Michigan Home Health Providers Fend Off Unionization, Hold onto Medicare Funding

In early November, Michigan voters turned down a proposed amendment to their state’s constitution, in turn protecting available home health care market options—at least for the time being. 

Proposal 4—the amendment that would require the unionization of home health care workers—was shut down with a 57% to 43% split in the polls.

Under the proposal, the Service Employees International Union (SEIU) would require private citizens who provide basic personal care to disabled adults to join union membership. With many of these workers providing care to family members, the Mackinac Center for Public Policy notes that SEIU unionization under Prop 4 would take away $6 million worth of Medicaid funding from home care workers for so-called “union dues.”


Among the biggest concerns regarding Prop 4 is the amendment would override recent Michigan legislation passed in March. The legislation states that any person whose private employment compensation comes from a government subsidy—either directly or indirectly—is not considered a government employee, and is therefore not subjected to induction into a government employee union. 

Vague in its ballot proposal, Prop 4 did not clearly express how much money the state would have to fund for the costs of training and background checks necessary for SEIU registry, aspects regarded trivially by the Mackinac Center, as most Home Help Program recipients and providers are related. 

“There’s a very vibrant market industry here in Michigan with many players. There really was no practical need for Prop 4 to create a government registry of home care workers put into our constitution,” said Barry Cargill, executive director of Michigan Home Health Association. 


If Prop 4 was passed, Michigan would have the state competing with private sector agencies. There would be not only be the risk of some agencies going out of business due to government competition, but would also limit the number of resources available to consumers, Cargill says.

“Basically, it’s an unfair competition issue where the government is competing in a service that is readily available in the private sector,” said Cargill. 

The amendment of Prop 4 would also spark the fear among home health providers that the government might extend their influence beyond just the one program regarding home health care, providers say. 

“With Proposal 4, we would fund and create a government-run home care agency that goes beyond its original intent of hiring family members to care for their loved ones,” added Cargill. 

With Prop 4 defeated, Cargill expressed the possibility that the amendment could return in the future under different state legislation, however, the second coming remains unlikely.

“I think that because we defeated it as soundly as we did, that it would be very hard for them to choose Michigan again,” he said.

Written by Jason Oliva