Ranked #1 on the PHI State Index with the highest HHA/PCA wages in the nation (∼$19.50/hr median). Washington leads in HCBS rebalancing at 82.7% of LTSS spending and has the nation's highest state minimum wage ($17.13/hr). SEIU 775 represents 90%+ of Medicaid-funded home care workers.
| # | Metric | Washington | Status |
|---|---|---|---|
| 1.1 | BLS median hourly wage (SOC 31-1120) | $19.50/hr (median); $20.19/hr (mean) | Public |
| 1.2 | PHI median hourly wage (all DCW, ACS) | TBD | Gap |
| 1.3 | Median annual earnings (DCW) | TBD | Gap |
| 1.4 | MIT living wage (1 adult, 0 children) | ∼$19-21/hr | Estimated |
| 1.5 | Wage gap (living wage minus BLS median) | Near parity or slight gap | Derived |
| 1.6 | State minimum wage (2026) | $17.13/hr | Public |
| 1.7 | Local minimum wage (highest city) | $21.65/hr (Tukwila) | Public |
| 1.8 | Low-income household rate (<200% FPL) | ∼28% | Estimated |
| 1.9 | Public assistance reliance (state-specific) | ∼49% (national proxy) | Proxy |
| 1.10 | Housing cost-burdened rate | ∼38% | Estimated |
| 1.11 | Uninsured rate (DCW) | ∼6% | Estimated |
| 1.12 | PHI Overall State Index ranking | #1/51 | Public |
| 1.13 | Wage competitiveness vs. similar jobs | TBD | Gap |
| 1.14 | Genworth median home health aide rate | TBD | Gap |
| 1.15 | Genworth median NF semi-private rate | TBD | Gap |
| 1.16 | Family Care capitation PMPM (NH LOC) | TBD | Gap |
| 1.17 | Blended HCBS avg cost (all acuity) | TBD | Gap |
| 1.18 | NF private pay monthly avg | TBD | Gap |
| 1.19 | HCBS-to-NF cost ratio (state-specific) | TBD | Gap |
| 1.20 | Exemption aggregate savings (national est.) | $500-700M/yr (∼0.2% of HCBS) | Estimated |
| 1.21 | Per-worker OT loss (50hr/wk worker) | ∼$4,100/yr (at WA wages) | Derived |
| # | Metric | Washington | Status |
|---|---|---|---|
| 2.1 | Headline caregiver vacancy rate | TBD | Gap |
| 2.2 | Open caregiver positions | TBD | Gap |
| 2.3 | Available job seekers (entire labor market) | TBD | Gap |
| 2.4 | Annual turnover rate | ∼79.2% (national proxy) | Proxy |
| 2.5 | Individuals denied/delayed services | TBD | Gap |
| 2.6 | Agencies unable to staff all hours | TBD | Gap |
| 2.7 | Nursing homes closed since 2016 | TBD | Gap |
| 2.8 | NF beds empty due to staffing | TBD | Gap |
| 2.9 | Total direct care workers | ∼79,080 (BLS); 45,000+ SEIU 775 members | Public |
| 2.10 | New jobs projected (2022–2032) | TBD | Gap |
| 2.11 | Total openings incl. separations (2022–2032) | TBD | Gap |
| 2.12 | Population 75+ growth projection | TBD | Gap |
| 2.13 | Workforce demographics: % women | ∼85% | Public |
| 2.14 | Workforce demographics: % people of color | ∼40-50% | Estimated |
| 2.15 | Workforce demographics: % immigrants | ∼15-20% | Estimated |
| 2.16 | Health insurance offered by agencies | TBD | Gap |
| 2.17 | Family caregivers providing 80%+ of all care | Yes | Public |
| 2.18 | Unpaid caregiver hours/economic value | ∼820K caregivers (AARP) | Estimated |
| # | Metric | Washington | Status |
|---|---|---|---|
| 3.1 | State companionship/OT exemption status | Pending — HB 2355 passed both chambers (2025); SEIU 775 contract provides OT for Medicaid IP workers | Public |
| 3.2 | State overtime threshold | 40 hrs/wk (via SEIU 775 contract for IP workers) | Public |
| 3.3 | Domestic Workers Bill of Rights | Pending (HB 2355, 2025) | Public |
| 3.4 | Paid sick leave law | Yes — WA Paid Sick Leave (2018) | Public |
| 3.5 | Paid family/medical leave | Yes — WA PFML (2020); up to 90% wage replacement, most generous nationally | Public |
| 3.6 | Primary self-directed Medicaid program | Individual Provider (IP) / CDE Program | Public |
| 3.7 | Self-directed program enrollment | ∼45,000+ (SEIU 775 members) | Estimated |
| 3.8 | Primary managed LTC program | TBD | Gap |
| 3.9 | Managed LTC enrollment | TBD | Gap |
| 3.10 | Combined HCBS enrollment | TBD | Gap |
| 3.11 | HCBS share of LTSS spending | 82.7% | Public |
| 3.12 | HCBS waiting lists status | TBD | Gap |
| 3.13 | Spouses as paid Medicaid caregivers | Yes (IP program) | Public |
| 3.14 | Parents of minors as paid caregivers | Yes (IP program) | Public |
| 3.15 | COVID family caregiver relaxations permanent? | TBD | Gap |
| 3.16 | SDPC maximum wage (self-directed) | TBD | Gap |
| 3.17 | OT rate cap in self-directed programs | TBD | Gap |
| 3.18 | IRIS/SDPC weekly hour cap | TBD | Gap |
| 3.19 | Minimum fee schedule for HCBS | TBD | Gap |
| 3.20 | Wage pass-through requirement | TBD | Gap |
| 3.21 | MCO contract wage floor provisions | TBD | Gap |
| 3.22 | Union representation (home care workers) | SEIU 775 (∼45,000 members; 90%+ of Medicaid IP workers) | Public |
| # | Metric | Washington | Status |
|---|---|---|---|
| 4.1 | Travel time/mileage reimbursement mandate | TBD | Gap |
| 4.2 | Caregiver-to-senior ratio by county | NOT COMPILED | FOIA |
| 4.3 | Counties with zero/limited home care agencies | NOT COMPILED | FOIA |
| 4.4 | Rural broadband coverage (for EVV compliance) | TBD | Gap |
| 4.5 | EVV system & vendor | TBD | Gap |
| 4.6 | EVV offline/low-connectivity accommodation | TBD | Gap |
| 4.7 | EVV hard launch date (personal care) | TBD | Gap |
| 4.8 | Rural vs. urban NF admission rates | NOT COMPILED | FOIA |
| 4.9 | Rural nursing home closures since 2016 | TBD | Gap |
| 4.10 | Rural HCBS alternatives (adult day, ALF) | TBD | Gap |
| 4.11 | Projected NF bed shortage (statewide) | TBD | Gap |
| # | Metric | Washington | Status |
|---|---|---|---|
| 5.1 | Medicaid rate-setting authority model | DSHS/ALTSA administered; IP program + Area Agencies on Aging | Public |
| 5.2 | Minimum fee schedule exists? | TBD | Gap |
| 5.3 | Fee schedule codified in statute or budget? | TBD | Gap |
| 5.4 | Wage pass-through % requirement | TBD | Gap |
| 5.5 | State-level 80/20 compensation rule? | No (federal CMS rule faces rescission) | Public |
| 5.6 | MCO contract cycle & next renewal | TBD | Gap |
| 5.7 | MCO workforce adequacy reporting required? | TBD | Gap |
| 5.8 | IRIS IBA formula inputs reflect market wages? | TBD | Gap |
| 5.9 | Premium pay structure for extended hours? | No statewide premium pay (SEIU 775 contract provisions) | Public |
| 5.10 | State domestic service OT exemption status | Pending elimination via HB 2355 | Public |
| 5.11 | Legislative path to eliminate state OT exemption? | HB 2355 headed to governor's desk (2025) | Public |
| 5.12 | Federal Medicaid loss projection (10yr) | TBD | Gap |
| 5.13 | Annual new cost to state taxpayers | TBD | Gap |
| 5.14 | State-directed payment limit impact (eff. 2028) | 110% Medicare cap; exact impact TBD | Pending |
| 5.15 | Provider tax moratorium status | TBD | Gap |
| 5.16 | NF staffing rule moratorium (10yr) | Applies (est. 13,000 add'l deaths/yr nationally) | Public |
| 5.17 | Work requirements effective date | Dec 31, 2026 (childless adults) | Public |
| # | Metric | Washington | Status |
|---|---|---|---|
| 6.1 | 2013 DOL rule status (as of March 2026) | Technically in effect; enforcement suspended July 25, 2025 (FAB 2025-4) | Public |
| 6.2 | Proposed rescission rule published? | Yes — July 2, 2025 (90 FR 28976) | Public |
| 6.3 | Final rescission rule published? | No (as of March 2026) | Monitor |
| 6.4 | Chevron deference status | Eliminated — Loper Bright v. Raimondo (2024) | Public |
| 6.5 | Private litigation still viable? | Yes — 2013 rule provisions still invocable by private parties | Public |
| 6.6 | DOL estimated annual transfer (2013 RIA) | .8M (medium scenario, 7% discount) | Public |
| 6.7 | Adjusted current estimate | -700M annually | Estimated |
| 6.8 | GAO post-implementation finding | Hour caps, not cost absorption; pay did not increase; workforce declined 11.6% | Public |
| 6.9 | Familial caregiver % in self-directed programs | 50-78% nationally; CA IHSS >70% | Public |
| 6.10 | Disparate impact demographics | 85% female; 67% POC; 27% Black; 26% Hispanic | Public |
| 6.11 | CMS 80/20 Access Rule status | Finalized May 2024; faces likely rescission/non-enforcement | Public |