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Two employers each commit the same dollars per employee to backup care. One pays its share at the moment of booking. The other reimburses employees after they submit receipts. A year later, the utilization curves look nothing alike, and the difference has almost nothing to do with communication or enrollment.
A day of in-home care can run $200. Under a reimbursement design, the employee finds and books care, pays the full amount out of pocket, collects receipts and provider details, submits a claim, then waits 30 to 90 days for the claim to be adjudicated and the reimbursement to arrive.
Each step is a filter. Together, they favor employees who have cash sitting idle and patience for paperwork—close to the inverse of the population the benefit was funded to help. The median American's emergency savings is only $500*. An employee with vulnerable cashflow is stressed about missing wages and putting their role at risk and doesn't weigh the reimbursement and decide against it. They call out of work instead.
When the trusted provider is a relative or neighbor, informal cash payments leave no documentation: awkward for the employee, unusable for a claim, unhelpful at tax time. These relationships are worth supporting. Subsidy design lets employees pay them formally, without giving them up.
The Employee Benefit Research Institute (EBRI) finds 47% of FSA holders forfeited funds in 2023, $422 per account on average, $4.5 billion nationally. The money was already theirs; receipt requirements and deadline-driven paperwork got in the way. Backup care runs the same test: a subsidy is automatic; reimbursement is opt-in. The gap between them is unused benefit, not unmet need.†
Under a subsidy or direct-pay design, the employer's share is applied at the point of booking. In practice, Helpr sets this up as a simple dollar amount per employee: hours allotted times the subsidy rate (for example, 80 hours × $15/hr = $1,200), that the employee can draw down as needed, no formula or math on their end. The documentation a reimbursement would have required is captured inside the transaction rather than reconstructed afterward. Helpr uses geolocation matching to confirm care providers are present when employees are physically present at work.
If they need to front the cost before any support arrives, financial burden is the real gatekeeper, not the plan. Bookings drop, access narrows, and the ROI you modeled on paper never shows up.