The Trump administration announced Tuesday it planned to end what it suggested was an illegal Obama-era rule allowing unions to collect dues from state subsidies intended for home health workers -- including family caregivers.
Federal law generally prohibits states from skimming money from Medicaid payments bound for independent in-home personal care workers. But in 2014, the Obama administration created an exception, saying that states could divert some of that Medicaid money to unions, on the theory that these workers effectively were public-sector employees.
Eleven left-leaning states have used that provision to raise more than $200 million a year for unions by taking it from health workers who often didn't even realize it, according to top GOP officials.
Those states include California, Massachusetts, New Jersey, and Illinois -- a blue state which has been at the center of recent Supreme Court rulings stripping power from organized labor.


But GOP leaders said the Obama administrative exception violates the federal Social Security Act, as well as the rights of home health workers.
The Trump administration's decision means that the Centers for Medicare & Medicaid Services (CMS) has begun the formal process of proposing a new rule to roll back the Obama regulation.
“The law provides that Medicaid providers must be paid directly and cannot have part of their payments diverted to third parties outside of a few very specific exceptions,” Tim Hill, acting director of the Center for Medicaid and CHIP Services, said in a statement. “This proposed rule is intended to ensure that providers receive their complete payment, and any circumstances in which a state does divert part of a provider’s payment must be clearly allowed under the law.”

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