Seema Verma
Administrator
Centers for Medicare and Medicaid Services
7500 Security Blvd.
Baltimore, MD 21244
Administrator
Centers for Medicare and Medicaid Services
7500 Security Blvd.
Baltimore, MD 21244
Re: Medicaid Program; Reassignment of Medicaid Provider Claims (CMS-2413-P)
Dear Administrator Verma:
On behalf of the members of National Taxpayers Union (NTU) across all fifty states, I write to express our strong support for docket number CMS-2413-P, the Departments of Health and Human Services’ Notice of Proposed Rulemaking (NPRM) to remove section (g)(4) of 447.10 from the Code of Federal Regulations. This provision of the federal code has permitted numerous state governments to siphon union dues and fees from the paychecks of in-home healthcare workers without their consent. The proposed rule would end this practice, known as union “dues skimming,” which runs in conflict with federal law and unethically deducts money for those on federal assistance to fund political activity by public sector unions.
Established in 1965, the Medicaid program was designed to be a state and federal program that provides health coverage for the disabled, vulnerable, and low-income families. While Medicaid’s aim is noble, the program today is straining state budgets, especially in states that have expanded Medicaid under the Affordable Care Act. As of 2017, taxpayers spent $565 billion on the program and it is the world’s largest health insurance program, covering over 70 million people. Since the program is funded by taxpayers, there is a responsibility from Medicaid administrators to ensure each dollar is spent in an efficient and cost effective manner by rooting out waste, fraud, and abuse.
Included in the Medicaid budget is $41.5 billion reserved for the Home and Community-Based Services (HCBS) waiver program. Under the HCBS waiver program, Medicaid recipients may use these funds to pay for in-home services rather than living at a long-term care facility. Generally, those in-home service workers are family members or friends and receive a paycheck directly from those funds.
However, lawmakers in 11 states (California, Connecticut, Illinois, Maryland, Massachusetts, Minnesota, Missouri, New Jersey, Oregon, Vermont, and Washington state) enacted rules reclassifying in-home providers as state workers in order to subject them to union rules and even financial dues. According to the State Policy Network, “In certain states, the government allows unions like the Service Employees International Union (SEIU) to automatically withdraw union dues from home healthcare providers’ Medicaid funds.”
Just in 2017, Freedom Foundation estimates state governments diverted close to $150 million from in-home care providers into the pockets of unions. And between 2000 and 2017, it is estimated that $1.4 billion in caregivers’ Medicaid funds were sent to the coffers of unions. Every dollar of Medicaid funds state governments divert to SEIU and other unions is one less dollar available to help those in need.
The hundreds of thousands of caregivers across the country should not be subjected to unwanted union participation when they’re working out of their own homes often caring for relatives. It is a shameful practice to require a hardworking mother or father to pay union dues just so they can look after their disabled son or daughter.
Ben and Tammy Olsen from Washington State are just one of many examples of this unethical practice. According to them, “Having the union take our money was a real hardship on us. We used to pay $2,000 a year in dues...that could be spent on gas, groceries, and medical bills. The union has never helped us, and we're better off without them.” For them, this money that is unwillingly taken away from their paycheck makes a big difference in their day-to-day life and makes taking taking care of their son more difficult.
Concerningly, the money earned by hard-working caregivers is involuntarily being used to fund organizations that engage in political activity and lobbying, which seek to influence policy that some workers may not support.
As you may know, this issue made it all the way to the Supreme Court which ruled in 2014 that home-health providers are not required to involuntarily pay union dues or fees. Despite the Court ruling that dues and fees were optional, state governments made it an incredibly complex and confusing process, often only allowing caregivers to opt out from paying dues within a small window of time. Such a costly process has made it intentionally difficult for many caregivers to officially get out of this scheme.
The current system represents a bad deal for caregivers, who are working hard to provide services to their clients and thus deserve the full paycheck they were promised. Should these caregivers wish to join or financially support a union, they are free to make that decision on their own without being forced to do so. Workers at the very least deserve to have that choice, not be forced to have their hard-earned money taken from their paycheck.
For the aforementioned reasons, NTU respectfully submits this comment in support of the NPRM to repeal 42 CFR 447.10(g)(4). NTU is at your service to further assist you in your deliberations and we are thankful for your consideration of our views
Sincerely,
Thomas Aiello
Policy and Government Affairs Associate
National Taxpayers Union