Medicaid-funded home- and community-based services make it possible for people with disabilities and older adults to live in their own homes and communities, where most people prefer to live. A long-standing direct care worker shortage, caused by low pay and poor working conditions and worsened by the COVID-19 pandemic, threatens access to direct care. State and local governments are innovating to respond to the care crisis. This brief highlights a selection of state best practices to improve wages for direct care workers in Medicaid-funded HCBS programs and help solve the workforce crisis. By raising wages, providing good benefits, and increasing job quality for direct care workers, who are disproportionately women and women of color, states can start to build a direct care system in which all consumers, workers, and families can thrive.
