(Source: MIRS.news, Published 07/03/2024) Homecare providers compensated through Michigan's Medicaid system could unionize under bills approved by the Senate last month. Also, the legislation creates the "Home Help Caregiver Council," overseeing payroll deductions for union fees.  

Around 9:47 p.m. on June 26, the Senate approved SB 790 and SB 791 by a party-line, 20-18.  

The bills were voted on amid a lengthy session period that ran from 10 a.m. that day to shortly before 5 a.m. the next morning, as legislators approved an $82.5 billion budget for the upcoming Fiscal Year (FY) 2025. Lawmakers are now in their summer recess period.  

SB 790 sponsored by Senate Health Policy Chair Kevin Hertel (D-St. Clair Shores), establishes the Home Help Caregiver Council, responsible for ensuring that negotiation agreements are followed through on, setting compensation rates, payment terms and practices and other benefit terms achieved through a collective bargaining process.  

The director of the state's Department of Health and Human Services (DHHS) and a department person they've designated will serve on the council, as well as five other individuals appointed by the head of DHHS.  

Moreover, the council will be responsible for maintaining a registry of individuals qualified to serve as caregivers through the Medicaid-funded "Home Help" program for elderly and disabled Michiganders. In the FY '25 budget, legislators appropriated $10 million for the "adult home help caregiver registry and council."  

"The council will help with providing more training to the individuals that are providing the care, and putting more infrastructure behind it," Hertel told MIRS on Wednesday, describing how when he shadowed a caregiver less than two months ago, he saw that "there's no real infrastructure in place today that ensures they have somewhere to go when they have an issue, whether that's an issue with their payment, whether they're not paid in a timely fashion, (or) whether (they) paid the proper amount."  

The $10 million appropriation could be spent on job skills training for a specialized area of caregiving, homecare worker marketing and recruitment efforts and other expenses related to career education and training programs.  

According to Michigan Home Care Workers United, which is affiliated with the Service Employees International Union (SEIU), roughly 35,000 caregivers are working under the state's Home Help program. The program allows Medicaid beneficiaries to hire the direct care worker of their choice.  

According to regulations, a caregiver cannot be under 18 years old, cannot be in control of the patient's budget and cannot be a spouse caring for a spouse, nor a parent caring for a minor child.  

Home Help caregivers organized to form a union in 2007, but were prohibited from unionizing in Michigan during 2012.  

If SB 790 and SB 791 were signed into law, the 2014 U.S. Supreme Court ruling in Harris v. Quinn would still apply. In that Illinois case, the justices ruled 5-4 that requiring homecare workers paid by the state to pay their "fair share" of union collective bargaining costs violated First Amendment freedoms of speech and association.   

According to the PHI, the research and policy analysis provider, Michigan's field of home health and personal care aids is projected to have 115,500 job openings from 2020 to 2030. Additionally, 43 percent of all direct care workers in Michigan – who provide in-home and outside support to disabled individuals – resided at less than 200 percent of the federal poverty level, and 44 percent were on some kind of public assistance.  

Incompass Michigan – a statewide network of human services providers – and the Michigan Assisted Living Association found that among 88 organizations who employ direct care workers, the average starting wage of a direct care worker was $15.72 per hour as of March of this year.  

The surveyed organizations include agencies that hire Home Help direct care workers and pay them with Medicaid dollars. The data found that 82 percent of those groups refused additional work or programming in the last 12 months because they could not recruit staff, and the average annual turnover rate was 35.9 percent. 

When asked where increased wages would come from under SB 790 and SB 791, Hertel pointed to the state budget-making process.  

"We'll have to work that through with the department budget. There are federal matching funds we believe that we can access to pull down more dollars, but ultimately, the state will have to make a choice," Hertel said. "To be honest, we are seeing the level of care workers, the amount of care workers across the state, becoming somewhat of a crisis. We are not going to have enough people doing the work to take care of those individuals who need it."  

Hertel said when Michigan does not have the proper population of caregivers ensuring individuals in need can remain in their homes, "it becomes more expensive." He said some of these un-served patients could end up in a facility or become faced with increased medical costs as they injure themselves on their own.  

"I would argue that if we do this on the front end, and make sure we have the correct (number) of care workers across the state who are trained properly, who can provide this level of care necessary, then we reduce costs in many other areas," he said. "I think a lot of us don't see the direct impact of this until either ourselves or somebody we love is in that situation, and the reality is that all of us, at some point, are going to need some level of care."  

While the budget sets aside money for SB 790 and SB 791 to be implemented in terms of the council and registry, a coalition of disability rights groups are concerned about the FY '25 budget appropriating $28.7 million, so direct care workers can be paid an additional 20 cents hourly through Medicaid reimbursements. 

"There (has) been a shortage of workers due to the wage levels, due to the lack of career advancement opportunities, and really a culture that is not affording folks who do this incredible work the appropriate level of respect," said Todd Culver, the president of Incompass Michigan, on last week's episode of the MIRS Monday Podcast.