Agency for Persons with Disabilities: Redesign of Adult Day Training and

Employment Services May 23, 2019

In recent years, law and policy and new expectations from those receiving services are driving the demand for system reform.

Agenda

1) Welcome and Introductions

2) National Influences

3) State Challenges

4) Q & A

Today’s Goal

The Inevitable: Understanding the Forces That Will Shape Our Future

Gaining Participation in Implementation

What is Behind all of the Change….

The National and State Disparity

Percent Employed Percent Below Poverty

American Community Survey, 2016

73.6

34.3

24.8

72.7

31.9

20.6

0

10

20

30

40

50

60

70

80

No Disability Any Disability Cognitive Disability

United States Florida

12.4

26.8

32

13

26

29.7

0

5

10

15

20

25

30

35

No Disability Any Disability Cognitive Disability

United States Florida

6

Barriers Contributing to the Disparity

❖ Myths and misperceptions of the “limitations” of working with a disability

❖ Fear of losing health benefits from public assistance programs due to income and resource limits

❖ Historic trend of employment not being a priority within the disability service systems

Floridians with Disabilities Receiving SSI Benefits in 2016

Total Recipients 439,184

Total Employed 12,673

Percent Employed 2.6%

Total Receiving an SSI Work Incentive

338

Percent Receiving an SSI Work Incentive

<0.01%

Social Security Administration, “SSI

Disabled Recipients Who Work”

National Influences

➢American with Disabilities Act

➢Employment First Movement

➢Medicaid Home & Community Based Services Final Regulation 2014

➢Workforce Innovation and Opportunity Act 2014

➢Changing demographics and expectations from individuals and their families

➢Proposed Federal Legislation to eliminate section 14(c) of Fair Labor Standards Act (subminimum wage option)

The Americans With Disabilities Act (ADA) of 1990

The nation's first comprehensive civil rights law addressing the needs of people with disabilities, prohibiting discrimination in employment, public services, public accommodations, and telecommunications.

Olmstead Decision June 22, 1999

• The Court held that public entities must provide community-based services to persons with disabilities when

• (1) such services are appropriate;

• (2) the affected persons do not oppose community-based treatment; and

• (3) community-based services can be reasonably accommodated, taking into account the resources available to the public entity and the needs of others who are receiving disability services from the entity.

Medicaid Home & Community Based (HCBS) Services Final Regulation

The final Home and Community-Based Services (HCBS) regulations set forth new requirements for several Medicaid authorities under which states may provide home and community-based long-term services and supports. The regulations enhance the quality of HCBS and provide additional protections to individuals that receive services under these Medicaid authorities.

HCBS Rules Were: Published January 16, 2014

Effective: March 17, 2014

Compliance Date for Settings Portion of the Rule: March, 2022

HCBS character

• The home and community-based setting requirements establish an outcome oriented definition that focuses on the nature and quality of individuals’ experiences

• The requirements maximize opportunities for individuals to have access to the benefits of community living and the opportunity to receive services in the most integrated setting

• The new standards are “experiential” and about “qualities” of the setting

HCBS setting requirements

42CFR441.310(C)(4)

• Is integrated in and supports access to the greater community

• Provides opportunities to seek employment and work in competitive integrated settings, engage in community life, and control personal resources

• Ensures the individual receives services in the community to the same degree of access as individuals not receiving Medicaid home and community-based services

HCBS setting requirements

• Ensures an individual’s rights of privacy, dignity, respect, and freedom from coercion and restraint

• Optimizes individual initiative, autonomy, and independence in making life choices

• Facilitates individual choice regarding services and supports, and who provides them

Workforce Innovation and Opportunity Act (WIOA)

• Signed into law on July 22, 2014

• Provides for a continuum of services and supports including transition services available to students and youth with disabilities; and

• Ushers in a new set of services for students with disabilities: Pre-Employment Transition Services (Pre ETS).

WIOA’s Legislative Purpose

• WIOA is designed to eliminate “the disproportionate burden of unemployment and underemployment experienced by people with disabilities in our country… [and] to help a new generation of young people with disabilities to prepare for, obtain, and succeed in competitive integrated employment….” See Congressional Record, S3964-S3991, Statement of Senator Tom Harkin (June 25, 2014).

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Legislative purpose and intent was to build employment outcomes that maintain:

➢Parity ➢Comparability and➢Typicality.

➢ Access to employment opportunities that are the same as those available to workers in mainstream economy.

Definitions Drive the System

• Begin with the end in mind.

• The definitions under the Rehabilitation Act as amended by WIOA set forth important parameters for the employment outcomes that must result from VR funding.

• It was Congress’ intention that VR funds be used to afford individuals with disabilities, including significant disabilities, “a full opportunity to integrate within their communities and participate in jobs that are available to the general population.” Final Regulations for State VR Services Program, 66 Fed. Reg. 7249 (Jan. 22, 2001).

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WIOA emphasis on Competitive Integrated Employment (CIE)

The Rehabilitation Act of 1973, as amended by the Workforce Innovation and Opportunity Act (WIOA), places emphasis on the achievement of competitive integrated employment (CIE) for individuals with disabilities. Definition outlines CIE as having the following qualities:

(1) competitive earnings,

(2) integrated location, and

(3) opportunities for advancement.

Employment First Policies: • 38 states with official policy

• 20 states passed legislation –like Florida these states state that integrated employment is a preferred over other service options

• 18 have policies issued by state agencies, Executive Orders, etc.

• 26 state polices cross-disability

As of April 2019

STATES Response to the Changing Demands

New Service Models

➢Supporting families

➢Develop relationship-based living arrangements

➢Focus on employment

➢Pay Family Caregivers

New Finance Models

➢ Implement resource allocation methodologies

➢Adopt managed care strategies

➢Look at new federal authorities for HCBSs

➢Create support waivers

National Landscape of Day and Employment Services

Wide variation on a local, state, and regional level in service investments and outcomes, nationwide, the service delivery system for individuals with IDD currently falls short of providing the demand for employment and community integration supports.

National Landscape of Day and Employment Services

• Almost half of the individuals supported by state IDD agencies who are not working in integrated jobs state they want to work in the community.

• Only 11% of the Medicaid waiver dollars spent by state IDD agencies go to integrated employment services. The majority of Medicaid dollars are spent on facility-based non-work (42.3%) and community-based non-work (33%) services.

Number in Employment and Day Services

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

1990 1993 1996 1999 2004 2008 2012 2016

Non-work

Facility-based work

Integrated employment

632,000

312,448

Source: ICI National Survey ofState IDD Agencies

State IDD Agency Investment in Employment Services

0%

20%

40%

60%

80%

100%

Source: ICI National Survey ofState IDD Agencies 2016

State

FL 11 %

Works In Integrated EmploymentNation

5.7%

5.0%

6.8%

14.0%

19.1%

0% 10% 20% 30% 40%

Group supported job

Individual job withoutsupports

individual job withsupports

Individual Job

Works in IntegratedEmployment

Source: National Core Indicators2015-2016

Self Sufficiency & Meaningful DayMean Hours and Wages per 2 weeks

Hours worked Gross Wages

Individual job with supports

25 $222

Individual job without supports

27 $237

Group supported job

26 $167

Source: National Core Indicators2015-2016

659846

1,751

2,099

2,528

2,835 2,905

0

500

1,000

1,500

2,000

2,500

3,000

3,500

FY 2011-12 FY 2012-13 FY 2013-14 FY 2014-15 FY 2015-16 FY 2016-17 FY 2017-18

APD Waiver and Waiting List Individuals Competitively Employed

What is the State of the State?

First year of EEP Funding

Florida’s leaders have worked to increase employment outcomes:

❖ The Florida Employment First Act of 2016

❖ The Employment Enhancement Program (EEP) for individuals on the APD waiting list

❖ Employer outreach initiatives, such as the “Abilities Work” Help Desk

❖ Other collaborative efforts, such as Career Counseling and Information Referral (CCIR) for individuals in subminimum wage employment

Source: National Core Indicators 2015-2016

What is the State of the State?

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APD Employment and Day Services

Institute for Community Inclusion (ICI), UMass-Boston, “The National Survey of IDD Agencies’ Day and

Employment Services,” 2017

2,465 2,337 2,236 2,416 2,372 2,149

16,717

14,316 15,178

17,194

18,516 18,510

0

5,000

10,000

15,000

20,000

25,000

2012 2013 2014 2015 2016 2017

Supported Employment Facility-Based and Other Day Services

$85,289,888.10

$40,415,827.97

$5,186,638.46

$0.00

$10,000,000.00

$20,000,000.00

$30,000,000.00

$40,000,000.00

$50,000,000.00

$60,000,000.00

$70,000,000.00

$80,000,000.00

$90,000,000.00

Facility-Based Adult DayTraining (ADT)

Companion Care Supported Employment (SE)

iBudget Expenditures on Life Skills DevelopmentFiscal Year 2017-18

Breakdown of iBudget Expenditures in Life Skills Activities in FY17-18

Life Skills ParticipantSpend in ADT

FacilitySpend in SE

Spend in All Life Skills

Average Billable Hours 1041.61 80.85

Average Spend in ALL Life Skills Activities $6,441.35 $3,001.53 $7,161.84

Average Spend if in BOTH ADT and SE $3,291.92 $2,473.35 $6,479.15

Average Spend if NOT in SE $6,508.15 $6,987.75

Average Spend if NOT in ADT $3,101.49 $3,798.68

Achieving Objectives

• Demands Collaborative Partnerships • Shared knowledge

• Shared Resources

• Shared attention

Opportunities and Solutions?

Discussion

What is the single biggest issue you face with the expected systems changes?

Discussion

What is the best way for APD to keep you informed and involved as the system transformation unfolds?

Contacts

NASDDDS APD

Rie Kennedy-Lizotte David Darm

rklizotte@nasddds.org david.darm@apdcares.org

Mary Sowers Kaleema Muhammad

msowers@nasddds.org kaleema.Muhammad@apdcares.org