Editor's note: This story was originally publishedMay 14th, 2024.

Corrine Hendrickson runs a day care out of her home in New Glarus. On a recent Friday morning, she was moving quickly to clean up dishes, play with dinosaurs and remind kids that throwing toys isn’t safe — all at the same time. 

The work is nonstop for Hendrickson, who is licensed to care for eight children by herself out of the two-room add-on to the back of her house. She loves the work, but said the child care industry is in crisis, with costs too high for families and pay too low to retain staff all at the same time. 

“We are all overburdened and stressed out,” she said, and one piece of that puzzle is health care.

It’s extremely rare for providers to get health insurance through their employer. She gets hers from her husband’s job, which she said is especially common in in-home child care.  

“Some of us are locked into marriages because we need that health insurance,” she said. 

Some child care workers stay on their parents’ insurance, but end up leaving the industry when they age out after their 26th birthday, Hendrickson said. Some find plans on the state’s health insurance Marketplace, and others get coverage through Medicaid. 

“Because they are really the working poor,” said Beth Swedeen, executive director for the Wisconsin Board for People with Developmental Disabilities, talking about people in caregiving professions including child care, disability care and elder care. “They are low wage workers, who, even when they work full time, are still eligible for programs.”

Reader wonders if Medicaid expansion could ease caregiver shortage

This election year, WPR is asking people what elected officials could do to improve their communities. Medicaid expansion and health care affordability are on many people’s minds, and we found that health care accessibility and affordability are particularly important to Wisconsin’s caregiving workforce. 

New London resident Mary Swifka’s 26-year-old son, Noah, has Down syndrome and works with a support professional for 32 hours each week. Swifka, who first reached out to WPR about the health care in caregiving issue, said it gives him a sense of independence.

“Giving him the opportunity to do things away from his home, and away from his mom and dad, are important,” she said. 

But she’s aware of how low the wages are for caregivers, and how finding health care can be a struggle. Noah’s caregiver gets coverage through Medicaid, she said.

According to the Kaiser Family Foundation, home health care and child day care are both in the top 10 industries with the largest number of working Medicaid enrollees. 

To qualify for Wisconsin’s largest Medicaid program, known as BadgerCare Plus, you have to earn at or below the federal poverty rate, which is about $1,200 a month for a one-person household. That creates an issue for some caregivers, Swedeen said.

“Quite a few workers are only working a certain number of hours a week because they will lose their Medicaid health insurance, which is the only health insurance they can get and afford, if they work more hours,” Swedeen said. 

Swifka said she has seen how hard it is to find and keep good caregivers for people with disabilities, and health care is one reason why.

Kaylin Neustifter, assistant director at Chiemsee Castle day care center in Oshkosh, has seen the same problem in child care. Some of the center’s staff members have to limit their hours in order to stay on BadgerCare, she said, which can cause issues with scheduling. 

“So then that affects the business in general because you’re having people who are like, ‘Sorry, I can only work three days a week because otherwise I’ll go over the amount,'” she said. 

Neustifter makes too much to qualify for BadgerCare and chooses to go without insurance, except for family planning coverage through a different Medicaid program that has a higher income limit. 

Nationally, the hourly median wage for child care workers is just $14.60 per hour. Knowing that, Neustifter said she’s surprised more of them don’t qualify for full coverage through Medicaid. 

“Day care’s not one of those things where you’re getting crazy high wages anyways,” she said. “So it’s already kind of hard to believe that we wouldn’t qualify … we’d have to make even less.” 

The center’s director, Ciera Cramer, said the low wages and lack of benefits in the industry create a cycle where they’re constantly short-staffed. They have more requests coming in from the community than they have space, she said. 

“But if we could get some more staff in, then we could get our enrollment up,” she said.

Expanding Medicaid could play a role, some advocates say

Wisconsin is one of 10 states that haven’t accepted federal money to expand Medicaid. If it did, those earning up to 138 percent of the federal poverty level could get BadgerCare. Some say that would allow caregivers to work more without worrying about losing their health insurance. 

Democratic Gov. Tony Evers has proposed expanding Medicaid in all of his budgets since he was elected in 2018.  

But Republican Assembly Speaker Robin Vos has said it’s a non-starter. It’s unnecessary, he said, because people at or under the federal poverty rate can already get coverage through Medicaid in Wisconsin, which isn’t the case in other non-expansion states.  

Robin Rudowitz, director of the Kaiser Family Foundation’s program on Medicaid and the uninsured, said many people who make too much for BadgerCare should qualify for subsidized plans through the Marketplace. 

“Many individuals in that income band are eligible for comprehensive coverage with zero premium,” she said. “But there may be some additional out-of-pocket costs that could be different than Medicaid coverage.”

But Rudowitz said there can be barriers. And data shows 35 percent of uninsured people nationwide are eligible for subsidized plans in the Marketplace.

Health care Marketplace is the right fit for some, but others encounter barriers

Kaylin Neustifter in Oshkosh has looked into the Marketplace, but says the process was too chaotic. 

“I felt like I was getting stuff sent to me from all different places,” she said. “I also just don’t go to the doctor unless I feel something is super necessary …  I’m pretty lucky on health.”

But for people like Al Trautman, getting a plan on the Marketplace made the most sense. She works in respite care, with kids with special needs in Milwaukee. She used to be on BadgerCare, but got tired of having to keep her hours low enough to continue to qualify. 

“It always sort of worked out that I was sort of on the edge,” she said. “Trying to make a little extra money to get ahead really didn’t get me ahead, it put me at greater risk of being in a whole lot more financial trouble.” 

Now, she says her Marketplace plan works well for her needs, and she can work as many hours as she wants. 

“It gives me a whole lot more freedom to do all these crazy, different jobs that I do and that I like doing and that families need help with,” she said. 

But still, she said people in caregiving industries deserve better options, and that will be on her mind as she decides who to vote for this year.