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Four Ideas to Transform Direct Care Jobs in New Mexico

June 22, 2021

New Mexico’s direct care workforce is critical to the state’s long-term services and supports sector, ensuring that older adults and people with disabilities can live and thrive in their homes and communities and across congregate settings.

Yet as the COVID-19 crisis has reinforced, these workers remain undervalued and inadequately supported—and their jobs remain poor in quality. For example, New Mexico’s direct care workers earn a median hourly wage of $10.89, and 64 percent live in or near poverty. Because of poor job conditions, direct care workers are increasingly leaving long-term care for other sectors (such as fast food and retail), which profoundly affects the individuals who rely on this support.

Did you know? PHI’s research shows that from 2018 to 2028, New Mexico’s long-term care sector will need to fill 74,600 job openings in direct care, including 12,800 new jobs to meet rising demand and 61,800 openings caused by workers who transfer to other occupations or exit the labor force altogether.

Yet, a sense of promise is in the air. A wave of new federal announcements—the American Rescue Plan and the American Jobs Plan, as two notable examples—signal a shift in how the federal government supports states to strengthen this workforce. Likewise, New Mexico is striving to find the best ways to improve jobs for the state’s 35,900 home care workers, residential care aides, and nursing assistants.


In this climate, as part of our Essential Jobs, Essential Care initiative, PHI has been working with the New Mexico Caregivers Coalition and its broad coalition of leaders to identify the primary policy barriers facing direct care workers in New Mexico and to co-create an advocacy roadmap in response.

In February of this year, we co-hosted a statewide virtual gathering where participants from across the state reviewed the latest data on this workforce, heard from direct care workers and other experts in the state about the policy landscape for this workforce, and agreed on the policy areas we want to tackle together in the years ahead. Here is a summary of the four most pressing policy needs that this initiative will be driving forward.


Increase direct care worker wages and strengthen benefits through Medicaid. Historically low wages for direct care workers in New Mexico undermine these workers’ economic stability and contribute to widespread workforce shortages across long-term care settings. To address this longstanding inequity, NMCC and its partners are advocating for Medicaid policy changes that would increase direct care worker compensation. During the 2021 legislative session, they successfully introduced the Medicaid Waiver Wage Act (SB 342), which would have required 70 percent of all future Medicaid reimbursement rate increases to be allocated toward the wages of direct support professionals employed under the state’s waiver programs for people with intellectual and developmental disabilities. Although the legislation did not pass this year, the coalition will continue advocating for such reforms—leveraging new federal funding sources as they become available.

Ensure workers have access to counseling on benefits cliffs and plateaus. The majority (65 percent) of direct care workers in New Mexico rely on public benefits to support themselves and their families. For these workers, incremental wage increases are often offset by reduced eligibility for benefits—leading to “benefits plateaus” (when net compensation remains the same) or “benefits cliffs” (when net compensation actually worsens due to the loss of benefits). To begin addressing these unintended consequences, NMCC and its partners will disseminate new financial planning tools developed by the Federal Reserve Bank of Atlanta to direct care workers and workforce development agencies across the state. These tools will help direct care workers and other low-wage workers make strategic and informed choices about their earnings.

Uphold direct care workers’ rights and labor protections. When direct care workers and other low-wage workers in New Mexico experience labor law violations, they may struggle to access legal support through the New Mexico Department of Workforce Solutions (due to persistent underfunding of the department), according to a recent report. To bolster protections for direct care workers, NMCC and its partners will work to promote education for workers and employers on their rights and responsibilities and advocate for increased funding for the enforcement of existing labor laws.

Establish new systems to collect data on the direct care workforce. The paucity of data on the size, stability, and compensation of the direct care workforce in New Mexico obscures the severity of the state’s workforce challenges and makes it difficult to design and evaluate state programs and policies. To fill these data gaps, NMCC and its partners are developing proposals for strengthening workforce data collection across state Medicaid programs, including both fee-for-service and managed care programs. The most robust state data collection systems require a range of resources, including state agency staff time and data analysis and visualization tools, so additional federal funding could help the state build this much-needed infrastructure.


For years, PHI and NMCC have been leading critical advocacy on the direct care workforce. Yet we have never seen the type of widespread policy interest at the state and federal levels that we are witnessing in this moment. Together, we must capitalize on this moment, transforming jobs for direct care workers and care for older adults and people with disabilities.

Learn more about Essential Jobs, Essential Care New Mexico

This initiative is made possible through generous support from the W. K. Kellogg Foundation.

Caring for the Future

Our new policy report takes an extensive look at today's direct care workforce—in five installments.

Workforce Data Center

From wages to employment statistics, find the latest data on the direct care workforce.