Supreme Court Invalidates Union Fee Requirements Imposed On Homecare Employees

On June 30, 2014, the U.S. Supreme Court rejected Illinois law that required homecare providers for Medicaid recipients to pay fees to a union. In Harris v. Quinn, the Court held that compulsory union agency fees imposed on Illinois homecare workers violated the First Amendment. The Court, however, did not issue a more expansive ruling that would have overruled Abood v. Detroit Bd. of Ed., 431 U.S. 209 (1977) and affected public-sector unionization and agency fees as a whole. While the Court's decision was narrow, it has widespread implications for the home healthcare industry as many other states allow homecare workers to unionize under statutory arrangements similar to those in Illinois, including California, Connecticut, Maryland, Massachusetts, Minnesota, Missouri, Oregon, Vermont and Washington.

Factual Background

Illinois' Department of Human Services Home Services Program, known as the Rehabilitation Program, allows Medicaid recipients who need institutional care to hire a personal assistant to provide homecare services. Many of the personal assistants are relatives of the person receiving care, and some provide care in their own home.

Illinois (and other state) law establishes an employer-employee relationship between the person receiving the care and the person providing it. The law states that the person receiving home care - the "customer" - "shall be the employer of the [personal assistant]."1 A "personal assistant" is defined as "an individual employed by the customer to provide . . . varied services approved by the customer's physician,"2 and the law confirms that the state "shall not have control or input in the employment relationship between the customer and the personal assistants."3 Other provisions emphasize the customer's employer status. The homecare recipients control most aspects of the employment relationship, including the hiring, firing, training, supervising, and disciplining of personal assistants. They also define the duties of a personal assistant by proposing a service plan. The customer has complete discretion over which personal assistant he or she wishes to hire.

While homecare recipients exercise near-exclusive control over their employment relationship with personal assistants, the state, subsidized by the federal Medicaid program, pays the personal assistants' salaries. Other than compensating personal assistants, the state's involvement in their employment relationship with the customer is minimal...