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Missouri Proposition B, Home Care Initiative (2008)

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The Missouri Proposition B, also known as the Home Care Initiative, was an initiated state statute on the November 4, 2008 ballot in Missouri, where it was approved.

The Statutory Amendment to the Revised Statutes of Missouri Relating to Home Care (2008-025) amended Missouri law to establish the Missouri Quality Homecare Council. The Quality Homecare Council ensures the availability of home care services to the elderly under the Medicaid program by recruiting, training, and stabilizing the home care workforce. The annual cost of the program has been estimated at $510,560.[1][2]

Election results

Missouri Proposition B (Home Care)
Approveda Yes 2,077,831 75.3%

Official results via: Missouri Secretary of State - Elections Division


The initiative was sponsored by Alphonso Mayfield and Missourians for Quality Home Care (MQHC).

These groups were backed by the Service Employees International Union. Part of the ballot measure allows home-care workers to unionize, although it does ban strikes.[3]

Kristina Wilfore of the Ballot Initiative Strategy Center, a national organization that advocates for liberal ballot measures, has written that "progressives should feel good" about the initiative.[4]


Campaign consultants

Campaign consultants hired by MQHC include:

  • CSI for collecting petition signatures: $543,717.[6],
  • Jobs with Justice, $15,000 for "petition support."[7]

Arguments in favor

Notable arguments made in support of the measure included:

  • The 11-member council that would be created if Proposition B passes would include at least six people with disabilities.
  • The council would recruit more people to the field;
  • It would help people with disabilities stay in their homes;
  • It would lead to better pay and benefits for home health assistants.[8]


Arguments against

Notable arguments made in opposition of the measure included:

  • Proposition B would place additional requirements on home care service providers operating under the Medicaid program.
  • It has an estimated cost greater than $510,000 annually for state governmental agencies.
  • Critics say this measure could increase overall health care costs.[9]
  • State programs such as the Missouri Consumer Directed Services Program are already in place to help people stay in their homes.
  • The effort is mainly about growing the ranks of SEIU, its main financial backer.


In April 2009, after a push by the SEIU and other unions to organize the affected health care workers, the Missouri Legislature declined funding for the newly formed council.[10]


Regarding Proposition B, the Associated Press reported,"The ballot summary shown to voters said nothing about making it easier for in-home care providers to unionize." In 2009 home health workers paid for by Medicaid are on the verge to unionize, which some say will increase Medicaid costs.[11]

See also

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