Home care staffing shortages could worsen in the coming months and years as states struggle to absorb federal Medicaid cuts and respond to the loss of immigrant labor, as shown by KFF’s latest survey of Medicaid home care programs, in which all responding states (49 plus DC) reported shortages of home care workers and most states (41) reported permanent closures of home care providers within the last year.
Many states have responded to ongoing workforce shortages by allowing home care programs to pay and/or provide other supports to family caregivers. All responding states allow payments to family and friends through one or more optional waiver programs and all also reported covering respite care, among other supports.
Tighter state budgets could lead to cuts in pay for home care workers and family caregivers; and spur other reductions in the availability of home care services. Nearly all such services are optional and most states have managed costs through spending or enrollment limits. At least half a million people have sat on waiting or interest lists each year since 2016, with over 600,000 in 2025.
To learn more about Medicaid home care, read about it in KFF’s explainer on home- and community-based services (HCBS).
