Working for Tomorrow_ September 2007 by lonyoo


									                                   Working for Tomorrow
                                        September 2007
                 A publication of the Center for Workers with Disabilities, APHSA


CMS Publishes NPRM on Medicaid Reimbursement for School-based Administration and
On August 31, the Centers for Medicare & Medicaid Services (CMS) placed on display at the
Office of the Federal Register a proposed rule (CMS-2287-P) regarding Medicaid reimbursement
for school-based administration and transportation. The rule proposes that federal financial
participation (FFP) would remain available for:
      Costs of allowable Medicaid administrative activities conducted by employees of the state
         Medicaid agency, as well as administrative overhead costs which are integral to the
         provision of a covered service; and
      Covered services in a child’s Individualized Education Program (IEP) and for
         transportation from school to a health care provider in the community for a covered

Federal Medicaid payments would no longer be available for:
    Administrative activities performed by school employees or contractors, or anyone under
        the control of a public or private educational institution; or
    Transportation from home to school and back for school-aged children with an IEP or an
        Individualized Family Services Plan established pursuant to the Individuals with
        Disabilities Education Act.

States would continue to be reimbursed for costs related to transportation to and from a school
for children who are not yet school aged but are receiving covered direct medical services at the
school. This includes transportation to school and back to receive direct medical services. The
visit cannot include an educational component or any activity unrelated to the direct medical
service. In addition, if an eligible child is transported from school to an appointment for a Medicaid
covered service with a provider that bills Medicaid, the costs of the transportation remain eligible.

The proposed rule is open for public comment until November 6, 2007. For more information,
please visit

CMS Releases Cash and Counseling SMD and Preprint
On September 13, CMS issued a Dear State Medicaid Director (SMD) Letter that provides
guidance on the implementation of Section 6087 of the Deficit Reduction Act of 2005. Section
6087, the Optional Self-Direction Personal Assistance Services Program (also known as Cash
and Counseling), amends Section 1915 of the Social Security Act to add 1915(j) as a new
subsection. Under this new subsection, states have the option to amend their state plan to
provide self-directed personal assistance services to beneficiaries, without regard to the Medicaid
requirements of comparability or state-wideness. Self-directed Personal Assistance Services is a
service delivery model that states may offer as an alternative to traditional agency-delivered
services. The self-directed Personal Assistance Services state plan option permits individuals to
hire, fire, supervise, and manage employees of their own choosing, including (at the state’s
option) legally liable relatives, and to direct a budget from which they purchase their Personal
Assistance Services.

The SMD is available at The Preprint
is available at

GAO Issues Report on Medicaid Waivers
A Government Accountability Office (GAO) report entitled Medicaid Demonstration Waivers: Lack
of Opportunity for Public Input during Federal Approval Process Still a Concern draws on a review
of recently approved comprehensive demonstrations, including the process the U.S. Department
of Health and Human Services (HHS) used to obtain public input on these proposals. The review
encompassed recently approved comprehensive demonstration programs in two states, Florida
and Vermont. GAO’s research found that recently approved Medicaid section 1115
demonstrations in Florida and Vermont have mixed implications for beneficiaries in terms of
coverage and eligibility. While officials in both states took steps to obtain public input in line with
HHS’s 1994 policy on soliciting input, HHS did not provide opportunity for public input at the
federal level once the proposals were received or post the states’ proposals on its website before
approving them. The GAO report finds that unless Congress and HHS take action, it appears
likely that HHS will continue to approve waivers for comprehensive demonstration proposals—
with potentially significant implications for program beneficiaries—without adequate opportunity
for public input.

The report is available at

ODEP Awards Grant to Establish a Technical Assistance Center on Youth
On August 30, the U.S. Department of Labor's Office of Disability Employment Policy (ODEP)
awarded a 24-month cooperative agreement for $1,850,000 to the Institute for Educational
Leadership's Center for Workforce Development in Washington, D.C., to establish a National
Technical Assistance Center on Transition and Employment for Youth with Disabilities. The
purpose of the Center will be to build the capacity of workforce development, economic
development and educational service delivery systems to ensure that youth with disabilities
graduate from high school and either enter employment or continue their education. A consortium
led by the Center for Workforce Development will develop and promote collaborations and
service coordination among agencies, programs and service providers at the national, state and
local levels. The other members of the consortium include the National Youth Employment
Coalition, Washington, D.C.; the PACER Center, Minneapolis, Minn.; the Center on Education
and Work at the University of Wisconsin-Madison; and the University of Minnesota's Institute for
Community Integration in Minneapolis.

For more information, see

CWD Part of Consortium Awarded ODEP Grant to Establish Research and Technical
Assistance Center on Adults with Disabilities
On September 20, ODEP announced the award of a two-year grant of $2,306,066 to a
consortium of organizations that will establish a center aimed at increasing the employment and
economic self-sufficiency of adults with disabilities. The center will build leadership and strategic
partnerships across workforce development, economic development, and relevant partner
agencies and systems. The consortium, led by the John J. Heldrich Center for Workforce
Development at Rutgers, The State University of New Jersey, will conduct research, develop and
disseminate information, and provide technical assistance and training in the five targeted areas
identified by ODEP's research over the past six years. These areas include partnership and
collaboration, self-direction, economic self-sufficiency, universal design, and customized
employment and other flexible work options. In addition to the Heldrich Center, consortium
members include the Center for Workers with Disabilities (CWD) at the American Public Human
Services Association, Washington, D.C.; the National Leadership Consortium for Developmental
Disabilities at the University of Delaware in Newark, Del.; the Elizabeth M. Boggs Center for
Developmental Disabilities at the University of Medicine and Dentistry in New Brunswick, N.J.;
and the Community Solutions Group LLC in Arlington, Va.

For more information, please visit

Congress Enacts the College Cost Reduction Act
On September 7, Congress enacted H.R. 2669, the College Cost Reduction Act of 2007. The act
will raise the maximum Pell Grant to $5,400 over five years and reduce interest rates on
subsidized student loans. To make student loans more affordable, the act phases-in cuts in the
interest rate charged to undergraduate student borrowers under the Federal Family Education
Loan and Direct Loan programs, reducing such rate from 6.8 percent in July 2006 to 3.4 percent
in July 2012. The act has a number of provisions that could help nontraditional students such as
older youth and working adults. Provisions include the following:
      The act makes dependent students eligible for a simplified means test if one of their
          parents is a dislocated worker or they or their parents received a means-tested federal
          benefit within the past two years. It also makes independent students eligible for a
          simplified means test if they or their spouses are dislocated workers and they have
          received a means-tested federal benefit within the past two years.
      The act excludes welfare benefits, Earned Income Tax Credits, federal special fuels tax
          credits, untaxed foreign income, untaxed Social Security benefits, and the additional
          federal child tax credit from the income and benefits which are considered untaxed and
          thereby included in student need analyses.
      The act establishes a College Access Challenge Grant program providing matching
          grants to philanthropic organizations that are members of eligible consortia for financial
          aid, mentoring, and outreach services to increase the number of needy students from
          underserved populations who enter and complete college.

On September 27, the President signed the College Cost Reduction Act into law. For more
information on H.R. 2669, please visit


Missouri Reinstates a Medicaid Buy-In Program
The Missouri Health Improvement Act of 2007 established healthcare coverage for employed
persons with disabilities in Missouri. Effective August 28, 2007, MO HealthNet (formerly Missouri
Medicaid) implemented the new program, known as the Ticket to Work Health Assurance
(TWHA) Program. TWHA will allow workers with disabilities to earn income up to 300 percent of
the federal poverty level (FPL) and still receive Medicaid services such as personal attendant
care. Monthly premiums are set on a sliding scale for persons with income above 100 percent of
FPL. Individuals will also be able to disregard certain expenses and savings when determining

For more information, see

Nevada Changes Unearned Income Limit in Buy-In Program
When Nevada’s Medicaid Buy-In program, the Health Insurance for Work Advancement (HIWA)
program, was implemented in July 2004, the program included a limit on unearned income (a
maximum of $699 per month in 2007). This limit was found to be a barrier for individuals to
become eligible for the program. In an effort to improve enrollment in HIWA, state legislators,
during Nevada’s 2007 legislative session, approved recommendations to remove the HIWA
program’s unearned income limit criteria. This program enhancement takes affect on October 1,
2007. Program administrators have worked with the Division of Welfare and Supportive Services
(which is responsible for eligibility) to prepare for the change in eligibility criteria. Additionally, a
notification letter was sent to agencies throughout the state informing them about the change and
available training as well as the kick off date for applications of October 1, 2007.

For more information, see


Mathematica Releases Brief on DMIE
Mathematica Policy Research, Inc., has released the sixth issue brief in a series on workers with
disabilities entitled What Is the Demonstration to Maintain Independence and Employment
(DMIE) and Who Is Participating? This brief reviews the rationale for the DMIE, the interventions
in the four most recent DMIE states, the DMIE evaluation, and next steps in disseminating
information about the effects of these demonstration projects. The DMIE is testing whether new
ways to improve access to health care and employment services for workers with potentially
disabling health conditions can prolong employment and promote independence from federal
disability benefits. The DMIE interventions differ from state Medicaid Buy-In programs in that they
provide a more comprehensive set of services to workers with potentially disabling conditions
who are not receiving any federal disability benefits. Currently, four states are testing DMIE
interventions: Kansas, Minnesota, Texas, and Hawaii. The brief provides summary information on
each state intervention. The DMIE is being evaluated at the state and the national level using a
random assignment design. Beginning in the spring of 2008, Mathematica will produce annual
interim reports on the DMIE and, in 2010, Mathematica will submit a final report to the Centers for
Medicare and Medicaid Services on the national findings.

The brief is available at http://www.mathematica-

MIG-RATS Launch New Website
The Medicaid Infrastructure Grant Research Assistance to States (MIG-RATS) center has
launched a new website to provide resources and support to states implementing MIGs. The
website is designed to help MIG staff find useful research reports and resources, learn about
current MIG-RATS activities and initiatives, and connect with fellow MIG researchers. The
website includes information on a range of topics such as Medicaid Buy-In programs, outreach
and marketing, and youth in transition and also provides links to tools and a calendar of events.

Visit the MIG-RATS website at

Article Examines Long-Term Trajectories of Participants in Supported Employment
The article ―Long-Term Employment Trajectories Among Participants With Severe Mental Illness
in Supported Employment,‖ published in the July 2007 issue of Psychiatric Services, presents
findings from an exploratory study of 8- to 12-year employment trajectories among adults with
psychiatric disabilities who participated in supported employment. The researchers found that
study participants reported numerous benefits related to employment, including enhancements to
self-esteem, relationships, and illness management. Psychiatric illness was the major barrier to
work while part-time employment and long-term supports were the major facilitators. The
researchers conclude that the long-term trajectories of participants in supported employment
programs, both vocational and non-vocational, appear to be positive.

For more information, see

ICI Brief Highlights Value of Professional Networking
The Institute for Community Inclusion (ICI) has produced a brief entitled Increasing Placement
through Professional Networking that examines professional networking for job developers.
Professional networking is a strategy to improve employment outcomes for clients and involves
networking with fellow job placement professionals working at other provider agencies or for the
state. The brief presents guiding principles for peer networking groups including building trust, fair
play, and sustainability. The brief also highlights strategies for success such as developing
protocols for sharing job leads, creating a leadership team, and setting up a meeting schedule.

The brief is available online at

Shriver Center Provides Toolkit on State Asset Limits
The Sargent Shriver National Center on Poverty Law has developed the State Asset Limit Toolkit.
Many public benefit programs have asset policies that restrict eligibility to households with
minimal assets and thus discourage savings. The State Asset Limit Toolkit is for advocates and
policymakers who seek to reform state asset limits. The Toolkit includes administrative rules, bills,
laws, public comments, and other advocacy materials as well as official analysis, media
coverage, and information regarding the implementation and results of asset limit reform
organized by state and by program. The Toolkit currently covers the Temporary Assistance for
Needy Families, Food Stamps, Medicaid, and General Assistance programs.

The Toolkit is available at

Census Releases Data on Income, Poverty, and Health Coverage
The U.S. Census Bureau report Income, Poverty, and Health Insurance Coverage in the United
States: 2006, presents data on these areas based on information collected in the 2007 and earlier
Annual Social and Economic Supplements to the Current Population Survey. The data in this
report indicate the following:
     Real median household income increased between 2005 and 2006 for the second
         consecutive year.
     The poverty rate decreased between 2005 and 2006.
     The number of people with health insurance coverage increased between 2005 and
         2006, as did the number and the percentage of people without health insurance

However, these results were not uniform across demographic groups. For example, between
2005 and 2006, the poverty rate decreased for Hispanics but remained statistically unchanged for
non-Hispanic Whites, Blacks, and Asians. The percentage of people without health insurance
increased for Hispanics, decreased for Asians, and remained statistically unchanged for non-
Hispanic Whites and Blacks. The report provides more detail on these findings and includes a
variety of data tables.

The report is available online at

Survey Assesses Whether Buy-In Participants Would Work More if Social Security Rules
The University of Kansas Center for Research on Learning and the Kansas Health Policy
Authority have produced a policy brief entitled Will Medicaid Buy-In Participants Work and Earn
More if Social Security Rules Change? The brief reports findings of a survey of participants in the
Kansas Working Healthy Medicaid Buy-In to assess how many would likely increase their
employment and earnings under a gradual Social Security Disability Insurance offset program
and the characteristics of those who thought they would do so. Survey responses indicate that,
overall, one-fourth of the respondents would try to work and earn more if such an offset program
were available and another fourth maybe would do so. One-half said they would not change their
work efforts in response to the hypothetical program change. There were no significant
differences in responses with regard to age, gender, marital status, parental status, number of
hours worked per week, or hourly earnings of respondents. Within disability types, however,
people with mental illnesses were statistically more likely to say they would increase work and
earnings (32.9 percent) and people with chronic illnesses and sensory disabilities were least likely
to say that they would (12.7 percent and 11.1 percent). Based on the findings, the researchers
suggest that benefit offset programs coupled with existing Medicaid Buy-In programs have the
potential to increase employment and earnings for a substantial number of beneficiaries.

The policy brief is available at

Kaiser Produces Overview of Medicaid Rehabilitation Services Option
The Kaiser Commission on Medicaid and the Uninsured at the Kaiser Family Foundation has
published a policy brief entitled Medicaid’s Rehabilitation Services Option: Overview and Current
Policy Issues, a timely brief in light of proposed changes to this option. Currently, 47 states plus
the District of Columbia provide at least some type of mental health, substance abuse, and
physical health services under the rehab option. States can use the rehab option to provide a
variety of services, although a dominant way that states use the option is for the rehabilitation of
people with mental illness. Compared to other service categories, the rehab option offers states
unique flexibility in delivering services. According to the authors, the unique and important role of
the rehab option in nearly every state Medicaid program is not well understood. This brief
explores current policy issues that include both issues around how states are using the rehab
option and what changes are being considered.

To view the brief, please visit

Impact has Feature Issue on Disaster Preparedness and People with Disabilities
The Spring/Summer 2007 issue of Impact is dedicated to examining disaster preparedness and
people with disabilities. In many cases, the planning and processes in place to respond to
disasters and emergencies have not made adequate provision for people with disabilities. This
issue of Impact seeks to address the need for greater inclusion of people with disabilities in
disaster preparedness, response, and recovery efforts by providing strategies, stories, and
resources that will be of use to disability service providers, advocates, individuals with disabilities,
families, and policymakers.

The issue is available at

RSA Provides Memo on High School/High Tech Program
The Rehabilitation Services Administration (RSA) describes the High School/High Tech (HS/HT)
program for youth in transition in a recent information memorandum. The HS/HT Program is a
comprehensive transition program that uses a variety of activities and innovative approaches to
expose transition-age youth with disabilities (ages 14 to 24) to careers in science, technology,
engineering, and math and other technology-based professions. It also encourages such youth to
pursue postsecondary education and training. HS/HT programs are designed to reduce the
likelihood that young people with disabilities will drop out of school, increase their chances of
graduating from high school with a regular diploma, increase their participation in postsecondary
education, and improve their chances of getting and keeping a job after graduation. The memo
describes the key design features of the HS/HT program and highlights state examples.

For more information, see

FEMA Releases Guide to Accommodating People with Disabilities in Disasters
On August 21, the Department of Homeland Security's Federal Emergency Management Agency
(FEMA) released a new reference guide that outlines existing legal requirements and standards
relating to access for people with disabilities. A Reference Guide for Accommodating Individuals
with Disabilities in the Provision of Disaster Mass Care, Housing and Human Services is the first
of a series of disability-related guidelines to be produced by FEMA for disaster preparedness and
response planners and service providers at all levels. The Reference Guide summarizes equal
access requirements for people with disabilities within disaster mass care, housing, and human
services functions. The Guide explains how applicable Federal laws relate to government entities
and non-government, private sector and religious organizations.

The Guide is available at

Urban Publishes Report on Work and Mental Health Among Low-Income Mothers
An Urban Institute publication entitled Mental Health, Work, and Mental Health Service Use
among Low-Income Mothers reports on a study analyzing how mental health problems impede

low-income mothers' ability to work and how health insurance improves access to mental health
treatment services. According to data from the 2002 National Survey of America's Families, low-
income mothers in poor mental health are significantly less likely to work and to work full time
than those without these problems. Low-income mothers with public or private health insurance
are significantly more likely to receive treatment than those without insurance. The researchers
find that mental health problems are an important barrier to work among low-income women, and
access to treatment could be improved through increased health insurance coverage.

To access the report, please visit


Applications Available for 2008 Mobility Planning Services Institute
The Mobility Planning Services Institute (MPS) is a program of Easter Seals Project ACTION
(Accessible Community Transportation In Our Nation). The Institute is designed to help
community leaders work together to address barriers to effective, coordinated transportation for
individuals with disabilities. Local teams will develop an action plan and receive follow-up
technical assistance from MPS faculty and Project ACTION staff. The 2008 Mobility Planning
Services Institute will be held April 21-24 in Washington, D.C. Applications are due December 21,

For more information and the application, visit

2008 MIG/DMIE Employment Summit Call for Abstracts
The Centers for Medicare & Medicaid Services (CMS) and Ascellon are hosting the 2008
MIG/DMIE Employment Summit: Reducing Barriers by Melding Data and Policy in New Orleans,
Louisiana. They have issued a call for abstracts from Medicaid Infrastructure Grant (MIG) and
Demonstration to Maintain Independence and Employment (DMIE) grantees to be presented at
the Summit. CMS and Ascellon are asking states to submit an abstract about the activity,
strategy, or component of their MIG/DMIE program that has been effective and that they would
like to share with other states. Abstracts should describe techniques, methods, strategies,
practices or activities that have proven to lead to a desired result, based on research or
cumulative experience. Abstracts are due November 9, 2007.

For more information and guidelines, visit

AAPD Accepting Applications for 2008 Summer Internship Program
The Mitsubishi Electric America Foundation and the American Association of People with
Disabilities (AAPD) are offering, for the seventh consecutive summer, a congressional internship
program for undergraduate students with disabilities. The Mitsubishi Electric America
Foundation–AAPD Congressional Internship Program provides an opportunity for students with
disabilities to work on Capitol Hill for eight weeks and acquire valuable work experience that will
enrich their academic studies. As congressional interns, participants gain insight into
congressional office operations, public policy development, and constituents’ roles in the
legislative and political processes. The internship program, administered by AAPD, was created
in 2002 through a major grant from Mitsubishi Electric America Foundation. Applications must be
received by 5:00pm (Eastern Time) on Friday, December 14, 2007.

For further information, guidelines, and application, visit

ARRT Applications Available for Fiscal Year 2008
The U.S. Department of Education has issued a notice inviting applications for new awards for
fiscal year 2008 for Advanced Rehabilitation Research Training (ARRT) projects. The purpose of

ARRT is to provide research training and experience at an advanced level to individuals with
doctorates or similar advanced degrees who have clinical or other relevant experience. ARRT
projects train rehabilitation researchers, including individuals with disabilities, with particular
attention to research areas that support the implementation and objectives of the Rehabilitation
Act of 1973, as amended (Act), and that improve the effectiveness of services authorized under
the Act. Applications are due by October 26, 2007.

For more information, see


US Chamber Education and Workforce Summit
Join business, chamber, and education leaders from around the country. Get the latest
information on what is working in school reform. Engage in debates on cutting edge strategies to
keep American schools competitive.
October 4-6, 2007
The Fairmont Hotel
Dallas, Texas
For more information, please visit
10 Annual Accessing Higher Ground: Accessible Media, Web and Technology
Conference for Education, for Businesses, for Web and Media Designers
In collaboration with AHEAD, EASI, ATHEN and CSUN ATACP
November 6-9, 2007
University of Colorado-Boulder
For more information, please visit

AUCD Annual Meeting and Conference
“Tomorrow is Here Today: The Interrelationship of Research, Education, Service, and
November 10-14
Renaissance Washington Hotel
Washington, DC
For more information, please visit

National Association of State Medicaid Directors Fall Meeting
November 12-14, 2007
Hyatt Regency Washington on Capitol Hill
400 New Jersey Avenue, NW
Washington, DC 20001
For more information please visit

TASH Conference
TASH is an international membership association leading the way to inclusive communities
through research, education, and advocacy.
December 6 - 8, 2007
Washington State Convention and Trade Center
Sheraton Seattle Hotel & Tower
Seattle, Washington
For more information, please visit

5 International Conference on Positive Behavior Support
“The Expanding World of PBS: Science, Values, and Vision”
March 27-29, 2008
Hyatt Regency O’Hare
Chicago, IL
For more information, visit

2008 MIG/DMIE Employment Summit: Reducing Barriers by Melding Data and Policy
Hosted by CMS and Ascellon
April 22-24, 2008
Hotel Monteleone
New Orleans, Louisiana
For more information, visit

National ADA Symposium
Hosted by the Network of DBTAC-ADA Centers
May 12-14, 2008
America's Center
St. Louis, MO

                October is National Disability Employment Awareness Month

To recognize the contributions of Americans with disabilities and to encourage all citizens to
ensure equal opportunity in the workforce, Congress has designated October of each year as
National Disability Employment Awareness Month. ―Talent for a Winning Team!‖ is the official
theme for 2007. For more information, visit


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