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RESEARCH BRIEF: States’ Failure to Expand Medicaid Hurts Direct-Care Workers

July 27, 2015

Nearly half a million direct-care workers are shut out of Medicaid eligibility because their states have refused to expand the program under the terms of the Affordable Care Act (ACA), a PHI research brief shows.

In Too Sick to Care: Direct-Care Workers, Medicaid Expansion, and the Coverage Gap, PHI Director of Policy Research Abby Marquand explains that many direct-care workers living in the 21 “non-expansion” states fall into the “coverage gap,” earning too much money to qualify for Medicaid in their states, but not enough to qualify for federal subsidies that would help them buy insurance on health care exchanges.

In Texas, for example, PHI estimates that 83,000 direct-care workers fall into the coverage gap. Their yearly wages are less than 100 percent of the federal poverty level (FPL), the point at which subsidies kick in, yet they are ineligible for the Texas Medicaid program.

Under the state’s Medicaid program, single adults without dependent children are ineligible for coverage regardless of how low their income is. Parents with dependent children are eligible only if they live in a household with income that is less than 18 percent FPL (less than $4,000 per year for a family of three).

Nationwide, 473,000 direct-care workers in non-expansion states are currently denied eligibility for Medicaid due to their states’ refusal to expand the program.

Direct-care workers earn, on average, just $10.85 an hour. Median earnings for the workforce are approximately $16,100 a year due to the part-time hours worked by many direct-care workers.

In 2015, the FPL was $11,770 for an individual and $20,090 for a family of three.

As originally passed in 2010, the ACA mandated that states expand Medicaid eligibility to all adults with household incomes up to 138 percent FPL, but a 2012 Supreme Court decision made that mandate optional.

Disproportionate Effects

In the report, Marquand writes that direct-care workers living in the Southern U.S. are disproportionately affected by the non-expansion of Medicaid. PHI estimates that nearly four out of five (78 percent) direct-care workers in non-expansion states with household incomes of less than 138 percent FPL live in the South.

Additionally, limiting Medicaid eligibility disproportionately hurts younger direct-care workers as well as black and Latino workers, the brief shows.

Marquand writes that non-expansion states should expand as quickly as possible to help ensure that they will be able to attract more workers to the rapidly growing field of direct-care.

Additionally, she writes, states that have already expanded Medicaid eligibility should consider further expanding eligibility.

Marquand also recommends additional steps that states and long-term care providers can take to ensure that direct-care workers can access affordable, quality health coverage when the ACA’s employer mandate takes effect in 2016.

— by Matthew Ozga

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