Dear Secretary Azar:
We write to oppose the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services (CMS) proposed rule: Medicaid Program; Reassignment of Medicaid Provider Claims. By prohibiting home care workers from paying for health insurance or union dues automatically from their paycheck, the proposed rule infringes on home care workers' right to join a union directly affecting their ability to access health insurance coverage, skills training, and improved working conditions. Health insurance in particular is a critical benefit, and we should be doing more to improve access--not adding additional and unnecessary roadblocks to coverage. The proposal would also exacerbate the existing home care worker shortage, and seriously impact the ability of seniors and people with disabilities in California to access quality care in their homes and communities. For these reasons, we strongly urge you to withdraw the proposed rule and protect the rights of American workers and patients.
HHS' proposed rule will disproportionately impact California. We have the largest consumer-directed home and community based service program in the nation, which allows more than half a million of the state's seniors and people with disabilities to receive care in their communities. These programs provide high-quality alternatives to institutions, delivering cost-effective and culturally responsive care in the comfort of a patient's own home or community.
The home care workforce--which is 90 percent women, the majority of whom are women of color--is critical to the success of home and community based services and the ability to deliver high-quality home and community care. In California and across the nation, unions have partnered with home care workers to begin to stabilize and grow the workforce, raising wages and ensuring access to benefits like health insurance coverage and skills training to improve job conditions.
If implemented as HHS currently intends, the proposed rule would unnecessarily deepen a growing care crisis. By making it more difficult for home care workers to join unions, the proposal will hinder the state's ability to combat high turnover rates through increased pay, professional growth opportunities, and countering the isolation that has been found responsible for workforce instability and the deficit of workers. The negative impact of the proposed rule would not only be felt by the home care workers, but by the thousands of seniors and people with disabilities that rely on them to deliver care every day.
Finally, we want to register our concern about the process underlying this Notice of Proposed Rulemaking. Under Executive Order 13563, Improving Regulation and Regulatory Review, agencies should afford the public a meaningful opportunity to comment on any proposed regulations, with a comment period that should generally be at least 60 days. HHS provided no justification for a 30 day comment period. Furthermore, as the proposed rule itself acknowledges, HHS has no data on which to make an analysis of the impact of the rule, including whether or not it may be economically significant. HHS' inadequate comment period and insufficient data are unacceptable grounds for a policy change that could be of serious consequence to state Medicaid HCBS programs, home care workers, and the consumers who rely on these services.
Home care workers have joined unions to advocate for increased wages, create sustainable career pathways, and improve the care their patients receive through Medicaid. We strongly urge HHS to protect many of our nation's most vulnerable workers and patients by immediately withdrawing this proposal.