This issue brief examines how Medicaid expansion affects healthcare coverage for direct care workers - including personal care aides, home health aides, and nursing assistants who provide essential support to older adults and people with disabilities. The research shows that in the 10 states that have not expanded Medicaid, nearly 80,000 direct care workers fall into a coverage gap where they earn too much to qualify for Medicaid but too little for marketplace subsidies.
Key Takeaways
Nearly 80,000 direct care workers fall into the healthcare coverage gap in states that haven't expanded Medicaid, with workers in non-expansion states almost three times more likely to be uninsured compared to expansion states.
Expanding Medicaid in the remaining 10 states would extend healthcare coverage eligibility to approximately 147,561 direct care workers, including both those currently in the coverage gap and those who would become newly eligible.
The current coverage gap creates an unsustainable situation where direct care workers, who perform physically demanding healthcare work with high injury rates, cannot access healthcare for themselves, impacting both worker wellbeing and care quality.
About The Author
Lina Stepick (they/them)
Director of Research
As Director of Research, Lina supports PHI’s strategy for building the evidence base on state and national policies and workforce interventions that improve the quality of direct care jobs and the quality of long-term services and supports for older adults and people with disabilities.
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This issue brief examines how Medicaid expansion affects healthcare coverage for direct care workers - including personal care aides, home health aides, and nursing assistants who provide essential support to older adults and people with disabilities. The research shows that in the 10 states that have not expanded Medicaid, nearly 80,000 direct care workers fall into a coverage gap where they earn too much to qualify for Medicaid but too little for marketplace subsidies. 