State Vocational Rehabilitation Agencies: How the VR Agency Can Fund Services and Equipment to Support a Work Goal February 4,

2 Today’s Presenters James R. Sheldon, Jr., Supervising Attorney National Assistive Technology Advocacy Project & Work Incentives Counseling Projects Neighborhood Legal Services, Buffalo, NY * ext. 262 Ronald M. Hager, Senior Staff Attorney National Disability Rights Network Washington, D.C. *

Early 2015 NABWIS Webinar Series February 26, 2015 – Railroad Disability and Retirement Benefits: What Work Incentives Specialists Need to Know - Michael Dalto, Work Incentives Project Director, Maryland Department of Disabilities, Baltimore, MD. April 16, The Transition from Disability to Retirement Benefits: What Work Incentives Specialists Need to Know - John Benbow, Research and Curriculum Specialist, Employment Resources Inc (ERI), Madison Wisconsin. 3

What is National Association of Benefits and Work Incentives Specialists? NABWIS is a membership organization of individuals and agencies who provide benefits and work incentives planning services to individuals with disabilities. Members typically serve individuals getting Social Security and/or SSI disability benefits. Members typically serve individuals getting Medicaid and/or Medicare. Members may also service individuals getting range of other cash benefits and health insurance coverage. 4

Presenters Work for National AT Advocacy Project National technical assistance and training project. Serving attorneys/advocates from Protection & Advocacy programs. Serving others seeking information about funding assistive technology (AT) and appealing denials of funding. Primary areas of focus: Medicaid, Medicare, special education, vocational rehabilitation, private insurance. Contact either presenter for assistance. 5

Purpose of Webinar Series NABWIS members work in various settings: Not-for-profits, state VR agencies, as self employed fee- for-service providers. Many received training through a national provider, like Virginia Commonwealth University or Cornell University, or through a training provider in their state. Webinars support the work of members: By offering sessions that may not be available to them. Bringing in experts on range of topics. 6

Format for Today’s Session Walk through power point. Post questions in question or chat box. Follow up questions can be ed to presenters. Additional resource –Work, Assistive Technology and State Vocational Rehabilitation Agencies: The VR Agency’s Obligation to Fund AT to Support Employment Preparation, Ron Hager, National Disability Rights Network (2013). –Contains extensive citations to law, regulations, policy. –Available at onal%20AT%20Advocacy/VRFundingofAT2013.pdf onal%20AT%20Advocacy/VRFundingofAT2013.pdf 7

Purpose of this Session Title I of Rehab Act funds State VR Agencies Will explore federal criteria for obtaining services through VR agency to support work goals How can the Rehab Act’s requirements be used –to ensure people with disabilities have the services and supports they need; and –to prepare them to enter competitive integrated employment. 8

Why Today’s Topic Important to NABWIS Members State VR Agencies, a Major Support for Work Goals Can counsel individual in selection of work goal. Can fund or partially fund a range of items to support the work goal. Can provide assistance in finding a job or developing a business/self employment goal. 9

Items Potentially Funded by State VR Agency A Non-Exclusive List Tuition for college/training program, books to support program Room and board, tutoring Smartphone/tablet applications for memory, organization, video recording of tasks Transportation, including accessible transportation to and from a college or training program Vehicle modifications Computers, computer accessories, software – including specially designed items to accommodate disability Tools required by the job (i.e., work goal) 10

Items Potentially Funded by State VR Agency (cont.) Modified workstations Equipment and supplies to start a business Computer assisted real time captioning (CART) – but could be college’s obligation under Americans with Disabilities Act/section 504 of Rehab Act Personal care aide to allow person to leave home for education or training (but must look to Medicaid first) Wheelchair or other mobility device (but must look to Medicaid, Medicare, private insurance first) Maintenance/repair costs for any of above Anything else reasonably needed to support work goal 11

Why Work Incentives Counseling Important to VR Agencies SSI/SSDI beneficiaries often reluctant to work due to: –Lack of information/misinformation about work incentives Work incentives counseling/benefits planning should be key part of any VR agency’s services plan or IPE. Many VR agencies pay for work incentives counseling. Ticket program reimbursement: VR agency can have cost of work incentives counseling reimbursed based on beneficiary’s success at work. 12

Hypothetical 13

The Case of Mario Mario is 17 years old and a high school senior. Has cerebral palsy, uses a 7-year old power wheelchair for all mobility, relies on accessible transportation to go to school. He will turn 18 in April He will graduate from high school in June He plans to go to college and study to become an English teacher at the high school level. Requires Master’s Degree for entry level teaching job. 14

Mario’s Current Education Mainstreamed with some special education services: Physical therapy, occupational therapy Use of standing frame in physical therapy (allows medical benefits of standing program) Laptop with adapted keyboard, voice dictation software – purchased by school district in

Mario’s Income Social Security, SSI Currently, Social Security dependent’s benefits - $420 per month (Dad gets Social Security Retirement, Mom works). In April 2015, at age 18, dependent’s benefits will convert to SSDI Childhood Disability Benefits, as disabled adult child (same monthly amount). Currently, no SSI as parental income too high. In April 2015, will qualify for $333 SSI check (based on state SSI rate) (parental income no longer counts). 16

Mario’s Health Insurance Private insurance Covered as dependent on Mom’s insurance. Will continue through age 26. Medicaid Not currently eligible. In April 2015, automatically eligible for Medicaid as SSI beneficiary. Medicare Eligible in April 2017 after 24 months of SSDI eligibility. 17

Mario’s VR Eligibility Mario has recently applied to State VR agency. During a May 2014 “transition planning” meeting the special education chair handed him a VR agency brochure and stated something about them helping with college expenses. He seeks sponsorship to attain his English teacher goal. He and his parents will meet with an assigned VR counselor in early February 2015 to proceed with his application. 18

Funding Needed to Support Mario’s College Education Tuition, fees for bachelor’s and master’s program (master’s needed for entry level teaching job) Books and supplies for college Accessible van transportation, to attend college A new laptop, with modified keyboard, voice input software (or ability to retain laptop purchased by public school in 2014) 19

Funding Needed by Mario to Support School and Work Goal A ramp at the home, to come and go in his wheelchair A modified van, with hydraulic lift, hand controls, etc. A power standing wheelchair, to replace old wheelchair, allow him to benefit from standing therapy throughout the day, to do work-related activities best done in standing position. 20

Introduction Rehabilitation Act first passed in 1973 Under Title I, states given money to provide VR services to persons with disabilities VR can fund wide range of goods and services, including “rehabilitation technology” (i.e., AT), connected to person’s vocational goal VR services are to empower individuals to maximize employability, economic self-sufficiency, independence and integration into the work place and the community through “comprehensive and coordinated state-of-the-art programs.” 21

Introduction Workforce Innovation and Opportunity Act (WIOA) of 2014 Amends Title I of the Rehab Act Makes it harder to find a person incapable of benefiting Better support for Masters-level degrees Adds pre-employment transition services Relies more upon AT—requires coordination between VR agency and AT Act programs Will severely limit access to sheltered workshops in two years 22

Eligibility 23

Basic Eligibility Criteria To receive services, an individual must –have a disability which results in a “substantial impediment” to employment; and –require VR services “to prepare for, secure, retain or regain employment.” Any service an individual is to receive from the VR system must be connected to employment goal. 24

Employment Outcomes Full or part-time competitive integrated employment Customized employment—developed in conjunction with an employer Supported employment, or Other employment in an integrated setting such as self- employment, telecommuting and business ownership “Homemaker” and “unpaid family worker” are acceptable Must be consistent with person’s strengths, abilities and informed choice Not a sheltered workshop, because it does not meet definition of competitive integrated employment 25

Disability Criteria Must have mental, physical, sensory, or learning disability that interferes with the ability to work Need not be so severe as to qualify for SSDI or SSI Must only be a substantial impediment to employment. Recipients of SSDI or SSI are presumed eligible, as individuals with a significant disability 26

Presumption of Eligibility VR services may be denied if person cannot benefit But presumed capable of employment, despite the severity of a disability, unless VR shows by “clear and convincing” evidence that he/she cannot benefit Clear and convincing means state VR program must have a “high degree of certainty before it can conclude that an individual is incapable of benefitting” 27

Presumption of Eligibility Must explore work potential through variety of trial work experiences, with appropriate supports, including supported employment Must be of sufficient variety and over sufficient length of time to determine eligibility Determination must be an individualized one, based on available data Determination may not be based on assumptions about broad categories of disabilities 28

The Individualized Plan for Employment (IPE) 29

IPE - Introduction Written IPE includes individual’s employment goal and specific services to reach goal For students, it may be the projected post-school employment outcome Comprehensive assessment as necessary to determine employment outcome, objectives, nature and scope of VR services 30

Informed Choice All activities implemented consistent with principles of –“respect for individual dignity, personal responsibility, self-determination, and –pursuit of meaningful careers, based on informed choice, of individuals with disabilities” Reason: Congress’ belief “that a consumer- driven program is most effective in getting people jobs” 31

Available Services 32

Intro – Available Services Any services to assist in preparing for, securing, retaining, advancing or regaining an employment outcome All necessary services to equip the individual for employment Severity of disability or cost of services can have no bearing on scope of services individual receives Available services are incredibly broad and varied May include benefits planning for SSI/SSDI beneficiaries – New in WIOA of

Required Service Options Transportation, including adequate training in use of public transportation, provided in connection with the provision of any other service and needed to achieve an employment outcome Transportation may include vehicle purchase –Very few states will pay for vehicles, but all should pay for vehicle modifications Advanced degrees in science, technology, engineering, math, law, medicine, or business 34

Required Service Options Rehabilitation technology (i.e., AT), including vehicular modification, telecommunications, sensory, and other technological aids and devices Transition services for students with disabilities to facilitate the achievement of the employment outcome or projected employment outcome Pre-employment transition services Supported employment, can now be provided up to 24 months without extension 35

VR Services Policies States must develop policies concerning provision of VR services. Must ensure services are provided based on each person’s individual needs. May not place “any arbitrary limits on the nature and scope of” VR services to be provided to achieve an employment outcome.” 36

AT Device Uses definitions from federal AT Act Any item, piece of equipment, or product system Whether acquired commercially off the shelf, modified, or customized Used to increase, maintain, or improve functional capabilities 37

AT Service Uses definition from AT Act Evaluation Purchasing, leasing or otherwise acquiring Selecting, designing, customizing, adapting Maintaining, repairing or replacing Coordinating and using other services Training to person, family and those working with person 38

Financial Need Criteria Need not have a financial need, or financial contribution, requirement. Must specify which services will be subject to financial need. Must take into account disability-related expenses. Must not be so high as to effectively deny an individual a necessary service. SSDI and SSI recipients (including 1619(b) Medicaid recipients) are exempt from financial needs test. 39

Employment Outcome 1997 RSA Policy Directive VR must approve goals and services to enable persons with disabilities to maximize their employment potential VR not intended solely to place individuals in entry-level jobs –Rather to assist individuals to obtain employment that is appropriate given their unique strengths, resources, priorities, concerns, abilities, and capabilities Person currently employed will, in appropriate cases, be eligible for VR services to allow for “career advancement” or “upward mobility” 40

“Maximization” Alternative Comments to 2001 Regulations –States must “look beyond options in entry-level employment for VR program participants who are capable of more challenging work” –Additionally, “individuals with disabilities who are currently employed should be able to advance in their careers” WIOA –Adds advancing in employment as an outcome –Adds advanced degrees as available services—law, medicine, business, engineering, sciences and math 41

Comparable Benefits VR agencies are considered payer of last resort for many services. Will not pay for a service if similar or comparable benefit available through another provider. For example, if person qualifies for services through Medicaid, VR will not provide them. AT exempt from comparable benefits. 42

Resources that are not Comparable Benefits Student loans, which must be repaid Scholarships and awards based on merit SSI’s Plan for Achieving Self-Support (PASS) No requirement to pursue these funding sources prior to VR agency payment for a service 43

Comparable Benefits State must coordinate with other public funding sources, including schools, Medicaid and public colleges—RSA guidance requires more specificity All services are listed on the IPE, even if not provided by VR If an agency fails to provide, VR must provide WIOA adds collaboration with: –DD agency, AT Act program, Medicaid waiver program 44

Meeting Mario’s Needs VR agency should pay for: Tuition, books – but could limit payment to state tuition rate if goal can be met through state university program. Wheelchair van service – if readily accessible public transportation available, could require he use cheaper service. Laptop with adaptations – even if need is not disability related, purchase could be required if cannot succeed in college without it. Ramp – if not reasonable and safe way to exit home without it. If Medicaid or Medicaid waiver will fund ramp, must seek their funding first. 45

Meeting Mario’s Needs A challenge to get funded through VR agency: Modified van – clearly VR agency should pay for modifications which will be expensive; very few states will pay for or lease a vehicle. –See “blended funding” example below using PASS and VR agency funding. Power standing wheelchair – Mario will need to seek Medicaid funding first; National AT Advocacy Project can assist advocacy effort. –See “blended funding” example using Medicaid and VR agency to fund wheelchair. 46

Blended Funding to Pay for Standing Wheelchair Using State VR Agency and Medicaid (or Insurance) to fund Standing Wheelchair Medicaid will pay for power wheelchair. Hearing or litigation may be needed to get standing feature. VR agency can pay for wheelchairs, as “rehabilitation technology,” but will want Mario to go to Medicaid first. Solution: Medicaid agrees to fund basic power wheelchair. VR agency agrees to fund standing feature. Advocate role may be crucial. 47

Blended Funding to Pay for Modified Van Using VR Agency and SSI Plan for Achieving Self Support (PASS) to Fund Modified Van Most VR agencies will pay for modifications but not van purchase. With approved PASS Mario can use $400 of SSDI to save for van. The $400 is excluded by SSI and SSI payment goes up by $400. If Mario saves throughout college, 48 months or more, can save most of cost for van purchase. See AT Advocate newsletter for more information on PASS: ATAdvocateNewsletters/ATAdvocateSpringSummer

Using VR Agency, PASS, and AT Loan Program* to Fund Accessible Van Over five years of college to obtain teaching credentials, Mario can save enough to purchase a van. Wants to get van much sooner, through a down payment and loan, to travel to internships and student teaching sites. He has a low credit score and no co-signer for a loan. Mario obtains a low-interest loan through a “alternative financing program” in his state. He can then use money deposited into PASS to pay off loan. *See links to alternative financing programs in more than 40 states

AT for Students in Transition 50

Special Education (IDEA) Requirements Transition planning begins no later than school year student turns 16. Services are to be coordinated, results orientated and to prepare student for post-school life—live, learn, work and play. Services are to be individualized and based on student’s needs, preferences and interests. IDEA anticipates VR will be involved in planning and provide some services. 51

VR Agency Requirements Also requires coordination with special education system –Consultation with schools to assist in preparing students and in developing IEP –Relative roles and financial responsibilities –Outreach to students needing transition services VR is to be active throughout transition planning, not just as student nears graduation Students make the decision of whether to apply for VR while still in school 52

VR Agency Requirements VR expected to provide services to at least some students WIOA adds pre-employment transition services –Job exploration counseling –Work-based learning experiences in integrated settings, in and out of school –Counseling on post-secondary opportunities –Social skills and independent living skills –Self-advocacy skills For those not receiving services while in school, VR must ensure eligibility and IPE before leaving school to ensure no gap in services 53

Reading Special Education and VR Requirements Together VR must be involved in transition planning with school districts (no later than 16) Options for students who will need AT upon exiting school –VR purchases outright while still in school –VR purchases from district when student leaves –VR purchases new AT for student to use IEP and IPE both developed for student 54

AT for the College Student 55

Obligations of Colleges (under ADA or section 504) Must provide auxiliary aids and services –Taped texts, interpreters, readers, adapted classroom equipment –Electronic readers, open and closed captioning, assistive listening systems, specialized gym equipment Must ensure e-readers are accessible Not required to provide personal devices or services for personal study 56

Obligations of VR Agency to College Student Anticipated VR agency will provide auxiliary aids for college students –Courts have held VR responsible Relative roles for public colleges and VR should be in state plan Even if college provides, should go in IPE as a needed service and if college does not provide, VR must 57

Looking at the VR and College Obligations Together – Who Pays? Real-time captioning for classes –An obligation for both, but AT is exempt from comparable benefits –Could do shared costs Use of modified computer to access library card catalogue—most likely college What about Mario’s laptop with adapted keyboard, voice dictation software? 58

Appealing VR Agency Decisions Any VR agency decision can be appealed if: It affects overall eligibility, including eligibility for post employment services It affects eligibility for a service It affects the amount of money the individual is expected to contribute toward rehabilitation costs It affects anything else that relates to the rehabilitation plan Appeal rights include the right to informal resolution procedures and the right to a “fair hearing.” See link on slide 7 to our article containing more extensive information on these issues. 59

Getting Help with Appeals Client Assistance Program (CAP) Will exist in every state. A primary role is advocating for individual in disputes with VR agencies. Many CAPs are housed within Protection and Advocacy (P&A) agencies. See for links to CAP and P&A programs nationwide. 60

Getting Help with Appeals Protection and Advocacy for Beneficiaries of Social Security (PABSS) Will exist in every state. Can advocate for SSI/SSDI beneficiaries or 1619(b)/Extended Medicare beneficiaries if issue deals with a barrier to employment. A PABSS could assist with VR agency appeals. See for links to PABSS programs nationwide. 61

Thank you! Please use your chat box to ask questions Or contact presenters to follow up. Ronald M. Hager, Senior Staff Attorney National Disability Rights Network * James R. Sheldon, Jr., Supervising Attorney Neighborhood Legal Services, Inc. * ext