Building Partnerships to Expand Employment: Massachusetts DMR & the MICEO John Butterworth June 2007

MICEO Collaboration between EOHHS, the University of Massachusetts Medical School and UMass Boston. Focus on Medicaid infrastructure & the infrastructure needed to support employment Goal is to improve employment services and outcomes for individuals with disabilities in Massachusetts who want to work.

MICEO Major Components Medicaid Infrastructure Development Comprehensive Employment Opportunities Infrastructure Development

Comprehensive Employment Opportunities (CEO) Develop consistent state-wide strategies and policies that communicate a clear message of work as a valued outcome & result in seamless coordination of supports across state agencies on an individual level Enhanced choice and self-direction of services and supports by providing ready access to information that helps identify and choose supports that make it possible to work

CEO…. (continued) Enhanced capacity of the service system at the direct support level to provide a coordinated array of employment-related supports Access to health care services and information for individuals with disabilities and support providers at all levels of the service system to ensure integration between health-related and employment supports

Major Project Areas EOHHS Policy Analysis and Development Consumer Advocacy, Outreach and Training Employer Outreach and Training Employment Provider Outreach and Training Clinical Provider Outreach and Training

Grant Leadership Team 7 representatives from disability community State agencies VR Department of Transitional Assistance Massachusetts Commission for the Blind Department of Workforce Development Department of Mental Retardation Department of Mental Health Office of Medicaid

Sample Projects Snapshot Report Employment & Disability Summit Mission Employment MassWorks.org ForEmployers.com MassCHEC.org

SEE-Technical Assistance Project DMR Technical Assistance Project Peer Employment Benefits Network EOHHS Task Force on Employment Employment Standards Subcommittee Employer Subcommittee

Research Analysis of MassHealth administrative data Surveys of MassHealth members Evaluations of specific EOHHS agencies to enhance service delivery Outcome data reporting by state agencies providing employment services Focus groups with MassHealth members Interviews with key informants for policy analysis

DMR Employment Services Strategic Task Force Initiative DMR Goal to Improve Employment Opportunities & Outcomes Commissioner Priority Identified by Statewide & Regional Quality Councils as Priority Develop a Strategic Plan to Re-Design Employment/Day Services Create Framework for Re-Procurement of Services in Fall for FY 2009

US Employment & Day Supports Similarly, in the DD system, following the burst of movement during the early years of supported employment… ICI CRP Survey 2003

MA Employment & Day Supports

State success in integrated employment varies widely But… We know its possible. Individual providers and states do much better A substantial number of providers only support community employment now, including several who will speak Percent supported in integrated employment by state MRDD Agencies – 2004 Source: ICI MR/DD Agency Survey

Charge – Statewide Employment Solutions Team Develop an Employment Strategic Plan to improve employment outcomes Develop recommendations to re-design employment/day services & build capacity Inform planning and framework for re-procurement of services (RFR) for FY 2008

Who Is Involved? Statewide Employment Task Force Regional Employment Solutions Teams SELN

Capacity Building Activities TA to community providers Build capacity Modify practices TA to individuals Address policy and practice barriers Direct service staff training 5-day curriculum for direct support professionals

Key Activities of Statewide Team Current Picture: Employment & day services National Trends & Features of HP States ID Strengths & Barriers in existing system Discussed services & supports needed in “ideal” system for all adults Created four Working Groups Consulted with other states

Statewide Employment Solutions Team Work groups on key issues Work First Contracts and Rate Structures Day Supervision Building Capacity

Regional Employment Solutions Teams Focus varies by region Training for providers (Southeast) Career assessment strategy (Metro) Transportation (Central/West) North Shore Pilot Project (Northeast) Interface between regional teams and statewide team informs the work of both Selected individuals & agencies to receive TA

“System-Wide” Influences Re-design of DMR’s Medicaid Waiver Program Service definitions; Provider Choice; Portability; Participant- Direction Transition Planning/Turning 22 Implementation of MASSCAP: Identify needs & priority for services EOHHS Joint Employment Procurement

Baseline: Number Participating by Activity Over 5400 individuals in employment Over 600 additional individuals in other services

363 Individuals began work in a new individual job May 2005 through April 2006

Mean Hours Worked per Month Over 5400 individuals in employment Over 600 additional individuals in other services

Mean Monthly Wage DMR 2005 Over 5400 individuals in employment Over 600 additional individuals in other services DMR 2005

Percent Earning Minimum Wage Over 5400 individuals in employment Over 600 additional individuals in other services

DMR Percent in Individual Jobs by Provider Over 5400 individuals in employment Over 600 additional individuals in other services

How We Are Using The Data Statewide & Regional Summaries & Trends Provider Reports: Summaries & Trends Comparison to State & Regional averages Trends by Specific Variables Website: Multiple Reports & Data Displays Education: Staff; Providers: Consumers

Provider Name Provider Provider Provider

Provider 1 Provider 2 Provider 3 Provider 4 Provider 5 Provider 6 Provider 7 Provider 8 Provider 9 Provider 10

Proposed Major Recommendations Develop & Adopt an “Employment First” Policy Re-design & Re-Structure Employment Services & Contracts Development of standardized rates for services Transportation Planning & Funding Strategic Focus on Transition-Age Youth

Separation of work and day supports Education & Promotion about Values & Benefits of Employment Capacity Development of Employment Provider Network Collaboration with EOHHS Agencies & Workforce System Comprehensive Approach to Training & Professional Development within DMR

John Butterworth john.butterworth@umb.edu (617) 287-4357 www.mi-ceo.org www.MassWorks.org www.ForEmployers.com www.masschec.org www.statedata.info

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Develop & Adopt an “Employment First” Policy Starts with a presumption of employability for working age adults Will require: Cultural shift in expectations Consistent communication of “pro-work” message Integrated into all aspects of service planning and delivery

Re-design & Re-Structure Employment Services & Contracts Unbundle integrated employment from facility/center-based work Review & clarify service definitions with specific quality standards Use of community-based day service options to supplement job if needed Promote participant-directed options Flexible allocation of resources to support choice in services & providers

Development of standardized rates for services Individual integrated employment as separate funding category Rates based on adequate pay scales for staff Flexibility to enable movement from sheltered or group to indiv. employment Availability of risk pool to respond to job loss or change in support needs

Transportation Planning & Funding Different approaches based on type of employment service Transportation to a job needs to be integral part of job development process Prioritize use of public & personal transportation alternatives Development of cost allocation standards Collaboration with HST and RTA’s

Strategic Focus on Transition-Age Youth Facilitate and support direct movement into employment Transition planning needs to be more career-focused Education & training for families & youth Partnerships with schools Partnership with workforce system Expand job experiences during high school years

Separation of work and day supports Consistent approach to assessment of support needs & requirement of structured day program- “day supervision” Increase number of hours individuals are working Access to more flexible ‘alternative day’ supports Collaboration with residential staff

Education & Promotion about Values & Benefits of Employment For all stakeholders Consumer friendly information & resource materials with pro-work message Develop “Guide to Employment Services” Information on service options & costs Resources for benefit planning Share employment outcome data

Capacity Development of Employment Provider Network Comprehensive training offered/required for all front-line staff Professional development opportunities Provision of technical assistance Address the diverse needs of the work force Develop career pathways Community colleges; Continuing education

Comprehensive Approach to Training & Professional Development DMR Service Coordinators and AO staff Quality employment services; customized employment; impact on benefits.. Integration & collaboration with residential & other non-employment service providers Integrate into orientation – values; role in supporting work; problem-solving;

Collaboration with EOHHS Agencies & Workforce System Partnership with MRC Access & collaboration with Career Centers Expanded use of other training resources & supports: for example- Benefits planners