State-by-state research

State Data

Every state page answers the same 100 questions across six categories — economic reality, workforce crisis, legal framework, geographic divide, state Medicaid toolkit, and federal FLSA status. We're building this database one state at a time, validated against primary sources.

Completed profiles

State pages

These states have 90+ metric profiles across six data categories. Tier 1 states have existing OT protections for home care workers.

Fully validated

Wisconsin

94.8% HCBS share (#1 nationally). 27.8% vacancy. Partial OT protections. $7.25 minimum wage.

Minnesota

84.0% HCBS share (#2 nationally). Full OT coverage. SEIU contracts. $11.41 minimum wage.

Cross-State Comparison

Side-by-side comparison of validated states across all six data categories.

Tier 1 — States with existing OT protections (14 states)

California

~700K IHSS workers. DWBOR (2013). SEIU 2015. $16.90 min wage. 47.5% HCBS share.

New York

623K+ DCW. First DWBOR (2010). CDPAP. 1199SEIU. $18.26/hr median. 76.6% HCBS share.

Washington

PHI #1. $19.50/hr median (highest nationally). SEIU 775. $17.13 min wage. 82.7% HCBS share.

Illinois

DWBOR (2016). SEIU $19.50/hr base. Paid Leave for All (2024). 49.4% HCBS share.

Massachusetts

PHI #6. 146,870 DCW. DWBOR (2014). 1199SEIU pathway to $25/hr. PFML. 77% HCBS share.

Connecticut

DWBOR (2015). SEIU 1199NE $23/hr min. CT Paid Leave. $16.94 auto-indexed min wage. 4% NF vacancy (lowest).

Oregon

PHI #3. $19.26/hr mean (#2). DWBOR (2015). SEIU 503. Paid Leave Oregon. 80.5% HCBS (99.4% of users).

New Jersey

PHI #5. DWBOR (2024). $18.92/hr LTC wage floor. NJ FLI/TDI. 1199SEIU.

Maryland

OT protections incl. live-in. $17.65/hr local max (Montgomery Co.). 69.5% HCBS share. FAMLI delayed to 2028.

Michigan

~225K DCW. Right-to-work repealed (2023). SEIU 32K members. ESTA sick leave restored. $16.92/hr median.

Hawaii

2nd state DWBOR (2013). Live-in workers covered. $16/hr min wage (2026). 14% healthcare vacancy. Island-geography challenges.

Nevada

DWBOR (2017). SB 511: $25/hr Medicaid reimbursement, $16/hr worker floor. 96% retention post-wage increase. SEIU 1107.

Pennsylvania

~242K workforce, near-50th in wages ($15.11/hr). $7.25 min wage (since 2009). 112K+ unfilled shifts/mo. CHC managed LTSS.

Vermont

Choices for Care 1115 waiver. ~75%+ HCBS share (top nationally). CPI-indexed $13.67 min wage. Rural workforce shortages.

Tier 2 — High-impact states without OT protections (35 states + D.C.)

Texas

PHI #51 (last). $7.25 min wage (federal floor). ~$13–14/hr median. No state OT law. STAR+PLUS HCBS. 90.2% LTSS users in HCBS.

Florida

~245K workforce. ~$14.63/hr median. 48K+ SMMC LTC waitlist. 60% immigrant workforce. No Medicaid expansion. 69.9% HCBS spending share.

Ohio

86K+ home care workers. ~50% PCA turnover. Haight v. Cheap Escape OT precedent. PASSPORT + MyCare Ohio. 93.3% HCBS user share.

Colorado

HB25-1328: $17/hr base wage, targeting $25/hr by 2028. COMPS Order daily OT. FAMLI paid leave. SEIU 105. ~60K direct care workers.

Georgia

~167K aides. ~$13.91/hr median (among lowest). No Medicaid expansion (Pathways waiver). Right-to-work. ~52% HCBS share. Atlanta vs. rural South Georgia divide.

North Carolina

~120K aides. ~$14.50/hr median. Medicaid expanded Dec 2023 (600K+ newly eligible). CAP/DA & Innovations waivers. ~48% HCBS share.

Virginia

~95K aides. ~$15.20/hr median. Medicaid expanded 2019. CCC Plus managed LTSS. Right-to-work repealed 2021. $12.41 min wage. ~58% HCBS share.

South Carolina

~50K aides. ~$13.50/hr median (near bottom nationally). No Medicaid expansion. Community Choices waiver. ~45% HCBS share. Right-to-work.

Tennessee

~78K aides. ~$14.20/hr median. TennCare block grant waiver (no traditional expansion). CHOICES managed LTSS. ~55% HCBS share.

Alabama

~38K aides. ~$12.80/hr median (among lowest nationally). No Medicaid expansion. E&D + SAIL waivers. ~40% HCBS share. Rural Black Belt gaps.

Indiana

~80K aides. ~$14.70/hr median. HIP 2.0 Medicaid waiver (2015). $7.25 min wage (federal floor). CHOICE & A&D waivers. ~53% HCBS share. Right-to-work.

Iowa

~38K aides. ~$15.10/hr median. Medicaid expanded 2014. IA Health Link managed care. $7.25 min wage. Severe rural gaps. ~56% HCBS share.

Kansas

~32K aides. ~$14.30/hr median. Medicaid not expanded (bipartisan attempts vetoed). KanCare MCOs. 80+ frontier counties. ~58% HCBS share.

Missouri

~72K aides. ~$14.50/hr median. Medicaid expanded 2021 (ballot initiative). $13.75 min wage. CDS self-directed program. Right-to-work repealed 2018. ~52% HCBS share.

Nebraska

~22K aides. ~$15.40/hr median. Medicaid expanded 2020 (ballot initiative). $13.50 min wage ($15 by 2026). Heritage Health MCOs. 75/93 rural counties. ~55% HCBS share.

Arkansas

~35K aides. ~$13.20/hr median. Medicaid expanded 2014 (Arkansas Works). $11.00 min wage. ARChoices & IndependentChoices waivers. ~62% HCBS share.

Kentucky

~45K aides. ~$14.80/hr median. Medicaid expanded 2014. HCB & Michelle P waivers. $7.25 min wage. Appalachian workforce gaps. Right-to-work (2017).

Louisiana

~55K aides. ~$12.90/hr median. Medicaid expanded 2016. No state min wage. Healthy Louisiana MCOs. Highest poverty rate nationally. ~48% HCBS share.

Mississippi

~28K aides. ~$12.50/hr (lowest nationally). No Medicaid expansion. No state min wage. MississippiCAN MCOs. ~35% HCBS (heavy NF reliance). Delta gaps.

Oklahoma

~42K aides. ~$13.80/hr median. Medicaid expanded 2021 (ballot SQ 802). SoonerSelect MCOs. ADvantage waiver. Tribal populations. ~55% HCBS share.

West Virginia

~18K aides. ~$13.90/hr median. Medicaid expanded 2014. $8.75 min wage. A&D + I/DD waivers. Highest Medicaid enrollment per capita. Appalachian crisis.

Delaware

~12K aides. ~$15.50/hr median. Medicaid expanded 2014. DSHP Plus managed LTSS. $13.25 min wage ($15 by 2027). PFML coming 2026. ~55% HCBS share.

Maine

~15K aides. ~$16.20/hr median. Medicaid expanded 2019 (ballot initiative). $14.15 CPI-indexed min wage. Oldest median age. Rural/island gaps. ~65% HCBS share.

New Hampshire

~12K aides. ~$16.50/hr median. Medicaid expanded 2014 (Granite Advantage). No state min wage. No income/sales tax. CFI waiver. ~58% HCBS share.

Rhode Island

~10K aides. ~$16.80/hr median. Medicaid expanded 2014. $14.00 min wage ($15 Jan 2025). TCI paid leave. Rhody Health Options MLTSS. ~55% HCBS share.

Washington, D.C.

~15K aides. ~$17.50/hr median. Medicaid expanded. $17.50 CPI-indexed min wage (highest). Universal Paid Leave. EPD/IDD waivers. 100% urban. ~70% HCBS share.

Alaska

~4K aides. ~$18.50/hr median. Medicaid expanded 2015. $11.73 CPI-indexed min wage. PCA/waiver programs. Extreme rural/frontier gaps. Highest cost of living. ~50% HCBS share.

Arizona

~65K aides. ~$16.20/hr median. AHCCCS (1982 Medicaid). $14.35 CPI-indexed min wage. ALTCS managed LTSS. Large tribal populations. ~65% HCBS share.

Idaho

~12K aides. ~$14.50/hr median. Medicaid expanded 2020 (ballot). $7.25 min wage (federal floor). Right-to-work. HCBS waivers. ~55% HCBS share.

Montana

~10K aides. ~$15.80/hr median. Medicaid expanded 2016. $10.30 CPI-indexed min wage. Big Sky Waiver. Frontier counties. ~55% HCBS share.

New Mexico

~22K aides. ~$15.20/hr median. Medicaid expanded 2014. $12.00 min wage. Centennial Care 2.0 managed LTSS. Mi Via self-directed. Tribal health. ~60% HCBS share.

North Dakota

~6K aides. ~$17.80/hr median. Medicaid expanded 2014. $7.25 min wage (federal floor). SPED/Aged waivers. Oil economy. Severe workforce shortage. ~50% HCBS share.

South Dakota

~8K aides. ~$15.50/hr median. Medicaid expanded 2023 (ballot). $11.20 min wage. CHOICES waiver. Tribal populations. ~48% HCBS share.

Utah

~18K aides. ~$15.80/hr median. Medicaid expanded 2020 (ballot, partial). $7.25 min wage (federal floor). New Choices Waiver. Youngest state demographics. ~52% HCBS share.

Wyoming

~3K aides. ~$16.50/hr median. No Medicaid expansion. $5.15 min wage (federal applies). Frontier state. Smallest workforce nationally. ~45% HCBS share.
All 50 states + DC

State research status

Click a state to view its profile. Gray states are in the research pipeline — see our Research Plan for the staged rollout.

AlabamaTier 2 AlaskaTier 2 ArizonaTier 2 ArkansasTier 2 CaliforniaTier 1 ColoradoTier 2 ConnecticutTier 1 DelawareTier 2 FloridaTier 2 GeorgiaTier 2 HawaiiTier 1 IdahoTier 2 IllinoisTier 1 IndianaTier 2 IowaTier 2 KansasTier 2 KentuckyTier 2 LouisianaTier 2 MaineTier 2 MarylandTier 1 MassachusettsTier 1 MichiganTier 1 MinnesotaComplete MississippiTier 2 MissouriTier 2 MontanaTier 2 NebraskaTier 2 NevadaTier 1 New HampshireTier 2 New JerseyTier 1 New MexicoTier 2 New YorkTier 1 North CarolinaTier 2 North DakotaTier 2 OhioTier 2 OklahomaTier 2 OregonTier 1 PennsylvaniaTier 1 Rhode IslandTier 2 South CarolinaTier 2 South DakotaTier 2 TennesseeTier 2 TexasTier 2 UtahTier 2 VermontTier 1 VirginiaTier 2 WashingtonTier 1 West VirginiaTier 2 WisconsinComplete WyomingTier 2 Washington, D.C.Tier 2
Research framework

Six data categories per state

1. Economic Reality

Wages, living wage gap, poverty indicators, cost of care benchmarks, overtime loss calculations. 21 metrics.

2. Workforce Crisis

Vacancy, turnover, projections, demographics, denied services, nursing home closures. 18 metrics.

3. Legal & Policy Framework

OT exemption status, self-directed programs, family caregiver rules, wage pass-through, union status. 22 metrics.

4. Geographic Divide

Rural caregiver deserts, EVV systems, broadband barriers, institutional pressure. 11 metrics.

5. State Medicaid Toolkit

Rate-setting, fee schedules, MCO contracts, reform levers, federal loss projections. 17 metrics.

6. Federal FLSA Status

2013 DOL rule, rescission status, Chevron elimination, private litigation, CMS 80/20 rule. 11 metrics.

Want to help research a state?

Download the State Research Spreadsheet and Research Guide from the Action Toolkit. Fill in your state's data following the template instructions, and we'll validate and publish it.