There is growing consensus in Iowa and around the country that employment in the general workforce should be the expected and preferred outcome of employment-related services. A job establishes someone as a contributor to, and full participant in, the community. In addition, the U.S. Department of Justice has affirmed in numerous settlements that the Olmstead community integration mandate applies not only to where a person lives, but to what that person does during the day. Meaningful daytime activity, including employment, is an essential part of an individual's successful transition from institution to community living.
Employment plays a key role in someone's sense of well-being, and facilitates and solidifies community inclusion and self-sufficiency. Real jobs and income are how most people maintain independence and create economic security for themselves and their families. Community based integrated employment is now the gold standard in employment service outcomes, receiving national attention.
To that end, realignment of the Medicaid service definitions and reimbursement methodology for employment services has been a major focus of CDD’s technical assistance. This has been collaborative work with The Department of Human Services, Iowa Vocational Rehabilitation and The Developmental Disabilities Council, through the Iowa Coalition for Integrated Employment. As a result of this work the employment service definitions, the reimbursement rates and methodology, and the provider and staff qualifications have all been updated and are consistent between Medicaid and Vocational Rehabilitation. Many stakeholders have been involved in this comprehensive effort. These links below contain several explanatory documents and the actual notes from the numerous stakeholder workgroup meetings involved in these efforts. These documents provide relevant, conceptual background information:
- Summary of Iowa employment systems improvement efforts
- Stakeholder Brief "Systematic Approach to Revising Iowa's Integrated Employment Funding System"
- Key Assumptions for a High Quality Funding System
- 2013 Iowa Employment Community Forums
- Employment Workgroup Notes 2013
CDD efforts include providing information for individuals, families, health service providers and care coordinators about the employment services changes and benefits of community inclusion and integrated employment. Efforts also focus on capacity building for employment service delivery, including training and development of direct employment services staff and supports for community providers' efforts to transition to primarily community services. CDD also worked on the development of a comprehensive E1st Guidebook and an Employment First information brochure for parents.
- Iowa Employment First Guidebook
- Employment First (E1st): A Family Perspective
- Employment First (E1st): A Family Perspective (text only)
- Addressing Parental Concerns - Q and A on Customized Employment
- "Working Together So All Can Work" Information and Resources - Iowa Department of Human Rights
Individual Employment Outcomes
CDD has completed an Individual Employment Outcomes Data Collection Pilot on behalf of the Iowa Coalition for Integrated Employment (ICIE). This pilot project was undertaken in an effort to lay a foundation for individual employment data and outcome data collection statewide. The survey report summarizes the feedback and the individual outcomes data collected from 19 employment service providers. The providers surveyed reported on an unduplicated total of 2,104 persons who work in individual, group, and facility-based settings, and those who are self-employed or receiving job development services.
ICIE Employment Outcomes Data Collection Pilot:
Medicaid Claims and Employment Research
The University of Iowa Public Policy Center researched the effects of employment on health care costs of Medicaid members. The dramatic results show that Medicaid members with disabilities participating in Iowa’s Medicaid for Employed Persons with Disabilities (MEPD) program and covered only by Medicaid have $161 per month lower Medicaid claims than Medicaid members who are not participating in MEPD. By multiplying the average saving of $161 per month by the 129,259 eligible months for MEPD members covered during the study period, we estimate the cost reductions are over $20 million during 2011. Cost reductions for MEPD participants also covered by Medicare are estimated to be twice that much. Read more about the Costs of Health Care study.
If Everybody Works - Success Stories
For more than 10 years, CDD administered Iowa's Medicaid Infrastructure Grant (MIG) on behalf of Iowa's Department of Human Services, with funding from the Centers for Medicare and Medicaid Services. MIG helped Iowa Medicaid members learn about work incentives, benefits planning, and increasing economic self-sufficiency. In collaboration with many Iowa partners, thousands of Iowa job seekers with disabilities were introduced to Home and Community-Based Services that support employment, Small Business/Microenterprise Development, Ticket-to-Work, AmeriCorps, and other employment services and supports available to people with disabilities.
Iowa now has several success stories of people with disabilities who are employed and earning wages or who are self-employed as small business owners. Local Community Rehabilitation (CRP) and Iowa Vocational Rehabilitation Services (IVRS) may have assisted achieving these successes. Follow the links below to view their stories:
- Wage Earners
- New Entrepreneur
- "Thinking Outside the Employment Box" - Self-Employment Success Stories
Increasing economic self-sufficiency is a major goal of working. Several years ago CDD published a compressive report on self-sufficiency and asset development strategies and helpful hints about employment related supports. This information, while several years old in still applicable today.
- Asset development resources available to people with disabilities
- Seven helpful hints about employment-related supports for people with disabilities
Additional information on working and benefits is available from Disability Rights Iowa Benefits Planning.
Additional Documents and Resources
- "Jobs" - Department of Human Rights Parents PowerPoint
- Customized Employment and Discovery, AKA "Horsing Around" - The Zack Becker Story
- Guidebook Appendix G - Elevating Parent Expectations
- Guidebook Appendix H - Qualities of a High-Performing Case Manager
- Guidebook Appendix I - The Influence of Families on the Employment Process
- Iowa Developmental Disabilities Council
- Disability Rights Iowa
- "Stalled on the Road to Olmstead Compliance" - Disability Rights Iowa Report on Segregated Employment