Mig Tax Guide 2006

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2008 MIG Grant Application

Background Analysis

Current Infrastructure
Since 2001, when Iowa was awarded the first Medicaid Infrastructure Grant, Iowa has been

committed to building the infrastructure and systems needed to support people with disabilities

in competitive employment. For the last six years individuals with disabilities, advocates and

state agencies have worked together to enhance opportunities for Iowans with disabilities to

work and live in settings of their choice. The work has been focused on:

      Improving the Medicaid Employed Persons with Disabilities Program (MEPD), Iowa’s

       Medicaid Buy-In program

      Improving access to information about Iowa’s Medicaid Buy-in Program

      Developing, implementing and marketing Consumer Choice Options, Iowa’s self-

       direction option similar to Cash and Counseling, in six of Iowa’s Home and Community

       Based Services (HCBS) Waiver programs.

      Sponsoring various education and awareness events and activities to promote

       employment for people with disabilities and

      Developing community and state agency partnerships to address the policy changes that

       are needed to improve Iowa’s Medicaid Buy-in program and competitive employment

       opportunities for Iowans with disabilities.

Description of people with disabilities currently competitively employed

       Data on employment of people with disabilities varies quantitatively depending upon

which source is cited, but all sources agree that the difference between employment data for the

general population and those with disability status is significant. The Census Bureau reports a

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poverty rate of 7.7% for Iowans without disabilities, compared to a 12.3% for Iowans with

disabilities. The correlation between poverty, unemployment and disability, according to the

data provided by the U.S. Census Bureau, is also significant. In 2000, the Census Bureau reports

an overall 84% employment rate for Iowans without a disability, and a 63% employment rate

among Iowans with a disability. According to the 2000 Census, the State of Iowa has a

“working age population” (16 to 64) of 1,828,699. Of those individuals, 268,708 self-reported

they have a disability of some type. Social Security Administration (SSA) reports 95,320 Iowans

that receive disability benefits have been issued a “ticket to work”. In April of 2007 economic

developers in Iowa reported a low unemployment rate of 3.4%, which combined with growing

community industries, is an indicator that emphasizes the need to attract and generate a new

talented workforce through out the state.

       In March of 2000 the Medicaid Buy-in program, Medicaid for Employed People with

Disabilities (MEPD), was implemented. As of March 2007, 10,380 Iowans are accessing this

program, which allows Iowans to work and increase their earnings without fear of losing

Medicaid benefits. In order to participate in the eligibility group, an individual must be disabled

and have earned income from employment. Net countable family income must be less than

250% of the federal poverty level for the family size. Resource limits are $12,000 for an

individual and $13,000 for a couple. A sliding scale is offered for individuals that have a gross

income above 150% of the federal poverty level. The average monthly premium paid by clients

using MEPD is $45 dollars. Approximately 14% have increased their total earnings from the

previous year; 68% stayed the same and 20% experienced a decrease in earnings. Participants

report 85% are self-employed working non-skilled jobs while 3.2% are working skilled self

employed jobs. The remaining 12.8 % are working skilled and non-skilled jobs in traditional

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employment settings. The majority (94.2%) of MEPD members in 2005 are satisfied or very

satisfied with the program. They perceive the benefits of the program are affordability and

financial support of MEPD that allows and encourages them to work. Survey results show

97.1% would recommend the MEPD program to other people with disabilities.

       Iowa has several programs working to remove employment barriers for individuals with

disabilities. Promise Jobs recently added disability specialists to assist any applicants with self-

report indicators that imply they may have disabilities such as difficulty reading or difficulty

keeping employment in the past. The disability specialist works with the applicant to begin a

comprehensive assessment process and develop an individualized training and support plan

before they utilize all of the time-limited assistance through Promise Jobs. Iowa’s Work

Incentive Planning and Assistance (WIPA) grant has disability navigators to assist individuals

with disabilities in accessing the variety of supports needed to help them achieve and sustain

employment. Iowa’s current MIG grant has provided benefit trainings to these disability


Current efforts to remove barriers to employment

       Leaders of seven state agencies developed a collaborative employment-related

partnership called the Governance Group. The seven agencies are the Iowa Governor's

Developmental Disabilities Council, Iowa Department of Human Services, (Medicaid, Mental

Health and Disability Services, and TANF), Iowa Vocational Rehabilitation, Iowa Department

For The Blind, Iowa Workforce Development, Iowa Department of Human Rights/Division for

Persons with Disabilities, and Iowa Department of Education. In 2003 the Governance Group

developed a Memorandum of Agreement (MOA) to support a collaborative service design to

improve employment outcomes for individuals with disabilities. The organizing document for

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this group and the MOA are attached in Appendix 2 and Appendix 2. The state agency partners

agree to support all their local offices in adopting the MOA objective and strategies to improve

employment outcomes and increase employment for Iowans with disabilities through state and

local collaboration. Iowa’s Governance Group has the benefit of data collected from hundreds of

focus groups conducted with Iowans with Disabilities, Iowa businesses throughout the state, and

staff within Iowa’s employment service programs. The data is used to assist in developing an

employment system that reduces barriers for individuals with disabilities seeking employment

opportunities. This group continues to address statewide barriers identified for Iowa’s job

seekers with disabilities.

       In 2003, The Governance Group was awarded two grants through the Department of

Labor. One is a youth transition initiative supported through the Office of Disability

Employment Policy (ODEP), and the other made Iowa one of the initial 17 states implementing

the navigator program.

       The Governance Group also collaborated on a successful Work Incentive Planning and

Assistance (WIPA) Project grant awarded in the fall of 2006. The grant employs two

Community Work Incentive Counselors (CWICs) who provide training and support to Benefits

Liaisons around the state. The networks developed and utilized by Benefits Liaisons and CWICs

have increased the ability to provide statewide quality benefits planning services to Iowans with

disabilities. The Governance Group has been supporting the development of Regional Workforce

Investment Boards (RWIB) to help rural areas create Employment Networks, under the Ticket to

Work Act. In early 2007, two Iowa RWIBs became Employment Networks, and through

planning with the other state agencies, Iowa Workforce Development is submitting an

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application to become an Employment Network on behalf of all Iowa RWIBs who would like to


        Iowa’s Centers for Independent Living (CILs) helped develop training materials about

benefits planning and self-direction in Medicaid services. The CILs implemented several

outreach activities to raise the awareness and interest in developing these supports within Iowa’s

employment services system that will be helpful as Iowa’s HCBS self-direction option is fully

implemented. A Robert Wood Johnson grant provided the resources needed for Iowa to develop

a self-direction option, called Consumer Choices Option (CCO) within six of the Medicaid

Home and Community Based Waivers. CCO began its roll out process in January of 2007 and

will be available statewide in July 2007. Consumer Choices Option consumers can choose to

“cash out” their HCBS waiver dollars and self direct the services and supports they need for

increased self-sufficiency. Consumer Choices Option program description and Consumer

Manual are attached in Appendix 3 and Appendix 4.

        In 2006, the Legislature re-established and funded the Division of Mental Health and

Disability Services within Department of Human Services. A similar division had been abolished

during the State’s fiscal crisis in the early 1990s. The Division will continue to help raise the

visibility of disability issues, improve coordination in policy development and program

administration and establish statewide consumer outcomes to be tracked including the numbers

of people with mental health or disability diagnosis able to maintain or achieve employment.

        Under the 2006 Real Choices Systems Transformation grants, the Iowa Medicaid

Enterprise will be implementing a transportation brokerage to offer flexible transportation

services and reimbursement methodologies that promote community inclusion and the

opportunities to become more financially independent. Transportation is a critical key to

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promoting access to successful employment and the transportation brokerage should provide the

flexibility needed to help individuals with disabilities accept employment offers during first,

second and third shift thought out many communities not just in urban areas of the state.

       In January 2007 Iowa received a Money Follows the Person Grant from CMS. This grant

will transition 528 individuals living in Intermediate Care Facilities for the Mentally Retarded

level of care (ICF/MR) settings into community settings of their choice. There is a

subcommittee working on defining how to address the employment interests and needs of these

528 individuals. Each of these individuals and their family members will learn how Consumer

Choices Option and other state or federal support services can be used to help them attain

competitive employment.

       With support from Iowa’s Aging and Disability Resource Center (ADRC) and Real

Choices Systems Change grants, Iowa COMPASS, (the State’s disability Information and

Referral service), will be augmented and enhanced with interactive software to help consumers

locate information and resources tailored to their location and personal circumstances. The

information enhancements will include benefits planning and MEPD information and resources.

Consumers will be able to store a personal profile and use an electronic process to access

services without repetitive data entry. Training in the use of the system will be available to

providers in addition to a web-based tutorial for individuals that want to explore their options


Description of services provided to people with disabilities who are employed or seeking


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State of Iowa Funded Services

       The In-Home Health Related Care (IHHRC) program, available statewide, provides

individualized healthcare services in the home to prevent out of home placement, and to preserve

independence in self-care. In order to be eligible, an individual must require health care because

of mental or physical challenges. An individual may use the IHHRC program to assist in getting

ready for work.

       The Iowa Finance Authority operates a rent subsidy program, which is available for those

eligible for HCBS waiver services while they are on the waiting list for subsidized housing. This

monthly rent assistance allows people to live and work successfully and maintain a home in the

community of their choice.

        Collaboration between the Department of Human Service’s Temparary Assistance for

Needy Families project under the Family Investment Program and Iowa Workforce Development

(IWD) Promise Jobs program created and funded eight Disability Specialists Positions in 2006.

Based on results of a pilot project conducted in 2003, the Promise Jobs Disability Specialists

now use a screening tool with participants to identify previously unreported or undiagnosed

disabilities. Those with identified problems are referred to Iowa Vocational Rehabilitation

Services and linked with local resources and services. Results of the pilot showed that these

participants were three times more likely to become employed as those in a comparison group.

The Promise Jobs Disability Specialists are in place in eight of the IWD service areas and

provide service to identify the existence of disability, and to link to services that accommodate

the person.

Medicaid Funded Services

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        Iowa Medicaid programs offer a variety of services to support individuals who are

competitively employed or those seeking competitive employment. Available to Iowans are

seven federally approved 1915(c) HCBS waiver programs serving over 22,000 individuals. The

HCBS waiver programs provide funding for individualized supports to maintain eligible

consumers in their own homes and communities who would otherwise require care in a medical

institution. Each HCBS program is available statewide and offers a variety of service options to

support the needs of the target population served. HCBS Waiver consumers are eligible for

Medicaid under the work incentives of Iowa’s buy-in coverage group (MEPD).

        Following are descriptions of the HCBS services available that specifically provide

support services to consumers who are employed or seeking employment:

        Consumer Directed Attendant Care provides personal assistance to the consumer with

self-care tasks.

        Supported Employment offers instruction, supervision and assistance associated with

attaining and maintaining paid employment.

        Prevocational Services: services to prepare a consumer for paid or unpaid employment

        Transportation: provides transportation services for consumers to conduct business

errands, essential shopping, to receive medical services, to travel to and from work or day

programs, and to reduce social isolation

        Supported Community Living: services designed to assist the consumer with daily

living needs, including, care services to assist individual to get ready for their workday.

        Home and Vehicle Modification: includes the purchase, installation or modification to a

consumer’s home and/or vehicle.

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        Assistive Devices or Specialized Medical Equipment: provide practical equipment

products needed to assist consumers with activities of daily living (ADL) and instrumental

activities of daily living (IADL).

        The Iowa Medicaid program offers Home Health Aide and Nursing services under both

HCBS waiver programs and as state plan service benefits. Homemaker services are available

through HCBS. The services can provide assistance and necessary cares to an individual to get

ready for their workday.

        The Habilitation Services Program is Iowa’s new HCBS State Plan Service available

statewide to individuals with chronic mental illness. As a result of the Deficit Reduction Act of

2005, Iowa was the first in the nation to be approved for any state plan HCBS service, which was

effective January 1, 2007. This new program provides pre-vocational and supported employment

services. There are 681 persons currently enrolled, and 138 are utilizing the pre-vocational and

supported employment benefits.

        Iowa received a Money Follows the Person grant in 2006. This program focuses on

moving residents of Iowa ICF/MR facilities into community setting. As the infrastructure

develops for this program, community based employment and supports are among the primary

needs identified.

        Currently Iowa is finalizing plans for a Demonstration to Maintain Independence and

Employment (DMIE) Project. This demonstration grant will focus on persons with a mental

illness diagnosis who are being released from prison. Employment and related supports are a

pivotal piece in this project.

Description of personal assistance services delivery systems currently in place

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       Iowa Medicaid offers services that include personal assistance supports in all seven

HCBS waiver programs. Each HCBS waiver serves a specified target population.

AIDS/HIV (46)           Elderly (8537)                 Physical Disability (670)

Brain Injury (849)      Ill & Handicapped (2350)       Mental Retardation (9798)

                                                       Children’s Mental Health (279)

                                                       Does not have CDAC or CCO

       Personal care services at home or in the workplace are available under supported

community living (3846 consumers), consumer-directed attendant care (5416 consumers),

supported employment (1652 consumers), home health aide (89 consumers) and homemaker

(4081 consumers).

       Individuals using supported community living (SCL) services through HCBS waivers can

get personal assistance with ADLs and IADLs for at least 40 hours per week. Consumers using

Iowa’s self direction option of CCO have control to develop their individual budget designed to

meet their needs. This budget may include directly hiring employees and/or purchasing other

goods and services to assist them in their home and work settings. They have the flexibility to

hire individuals from a traditional Medicaid provider or an individual they employ and train to

address their personal assistance needs. Consumers will have the opportunity to build their

budget to cover the direct personal care services in their home to get ready for work as well as

during the workday in their employment setting. Consumer Choices Option will allow more

creative discussions and support options than those accessed through the traditional service

model, as the person builds their personalized plan. It is anticipated that 10-15% of Iowa’s

22,000 HCBS wavier recipients will use this option. It is anticipated that the increased flexibility

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of an individualized budget will increase the individual’s ability to access and utilize personal

assistance supports during their workday within a traditional work setting.

Strengths and Weaknesses of Iowa’s capacity to support people with disabilities working:


   MEPD - Having an existing Medicaid Buy- In option is a distinct advantage. Iowa is

committed to making policy improvements that enhance opportunities for individuals with

disabilities to earn a sustainable living through self- employment or traditional employer settings.

   MEPD Advisory Committee – Established to assist in the implementation of the buy-in

program, this committee meets monthly to provide input into the MEDP program, the participant

survey, and resulting program change possibilities. Members of this group are largely current

and former MEPD participants. There are a variety of success stories among the members and

they provide the participants eye view of program operations, issues and results. Most recently

we have had the parents of an MEPD member who have been on the committee for some time

tell the story of their child obtaining competitive employment and looking toward financial

resource accumulation under the provision of MEPD. We recently lost a long-term committee

member and MEPD participant who obtained her graduate degree and is now fully employed and

off benefits. She resigned from the committee in order to meet her employment obligations.

       Governance Group – This collaboration among seven state agencies has increased

opportunities to assist individuals with disabilities in locating employment supports and

understand benefit-planning options when they are employed. In 2006, “Disability Employment

Specialist” positions were created within Iowa’s TANF program, capitalizing on the lessons

learned and implementing them within Iowa’s Workforce Center systems. The Governance

Group collaboration resulted in a web-based service for employers “Employment Disability

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Resource Network” (EDRN), which will be available this summer. The EDRN is designed to

provide businesses with information regarding employment of Iowans with disabilities in a

single location. Focus groups and research demonstrate that this approach is desired by Iowa’s

businesses. The Governance Group includes a “Support Team”. This team is active in meeting

with community employment partners and is an integral component of Iowa’s strategy to assure

that the various initiatives within our state are connected and compliment each other working

effectively in helping Iowa’s communities offer employment opportunities and services for

people with disabilities.

       Olmstead Consumer Task Force, In 2003 Iowa Governor Thomas Vilsack signed

Executive Order 27 calling for the swift implementation of Olmstead in Iowa. The task force

provides a consumer and state agency forum to address the barriers to community living for

persons with disabilities in Iowa. In the fall of 2006, the Task Force hosted a State Agency

Public Policy Summit. The purpose of the summit was to identify barriers to community living

as they exist in policy and practice among and within the state agencies and service programs.

While the summit report is not been finalized, there can be little doubt the issues of healthcare,

employment, financial resources and system complexity will be included.

       The Habilitation Services Program is Iowa’s new HCBS State Plan Service available

statewide to individuals with chronic mental illness. As a result of the Deficit Reduction Act of

2005, Iowa was the first in the nation to be approved for this state plan HCBS service, which was

effective January 1, 2007. This new program provides pre-vocational and supported employment

services not previously available in this coverage group. There are 681 persons currently enrolled

and 135 are utilizing the pre-voc or the supported employment benefits.

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       Mental Health and Disability Services Division was recently reestablished within DHS

provides direct coordination of the services and supports relating to employment needed by this

population. The recent survey of MEPD members shows 23.9% of members reporting a mental

health problem as their primary disability. Both the head of Consumer Advocacy and the Bureau

Chief of Adult Services serve on the MEPD Advisory Committee

         Iowa’s seven HCBS waiver programs serve over 22,000 consumers and offer services

that help support people within their homes and work settings. The recent addition of Consumer

Choices Options in all of these waivers increases the flexibility for more people with disabilities

to access personals support services within their work settings.

        Synergy of various initiatives that share common directions and common goals –

Iowa is fortunate to have many efforts underway which share the common goals of supporting

persons with disabilities in efforts to live and work in the communities of their choice. The

projects and programs are working in a coordinated way to meet the needs for the wide variety of

services required to promote independence. As a result, Iowa is making significant progress in

enhancing community supports and developing the service networks needed by persons with

disabilities. These range from the transportation improvements of the Real Choices grant to the

self direction opportunities provided by Consumer Choices Option. The newest of these

projects, Money Follows the Person and Demonstration to Maintain Independence and

Employment, provide the opportunity for dramatic changes in the delivery of Medicaid and long

term care services for long underserved populations. Iowa MIG grant programs with the

emphasis on the Medicaid infrastructure and improving employment and earnings can “connect

the dots” as these programs work to enhance competitive employment opportunities.

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       Low earning levels among MEPD members and others with disabilities will be a focus

for improvement in the coming year. The average monthly-earned income for MEPD

participants is $179 as of year-end 2006. While, obtaining earned income data for other Medicaid

members with a disability is challenging, it is estimated to be a similarly low number.

        Lack of State Plan Personal Assistance Services may be a barrier for disabled adults

who want to work While Personal Assistance Services in the workplace are available across the

state, funding for these services comes through a variety of delivery systems This adds to an

already confusing and complex system for consumers and service workers alike.

       Iowans with disabilities are confused or unaware of services available to them.

People with disabilities express confusion due to the many programs and projects providing

employment supports and the diversity in funding sources and eligibility requirements it is no

wonder persons with disabilities expression confusion. In the consumer workshops conducted so

far many have expressed their surprise at how much they can earn by working. This is

particularly true of those with SSDI benefits and those applying for SSI in order to receive

medical benefits.

        Limited funding for Benefits Planning Services - Under the Iowa WIPA grant

funding is available for two Certified Work Incentive Coordinators (CWICs) to serve the entire

state. There are many creative ideas being implemented to make the service available, such as

trainings of Benefits Liaisons, who can inform consumers of these incentives, and the use of web

based services for meeting and communications. Regardless there remains a need for benefits

planning services for consumers who want to go to work.

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       Confusion among the business sector on employment systems and services for

persons with disabilities – Businesses have expressed frustration over the lack of consistent and

coordinated information on the services and supports available for the employment of persons

with disabilities. This issue becomes more and more pressing as it collides with the workforce

availability issues Iowa is facing.

       Staff in many offices of Iowa employment service agencies lack experience in

including Iowa job seekers with disabilities in their employment services – While many

efforts to inform and train employment service staff statewide have occurred, there are many

employment services providers who are not aware of or trained in the use of the work incentives

and employment supports available for the placement of persons with disabilities in competitive

jobs in communities across the state.

        Waiting Lists for HCBS Services - There are caps on the number of people served in

each of the seven waivers. These caps are imposed, as well as limits placed on the type and

amount of services to be available, out of concern that excessive demand will raise the Medicaid

budget to unsustainable levels.

       Service limits within the waivers vary in Iowa - The annual cap for home and vehicle

modifications is not consistent between all of the HCBS waivers. For example the Mental

Retardation (MR) waiver has a $5,000 life time limit and the Ill and Handicapped (IH) waiver

and Brain Injury (BI)) waivers allow an annual $6,000. While these services do provide

flexibility to provide assistive devices for use in the workplace, the discrepancy in the limits

causes confusion.

       Ill and Handicapped Waiver consumers’ inability to maximize opportunities for

Plan for Achieving Self Support (PASS) as adults - Eligibility requirements for the Ill and

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Handicapped Waiver include an exclusion for adults over the age of 18 who are eligible for

Supplemental Security Income (SSI) benefits. However, there is an exception to this policy to

allow for continued SSI benefits for those who are age 18-25 and already covered under the

waiver. A person must be SSI eligible to utilize the Social Security work incentive, Plan for

Achieving Self-Support (PASS). Under the Ill and Handicapped Waiver coverage group, an

individual may have an SSI-related PASS plan to help pay for a work or vocational goal only up

to age 26. This means an individual who has reached age 26 would not be able remain on the Ill

and Handicapped Waiver and access a PASS at the same time.

       Availability of Data: Most of Iowa’s tracking systems are limited by programs that do

not allow them to integrate information effectively with other systems, and allow us to capture

the picture of “whole” communities. We are currently looking at “snapshots” of data from

different systems at the state level, from the employment standpoint, and will increase this

representation to include other systems as well.

Current Economic Landscape

       Iowa is a small state with low population density, deep rural traditions, and small

metropolitan regions. About 89% of Iowa’s land mass is dedicated to agriculture. Thanks

largely to the skyrocketing growth of the Renewable Fuels industry, (in 2006, Iowa ranked first

in the United States in production of Ethanol), Iowa has the nation’s third highest total cash

receipts from farm commodities- a large pool of money for agriculture and biotechnology

capitalization for growth. Conversely, Iowa’s aging workforce population is increasingly

moving from farm to urban areas, creating skilled labor shortages and a grim horizon of potential

business loss due to lack of qualified talent equally distributed throughout the state.

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       For a state its size, Iowa maintains a large per capita percentage of workers in

manufacturing. According to Census data, nearly 20% of Iowa workers are in some form of

manufacturing. This manufacturing workforce has a high percentage of workers with a high

school education, (6.1% higher than the national average), and many with some form of post-

secondary education. Business growth and attraction in Iowa are difficult not because of

declining population, (the state is actually growing at a slow 1.5% annually), but rather due to a

low unemployment rate and a shortage of skilled mobile workers, especially among the highly

educated talent needed for Iowa’s top wealth generating industries. Companies are skittish about

business growth in Iowa due to perceptions that the state cannot meet their workforce needs.

        As of March 2004, Iowa had over 82,000 employers employing nearly 1.4 million

persons. Seventy seven thousand of those employers have fewer than 50 employees and

represent 528,000 of the total employment. The leading industry in terms of number of

employees is manufacturing, Retail trade, and Health care & social assistance nearly tied for

second. These three industries represent about half of Iowa’s employment. Another one fourth

of the employment is in Education and Hospitality industries. The remaining one fourth includes

Finance and Insurance, Public Administration, Construction. Wholesale trades and

Administrative Support. Appendix 5 contains graphic descriptions of this information.

       In 2004, The Iowa Department of Economic Development contracted the Battelle

Memorial Institute, a globally recognized consulting firm, to perform a set of studies on the

future of Iowa business, technology and workforce issues. Recommendations’ stemming from

the Battelle’s needs assessments for Iowa include the following suggestions that enhance

employment opportunities for individuals with disabilities.

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       Provide continued support for ongoing initiatives aimed at enhancing workforce

       diversity in Iowa

      Enhance staffing and resources to supporting early stage entrepreneurs and to provide


       In addition, the Iowa General Assembly has charged the Iowa Department of

Management with creating a 5-year plan to address Iowa’s workforce development needs. Iowa

will have between 150,000 and 200,000 more jobs than workers by 2012, (from the Iowa Works

Campaign, 2006). Over half of the jobs will require education beyond high school. That portion

of the labor market that requires a higher level of education will produce the most

sustainable base for careers with a living wage for families. It is critical for Iowa to have an

inclusive, comprehensive, and multi-channel strategy recruit, retain, and retrain every Iowan who

desires to work. The implementation committee for the 2012 Task force, will work to address

the following:

      Identify solutions to achieve data integration and common assessment tools to be used by

       Iowa Workforce Development, the Iowa Department of Economic Development, and the

       Iowa Department of Education

      Methodologies to ensure maximum participation in the workforce by targeted


      Identify best practices in recruiting new workers to Iowa’s economy

       The U.S. Department of Labor has published the findings of a study showing that 80

percent of the fastest-growing jobs in the United States require some postsecondary

education. Unfortunately, there is a much higher percentage of Iowans

needing special assistance who do not have any post-secondary education, leaving a critical

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cohort of the population unable to participate in the economy. It is important that the

collaborative efforts of Iowa state agencies working to include Iowans with disabilities in

targeted services make our best effort to expand on the promising practices identified in earlier

initiatives so that we can include every Iowan who desires to work, including those with


Use of Grant Funds

     Iowa specifically wants to achieve the following four goals:

1) Improve the administrative infrastructure of Iowa’s Buy-In, Medicaid for Employed People

with Disabilities program (MEPD);

2) Improve other Medicaid Services that support employment; 3) Promote and enhance

linkages between Medicaid and other employment-related services; and 4) Investigate financial

planning and saving issues, attitudes and roadblocks to increased self-sufficiency within the

community of persons with disabilities, using the data to inform policy and practice.

        The basic need for health care is paramount and Iowa recognizes that need, as well as the

need to cross systemic and attitudinal barriers to improve successes by persons with disabilities

in working and living in an integrated community setting. Over the past grant years we have

been successful in developing and strengthening collaborations and partnerships with the

agencies and entities working with all types of supports and services for people with disabilities

in their efforts to obtain and improve employment as well as increase self-sufficiency and

inclusion in their communities. During this grant cycle these efforts will be built upon and

further strengthened and new ones forged. Iowa MIG also recognized the need to partner and

collaborate verses duplicate the many efforts being undertaken in providing services in the area

of employment services and supports for persons with disabilities. Many of these efforts

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represent federal and state initiatives as well as local service efforts, and are described in the

background section of this narrative. This is done in such a way that the complementary and non-

duplicative nature of our systems change and infrastructure development initiatives are clear as

we all work at increasing and enhancing employment options for persons with disabilities.

A. Removal of Barriers

   In March 2000, the Iowa Medicaid Buy-in coverage group, “Medicaid for Employed People

with Disabilities” (MEPD), was implemented under the provisions of the Balance Budget Act of

1997. The intent of the program was to allow individuals with disabilities the opportunity to

increase their self-sufficiency by earning a substantial income without jeopardizing their

eligibility for Medicaid coverage. There are currently over 10,000 Iowans enrolled in the MEPD

program. Specifically, the four goals of the program are:

              Allow people with a disability to work and still retain Medicaid;

              Move people with a disability from non-work to work status;

              Increase the number of hours people with a disability are working;

              Increase the earned income of people with a disability

   Medicaid for Employed People with Disabilities, (MEPD) participant members represent

15.7% of Medicaid members with a disability. While MEPD is a significant piece in meeting the

increased employment and earnings goals of MIG Infrastructure work, there are other Medicaid

populations with disabilities who can benefit from efforts to increase earned income and thereby

increase self-sufficiency. Iowa has therefore elected to expand efforts to impact the earned

income of all Medicaid members with disabilities.

    The average monthly-earned income for MEPD participants is $179 as of year-end 2006.

While, obtaining earned income data for other Medicaid members with a disability is

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challenging, it is estimated to be a similarly low number. In 2007, Iowa passed an increase to the

state minimum wage from $5.15 to $6.25 per hour with an increase to $7.25 per hour effective

Jan. 7, 2008. While the new minimum wage will impact earnings figures, this low earnings level

is a significant barrier to self-sufficiency and financial security.

    Iowans with disabilities are not widely aware of self –employment options. MIG has

supported six self-employment seminars around the state with four more planned for 2007. These

seminars provide both small group and individual assistance in the planning necessary to set a

small business. Increased follow-up and support for those who are really ready to go with a

business is being incorporated into the 2007 sessions. These seminars have been popular and

several success stories have been highlighted in our newsletters. (See Appendix 6) Continued

self-employment seminars and outreach to Iowans with disabilities plus information and training

on self-employment options designed for service and support professionals is needed. This will

provide integration of resources available to support Iowans pursuing self-employment on an

ongoing basis into the network of resources already in existence.

Iowa has conducted an annual survey of MEPD members beginning in 2004. The information

gathered has been used to guide the efforts of the Department of Human Services in program

administration and customer service improvements. Concerns of members voiced in the survey

include: paperwork for initial eligibility and re-determination of eligibility, premium

determination and payment timing issues, and lack of full understanding of the program.

    Additionally, program procedures as originally written in the Code of Iowa and the Iowa

Administrative Code have proven to be cumbersome to the members. Efforts to address these

issues and improve efficiency and effectiveness have begun in the 2007 grant year and will

continue with the 2008 cycle. For instance, we are requesting an amendment of the

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administrative rules to reduce changes to the global premium rate setting to occur only once per

year. The amendment will combine the premium rate adjustments based on comparable health

insurance cost for state employees with the annual adjustment in the federal poverty level which

have occurred separately until now. Another requested amendment would allow an automatic

reinstatement to the MEPD coverage group when an assessed premium is paid no later than the

end of the month following the month the premium was to cover. In addition, we are researching

the options for electronic fund transfer (EFT) for premium payments based on requests from

MEPD members to make this an option for premium payments.

   The gathering and reporting of MEPD program results and interactions with other programs

has been a challenge. The emphasis on outcome measures and the length of the feedback loop

for reported data such as the finder file and premiums files has resulted in the recognitions of the

challenges in gathering and reporting objectively measurable outcomes. Iowa program staff has

developed methods to select and gather objective data regarding member characteristics,

earnings, premiums and program participation in the Medicaid Data Warehouse. Staff continues

to research methods to record and track work intensity, health outcomes and use of supportive

programs from other agencies. It is important to this process to both produce meaningful data

over time, and to avoid the “paralysis of analysis”. Efforts continue to explore further

automation of data sources and data gathering to every extent possible.

       Just as most of the programs and services directed to assist persons with disabilities have

complexity as their middle name, the MEPD program is not exempt. In order for MEPD

members to take full advantage of the potential for increased earnings and financial security,

staff are providing opportunities for members to learn how the MEPD coverage group allows for

substantial financial resources and higher earnings through workshops and newsletter articles.

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Networking with service workers within the Department and support service providers in other

agencies led to more intensive outreach about the benefits of participation in the MEPD coverage

group. Iowa staff continues to promote an information campaign aimed at MEPD members.

However, the current web-based material is disjointed. MEPD and employment efforts of MIG

do not present and unified face to the public or to service providers. Staff has plans to improve

web-based access to information and coordinate and link to other sites yet this year. Department

local office workers and service support workers from other agencies continue to provide

education on the MEPD program guidelines on earnings and asset accumulation. In the future,

staff plans to provide education on how income and assets are used for eligibility for other

assistance programs such as Food Assistance, housing and transportation supports.

       Iowa lacks the State Plan Service providing personal assistance in the workplace. While

this need is addressed within various Medicaid Services and Waiver programs providing

personal care and these programs can provide these services in the workplace, the state Plan

Amendment opportunities provided by the DRA would directly provide the service. The concept

of workplace personal assistance fits well with all other efforts to improve competitive

employment outcomes and the provisions of the DRA may make it possible for Iowa to cap off

the Medicaid employment supports with Workplace Personal Assistance.

       With the implementation of Consumer Choices Option Iowans have the opportunity to

customize their Waiver supports and services to meet their individual needs. Many of these

relate to obtaining and maintaining employment. As CCO moves forward, consumers need

information and training on the ways they can customize their own program. As these

consumers use this option they may very well use the new flexibility to come up with creative

way to meet their needs. Iowa needs to continue and expand efforts to gather and provide

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information regarding the uses of these dollars as they impact individual lives. MIG funds will

support the recruiting of MEPD and other Medicaid beneficiaries to become Independent

Support Brokers and service workers for Waiver consumers choosing CCO. The CCO program

and its consumers will need personnel to provide the Independent Support Broker service to

provide personal services. These needs can be at least partially met by other persons with

disabilities, providing both the workers to meet the needs of Medicaid members and employment

opportunity for other Medicaid members to work.

       Another barrier to the ideal operation of the Medicaid waiver services is the inconsistent

service limits within the waivers as they relate to Home and Vehicle Modifications and the

conflict between the use of the SSA PASS work incentive and the Ill and Handicapped waiver.

MIG funding will be used to address these issues through exploring and implementing

administrative or policy changes to the waivers to eliminate these incongruities.

       A major barrier to employers in furthering their efforts to employ persons with

disabilities is the many projects and programs they must sort through and access in order to make

the necessary accommodations and utilize the many services available. MIG will address this

through the support of the Governance Group in its implementation of the web-based EDRN. In

focus group sessions with Iowa employers conducted by the Governance Group, it was

determined that this is a desirable tool and method to provide consistent information and

assistance to employers in the recruiting and hiring efforts they are making. Along the same

lines, Iowans with disabilities continue to express confusion about services and supports

available to them. Iowa MIG produces a newsletter and will be produce informational material

to address the gap in information and continually inform the consumers of available resources.

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These efforts will be continuous and take the form of workshops in addition to published


       Staff in employment service agencies continue to ask for information and training in

effectively providing services aimed at the competitive employment of persons with disabilities.

Many are not well informed of the use of work incentives, self-employment options and assistive

technology innovations. As these issues are complex, individualized and ever changing, MIG

efforts to inform these employment service agency staff through job developer training, work

incentive information and assistive technology resources are instrumental in improving the

effectiveness of these services for persons with disabilities.

       Iowa MIG activities prioritize increasing self sufficiency and financial security of person

with disabilities with main activities focused on employment. At the same time, with increases

in earnings and capacity for earnings comes increased needs for financial services and

knowledge as well as continuing public funded services in a way which allows and provides

incentive for continuing the move out of poverty.

   Experience gained from discussions with the asset building community: banks, credit unions,

IDA providers, micro enterprise lenders, and financial education program leaders, there is a lack

of understanding about how to market and outreach to the disability community and a need to

learn more about products and services that would be responsive to this target population. For

persons with disabilities, disability-related organizations, and government agencies that provide

supports and services, there is limited understanding of tools and strategies that are now helping

millions of working age low-income families improve their economic status. There has been

limited interaction and relationship building between the two communities.

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    Based on national samples, University of Iowa Law, Health Policy and Disability Center’s

(LHPDC) groundbreaking work with the National Organization on Disability (Schmeling,

Schartz, Morris and Blanck, 2006) has found that individuals with disabilities are more likely to

be asset poor, have fewer relationships with financial institutions, and be less likely to have

savings accounts, own stocks and bonds, or hold IDAs than their non-disabled peers.

Furthermore, individuals without disabilities are less likely to utilize the home mortgage tax

deduction than their non-disabled peers, despite reporting similar rates of home ownership.

Although limited national research is available, it is unknown how Iowans with disabilities fare

compared to the national sample.

    Iowa intends to conduct research on financial planning and saving issues, attitudes and

roadblocks to increased self-sufficiency within the community of persons with disabilities. With

the 2007 MIG funding, we are partnering with the LHPDC to conduct a detailed survey of

Iowa’s Medicaid beneficiaries with disabilities on experiences with, attitudes about and barriers

to improved financial security by the end of December 2007. Information from the survey will

be used to design focus group research across the state to validate the results and plan outreach

and programming to address the identified barriers. The results of these research activities will

be used to inform policy makers and financial service providers at the state and local levels about

barriers to and ways to improve financial security for individuals with disabilities across the


         Iowa Medicaid through the Consumer Choices Option has an agreement for fiscal

management services through Veridian Credit Union. Veridian has committed to serving Iowans

with disabilities statewide with products, services and opportunities. With data from the research

and the experiences with the Consumer Choices Option, MIG funds will be used to support this

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partnership, expand it to additional financial service providers around the state and to address the

menu of services offered and inform the efforts to serve persons with disabilities in ways they

want to be served.

       Iowans, like many across the country fail to take full advantage of the Earned Income

Tax Credit. In many cases person with disabilities and low levels of earned income are not

required to file a tax return and therefore do not claim the credit. Lack of knowledge of the

”refundable” nature of this credit results in these individuals are leaving this money on the table.

       Support the free tax preparation programs across Iowa through marketing and training

materials. As young people with disabilities transition from youth to adult support services the

time is right to inform and encourage the natural instincts to be independent. At the same time, it

is natural for families to be protective and particularly concerned due to the sometimes extensive

and expensive support needs of the young person. Providing accurate information at the time

and place it is most useful for these families is something MIG plans to address

B. Health Systems Change

       The possible implementation of State Plan Personal Assistance services would greatly

impact the health system in Iowa, providing this unified service under the state plan would

impact many of related effort going on in the state. The program improvements to the

administrative infrastructure discussed above will impact overall Medicaid service utilization in

several ways; 1) decreasing the Medicaid cancellation rate for nonpayment of the buy-in

premium, the continuity of medical care will improve; 2) implementing electronic payments for

consumers will provide greater convenience and has potential to impact other Medicaid services;

3) data gathering and reporting capacity will impact Medicaid and other support services widely;

and 4) improved understanding of MEPD will impact participation levels as well as coordination

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of related services. Upgrades in the HCBS waivers and the continued refinements in CCO will

offer the consumers the flexibility to appropriately use resources available. By providing services

and information for persons with disabilities to maximize their own resources and to more

effectively manage them, they will have increased capacity to improve health outcomes and

appropriately utilize health care supports.

C. Communication/Access Plan

       Iowa MIG will communicate these activities and opportunities by utilizing community

based service provider networks as well as newsletters and focused topical fact sheets and fliers

mailed directly to Medicaid consumers. MEPD members will be informed of changes through

normal channels of notification such as premium notices and DHS service worker relationships.

Informational fliers and newsletters will be sent using direct mail. DHS workers will be

informed and trained relating to program changes using normal channels of electronic and

written communications. The quarterly management report will be distributed to stakeholders

resulting in increased knowledge of MIG efforts and attention to the items we are tracking and

measuring. The MEPD Advisory Committee provides both input into these activities and

assistance in the dissemination efforts, The Olmstead consumer task force is also a resource for

communication with constituency groups. As peer networks are developed they will be heavily

utilized to disseminate information and resources. The Governance Group and the networks

represented will be invaluable in the coordinated communication to all stakeholders.

D. Partnerships

   The MEPD Advisory Committee is a key partner in the efforts under this outcome area. The

committee includes nine current and past MEPD members and they bring a perspective on the

operations of the program from personal experience. The committee also includes members from

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DHS, (the Medicaid Bureau of Long Term Care, the Office of Consumer Affairs, the Division of

Mental Health and the Division of Financial, Health and Works Supports, the and Bureau of

Results Based Accountability) and Iowa Workforce Development and the Disability Navigator

program. We are also working to add members from the Division of Vocational Rehabilitation

Services and from community businesses. (See Appendix 7)

   A key partnership in our MIG Project is the Governance Group.              Its membership and

collaborative partners (including the Disability Navigators, the Promise Jobs Disability

Specialist, Iowa VR, Workforce Development and the WIPA staff) all play key roles in MIG

efforts supporting competitive employment of persons with disabilities.

   Other partners in this area are generally interdepartmental; however, the Medicaid Bureau of

Long Term Care, the Division of Financial, Health and Works Supports and Bureau of Medical

Systems and Data Warehouse the new Division of Mental Health and Disability Services are also

heavily involved. Additionally, we work closely with the Bureau of Results Based

Accountability and the Medical Systems and Data Warehouse in the completion of these

activities. Outside of state government our partners in these efforts include: The University of

Iowa Center for Disabilities and Development’s Employment Policy Group (providing staff

support); The University of Iowa’s Law, Health Policy and Disability Center (providing survey

research and publication assistance); the IRS and local tax preparation sites; The National

Disability Institute’s Real Economic Impact tour efforts; and youth transition service agencies.

E. Monitoring Plan

       The MIG management report will serve as the tool to monitor the effectiveness of the

overall project and will be in place by 12-31-2007. Other measures of effectiveness and progress

toward achievement of these goals are: 1) administrative and cost efficiency improvements in the

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MEPD program, 2) MEPD Member survey consumer satisfaction trends 3) HCBS waiver service

upgrades and improvements 4) numbers of Job Developers trained, and 5) peer network

participants and contacts. Monitoring activities will include: participant evaluations of

workshops and response to direct informational materials; quality and timeliness of contractual

products such as the research survey; and level of interest and participation in activities.

Measurement areas include; attendance and participation in financial resource activities, number

of new tax filers and EITC credits claimed, and number and nature of policy and practice

changes resulting from survey data and resulting publications.

F. Research/Program Development

       The MEPD Member Survey is conducted annually, with the results published for internal

and external use. It has become a sought after tool for use in providing feedback to Medicaid on

program operation and to guide program improvement as well as project activities.

       To our knowledge there has been limited research into the attitudes and barriers to the

accumulation of financial resources and savings. The survey research we have planned will be

published to inform both policy makers and practitioners in the field. The time frame for

completion of this research activity is 12-31-2007 for the survey contacts and report and June

2008 for completion of the focus group report.

Products and Timeline

        MIG Grant products will include the MIG Management report, the MEPD Survey and

Evaluation, the Financial Planning and Savings attitudes and behaviors Survey, Quarterly

newsletters directed to MEPD members and stakeholders, monthly fact sheet style fliers for

Medicaid members with disabilities describing services and supports, self employment seminars,

and peer network, job developer and consumer workshops.

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GOALS                                                                                                               2007     2008
                                                                                                                   Q3 Q4 Q1 Q2 Q3 Q4
GOAL 1 - Improve the administrative infrastructure of Iowa’s Buy-In, Medicaid for Employed People with
Disabilities program (MEPD).
 Streamline premium determination both on a global and individual level to a maximum of once per year.
 Research the options for automation of premium payment through electronic methods such as paycheck auto
   deposit, electronic transfers from bank accounts and bill payer style banking services.
 Prepare and distribute marketing materials related to the MEPD program in the form of monthly “fact sheet”
   mailings, quarterly newsletters, marketing brochures; provide public education/outreach on MEPD, work
   incentives, and the “contradictory messages” people with disabilities receive regarding employment.
 Develop an automated Quarterly MIG Management report to include earnings and participation numbers in
   Medicaid and related support services to guide administration, policy and practice review.
 Disseminate the MIG management reporting results to service workers to keep them updated on the MEPD
   program and related support services for persons with disabilities.
 Streamline and consolidate the web-based information relating to MEPD for ease of use by consumers and
   service providers.
 Continue the annual MEPD member survey and evaluation to improve Iowa’s Medicaid Buy-In program;
   publish the results for all stakeholders and other state Buy-In programs.
GOAL II - Improve other Medicaid Services that support employment. (HCBS, CCO)
 Explore State Plan Personal Assistance Services in the workplace under the DRA.
 Develop models of flexible employment supports that can be funded under Iowa’s new Consumer Choices
 Support the HCBS Program Managers and Specialists and DHS staff as they administer and improve HCBS
   employment services to illuminate the inconsistencies and provide for continuity of services, specifically in
   the Home and Vehicle Modification Caps and the SSA work incentive eligibility gaps.
 Promote the use of Consumer Choices Option within the HCBS waiver system as it rolls out statewide
   through consumer information and workshops.
 Recruit Medicaid members to become Individual Support Brokers and personal service workers for CCO
   consumers to help others achieve competitive employment through newsletters, fliers, workshops and other
   public information. (This activity supports both the needs for workers to be available for those Medicaid
   consumers choosing to self-direct through Consumer Choices and provides jobs for other Medicaid members)
   Monthly Flyers, quarterly newsletter.

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GOALS                                                                                                            2007     2008
                                                                                                                Q3 Q4 Q1 Q2 Q3 Q4
GOAL III - Promote and enhance linkages between Medicaid and other employment-related services.
 Expand the role of the MEPD Advisory Committee to advise on all MIG, employment, and resource
    development activities.
 Further develop and support the collaborative activities of the Governance Group in efforts coordinate
    projects and programs relating to the employment of persons with disabilities.
 Support and participate in outreach to employers as the web-based tool Employers Disability Resource
    Network, EDRN rolls out.
 Support employment related improvements and utilization of Iowa COMPASS as the state designated
    Information and Referral resource for persons with disabilities.
 Conduct four Self Employment Seminars for persons with disabilities who are motivated and interested in
    pursuing self-employment.
 Conduct job developer seminars providing training and resources for the development of competitive
    employment opportunities for persons with disabilities.
 Support consumer informational workshops regarding the SSA work incentives for persons with disabilities
    in conjunction with CCO consumer workshops.
 Develop a Peer network of youth with disabilities using the established leadership and transition groups,
    providing information and resources.
GOAL IV - Investigate financial planning and saving issues, attitudes and roadblocks to increased self-
sufficiency within the community of persons with disabilities, using the data to inform policy and practice.
 Complete and publish a research survey of Medicaid members that have disabilities assessing knowledge,
    attitudes and barriers related to financial resource issues.
 Conduct four follow-up focus groups to validate survey findings and develop strategies to improve financial
 Use research data results to develop policy recommendations for the General Assembly and Iowa Medicaid
    Enterprise to address current member issues.
 Use research data and results to develop consumer information and outreach materials to address identified
 Use survey results to inform financial service providers how they may better service customers with
 Participate in the National Disability Institute, Real Economic Impact Tour (REI) as a stop on the tour and

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GOALS                                                                                                            2007     2008
                                                                                                                Q3 Q4 Q1 Q2 Q3 Q4
    with related follow-up activities.
   Conduct asset development, financial and benefits planning workshops and forums targeting transition aged
    youth and their families.

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             Organization and Staffing

                                               Eugene Gessow
                                               Medicaid Director

                                                 Eileen Creager
                                     Bureau Chief, Bureau of Long Term Care
                                            MIG Co-Project Manager

                                              Jennifer Steenblock                                                   Jim Overland
                                       Long Term Care Program Manager                                Bureau Chief, Bureau of Community Services
                                             MIG Project Director                                             MIG Co-Project Manager

          Karen Ackerman, Policy Analyst                           Tamara Amsbaugh, Policy Analyst
         Contract Employee from CDD/EPG                            Contract Employee from CDD/EPG
              MIG Project Coordinator                                   MIG Project Coordinator

                                                  GOAL II & III                            GOAL IV
             GOAL I
                                          Increase Earnings & Enhance            Financial Planning & Savings
  Improving the MEPD Program
                                              Employment Supports                          Activities

   MEPD Advisory Committee                 MEPD Advisory Committee                MEPD Advisory Committee

            Jill Whitten
    Program Manager, Bureau                Governance Group Partners                 Consultant CDD/EPG
       of Financial Services

         Mathew Haubrick                                                        Consultant Law, Health Policy &
Chief, Bureau of Research Analysis           Consultant - CDD/EPG                 Disability Center (LHPDC)
   & Performance Management                                                        Helen Schartz, PhD, JD
                                                                                      Research Director

                                          DHS HCBS Program Managers

                                                 Brian Wines
                                           HCBS Specialist Supervisor

             Key Project Staff:

             Eugene Gessow Medicaid Director -Eugene will have overall responsibility for the project.

             Eugene has served as the Iowa Medicaid Director since May 2003.

             Eileen Creager, Chief, Bureau of Long Term Care- Eileen is responsible for the management

             of the Bureau of Long Term Care which includes a staff of nine program managers and HCBS

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specialists covering Medical programs which includes Nursing Facilities, HCBS waivers, Home

Health, Children’s Medical Programs EPSDT, as well as others. Eileen has over 20 years

experience administrating and managing Medicaid Programs. For the project, Eileen will serve

as Co-Project Manager and her primary responsibilities will be oversight of the administrative

functions related to the project.

Jim Overland, Chief, Bureau of Community Services- For over the past twelve years, Jim has

been working with people with disabilities, providers, county management staff, and state

government leaders to develop a community environment for people with disabilities, making it

easier for people to live and work in their community. Jim was instrumental in the planning and

implementation of the MEPD program. For the project, Jim will serve as Co-Project Manager

and he will have administrative responsibility for the project. Jim will also serve as a staff

member to the MEPD Advisory Committee.

Jennifer Steenblock, Program Manager, Bureau of Long Term Care-Jennifer is responsible

for coordinating long term care Medicaid Policy for nursing facilities and HCBS waivers.

Jennifer has 12 years experience administrating and managing Medicaid programs.

For the Project, Jennifer will serve as Project Director and will be responsible for direct oversight

of the project goals and timelines. Jennifer will approve all contracts and requests for payments.

Consultant-The University of Iowa Center for Disabilities and Development’s Employment

Policy Group (EPG)- The Employment Policy Group is the employment policy arm of the

Center for Disabilities and Development. Since 1972, the Center has been nationally designated

as Iowa's University Center for Excellence on Disabilities. EPG’s mission is to promote public

policy to help Iowa businesses and people with disabilities expand the workforce and strengthen

Iowa’s communities. EPG will be responsible for staffing the two project coordinator positions.

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Consultant - Law, Health Policy and Disability Center, University of Iowa, College of Law

(LHPDC)- will be engaged to provide independent research and conduct focus group relating the

attitudes and barriers to financial planning and saving by persons with disabilities. ----

Tamara Amsbaugh, Policy Analyst, Employment Policy Group- Tamara is currently hired

full time through a contract with the Department of Human Services and the University of Iowa

Center for Disabilities and Development’s Employment Policy Group. Tamara has worked with

the Medicaid Infrastructure Grant for the last year. Previously, she worked with the employment

Policy Group as Asset Policy Analyst, and has over 20 years experience in Human Resource

Management in the private sector.

Karen Ackerman, Policy Analyst, Employment Policy Group- Karen is currently hired full

time through a contract with the Department of Human Services and the University of Iowa

Center for Disabilities and Development’s Employment Policy Group. Karen is a Certified

Benefits Planner and has over 25 years of small business management and ownership experience.

She provided employment-consulting services for people with disabilities and rehabilitation

professionals on Social Security Work Incentives.

       For the project, Tamara and Karen will serve as Project Coordinators and will be

responsible for coordinating all the day-to-day activities related to this project. Tamara will

focus on the MEPD program improvements and the asset development activities. Karen will

focus on the work incentives and employment support activities. She will also be responsible for

coordinating the MEPD Advisory Committee. Both Tamara and Karen will serve as staff

members to the advisory committee.

MEPD Advisory Committee- The committee was established in September 2003 and consists

of people with disabilities that are enrolled in the MEPD program, family members and state

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policy makers. The committee meets monthly and currently has 12 members and six providing

staff support. Plans are to add additional stakeholder members and expand the role of the

committee to cover all MIG activities.

Jill Whitten, Program Manager, Bureau of Financial Supports - Jill is responsible for basic

oversight of the MEPD program. She directs development of polices and procedures of MEPD

and manages necessary refinements and changes. Jill provides technical assistance and training

to eligibility determination workers. For the Project, Jill will be largely working with Goal I

relating to improvements in the MEPD Program, including the management report development.

She will also be heavily involved in State Plan PAS efforts. Jill will also serve as a staff member

of the Advisory Committee.

Debbie Johnson, Joann Kazor, Sue Stairs, Micheala Funaro, Lin Christensen, and Anne

Volker , HCBS Program Managers - The HCBS program managers are responsible for

administration of the six HCBS waiver programs. They develop Medicaid Policy in accordance

with federal requirements, provide technical assistance and training and assure quality standards

are met. For the project, the Program Managers will act as HCBS policy experts. They will act as

a liaison with providers, Case Manager and County Management Staff.

Brian Wines, HCBS Supervisor- Brian is responsible for supervising 10 HCBS

Specialists who provide technical assistance on HCBS services to providers, case mangers and

people with disabilities statewide. Brian and his staff also monitor quality assurance for all

HCBS waiver services. For this project, Brian and his staff will be supporting activities relating

to HCBS waiver services and Consumer Choices Option. They will also act as a liaison with

Providers, Case Managers and County Management Staff.

Mathew Haubrick Chief, Bureau of Research, Analysis and Performance Management-

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Mathew is responsible for research, statistical analysis and on going reporting related to most

programs in the Department of Human Services. For this project, Mathew and his staff will be

responsible for the MEPD survey and Evaluation, assisting with the Management Report

Development and administrative improvements in the MEPD program. Mathew will also

participate in the MEPD Advisory Committee.

Technical Assistance Plan

        Our project will provide technical assistance to other states through the Centers for

Medicare and Medicaid Services online reporting system, membership in a technical assistance

organizations, and state-to-state collaboration via conference calls, individual calls, and

electronic mail. Specifically, we will disseminate the results of our MEPD Survey and evaluation

along with any training, public awareness activities and newsletters informational fliers and other

collateral materials to other states.   Our project will contract with the American Public Human

Services Association Center for Workers with Disabilities for (APHSA)/ CWD) $25,000 per


        The Center for Workers with Disabilities (the Center), a special project of the National

Association of State Medicaid Director’s (NASMD), an affiliate of APHSA, provides a locus for

information exchange, policy and program development and direct technical assistance to and

between states as they develop and enhance work incentives and seek to strengthen programs

providing services to people with disabilities. Our project will contract with the Center to

provide technical assistance in the following areas:

        1) Asset building and financial planning and savings issues for persons with disabilities.

        Iowa participates in the asset building task force.

        2) Work on the State Plan Amendment for Workplace PAS under the DRA.

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       3) Working with State and Federal Lawmakers.

       4) Developing relationship with key disability groups.

       5) Information gathering and dissemination, we will work with the Center at

       disseminating our products and materials, we will also continue to work with the Center

       to gather information on other states evaluations and longitudinal studies.

       5) Facilitating communication between states, in particular we will want technical

       assistance from other states that have created peer networks and provided job developer


   In addition, the Center of Workers with disabilities will act as a liaison to federal agencies

and other sister technical assistance agencies on our behalf.

Direct Services

Expansion of SSA Benefits Planning Services in Iowa

       The Governance Group has become the recipient of the SSA WIPA grant providing

benefits planning services throughout the state of Iowa. Different agencies have assumed

different roles in recognizing and providing assistance to SSA beneficiaries in their use of work

incentives since 1994, and it is through the joint application for the WIPA, that these entities

have come together to invest in a common system for serving all Iowa SSA disability

beneficiaries. The joint planning in their application in the Fall of 2006 built on a foundation of

other statewide networks including rehabilitation programs, advocacy organizations,

Employment Networks, case management systems and One-Stop Workforce Programs

(including navigators) in outreach and in connecting beneficiaries to these services.

       Reaching all Iowa SSA disability beneficiaries in a concerted campaign through Iowa’s

MIG initiative will stretch the benefits planning resources beyond the funds available through the

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WIPA grant provided to Iowa. To bolster this effort, the Governance Group would like to

contract benefits planning services through WIPA, with additional funds available through the

MIG implementation. WIPA will have the same benefits planners on contract that worked

through Iowa’s earlier initiative with the BPAO. The focus of these contracted services will be

with Iowa’s Medicaid buy-in citizens, or those projected to become buy-in participants as a

result of successful career initiatives.


Description: Mig Tax Guide 2006 document sample