Published
December 11, 2025
New York State’s Medicaid system includes a feature called the Consumer Directed Personal Assistance Program (CDAP). CDAP permits eligible Medicaid beneficiaries to choose and hire their own personal caregiver to provide home health services.
In 2024, Governor Kathy Hochul and the state legislature signed off on changes to the CDAP program. These changes replaced 700 firms that had administered payroll services to the home health aides providing care to Medicare beneficiaries with a single company called Public Partnerships, LLC (PPL). Aside from alleged corruption concerns regarding the new arrangement, there is another troubling issue—specifically that PPL has been meeting weekly with the Service Employees International Union (SEIU) in what looks like a bid to unionize some 200,000 home health care aides.
These workers have no doubt been on the SEIU’s radar for some time, but, as the union has found with trying to unionize entities like franchise restaurants, organizing workers who are employed by hundreds of different businesses is time-consuming and expensive. Now that all of these aides are covered by a single entity, they can be organized with just one election.
Regardless, the ground is now set for the SEIU to gain hundreds of thousands of new members and the dues revenue that comes with them. Mandatory union dues would even apply to family members who care for their own relatives. In other states that have allowed unionization of home health care aides under Medicaid, family members who had no need or desire for unionization suddenly saw deductions for dues to the SEIU taken out of their state Medicaid reimbursements. There would be no way to opt out of dues payments because New York lacks a right to work law.
For taxpayers who are footing the bill, there is also the issue of the increased costs that would come with unionization. So ironically, even though consolidation was sold under the guise of efficiency, expenses are likely to go up if the SEIU has its way.
It’s not surprising that the SEIU would leverage its government influence to gain new members, but it is unfortunate that New York workers and taxpayers are the ones impacted the most.
About the author
Michael Billet
Michael Billet, director of policy research for Employment Policy at the U.S. Chamber of Commerce, keeps members and internal Chamber policy staff abreast of pending labor, immigration, and health care legislation, as well as federal regulatory and subregulatory activities. He is also responsible for planning the Chamber’s annual workplace and community wellness forum.
