Washington, D.C. — A federal advisory panel is calling on Congress to take a direct role in fixing the long-term care workforce shortage — and the fix it’s proposing starts with something surprisingly simple: knowing what caregivers are actually paid.
The Medicaid and CHIP Payment and Access Commission released its March 2026 Report to Congress this week, recommending that states be required to publicly report the hourly wages paid to home- and community-based services workers. The goal is to give state Medicaid programs better data to set competitive payment rates — and, ultimately, to slow the revolving door of caregivers leaving the profession.
“Improving wage transparency for people who deliver care in home-and community-based settings will help states strengthen this vital workforce,” said MACPAC Chair Verlon Johnson. “This report also gives federal and state policymakers valuable insights into behavioral health use and spending in Medicaid and CHIP, as well as how Medicaid can meet the needs of some of the most vulnerable people it serves.”
A Workforce Problem Hiding in Plain Sight
The commission’s report points to a straightforward problem: states can’t pay competitive wages if they don’t know what competing employers are paying. Right now, most states lack reliable data on what home-and community-based services workers earn — which makes it nearly impossible to calibrate Medicaid reimbursement rates high enough to keep workers in the field.
That gap has real consequences. According to the report, workforce shortages are already limiting Medicaid’s ability to serve older adults and people with disabilities who need long-term care at home or in community settings. As demand grows and the workforce shrinks, pressure mounts across the entire post-acute care system — including skilled nursing facilities, which compete directly with home care agencies for CNAs, aides, and support staff.
Under MACPAC’s recommendation, states would collect and report hourly wage data for HCBS workers in specific service categories. States would also gain access to wage comparison data from neighboring states, giving them a clearer benchmark when setting payment rates. The theory is that more data leads to better decisions, which leads to better wages, which leads to fewer workers walking out the door.
Part of a Larger Picture
The workforce issue doesn’t exist in isolation. Nursing homes across the country are already feeling the strain from proposed federal staffing standards and the political battles surrounding them, and HCBS expansion has long been positioned as a way to divert residents away from institutional care. But if home-based care can’t staff up either, that alternative gets harder to deliver.
Beyond the workforce chapter, the March 2026 report covers behavioral health utilization in Medicaid, care transitions for justice-involved youth, and access to care for children in foster care — a broad policy agenda that reflects MACPAC’s role as a nonpartisan advisory body.
The commission submits reports to Congress twice each year. While its recommendations are advisory, they carry weight with policymakers who use them to shape Medicaid legislation and regulations.
Whether Congress acts on the wage transparency recommendation remains to be seen. But with workforce shortages tightening across every corner of long-term care, the pressure to get this data — and do something with it — is only going to grow.
