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Size of Workforce: Totaling approximately 12,000 workers, Montana’s direct-care workforce provides daily services and supports to elders and individuals with disabilities who need assistance with personal care and other daily activities. Direct-care workers fall into three main categories tracked by the U.S. Bureau of Labor Statistics: nursing aides, home health aides, and personal care aides. Personal care aides include workers with many other titles—for example, personal attendants, direct support professionals, and home care aides. The estimates shown below for each occupation may heavily undercount independent providers hired directly by households.

Occupational Growth: Direct-care workers constitute one of the nation’s largest occupational groupings. Moreover, across the country, direct-care jobs are among the fastest growing occupations and those expected to produce the largest numbers of new jobs over the coming decade. In Montana, demand for direct-care worker positions is expected to increase by 19 percent from 2008 to 2018. In contrast, jobs overall are expected to increase by only 11 percent. Direct-care workers employed in home and community-based settings are a growing segment of Montana’s workforce in both size and significance.

Median Wages: Direct-care workers in Montana earn significantly less than the average wage across all occupations in the state. Furthermore, wages for Personal Care Aides and Home Health Aides fall below 200 percent of the 2009 federal poverty line for a single individual working full time ($10.42). The 200 percent poverty level is low enough to qualify households for many state and federal assistance programs.

Wages Adjusted for Inflation: Over the past decade, inflation-adjusted median hourly wages for Nursing Aides, Orderlies, and Attendants in Montana increased by 12 percent, from $7.71 to $8.66. Real wages for Personal Care Aides increased by 22 percent while those for Home Health Aides remained virtually unchanged.

Health Insurance: Compared to the national civilian workforce, significantly more of Montana’s direct-care workers are uninsured. Because of low wages, direct-care workers often have difficulty affording private health insurance coverage; however, many earn too much to qualify for Medicaid.

Employer-Sponsored Insurance: Compared to the national civilian workforce, significantly fewer of Montana’s direct-care workers have access to and use employer-sponsored insurance. Some work for employers that do not offer health insurance. Others work for employers that limit eligibility for health insurance to full-time employees. This creates a barrier for many direct-care workers, especially those in home and community-based settings, who often work only part-time due to the episodic nature of direct-care work. Even workers who do have access to insurance from their employer may find the co-pays and premiums unaffordable.

Public Assistance: Thirty-five percent of direct-care worker households in Montana rely on some form of means-tested public assistance, particularly Medicaid or food and nutrition assistance. This reliance reflects the generally poor quality of direct-care jobs in terms of wages and benefits, and the part-time nature of many direct-care jobs.

Legislation/Regulation

HB 625: This bill appropriates funds which must be used to provide a wage increase of 50 cents per hour, including benefits, to direct-care and ancillary workers in fiscal year 2012 and to maintain the wage increase in fiscal year 2013. (Enrolled April 2011)

HB 2: This bill included an amendment that appropriates funding for a time-limited pay increase or lump sum bonus for direct-care workers employed by Medicaid-funded nursing homes and community-based services. (Engrossed May 12, 2011)

Notable Initiatives

Health Care for Health Care Workers: This program run by the Montana Department of Public Health and Human Services provides reimbursement to providers who offer health insurance to their direct care workers.

Resources

Healthcare for Montanans Who Provide Healthcare: A Case Study: This case study describes the process implemented to pass the Health Care For Montanans Who Provide Healthcare initiative as well as lessons learned.

Montana Highlights: A Model Providing Health Insurance for Direct Care Workers that is Linked to Medicaid Reimbursement Rates (pdf): This 2010 resource from the Muskie School of Public Service describes Montana’s strategy of linking payment of direct-care workers’ health insurance to Medicaid reimbursement rates.

ABOUT THE CENTER: The PHI State Data Center provides state-by-state data and resources relating to nursing aides, home health aides, and personal care aides (including direct support professionals). These occupations are known collectively as the direct-care workforce (learn more).
DATA SOURCES: See our page on data sources and definitions.
CONTACT: For more information or to suggest a resource for addition to this page, contact Abby Marquand, PHI policy research associate, at amarquand@phinational.org
CREDITS: The PHI State Data Center was developed with support from The SCAN Foundation and Centers for Medicare and Medicaid Services/National Direct Service Workforce Center.

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