1 | Impacts to Talent | Reference Information | Evaluation Criteria | |||||||
---|---|---|---|---|---|---|---|---|---|---|
2 | Intervention Type | Attraction | Retention | Advance-ment | Example interventions | Example state | State policy description | Pros | Cons | Impact term |
3 | Wage Subsidy | - Wage floor (i.e., direct care hourly wage) - Wage expenditure mandates (providers spend X percent of revenue on wages / benefits) - State-funded one-time bonuses or stipends | NJ, MN, WI, IN, ME, IL, CA, NV, AZ, FL, VT, GA, MA | The New Jersey legislature implemented a $23 per hour wage for direct care workers and implemented a temporary Medicaid rate increase where 60 percent of the revenue was allocated directly to certified nursing assistant (CNA) wages and benefits. | Direct economic incentivization. | Costly in a single instance; sets precedent for future wage subsidy interventions (that may not be possible in absence of ARPA support); wage subsidies resolve compensation concerns, but fail to address other systemic challenges for retention and recruitment. | Near | |||
4 | Revenue- side Subsidy | - Reimbursement rate increases (Medicaid / Medicare) | ME, NY, AL, CO, WI | Maine’s Governor, Janet Mills, pushed forward investment of $600 million in state and federal funds to raise Medicaid reimbursement rates, enabling doctors to see more low-income patients. | Revenue growth – albeit affected by government spending – creates "sustainable" financing for increased wages (vs. a one-time subsidy); more low- income families are able to access quality healthcare service. | Indirect impact on talent; revenue uplift may not be "passed-through" unless paired with wage expenditure mandate. | Long | |||
5 | License Requirement Easing | - Recognition of out-of-state licenses - Permission of employment for students - Waiving of licensing fees | CO, AZ, NY, Interstate Medical Licensure Compact includes WI, AZ, IL, CO, NV | The Governor of Colorado, Jared Polis, issued an order enabling the creation of temporary licenses for nursing graduates who had not yet completed required licensing examinations. | Fights degree inflation and widens the healthcare professional intake funnel. | Potential adverse impact to professional preparedness and, therefore, quality of care. However, there are ways for states to rethink occupational licensing that don’t infringe on the quality of care (e.g. recognizing licenses from other states that offer equally rigorous occupational licensing requirements). | Immediate | |||
6 | Training Enhancements | - Compensation for on-the-job training - Public-private partnerships with community colleges and universities to train students - Apprenticeship program financing (for direct care worker advancements or for high school students) - Financial incentives for workers who complete specialized training | TN, WA, IA, GA, HI, ME, NM, OK | The state of Tennessee introduced a program that compensated individuals for on-the-job training, increased wages by $3.50 per hour upon completion of the program, and partnered with community colleges and universities to train students in direct care work. | Reduces costs (financial and, sometimes, temporal) to enter healthcare occupations; quality of training has a large impact on recruitment and retention for healthcare workers. | Potentially costly, similar to "Wage Subsidy"; does not address other pain points in training program administration (i.e., instructor shortages). | Near | |||
7 | Education Financing Support | - Loan forgiveness programs - State-funded scholarships - Tuition reimbursement | IA, NY, IL, RI | Governors from New York, Illinois, Rhode Island, and Iowa pledged additional scholarships, tuition reimbursement, or loan forgiveness for students training in health care, particularly for those who stay to practice in those states. | Reduces costs to enter healthcare occupations. | Potentially costly, similar to "Wage Subsidy" and “Training Enhancements”; likely to improve retention more than attraction. | Near | |||
8 | Social Support | - Transportation grants - Housing grants - Investments in childcare services | NY, CO | The state of New York offered grants that helped direct care workers commute to their jobs, which offset transportation costs typically carried by workers. | Reduces logistical pain points ("social determinations of attrition"). | Highly difficult to effectively implement programs that combat issues related to housing and childcare. | Near/long |