powerpoint presentation · 2020. 2. 4. · title: powerpoint presentation author: rie...
TRANSCRIPT
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).
15
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
[email protected] [email protected]
Mary Sowers Kaleema Muhammad