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Wisconsin legislative breakfast ppt

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Wisconsin legislative breakfast ppt

  1. 1. EMPLOYMENT FIRST:Modernizing Disability Policy in the 21st Century April 9, 2013 Madison, Wisconsin Madeleine WillThe Collaboration to Promote Self-Determination National Down Syndrome Society mwill@thecpsd.org 1
  2. 2. Evolved Thinking: Changed Public PolicyFrom: To:Assuming that people with I/DD Discovering that people with I/DD  Need to be taken care of  Can be self sufficient  Can’t work  Can work and pay taxes  Need constant supervision  Don’t need constant  Are a burden to families supervision  Are valued family members Key Point: People need support that match their needs.
  3. 3. Persons with disabilities were living with families and in communities Children with disabilities were given a guarantee of education Classrooms created and schools made physically accessible Classroom instruction developed in an individualized way The profession of special education greatly expanded Progress in medical care leading to increased longevityProgress in technology and pedagogy is laying the foundation for improved learning, working and living opportunities 3
  4. 4. Supported Employment—a Wisconsin Legacy In 1984-1986, development of Supported Employment systems change grants; state experimentation in Wisconsin, Washington and other states In 1986, Supported Employment (SE) services were permitted through HCBS waivers to individuals who had been institutionalized before entering waiver program In 1997, permissible to receive SE without having been institutionalized before entering waiver program 4
  5. 5. A Heavy Lift: 1986 Rehabilitation Act Definition of Supported Employment(A) In general the term "supported employment" meanscompetitive work in integrated work settings, oremployment in integrated work settings in whichindividuals are working toward competitive work,consistent with the strengths, resources, priorities,concerns, abilities, capabilities, interests, and informedchoice of the individuals, for individuals with the mostsignificant disabilities —who require intensive servicesand support 5
  6. 6. 6
  7. 7. Moving into the New Millennium Expectations were high for continued progress… Not so fast… 7
  8. 8. The Reality is Poverty: Look at the Numbers SUBPOPULATION 2009 Poverty Rate 2010 Poverty Rate Children 20.7% 22.0% African-American 25.8% 27.4% Hispanic 25.3% 26.6% Disability 25.0% 27.9% Total U.S. Population 14.3% 15.1% U.S. Census Bureau (13 September 2011)•46.2 million Americans were living in poverty in 2010•Persons with disabilities experienced the highest rates of poverty of anysubcategory of Americans for the tenth year in a row•They experienced unacceptably high unemployment rates for decades—70% forall persons with disability and 90% for those with ID/DD (between 500-600kindividuals are in sheltered workshops or non-work programs earning little ornothing)•SSDI/SSI annual cost will likely approach 1 trillion dollars in 2023(currently, only .02 of 1% of beneficiaries leave rolls voluntarily)
  9. 9. Figure 1. Percentage of Estimated Federal and State Expenditures forWorking-Age People with Disabilities by Major Expenditure Category, FiscalYear 2008[1] Housing & Education, E Other Food mployment & Services Assistance Training 0% 3% 1% $357 Billion Income Maintenance in Healthcare 41% 55% FY2008 Also includes LTSS for PWD via Medicaid & Medicare[1] Adapted from Livermore, Stapleton and O’Toole (2011, Health Affairs) 9
  10. 10. Lifelong poverty and dependence UnemploymentLack of choice and opportunity 10
  11. 11. High expectations and accountability in school Work experience as part of transition Integrated employment in the general workforceFocus on getting a person a place to life in the community Opportunity to make choices and direct one’s life 11
  12. 12. We Had Proved that People Can Work When Services Focus on Employment But success in employment varies widely across 30 states 100% Washington State (88 %) Oklahoma (60%) Connecticut (54%) 80% Louisiana (47%) New Hampshire (46%) 60% 40% 20% 0%2009 – UMASS Boston ICI ID/DD Agency Survey 12
  13. 13. SERVICE AREA CYCLICAL DEPENDENCY SELF-SUFFICIENCY MODEL Segregated: Full Inclusion:Education $25-45K/student/year $12-26K/student/year Average annual costs of Ave annual costs of Supported Sheltered Work Employment (SE)/Individual: (SW)/Individual: $19,388 $6,619 SW is less cost-efficient to SE is more cost-efficient toEmployment taxpayers: 0.83 taxpayers: 1.21 SW is less cost-efficient to SE is more cost-efficient to workers: 0.24 workers: 4.20 Data Sources: Education: Weiner, 1985; Carlberg & Kavale, 1980; Baker, Wang & Walberg 1995; Piuma, 1989; Blackorby & Wagner, 2001. Employment: Cimera, R. (2007, 2008, 2009, 2010) 13
  14. 14. Lots of Data Available Lower per capita costs Average follow along supports three times lower over an eight year period (Wisconsin study) Individual with disabilities earn more and costs less Greater return in wages than in monetary costs regardless of their state of residence or number of disabling conditionsData Source: National Council on Disability: Medicaid Managed Care for People with Disabilities (March 2013)1) R. E. Cimera, ―The Cost Trends of Supported Employment Versus Sheltered Employment,‖ Journal of Vocational Rehabilitation 28 (2008): 15–20.2) R. E. Cimera, An Evaluation of the Long-Term Service Costs and Vocational Outcomes of Supported and Center-Based Employees in Wisconsin (August 2010), http://www.dhs.wisconsin.gov/wipathways/pdf/cimera.pdf.3) R. E. Cimera, ―The National Cost-Efficiency of Supported Employees with Intellectual Disabilities: The Worker’s Perspective,‖ Journal of Vocational Rehabilitation 33 (2010): 123–31.4) R. E. Dunn, N. J. Wewiorski, and E. S. Rogers, ―The Meaning and Importance of Employment to People in Recovery from Serious Mental Illness: Results of a Qualitative Study,‖ Psychiatric Rehabilitation Journal 32, no. 1: 59–62. 14
  15. 15. Inability to save – asset limitation of $2000Inability to earn – income limitation (approx. $600)Fear of loss of benefits and other disincentives toemploymentFragmented and confusing system of supports at federaland state level of government 15
  16. 16. New ThinkingInvesting in the competency and value of persons withdisabilities to achieve economic and personal freedomNot exchanging benefits for poverty and dependenceSpending public dollars more wisely to help build thecapacity of providers to make the transition toemployment and to the self sufficiency investmentmodel 16
  17. 17. An Concept Emerging From States: Employment First In general, employment in the workforceneeded to be the first and preferred outcome inthe provision of publicly funded services for all working age citizens with disabilities, regardless of level of disability. 17
  18. 18. State Employment First Initiatives› 30+ states have some type of ―Employment First‖ effort› At least 19 states have official Employment First legislation and/or polices› Employment First is not just a policy – to do it right requires comprehensive systems modernization
  19. 19. Ohio Governor John Kasich Delaware Governor Jack Markell 19
  20. 20. State Initiatives Influenced the National Disability Community The Collaboration to Promote Self-Determination (CPSD)A national coalition that seeks to: Modernize federal programs so they maximize self-sufficiency and economic security; Eliminate barriers to work and savings while preserving vital, long-term public supports; Build on state and grass roots innovation 20
  21. 21. A Breakthrough:Centers on Medicare and Medicaid (CMS) Guidance – September 16, 2011 CMS addresses implementation of goal to promote integrated employment option through Medicaid (HCBS) waiver program
  22. 22. Medicare and Medicaid Guidance Acknowledges best practices in employment support, including self direction and peer support options Clarifies that reimbursements can be for outcomes, not service delivery Adds a new core service definition for individual and small group supported employment Includes a new service definition for career planning 22
  23. 23. Using Employment First Strategies The Collaboration to Promote Self-Determination Achieving a Better Life Experience (ABLE) Act (H.R. 647/S.313) Transition toward Excellence Achievement & Mobility (TEAM) Act › TEAM – Employment (H.R. 509) › TEAM – Education (H.R. 510) › TEAM – Empowerment (H.R. 511)L Incentives for earning and saving (re-structuring asset and income limitations)
  24. 24. Allow individuals and families to create a taxadvantaged 529-education –like savings account thatdoes not jeopardize benefitsEncourage planning and saving for expenses incurredacross the lifespan—education, health care,employment training and support, transportationand housingRequires a Medicaid pay-back when the individualpasses away 24
  25. 25. Establish a coordinated, comprehensive approach to theinvestment of public resources based on Employment FirstconceptExpand and improve the opportunities for youth withsignificant disabilities who are transitioning into adulthoodEnsure meaningful postsecondary educational opportunitiesand employment in integrated settings at a competitive wage 25
  26. 26. Policy Makers will Shape Their Future 26
  27. 27. 27

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