Saturday, October 20, 2012

Election 2012: Michigan's Proposal 4 and Home Help Services

Proposal 4 is a controversial ballot proposal that takes a non-controversial Medicaid-funded service for people who need help to remain in their own homes and places it at the center of a debate over left-right politics, public employee unions, the role of advocates for seniors and people with disabilities, and a formerly state-funded organization - the MQC3 - that may or may not disappear unless Proposal 4 passes.

Whether or not Proposal 4 passes, Home Help Services will continue to be provided for people on Medicaid. The Home Help Services program has been around for over 25 years. If you are on Medicaid, you are entitled to these services based on your need for them.

The following is the wording for Prop 4: 


This proposal would:

  • Allow in-home care workers to bargain collectively with the Michigan Quality Home Care Council (MQHCC). Continue the current exclusive representative of in-home care workers until modified in accordance with labor laws.
  • Require MQHCC to provide training for in-home care workers, create a registry of workers who pass background checks, and provide financial services to patients to manage the cost of in-home care.
  • Preserve patients’ rights to hire in-home care workers who are not referred from the MQHCC registry who are bargaining unit members.
  • Authorize the MQHCC to set minimum compensation standards and terms and conditions of employment.
Background Information and Analysis of Prop 4

To understand proposal 4, the best place to go for an objective analysis of the issues is to a report from the Michigan Senate Fiscal Agency (SFA) that provides background information on the proposal and explains the ramifications of a "yes" or "no" vote.

The Introduction to the SFA report lays out the issues involved in this proposal:

"Proposal 12-4 relates to workers who provide in-home care to Medicaid-eligible recipients of services under an existing State program called Home Help Services. These workers, who are hired by the recipients and paid by the State, are often relatives or friends of the recipients. The workers belong to a labor union, SEIU [Service Employees International Union] Healthcare Michigan. For this purpose, the workers are considered public employees of an entity called the Michigan Quality Community Care Council.

"In April 2012, legislation was enacted to prevent these workers from being considered public employees, and to prevent SEIU Healthcare Michigan from being recognized as their bargaining representative. A Federal lawsuit was filed to challenge that law. In June, the judge issued a preliminary injunction, preventing the law from taking effect for the time being. The Attorney General has filed a motion to appeal."

The Home Help Services Program is administered by the Michigan Department of Human Services and is paid for with state and federal Medicaid funds. The program supports services to seniors and people with disabilities on Medicaid who need assistance with personal care activities and household chores. For more information, see The DD News Blog According to the SFA report, Proposal 4 reflects current practice with regard to recipients being allowed to hire and direct individual providers paid for by the state. Proposal 4 would not change this program.

The Michigan Quality Home Care Council (MQHCC) would replace the Michigan Quality Community Care Council (MQC3) and do what the MQC3 was doing, at least while it had funding: provide training for in-home care workers, create a registry of workers who pass background checks, and provide financial services to patients to manage the cost of in-home care. The MQC3 Board is made up of advocates for seniors and people with disabilities including Dohn Hoyle, the Executive Director of the ARC Michigan, who was the first Chair of the Board of Directors for MQC3. Here is a link to the MQC3 Web site.

According to the SFA, the MQHC "would set compensation standards, subject to appropriations by the legislature, and other terms of employment for the providers by program participants." Participant-employed providers would have the right to collectively bargain as public employees who do not belong to the civil service. "The providers would not be considered public or State employees for any other purpose, and would not have the right to strike," according to the SFA report.

Other pertinent facts are: 

  • The MQC3 was created in 2004 to coordinate personal assistance services provided by Home Help Services and to create a registry of providers. 
  • An election to organize Home Help Workers was held in 2005 with ballots sent out to 43,000 providers. Only about 8500 of them voted, with "yes" votes winning about 7 to 1 over "no" votes. 
  • According to a report from the Anderson Economic Group on "The Role of MQC3 and Home Help" from 2011, about 75% of the total number of home help workers are family members or friends of seniors or people with disabilities and 80% have only one client. 
  • In 2010 there were 53,516 consumers of home help services;  In 2008, there were on average 44,000 home help providers each month. 
  • MQC3 had an annual budget of about $1.1 million from the Michigan Department of Community Health. Its registry contains the names of about 900 providers.
Objections to the organizing of home help workers have come from many of those who are family members or friends of the person they are caring for in their own homes who do not consider themselves State employees. Others object to paying 2.75% of their meager wages (about $8 per hour) in union dues. They may opt out of belonging to the union but they still pay a fee to the union for representation.  As I understand it, the Michigan Department of Community Health deducts union dues and fees from Home Help workers pay checks, which are then sent through the MQC3 to SEIU Healthcare Michigan.

Others believe that the legislature, by passing Public Act 76 in April 2012 that amends Michigan's Public Employment Relations Act,
has undermined collective bargaining rights and that a constitutional amendment is necessary to protect these rights.  The law excludes people who receive government subsidies for their work from the definition of "public employee" and prohibits recognition of bargaining units made up of non-public employees. A Federal lawsuit challenged the law and an injunction has prevented it from going into effect.

The MQC3 has been defunded by the legislature and passing proposal 4 will put it back on its feet as the MQHCC. The organization's training programs and the registry of providers seem to be helpful, but whether it needs to be part of the Michigan Constitution is up to the voters.

One question that I have that I have not seen anyone address has to do with the MQC3 (and potentially the MQHCC) representing the "employers" of home help workers, seniors and people with disabilities who generate the Medicaid funding to pay for services.  Were these "employers" ever asked if they approved of the MQC3 representing them or if they wanted such representation? It appears that the State assigned the MQC3 to represent seniors and people with disabilities without their knowledge or participation.  

For Pro and Con views on Proposition 4, see opinion pieces in the Detroit Free Press from October 19, 2012:

Prop 4: Proposal assures higher standards for home caregivers, greater safety for patients by Dohn Hoyle


Prop 4: Family and loved ones providing home health care shouldn't be forced to pay union dues by Robert and Patricia Haynes

There will be a live chat on Proposal 4 at noon on Tuesday, October 23, 2012, sponsored by the Detroit Free Press. Go to the Web site  to submit questions in advance.

I will be the first to admit that I am not an expert on many of these issues. I am just doing the best I can to piece together the information available to me. If you have  questions, corrections, or comments on this blog post, please say so in the comments on my blog. I will publish them as long as they are civil and coherent. A diversity of views and opinions on this issue are welcome.

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