A scheme by state governments that costs sick, elderly, and disabled Americans hundreds of millions of dollars each year appears to be on thin ice, thanks to the Trump administration taking action.
In July, the Department of Health and Human Services published a Notice of Proposed Rulemaking that, if enacted, would prohibit states from diverting money from the Medicaid program and sending it to public-sector unions.
This practice, known commonly as dues-skimming, is allowed in 11 states where governors and legislatures have wrongly classified relatives and friends who provide in-home care to their needy loved ones as public employees simply because they receive money from the taxpayer-funded Medicaid program to offset the cost of care. Each year, these caregivers lose an estimated $150 million to unions that skim off the top of their loved ones’ benefits, often without their knowledge.
“I don’t believe it’s fair, especially for parents who are overwhelmed with the care of their children, parents who have a lot of other legal paperwork they have to do every month to make sure their children receive benefits,” said Miranda Thorpe, a mother in Washington state who once had money skimmed from the Medicaid checks she uses to provide in-home care for her 21-year-old disabled daughter Sarena.
Thorpe, her daughter, and another caregiver, Kris Greene of Minnesota, traveled to Washington, D.C., earlier this year to raise awareness about the little-known, yet costly, dues-skimming scheme.
“I don’t think the government should be involved in removing dues,” Thorpe said. “The union should make it a separate, voluntary, opt-in arrangement, and the state should have nothing to do with it.”
The public largely agrees with Thorpe. Nationwide polling conducted in late 2017 found 87 percent of Americans think tax dollars should support those in need, not unions. Eighty-eight percent think the federal government should prohibit states from skimming dues in this manner. And now HHS has proposed to step in and do just that.
Although a 2014 U.S. Supreme Court decision ruled in-home caregivers cannot be forced into a union, stories of government unions using coercion and deception to keep caregivers in are widespread and well-documented. In Minnesota, caregivers have signed affidavits alleging the union went so far as to forge their signatures on membership cards to authorize the state to continue the skim.
Caregivers in Washington state are unlikely to notice they belong to a union because the state deducts dues prior to delivering their check, then puts the onus on the individual to figure out how to drop their unwanted union membership. Oregon caregivers are only allowed to leave their union during arbitrary and brief periods each year that vary for each member. The state of California requires would-be caregivers to watch a union pitch before they may look after a loved one who receives Medicaid.
In most cases, affected caregivers do not work for any company or agency where one might expect a unionized workforce. Rather, they are related to or close friends of their patients, like Thorpe and Greene.
Greene explained that it’s not realistic to think caregivers can take a vacation or time off from looking after their loved ones. They need the checks to cover the cost of care, not to pay for time off.
“[The Medicaid program has] been able to keep [my daughter] Meredie at home instead of having to be in a group home or state-funded place,” Greene said. “It’s helped maintain her stability. … It’s been really good for her. I can only imagine where she’d be without it.”
The union covering caregivers in Greene’s state often claims responsibility for securing paid time off and vacation for caregivers, but that simply means there are fewer resources for the stipends.
“It’s all the same pot of money,” she said.
Sally Coomer is another Washington state caregiver whose family has been victimized by dues-skimming. In previous testimony before a House oversight committee, she eloquently said, “Caring for my daughter is not a job that needs union intervention. This is my daughter and this is our life circumstance.”
Each dollar a state takes from Medicaid funds to give to government unions is one less dollar that can help a person in need.
The idea that a union could negotiate better working conditions or time off for a family member looking after a loved one borders on absurd. The Supreme Court was right to call this sort of dues-skimming a “scheme,” because that’s exactly what it is — a scheme to take money from those in need and give it to well-connected, government unions.
Caregivers who wish to voluntarily join a union should obviously be free to do so, but state governments should not use tax dollars to skim on behalf of unions, nor should they jeopardize needed programs like Medicaid to send money where it’s not intended.
No mother should be coerced into joining a union just so she may stay home to provide individualized, quality care to her adult, disabled child. HHS’ proposed rule is a necessary measure to stop an injustice. It is both right and long overdue.
Chantal Lovell is the director of strategic communications at the State Policy Network. F. Vincent Vernuccio is a senior policy adviser there.
