The Trump administration announced Tuesday that it would change Medicaid’s rules to prevent unions from automatically getting a cut of the checks sent to state-subsidized home healthcare workers.
Under the proposed new rules announced by the Centers for Medicare and Medicaid Services, states would be prohibited from diverting any funds away from the workers to a third party, such as unions.
Critics of the current arrangement argue that homecare workers often aren’t aware that they are members of unions or that the deductions are being made, since they usually start automatically once they enter the subsidy programs. Under Tuesday’s proposed rules change, providers would likely still be eligible to join unions but would have to act on their own to make the payments.
“The law provides that Medicaid providers must be paid directly and cannot have part of their payments diverted to third parties outside of a few very specific exceptions,” said Tim Hill, acting Director for the Center for Medicaid and Children’s Health Insurance Program Services. “This proposed rule is intended to ensure that providers receive their complete payment, and any circumstances in which a state does divert part of a provider’s payment must be clearly allowed under the law.”
Medicaid-funded homecare subsidy programs are common in states and pay people to take care of invalids, in many cases family members. Public-sector unions have sought to represent these workers, and in at least 14 states since 2003 they were able to find friendly governors or state legislatures to pass legislation or sign executive orders declaring the workers state employees. This allowed the state, as the workers’ employer, to enter into contracts with unions to represent the workers, which in turn entitled the unions to a portion of the subsidy checks.
The practice has been controversial. The homecare workers were typically recognized as state employees only for the purpose of collective bargaining, meaning they received no benefits from the state such as pensions. In a 2014 Supreme Court case, Harris v. Quinn, a 5-4 majority said the homecare workers were not public-sector employees and therefore not eligible to organize. That has not ended the practice in other states though.
Critics of the practice cheered the news.
“Today’s announcement by the Centers for Medicare and Medicaid Services is a vital first step in ending the illegal dues skim that diverts public funds away from the care of Medicaid recipients and into union officials’ coffers. For years, aided by a compliant Obama Administration, Big Labor has siphoned off hundreds of millions of tax dollars in violation of federal law, which is why this rulemaking is now needed make it clear that states cannot legally divert Medicaid funds into the bank accounts of politically-connected union bosses,” said National Right To Work President Mark Mix.
The announcement would roll back a regulation approved in 2014 under the Obama administration that authorized states to divert Medicaid funds to third parties, a move done to put the union dues diversions on firmer legal footing.
Representatives of the Service Employees International Union and the American Federation of State, County and Municipal Employees, which represent most of the organized healthcare workers, could not be reached for comment.
