Michigan’s Direct Care Workers Win Union Representation: What It Means for Providers, Clients, and the National Landscape
Michigan just crossed an inflection point: nearly 32,000 Home Help direct care workers voted to unionize under SEIU Healthcare Michigan, launching a first contract process that will intersect with CMS’s Ensuring Access rule and the state’s existing self-direction model. For agencies, health tech teams, and care leaders, this is not a narrow labor story—it’s a system story about workforce stability, wage floors, paid training, documentation discipline (EVV, payroll timeliness), and rate transparency. For clients and families, choice and control remain central while the state and union negotiate high-level terms intended to reduce turnover and missed hours. This two-page brief distills what changes now, what to watch over the next 12–24 months, and how to position your organization—whether you operate in Michigan or are tracking the ripple effects in other states considering similar structures.
1) What happened—and why it matters
The vote: Michigan held a statewide mail ballot for ~30–32k Home Help caregivers to decide on representation with SEIU Healthcare Michigan. MERC (the state labor board) administered the election; MDHHS published the official ballot and election notice. Certification follows MERC’s post-election process.
The legal framework: The Home Help Caregiver Council Act (2024) designates individual Home Help caregivers as public employees solely for collective bargaining with the Home Help Caregiver Council, while preserving self-direction (clients continue to hire, schedule, and direct workers).
Current rate floor (still in effect): $15.88/hour for individual caregivers and $27.00/hour for agencies (effective Nov 1, 2024). These remain until changed by policy or bargaining.
Federal backdrop: CMS’s Ensuring Access to Medicaid Services final rule (Apr 22, 2024) phases in requirements that states direct ~80% of certain HCBS payments to worker compensation and publish transparent rate/compensation data—raising the stakes for wage and workforce policy.
2) What changes now (near-term expectations)
For DCWs (Home Help individual caregivers)
A unified bargaining table with the Home Help Caregiver Council on wages, benefits, training access, and dispute processes—self-direction stays intact.
Today’s $15.88/hour operates as a floor, not a ceiling; bargaining commonly targets wage steps, differentials (nights/weekends/advanced skills), paid training, and grievance timelines (mirroring other states’ CBA patterns).
For clients & families
No change to choice and control (hire/fire/schedule remains with the consumer). Potential medium-term gain: greater workforce stability as wages/training improve, reducing missed hours.
For providers & agency owners
Market wage pressure: If individual caregiver floors rise via the CBA, expect spillover competition for talent across Home Help agencies, other HCBS lines, and private-pay.
Documentation & operations: Tighten EVV, timely pay, and record-keeping; these are frequent friction points that can become grievances under a contract. (MDHHS EVV requirement effective Sept 3, 2024.)
Rate strategy: The CMS access rule will push rate transparency and worker-compensation pass-throughs; align your cost story now.
3) What similar states tell us (benchmarks for Michigan)
States with long-standing statewide bargaining for consumer-directed/home help workers show durable patterns:
Washington (SEIU 775): State-level bargaining for “individual providers” under RCW 74.39A; multi-cycle CBAs include wage schedules, benefits, paid training, and differentials.
Oregon (SEIU 503): The Home Care Commission is employer of record for bargaining; the 2025–2027 settlement includes multi-step hourly increases and benefit improvements.
Massachusetts: The PCA Workforce Council bargains with 1199SEIU while preserving consumer-employer self-direction.
Minnesota: PCA Choice & CFSS workers bargain with the state; recent terms include stipends and tiered wage scales.
Illinois: Personal Assistants in the DHS Home Services Program bargain statewide with SEIU; CBA covers wages, training, and benefits.
California: IHSS providers bargain (primarily via county public authorities as employer of record); 2025 AB 283 would centralize to a statewide authority for bargaining—illustrating evolving structures.
Vermont: Statutes authorize collective bargaining for independent direct support providers with the state.
Common outcomes elsewhere:
Rising wage floors + differentials; expanded paid training and orientation; clearer grievance and discipline processes; targeted benefits (e.g., health, retirement pilots); and improved recruitment/retention—all with ongoing state budget negotiations and compliance guardrails.
4) States with DCW* unions today (statewide structures for consumer-directed attendants)
California, Connecticut, Illinois, Massachusetts, Minnesota, Oregon, Vermont, Washington, and Michigan (post-election certification pending).
*DCW here refers to consumer-directed personal care attendants/home help “individual providers,” not agency-employed aides (who may also be unionized via private-sector CBAs).
5) States where DCW unionization (or structure changes) are active or under discussion
California: AB 283 (2025) proposes moving from county-based IHSS bargaining to a statewide employer of record, reshaping negotiations and potentially standardizing wage/benefit floors.
Pennsylvania: The state’s own materials reference Executive Order 2015-05 supporting representation for home care workers; while litigation and administration changes complicated implementation, PA remains a watch-list state given its large self-directed population and recurring policy attention.
NCSL hosts current legislative databases with a 50-state tracker for new bills touching collective bargaining or HCBS workforce, such as:
6) Scenario outlook for Michigan (12–24 months)
National ripple effects: Michigan’s data on fill rates, turnover, overtime, and waitlists—reported alongside CMS access-rule transparency—will inform other states weighing similar structures. Expect increased adoption of career ladders, competency-based paid training, and wage-pass-through models.
7) playbook—what to do next (practical steps)
Quantify exposure: Build “what-if” models at +$1 / +$2 / +$3 to the individual caregiver floor; include differentials and paid-training assumptions. Anchor to MDHHS’s $15.88/$27.00 baseline.
Ready your rate narrative: Map each reimbursement dollar to frontline compensation (base, differentials, PTO, training) to align with CMS transparency and bolster budget asks.
Tighten compliance: Re-train supervisors on EVV, timely pay, documentation standards; reduce grievance risk.
Invest in skills: Propose paid on-ramps (orientation, dementia basics) and stackable credentials that match consumer needs and reduce re-training costs—track outcomes for advocacy. (Use AARP LTSS Scorecard metrics for workforce context.)
Communicate early with clients: One-page explainer: your choice/control remains; any negotiated improvements aim to reduce turnover and missed shifts.
key sources
Centers for Medicare & Medicaid Services. (2024, April 22). Ensuring Access to Medicaid Services final rule (CMS-2442-F). (fact sheet, Centers for Medicare & Medicaid Services)
Michigan Department of Health & Human Services (MDHHS). (2024, Nov 14). Numbered Letter L-24-66: Home Help individual caregiver rate $15.88/hr. (Michigan.gov)
MDHHS. (2024, Nov 14). Numbered Letter L-24-74: Home Help agency rate $27.00/hr. (Michigan.gov)
MDHHS. (2025, Oct). Official ballot & election notice—Home Help Caregiver Council. (Michigan.gov)
AARP Public Policy Institute. (2023). LTSS State Scorecard (2023). (ltsschoices.aarp.org)
Washington State RCW 74.39A; SEIU 775 CBA. (2021–2025). (Recognition of individual providers; example CBA terms). (apps.leg.wa.gov)
Oregon Home Care Commission. (2023–2027). SEIU OHCC Collective Bargaining Agreements & 2025–27 summary. (Oregon)
Massachusetts PCA Workforce Council. (2021). Council role & CBA authority. https://www.mass.gov/ (Mass.gov)
Minnesota DHS. (2025). PCA Choice/CFSS—collective bargaining references & 2025–27 terms. (Minnesota Department of Human Services)
Illinois CMS. (2024). CBA covering Department of Human Services Personal Assistants (2023–27). (Central Management Services)
California Department of Social Services & LA County. (2000–2025). IHSS employer-of-record authorities; AB 283 (2025) statewide bargaining proposal. (California Department of Social Services)
Vermont Legislature. (2013–2025). Statutes authorizing bargaining for independent direct support providers. (legislature.vermont.gov)
NCSL. (2025). Unions & collective bargaining legislation databases (for tracking live bills). (NCSL)
