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. With regard to Medicaid-funded employment services it is the state’s responsibility to ensure that 1915(c) HCBS supported employment waiver services are furnished to a waiver participant to the extent that they are not available as vocational rehabilitation services funded under section 110 of the Rehabilitation Act of 1973.
East Bay Innovations (EBI) is a non-profit agency that has been providing integrated employment supports to people with disabilities in the San Francisco Bay area since 1994. Today, EBI provides employment supports to 200 individuals with intellectual and developmental disabilities including 145 people who are employed in the community.
EBI receives HCBS waiver funding through the Regional Center of the East Bay. Medicaid funds services such as long term follow-along coaching services provided through supported employment after the individual's Department of Rehabilitation case closes. The center is one of 21 regional centers in California that contract with the state’s Department of Developmental Services to provide services to people with developmental disabilities. The close partnership with the regional center also allows individuals one-stop access to a broad range of coordinated services offered by a variety of providers.
EBI helps individuals identify the types of careers they are interested in and match them with local employers. They also provide on-going support including on-the-job training and help navigating areas such as public transit, the interview process, and Social Security work incentive programs. The team providing these services includes job coaches, front line supervisors, job developers who match individuals and employers, a contractor who works as a job developer with larger employers, and a Director of Employment Services who oversees the agency’s model including funding streams and administration.
Central to this model is aligning with state and federal employment initiatives. According to Tom Heinz, EBI’s Executive Director, keys to success include:
Optimizing funding mechanisms and policy levers from the state’s Vocational Rehabilitation program.
Utilizing Ticket to Work and Work Incentive Improvement Act Employment Network funds
Becoming an eligible training provider through the U.S. Department of Labor‘s American Job Centers (formerly known as One Stop Career Centers)
Participating in Project SEARCH
Alameda County’s Project SEARCH program gives adults with developmental disabilities the opportunity to build transferrable work skills through year-long internships. The program is collaboration between EBI and the Oakland Unified School District. The program provides support for 24 people each year at two Project SEARCH model sides: the Downtown Oakland offices of the County of Alameda and the University of California San Francisco (USCF) Benioff Children’s Hospital.
This is ACL’s fourth profile of a local program promoting integrated employment for people with disabilities; learn about Community Link in Colorado, the Arc of Washington County, Maryland, and LIFEDesigns in south central Indiana. ACL is interested in hearing from states, providers, and advocates working on integrated employment. Share your successes, challenges, and questions by e-mailing firstname.lastname@example.org.