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Essential, Undervalued, and Underpaid: Home Health Care Workers in the United States during the COVID-19 Pandemic 45 workers deserve to be adequately compensated for the vital services they provide. The federal minimum wage should be increased to $15/h as quickly as possible. The current plans to achieve this goal in six years is not satisfactory to achieve living wages for these workers. Any federal response to the COVID-19 pandemic should include a permanent increase of the minimum wage to $15 for all workers, including the often-overlooked home health care workers. To ensure adequate financial support for the risks assumed by home health care workers during the COVID-19 pandemic, the federal government should provide a framework for all states to adopt regarding hazard pay for home health care workers. Collectively, this set of recommendations will advance the safety and well-being of a crucial subset of workers in the battle against COVID-19 and in support of the home bound, often the most vulnerable of American citizens. References 1. ASPE (Office of the Assistant Secretary for Planning and Evaluation). HHS Poverty Guidelines for 2021. US Department of Health and Human Services. 2. Bagcal, Jenna. “New Legislation to Provide COVID-19 Compensation to Thousands of Home Health Care Workers from the Bronx.” Bronx Times , June 2020. 3. Bryant, Bailey. “HomeHealthCareAgenciesThreatened asWages Rise, Reimbursements Lag.” HomeHealthCare News , February 2019. 4. Christman, Anastasia & Connolly, Caitlin. “Surveying the Home Care Workforce: Their Challenges & The Positive Impact of Unionization .” National Employment Law Project , 22 September 2017. 5. De La Rosa, Shawna. “Home Health Care Workers to Get Hazard Pay.” State of Reform , 2 November 2020. 6. H.R. 582—116th Congress (2019-2020); Raise the Wage Act. 7. Hecker, Steven. “Hazard Pay for COVID-19? Yes, But It’s Not a Substitute for a Living Wage and Enforceable Worker Protections.” New Solutions: A Journal of Environmental and Occupational Health Policy , Vol. 30, no. 2, 2020, pp. 95–101. 8. Kessler, Glenn. “Ocasio-Cortez’s Misfired Facts on Living Wage and Minimum Wage.” The Washington Post , 26 January 2019. 9. Kinder, Molly, Stateler, Laura, & Du, Julia. The COVID-19 Hazard Continues, but the Hazard Pay Does Not: Why America’s Essential Workers Need a Raise. Brookings, 29 October 2020. higher-quality care; and the economy would expand as home health care workers would havemoremoney to spend (Weller et al.). One of the ways providers could raise wages for their workers is throughMedicaid reimbursement. Medicaid is the largest public payer of home health care services, and many agencies are able to operate primarily through Medicaid reimbursement (Weller et al.). However, if the reimbursement rates are not even keeping up with minimum wage and inflation each year, Medicaid ceases to be a sustainable option for agencies (Bryant). In this instance agencies would be forced to turn to private pay or cease to operate, leaving many patients without care. Thus, it is important that states invest in funding reimbursements proportionally to prevent a shortage of home health care workers. The US Congress should pass H.R. 63055 Coronavirus Relief for Seniors and People with Disabilities Act of 2020, a bill that would funnel more money into Medicaid, which will help immediately increase wages and include hazard pay compensation for home careworkers on the front line of the pandemic (Hecker). Conclusions and Recommendations The COVID-19 pandemic has exposed the shortcomings of the current wages and working conditions of home health care workers in the United States, who bear enormous bur- dens throughout this crisis, while still being underpaid. However, with COVID-19, the perception of the value of home care workers has shifted, creating a positive narrative around those who put their lives on the line to protect the nation’smost vulnerable patients. With this new focus on the health care workers, there is an opportunity to improve con- ditions for home health care workers, both in the pandemic and beyond. Action should be taken at several levels, both in the short term and longer term. State governments across the country can immediately provide adequate PPE for all frontline workers, including home health care workers, and lawmakers can advocate for emergency rules to expand further PPE availability. Expanding home care workers access to unions will improve conditions not onlyduring thepandemic but also long after the pandemic is under control. Unionization will enable advocacy for worker rights and air pay, safe practices, and health care benefits. While some states already have given home health care workers the right to unionize, many still have not. Even as the cost of living has steadily increased, minimum wage levels across the United States have largely remained stagnant for the past decade. Home health care