Research & Commentary: State and Home Care Workers Lose When SEIU Skims Medicaid Funds

Published August 13, 2018

The Home and Community-Based Services waiver program provides about $41.5 billion for in-home care services each year to individuals with a disability, illness, or other chronic condition. Often, family members, friends, or local providers deliver these in-home services. Medicaid funds are used for the program and are sent directly to providers on behalf of the patient.

Although these funds are meant to help cover the costs of taking care of the sick and disabled,  11 states, thanks in large part to the efforts of labor unions, have passed legislation reclassifying in-home workers as “public employees” or “state workers,” subjecting them to union rules and dues.

Thankfully, in July, the Centers for Medicare and Medicaid Services (CMS) introduced a proposed rule change to protect Medicaid provider payments. This rule adjustment would help end the practice of public funds being diverted to union coffers. CMS is requesting public comments until August 13, 2018.

The practice of siphoning off government funds meant to help the poor and sick to aid unions has a long history in Minnesota. According to the Freedom Foundation, home care worker unionization by the Service Employees International Union (SEIU) in Minnesota “was the culmination of a multi-year political effort that first produced the election of Gov. Mark Dayton (DFL).” (SEIU and the American Federation of State, County and Municipal Employees donated to Dayton’s 2010 campaign.)

In 2012, Dayton issued an executive order requiring “any independent child care worker or home health care provider who received state funds to be included in a potential statewide bargaining unit.” In April 2012, the order was declared unconstitutional.

Also in 2012, after the Democratic Farmer-Labor party took control of the state’s legislature, Dayton signed S.F. 778, which declared home care workers are public employees and “the State recognizes [SEIU] as the exclusive representative under Minnesota Public Relations Act.” Through this legislation, child care workers and home health care providers were forced to join a union.

In June 2014, the U.S. Supreme Court ruled in Harris v. Quinn collecting fees from “home health care providers who do not wish to join or support a union” is unconstitutional. SEIU lobbied for BMS to conduct a certification vote for home health care workers in August 2014. Only 13 percent of home health care providers voted in favor of union representation, 8.5 percent voted against, and 78 percent did not participate.

In 2015, a collective bargaining agreement (CBA) was approved by the Minnesota State Legislature. Under the terms, the North Star State agreed to “provide $250,000 per year to the Training and Orientation Committee,” and it required all newly hired individual providers “to complete an orientation to the State’s home care programs.” 

In 2017, SEIU and Minnesota approved another CBA. It increased the funding for the Training and Orientation Committee and included a “one-time funding of $2.5 million … in stipends of $500 for up to 5,000 Individual Providers who complete designated, voluntary trainings.” According to the Freedom Foundation, “the committee will receive $3,056,000 in Medicaid funds from the state.”

MNPCA, a coalition of personal care attendants, is working to decertify SEIU and has gathered more than 10,000 signatures in favor of a decertification vote. In Minnesota, SEIU’s membership includes about 28,000 personal care assistants, and SEIU collects approximately $948 per worker annually, about $5 million per year in total. According to MNPCA, 25 “SEIU officers are paid more than $70,000, almost three times what the average full time [personal care assistant] earns.” The president of Healthcare Minnesota is paid more than $120,000.

Not only does this scheme perpetrated by labor unions and their allies in state legislatures redirect money away from those who truly need it, it also violates worker freedom. Forced membership infringes on the rights of employees to associate as they see fit. Home health care providers should be given the choice of whether to join a union, not coerced into paying the salaries of union bosses and their numerous political causes.


The following documents examine dues skimming and Medicaid spending in greater detail.

Getting Organized at Home
Maxford Nelsen of the Freedom Foundation explores how unions in states are siphoning Medicaid funds from home care workers despite the U.S. Supreme Court’s 2014 Harris v. Quinn ruling, which found forcing home care workers into unions was a violation of workers’ First Amendment rights. Nelsen also examines union and state activities in 15 states and explores the legality of such agreements.

Dues Skimming FAQs
The State Policy Network examines the issue of dues skimming in detail, answering commonly asked questions, how the issue emerged, and what federal lawmakers can do to stop it.

Time For Congress To End ‘Dues Skimming
Rob Roper of the Ethan Allen Institute examines Medicaid dues skimming and argues Congress should act to end the practice. “By simply clarifying administrative rules, HHS could ensure Medicaid dollars are spent where they are needed — on caring for those in need. Congress could also prevent Medicaid funds from being wrongfully diverted to unions. Both solutions would free up more money for patients who deserve the best care possible, while allowing caregivers to spend their time where it’s needed — on serving their loved ones, not fighting unions,” wrote Roper.

How to Stop the ‘Dues Skim’ of Federal Home Health Care and Child Care Funding
Sam Adolphsen of the Mackinac Center outlines several ways the U.S. Department of Health and Human Services could modify administrative rules so that Medicaid and other government funds are used appropriately and benefit the people who actually need them.

Congress Must End Union Dues Skimming of Family Caregivers’ Paychecks
Thomas Aiello of the National Taxpayers Union argues Congress should move to end Medicaid dues skimming of family caregivers. “Ensuring Medicaid dollars are spent in a responsible manner and not to advance political motives should be common sense. But most importantly, this is an issue about protecting caregivers looking after their handicapped loved ones. Everyone should agree that hard working caregivers who make unbelievable sacrifices deserve to have a full paycheck,” wrote Aiello.


Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit Health Care News, The Heartland Institute’s website, and PolicyBot, Heartland’s free online research database. 

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