For Most of the twentieth century it was assumed that people
with significant developmental disabilities could not be employed in regular
jobs at reasonable wages. In recent decades, we have demonstrated that people
with developmental disabilities can be productive and valuable employees if
they have specialized training and workplace supports. Community Supported
Employment (CSE) services are intense, often one to one, on the job training
and workplace assistance that can create real employment opportunities. CSE is
the only Medicaid funded service that promotes employment for people with
disabilities. It is available to people who qualify for the Developmental
Disabilities Home and Community Based Services waiver.
In Idaho, Medicaid services for adults with developmental
disabilities are allocated according to individual services budgets. The amount
of a person’s budget is determined by a formula. The formula uses assessment
scores, medical diagnoses and other factors to predict the cost of the services
a person needs. The participant decides
the types and amounts of each Medicaid service they want within the formula
based budget. However, the formula does not always work. Individual
circumstances and issues sometimes require that the budget be modified to meet
the person’s basic needs.
In 2011 the legislature passed H260 to implement $113,000,000
in Medicaid cuts ($34,000,000 General Fund).
One of the changes limited a
person’s ability to modify the budget to changes necessary to protect the
person’s health or safety. Employment is not a health or safety issue. This had
the unintended consequence of seriously reducing access to community supported
employment (CSE). From 2011 to 2013, the number of people getting or
maintaining jobs through CSE dropped from 275 to 182. I believe that the trend
is continuing and there are fewer people receiving these services today.
H476 would allow people to request modification of their
individual service budget if the modification is needed to obtain or maintain
employment. It does not restore the
statute to the language before 2011. Employment is merely added to health and
safety as a basis for requesting a budget Modification. Any modification
requested would still have to be reviewed and granted or denied by Medicaid
case managers.
If we could instantly develop a hundred jobs for people with
developmental disabilities and return the program to 2010 levels, the impact to
the state general fund would be about $235,000 (see Fiscal Note). It will
probably take several years to return to that level of participation.
Passing H476 will open the door to real world work opportunities
for hundreds people who have no other way to experience the benefits of
employment. It is also an opportunity to demonstrate to employers the benefits
of hiring people with disabilities and to show them how to support and
accommodate these employees.