Transcript Keeping the Dream Alive: Continuing Systems Change Beyond

MIG Annual Summit
Denver, CO
May 10, 2011
Serena Lowe
Executive Director
Collaboration to Promote SelfDetermination
[email protected]
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Equity
Equality
Home
Work
Choice
Community
Competence
Dignity of Risk
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Collaboration to Promote Self-Determination (2007)
◦ Driven by national organizations representing individuals
with I/DD and their families
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National Disabilities Leadership Alliance (2009)
◦ Formerly known as Justice For All Action Network, or JFAAN
◦ Network of national disability consumer-driven
organizations
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Initial collaborative work around proposing
consistent reforms to state Medicaid waiver and plan
processes (2012 HCBS Waiver Technical Guide) led to
eventual discussion around a “MIG-II” strategy.
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We saw what was on the
horizon, and decided
that reform was going to
happen with or without
us, so we better be
proactive and use the
current national focus as
an opportunity to elevate
the connection between
Medicaid and
employment.
Reform is inevitable…..
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We must create an
opportunity to push the
reforms that are
necessary to address the
systemic barriers that
continue to impede
progress in improved
employment outcomes
for PWD.
The Question is, will we use
the current dynamic as an
opportunity or be bogged
down by its inherent theats?
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House Budget
Resolution
Congressional
Impasse
•H.Con. Res. 34
(nonbinding)
•Govt will hit $14.3 trillion
debt ceiling by late June
•Ends Medicaid and
Medicare entitlements
for FY2012 budget
•Various proposals, little
agreement (Gang of 6;
Corker-McCaskill;
Commission on Fiscal
Reform and Responsibility)
•Cuts Medicaid by 1/3
and block grants
State Fiscal Crises
•Majority of states with
their own deficits with
Medicaid spending
surpassing education as
the largest share of state
spending.
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Michael Morris
Executive Director, Burton Blatt Institute
Executive Director, National Disability Institute
[email protected]
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1) maximize employment opportunities for
people with disabilities;
2) protect and enhance access to health care,
other benefits, and necessary employment
supports; and
3) expand the states’ labor force through the
inclusion of individuals with disabilities.
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Between 2001 and 2011, over $300 million
was awarded by CMS to 49 states, DC, and
the US Virgin Islands.
The average inflation-adjusted annual
earnings among Buy-In participants across all
37 MIG/Buy-In states in 2009 were $8,677, a
three percent decline from the 2008 average.
Again, this likely reflects the effects of the
economy on hours worked and hourly wages.
◦ Average annual earnings ranged from $4,652 per
year in Wisconsin to $15,446 per year in Arkansas.
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Average earnings remained below the
annualized substantial gainful activity
(SGA) level for non-blind individuals in
all but 7 of the 37 states.
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In 2009, 43.6 million people were living in
poverty in the US. This is up 3.8 million from
2008 and is the highest number since 1959.
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Poverty rate jumped 14.3% in 2009.
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This number is equal to one in seven residents.
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For people with disabilities, the number is one
in three.
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For the last five years, Social Security has paid
out more in benefits to disabled workers than it
has taken in from payroll taxes.
The downturn in the economy has led to record
increases in application for Social Security
benefits.
About 8.2 million people collected disabled
worker benefits totaling $115 billion in 2010.
About one in 21 Americans from ages 25-64
receive the benefit.
◦ In Arkansas, it is one in 12.
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Out of 12.5 million disabled workers and
those who receive benefits for the disabled
poor, only 13,656 returned to work during
2009-2011, with less than a third earning
enough to drop benefits altogether
In 2009, 32,445 recipients left the benefit
rolls because they were earning enough in
jobs without the Ticket to Work program.
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The proportion of employed US workers
identified as having disabilities declined by
9 percent.
The proportion of workers between ages of
18 and 39 reporting disabilities dropped by
17.5 percent over the same period.
Workers with disabilities are more likely to
be in low-skill occupations. However, there
is no disproportionate impact of the
recession on workers in high-skill and lowskill occupations.
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Many people with disabilities exit the labor
force permanently during economic
downturns.
Men with disabilities were more likely to
experience the effects of the recession than
women with disabilities.
People with disabilities working in highly
skilled occupations appear to have been least
affected throughout the period.
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44 of the 47 employment and training
programs overlap with at least one other
program in that they provide at least one
similar service to a similar population.
In 2009, 47 programs spent about $18 billion
to provide services, such as job search and
job counseling.
GAO found these programs maintain parallel
administrative structures to provide some of
the same services.
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Karen Jane McCulloh, RN, BS
Past-President
National Organization of Nurses with Disabilities
[email protected]
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Increase in states adopting Buy-In
Increase in number of Buy-In participants
Improved cross-agency collaboration
Changes in Infrastructure
Changes in Capacity for Benefits Planning
Changes in provision of PAS
Expanded connection between employment
and economic stability, savings, and asset
building
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Metrics and Measurement
 All costs must produce clear
measurable benefits
 States pocket of excellence must be
scalable; disparities in state outcomes
must translate nationwide
 Sustainable value that can be
quantified
 Transformational policy and
infrastructure change
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Many MIGs were successful in building the
sustainable infrastructure required to
perpetuate systems-change and
transformation. But disparities among states
exist.
Now is the time to make sure that
transformation continues, is sustained over
time and results in improved outcomes.
Moving forward, systems change must lead to
improvements in employment outcomes at
the individual level.
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Allan Bergman
High Impact Mission-based Consulting & Training
[email protected]
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Emphasis on person-centered practices
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Primary focus on Employment First strategies*
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Stronger accountability through improved consumer outcomebased performance measures
Compliance with ADA and Olmstead decision re: “most
integrated setting”
Use of Medicaid waiver or state plan services for the purchase
of benefits planning services
Increased cross-systems coordination
Statutory authority and stronger leadership role by CMS in
establishing fee structures and reimbursement rates to assure
financial incentives that promote community-based outcomes
* = Recognition that Medicaid services should increase individual self-sufficiency but a majority of
individuals will still require a certain level of long term supports throughout the lifespan that are not
available through private health insurance or The Exchanges in 2014.
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Greater flexibility to states through the coordination and
sharing of resources across systems through planning,
braiding and blending strategies for multiple funding streams
Increased consumer & family control over planning processes,
service options and resources
Broader focus on the role of families or friends as caregivers
(when necessary and appropriate)
Significant transparency in the dissemination of information
to individuals and families to ensure an easier navigation
through various systems and support options focused on
promoting the optimal independence and self-sufficiency of
each individual
Attention to programs for dual eligibles to assure continued
optimal integrated engagement
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Promote Employment First strategies through systemscoordination, aligned guidance, and consistent definitions and
objectives related to the use of public funds.
Develop a model for the Establishment of a National Medicaid
Buy-In program.
Incentivize integrated employment through enhanced FFP rate.
Time limit HCBS funding for prevocational training services and
segregated placements.
Work with SSA and other federal agencies to fund state-centric
work incentives, technical assistance and other collaborative
strategies.
Provide continued statutory support for rebalancing initiative.
Improve data collection systems across state programs.
Promote evidence-based promising practices to scale.
Improve evaluation and accountability of State Medicaid plans
and Waiver applications.
Outline criteria to ensure state compliance of Olmstead decision
through legislative and regulatory guidance.
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Feedback on Proposed
Recommendations & Strategy
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How can we bridge the real-time experiences
at the state level with the policy decisionmaking process at the federal level?
What are some continual policy barriers that
are impeding progress of MIG-initiated
systemic reforms, infrastructure
development, and capacity-building efforts?
What gaps do you see in our framework,
recommendations, and strategy?
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