Final Issue
September, 2012
The Kansas Medicaid Infrastructure Grant: Transforming Kansas Infrastructure to Support the Competitive Employment of People with Disabilities
By Mary Ellen O'Brien Wright, MIG Director
Medicaid Infrastructure Grant (MIG) funding, and the flexibility allowed by the Centers for Medicare and Medicaid Services (CMS), provided the opportunity for Kansas to address employment barriers for people with disabilities over the past 11 years. As we plan for the future during this final year of MIG funding, now is a good time to look back and review our accomplishments.
Background
Created by the Ticket-to-Work and Work Incentives Improvement Act of 1999 (TWWIIA), the mission of MIGs was to implement a Medicaid Buy-In program, improve access to personal assistance services, and develop and establish a comprehensive employment agenda for people with disabilities at the state level. States with MIG projects were expected to do this by working with consumers, disability stakeholders, state agencies and community providers in order to coordinate, improve, and expand existing state infrastructures to promote and support competitive, integrated employment. Kansas was awarded four grants from 2001 through 2011, totaling $7,534,923 in MIG funds.
Basic MIG Accomplishments
The focus of the first two MIGs from 2001 through 2006, called Basic MIGs by CMS, was to address the following barriers to employment:
• inconsistent health care coverage for individuals with disabilities, including a major dis-incentive to become employed, or increase work hours;
• personal assistance services (PAS) for individuals who are employed; and
• insufficient knowledge of Social Security work incentives among people with disabilities, family members, and service providers.
Utilizing MIG funds, these barriers were addressed by:
• implementing the Kansas Medicaid Buy-In, Working Healthy, for Medically Needy individuals who were employed, allowing them to obtain affordable and consistent health care;
• implementing statewide Social Security benefits planning and work incentives education;
• adding individuals who are considered Medically Improved to Working Healthy, thereby preventing a worsening of their medical condition due to of lack of health care; and
• implementing Work Opportunities Reward Kansans (WORK), a program providing personal assistance and other services to support competitive employment for individuals with severe cognitive and physical disabilities eligible for Working Healthy.
After achieving the goals of the Basic MIG, in 2007 Kansas was in a position to competitively apply for the Comprehensive Employment MIG. States awarded these grants were expected to go beyond the scope of the Medicaid Buy-In program and develop a strategic plan to address employment barriers. Following a year of meeting and gathering information from stakeholders, the 2007-2010 Kansas Strategic Plan proposed to address the following barriers:
• Lack of a clear and consistent employment policy in Kansas regarding employment of individuals with disabilities, as well as lack of coordination among state agencies;
• Attitudinal barriers toward employment among employers, individuals with disabilities, their families, and providers;
• Inability to meet employers’ needs in order to create job
opportunities; and
• Limited cross-agency data sharing capabilities for improved program planning and evaluation of outcomes.
Efforts to address these barriers during the past five years include:
• facilitating efforts to obtain both a Governor’s Executive Order and state statute, establishing competitive employment as the first priority for Kansans with disabilities, setting the stage for an era of persons with disabilities as full contributing members of their local communities;
• promoting the Kansas Employment First movement for individuals with developmental disabilities;
• co-coordinating and co-funding two Kansas Employment Summits;
• funding of numerous projects designed to address attitudinal barriers, including Family Employment Awareness Training (FEAT), Soaring to New Heights, Youth Employment Program, and Medical Professional Continuing Education;
• co-sponsoring advocacy and educational activities for youth and adults with disabilities, including the bi-annual Kansas Disability Caucus, annual Self-Advocacy Coalition of Kansas conferences, Disability Mentoring Days throughout the state, the Kansas Youth Leadership Forum, continuing education programs at colleges, etc.;
• funding training events for professionals, including statewide vocational rehabilitation staff, developmental disability providers, and Independent Living Center staff;
• funding the Business Leadership Network of Greater Kansas City, and Business Advisory Councils in north central Kansas; providing disability training for Workforce Center staff throughout the state;
• offering Benefits Academies to increase the capacity of disability providers to provider benefits counseling;
• establishing an inventory of baseline health and disability data available through state agencies, and developing several data sharing agreements between state agencies; and
• conducting a longitudinal research study of Working Healthy participants, demonstrating increased earnings, increased state and federal taxes paid and lower medical expenses compared to other dual eligibles over time.
Comprehensive Employment MIG Accomplishments
Even though MIG funding has ended, the state remains committed to continuing the Working Healthy and WORK programs and supporting a network of Benefits Specialists (see page 5).
Employment First: A Lasting Legacy to Ensure that Competitive, Integrated Employment is the First Option in Kansas!
By Rocky Nichols, Chairperson Employment First Oversight Commission
With the State of Kansas Medicaid Infrastructure Grant (MIG) winding down, now is an excellent time to assess where Kansas stands in regard to employment policy for people with disabilities. The MIG has been an important catalyst in breaking down barriers to employment experienced by people with disabilities. One key barrier to employment can be state policy. Several positive policy changes have occurred regarding employment for people with disabilities in Kansas; the crowning achievement being the Employment First law. Employment First requires all state agencies and those that carry out state services (e.g. Community Developmental Disability Organizations, IEP/Transition Teams, Community Mental Health Centers, etc.) to make competitive, integrated employment the first option when serving people with disabilities – a simple but very powerful and beautiful policy. Kansas was the first state in the nation to pass an Employment First law.
What does the Employment First Law do?
The four key requirements in the Employment First law are:
1) Competitive, integrated employment must be the first option when providing services or supports to people with disabilities;
2) All state agencies must follow Employment First and ensure it is effectively implemented in all programs and services;
3) All state agencies must coordinate efforts and collaborate to ensure that all state programs, policies, procedures and funding support competitive and integrated employment of individuals with disabilities; and
4) All state agencies must share data and information across systems in order to better track outcomes and successes under Employment First.
It is important to note that passage of the Employment First law was an effort driven by advocates from across the state who wanted to ensure that competitive, integrated employment is always the first option. The MIG also played an incredibly vital role in bringing together self-advocates, families, state agency staff, service providers and other stakeholders in order to facilitate the writing and adoption of Employment First.
The reasons for Employment First are numerous and compelling. People with disabilities who are engaged in competitive integrated employment have higher incomes and greater independence. They have more disposable income to help fuel the Kansas economy and they pay more in taxes. Their health may improve as their independence increases. Many advocates went to the Statehouse and requested Employment First be implemented so they could become Kansas taxpayers instead of living off their benefits, paid for by tax dollars. These advocates effectively argued that they aren’t successful, tax paying citizens if they are stuck in sheltered workshops. They demanded real jobs, at real wages, in real places. They argued that when they are employed in competitive and integrated settings, they rely less on welfare and public benefits programs. As they correctly pointed out, this reduces the cost of variety of government programs funded by taxpayer dollars. In short, this law promotes independence and dignity for people with disabilities.
The Employment First law created an Oversight Commission which thus far has completed the following activities:
• Met with the Governor’s Subcabinet on Disability;
• Implemented an operating and reporting infrastructure with all state agencies;
• Requested each state agency assign a liaison to the Commission;
• Collected preliminary data from state agencies, including policies and procedures impacting people with disabilities, and their method(s) of tracking and/or measuring competitive employment of people with disabilities;
• Identified barriers and effective policies;
• Gathered stakeholder input (on-going);
• Created a website for communication of the Commission’s activities with stakeholders
• Established draft goals and objectives.
The goals set forth by the Oversight Commission are aligned with the law’s four key requirements:
Competitive and Integrated Employment is the First Option
Goal 1: Kansas’ relevant state agencies successfully execute specific strategies to fully implement the Employment First law and to ensure competitive and integrated employment of people with disabilities is fully supported in their programs, policies, procedures and funding.
Policy is Effectively Implemented in all Programs and Services
Goal 2: Each relevant state agency has a strong and effective policy detailing how it will implement the Employment First law.
State Programs, Policies, Procedures and Funding Support Competitive and Integrated Employment
Goal 3: Kansas has measurable annual performance goals and outcomes with clear and meaningful benchmarks that track a number of key indicators to prove full support of competitive and integrated employment and effective implementation of the Employment First initiative, including outcomes and goals for the numbers and percentages of persons with disabilities in competitive and integrated employment.
Goal 4: Kansas has effective, meaningful and productive collaborations among stakeholder groups and between these stakeholders and state government to support the Employment First policy and competitive and integrated employment of people with disabilities.
Data Sharing
Goal 5: Kansas has an effective method for collecting and publishing outcomes data involving competitive and integrated employment for people with disabilities. This method tracks a variety of data, including but not limited to competitive and integrated employment data. These data are used to engage stakeholders and inform strategy and policy decisions.
The Commission is required to provide an annual report to the governor and legislature on the progress in each area.
Kansas is a trailblazer in the area of competitive and integrated employment, as we were the first state in the nation to pass Employment First into law. Kansans with disabilities, disability advocacy organizations and stakeholders in the disability community are to be commended for this historic accomplishment.