Saint Louis University Journal of Health Law & Policy

Document Type

Symposium Article


The COVID-19 pandemic has exposed and magnified existing problems in the American health care system. One of these problems—existing at the intersections of race, age, disability, class, power, poverty, and health—is the widespread misclassification of home care workers as independent contractors Home care workers, who are predominantly women and people of color, provide personal assistance services and health care supports to older adults and people with disabilities in home- and community-based settings, usually for very low wages. Misclassification cuts them out of the social safety net in case of job loss or injury, imposes a greater tax burden than that of properly classified employees, reduces businesses’ tax contributions to state unemployment insurance funds, makes it difficult or impossible to obtain the protections of anti-discrimination statutes, increases the likelihood of wage theft, and creates a race to the bottom among businesses. Further, misclassification makes it harder to effectively manage the COVID-19 pandemic by making home care a less appealing job at a time of increasing need, putting an additional obstacle in the way of state government contacting workers directly about public health protocols, and disincentivizing home care employers from providing appropriate training and personal protective equipment. Using Maryland as a case study, this Article aims to explain these challenges, articulate some of the barriers standing in the way of correcting them, and propose solutions to chart a path forward.