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News from EPI New report finds that home health care workers are severely underpaid in every state

A new report from the Economic Policy Institute and New America shows that home health care workers are paid extremely low wages in every state—and estimates what these workers should be paid to appropriately compensate for their labor.

Nationally, home health care workers are paid an average wage of about $13.50 an hour. Home health care workers typically make less than $12 an hour in the lowest-paying states—Louisiana, West Virginia, Texas, Mississippi, and Oklahoma. Average wages top out below $18 per hour even in the highest-paying states—Massachusetts, North Dakota, Alaska, Washington state, and Colorado. 

The underpayment of this workforce is due to the explicit lack of labor protections available to these workers, the undervaluing of care work in our economy, and the discrimination faced by the (often immigrant) Black, Latinx, and Asian women who have historically and continue to make up the majority of the home health care workforce. If these factors that depress wages were reduced and these workers received the wage boost that typically comes from unionization, their average wages would range from $19.58 per hour in West Virginia to $28.98 in Massachusetts.

Raising wages for home health care workers would be beneficial for a number of reasons. With more than 1 million additional home health care workers estimated to be needed by 2029, raising wages could bolster the workforce to meet the growing demand for home care. One in 6 home health care workers live below the poverty line, and raising pay would decrease workers’ reliance on the social safety net. Studies also suggest that stabilizing the home health care workforce could improve the quality of care, strengthen economic growth, and allow family members of individuals needing care to return to the workforce.

“Home health care workers perform vital work for older adults and people with disabilities, but they are extremely undervalued and underpaid. At bare minimum, policymakers must ensure home health care workers are paid a living wage. Not only would higher wages allow more workers to enter this profession and provide for their families, but those receiving care would enjoy better outcomes and more stability of care,” said Cassandra Robertson, policy director of the New Practice Lab at New America and co-author of the report. 

States play a crucial role in setting wages for the home care workforce. The majority of home care workers are paid through Medicaid’s Home and Community Based Services program (HCBS), which is administered at the state level through a federal waiver program. Although HCBS is funded through a combination of state and federal dollars, each state chooses what services to offer under the program and how much providers will be reimbursed for HCBS services. 

State officials could increase reimbursement rates to HCBS-funded home health care providers and encourage them to use the additional funding to raise pay for frontline caregiving staff to be more in line with the benchmark wage rates presented in this report. Congress could also include additional funds for the HCBS program in legislation, as has been done twice in recent years. Lawmakers and the Biden administration could provide additional guidance on how these dollars could be spent that prioritizes higher pay for home health care workers.

“As the diverse home health care workforce grows over the next decade, this industry could provide economic security and mobility, or it could trap these workers in low-wage jobs that have little room for growth. State policymakers have the opportunity and responsibility to improve outcomes for home care workers and the families they serve by ensuring that the home health care workforce is supported by sustainable wages,” said Robertson.