Bill Would Incentivize States to Increase Integrated Work
Sen. Chuck Grassley of Iowa, Sen. Ron Wyden of Oregon and Sen. Bob Casey of Pennsylvania have introduced bipartisan legislation that would create a demonstration project intended to encourage states to improve opportunities for individuals with disabilities to obtain employment in the community. The Transition to Independence Act, S. 1604, would create a five-year, 10-state Medicaid demonstration program to give bonuses to states that increase the number of individuals with disabilities they support to work and spend their days in the community. It seeks to encourage coordination among those who provide health services, housing, education and workforce training, transportation and other support to people with disabilities to maximize the outcome for the individual.
The bill seeks to establish the Transition to Independence Medicaid Buy-In Option demonstration program, which will give ten Medicaid Buy-In states an opportunity to receive bonus payments for meeting benchmarks tied to expanding individual integrated employment and reducing subminimum wage work, congregate setting work, or facility-based day habilitation placement for people with disabilities who receive Medicaid-funded home or community-based services (HCBS), and for taking other actions that help expand employment opportunities for people with disabilities within the state. In order to receive a bonus payment of 2% additional Federal Medical Assistance Percentage (FMAP) for all services provided to individuals enrolled in the state’s Medicaid Buy-In program, a state must meet two mandatory benchmarks:
- achieve a 10% increase in the population in the state of working-age individuals with disabilities who are receiving Medicaid funded HCBS and are in individual integrated employment, and
- achieve a 10% reduction of working-age individuals with disabilities who are receiving Medicaid-funded HCBS or who are receiving services through an Intermediate Care Facility for Persons with Developmental Disabilities (ICF-DD), a nursing facility, an institution for individuals with mental illness, or other congregate facilities and are in submininum wage work, congregate setting work, or facility-based day habilitation or day treatment.
States can receive an increased bonus payment for achieving a percentage increase or reduction of 20, 30, 40 or more with respect to the prior year’s census of this population. States can also achieve another .5% FMAP bonus for achieving each of the following additional benchmarks:
- Elimination of new placements of working-age individuals with disabilities receiving Medicaid-funded HCBS in subminimum wage work, congregate setting work, or facility-based day habilitation or day treatment;
- Demonstration of interagency collaboration;
- Ceasing to use vocational rehabilitation funding for subminimum wage work, congregate setting work, or facility-based day habilitation or day treatment;
- Increasing Medicaid payments for supported employment providers;
- Adoption of employment strategies to recruit, hire, and retain people with disabilities who are receiving Medicaid-funded HCBS as full-time employees of State government or government contractors;
- Development of a State equivalent of Section 503 of the Rehabilitation Act of 1973 to recruit, hire, promote, and retain working-age individuals with disabilities who are receiving Medicaid-funded HCBS with a utilization goal of 7 percent of the State government workforce;
- Development of a special hiring authority mechanism akin to the Schedule A appointing authority of the Federal Government;
- Provision of State tax credits for employers that hire new working-age people with disabilities who receive Medicaid-funded HCBS
All performance bonus payments must be used only to expand individual integrated employment and community integration for working-age individuals with disabilities who are receiving Medicaid-funded HCBS.
The National Council on Disability provided technical assistance in developing the bill. Other organizations supporting the bill include the American Association of People with Disabilities, the American Association on Health and Disability, the American Network of Community Options and Resources, the Autistic Self Advocacy Network, the Muscular Dystrophy Association, the National Adult Day Services Association, the National Association of State Directors of Developmental Disabilities Services and Autism Speaks.
FMI: The text of the bill is available at http://www.grassley.senate.gov/sites/default/files/news/upload/LYN15367.pdf.