Controversial Home Care Overhaul Passes in Washington State

About 35,000 individual home care workers in Washington will be managed by a private entity rather than the state by 2021, under a law signed Tuesday by Democratic Governor Jay Inslee (pictured above).

The divisive measure pitted Democrats and union interests against Republicans and the conservative nonprofit Freedom Foundation, based in the state capital of Olympia.

The law relates to caregivers known as “individual providers.” These are often people providing care to homebound family members, and they are currently being paid by Washington’s Department of Social and Human Services under the state’s Medicaid program.


Per the new law, the state will contract with a “consumer directed employer” (CDE)—that is, a private-sector entity that will take over administration of the home care program for individual providers.

The CDE will be the IP’s legal employer and handle tasks such as: verifying that the caregivers have met training requirements; conducting background checks; implementing an electronic visit verification system; and confirming that the individual provider is able to carry out the plan of care.

Supporters of the measure argue that contracting with a CDE will bring more efficiency to how the home care program is run, including by creating a better payroll system.


Opponents counter that the CDE contract will be costly, running to an estimated $22 million every two years. And they say it is a pro-union measure meant to get around a 2014 U.S. Supreme Court ruling.

That case, Harris v. Quinn, involved home care workers in Illinois. The workers objected to being forced to pay fees to the Service Employees International Union (SEIU), even though they had opted not to join the union. At that time, because the workers were considered state employees and benefited from SEIU’s collective bargaining actions, they could be compelled to pay certain fees. The Supreme Court ruled that this violated the First Amendment of the U.S. Constitution.

In Washington, the individual providers will no longer be considered employees of the state, so the playing field will change.

“That private status would allow SEIU 775 to create a shop where home-care workers must pay either union dues or agency fees if they don’t claim religious exemptions,” The Olympian reported.

At least 17 other states states use a similar third-party system for home care administration, according to information cited by the newspaper.

The Freedom Foundation collected more than 1,000 petitions from home care workers who were against the new law and wanted Inslee to veto the bill. The foundation anticipates that legal challenges will be mounted as the law takes effect.

The state has until July 1, 2021, to contract with a maximum of two CDEs.

Written by Tim Mullaney

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