As policymakers tackle strategies to strengthen the direct care workforce, addressing benefits cliffs could be a game-changer.
At MissionCare Collective, we see the challenges caregivers face every day through our caregiver network and in our 2024 Direct Care Workforce Report. The findings are sobering: America’s caregiving system is at a critical juncture. This workforce—comprised largely of minority women with seven key personas—is not only struggling to meet the rising demand for care but also to make ends meet. Shockingly, 32% of caregivers rely on Medicaid, even as they provide essential care to Medicaid recipients.
A Workforce in Crisis
Too few caregivers are entering the profession, turnover is alarmingly high, and demand continues to rise. Over 70% of home care agencies turn away hours due to workforce shortages, with care deserts becoming more common as agencies reduce territories and service areas.
To make matters worse, home care providers aren’t just competing with other companies for hours—they’re also competing with the benefits cliff. Many caregivers are hesitant to take on more hours for fear of losing critical benefits like Medicaid and SNAP. This reluctance is amplified by the nature of home care work, where hours are often unpredictable and far from guaranteed.
Raising Medicaid Income Thresholds for Direct Care Workers
What if we allowed direct care workers to earn more without losing their benefits? Raising Medicaid income thresholds could potentially unlock more workforce capacity. This simple change could empower caregivers to work additional hours without the fear of losing vital resources, increasing the total hours of care provided by the existing workforce.
The potential ripple effects are interesting:
Caregivers Earn More Without Penalty
Workers could increase their income without the stress of benefit disqualification.
Providers Can Staff More Cases
Agencies could take on more hours and expand their service areas, alleviating care deserts.
Patients Receive Consistent Care
Increased workforce capacity would result in more consistent care delivery, improving patient outcomes.
System Costs Decrease
Expanding home care delivery could reduce reliance on costly institutional care, such as nursing homes, creating savings across Medicaid.
Supporting Caregivers: The Bigger Picture
This is just one idea, but the broader takeaway is clear: We must build strategies that directly support the workforce. For anyone reading this that's also passionate about this, I welcome a conversation (here's my personal Linkedin).
Caregivers are leaving the profession or working under the table to survive, while agencies struggle to meet care demands and the social determinants of health (SDOH) needs of their employees. Without intervention, the cracks in the system will widen.
Let’s prioritize strategies that put caregivers at the center of the conversation.
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