JEFFERSON CITY, Mo. -- In-home care providers for the elderly and disabled in Missouri have voted overwhelmingly for union representation, forming what they say is the state's largest health-care union.

The unionization vote passed 2,729 to 499, according to results of a mail-in ballot released Wednesday by the state Department of Labor and Industrial Relations.

The new Missouri Home Care Union will represent about 13,000 workers who help people living in their own homes to perform daily activities such as bathing, dressing, cooking and cleaning. The attendants are hired by consumers but paid through the state's Medicaid program. The new bargaining unit does not included attendants working for private companies.

The Medicaid-funded home-care providers could band together as a collective-bargaining unit because of a ballot measure approved in November. That initiative established the Missouri Quality Homecare Council and gave it the authority to negotiate with workers over wages and benefits.

The Service Employees International Union spent $1.7 million on the ballot initiative. It then joined with the American Federation of State, County and Municipal Employees to create the new Home Care Union.

Union director Carolyn Klinglesmith said many of the Medicaid-funded personal care attendants receive no health insurance, sick leave or vacation time.

"What I've heard the most from providers across the state is they want their work recognized and respected," Klinglesmith said.

Any union-negotiated increase in wages and benefits still would depend on legislators approving an increase in Missouri's payments to care providers. That may be difficult to accomplish in a Republican-led legislature that often has been at odds with unions and is dealing with slumping state tax revenue.

Earlier this year, the legislature declined to fund Democratic Gov. Jay Nixon's $360,000 request to allow the Missouri Quality Homecare Council to hire staff, buy equipment and run an office.

Labor department spokeswoman Amy Susan said Wednesday that the Home Care Union is the largest health-care bargaining unit for which the state Board of Mediation has conducted an election.

Home Care Union spokesman Joe Lawrence said the International Association of Machinists Lodge 142 represents about 22,000 people in Missouri and Teamsters Joint Council 13 represents about 19,000. But he said neither of those is a health-care union.