Increasing expenditures on home- and community-based services: Do home care workers benefit?

Area of Science:

• Health Services Research
• Public Health Policy
• Labor Economics

Background:

• Medicaid home- and community-based services (HCBS) are crucial for long-term care.
• Understanding the impact of HCBS expenditures on the home care workforce is vital for service delivery and worker retention.

Purpose of the Study:

• To analyze the association between Medicaid HCBS expenditures and the home care workforce.
• To investigate the relationship between HCBS spending and workforce size, wages, and hours worked.

Main Methods:

• Utilized national secondary data from 2008-2019, including state-level Medicaid HCBS expenditures and the American Community Survey.
• Employed negative binomial, linear, and generalized ordered logit regression models to assess associations.
• Controlled for demographic, socioeconomic factors, potential beneficiary numbers, and state/year fixed effects.

Main Results:

• Medicaid HCBS expenditures rose significantly between 2008 and 2019.
• Home care worker wages remained stagnant ($11-12/hour) despite increased spending.
• A $1 million increase in HCBS expenditures correlated with a 1.2 increase in workers and a marginal rise in overtime probability.

Conclusions:

• No significant relationship was found between Medicaid HCBS expenditure changes and home care worker wages.
• A significant, albeit small, association exists between increased HCBS spending and workforce size and hours worked.
• Findings highlight the need for policies addressing home care worker compensation.