“The Trump Administration's final rule would not only deny home care workers the right to fight for basic workplace rights, but it would jeopardize the health and well-being of the 15,000 Medicaid recipients who rely on this program for assistance,” said state Attorney General William Tong in a news release on Tuesday announcing that Connecticut had joined the suit.

And the 36-page federal complaint states at one point, “Finally, any changes to the States' Medicaid personal care services program that reduce the quality or stability of providers create real human costs for the beneficiaries of those programs.”

It then adds that “individuals who are aged, blind and disabled and need assistance to perform activities of daily living are better served by consistent and well-trained caregivers.”

Both Tong in the news release and the complaint do concede that there would be one way around the effects of the new rule, but say that it would not be tenable.

“While the States could, in theory, avoid risking this disruption by foregoing federal Medicaid funding for personal care services, doing so would forfeit more than $6.5 billion in federal dollars, causing devastating harm to state healthcare budgets and eroding the States' capacity to provide needed homecare for seniors and persons with disabilities,” the complaint says.

The Department of Health and Human Services on Wednesday declined to comment on the multistate lawsuit or Connecticut's role in it.

According to the suit, which is being led by California but has been joined by Connecticut, Massachusetts, Oregon and Washington, “each of the States has sought to improve the quality and stability of Medicaid homecare by extending state laws that authorize public-sector bargaining to the homecare workforce and permitting voluntary payroll deductions and/or benefit contributions.”

More specifically, as Tong explains about Connecticut in his news release, the state in 2012 enacted legislation creating the Personal Care Attendants Workforce Council, and it gave home personal care attendants the right to form labor organizations for collective bargaining with the state.

Moreover, Tong said, the majority of state home personal care attendants have joined the union and pay their dues through payroll deductions.

“Connecticut law specifically provides for deductions of union dues from the wages of personal care attendants pursuant to collective bargaining agreements, by a fiscal intermediary of the state,” he added.

But the new final rule from the health and human services department, he said, “interferes with the state's ability to deduct payments for worker benefits obtained through collective bargaining, like healthcare coverage or voluntary union dues, from homecare workers' paychecks.”

“This rule would disrupt well-established collective bargaining relationships authorized for decades by state labor laws,” Tong added.

The broader federal complaint, meanwhile, which seeks injunctive relief and a declaration that the new final rule is unconstitutional, argues that “if implemented in accordance with the Secretary's reinterpretation of the Medicaid Act, the Final Rule would undermine laws and agreements that have improved the provision of homecare to the States' residents,” and “it would disrupt well-established collective bargaining relationships and weaken an organized workforce infrastructure that the States have.”

“Historically, homecare workers have engaged in difficult, often physically-demanding work and faced low wages, few benefits, frequent injuries, and unpredictable hours, with no means to collectively address working conditions,” the complaint also points out, adding that “since States' authorization of collective bargaining, homecare workers have collectively chosen union representation.”

Then, in arguing against the Trump administration's rule implementation, the states say in the complaint that the “Final Rule … purports to reinterpret the Medicaid Act in a manner that would prohibit States from directly withholding these ordinary, voluntary deductions from homecare workers' paychecks.”

They then add that “defendants' purported basis for this rule change is a 47-year-old provision of the federal Medicaid Act, 42 U.S.C. Section 1396a(a)(32) … that prohibits assignment of rights to collect payment for Medicaid services to third parties,” but “Congress enacted that provision to prohibit a fraudulent medical financing scheme that bears no relationship whatsoever to legal payroll deductions such as union dues or other worker benefits.”

The suit names the Health and Human Services Department and its secretary, Alex M. Azar II, as defendants.

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