New Policies and Programs for Direct-Care Workers
Research conducted by RTI International for the Office of the Assistant Secretary for Planning and Evaluation found that federal and state governments implemented policies aimed at improving DCW recruitment and retention during the pandemic.
For example, some states used funds from the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act and other state funding to increase Medicaid payment rates for home care services. Some of these states intended for the funds to help home care agencies temporarily provide workers with add-on pay, hazard pay, and retainer payments to help overcome disruptions in care. Our policy scan found that 27 states implemented retainer payments and 19 states used add-on or hazard pay for workers. Some states specified the amount of the wage increase and detailed the types of staff it covered.
To ease entry into the workforce, 32 states temporarily modified policies related to staff training, qualifications, or duties, including delaying some pre-employment requirements. These changes also expanded home care agencies' ability to provide virtual training for staff.
In addition, the American Rescue Plan Act (ARPA) has temporarily increased the federal medical assistance percentage—the share of Medicaid expenditures paid by the federal government—for certain home and community-based services. One goal of ARPA is to strengthen the direct-care workforce through improved wages and training, and many state plans for ARPA funds include this goal. These plans are just beginning to be rolled out by states, so their effect on DCW recruitment and retention is unknown. Research and evaluation are needed to determine which state plans have the greatest success so that other states can replicate those models. Of course, this assumes that policies and programs implemented using ARPA funds have staying power after funding ends.