Waiver Funding For Work:
Supported Employment for People with IDD
By Carli Friedman | CQL Director of Technical Assistance and Data Analysis
People with disabilities are employed at significantly lower rates than people without disabilities. This is especially true for people with intellectual and developmental disabilities (IDD). Those people with disabilities who are employed are often underemployed, being placed in positions where their skills are not utilized, they do not have enough opportunities, and are not paid at fair rates.
The majority of people with IDD are funneled into segregated services such as day services or prevocational sheltered workshops. Although the goal of prevocational settings is to provide work related training, research has found the skills taught rarely translate to integrated employment settings (Nazarov et al., 2012). In contrast, supported employment services allow people with IDD to work in integrated employments with proper supports. Compared with other settings, the benefits of supported employment include higher quality of life, more engagement, and more interaction with nondisabled people (Jahoda et la., 2008; Kilsky & Breyer, 1996; Verdugo et al., 2005). With the proper supports people with IDD, even those with high support needs, can excel in integrated employment settings (Braddock et al., 2015).
Medicaid Home and Community Based Services (HCBS) 1915(c) waivers are the largest provider of long-term services and supports (LTSS) for people with IDD. Because of the role HCBS waivers can play in facilitating integrated employment the aim of this study completed by CQL | The Council on Quality and Leadership was to examine how HCBS waivers from across the country provided supported employment in fiscal year (FY) 2014. To do so, this study analyzed 110 HCBS waivers from 45 states and the District of Columbia gathered from the Centers for Medicare and Medicaid Services (CMS). Waivers were analyzed to determine utilization and expenditures of supported employment services for people with IDD.
Findings revealed more than three-quarters of waivers offered supported employment services such as career planning, job placements, employment assistance, accommodations, ongoing support and job-coaching. A small proportion of states also allowed supported employment services to be used to assist people with IDD with running their own businesses and other forms of self-employment or entrepreneurship.
A total of $813 million was projected in spending, for the supported employment services of approximately 95,000 people in FY 2014. While this may seem significant, it is only 3% of all waiver spending in FY 2014. Moreover, spending varied widely by state and service; for example, while an average of approximately $6,700 was projected per person for supported employment, it ranged from $122 (New Mexico “level 1 group” supported employment) to $41,000 (Connecticut “group per diem” supported employment); see figure 1.
Only 14% of people with IDD being served by the HCBS waiver in FY 2014 were projected to receive supported employment services. For comparison, approximately four times the amount of people with IDD were projected to receive day services in FY 2014 (380,000) (Friedman, 2016).
Both the Americans with Disabilities Act and Olmstead v. LC (1999) require people with disabilities receive services in the most integrated settings possible. With the right supports, people with IDD are able to work in the community. Research has also found that supported employment should be based not on job-readiness or ability but the preferences and choices of people with IDD (Nazarov et al., 2012). According to the Centers for Medicare and Medicaid Services (2011) “work is a fundamental part of adult life for people with and without disabilities. It provides a sense of purpose, shaping who we are and how we ﬁt into our community” (p. 3).
- Braddock, D., Hemp, R., Rizzolo, M. C., Tanis, E. S., Haffer, L., & Wu, J. (2015). The state of the states in intellectual and developmental disabilities: Emerging from the great recession (10th ed.). Washington, DC: The American Association on Intellectual and Developmental Disabilities.
- Centers for Medicare and Medicaid Services (2011, September 16). CMCS informational bulletin: Updates to the §1915 (c) waiver instructions and technical guide regarding
employment and employment related services. Baltimore, Maryland: Department of Health and Human Services. Retrieved from http://www.medicaid.gov/federalpolicy-guidance/downloads/CIB-09-16-2011.pdf.
- Friedman, C. (2016). Day Habilitation services for people with intellectual and developmental disabilities in Medicaid Home and Community-Based Services waivers. Research and Practice for Persons with Severe Disabilities, 41(4), 244-255.
- Jahoda, A., Kemp, J., Riddell, S., & Banks, P. (2008). Feelings about work: A review of the socio-emotional impact of supported employment on people with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 21(1), 1-18.
- Kilsby, M., & Beyer, S. (1996). Engagement and interaction: A comparison between supported employment and day service provision. Journal of Intellectual Disability Research, 40(4), 348-357.
- Nazarov, Z. E., Golden, T. P., & Schrader, S. V. (2012). Prevocational services and supported employment wages. Journal of Vocational Rehabilitation, 37(2), 119.
- Verdugo, M., Jordan de Urries, F., Jenaro, C., Caballo, C., & Crespo, M. (2006). Quality of life of workers with an intellectual disability in supported employment. Journal of Applied Research in Intellectual Disabilities, 19(4), 309-316.