We are particularly encouraged by the commitment to improving wages, benefits, training, and career pathways for direct care workers; addressing workforce shortages through investments in workforce development; supporting family caregivers; and ensuring caregivers are recognized as essential members of the care team. These priorities align closely with PHI’s Universal Direct Care Workforce Initiative, which seeks to address longstanding, systemic challenges facing the workforce through core competencies, stackable and portable credentials, career pathways, an accessible training infrastructure, and a comprehensive wage strategy.

As this effort advances, PHI looks forward to working with Senator Wyden and other leaders to develop policies that strengthen the direct care workforce, expand access to high-quality care, and build a long-term care system in which older adults and people with disabilities can receive the support they need in the settings they choose.

The post PHI Statement on Senate Effort to Reimagine Long-Term Care appeared first on PHI.

Strong program integrity is critical to Medicaid—but withholding funding from a state Medicaid program is a blunt instrument that puts care itself at great risk. The deferral of federal funds threatens California’s ability to sustain the In-Home Supportive Services (IHSS) program and other home and community-based services (HCBS) that allow older adults and people with disabilities to remain safely in their homes. CMS’s simultaneous 50-state warning indicates that similar actions could follow elsewhere.

PHI is also concerned by narratives that conflate the necessary expansion of the home care sector with systemic abuse. As PHI has consistently documented, the rapid growth of the direct care workforce across the country is driven by surging demographic demand. Our growing population of older adults, combined with individuals living longer with complex conditions, increasingly requires paid care—and the majority of people prefer to age and receive services at home, a preference that has been supported by bipartisan policy choices. IHSS and similar programs are not only essential to making independent living a reality; they also offer a cost-effective alternative to nursing home care.

Direct care workers outnumber every other segment of the U.S. labor force, but remain among the most under-supported. Imposing broad financial penalties misses a critical opportunity to strengthen the LTSS sector. The most effective way to ensure that care is delivered effectively to all who need it is to invest in the direct care workforce— through better training, standardized credentials, and livable, competitive wages that simultaneously protect public dollars and program integrity while also elevating the quality of care.

Medicaid is structured as a federal-state partnership, and that partnership is the foundation on which the program’s stability rests. Unilateral federal actions that destabilize state Medicaid programs—whether in California or in any of the other states and jurisdictions now on notice—fundamentally alter that relationship, with lasting consequences for the people who provide and depend on these services. PHI urges the Administration to work with California and every state to identify where additional data collection or oversight might be needed to protect program integrity—recognizing that many statutory safeguards are already in place—without severely compromising the entire system itself. The Administration’s actions threaten the stability of the direct care workforce and the well-being of the millions who rely on them, and we urge a reversal of this course before they create far greater challenges than those they purport to address.

The post PHI Statement on CMS’s Deferral of Medicaid Payments to California appeared first on PHI.

More than 3.2 million home care workers assist older adults and individuals with disabilities with daily personal care, and help them maintain their health, safety, and social engagement. By fulfilling the rising need for services, home care workers in turn enable family caregivers to stay in the labor force and sustain their own careers and overall wellbeing.

While Congress extended labor protections to most domestic workers in 1974, it took until 2015 for home care workers to finally gain the same basic labor protections that most American workers take for granted. Since then, the home care workforce has more than doubled, outpacing growth in every other occupation in the country. Home care industry revenue rose more than 50 percent, from $68.3 to $102.7 billion. The dire predictions that wage protections would devastate this industry never came true. Home care providers adapted, albeit with challenges for Medicaid-funded providers operating on narrow margins set by inadequate reimbursement.

Yet the Department of Labor now proposes to strip home care workers of the right to minimum wage and overtime pay, devaluing their labor and demeaning their skilled contributions to families, communities, and the economy.

There is a bitter irony here. The Department of Labor exists to protect workers by setting employment standards, enforcing rights, and ensuring fair treatment on the job. This rule would turn that mission on its head, using the agency’s authority not to safeguard workers but to strip away protections they have held for a decade. What’s more, by repealing these hard-won protections, the Department of Labor risks returning to the racist and sexist roots of home care workers’ original exclusion from the Fair Labor Standards Act.

We must be honest about that history, and honest about what it means to repeat it.

The Department of Labor argues its proposed rule will expand access to care by reducing costs and attracting more workers, disingenuously suggesting that the ratio of home care workers to individuals receiving services has declined in the past decade due to the extension of the Fair Labor Standards Act to this workforce. The reality is that, in a sector plagued by poor job quality and resulting recruitment and retention challenges, demand for care is rising faster than the labor market can match. This challenge will only intensify as the U.S. population over 65 approaches 89 million by 2060.

The solution to the growing care gap is to improve jobs, not eliminate worker protections.

Currently, the median pay for home care jobs is $16.77 an hour—less than most retail and fast-food jobs—and annual earnings hover around $22,500. Two in five home care workers live near or below the federal poverty line, and more than half rely on public assistance. Driven by poor job quality, home care workforce turnover is approximately 75 percent. Ensuring basic employment protections is fundamental—and only a starting point for strengthening and stabilizing this workforce to meet rising demand.

Instead, home care workers are currently experiencing a convergence of damaging policies. The Department of Labor’s proposal to repeal home care workers’ employment rights has arrived alongside $900 billion in Medicaid cuts that will gut long-term care funding, immigration restrictions that are driving paid caregivers—29 percent of whom are immigrants—out of the workforce, and the rescission of federal nursing home staffing standards that researchers estimated would have saved 13,000 lives per year. Together, these policies are destabilizing America’s care infrastructure, even as demand grows.

There is a different path forward. Congress can and should take action to strengthen the direct care workforce in sustainable, forward-thinking ways. Representative Alexandria Ocasio-Cortez (D-NY) and Senator Patty Murray (D-WA) have introduced the Fair Wages for Home Care Workers Act—bicameral legislation that would amend the Fair Labor Standards Act to codify in statute the minimum wage and overtime protections home care workers have held since 2015. This approach recognizes what should be obvious: quality care requires quality jobs. At the state level, Oregon recently codified these protections for home care workers into state law, Virginia’s legislature enacted state overtime protections for agency-employed home care workers and all domestic workers through two state bills, and Washington, D.C. legislators are working to advance comparable measures.

Growing demand for care is not a problem to be solved by deregulation; it is a reality that requires investment, planning, and respect for the workers who will meet it. This is not a debate about labor regulations. It is a debate about what we owe the people who need support and the people who provide it. Right now, we are failing both.

The post It Took Over 75 Years for Home Care Workers to Win Basic Rights. A New Rule Would Strip Them Away. appeared first on PHI.

Direct care is projected to add more new jobs than any other occupation over the coming decade. Yet, the field continues to be marked by inadequate compensation, inconsistent training, and high turnover—conditions that strain workers, providers/employers, and the millions of older adults and people with disabilities who rely on their care. 

“The direct care workforce is growing rapidly, and ensuring job quality and stability is essential to meeting demand,” said Amy Robins, Senior Director of Policy at PHI. “Together, these bills represent significant, meaningful steps toward the kind of sustained investment and structural innovation this field has long needed.” 

In alignment with PHI’s policy priorities, including the Universal Direct Care Workforce Initiative, the Long-Term Care Workforce Support Act would establish a National Direct Care Professional Training Standards Commission to develop competency-based, industry-recognized, and portable training standards across settings and states. PHI has championed this approach for decades as the foundation of a more consistent and connected workforce infrastructure. 

The bill would also direct the Secretary of Health and Human Services to convene an Advisory Council to develop a national direct care compensation strategy, including reimbursement rates, federal investments, and related actions needed to achieve livable, competitive wages across the field. 

The HCBS Access Act complements these workforce reforms by making HCBS a mandatory Medicaid benefit and directing substantial new resources to the direct care workforce, including measures to improve pay and benefits, expand recruitment and retention programs, and support states in building the infrastructure needed to deliver quality services at home. 

“Quality care depends on quality jobs,” Robins added. “By investing in the direct care workforce through better training, better compensation, and better access to services, these critically important bills move us closer to a care system that works—for workers, for families, and for the individuals they support.” 

PHI extends our gratitude to Representative Dingell and her colleagues for their continued leadership on these critical issues, and we look forward to working alongside them, our partners, and advocates across the country to advance these bills through Congress.

The post PHI Endorses Reintroduction of the Long-Term Care Workforce Support Act and the HCBS Access Act appeared first on PHI.

Background: Federal Policy Changes Threaten to Reverse Progress

In 2025, the DOL proposed a rule that would reverse a decade of progress under the Fair Labor Standards Act (FLSA) by reinstating an exemption that once denied home care workers the right to minimum wages and overtime pay. The DOL’s proposed rollback would  effectively deem home care work unworthy of the labor rights extended to virtually every other American worker. On top of the proposed rulemaking, the DOL has already instructed its field staff to stop enforcing home care workers’ existing FLSA protections while the rule is pending.

What Oregon’s Law Does

While Oregon’s home care workers already had stronger labor protections than federal law affords, the state’s  2015 Domestic Workers Protection Act referenced federal definitions that the DOL’s proposed rule could undermine. SB 1518 fixes that vulnerability by decoupling Oregon’s minimum wage and overtime protections for home care workers from any new federal definitions. This new state law now ensures that home care workers retain the right to at least Oregon minimum wages and overtime pay, regardless of changes at the federal level. The new law also provides clarity for employers and for the Oregon Bureau of Labor and Industries in enforcing these labor rights—an especially important focus in the highly dispersed home care industry.

Guaranteeing fundamental labor rights for home care workers is critical to the future of care. PHI’s testimony in support of SB 1518 noted that Oregon will need to fill more than 70,000 total openings in home care between 2022 and 2032, while workers in this field continue to face serious economic insecurity and poor job quality. Stripping minimum wage and overtime protections from Oregon’s home care workers would have only deepened that precarity.

Preserving minimum wage and overtime rights will not in itself solve workforce challenges in Oregon, but this law does establish a crucial foundation upon which to build quality home care jobs, and recruit and retain a workforce capable of providing quality home-based care to older adults and people with disabilities across Oregon. The bill also sends a clear message rejecting the DOL’s misguided assertion that home care workers’ essential labor does not deserve the same basic recognition and respect as other work. Oregon correctly recognizes that valuing workers and ensuring access to care are not competing goals; they are interdependent.

A Model for Other States

Oregon’s home care workers are not alone in facing a threat from the DOL’s proposed rollbacks. Several states do not have their own minimum wage and overtime protections at all, or they exclude home care workers from these protections. Other states share the same vulnerability that Oregon addressed with this law: cross-references to federal definitions that could be weakened by federal rulemaking. Oregon’s approach of affirmatively extending state minimum wage and overtime protections to home care workers offers a straightforward and replicable model.

PHI asks state lawmakers across the country to determine whether their home care workers have state-level minimum wage and overtime protections in place that are distinct from federal law. If not, it is crucial to take steps (like D.C.’s B26-0653 and Virginia’s HB238) to ensure that home care workers’ labor rights are protected under state law, while we all continue to advocate for the federal protections that are also needed (like the Fair Wages for Home Care Workers Act, H.R.7917/S.4081). No state will be able to build a successful care system if direct care workers lack basic, fundamental labor protections and respect and recognition for their contributions. The essential workers who enable older adults and people with disabilities to live safely in their homes and communities deserve nothing less than the same rights already afforded to all other workers.

The post Oregon Acts to Ensure Fundamental Labor Rights for Home Care Workers appeared first on PHI.

Misclassification is a Significant Job Quality Issue for Home Care Workers 

As documented by the National Employment Law Project, most home care workers at home care agencies do not operate as independent contractors. Instead, they have all the hallmarks of an employee: they perform work that is integral to their agencies’ core business and generally have little ability to set their own duties, hours, or wages, among other factors.  

Yet some agencies require workers to sign independent contractor agreements as a condition of employment. That enables the agencies to gain a competitive advantage by charging lower rates and/or offering higher wages—but only by shifting the costs of payroll taxes, insurance, and legal obligations to their workers.  

For workers, being misclassified as an independent contractor means losing access to employee benefits and protections, such as minimum wage and overtime rights, unemployment insurance, workers’ compensation, employer-provided health insurance, paid leave, and anti-discrimination protections. As noted, independent contractors also assume the full burden of payroll taxes—paying both the employer and employee shares. 

The Economic Policy Institute estimates that misclassification costs home health and personal care aides between $7,229 and $10,247 per worker per year in lost compensation and benefits. In an occupation where the median annual wage is only $22,429, that represents a devastating loss. 

The Scale of the Problem 

While the full measure of this issue is difficult to determine, a 2021 study found that nearly 13 percent of personal care aides nationally were classified as independent contractors, with considerable variation by state. While not representing misclassification in every case, this figure highlights the prevalence of independent contractor status among home care workers and their potential risk of misclassification.  

Misclassification enforcement actions also underscore how widespread this issue is in home care. Maryland’s Joint Enforcement Task Force on Workplace Fraud reported in January 2026 that state agencies had identified almost 8,000 misclassified workers statewide and uncovered more than $174 million in total unreported wages, with home care identified as one of the sectors where misclassification is particularly common. 

In a 2025 investigation, the U.S. DOL found that two Louisiana home care companies had misclassified nearly 160 workers in total, failing to pay over $422,000 in overtime wages. And in a case last year, California’s attorney general secured a $10 million judgment against an in-home caregiving company whose workers were sometimes paid as little as $5 per hour for 24-hour shifts, due to their misclassification as contractors. 

The transfer of costs and risks from employers to home care workers harms those who already earn some of the lowest wages in the U.S. economy. Furthermore, misclassification doesn’t just impact the workforce—it destabilizes an already fragile care system. When home care workers lose basic protections, recruitment and retention suffer, turnover accelerates, and access to much-needed care erodes for individuals and families. 

This Proposed Rule Would Make Misclassification Worse 

The specific details of the DOL’s proposal are particularly harmful for the home care sector. Under the current approach to classifying an employee, the fact that home care workers perform work that is integral to a home care agency’s business, have ongoing relationships with the agency, and depend on the agency for training all weigh strongly towards full status as employees. The DOL’s new proposal would demote these considerations to secondary status that can be overridden by other factors (like scheduling flexibility)—even if the home care agency is acting like a traditional employer by assigning clients, setting pay rates, and managing the scope of work.  

What You Can Do 

Join PHI in submitting comments on this proposed rule by April 28, 2026. The DOL has explicitly requested comments on the consequences of this proposed change on industries, like home care, that are more likely to rely on independent contractors than many other industries. It is important for policymakers to hear the voices of direct care workers, advocates, and the older Americans and people with disabilities and chronic illnesses receiving home care. Please feel free to use claims and content from this article in your comments. 

Read PHI’s full comments here.

Support state-level protections, oversight, and enforcement of misclassification. Whatever happens at the federal level, state laws can and do provide employment safeguards. Advocates should urge their state legislatures to adopt or strengthen worker classification standards, oversight, and enforcement. New Jersey is an example: the state’s Task Force on Employee Misclassification catalyzed an effort to tighten rules and enforcement, leading to a misclassification enforcement program that has assessed more than $10.6 million in penalties to be paid directly to over 12,500 misclassified workers since 2021. Focused more specifically on home care, Maryland’s Homecare Workers Rights Act requires all Medicaid home care providers to classify their home care workers as employees. As noted, Maryland has also established a Joint Enforcement Task Force on Workplace Fraud that brings together multiple state agencies for coordinated investigations and data sharing.

A Call to Protect Direct Care Workers 

For more than 30 years, PHI has documented the connection between direct care job quality and the strength of our long-term care system. This proposed rule threatens that connection by rolling back another layer of labor protections from this workforce, even as demand for these workers continues to rapidly grow—which is not just unjust, but irrational. PHI urges the DOL to withdraw this proposal and instead pursue policies that value direct care workers as the essential employees they are.  

The post A New Federal Proposal Would Further Undercut Home Care Workers’ Labor Rights appeared first on PHI.

We share the goal of ensuring Medicaid funds are used appropriately and that beneficiaries receive the care they need.

The letter emphasized the value of the federal-state partnership that drives Medicaid. PHI believes that such a partnership—when pursued in good faith—is essential for the quality of direct care jobs, and the quality of care for older adults and people with disabilities.

Unfortunately, CMS’s letter names the growth of the home care workforce in New York as an area of concern—instead of recognizing that workforce growth is driven by real demand. As PHI has long recognized, the growing population of older adults, combined with people living longer, often with complex conditions, is increasing demand for direct care workers —not just in New York but across the country—and will continue to drive growth for decades to come.

Focusing on the size of the workforce as a challenge to be addressed through federal investigation misses a real opportunity to invest in direct care workers. Strengthening workforce training, wages, and opportunities for advancement are the most effective ways to strengthen workforce recruitment, reduce turnover, improve care delivery and outcomes, and ultimately reduce costs to the system.

Home care workers are among the most underpaid and under-supported members of the labor force. In New York, the median wage for personal care and home health aides is just $18.26 per hour, a wage so low that 41 percent of these workers live in or near poverty and 61 percent draw on public assistance to make ends meet.

In the spirit of the essential federal-state partnership that sustains Medicaid, our hope is that New York State and the federal Administration will work together to ensure New York’s Medicaid program is supported by strong program integrity tools, provider credentialing, and robust oversight mechanisms. This effort must also recognize that a well-trained, fairly compensated, and properly credentialed direct care workforce is essential for quality care. By contrast, penalizing workers, creating unnecessary barriers to care, and destabilizing programs that support community living will only serve to shift costs—and suffering—elsewhere.

See recent Associated Press coverage of this story here for more information:  https://apnews.com/article/oz-medicaid-new-york-fraud-investigation-a00bd997ee5b8d839254144377c3b167.

The post PHI Statement on CMS Letter to New York State Regarding Medicaid Program Integrity appeared first on PHI.

The State of New Jersey Direct Care Workforce Strategic Plan is the product of a year-long collaboration facilitated by PHI through the Direct Care Workforce Strategies Center’s technical assistance program. The plan was heavily informed by collective input, including from the Essential Jobs, Essential Care New Jersey coalition, a diverse group of more than 100 organizations across the state, co-led by PHI and the New Jersey Health Care Quality Institute. As Governor Mikie Sherril begins her term, this plan serves as a blueprint for how the state can tackle the direct care workforce crisis.

Why this plan matters

The new strategic plan documents the scale of the direct care workforce challenges facing New Jersey. Across the state, the need for care and support is rising precipitously. For example, according to American Community Survey data, the number of residents with disabilities in the state reached over one million in 2023, and the plan notes a nearly 200 percent increase in individuals seeking to enroll in developmental disabilities services.

At the same time, the direct care workforce faces persistent job quality challenges. New Jersey’s direct care workers earn a median annual income of just $27,889. More than a third rely on public assistance programs, and 43 percent lack access to affordable housing. Poor job quality is driving workers to leave the field for other industries (like retail and fast food) and preventing employers from recruiting the workers they need to meet rising demand. These job quality challenges also exacerbate existing inequities as the workforce is predominantly female (86 percent) and people of color (82 percent), while more than half are immigrants.

The plan highlights significant growth for home health and personal care aide employment in New Jersey, putting a spotlight on growing demand as this workforce increased 76.8 percent between 2019 and 2023—from 57,060 to 100,860 jobs, and outpaced national growth during that same period. The state also implemented six wage increases for direct support professionals during former Governor Murphy’s eight-year Administration, totaling $6.50 per hour.

A Three-Pronged Approach

The strategic plan organizes more than 40 strategies into three categories:

• Gathering Data and Input: The plan emphasizes the need for better workforce data and ongoing engagement with workers, employers, and care recipients. Strategies include hosting ongoing listening sessions, establishing a Direct Care Worker Advisory Board, incentivizing participation in existing surveys, and advocating for the inclusion of direct support professionals in the federal Standard Occupational Classification system.
• Recruitment—Attracting Talent and Building Educational Pathways: Recruitment strategies focused on raising awareness of direct care careers, streamlining licensure processes, expanding training programs, and developing clear career pathways. A centerpiece recommendation calls for developing a universal training and certification system with stackable credentials, to allow workers to transfer skills across care settings and roles.
• Retention—Creating a Sustainable and Rewarding Workplace: Retention strategies address compensation, benefits, career advancement, and workplace supports. The plan recommends exploring structures for consistent wage increases tied to experience or qualifications, providing essential supports like transportation and childcare, and partnering with higher education institutions to create advancement opportunities.

The plan also includes nine employer-focused strategies that providers can implement to improve job quality, including establishing employee resource networks, providing mental health support, and creating internal career ladders.

“If we want New Jerseyans to live and age in their community with dignity, stability, and choice, we must ensure the workers who make that possible have the support, respect, and opportunities they deserve. This strategic plan reflects what we heard directly from families, workers, and providers across the state, and it outlines actions that will strengthen pathways into the field and better support workers on the job.” – Sarah Adelman, Former Commissioner of the New Jersey Department of Human Services

Looking Ahead

The plan acknowledges that addressing the direct care workforce crisis will require sustained effort and investment. “While each strategy on its own makes an impact,” the plan notes, “a concerted effort to address the specific needs of the direct care workforce requires a systematic approach in which State agencies and other stakeholders work together to identify gaps and implement solutions.”

The strategic plan is ultimately a roadmap: it pairs concrete strategies with time horizons and identifies where outreach, policy changes, incentives, training, and technical assistance will be required. With Governor Mikie Sherrill’s administration, PHI will be working with state officials, the Essential Jobs, Essential Care New Jersey Coalition, and advocates across New Jersey to advance these strategies that treat direct care as the essential, skilled work it is.

The post New Jersey Releases Strategic Plan to Strengthen the Direct Care Workforce appeared first on PHI.

This ill-conceived change comes via an interim final rule issued to repeal the minimum staffing standards for long-term care facilities established in 2024.

This week, PHI submitted formal comments to CMS strongly opposing this change and urging the agency to withdraw the rule. The repeal abandons standards that were decades in the making—and long-advocated for by PHI.  It ignores overwhelming evidence that links adequate staffing directly to the quality of care residents receive. Furthermore, it fails to offer any viable alternative to ensure the safety and well-being of the nursing home workforce and the residents they support.

A Misdiagnosis of the Workforce Crisis

CMS justifies this rollback by citing workforce shortages, arguing that facilities are unable to meet staffing mandates due to a lack of available labor. However, this rationale fundamentally misinterprets the nature of the crisis.

The challenge facing long-term care is not a shortage of workers, but a crisis of recruitment and retention driven by inadequate wages, unsustainable workloads, and poor job quality. When nursing assistants face unsafe workloads and insufficient compensation, the result is extraordinarily high annual turnover–estimates range from 40 to nearly 100 percent. This means that a typical facility must replace half to nearly its entire nursing assistant workforce every year.

Eliminating minimum standards will not solve this problem. Instead, it effectively guarantees that—until more responsive policies are enacted—the cycle of understaffing, burnout, and attrition will continue unabated, harming both staff and residents.

A Flawed Process

The 2024 Final Rule was grounded in robust research and advocacy from experts across the field. Reversing course through an interim final rule repeals a set of standards developed with robust public input and overwhelming support without engaging in that same discourse and process. Of graver concern: The standards CMS just repealed would have saved approximately 13,000 lives annually. Moving to repeal these protections without a replacement will result in the preventable deaths of thousands of nursing home residents every year.

Job Quality, Not Repeal

The 2024 Final Rule was a historic step toward ensuring safe, high-quality care. The solution to high turnover is to improve job quality, not to ignore staffing standards. Removing regulatory pressure will only reduce the incentive for facilities to invest in their workforce and provide the transparency that is critically needed.

Instead of abandoning worker protections, CMS should be leading a coordinated effort across federal, state, and employer levels to improve job quality. By strengthening recruitment and retention, we can achieve the safe staffing levels required to deliver high-quality care.

To erase minimum staffing standards without a viable alternative is to accept an unacceptable status quo.

Read our full comments to CMS here.

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In response, Maine’s Essential Care & Support Workforce Partnership brought experts from across the state together into three working groups—focused on 1) wages and benefits, 2) credentialing and training, and 3) technology. Each group developed targeted recommendations to address the challenges facing Maine’s direct care workforce. As detailed below, these recommendations informed an omnibus bill championed by Speaker Ryan Fecteau that will be taken up in Maine’s current legislative session.

Working Groups and Their Recommendations

1. Wages & Benefits and General Working Conditions

This working group addressed one of the most pressing challenges facing the direct care workforce: low pay and benefits. They focused on ways to increase total compensation (not just wages, but also the hours available to workers), to help with access to needed benefits, and to improve working conditions to make essential care and support work more attractive and sustainable.

The Working Group’s recommendations include:

• Increase wages by raising the labor portion of the MaineCare reimbursement rate to 140% of the state minimum wage. Since the vast majority of direct care services are funded through the MaineCare program, the state can meaningfully improve job quality for thousands of direct care workers by increasing payments to providers (like home health agencies) and ensuring that payment increases make their way into workers’ pockets. This would be particularly impactful for the nearly one-third of direct care workers in Maine living in poverty, and the 42 percent relying on public benefits.
• Establish a Direct Care Professional Monthly Benefit Stipend, allowing workers to apply for financial assistance to help pay for the benefits most important to them. This state-created fund would help workers access benefits like healthcare, retirement, childcare, transportation, and educational expenses.
• Create a centralized resource hub to help workers and employers access assistance programs available from the state and their local communities. Even though many direct care workers are eligible for existing benefits, many are not enrolled in them. This state-run hub would help connect the dots.

2. Improving Credentialing & Training

This working group identified how Maine’s fragmented credentialing and training system creates significant barriers to entering the direct care workforce and finding opportunities for career mobility and advancement. Currently, workers do not have the stackable and portable credentials that would allow them to move between settings or move up a career ladder.

The Working Group’s recommendations include:

• Establish a Universal Standardized Core Curriculum that ensures consistency across training programs, improves worker preparedness, and facilitates career mobility. To do this, Maine should create a stakeholder group to oversee reforms, bringing together representatives from state agencies, higher education, providers, workers, and care recipients. Focus particularly on reducing redundant training requirements and certifications while improving the applicability and quality of workers’ training.
• Expand the capacity of education and training providers to reduce wait times for training.
• Increase accessibility through multilingual training options and flexible training schedules. This will allow more people to access and succeed in training.

3. Utilizing Technology to Bridge the Gap

This working group looked at ways to use technology to streamline workforce deployment and scheduling, support people who are currently not being served by Maine’s long-term care system, and enhance the efficiency of the workforce. Their central aim was to advance the use of technology to alleviate workforce shortages and improve service delivery.

Their primary recommendation was to require Maine’s Department of Health & Human Services to develop a Technology Plan to maximize direct care workforce job quality, and the quality and efficiency of care for older adults and people with disabilities.

The Maine Essential Care & Support Workforce Enhancement Act

Integrating recommendations from these three working groups, Speaker Ryan Fecteau introduced the Maine Essential Care & Support Workforce Enhancement Act in 2025. The bill, which has been carried over from last session and will be taken up at a hearing today (January 20), is an omnibus measure designed to more comprehensively address Maine’s direct care workforce shortage. If enacted, the bill would:

1. Raise Wages… by setting the labor portion of MaineCare reimbursement rates to 140% of the minimum wage and making a wage floor of 125% of the minimum wage for all essential care and support workers.
2. Develop a Universal Training and Credentialing System… establishing a stakeholder-driven process to design a universal, standard core curriculum, high-quality training programs, and credentials that ensure a streamlined, more accessible, and competency-based system.
3. Create a Technology Plan… requiring the state to create an Innovations in Care and Support Technology Plan, positioning Maine to harness technological advancements to support direct care workers and improve service delivery.
4. Expand the Advisory Committee… requiring the membership of the Essential Support Workforce Advisory Committee to include a broader range of stakeholders.
5. Begin Comprehensive Data Collection and Reporting… by directing the Maine Health Data Organization to identify gaps in workforce data and to develop a plan to measure and report on the total scope of unmet care needs in the state.
6. Budget for All Care Needs… by requiring the annual MaineCare budget to account for the estimated 23,500 hours of weekly authorized care that currently go unfilled, ensuring future budgets reflect the actual demand for services.

A Path Forward

While Maine has been developing this framework, the federal administration has begun a major shift toward deregulation and federal spending cuts that directly threaten the stability of the direct care workforce nationwide—placing further burden on individual states and long-term care providers to maintain existing service levels.

The recommendations from Maine’s Essential Care & Support Workforce Partnership have given the state a clear framework for recruiting and retaining the direct care workforce Maine’s people and economy desperately need. In the Maine Essential Care & Support Workforce Enhancement Act, the state has a legislative vehicle to take action. Based in the realities faced by workers and care recipients, the bill would raise wages, improve training and credentialing, and harness technology, and it would represent a significant step towards closing Maine’s care gap. If legislators pass this bill, it will help make Maine a leader in building the resilient, well-supported direct care workforce the state needs now and, especially, in the years ahead.

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