Amid Albany’s Medicaid over-spending crisis, the state Health Department is reconfiguring a little-known portion of the deficit-ridden program in what looks like a scheme to squeeze union dues from roughly 110,000 Medicaid-subsidized in-home caregivers.

About 74,000 New Yorkers are enrolled in Medicaid’s consumer-directed personal assistance program, or CDPAP, in which Medicaid pays personal assistants, or PAs, to provide household help to disabled or elderly patients who otherwise would need to be cared for in a nursing home or other more costly setting. 

PAs are selected by the patients themselves, who set their hours and instruct them on their duties. In many cases, assistants are prior acquaintances or relatives of the patient. Medicaid picks up the tab by paying a third party, known as a fiscal intermediary, which handles the paperwork.

The Health Department (DOH) last year moved to cut costs by changing how intermediaries are paid and laid out a new “Request for Offers” process aimed at thinning the ranks of roughly 600 fiscal intermediaries involved with CDPAP. But the new application came with an odd and unprecedented requirement: each applicant must agree to sign a “joint employment attestation” in which the intermediary “accepts and acknowledges their role” is “that of a joint employer, with the CDPAP consumer, of the personal assistant (PA).” 

That’s a strange move, because the Health Department can already hold intermediaries responsible for every facet of their relationship with a PA. The intermediaries, for instance, agree to pay workers’ compensation premiums, and their responsibilities are further detailed in 17 bullet points listed in DOH bid papers. 

DOH says the employer attestation “does not alter the Department’s view of the current relationship between the FIs and the PAs.”

If that’s the case, there’s another reason why the Cuomo administration would force PAs to sign these documents: to unionize them.

By grouping Medicaid PAs together as employed by each fiscal intermediary (instead of just each patient they help), DOH is creating a “community of interest” in which a union can collect enough signatures to have federal (or state) officials conduct an election. The union wouldn’t need to get a majority of the PAs to consent to unionizing–it would just need to win a majority of the mail-ballot votes that are completed and returned.

Labor unions are continually on the hunt to organize new groups of potential dues-paying members, and they don’t hesitate to ask elected officials to change the rules when necessary. Governor Eliot Spitzer in 2007 issued an executive order that let a pair of friendly unions represent child-care providers who received state subsidies, and the state Legislature last year voted to allow farm workers to unionize.

New York wouldn’t be the first state to impose a unionization scheme on consumer-directed providers paid by Medicaid. Fifteen other states have let unions tap into their own similar programs. New York, in fact, was something of an outlier: while Spitzer’s 2007 order helped two politically-aligned unions organize state-subsidized childcare providers, he didn’t do the same thing for personal care. Spitzer at the time was warring over proposed budget cuts with 1199SEIU, the healthcare worker union best positioned to capitalize on any unionization scheme.

Unionizing Medicaid personal assistants wouldn’t immediately cost the state anything, especially since the intermediaries can’t bargain over payment rates (which are fixed by Medicaid). While the individual PAs would have no say the matter, organized labor would see an immediate reward: a union that organizes PAs will be able to skim dues from every paycheck issued by that fiscal intermediary in the CDPAP program, without having to incur many of the typical costs of bargaining or representing workers in disciplinary proceedings.

If this is indeed the first step to helping 1199SEIU organize CDPAP caregivers, and pocket 2 percent of their pay, that windfall could add up to tens of millions of dollars per year for the union’s coffers–and a handsome reward at election time for the politicians who help put it there.

About the Author

Ken Girardin

Ken Girardin is the Empire Center’s Director of Strategic Initiatives.

Read more by Ken Girardin

You may also like

NYC Pension Funds’ Return Was a Subpar 4.4% in FY 2020

New York City's five municipal public pension funds ended their 2020 fiscal year with a net investment gain of 4.44 percent, well below their 7 percent assumed rate of return. That shortfall, reflecting the pandemic recession and its impact on financial markets, is expected to drive up the city's annual tax-funded pension costs by up to $200 million within the next three years. Read More

New York Has Widened Its Lead in Per-Capita Spending on Medicaid

New York's per-capita Medicaid spending soared to more than double the nationwide rate in 2018, widening its gap with the other 49 states. Read More

State Pension Fund Lost Money in 2020, Pointing to Higher Costs Ahead

New York State’s biggest public pension lost money on its investments during the fiscal year that ended March 31—a completely unsurprising result, given the coronavirus crisis and its impact on financial markets in early spring. Read More

New York’s Medicaid Enrollment Surges to an All-Time High

New York's Medicaid program is growing at its fastest rate in six years, with a quarter-million additional enrollees landing in the safety-net health plan during the first three months of the coronavirus pandemic.  Read More

Lawmakers Look To Dump More Public Cash On Teamsters

State lawmakers this week moved to make public construction more expensive in a bid to steer work to one of New York’s struggling construction unions. Read More

In Slow Recovery, NY’s Job Drop as of June was Still Among the Worst in U.S.

While New York's economy continued to ever-so-slowly recover in June, the Empire State's year-to-year percentage decline in private employment since the pandemic lockdown remained the worst in the continental U.S., according to the latest payroll establishment data from federal and state agencies. Read More

New York’s Health Premiums Remain Among the Highest in the U.S.

The average cost of New Yorkers' health benefits increased by less than the national average in 2019 but remained among the highest in the U.S., according to recently published federal data. Read More

New York’s Medicaid Roller Coaster Takes an Unusual Turn

The state's Medicaid spending was significantly lower than projected in the first quarter, but that's not necessarily a positive sign for state finances. Read More

Subscribe

Sign up to receive updates about Empire Center research, news and events in your email.

CONTACT INFORMATION

Empire Center for Public Policy
30 South Pearl St.
Suite 1210
Albany, NY 12207

Phone: 518-434-3100
Fax: 518-434-3130
E-Mail: info@empirecenter.org

About

The Empire Center is an independent, non-partisan, non-profit think tank located in Albany, New York. Our mission is to make New York a better place to live and work by promoting public policy reforms grounded in free-market principles, personal responsibility, and the ideals of effective and accountable government.