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Union efforts to organize home care workers got a boost last week after the Biden administration ruled that state Medicaid programs can withhold union dues and employee benefits from home care workers’ paychecks.

“This is a huge win for home care workers, who have been organizing, mobilizing and talking to regulators and members of Congress on this and many other issues — including raising demands for a major federal investment in expanding access to care and creating good union home care jobs,” Service Employees International Union said in a statement.

The administration’s final rule is the latest back-and-forth skirmish between Democrats and Republicans over Medicaid making payments to third parties on behalf of individual providers. In 2014, the Obama administration ruled state Medicaid programs could take out money for union dues and other benefits. But the Trump administration reversed the ruling in 2019. 

President Joe Biden may have telegraphed his intention about the rule weeks after taking office last year when he rolled out his American Jobs Plan. The plan promoted home care workers’ right to organize and bargain collectively, in addition to pumping billions of dollars into the care economy for job creation and benefits.

In issuing the ruling, the Centers for Medicare and Medicaid Services noted that Medicaid spending for long-term services and supports is increasingly shifting from facilities to home- and community-based services. In 2013, HCBS accounted for 51% of LTSS; in 2019 it accounted for 58.6%. 

“We recognize that HCBS workforce issues, such as workforce shortages and staff turnover, have a direct and immediate impact on the quality of and access to services available to beneficiaries,” CMS stated in the rule. “We believe that State Medicaid agencies can play a key role in influencing the stability of this workforce by determining payment rates and facilitating greater access to benefits that support this class of providers.” 

The new rule will take effect in mid-June.