1. What State VR Agencies and CRPs Can Learn From Medicaid Infrastructure Grant Projects and Work Incentives Planning and Assistance Projects Robert “Bobby” Silverstein Powers Pyles Sutter & Verville, P.C. September 9, 2009 Seventh Floor 1501 M Street, NW Washington, DC 20005 Phone: (202) 466-6550 Fax: (202) 785-1756

2. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 2 The Webinar describes how selected State VR agencies are participating in Medicaid Infrastructure Grant (MIG) projects to enhance employment outcomes for persons with disabilities through systems change initiatives in collaboration with other state agencies. Background materials regarding MIGs; Examples of programs, projects, and activities pursued by State VR agencies and other grantees; Official employment-related websites used by MIG grantees and others; and Examples of initiatives pursued with MIG funding by specific State VR agencies in the Southeast Region and in other regions. Introduction

3. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 3 The Webinar also describes the role State VR agencies are playing in implementing Work Incentives Planning and Assistance (WIPA) grants, which provide timely and accurate information to SSI and SSDI beneficiaries on SSA’s work incentives and other federal initiatives to remove barriers to employment for beneficiaries. Background materials regarding WIPA grants; The role played by state VR agencies regarding the implementation of WIPA grants; and Examples of accomplishments of State VR agencies in the Southeast Region and other Regions. Introduction

4. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 4 Background In 1999, Congress passed the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA). Section 203 of TWWIIA authorizes the funding of Medicaid Infrastructure Grants (MIGs). The Center for Medicare and Medicaid Services (CMS) in the Department of Health and Human Services (HHS) is the designated agency with administrative responsibility for this grant program. Medicaid Infrastructure Grants

5. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 5 Background The MIG program is intended to: Facilitate enhancements of State Medicaid programs and services, Promote linkages between Medicaid and other employment-related services and agencies, and Develop a comprehensive system of employment supports for people with disabilities. Medicaid Infrastructure Grants

6. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 6 Background Under the terms of the program, State VR agencies may apply for MIG funds in partnership, agreement, and active participation with the single State Medicaid agency, the State legislature, or the Office of the Governor. Currently, MIG grants have been awarded to 41 states and the District of Columbia. In 10 states, the lead agency is the State VR agency. Currently, Alabama, Florida and North Carolina have MIG funding. In the past, South Carolina received MIG funding. The Alabama and North Carolina grants are administered by the VR agency. The statute requires participating states to offer personal assistance services through the State’s Medicaid program sufficient to support individuals in employment. Medicaid Infrastructure Grants

7. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 7 Background It is expected that State VR agencies and other grantees participating in the MIG program will use funding to: Initially, remove employment barriers for people with disabilities by creating systemic change throughout the Medicaid program; and Later, to remove employment barriers within State and local systems generally. Medicaid Infrastructure Grants

8. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 8 Background In addition to participating in basic Medicaid Infrastructure Development grants, States may then use program funds to enhance these supports by building other infrastructures needed to develop a comprehensive employment system that coordinates disparate State service delivery systems i.e., form linkages between Medicaid services and other non-Medicaid programs. Medicaid Infrastructure Grants

9. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 9 Background The major objectives of the comprehensive employment system are to: Maximize employment of people with disabilities; Increase the State’s labor force through the inclusion of people with disabilities; and Protect and enhance workers’ healthcare, other benefits, and needed employment supports. Medicaid Infrastructure Grants

10. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 10 Examples of Uses of MIG Funds Medicaid Buy-In Programs Medicaid Services That Directly Support Individuals with Disabilities Who are Employed Benefits Counseling and Work Incentive Programs Employment Training, Education, and Networking Research and Evaluation Outreach Technical Assistance—Sharing of Lessons Learned Medicaid Infrastructure Grants

11. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 11 Official MIG Website The Federal Government’s Official MIG Website The official government website for MIGs and Medicaid Buy-In programs is: http://www.cms.hhs.gov/TWWIA/03_MIG.asp http://www.cms.hhs.gov/TWWIA/03_MIG.asp Medicaid Infrastructure Grants

12. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 12 Technical Assistance Centers The National Consortium for Health Systems Development The National Consortium for Health Systems Development (NCHSD) is a technical assistance partnership providing flexible, state-tailored technical assistance for Medicaid Infrastructure Grant (MIG) projects across the country. NCHSD is a project of Health & Disability Advocates (HDA). The website www.nchsd.org offers comprehensive disability and employment technical assistance.Health & Disability Advocates (HDA)www.nchsd.org A key feature of the website is the Resource Exchange which offers the latest information, events, reports and resources on disability and employment, especially tailored for Medicaid Infrastructure Grantees.Resource Exchange Medicaid Infrastructure Grants

13. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 13 Medicaid Infrastructure Grants Asset Development Benefits Planning Engaging Employers Housing Medicaid Buy-In (MBI) National Marketing Campaign Outreach and Education Personal Assistance Services Research and Evaluation Resource Mapping Stakeholder Groups Strategic Planning Ticket to Work Transportation Technical Assistance Centers The National Consortium for Health Systems Development For example, the website includes the following “hot topics”:

14. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 14 Technical Assistance Centers The Center for Workers with Disabilities The Center for Workers with Disabilities is a technical assistance center operated by the American Public Human Services Association (APHSA) for states enhancing or developing employment supports programs for working persons with disabilities. The Center’s website is http://www.aphsa.org/disabilities/home/index.htm. http://www.aphsa.org/disabilities/home/index.htm The Center operates several task forces, including: Asset development, Working with business, and Comprehensive employment. Medicaid Infrastructure Grants

15. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 15 Medicaid Infrastructure Grants Transportation PAS/ Caregiving Housing Financial Literacy/ Asset Development Health Supports Advocacy Disability Laws Benefits Planning/WIPA Education Transition Research ADA and Disability Rights Independent Living Technical Assistance Centers The Center for Workers with Disabilities Comprehensive Employment Below are links and resources providing more information on the following comprehensive employment topics:

16. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 16 Technical Assistance Centers Medicaid Infrastructure Grants—Research Assistance to States (MIG-RATS) www.migrats.org Medicaid Infrastructure Grants

17. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 17 Technical Assistance Centers The Clearinghouse for Home and Community Based Services The website www.hcbs.org promotes the development and expansion of home and community-based services by gathering resources and tools for research, policy making and program development into one-stop website. By facilitating the sharing of information, the website empowers professionals and consumers to be more effective in supporting real choice and independence for people with disabilities.www.hcbs.org Medicaid Infrastructure Grants

18. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 18 Technical Assistance Centers Below is an illustrative list of links to papers and articles specifically related to competitive employment: Home and Community-based Waivers and Self-Employment Customized Employment Self-determination and Revitalization of Integrated Employment Employment Options and Personal Assistance Services Employment for Persons with Brain Injury Supported Employment as Evidence-Based Practice Quality Indicators for Competitive Employment Outcomes Public/Private Partnerships and Employment of People with Disabilities Employment and Women with Disabilities Health Care for Workers with Disabilities—Supporting and Encouraging Employment. Medicaid Infrastructure Grants

19. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 19 State VR Agencies and the Implementation of MIGs This webinar includes a discussion of the following roles played by State VR agencies: State VR agency leadership role in the development and/or administration of MIG projects Examples of MIG programs, projects and activities operated by VR agencies Medicaid Infrastructure Grants

20. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 20 The Role of State VR Agencies in the Development of MIG Projects In Alabama, Connecticut, Indiana, North Carolina, South Dakota, Oregon, Texas, Utah, Vermont, and West Virginia the State VR agency administers/houses the MIG project and was the agency primarily responsible for the development of the original MIG proposal. This arrangement provides an incredible opportunity for these VR agencies to influence/affect policies, practices, and procedures within the Medicaid agency regarding the provision of health-related services and supports that enhance employment of persons with disabilities. **The written materials include emails for all the state VR agency contacts. Medicaid Infrastructure Grants

21. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 21 Medicaid Infrastructure Grants Alabama North Carolina Connecticut Indiana Oregon Texas Utah Vermont Examples of MIG Projects Administered by VR Agencies

22. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 22 Background and Overview The intent of the WIPA grants is to enhance the employment outcomes for State VR agency clients by: Reducing uncertainty and fear related to potential loss of benefits, if working; Enabling informed choice and decision-making concerning work; Supporting clients in using work incentives; Engaging community rehabilitation providers in these efforts to reduce fragmentation and improve coordination among providers; and Preventing duplication and ease of access by clients. Work Incentives Planning and Assistance Grants

23. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 23 Background and Overview WIPA projects are provided services to SSI and SSDI beneficiaries in all 50 states. Collectively, the 104 projects employ over 400 Community Work Incentive Coordinators (CWICs). Work Incentives Planning and Assistance Grants

24. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 24 The Role Played By State VR Agencies Regarding WIPA Grants The WIPA projects assist many entities, including State VR agencies, to provide employment services and supports. In some states in the Southeast region, the State VR agency is a WIPA grantee: Georgia Department of Labor, Division of Rehabilitative Services Mississippi Department of Rehabilitation North Carolina Division of Vocational Rehabilitation South Carolina Department of Vocational Rehabilitation Work Incentives Planning and Assistance Grants

25. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 25 Work Incentive Planning and Assistance Grants Examples of Accomplishments of WIPA Projects Georgia Mississippi North Carolina South Carolina Tennessee (Center for Independent Living of Middle Tennessee) Texas (Easter Seals of North Texas) Work Incentives Planning and Assistance Grants

26. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 26 Comments & Questions

27. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 27 Contact Information Robert “Bobby” Silverstein Powers Pyles Sutter & Verville, P.C. Email: Bobby.Silverstein@ppsv.comBobby.Silverstein@ppsv.com

28. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 28 THANK YOU!

29. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 29 TACE Center: Region IV Toll-free: (866) 518-7750 [voice/tty] Fax: (404) 541-9002 Web: TACEsoutheast.orgTACEsoutheast.org My TACE Portal: TACEsoutheast.org/myportalTACEsoutheast.org/myportal Email: tacesoutheast@law.syr.edutacesoutheast@law.syr.edu

30. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 30 Education Credits Participants may** be eligible for CRCC and CEU credits. CRCC Credit - (2.0) By Tuesday, September 15, 2009, participants must score 80% or better on a online Post Test and submit an online CRCC Request Form via the MyTACE Portal. CEU Credit - (.10 pending) Site Coordinators must distribute the CEU form to participants seeking CEU credit on the day of the webinar. Site coordinators must submit CEU form to the TACE Center: Region IV by fax (404) 541-9002 by Tuesday, September 15, 2009. My TACE Portal: TACEsoutheast.org/myportalTACEsoutheast.org/myportal **For CRCC credit, you must reside in the 8 U.S. Southeast states served by the TACE Region IV [AL, FL, GA, KY, MS, NC, SC, TN]. If beyond TACE Region IV, you may apply for CEU credit.

31. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 31 Disclaimer This presentation was developed by the TACE Center: Region IV ©2009 with funds from the U.S. Department of Education, Rehabilitation Services Administration (RSA) under the priority of Technical Assistance and Continuing Education Projects (TACE) – Grant #H264A080021. However, the contents of this presentation do not necessarily represent the policy of the RSA and you should not assume endorsement by the Federal Government [34 CFR 75.620 (b)].

32. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2009 All Rights Reserved 32 Copyright Information This work is the property of the TACE Center: Region IV. Permission is granted for this material to be shared for non-commercial, educational purposes, provided that this copyright statement appears on the reproduced materials and notice is given that the copying is by permission of the authors. To disseminate otherwise or to republish requires written permission from the authors.