Analysis of State Efforts to Comply with Fair Labor Standards Act Protections to Home Care Workers


The purpose of this study is to describe and document changes states have made to their Medicaid or other publicly-funded consumer directed home care programs for seniors and individuals with disabilities to comply with the 2013 update to Fair Labor Standards Act (FLSA) regulations. This report provides an overview of early implementation activities at the state level and perspectives from various stakeholder groups. After introducing the study methods, we describe issues that emerged from interviews conducted with stakeholder group representatives. We then present findings from an environmental scan of state policies and procedures conducted in all U.S. states, including the District of Columbia. Finally, to illustrate both state variations in FLSA implementation and promising practices, we present examples of select case study states with well-documented hardship exceptions policies: California, Massachusetts, Wisconsin, and Ohio; and provide insights from all case studies. This report, prepared by ASPE staff, synthesizes and expands upon key study findings from several reports prepared by Mission Analytics.

This report was prepared under contract #HHSP233201600018I between HHS's ASPE/DALTCP and Mission Analytics Group, Inc. For additional information about this subject, you can visit the DALTCP home page at or contact the ASPE Project Officer, Marie Squillace, at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. Her e-mail address is:

DISCLAIMER: The opinions and views expressed in this report are those of the authors. They do not reflect the views of the Department of Health and Human Services, the contractor or any other funding organization. This report was completed and submitted on September 5, 2019.


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