1199 SEIU United Healthcare Workers East is already America’s largest healthcare union — but could grow by over 47% with one of the largest union election votes in U.S. history now pending.
The union announced Tuesday morning it has filed for an election through the National Labor Relations Board for workers under the state’s Consumer Directed Personal Assistance Program (CDPAP) after obtaining 70,000 authorization cards.
The vote, by mail, could happen by the end of the year, executive vice president of 1199’s Upstate Division Todd Hobler said.
"The NLRB will have to print 200,000 ballots," Hobler told BTPM News. "They'll have to hire somebody to count all those ballots, and they have to have time for it to go out and then come back."
1199 SEIU believes the vote, if successful, will be the largest in American history, with approximately 190,000 workers eligible to vote. The current largest-known vote appears to have been in 1940, when about 137,000 General Motors workers voted to form their union.
CDPAP allows disabled people to pay people they know using Medicaid funds to provide home care for them. While the consumer manages their workers, the workers are paid through Public Partnerships LLC, or PPL. Buffalo consumer Andrea Rodriguez said she’s supportive of her workers unionizing.
"I know that the union will be able to take care of the care workers as well as they take care of us," Rodriquez told BTPM. "So, this way I know they're protected. I know they'll be paid properly. I know it's going to be a hard road. It's going to be work for us as a union to get to those things."
Some of the issues workers want to see change, and that the union believes it can help with, include pay and benefits, which are determined by state funding and predate the PPL switch. However, since the state moved to PPL in 2025, many CDPAP workers have also described issues with payments, payroll, training, and communications.
"The union is going to be there for us. It's going to represent us," said Ingeri Eaton, Rodriquez's friend and CDPAP worker. "It's not going to make decisions on its own about what they think we need. They are going to be our voice in helping us get what we need and what we deserve."
However, the union’s involvement in CDPAP comes with scrutiny. In 2025, the state cut the number of companies administering it from more than 700 to just one. The contract for a single administrator of the program, referred to as a fiscal intermediary, was ultimately awarded to PPL.
In July 2026, New York Focus reported internal records show the union has been working closely with PPL for years.
Hobler said the union has been supportive of the transition.
"There was no way that you could possibly organize 200,000 people spread out over seven, eight hundred fiscal intermediaries, and the problems that existed in different FIs could hardly be addressed one by one," Hobler said. "I mean, it was a system that needed to be reformed."
1199 SEIU and PPL have entered into an agreement that made it possible for 1199 SEIU to contact homecare workers who might be interested in unionizing. Hobler said the union won't be asking PPL to voluntarily recognize the union.
"I think it's a better process, quite honestly, to have the the workers vote for the union rather than have the union and the employer reach an understanding or a recognition based on the number of cards," Hobler said. "I think our intention is to go forward with an election and have the workers decide by voting whether they want to be represented by 1199."
