Employment First State Leadership Mentoring Program Federal Briefing

1. Employment First State Leadership Mentoring Program Federal Briefing Interagency Coordination August 9, 2018

2. Employment First A framework for systems change that is centered on the premise that ALL individuals, including individuals with significant disabilities, are capable of full participation in competitive integrated employment and community life. Cross-Disability in focus, including physical, mental health, intellectual, and developmental disabilities.

3. 3 “Tiers” of EFSLMP • Core State • Vision Quest State • Community of Practice

4. Vision question: A 3 Pronged Approach To System Change In 9 Months

5. VQ States (since 2016)

6. Employment First State Leadership Mentoring Program: Unique Features • ODEP requires a minimum of six state agencies receiving Federal funds to be involved in EFSLMP Core State teams: • Intellectual & Developmental Disability (I/DD)2. Vocational Rehabilitation (VR)3. Workforce Investment4. Mental Health5. Education6. Medicaid

7. Employment First State Leadership Mentoring Program: Unique Features • ODEP requires a minimum of six state agencies receiving Federal funds to be involved in EFSLMP Core State teams: • Intellectual & Developmental Disability (I/DD)2. Vocational Rehabilitation (VR)3. Workforce Investment4. Mental Health5. Education6. Medicaid

8. Why Participate in Vision Quest? Incredible Results! • “Super MOUs” (MI) • Executive Order (PA, LA) • School to Work Pilots (MI, UT) • Rate Restructuring (TN, IL) • Guides (OH)

9. Today’s Speakers • Allan Bergman, Subject Matter Expert, Employment First State Leadership Mentoring Program • David Mitchell, Administrator, Iowa Vocational Rehabilitation Services • Tania Morawiec, Employment First Manager, Illinois Department of Human Services

10. Employment First & Interagency Collaboration Matter Now: Money in the Moment EFSLMP Federal Briefing Washington, D.C. August 9, 2018 Allan I. Bergman

11. Employment First is the Imperative • General theme:Employment in the community is the first/primary service option for individuals with disabilities APSE Statement on Employment First Employment in the general workforce is the first and preferred outcome in the provision of publicly funded services for all working age citizens with disabilities, regardless of level of disability.

12. Employment First is not just about“best practice”.It is aboutclear public policiesthat employment is the priority A critical focus of Employment First must be on shifting public resources to be in alignment with our values…

13. Aligning Federal Agency Policy & Financing1988-2018

14. Employment participation June 2018 Percent Working American Community Survey

15. FUNDING:Money Matters….and Drives Practice Be Bold. Embrace Difference. Change Lives.

16. Data: 8.2 M.SSI Recipients;2016 • 4.8 million between ages 18 and 64 (29.5% of these beneficiaries also received some type of Social Security payment) • Only 4.8% of the SSI beneficiaries of working age reported earned income: 19/20 ZERO earnings • The average earned income is $300/year (for individuals who are blind, $460/year) • Less than 1% leave the rolls per year and only ½ of those for employment Source: SSA

17. Medicaid Overview: 2016 data fromCongressional Budget Office; 1-2017 • Over 74 million beneficiaries: • 45 % children ; 19% of expenditures • 36% adults; 34% of expenditures • 8% seniors; 14% of expenditures • 12% PWD; 33% of expenditures (20 % of population for 47% of $$ in 2016) Total expenditures for federal governments, FY'16: $331 Billion…

18. Poverty By The Numbers U.S. Census Bureau (September 2017) 40.6 million Americans (of 319.9 M) were living in poverty in 2016. Persons with Disabilities experienced the highest rates of poverty of any other subcategory of Americans for the 15th year in a row. It is expected that SSDI/SSI annual payments will reach over $1 trillion by 2023.

19. Longer Lifespans for Individuals with Disabilities Impacts Multiple Public Funding Sources: • Life expectancy for PW/IDD has increased from average of 19 years in the 30’s to 66 years in 2010 (Coppus, A.M.W., 2013) • Individuals with Mild ID have life expectancies similar to the general population of 74 years (Coppus, 2013) • As people with disabilities live longer, the number of years that they require a variety of publicly funded supports. • Employment makes a huge difference

20. Current Policies Are Not Fiscally Sustainable Source: CBPP projections based on CBO data.

21. Heading for a massive crash! Weighty Legacy Services & Structures Budget Shortfalls Rising Unmet Demand Workforce Shortages Fragmentation Quality Problems Antiquated Technologies

22. Where Do We Go?What Do We Do?

23. ADA Findings P.L.101-336; 1990 • The continuing existence of unfair and unnecessary discrimination and prejudice denies people with disabilities the opportunity to compete on an equal basis and to pursue those opportunities for which our free society is justifiably famous, and costs the United States billions of dollars in unnecessary expenses resulting from dependency and nonproductivity.

24. Goals of the Americans with Disabilities Act of 1990 • The nation’s proper goals regarding individuals with disabilities are to assure: • Equality of Opportunity • Full Participation • Independent Living • Economic Self Sufficiency

25. TRANSFORMATION: Moving from Paper Compliance and Health, Life Safety to Accountability for MissionDriven Valued Outcomes for a Good Life as a Valued Member of the Community

26. Workforce Innovation & Opportunity Act • Requires that the State VR Agency have a Formal Cooperative Agreement with the State Medicaid Agency • Requires that the State VR Agency have a Formal Cooperative Agreement with the agencies responsible for providing long term services and supports for people with disabilities; ID/DD; mental health; physical; sensory; • Must define the respective roles in the provision of VR services, including extended services

27. Interagency Collaboration “Collaboration is a process to reach goals that cannot be achieved acting singly ( or not as efficiently or effectively). Collaboration is a means to an end, not an end in itself.” (Charles Bruner, Ph.D. 1991) The desired end for Employment First is more comprehensive and appropriate supports and services that result in increased rates of competitive integrated employment for all individuals with disabilities, regardless of complexity.

28. “Collaborate” and Webster’s “1. To work together, especially in some literary, artistic, or scientific undertaking; 2. to cooperate with an enemy invader.”

29. Elements of Collaboration: Bruner • Jointly developing and agreeing to a set of common goals and directions; a process 2. Sharing responsibility for obtaining those goals; 3. Working together to achieve those goals using the expertise and resources of each of the collaborators (e.g. braided funding)

30. Collaboration…..Coordination; Different • Collaboration requires more than either communication or coordination. • Coordination involves joint activity but allows individual organizations to maintain their own set of goals, expectations and responsibilities. • In contrast, collaboration requires the development of joint goals to guide the actions of each of the collaborators.

31. Collaboration, cont. • Because collaboration requires sharing responsibility, it requires consensus and cannot be imposed hierarchically. • Collaborators often have to develop skills in shared goal setting and in shared responsibility, which may not be part of their other work.

32. DISABILITY CONSTRUCT IN MULTIPLE FEDERAL LAWS • “Disability is a natural part of the human experience and in no way diminishes the right of individuals to: • Live independently • Enjoy self determination • Make choices • Contribute to society • Pursue meaningful careers • Enjoy full inclusion and integration in the economic,political, social, cultural, and educational mainstream of American society.

33. Why is Employment Becoming Part of Medicaid’s Focus? CMS’s commitment: “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. Meaningful work has also been associated with positive physical and mental health benefits and is a part of building a healthy lifestyle as a contributing member of society.Because it is so essential to people’s economic self sufficiency, as well as self esteem and well being, people with disabilities…who want to work should be provided the opportunity and support to work competitively within the general workforce in their pursuit of health, wealth and happiness. All individuals, regardless of disability and age, can work – and work optimally with opportunity, training, and support that build on each person’s strengths and interests. Individually tailored and preference-based job development, training, and support should recognize each person’s employability and potential contributions to the labor market.” Highlights CMS’s goal to promote integrated employment options 82

34. SERVICES AUTHORIZED UNDER HCBS: • Case Management • Homemaker • Home Health Aide • Personal Care • Adult Day Health • Habilitation, including supported employment • NO funds for room and board • Environment Accessibility & Adaptability Equipment • Respite Care • Day Treatment or Other Partial Hospitalization • Psychosocial Rehabilitation Services • Clinic Services • Enhanced Therapies… • Transportation-Non Med. • Personal Emergency Response Systems • Assisted Living • Other……..

35. Social Security’s Mixed Message to People with Disabilities

36. SSDI & SSI Work Incentives • Impairment Related Work Expenses • Subsidies and Special Conditions • Unincurred Business Expenses; • Unsuccessful Work Attempts; • Continued Payments Under a Vocational Rehabilitation Program; • Expedited Reinstatement • http://www.ssa.gov/disabilityresearch/wi/detailedinfo.htm

37. SSDI Work Incentives • Trial Work Period • Extended Period of Eligibility • Continuation of Medicare coverage • Medicaid Buy-in for Workers with Disabilities • Protection from Medical Continuing Disability Reviews

38. SSI Work Incentives • Blind Work Expenses • Earned Income Inclusion • Student Earned Income Inclusion • Plan to Achieving Self Support • Property Essential to Self-Support; • Special SSI Payments for People Working • Continued Medicaid Eligibility/Buy-In • Special Benefits for People Eligible under Sections 1619 (a) or (b) Who Enter a Medical Treatment Facility • Reinstatement Without a New Application

39. Achieving a Better Life Experience Act: ABLE Act • P.L. 113-295; December 19, 2014 • Passed with huge bipartisan support • Parallels the Section 529 tax free qualified college tuition savings accounts • Each state must act to make this available • Goal: To help people with disabilities and their families save to meet their long-term ongoing support needs • Up to $100,000 and no loss of SSI or Medicaid benefits

40. THE ULTIMATE TEST OF POLICY IS YOUR BUDGET • Many words of law represent hollow promises for individuals with disabilities; • No incentives or accountability for valued outcomes and results; must develop outcomes and incentives! • We need to talk about ROI? • A return on investment to the government and, thus, the tax payer?

41. Where is the Return on Investment (ROI) for Taxpayers? • What do we value as outcomes/results? • What do we owe the taxpayer and society? • Are the outcomes and results of our work quantifiableand are they compatible with the valued outcomes of the DD Act, IDEA, WIOA, and the ADA that we espouse?

42. The Essence of Strategic Planning “Long range planning does not deal with future decisions, but with the future of present decisions.” Peter Drucker

43. Wisdom from Jim Collins “Great performance is about 1% vision and 99% alignment” (It all starts with a vision and then a specific plan and process to execute that vision.) Built to Last

44. For Additional Information, contact Allan I. Bergman HIGH IMPACT Mission-based Consulting and Training 757 Sarah Lane Northbrook, IL. 60062 (773) 332-0871 aibergman@comcast.net

45. Interagency Coordination MOUs- Iowa Workforce Development System, Department of Human Services, Iowa Department of Education Establishing the Foundation: Iowa Coalition for Integration and Employment Disability Employment Initiative Disability Access Committees Vision Quest

46. “Work is about a search for daily meaning as well as daily bread, for recognition as well as cash, for astonishment rather than torpor; in short, for a sort of life rather than a Monday through Friday sort of dying.” ― Studs Terkel IL EFSLMP Tania Morawiec, IL Employment First Manager

47. Interagency Coordination

48. Braiding and systems evolution Explore Braided funding to support distinct CIE phases Leverage new & existing funding/TA for cie • Engagement • Discovery/vocational exploration • Job development • Retention • Advancement DRS milestones ($6772) for job placement and limited job coaching & I/DD waiver for vocational assessment/discovery and or long term coaching DRS milestone contracts for vocational placement, CIPSFR Program, fidelity reviewer and policy consultant & Rule 132/140 Medicaid billing for medically necessary MH services (IPS) Between 40-50% of IPS clients are not in DRS plan status DMH funds 5 regional IPS trainers/fidelity reviewers DEI Grants to create educational videos and learning opportunities to expand awareness and increase referrals • 1115 Medicaid Demonstration waiver for SE in the behavioral health population • Title XX funds (Social Services Block Grant) • Balancing Incentive Program (Medicaid), IPS, Customized Employment and Employment First Services • Applying for supports only Medicaid Waiver for I/DD to actualize SE goals • DEI grants for innovative programming like a Project SEARCH start-up • ODEP’s EFSLMP and Cornell Diversity Partners Demand Side Training Series

49. Exposure to new systems fuels innovation Interagency collaboration Administrative Directive (mou) codified innovation • Timed IPS DRS referral to action phase of job search • Informed a DRS policy directive that allowed for expedited case opening and added 2 post 90-day job retention supports • Research in IPS for new populations • Created new partnerships allowing for virtual reality training in interviewing and soft skills • Expanded knowledge of EBP in AJC’s and led to coordinated training in job development best practice for persons with disabilities (partnership with VR team and business services reps from AJC) • MOU • Clarifies how IDHS Divisions work together to support and fund IPS-shared values, scope of service, obligations • Defines quality assurance process and addresses resolution of conflicts • Details technical assistance options available in DRS and DMH • Dissemination of information • Requires an implementation guide for field of practice • DMH on-boarding for IPS Providers • DRS IPS on-boarding • TIPSFR guidelines • Exploring other potential funding resources • Warning signs of an IPS Provider having challenges

50. Interagency collaboration Requires on-going communication • EEOPD-Employment and Economic Opportunity for Persons with Disabilities Taskforce established in 2009 via legislation, quarterly meetings-13 designated state agencies • Increased IDHS Divisional communication via the Employment First Interagency Council, monthly meetings • Regularly scheduled technical assistance, strategic planning and deadline based work assignments with ODEP EFLSMP SME, Virginia Selleck • AD addresses on-going Divisional communication requirements to address challenges, build awareness and support capacity EBP building