds are extensive and multifaceted:
Caregivers Earn More Without Penalty
Caregivers could increase their income without the looming stress of benefit disqualification, enhancing their financial security and quality of life.
Providers Can Staff More Cases
With fewer restrictions on hours, agencies could take on more cases, expand their service areas, and alleviate the growing care deserts across the country.
Patients Receive Consistent Care
By increasing workforce capacity, agencies could provide more reliable and consistent care, improving patient outcomes and satisfaction.
System Costs Decrease
Expanding home care services could reduce reliance on costly institutional care options, such as nursing homes, creating substantial savings for Medicaid programs.
Supporting Caregivers: The Bigger Picture
While raising Medicaid income thresholds is a crucial step, it is just one piece of the puzzle. We need a broader strategy that directly supports caregivers and addresses the systemic challenges they face. These workers are the backbone of the care system, yet they often work under the table or leave the profession entirely to make ends meet. This exodus exacerbates workforce shortages and places further strain on agencies struggling to meet both care demands and the social determinants of health (SDOH) needs of their employees.
To build a sustainable and thriving care industry, we must:
• Prioritize caregiver compensation and benefits.
• Address SDOH barriers that impact caregivers’ ability to work and thrive.
• Foster partnerships to drive systemic solutions.
A Call to Action
The direct care workforce is at a critical crossroads. Without intervention, the cracks in the system will continue to widen, leaving caregivers and the patients they serve at risk. It’s time to prioritize conversations that place caregivers at the center of the conversation – it’s a different angle to drive solutions towards driving real change in the care ecosystem.
Sources:
• MissionCare Collective Workforce Report 2024
• PHI National: U.S. Home Care Workers in 2019
• Politico: Elder Care Workforce Shortages and Immigration
Brandi Kurtyka, CEO
MissionCare Collective