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WHAT STATE VR AGENCIES AND CRPS CAN LEARN FROM MEDICAID INFRASTRUCTURE GRANT PROJECTS AND

WORK INCENTIVES PLANNING AND ASSISTANCE PROJECTS

Prepared by

Bobby Silverstein

Powers Pyles Sutter and Verville, PC

[email protected]

TABLE OF CONTENTS

INTRODUCTION...... 1

MEDICAID INFRASTRUCTURE GRANTS...... 3

BACKGROUND...... 3

EXAMPLES OF USES OF GRANT FUNDS...... 8

1. Medicaid Buy-In Programs...... 8

2. Medicaid Services That Directly Support Individuals with Disabilities Who are Employed.9

3. Benefits Counseling and Work Incentive Programs...... 12

4. Employment Training, Education, and Networking...... 13

5. Research and Evaluation...... 14 6. Outreach...... 15

7. Technical Assistance—Sharing of Lessons Learned...... 16

OFFICIAL MIG WEBSITE AND TECHNICAL ASSISTANCE CENTERS...... 17

The Federal Government’s Official MIG Website ...... 17

The National Consortium for Health Systems Development...... 18

The Center for Workers with Disabilities...... 20

Asset Development...... 21

Working with Business...... 23

Examples of questions and topics the taskforce will look at include:...... 25 Comprehensive Employment...... 28

Medicaid Infrastructure Grants—Research Assistance to States (MIG-RATS)...... 31

Mission and History...... 31

MIG-RATS Organizational Structure...... 35

MIG-RATS Contact Information...... 38

STATE VR AGENCIES AND THE IMPLEMENTATION OF MIGs...... 40

The Role of State VR Agencies in the Development and/or Administration of MIG Projects...... 41

EXAMPLES OF MIG PROJECTS ADMINISTERED BY VR AGENCIES...... 44

Alabama...... 44 North Carolina...... 49

Indiana...... 59

Oregon...... 66

Texas...... 68

Utah...... 69

Vermont...... 74

Subsidized Training Options...... 84

WORK INCENTIVES PLANNING AND ASSISTANCE GRANTS...... 87

BACKGROUND AND OVERVIEW...... 87

THE ROLE PLAYED BY STATE VR AGENCIES REGARDING WIPA GRANTS...... 90

EXAMPLES OF ACCOMPLISHMENTS OF WIPA PROJECTS...... 92 Georgia...... 92

Mississippi...... 97

North Carolina...... 101

South Carolina...... 102

Tennessee (Center for Independent Living of Middle Tennessee)...... 107

Texas (Easter Seals of North Texas)...... 113 WHAT STATE VR AGENCIES AND CRPS CAN LEARN FROM MEDICAID INFRASTRUCTURE GRANT PROJECTS AND

WORK INCENTIVES PLANNING AND ASSISTANCE PROJECTS

INTRODUCTION

The written materials accompanying the webinar PowerPoint describe how selected State VR agencies in the Southeast Region and other regions in the country are participating in Medicaid Infrastructure Grant (MIG) projects to enhance employment outcomes for persons with disabilities through systems change initiatives in collaboration with other state agencies. The written materials also describe the role State VR agencies are playing in implementing Work Incentives Planning and

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 1 Assistance (WIPA) grants, which provide timely and accurate information to SSI and SSDI beneficiaries on SSA’s work incentives and other federal initiatives to remove barriers to employment for beneficiaries.

With respect to MIGs, the written materials include:

 Background materials regarding MIGs;

 Examples of programs, projects, and activities pursued by State VR agencies and other grantees;

 Official employment-related websites used by MIG grantees and others;

 Examples of initiatives pursued with MIG funding by specific State VR agencies in the Southeast Region and in other regions.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 2 With respect to WIPA grants, the written materials include:

 Background materials regarding WIPA grants;

 The role played by state VR agencies regarding the implementation of WIPA grants; and

 Examples of accomplishments of State VR agencies in the Southeast Region and other Regions.

MEDICAID INFRASTRUCTURE GRANTS

BACKGROUND

In 1999, Congress passed the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA). Section 203 of TWWIIA authorizes the funding of Medicaid Infrastructure Grants (MIGs). The Centers for Medicare and Medicaid Services

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 3 (CMS) in the Department of Health and Human Services (HHS) is the designated agency with administrative responsibility for this grant program. The MIG program is intended to:

 Facilitate enhancements of State Medicaid programs and services,

 Promote linkages between Medicaid and other employment-related services and agencies, and

 Develop a comprehensive system of employment supports for people with disabilities.

Under the terms of the program, State VR agencies may apply for MIG funds in partnership, agreement, and active participation with the single State Medicaid agency, the State legislature, or the Office of the Governor. Currently, MIG grants have been

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 4 awarded to 41 states and the District of Columbia. In 10 states, the lead agency is the State VR agency. Currently, Alabama, Florida and North Carolina have MIG funding. In the past, South Carolina has received MIG funding. The Alabama and North Carolina grants are administered by the VR agency.

In 1999, Congress authorized the MIG program for 11 years. It appropriated $150 million in funding over the first five years of the program. Since 2006, the funding amount has been taken from the previous year and increased using the consumer price index. The 2010 funding amount is $45.76 million. The grant period will run from January 1, 2010 to December 31, 2010, with a subsequent annual continuation request. The minimum annual award to an applicant will be $500,000. The statute requires participating states to offer personal

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 5 assistance services through the State’s Medicaid program sufficient to support individuals in employment.

It is expected that State VR agencies and other grantees participating in the MIG program will use funding to:

 Initially, remove employment barriers for people with disabilities by creating systemic change throughout the Medicaid program; and

 Later, to remove employment barriers within state and local systems generally.

More specifically, grantees may develop employment systems through a progression of activities beginning with the development of core Medicaid components, including:

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 6  Increasing the availability of personal assistance services and supported employment through the Medicaid State plan or waiver programs;

 Develop and implement Medicaid Buy-In programs that enable people with disabilities to participate in their communities through meaningful employment opportunities; and

 Assure access to other healthcare supports that may support the employment objectives of people with disabilities.

In addition to participating in basic Medicaid Infrastructure Development grants, states may then use program funds to enhance these supports by building other infrastructures needed to develop a comprehensive employment system that coordinates disparate State service delivery systems,

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 7 i.e., form linkages between Medicaid services and other non-Medicaid programs. The major objectives of the comprehensive employment system are to:

1. Maximize employment of people with disabilities;

2. Increase the State’s labor force through the inclusion of people with disabilities; and

3. Protect and enhance workers’ healthcare, other benefits, and needed employment supports.

EXAMPLES OF USES OF GRANT FUNDS

Medicaid Buy-In Programs

 Buy-In design and implementation, including cost-modeling, development and initial administrative implementation (e.g., changes to the state’s automated eligibility determination

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 8 systems), benefits counseling, training materials, outreach;

 Tracking, reporting and learning systems; and

 Coordination of benefits, including expenses involved in designing and implementing methods to coordinate the Buy-In program effectively with Medicare and with other public or private insurance coverage.

Medicaid Services That Directly Support Individuals with Disabilities Who are Employed

 Design, cost-modeling, and development of a Medicaid state plan service to cover personal care services optional benefit under the state plan;

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 9  Development of provider capacity and reliability to support the provision of personal assistance services seven days a week, during the day and night as needed by competitively- employed individuals with disabilities;

 Design and implementation of changes to the adequacy of Personal Assistance Services (PAS) that substantially improve the extent to which the service supports the competitive employment of people with disabilities;

 Training Medicaid case managers regarding the Medicaid Buy-In program, the availability of VR services and the procedures for working with VR agencies, understanding work incentives under the SSI and SSDI programs,

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 10 and other programs which will assist people with disabilities to be employed competitively.

 Incorporating in Medicaid case management design valued social and economic roles defined and desired by the individual with a disability;

 Incorporating self-determination designs, i.e., new employment possibilities in the evolving field of self-determination within the Medicaid program or redesigning traditional Medicaid services to incorporate self-determination principles with an employment focus;

 Improvements in the design, cost-modeling, development and initial implementation or evaluation of other Medicaid services which have a direct impact on the ability of individuals with disabilities to sustain competitive

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 11 employment such as transportation services or modifications, assistive devices, communication aids, or community mental health services; and

 Coordinating activities between other State agencies with direct responsibilities to individuals with disabilities in their pursuit of competitive employment and the Single State Medicaid agency, e.g., use of peer supports, supported employment, customized employment strategies, and self-directed PAS.

Benefits Counseling and Work Incentive Programs

 Provide work incentives benefits counseling services, including services to targeted groups;

 Provide training to service providers on benefits counseling services;

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 12  Develop online benefit counseling tools;

 Develop/increase benefits counseling capacity;

 Develop new programs, modify or expand existing programs, develop technical assistance network of benefit counselors; and

 Collaborate with other benefit counseling and work incentive programs.

Employment Training, Education, and Networking

 Provide training to service providers on employment and work incentives;

 Provide training to consumers;

 Develop employment and technical assistance networks;

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 13  Build linkages/relationships with other agencies to sustain employment networks or educational programs;

 Build partnerships with employers and business organizations; and

 Establish/support peer networks for employed persons with disabilities.

Research and Evaluation

 Conduct research with consumers, e.g., surveys, focus groups, key informant interviews;

 Develop data sharing agreements;

 Build integrated database/data warehouse;

 Track project participants over time;

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 14  Conduct research with service providers and employers; and

 Develop quality assurance measures and evaluation plans.

Outreach

 Conduct outreach to consumers, service providers, employers, and healthcare professionals;

 Conduct outreach on PAS service availability to consumers and service providers;

 Conduct outreach on supported employment, such as job coaching to consumers and service providers;

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 15  Conduct outreach/education on waiver programs and supported employment to consumers and service providers;

 Inform consumers about availability of benefits counseling; and

 Develop outreach tools for employers on employment of persons with disabilities.

Technical Assistance—Sharing of Lessons Learned

 Online reporting structure used by all grantees will be used to develop an information exchange mechanism;

 Disseminate lessons learned—facilitate sharing of knowledge among states and state agencies, consumers, employers, service providers;

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 16  Submit technical assistance plan; and

 Contract with established state-to-state technical assistance networks or with any other TA provider that can meet the needs of the State.

OFFICIAL MIG WEBSITE AND TECHNICAL ASSISTANCE CENTERS

Below is the official federal government’s website for MIGs and Medicaid Buy-In programs, as well as descriptions and links to key technical assistance websites used by MIGs, VR agencies, and others interested in enhancing employment opportunities for persons with disabilities.

The Federal Government’s Official MIG Website

The official government website for MIGs and Medicaid Buy-In programs is:

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 17 http://www.cms.hhs.gov/TWWIA/03_MIG.asp.

The National Consortium for Health Systems Development

The National Consortium for Health Systems Development (NCHSD) is a technical assistance partnership providing flexible, state-tailored technical assistance for Medicaid Infrastructure Grant (MIG) projects across the country. These CMS-funded state projects are developing comprehensive health and workforce service systems for people with disabilities who want to work. Serving people with disabilities, providers, state agencies, research institutes, advocates and businesses, NCHSD is a project of Health & Disability Advocates (HDA). (http://www.hdadvocates.org/ ) The website www.nchsd.org offers comprehensive disability and employment technical assistance. A key feature of the website is the Resource Exchange (http://www.nchsd.org/resource/index.asp) which offers the latest information, events, reports and resources on disability and employment, especially tailored for Medicaid Infrastructure Grantees. For

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 18 example, the website includes the following “hot topics”:  Asset Development (http://www.nchsd.org/topics/asset- development.asp)  Benefits Planning (http://www.nchsd.org/topics/benefitsplan.asp)  Engaging Employers (http://www.nchsd.org/topics/employers.asp)  Housing (http://www.nchsd.org/topics/housing.asp)  Medicaid Buy-In (MBI) (http://www.nchsd.org/topics/mbi.asp)  National Marketing Campaign (http://www.nchsd.org/topics/national- marketing-campaign.asp)  Outreach and Education (http://www.nchsd.org/topics/outreach.asp)  Personal Assistance Services (http://www.nchsd.org/topics/assistance.asp)

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 19  Research and Evaluation (http://www.nchsd.org/topics/research.asp)  Resource Mapping (http://www.nchsd.org/topics/mapping.asp)  Stakeholder Groups (http://www.nchsd.org/topics/stakeholdergroups. asp)  Strategic Planning (http://www.nchsd.org/topics/stratplanning.asp)  Ticket to Work (http://www.nchsd.org/topics/tickettowork.asp)  Transportation (http://www.nchsd.org/topics/transportation.asp) The Center for Workers with Disabilities

The Center for Workers with Disabilities is a technical assistance center operated by the American Public Human Services Association (APHSA) for states enhancing or developing employment supports programs for working persons with disabilities. The

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 20 Center’s website is http://www.aphsa.org/disabilities/home/index.htm. The Center operates several taskforces, including:

 Asset development,  Working with Business, and  Comprehensive employment.

Asset Development

The Asset Development and Financial Literacy taskforce explores initiatives in asset development that impact the MIGs and participation in the Medicaid Buy-In programs. The taskforce builds on emerging CWD work in this area, and examines and supports initiatives in asset development which directly impact the economic well-being and security of individuals with disabilities, their families, and their communities. In particular, the taskforce

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 21 highlights national initiatives which states may utilize in expanding asset development, financial literacy, and tax policy programs, and state initiatives which may be replicated. More specifically, the taskforce supports asset development and the development of financial literacy initiatives for persons with disabilities by:

 Developing a resource-mapping template to assist state activities in asset development and financial literacy.

 Providing a monthly forum for discussing current initiatives and issues in asset development and financial literacy for persons with disabilities, including topics in: tax policy, the Earned Income Tax Credit (EITC), benefits planning, individual development accounts (IDA), asset limits in public assistance

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 22 programs, and federal initiatives in asset development.

 Incorporating the expertise and perspectives of diverse stakeholders within the taskforce, including state and federal government representatives, persons with disabilities, national leaders in asset development, and policy planners.

Working with Business

The Working with Businesses and Community Partners taskforce provides a forum for members to identify strategies to develop and implement partnerships with the business and employer communities and increase employment outcomes for individuals with disabilities. Discussions focus on thinking of and utilizing unorthodox methods for

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 23 increasing connections with employers, community groups, stakeholders, and other resources for individuals with disabilities to seek and maintain employment, including self-employment options. The group thinks about employer-oriented, non- policy, non-governmental solutions and ideas for building employer interest in hiring workers with disabilities, including dispelling common myths, connecting employers and employer groups with interested potential employees, etc. The group aims to increase public-private partnerships. Employers and stakeholders will participate in the task force.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 24 Examples of questions and topics the taskforce will look at include:

What are the major barriers facing the following elements of increasing employment opportunities for individuals with disabilities?:

 Locating and reaching out to employers;

 Engaging employers, finding partners in the business and employment world;

 Locating and reaching out to interested individuals with disabilities;

 Engaging interested individuals with disabilities; and

 Locating/working with local and community organizations (stakeholders, champions) that

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 25 provide services and assistance to individuals with disabilities.

How can these barriers be addressed?:

 What are some creative resources and who are some creative ideas for partners in these efforts? (For example, community groups, faith-based organizations, chambers of commerce, etc.)

 What are some success stories at the state, local, or individual level? What are some ways to locate and highlight more of these success stories?

 How can small success stories become models of innovative policy?

 What are the figures for the employment of individuals with disabilities? What

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 26 incentives/programs/factors have shown to be effective in increasing employment outcomes? How can these be maximized?

 What are common requests for workplace accommodations? How much did these accommodations cost? What was the burden? How effective were they?

 What are the similarities and differences of working with small versus large employers? (e.g., differences in approach, information, message, etc.)

 What are the similarities and differences in accommodations requests, experience, and costs associated with employing individuals with different types of disabilities? What are the

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 27 myths associated with different types of disabilities?

 Once employed, what issues are associated with the retention of individuals with disabilities?

 Is there a unified approach that states can use to address employers to ensure consistency across states?

 How can states coordinate employer outreach efforts and other employer-related efforts with other employment support services in the state?

Comprehensive Employment

Below are links and resources providing more information on the following comprehensive employment topics:

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 28  Transportation (http://cwd.aphsa.org/statetostate/compemp.asp# tptn)

 PAS/ Caregiving (http://cwd.aphsa.org/statetostate/compemp.asp# pascare)

 Housing (http://cwd.aphsa.org/statetostate/compemp.asp# house)

 Financial Literacy/Asset Development (http://cwd.aphsa.org/statetostate/compemp.asp# flit)

 Health Supports (http://cwd.aphsa.org/statetostate/compemp.asp# hesp)

 Advocacy (http://cwd.aphsa.org/statetostate/compemp.asp# adv)

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 29  Benefits Planning/WIPA (http://cwd.aphsa.org/statetostate/compemp.asp# beneful)

 Education (http://cwd.aphsa.org/statetostate/compemp.asp# education)

 Transition (http://cwd.aphsa.org/statetostate/compemp.asp# trans)

 Research (http://cwd.aphsa.org/statetostate/compemp.asp# rch)

 ADA and Disability Rights (http://cwd.aphsa.org/statetostate/compemp.asp# ada)

 Disability Laws (http://cwd.aphsa.org/statetostate/compemp.asp# dl)

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 30  Independent Living (http://cwd.aphsa.org/statetostate/compemp.asp# idp)

Medicaid Infrastructure Grants—Research Assistance to States (MIG-RATS) www.migrats.org

Mission and History

In April 2006, the Centers for Medicare and Medicaid Services (CMS) announced the concept for a state-based research resource center (MIG-RATS) to support activities under the Medicaid Infrastructure Grants (MIGs). The original vision called for establishing a resource center to support ongoing state research activities and would be based on voluntary participation and a core mission of being (1) responsive to states' research needs and (2) accessible to all states.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 31 Based on input collected from the MIG states during the fall of 2006, MIG-RATS identified four key areas in which MIG states desired research support and assistance:

 Facilitation of multi-state research efforts;

 Facilitation of access to data not available through state sources;

 Access to research information from other states and projects; and

 Guidance on research processes, strategies, and analyses.

In 2008, CMS requested a re-assessment of MIG states’ needs from MIG-RATS. An inventory was administered to MIG state researchers in August, 2008 that included sections to 1) re-assess states’ internal research capacity and perceived usefulness

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 32 of a variety of types of research support, and 2) solicit input on new directions for the four activity areas. Responses were received from 33 of 40 MIG states (83%). Findings from the inventory indicate that:

 Coordination of interests, coordination of activities, and assistance in accessing federal data remain the highest priority supports states want to receive from MIG-RATS.

 Internal research capacity among the MIG states has increased since the initial inventory, with only nine percent indicating internal research capacity at the ‘freshman’ level as opposed to twenty-three percent in 2006.

 States with lower research capacity continue to have significantly different needs for

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 33 support; notably access to direct technical assistance and assistance with research design.

 The overall findings of the reassessment support continued focus on the four main activity areas although opportunities for expansion of specific activities were identified.

To see the full report on state research needs and interests in 2008, see: MIGRATS Needs Assessment Report (January 2009) (http://www.migrats.org/uploads/About_Us/2008_M IG-RATS_needs_assessment_report.pdf)

For the 2007 report, see: MIGRATS Needs Assessment Report (June 2007) (http://www.migrats.org/development/uploads/MIG RATSNeedsReportJune2007.pdf)

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 34 MIG-RATS Organizational Structure

The MIG-RATS represent an innovative collaboration among state researchers, Mathematica Policy Research (MPR), and CMS. Overall, the center provides a mechanism to enhance states' capacities to use quantitative information to shape programs and policies for promoting the employment of individuals with disabilities. CMS provides financial support for the center and a federal perspective on policy issues. MPR has developed several databases related to employment and public program participation that can have direct application to state research efforts. MIG-RATS staff provides leadership and organization for states to identify their research needs, share ideas, and develop strategies for using available data to improve their programs.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 35 The MIG-RATS also provide opportunities for MIG state researchers to have direct voices on the availability of data to the MIG states. Two committees with state representation are actively involved in shaping state access to information from MPR's set of integrated dataset of Medicaid Buy-In participants. The Data Dissemination Advisory (DDA) Committee provides input and guidance to MPR and CMS on technical specifications for analyses that would be generally useful for all MIG states and formats for publishing this information. Current representatives on the DDA Committee as of July 2007 are:

 Karen Ward (Alaska)

 Eric Glunt (California)

 Tamara Amsbaugh (Iowa)

 Melissa Money-Beecher (Nebraska)

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 36  Elaina Goldstein (Rhode Island)

 George Julnes (Utah)

In addition, the Integrated Data Request (IDR) Committee is developing a process by which MIG states can request specific analyses to be run on the integrated dataset to inform their individual projects. When the proposal process is finalized, IDR committee members will be responsible for reviewing proposals and selecting projects for analysis. Current representatives on the IDR Committee as of July 2007 are:

 Patty Kates (Illinois)

 Lobat Hashemi (Massachusetts)

 Barry Delin (Wisconsin)

Anne Reither and Amy Porter serve as Co-Directors for the MIG-RATS. Mathematica Policy Research

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 37 (MPR) staff members, including Su Liu, Gilbert Gimm, and Tara Anderson, provide additional reseach and technical support.

MIG-RATS Contact Information

For more information, please contact Anne Reither at [email protected] or 435 757-9314 or Amy Porter at [email protected] or 860 424-4864.

The Clearinghouse for Home and Community Based Services

The website www.hcbs.org promotes the development and expansion of home and community-based services by gathering resources and tools for research, policy making and program development into one-stop website. By facilitating the sharing of information, the website empowers professionals and consumers to be more effective in

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 38 supporting real choice and independence for people with disabilities.

Below is an illustrative list of papers and articles on their website specifically related to competitive employment:

 Home and Community-based Waivers and Self- Employment

 Customized Employment

 Self-determination and Revitalization of Integrated Employment

 Employment Options and Personal Assistance Services

 Employment for Persons with Brain Injury

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 39  Supported Employment as Evidence-Based Practice

 Quality Indicators for Competitive Employment Outcomes

 Public/Private Partnerships and Employment of People with Disabilities

 Employment and Women with Disabilities

 Health Care for Workers with Disabilities— Supporting and Encouraging Employment.

STATE VR AGENCIES AND THE IMPLEMENTATION OF MIGs

This webinar includes a discussion of the following roles played by State VR agencies:

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 40  State VR agency leadership role in the development and/or administration of MIG projects

 Examples of MIG programs, projects and activities operated by VR agencies

The Role of State VR Agencies in the Development and/or Administration of MIG Projects

In Alabama, Connecticut, Indiana, North Carolina, South Dakota, Oregon, Texas, Utah, Vermont, and West Virginia the State VR agency administers/houses the MIG project and was the agency primarily responsible for the development of the original MIG proposal. This arrangement provides an incredible opportunity for these VR agencies to influence/affect policies, practices, and

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 41 procedures within the Medicaid agency regarding the provision of health-related services and supports that enhance employment of persons with disabilities.

Below are the state VR agency contacts:

 Alabama: Karen Coffey [email protected]

 Connecticut: Amy Porter [email protected]

 Indiana: Theresa Koleszar [email protected]

 North Carolina: Wayne Howell [email protected]

 Oregon: Sara Kendall [email protected]

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 42  South Dakota: Grady Kickul [email protected]

 Texas: Lynn Blackmore [email protected]

 Utah: Carol Ruddell [email protected]

 Vermont: Susan Wells [email protected]

 West Virginia: Deborah Lovely [email protected].

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 43 EXAMPLES OF MIG PROJECTS ADMINISTERED BY VR AGENCIES

Alabama

In Alabama, grant activities for 2000-2005 included:

 Contracted with the Lewin Group to conduct a Medicaid Buy-In Feasibility Study for Alabama.

 Contracted with Easter Seals of Central Alabama to develop and provide a component on Personal Assistant training that was integrated into its certified nursing assistant program and replicated in two sites in the state and to establish a register of available workers.

 Developed a Personal Assistant Handbook as a guide for persons with disabilities desiring to

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 44 hire a worker. The handbook is available by accessing www.rehab.state.al.us through the “Independent Living” section under “Services.”

 Created an Employment team that developed a video entitled “Alabama Employs Ability”. In the video, employers speak with each other about the benefits of hiring persons with disabilities. Employers who hire persons with disabilities address some of the common fears. The video can be used by job developers and job coaches to hand to employers currently not hiring persons with disabilities to remove fears and create employment opportunities. The video can be obtained by contacting Ms. Veleda Davis, MIG Coordinator at [email protected].

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 45  Partnered with the system change grant to develop and implement a basic core training module for case managers.

 Created the Policy Consortium of stakeholders to help identify barriers to work and systemic barriers to employment for persons with disabilities.

 Added Personal Assistant Services as an individual service on the State of Alabama Independent Living (SAIL) waiver for those persons employed a minimum of 40 hours per week.

 Provided Outreach and Education to persons with disabilities, support groups, service providers regarding work supports and the SSA Ticket to work program.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 46 In Alabama, grant activities for 2006-2007 included:

 Partnered with local education associations and other community partners in two pilot sites that led to the development of a model of collaboration that can be replicated. The manual can be obtained by contacting the project coordinator at [email protected].

 Reviewed the Lewin Feasibility Study and compiled additional information from surrounding southern states to design a Medicaid Buy-In.

 Expanded Personal Assistance Services availability into other waiver programs.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 47  Continued efforts to expand the membership of the Policy Consortium.

 Continued outreach efforts and worked collaboratively with the Benefits Planners and Outreach Assistance personnel to inform the public of available work supports for persons with disabilities. Distributed the video to job developers, supported employment personnel and other stakeholders.

In Alabama, grant activities for 2008-2011 include:

 Designing, creating and testing a cross training initiative between the Community Work Incentive Coordinators and Waiver Case Managers to increase collaboration and employment outcomes for persons with disabilities.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 48  Partnering with AL-APSE and Virginia Commonwealth University to develop a Personal Assistant training module for waiver case managers and supported employment personnel to increase PAS utilization.

 Continuing design of Medicaid Buy-In for possible implementation.

 Continuing expansion of the Policy Consortium through establishment of local groups.

North Carolina

In North Carolina, the MIG grant was made to the North Carolina Vocational Rehabilitation Services beginning in 2004. The Grant is currently in the first year of the second funding cycle. DVR is partnering with the Division of Medical Assistance to create

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 49 enhancements in the current Medicaid system to assist in removing barriers for individuals with disabilities, allowing them to work.

MIG goals include:

1.Implementing a Medicaid Buy-In in North Carolina,

2.Enhance Personal Assistance Services in the workplace for individuals with disabilities and

3.Increase employment for individuals with disabilities by providing information to Supplemental Security Income recipients on SSI Work Incentives.

Medicaid Buy-In

The Medicaid Buy-In, now called Health Coverage for Workers with Disabilities (HCWD) in North

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 50 Carolina, was signed into law by the Governor in August 2005. This program allows individuals with disabilities receiving Medicaid the opportunity to purchase Medicaid coverage at a reasonable cost as opposed to losing it when earnings from employment would otherwise cause them to lose this coverage. Although implementation was originally scheduled for July 1, 2007, it was delayed because of issues with the Division of Medical Assistance MMIS system (claims processing system). DMA actually implemented HCWD on November 1, 2008. Implementation will occur in three phases. Phase one involved implementing HCWD to eligible individuals with disabilities with incomes at or below 150% of the federal poverty guidelines. The second phase involved implementing to eligible individuals at or below 200% of the federal poverty

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 51 guidelines. Phase two was implemented in May 2009. Phase three involves implementing to individuals at or below 450% of the federal poverty guidelines. There is no exact time scheduled to implement phase three. MMIS implementation issues must still be addressed.

The Medicaid Buy-in was designed by a workgroup formed from members of North Carolina’s MIG Advisory Council including Vocational Rehabilitation, Medicaid and other state Health and Human Services personnel, representatives from advocacy groups, consumers, and academics. This group designed the new program and developed cost projections to aid the state legislature and the Division of Medical Assistance, North Carolina’s Medicaid agency (http://www.nchsd.org/state/index.asp?

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 52 st=North+Carolina). North Carolina passed legislation to implement Health Coverage for Workers with Disabilities (HCWD) in NC Session Law 2005-276.

Although the Ticket To Work and Work Incentives Improvement Act explicitly allows states to continue to cover individuals once they lose their disability status, known as the medically improved group, only eight states have adopted this option thus far. In North Carolina, we included this option because we felt it was critical for supporting long term employment (http://www.newsobserver.com/news/story/1316873. html).

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 53 Enhanced Personal Assistance Services

Enhanced Personal Assistance services will allow for an additional forty hours of PAS to be available in the workplace to individuals with disabilities wanting to work. North Carolina is currently rolling out E-PAS across the state. Implementation is expected to be completed by the summer of 2010. E- PAS is being implemented via the CAP-Choice waiver. Ultimately, NC will pursue a state plan amendment for E-PAS.

Outreach to Consumers and Providers

Outreach to consumers and service providers conducted by MIG staff and Community Work Incentives Coordinators (CWICs) from the Work Incentives Planning and Assistance (WIPA) project

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 54 continue to ensure that information is received by these target groups regarding SSI Work Incentives. These Work Incentives assist individuals with disabilities greatly in transitioning to work by preventing the loss of their cash and Medical Social Security benefits. The more knowledgeable they are about Work Incentives, the better the chance they will want to work.

MIG funding has actually assisted in keeping the WIPA project afloat during tough economic times. MIG funding currently allows up to 10% support to WIPA. These funds are used primarily to allow CWICs to travel and provide services throughout their coverage areas.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 55 Wayne Howell currently serves as Project Director for both grants for the Division of Vocational Rehabilitation.

In Indiana, the MIG is used for various projects including those described below. For more information contact

Theresa Koleszar MS, CRC Director of Program Support Director, Medicaid Infrastructure Grant Bureau of Rehabilitation Services 317-232-1432 office 317-910-5455 mobile

VR Corporate Job Development Efforts

Improving employment opportunities for Indiana citizens with disabilities is a priority for Vocational

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 56 Rehabilitation (VR) Services. In support of this effort, VR has implemented Project SEARCH, a nationally recognized training and employment model for individuals with significant disabilities. A pilot Project SEARCH site began in Indiana in February 2008 at an Indianapolis hospital with five students. Indiana has focused on implementing the Project SEARCH Transition model which involves partnership with schools and provides in-depth training and internship opportunities to students with significant disabilities, allowing them to obtain the skills necessary for achieving quality employment outcomes. Project SEARCH benefits businesses by increasing workforce diversity, helping businesses to better utilize an untapped workforce, and by providing a single point of entry for hiring individuals with disabilities. Other potential benefits

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 57 include national, state and local recognition, reduced recruitment costs, and improved job retention.

VR is committed to statewide rollout of this project. There are currently six additional sites throughout the state preparing for Project SEARCH implementation in their communities. Indiana will have a minimum of seven Project SEARCH sites operating by Fall 2009, with plans for additional expansion. VR is funding this project through an outcome-based payment model, similar to the Results Based Funding model for Supported Employment. Indiana’s Medicaid Infrastructure Grant (MIG) provides funding for a statewide Project SEARCH Coordinator whose primary role is to provide training and technical assistance to Project SEARCH sites, conduct ongoing evaluation of the program, and maintain the integrity of this

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 58 national model. Project SEARCH Team members for all sites will participate in ongoing training and collaboration.

Indiana

Indiana VR also invested in Corporate Job Development Initiatives in 2008. MIG funding has made it possible to hire a Corporate Job Development Consultant to assist VR in establishing partnerships with local businesses, enhancing existing business relationships, developing collaboration among employment service providers, and other initiatives aimed at increasing quality employment opportunities for Indiana Citizens with disabilities. The primary responsibilities of the Consultant include:

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 59 . Developing a Corporate Job Development Strategic Plan;

. Facilitating collaboration among VR employment providers to enhance hiring opportunities for individuals with disabilities and develop a single point of contact system;

. Developing long-term relationships with businesses and enhancing existing business partnerships. Provide education to businesses on the benefits of hiring individuals with disabilities;

. Developing training programs to better prepare consumers for quality employment; and

. Developing training curriculum for VR employment providers to help improve job development efforts and increase quality of employment outcomes.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 60 While much progress has been made this year in laying the groundwork, there is still much work to be done in order to enhance employment opportunities for individuals with disabilities. VR strongly believes that Project SEARCH and Corporate Job Development Initiatives will substantially improve employment opportunities for consumers with disabilities, leading to quality employment outcomes and increased independence and self-sufficiency.

Benefits Information Network (BIN)

Indiana Vocational Rehabilitation Services (VRS) in collaboration with Indiana Works Benefits Counselors and the Social Security Administration (SSA), have developed the Benefits Information Network (BIN). The BIN has allowed Indiana to build the infrastructure within the state to support

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 61 individuals receiving federal and state benefits in utilizing work incentives and maximizing their employment outcomes. The BIN is funded by Indiana VR as well as Indiana’s Medicaid Infrastructure Grant (MIG). The MIG supports training, technical assistance, quality assurance, and evaluation of the BIN program. As of September 2008, over 150 individuals from Community Rehabilitation and Mental Health Providers have been certified as BIN Liaisons. The BIN allows VR consumers to receive both employment services and benefits counseling from a single provider. By the end of 2008, there will be nearly 200 certified BIN Liaisons. Indiana VR utilizes case service dollars to pay a fee for service of $300 for each BIN evaluation. This fee covers the following services, provided by BIN Liaisons, to:

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 62  Gather important information from beneficiaries served in their agency regarding federal and state benefit programs, and identify potential work incentives as their agency supports them through all aspects of profiling, job development, job placement, job stabilization and follow-along;

 Verify benefit information with the Social Security Administration;

 Provide important information to Indiana Works Benefits Counselors to complete benefits analysis and recommend individual work incentives to increase employment outcomes;

 Collaborate with Indiana Works Benefits Counselors to develop a strategic plan for benefits management and support and use of

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 63 available work incentives. This plan may also be available to include in the beneficiaries individual plan for employment; and

 Ensure that the beneficiary continues to follow up with work incentives and ongoing collaboration with Indiana Works throughout employment to maximize their employment outcomes.

Recently, 22 BIN Liaisons have been elevated to Tier II BIN Liaisons. They have demonstrated high levels of competency in delivering BIN services and are no longer required to have their work reviewed by the BIN quality assurance team. In addition, they can serve as mentors for other BIN Liaisons at their places of employment, increasing overall quality assurance of the BIN program. Through the MIG,

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 64 Indiana is exploring additional ways to build capacity of the BIN program.

Indiana VR is pleased with the involvement of many provider agencies who value working with the BIN. BIN Liaisons not only provide initial benefits counseling, but also ensure that work incentives are implemented and supported over time for VR consumers. VR believes that with the support of the BIN and other employment initiatives, more individuals with disabilities will achieve their employment goals and maximize their income potential.

Oregon

In Oregon, the MIG is called the Competitive Employment Project. The Project website is http://www.oregon.gov/dhs/vr/cep. Its mission is to

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 65 enhance the quality of life of people with disabilities in Oregon by achieving, maintaining, and advancing the competitive and inclusive employment of persons with disabilities. Major initiatives for 2009- 2010 include:

 The Work Incentives Network—a free benefits and work incentives planning service for people with disabilities who want to obtain, maintain, or advance in employment http://www.oregon.gov/DHS/vr/cep/index.shtml.

 A national and state employer awareness campaign around hiring people with disabilities —collaborating with other states to develop a creative message and materials for a national employer awareness campaign on hiring people with disabilities. For more information, go to the

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 66 website for the Oregon Business Leadership Network: www.obln.org.

 Activities that support employment of people diagnosed with mental illnesses, traumatic brain injuries or developmental disabilities. The grant supports the Oregon Supported Employment Center for Excellence (OSECE), which assists counties moving from a day treatment to a supported employment model and includes a peer mentoring component. OSECE provides technical assistance in implementation of evidence-based supported employment models. http://www.rri.pdx.edu/or_excellence_center.ph p

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 67 Texas

In Texas, the State VR agency’s MIG program, Employment and Disability Connections, recently launched a new website designed to assist job seekers, the business community and other interested in enhancing employment for persons with significant disabilities. The site is www.dars.state.tx.us/edc. The links are to:

 Job Seekers (http://www.dars.state.tx.us/edc/jobseekers.shtm l)

 Business (http://www.dars.state.tx.us/edc/business.shtml)

 Service Providers and Professionals (http://www.dars.state.tx.us/edc/stakeholders.sht ml)

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 68 Utah

In Utah, the Work Ability Utah program began in October 2000 with a Medicaid Infrastructure Grant from CMS. The goal of the project is to create a comprehensive system of work incentives and supports that will increase employment and healthcare outcomes for individuals with significant disabilities.

Five agencies partner to improve and sustain the infrastructure of employment supports, including benefits planning, personal assistance and health care benefits for people with disabilities who work. These partners are the Utah Department of Health, the Utah Department of Workforce Services, the Utah State Office of Rehabilitation, the Division of

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 69 Services for People with Disabilities and the Utah State Office of Education.

Currently, a network of publicly funded agencies, including federal, state, county and private human service and health agencies, schools, colleges, universities and private providers, comprise a system of supports for people with disabilities in Utah. Collaboration and linkage with multiple agencies, as well as other employment initiatives, is critical within the foundation of the Work Ability Utah project. Work Ability Utah seeks to coordinate and share information among all parties to ensure positive employment and healthcare outcomes.

Utah businesses are ready and willing to hire qualified individuals who are seeking employment. Building networks among employers, job seekers

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 70 and provider supports ensures successful employment for individuals with disabilities.

A comprehensive public awareness campaign has been developed around the Work Ability Utah project, with a website, posters, postcards and radio spots, and an interactive CD as a guide for employers and job seekers with disabilities.

People with disabilities can work and want to work. Work Ability Utah is designed to assist people with disabilities, who receive public benefits such as Medicaid and Social Security, to connect with supports to help them find and maintain employment. Businesses benefit from hiring qualified workers with disabilities. Work Ability Utah helps employers by providing training about disabilities and connecting them with this often

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 71 untapped workforce of people with disabilities. The overall goal of the Work Ability project Utah is to create a comprehensive, consumer-responsive system of work supports that will increase employment and healthcare outcomes for individuals with disabilities in Utah. Work Ability Utah connects people who receive Social Security (SSI or SSDI) and/or Medicaid due to a disability with the following resources:

Medicaid Work Incentive Program: The Medicaid Work Incentive Program (MWI), sometimes referred to as the Medicaid Buy-In Program, is an eligibility category created to allow individuals with disabilities to work and qualify for Medicaid. In short, this program is for people with disabilities who are working.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 72 (http://www.workabilityutah.org/healthcare/mwi.php )

Benefits Planning : The Utah Benefits Planning, Assistance and Outreach (UBPAO) program is designed to give Social Security Disability Beneficiaries information on how employment may affect their benefits so that they may make an informed choice about working. The UBPAO can also look at any other benefits a person receives and assess how working may affect those benefits. (http://arcutah.org/bridgetrain/benefits)

Employment Related Personal Assistance (EPAS): EPAS is a Medicaid service for people with disabilities who are employed, and who because of their disability, need personal care assistance to work. A licensed agency or qualified personal care

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 73 assistant can provide the services at work and/or at home. (http://www.workabilityutah.org/healthcare/epas.php )

Vermont

In Vermont, the MIG project list for 2009 includes the following:

1.Enhancing Work Incentives to Increase Employment of People with Disabilities

 Benefits Counseling: Provide individuals with disabilities with information about the interrelationship between work and public benefits;

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 74  Continuation of $1 for $2 Study: Continue evaluation of the Social Security $1 for $2 pilot focused on Buy-In participants.

2.Increasing Employment Options for People with Disabilities

 State as a Model Employer: Provide internships, work experiences, and assistive technology training and assessment to increase placement and retention in State government;

 Self Employment: Provide information and training to service providers to enhance support services to individuals with developmental disabilities who wish to become self employed;

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 75  Telecommuting and Work At Home Options: Work with employers to provide opportunities for telecommuting, and work with VR Counselors to provide information and assistance for individuals to work from home;

 Supported Employment: Through incentives, enhanced Ticket to Work provisions, and technical assistance, increase the quality of supported employment services for individuals with mental illness;

 Reuse of Assistive Technology: Develop a statewide system for the retrieval, refurbishment and reuse of assistive technology in the Medicaid and public school arenas that will make assistive technology

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 76 more affordable and available to individuals with disabilities;

 Increase awareness of disabilities and employment: Through media and events sponsorship, increase awareness of the abilities of people with disabilities and the activities of the MIG.

 Poverty Initiative: Provide employers with education and support to retain workers with barriers stemming from disability and poverty and conduct pilot study on the effectiveness of providing on-site resource coordination;

3.Enhancing the Relationship with Employers

 The Employer as Customer: Through a variety of mechanisms, coordinate key stakeholders for strategic planning on ways to

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 77 increase the quality of recruitment, retention, and training of the workforce of Vermont employers;

 Job Developer Coalitions: Continue and expand local coalitions that enhance communication with employers and increase job placements.

Resource Coordinator Program

A Resource Coordinator is one of many best practices in human resources to help organizations of all sizes hire and retain employees coming from generational poverty and maximize the effectiveness of an economically diverse workforce. Based on a model piloted by Cascade Engineering, a small group of Vermont employers and state agency

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 78 people developed a pilot whereby multiple employers could engage one person at their worksites to provide work supports to their employees.

The program, begun in July of 2008, is funded by the Division of Vocational Rehabilitation’s Medicaid Infrastructure Grant and is in partnership with Invest EAP (Employee Assistance Program), the Department of Labor, the VT Society of Human Resources Managers, United Way of Chittenden County and Vermont 211. The initial employer participants were Rhino Foods, Fletcher Allen Health Care, and Engelberth Construction. Green Mountain Coffee Roasters joined the program in early 2009.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 79 The Resource Coordinator (RC) is available a few hours a week at participating businesses to meet with employees who are experiencing problems that interfere with work, cause stress, or result in employee turnover. Low-income workers have particular challenges that can keep them from being successful at work or even traveling to the workplace. Here are some examples of issues the RC helps employees with:

 My apartment building was just condemned – what do I do?

 The transmission in my car just blew – what are my transportation options and how am I going to pay for a $3,000 car repair?

 I’m moving and need to find childcare near my new home.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 80 The most critical piece is building relationships with the employees. For those in poverty, relationships with friends and family are the individual’s most valuable resource and affect most of their actions. The RC is not an employee of the company nor is she a counselor, but she does provide the listening support, resources and coaching an employee may need to solve a non-work issue that may not only be affecting work, but may also be causing them stress.

The top three issues reported to date are: financial, state benefits and housing. The RC provides the “hand-holding” needed to connect to the resource and navigate the often complex bureaucracies and application processes to solve an immediate crisis. This is especially important for the many employees for whom English is a second language. Employers were surprised by the complexities of employees’

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 81 needs and the diverse number of resources in the community. Having an RC onsite saved time for the employees as well as the supervisors and human resources staff.

To provide more proactive support, the RC helps employees head off potential problems and plan for the future through articles in company newsletters, postings on staff bulletin boards and presentations at staff meetings. This proactive approach prevents, for example, an employee from leaving a job due to lack of summer daycare or provides employees the support needed to take advantage of food stamps or the Earned Income Tax Credit.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 82 Creative Hiring Opportunities

Creative Workforce Solutions (CWS) offers several innovative ways to introduce employers to potential workers. Training programs can be designed to meet specific needs and are “customized” according to the skill level of the trainee.

The CWS Employment Consultant reviews an employer’s needs, offer qualified candidates, and develops a training plan before the new trainee/employee starts working or training. The Consultant assists with any questions and provides technical assistance during training and any needed follow-up services.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 83 Subsidized Training Options

Company Tours

A tour can provide a real-world understanding of an employer’s workplace, the skills needed to be successful, and other important information.

Short-term Job Shadows

Ranging from a few hours to a week or two in length, short-term job shadows are a great way for employers and potential candidates to meet. For many individuals, this is an opportunity to get a hands-on understanding of an employer’s business while at the same time gaining important skills. During this period, the trainee is paid a stipend by CWS and is covered under a blanket liability policy, so there is no risk to the employer.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 84 Risk Free Trial

For individuals who meet many an employer’s skill requirements, but need additional training, this option provides an opportunity to introduce a candidate to the workforce prior to actually making a hire. A CWS Employment Consultant will work with the employer to determine the duration and schedule of the work experience. The trainee is paid a stipend by CWS and is covered under a blanket liability policy, so there is no risk or cost while the candidate is in formal or informal training program developing industry-specific skills.

On-the-Job Training (OJT)

OJT is designed to train new employees in the business setting, thereby creating a workforce of

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 85 employees with job-specific skills. The new employee will be on the employer’s payroll and be covered by Workers’ Compensation. The employer is reimbursed a percentage of the training wage, which reflects the employee’s productivity. In other words, the amount may be a higher percentage to start and then decrease as the employee develops competencies.

Temp-To-Hire

Designed for those candidates who have the skills and experience needed to be successful, but who may need a training period to be fully productive, the Temp-to-Hire program offers a six-week introductory period during which the employer pays only the hourly wage. All other costs such as Worker’s Compensation, FICA etc are covered by

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 86 CWS. During the training period, the worker is an employee of a staffing agency, so there is no risk to the employer.

All Temp-to-Hire arrangements require a commitment to hire on the part of the employer upon the successful completion of the training period. Should the employer decide that a candidate is not a good match, the candidate can be terminated at any time.

WORK INCENTIVES PLANNING AND ASSISTANCE GRANTS

BACKGROUND AND OVERVIEW

This section of the written materials describes the Work Incentives Planning and Assistance (WIPA) Grants and then provides specific information regarding the role of State VR agencies in

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 87 implementing WIPA grants. The intent of the WIPA grants is to enhance the employment outcomes for State VR agency clients by reducing uncertainty and fear related to potential loss of benefits, if working; enabling informed choice and decision-making concerning work; supporting clients in using work incentives; engaging community rehabilitation providers in these efforts to reduce fragmentation and improve coordination among providers; and preventing duplication and ease of access by clients.

According to Dr. John Kregel, Center Associate Director & Director of Research, Virginia Commonwealth University, Rehabilitation Research and Training Center on Workplace Supports and Job Retention, in testimony before the Subcommittee on Social Security of the House Committee on Ways and Means (May 19, 2009), the WIPA grant

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 88 program is an integral part of the Social Security Administration’s strategy to promote employment among SSI and SSDI beneficiaries, reduce dependence on cash benefits, reduce the number of burdensome overpayments and other post entitlement problems experienced by beneficiaries engaged in work, and decrease Trust Fund and general expenditures by reducing cash payments to beneficiaries. WIPA projects are provided services to SSI and SSDI beneficiaries in all 50 states. Collectively, the 104 projects employ over 400 Community Work Incentive Coordinators (CWICs).

According to Kregel, the mission of the WIPA program is to provide timely and accurate information to beneficiaries on SSA’s work incentives and other Federal efforts to remove regulatory and programmatic barriers to employment

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 89 for persons with disabilities. CWICs work with individual beneficiaries to explain the myriad of regulations, provisions, work incentives, and special programs that impact a beneficiary’s decision to enter or reenter the workforce. CWICs complete a demanding preparation and certification program and participate in an intensive program of ongoing technical assistance and training.

THE ROLE PLAYED BY STATE VR AGENCIES REGARDING WIPA GRANTS

The WIPA projects assist many entities, including State VR agencies, to provide employment services and supports. In some states in the Southeast region, the State VR agency is a WIPA grantee:

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 90  Georgia Department of Labor, Division of Rehabilitative Services Shanti Aaron, Program Manager (404) 638-0375

 Mississippi Department of Rehabilitation Vicki Thornton, Project Coordinator (601) 853-5332

 North Carolina Division of Vocational Rehabilitation Wayne Howell, Project Coordinator (919) 855-3587

 South Carolina Department of Vocational Rehabilitation Denise Koon, Project Manager (803) 896-6374.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 91 EXAMPLES OF ACCOMPLISHMENTS OF WIPA PROJECTS

Georgia

Georgia Vocational Rehabilitation has provided work incentive planning and assistance to more than 950 Social Security Administration's (SSA) beneficiaries receiving SSDI and SSI benefits under the SSA Work Incentive Planning Assistance (WIPA) Program, since its inception in October 2006, throughout 109 mostly rural counties. Georgia’s WIPA program will build on the previous success of VR's Georgia Rehabilitation Outreach Program (GROUP) and will continue to use the GROUP name. GROUP provided work incentives information and benefits planning to over 1,600 individuals in the five years the program operated in

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 92 Georgia. Georgia VR’s organizational location within the Georgia Department of Labor (GDOL) provides important linkages to the workforce system resources throughout the state. Its mission fully supports that of the WIPA project - "Assist people with disabilities to work" and it holds a vision of being "A workforce development system that serves all Georgians with disabilities”.

GROUP is housed within the SSA/WIPA Unit of the Georgia Department of Labor/VR Program. As stated in its "Strategic Agenda: 2005 and Beyond", the mission of the VR Program is to "assist people with disabilities to work". Its vision is "a workforce development system that serves Georgians with disabilities." GROUP complements existing services of the VR Program, and is dedicated to assisting Georgians with disabilities to obtain, regain, and

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 93 maintain self-supporting employment. The Project design builds upon the success of the existing GROUP benefits planning project and adds greater focus to the areas of: employment outcomes, case management services and follow-up. Design elements include: Intake and Assessment, Benefits Counseling and Advisement, Benefits and Employment Plan Development, Follow-Along Services and Plan Monitoring and Follow-Up Services.

GROUP is one of two projects in Georgia participating in this cooperative agreement.

GROUP provides services in 109 rural Georgia counties and Shepherd's Benefits Navigator provides services in 50 Georgia counties (including Metro Atlanta).

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 94 GROUP is built upon extensive collaborative efforts with other social service agencies that provide support services to persons with disabilities, including the Georgia Department of Labor community One-Stop and Career Centers, the Georgia Department of Education and local schools systems, Centers for Independent Living, Community Rehabilitation Programs, the Georgia Department of Community Health, and the Georgia Department of Human Resources/Division of Public Health and Georgia Division of Family & Children Services.

Traditionally, the VR Program serves youths with disabilities 16 years of age and older. In order to assure WIPA work incentives planning and assistance is made available to youths with disabilities who are 14 years of age and older, the

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 95 Georgia WIPA Project links with local school systems, Community Rehabilitation Programs (CRP), and a network of Centers for Independent Living (CILs).

The Georgia VR WIPA project has developed into a valued component of the Employment team for serving VR clients who are Social Security disability beneficiaries. Having the project housed in GDOL vocational Rehabilitation services has increased the awareness of the services and value to the VR counselors and also to the GDOL career Center staff as part of Georgia’s Service integration of VR and DOL services. Referrals to CWICs are occurring earlier in the Vocational Rehabilitation process and the CWICs are participating in monthly consultations with the counselors on clients that are referred to them.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 96 Mississippi

The Mississippi Department of Rehabilitation Services’ (MDRS) Mississippi Partners for Informed Choice (M-PIC)/Work Incentives Planning and Assistance (WIPA) Project is a statewide collaborative outreach program to the state’s 169,772 Social Security beneficiaries receiving Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI) based on disability and/or blindness, including transition-to- work aged youth. M-PIC provides WIPA services through a certified staff of four Community Work Incentives Coordinators (CWICs), a Project Coordinator, and a Project Director both of whom also completed the recertification process for CWICs. Since its inception as a Benefits Planning Assistance and Outreach (BPAO) Project in 2000 to

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 97 present, M-PIC has provided direct services to over 7,000 beneficiaries regarding Social Security Administration (SSA) work supports to help them make the transition from benefits to self sufficiency through employment.

Each of the project’s four full-time CWICs serves beneficiaries in approximately 20 counties. Half of MDRS’ CWICs have been with the M-PIC project since its inception. Recently, two MDRS clerical staff persons completed the CWIC training and became certified, enabling them to assist in triaging calls received on M-PIC’s toll-free number.

In addition, MDRS has a subgrant contract with the Mississippi Band of Choctaw Indians to enable Native American beneficiaries to receive WIPA services on the reservation. Two certified CWICs

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 98 devote a portion of their time to providing WIPA services to those on the reservation seeking vocational rehabilitation.

“ Providing the freedom to live” is the motto of MDRS. M-PIC’s efforts are by no means restricted to providing assistance only to MDRS consumers. Through successful partnerships with fellow community organizations and service providers, M- PIC reaches out to beneficiaries across the state to encourage them to choose work. However, as employees of the state Vocational Rehabilitation (VR) agency, M-PIC staff work closely with MDRS counselors and evaluators who refer consumers receiving SSA disability benefits to M-PIC for WIPA services enjoying a cooperative relationship with VR that some WIPA projects do not have with their state VR. M-PIC believes that careful planning

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 99 is the key to making the transition from receiving benefits to working successfully. The services provided help promote successful outcomes for the referred MDRS consumers because they receive accurate information regarding the disability program under which they currently receive benefits and the work incentives available to them. Informed consumers make better decisions leading to successful experiences and closures.

MDRS counselors and managers are grateful for the planning and assistance provided to Vocational Rehabilitation consumers by CWICs. The WIPA services CWICs provide add to the array of VR services necessary to move beneficiaries closer to employment and self sufficiency. Come to think of it, isn’t that the goal of both VR agencies and WIPA projects?

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 100 North Carolina

Under the state’s WIPA project, Community Work Incentives Coordinators (CWICs) provide counseling to individuals receiving Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) on how work will affect these and other benefits received. Information is also provided on how to utilize Social Security Administration Work Incentives. This information is crucial in allowing individuals with disabilities to transition into the workforce. These individuals choose not to work many times when they are unaware of the information CWICs provide. CWICs also educate service providers on how benefits are affected by work and the SSA Work Incentives as well.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 101 The NC Division of Vocational Rehabilitation serves 27 counties in North Carolina under WIPA. All North Carolina counties are served under the NC MEANS Project. MEANS partners include, Life Plan Trust, OptionsAccess of Tri-County Industries, Easter Seals/United Cerebral Palsy of North Carolina and the Division of Vocational Rehabilitation. CWICs are quite mobile and can meet with consumers in a number of locations. These locations include, but are not limited to Vocational Rehabilitation Unit offices, One-Stop Career Centers, Employment Networks, Supported Employment facilities and Mental Health agencies.

South Carolina

The South Carolina Vocational Rehabilitation Department (SCVRD) has managed the South

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 102 Carolina Pathways Toward Employment (SCPTE) program under the Work Incentives Planning and Assistance (WIPA) grant since its inception in 2002. With four community work incentive coordinators (CWICs) serving beneficiaries in 30 counties in South Carolina, it has been a very positive experience for SCVRD in many ways.

The CWICs work closely with the vocational rehabilitation counselors to assist individuals in their efforts to go to work, some for the very first time. Once the CWIC has met with the beneficiary, each counselor, employment coach, or other staff member receives a benefits information sheet detailing any limitations the individual may have and listing any follow-up that may be required once the person begins employment. The VR staff recognizes the important role the CWICs play and encourages

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 103 continued collaboration with the CWIC once the individual returns to work and makes the transition from benefits to self-sufficiency.

Each CWIC has an active caseload of beneficiaries and provides long-term case management support. This includes monthly wage tracking and reporting, the creation of PASS plans, subsidy development, and the identification of other federal and state programs to support the individual’s efforts with the transition- to-work process.

One case in particular involved a young woman who was extremely hesitant to return to work for fear of losing not only her cash assistance but her Medicare, Medicaid, and subsidized housing support as well. This was her first experience with employment since she began receiving benefits so she was very

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 104 anxious. The CWIC met with this beneficiary and completed a full benefits analysis for her. She met with him several times over a three-month period before she felt confident enough to attempt work. After working closely with the VR counselor as well as her mental health employment service provider, she decided she was ready to try to work. She was employed at the local Air Force base as a telephone operator.

Once she began her employment, she met with the CWIC on a monthly basis to track her trial work period and report her earnings to SSA, Medicaid, and her housing provider. The CWIC also helped her secure continued Medicaid benefits under the Medicaid buy-in program to assist with her medical and prescription drug costs.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 105 Today she is still working and meets with the CWIC on a quarterly basis to confirm the status of her benefits. This service has been a tremendous help in easing her fears and anxiety.

The CWICs work one-on-one with our partners to assure a smooth transition for the beneficiaries, whether they are returning to work or going to work for the first time. Our partnering agencies include the South Carolina Commission for the Blind, the South Carolina Department of Mental Health, the South Carolina Employment Security Commission, the South Carolina Disabilities and Special Needs Board, the South Carolina Department of Mental Health Individual Placement and Supports program, many local employment networks, and several high school transition coordinators throughout the coverage area.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 106 Tennessee (Center for Independent Living of Middle Tennessee) [Kregel Testimony]

The Center for Independent Living of Middle Tennessee (CIL-MT) Work Incentives Planning and Assistance (WIPA) Program serves 44 counties in western and central Tennessee. This area includes Nashville and Memphis – two of the most populous areas in the state. The project covers a WIPA service area that contains more than 150,000 WIPA eligible adults with disabilities receiving SSI and/or SSDI (nearly three fourths of the of the state’s disability beneficiaries).

Five full-time CWICs provide WIPA services across the 44 counties. Three of the five CWICs have been with the project since the inception of the program eight years ago. Based on data from the National

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 107 Beneficiary Survey, the National BPAO database, and the perceptions of the project, there are an estimated 60,000 individuals in the counties served by the project who are interested in obtaining employment, including 25,000 who have engaged in employment or actively sought employment during the past 12 months.

The CIL-MT is a highly productive program staffed by outstanding CWICs. The project has provided intensive WIPA services to 1,224 beneficiaries since the inception of the WIPA contract in 2006. Two of literally hundreds of success stories documenting the delivery of quality services by the project are provided below.

In Shelby County, CWIC Hope Johnson worked with Shawn, a 39-year old woman who is visually-

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 108 impaired who came to the WIPA program in 2007 after being referred by her VR Counselor. Shawn was a concurrent beneficiary. The CWIC assessed her situation and found that she was a good candidate for a PASS, a very powerful, although complex, SSA work incentive. Her goal was to be a massage therapist. She needed assistive technology and training before she was ready for school. She began Orientation and Mobility training, plus Braille and computer classes.

After completing her training at Clovernook Center for the Blind and Visually Impaired, her VR Counselor agreed to pay for tuition, books, some supplies, some assistive technology, and transportation for her to attend school. However, VR was not able to pay for the Braille Writer that she would need. In addition, there were many other

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 109 school-related expenses, such as a school application fee, massage supplies, massage table, uniforms, required background check, licensure exam, and CPR certification.

Ms. Johnson helped Shawn write her PASS and gather all of the needed documentation regarding expenses and steps to reach her goal. The PASS was approved in February 2008 and Shawn received the funds necessary to start massage therapy classes the same month. Shawn has now completed her classes, passed her licensure exam, and started working as a massage therapist in Memphis. She uses her own Braille Writer to keep up with appointments. Shawn utilized community resources, such as VR and Clovernook, to get her schooling and equipment. The PASS was a great SSA work incentive for Shawn to use in order to receive all of the items,

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 110 supports and equipment she needed in order to be successfully employed.

In Tipton County, Ms. Johnson worked with Cindy, a 27-year old, visually-impaired woman from Millington, TN, who contacted the WIPA program in 2007 after receiving confusing information in the mail from SSA. Her father had recently retired, making her eligible for Childhood Disability Benefits (a special type of SSDI benefit for adults disabled as children). The SSA letter stated that her SSI check would be stopping and SSDI would start. Ms. Johnson explained the ramifications of “switching” from one disability program to another. Since she was currently working full-time, she had many questions about the work rules under the SSDI program, Medicare, and TennCare coverage.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 111 Cindy and her CWIC gathered earnings information and disability-related work expenses to report to SSA. They tracked her Trial Work Period and the CWIC assisted her with the SSA work review. Because Cindy had so many work and disability- related expenses, her SSDI check continued past the Trial Work Period even though her gross earnings exceeded the Blind SGA (earnings) level. That was only due to the CWIC’s help in documenting Impairment-Related Work Expenses (IRWE). Otherwise, Cindy’s SSDI check would have stopped. The CWIC has continued to assist Cindy with questions regarding her health insurance and properly reporting earnings information to SSA. She has received two raises in the past couple of years and has contacted the WIPA program as needed.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 112 Texas (Easter Seals of North Texas) [Kregel Testimony]

The WIPA program of Easter Seals North Texas serves individuals receiving Social Security Disability and/or Supplemental Security Income benefits in 19 counties in the North Texas area. Each beneficiary we meet receives an individualized Benefits Summary which summarizes the work incentives discussed and an action list. This action list acts as a catalyst for taking those needed steps to enter employment. It is the goal of the WIPA project to not only educate beneficiaries but to guide them to take the steps necessary to obtain and maintain employment.

Over the past three years, the project’s five CWICs have provided intensive, long-term work incentives

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 113 support to 1,302 beneficiaries. Of these 1,302 consumers, 184 are employed, with 52 working at or above the current SGA level of $980 a month. Sustaining this level of income will mean that approximately 3.5 percent of the individuals provided more intensive WIPA services will eventually become self sufficient. This success rate is more than three times the national benchmark rate of 1 percent of all SSA disability beneficiaries.

The project employs four full-time CWIC’S, with one serving as both a CWIC and the Project Director, and one part-time CWIC. The project serves a 19-county area in North Texas, some parts of which are rural. Out of five staff members, three have significant disabilities. Two were once on the Social Security benefit roles but have now worked to the point where they are not. One staff member was

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 114 a client under the BPAO program and now is employed as a full-time CWIC covering three counties. The project director, Ms. Cindy Herzog stated recently,

Over the history of both BPAO and WIPA, thousands of beneficiaries have entered into employment. Clients who have never worked before have entered into employment for the first time, breaking the cycle of dependence on benefits. The program as a whole has been a great success; hopefully the numbers of beneficiaries who leave the roles completely will continue to increase. This is a challenging but fulfilling line of work. We have the opportunity and privilege to present and create positive change for individuals living with disabilities.

TACE Region IV Webinar 09/09/09: What State VR Agencies Can Learn - Handout 115

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