Earlier this month, the Centers for Medicare & Medicaid Services (“CMS”) promulgated a new rule removing 42 CFR § 447.10(g)(4) in its entirety. Section 447.10 implements the general rule that Medicaid payments must be made to “providers” or “beneficiaries” and makes clear that those payments cannot be “reassigned” to any other entity. In other words, Medicaid payments must go straight to the person or entity providing services. Subsections (e), (f), and (g) included exceptions to that general rule.

For some time, subsection (g)(4) was used to justify union dues deductions from Medicaid’s payment to homecare workers. Specifically, it provided that, for certain providers, “payment may be made to a third party on behalf of the individual practitioner for benefits such as health insurance, skills training and other benefits customary for employees.”

According to CMS, now that this language is gone, homecare workers cannot reassign a portion of their Medicaid payments to a union or any other entity. They can, however, join a union if they desire and “voluntarily agree to automatic credit card or bank account deductions to pay for union dues once 100 percent of reimbursement has been received.”1


1 Medicaid Program; Reassignment of Medicaid Provider Claims, 84 Fed. Reg. 19718, 19723 (May 2, 2019).