PHI

06/19/2026

Today, marks 161 years since the last enslaved people in Galveston, Texas, learned of their freedom, more than two years after the Emancipation Proclamation had been signed. The day has always carried a dual meaning: a celebration of liberation, and an accounting of how long this country made freedom wait. For PHI, it is also a day to reflect on how that history lives on in the direct care workforce.

Nearly one in three direct care workers in this country is Black. That representation is not incidental. After emancipation, domestic and care work was among the few occupations open to Black women, and that labor was systematically devalued from the start. When Congress established the nation's foundational labor protections in the 1930s, domestic workers (a workforce composed largely of Black women) were deliberately excluded from minimum wage, overtime, and collective bargaining rights. It took over 75 years for home care workers to win basic rights—and today, those protections face significant risk of being lost again.

Juneteenth asks us to hold both celebration and accountability. PHI celebrates the skill, expertise, and leadership of Black direct care workers. And we dedicate our work to what that sense of accountability demands: producing research documenting disparities in this workforce, advancing policies that raise compensation and strengthen protections, and elevating the voices of direct care workers in shaping the future of this sector. Honoring the day means building a long-term care system where the people who provide care are compensated, protected, and recognized in full measure of their worth.

Read our full statement here:

This Juneteenth marks 161 years since the last enslaved people in Galveston, Texas, learned of their freedom, more than two years after the Emancipation Proclamation had been signed. The day has always carried a dual meaning: a celebration of liberation, and an accounting of how long this country ma...

06/15/2026

This , PHI proudly recognizes the LGBTQ+ community and recommits to championing the conditions that allow every person to live, work, and age with dignity. Across the long-term care field, this shared commitment is vital. LGBTQ+ people are an essential part of the direct care workforce that makes this care possible, and a growing share of those who rely on it. Fostering supportive, equitable workplaces is inseparable from delivering quality care.

Read our full statement here: https://www.phinational.org/this-pride-month-inclusion-is-inseparable-from-quality-care/

05/20/2026

Last week, the Centers for Medicare & Medicaid Services (CMS) deferred $1.3 billion in Medicaid reimbursement payments to California and issued warning letters to all 50 states.

Strong program integrity is critical to Medicaid, but withholding funding from a state Medicaid program is a blunt instrument that puts care itself at great risk.

At PHI, we are concerned by narratives that conflate the necessary expansion of the home care sector with systemic abuse. The rapid growth of the direct care workforce across the country is driven by surging demographic demand. Our growing population of older adults and people with disabilities increasingly requires paid care, and the majority of people prefer to receive services at home.

Read PHI’s full statement here.

The Centers for Medicare & Medicaid Services has deferred $1.3 billion in Medicaid reimbursement payments to California, while issuing a six-month national moratorium on new Medicare enrollments for home health and hospice agencies and sending warning letters to all 50 states. These measures represe...

05/18/2026

Across the country, direct care workers do skilled, demanding, and deeply relational work supporting older adults and people with disabilities. Yet their essential contributions are persistently overlooked and undervalued. Training varies widely by state, setting, and employer. Career mobility is limited, and advancement opportunities are rare. Wages hover near the poverty level, regardless of skills and experience.

The status quo cannot hold.

In our latest piece for Generations Journal, PHI's Kezia Scales, Emily Dieppa Colo, and Jodi M. Sturgeon introduce the PHI Universal Direct Care Workforce Model. By establishing universal competencies, portable credentials, and clear career pathways, we can turn a disjointed landscape into a thriving caregiving ecosystem. A well-prepared, stable workforce strengthens care access and quality for everyone who relies on it.

Learn more about our transformative vision for the future of direct care and how we are building the evidence base through demonstration projects in Wisconsin, New York, and a growing number of other states: https://generations.asaging.org/putting-the-pieces-together/

05/14/2026

In 1938, the Fair Labor Standards Act granted minimum wage and overtime protections to most American workers, but deliberately excluded domestic workers—predominantly Black women. It was a choice grounded in both racism and sexism, and home care workers lived with the consequences for 75 years.

It took until 2015 for the home care workforce to finally gain the same basic labor protections that most American workers take for granted.

Yet the Department of Labor now proposes to strip home care workers of the right to minimum wage and overtime pay, devaluing their labor and demeaning their skilled contributions to families, communities, and the economy.

As PHI's Jodi M. Sturgeon writes in her latest opinion piece, this rule risks "devaluing their labor and demeaning their skilled contributions to families, communities, and the economy."

"The solution to the growing care gap is to improve jobs, not eliminate worker protections. This is not a debate about labor regulations. It is a debate about what we owe the people who need support and the people who provide it."

Read the full piece on why we must protect these hard-won rights:

A critical challenge facing home care in the United States dates back to 1938, when Congress passed the Fair Labor Standards Act. The law granted minimum wage and overtime protections to most American workers, but deliberately excluded domestic workers—predominantly Black women. It was a choice gr...

05/07/2026

By January 1, 2027, all states that have expanded Medicaid must impose "community engagement requirements"—more commonly known as work requirements—as a condition of Medicaid coverage for the expansion population.

Approximately one-third of the nation's 5.4 million direct care workers rely on Medicaid for their own health coverage. Because of the unique characteristics of their jobs—variable hours, employment disruptions, verification challenges, and family caregiving responsibilities—many will face heightened barriers to comply with or prove their compliance with the 80-hour requirement, even when they are eligible.

Destabilizing this workforce—the largest single workforce across the country—will have ripple effects across the long-term services and supports system, the broader health care system, the labor market, and state economies overall.

States hold significant ownership over program design and implementation. A new PHI policy brief outlines practical strategies for state leaders and advocates to meet the federal requirements while minimizing unnecessary coverage loss: maximizing exclusions, adopting streamlined reporting systems that leverage existing data sources, and investing in targeted outreach and support.

Read our full brief here:

The budget reconciliation act of 2025 (HR 1) mandated that all states which have expanded Medicaid impose community engagement requirements—more commonly known as work requirements—as a condition of Medicaid coverage by January 1, 2027. Because approximately one-third of the nation’s 5.4 milli...