Home and community-based services (HCBS) provide opportunities for individuals with disabilities and older adults to receive services in their own home or community.
On January 16, 2014, the Centers for Medicare & Medicaid Services published a final rule that sets forth new requirements for states using Medicaid funds to pay for HCBS, supports enhanced quality in HCBS programs, and adds protections for individuals receiving these services. In addition, the rule reflects the intent of CMS to ensure that individuals receiving services and supports through Medicaid’s HCBS programs have full access to the benefits of community living and are able to receive services in the most integrated setting.
The Administration for Community Living (ACL) is highlighting an example of a promising practice for employment benefits designed to meet the needs of individuals, promote integrated employment, and comply with requirements of the HCBS settings rule and the Supreme Court’s Olmstead v. L.C. ruling.
Staci Jones, Director of Day and Employment Services at the ARC of Washington County, MD recently led the conversion of the agency’s employment program to a more integrated model, which includes a commitment for all transitioning youth to experience a seamless transition from school to work or school to services within integrated, community-based settings.
In 2012, the ARC of Washington County was prepared for a change after receiving technical assistance (TA) focused on diverting transition age youth (up to age 26) from sheltered workshop placements to supported employment. After one year of TA, staff training, and working with parents, board members, and state funding agencies the philosophical shift toward integrated employment started to gain traction. TA had a significant focus on the use of individualized supports; including person centered planning tools, as well as subtle changes including using different language when speaking about day services.
“It took taking the leap,” Staci said, because there was no infrastructure at the time to support the business model shift. By the second year, they decided to take small steps to build the infrastructure, including reallocating a staff member to work in the community and focusing on ten youth in the sheltered workshop who expressed a strong interest in getting jobs.
Today, they have nine staff focused on an individualized, customized approach to supporting employment. More individuals now participate in integrated day services wrapped around employment, employment supports, and day services that support community activities such as gym/fitness, cooking, volunteering, and job experience training to prepare the individual for work life.
The ARC of Washington County Employment Services optimizes federal funding options by sequencing Vocational Rehabilitation (VR) funds with Medicaid waiver funding. The VR agency is actively engaged and willing to be a strong partner. In the beginning, parents and board members were resistant. One parent noted that at first she was not in agreement with her son moving from facility based services. But a year later she commended the agency saying that since receiving community-based services, he was happier and talking more. The agency is getting the word out about the experiences of those who are working through newsletters, email blasts, board meetings, parents group or any relevant forum providing the opportunity for the community to “hear good stuff” about the program. There is now a waiting list for the employment service model, an increase in referrals, and interest from local school systems.
While the agency is still in the middle of the process, they have learned a number of lessons so far, including:
- Talk to staff early and frequently about the changes and reassure them that the plan is not to fire them but to refocus their efforts on working towards expansion of integrated employment opportunities.
- Create a core team which really believes in the model and get them together regularly so they can overcome issues and keep things moving so as to avoid falling back on the old model.
- Stay connected to other providers who have either gone through or are experiencing the same transformative change.
- Learn from each other.
- Communicate with families about their fears.
As Staci Jones notes, “Safety and support don’t come from the building but how we craft our services and supports” around the individual.