We’re in a caregiving crisis. We need more caregivers – and we’re not providing the care they need. 

Caregivers are doing critical work in our communities and playing key roles in the health justice movement. Whether they are family caregivers or paid workers like direct care workers, home health care aides, nursing assistants, or people who work in residential nursing homes, caregivers provide lifesaving care and allow people with disabilities, older adults, and their families to lead full lives. Their work is especially critical as care is harder to find than ever.

Still, caregivers and direct care workers are often overlooked and undervalued in our society, evidenced by the lack of policies that support them like Medicaid expansion, permanent Marketplace subsidies, paid family leave, and higher wages.

The direct care workforce is made up of 67% people of color and 84% women. It’s no accident that people in power are standing between them and their health and due to structural racism, classism, and other forms of oppression, they experience higher burdens when left without care.

Closing the Coverage Gap: Medicaid Expansion and the Direct Care Workforce 

In the 10 states that haven’t expanded Medicaid, caregivers like Pam are even further harmed by a lack of comprehensive policies to support them like affordable health care. Pam is a home health care aide in Pittsburg, Kansas who is forced to care for others without being able to care for herself. She has no realistic way to get the health care she wants and needs and when she does need to go to the doctor, she has no way to avoid accruing even more medical debt.

A person with short blonde hair and glasses looks ahead while sitting at a conference table.
Pam Brown, a home health care aide, says “[having health insurance] would take away the fear that my bank account may be garnished. It could make my life a little bit more than just an existence.”

Pam is one of more than 80,000 direct care workers living in the Medicaid coverage gap. There are another nearly 70,000 in those states whose Marketplace health care costs are out of reach and who would be helped by Medicaid expansion. That’s why Community Catalyst partnered with PHI to look deeply into the health coverage and care realities of those caregivers whose policymakers are standing between people and their health by not expanding Medicaid in our new report Closing the Coverage Gap: Medicaid Expansion and the Direct Care Workforce.

Nearly 150,000 direct care workers would be able to afford coverage and care if policymakers in all 10 non-expansion states expanded Medicaid.

Key Findings
  • More than 80,000 direct care workers are currently in the Medicaid coverage gap.
  • The current rate of direct care workers without any health insurance in the non-expansion states (9%) is significantly higher compared to the expansion states (2%).
  • More than 148,000 direct care workers would become newly eligible for coverage if the 10 remaining states expanded Medicaid. This includes 80,499 direct care workers who are currently in the coverage gap, plus 68,044 who are currently eligible for enhanced tax credits– but whose coverage remains unaffordable.
Policy Recommendations
  • Close the Medicaid Coverage Gap. Expanding Medicaid is imperative for supporting the health of direct care workers and the individuals who rely on their services.
  • Increase Medicaid eligibility for immigrants and others. Further extend Medicaid eligibility by adopting Basic Health Program or buy-in programs and removing citizenship, residency, or waiting period requirements.
  • Invest in culturally competent Medicaid and Marketplace outreach and enrollment. Medicaid expansion must also be matched by other efforts to facilitate Medicaid enrollment and address low enrollment among direct care workers.
  • Make Enhanced Premium Tax Credits permanent. Enhance subsidies for health insurance Marketplace for direct care workers and make the current enhancements permanent.
View the Full Report

Thank a Caregiver Join the movement to support caregivers in the coverage gap by sending a message of thanks. Our caregivers need recognition, support, and policy changes. Your sign of support is an important first step to joining the movement. 

Sign our thank you to caregivers

If you’re a caregiver yourself, spend 2 minutes filming a video of your story of caregiving to help push for coverage, care, and support.