The Honorable Seema Verma
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-2413-P
P.O. Box 8016
Baltimore, MD 21244

Re: Proposed Rule: Medicaid Program; Reassignment of Medicaid Provider Claims (RIN 0938-AT61)

Dear Administrator Verma:

The Economic Policy Institute (EPI) is a nonprofit, nonpartisan think tank created in 1986 to include the needs of low- and middle-income workers in economic policy discussions. EPI conducts research and analysis on the economic status of working America, proposes public policies that protect and improve the economic conditions of low- and middle-income workers, and assesses policies with respect to how well they further those goals.

EPI strongly opposes the Centers for Medicare & Medicaid Services’ (CMS) proposal to rescind a provision of a 2014 rule affirming that states may make payments to third parties on behalf of an individual provider “for benefits such as health insurance, skills training, and other benefits customary for employees.”1 The proposal, which would also newly apply an unrelated prohibition on payments to third parties, will impact individual provider home care workers and will limit these workers from contributing their wages to support collectively-bargained-for benefits including healthcare coverage or authorized union dues. The proposed rule is nothing more than an attack on working people and their freedom to choose to join a union and advocate for better wages, benefits, and training.

Home care workers provide critical services to millions of Americans. These services, which are primarily funded by state Medicaid programs, enable seniors and people with disabilities to remain in their homes and communities, rather than more costly care facilities. In spite of the valuable role home care workers play in our communities, home care jobs are low-wage positions. Home care workers have a median hourly wage of $10.49.2 Furthermore, this work often involves inconsistent scheduling, resulting in home care workers typically earning $13,800 annually.3

By making it more difficult for home care workers to join a union and collectively bargain, the proposed rule will further erode home care workers’ wages and working conditions. This disproportionately impacts women—who make up 90 percent of the home care workforce—and people of color, who make up more than half. This erosion of job quality will also likely lead to an erosion in the quality of home health care by increasing job turnover and reducing continuity of care. This is even more troubling considering that home care jobs are among the fastest-growing occupations in the country as our population ages—but it is already difficult to attract workers to these jobs.4

All workers must have a strong and effective collective voice in the workplace. The erosion of collective bargaining rights has been the largest single contributor to the rising inequality that characterizes the U.S. labor market. This proposal is merely another example of the anti-worker policy the Trump administration routinely advances. It is a clear attempt to make it more difficult for working people to join together to advocate for better wages and working conditions.

In spite of the potential impact of the proposal, the Department of Health and Human Services (HHS) admits that it lacks information and data to support the change in its regulations. HHS has not conducted an economic analysis. Further, the proposal solicits information on a wide range of impacts, yet provides a public comment period of only 30 days. This is a deviation from the more standard 60-day public comment period and is insufficient time for the agency to obtain information necessary to evaluate the true impact of the proposal. If the agency continues with this flawed proposal, it should extend the comment period to 60 days to allow for meaningful public comment.

Sincerely,

Celine McNicholas
Director of Labor Law and Policy
Economic Policy Institute

Endnotes

1. Medicaid Program; Reassignment of Medicaid Provider Claims, 83 Fed. Reg. 32252 (proposed July 12, 2018) (to rescind 42 C.F.R. § 447.10(g)(4)).

2. Campbell, Stephen. U.S Home Care Workers: Key Facts. Paraprofessional Healthcare Institute. (September 6, 2017).

3. Campbell, Stephen. U.S Home Care Workers: Key Facts. Paraprofessional Healthcare Institute. (September 6, 2017).

4. Farrell, Chris. The Shortage of Home Care Workers: Worse Than You Think. Forbes (April 18, 2018).