Policy Brief: New Opportunities for Individuals with Disabilities to Expect Better Quality Services and Outcomes

The Home and Community-Based Settings Rule Attempts to Usher In Long Overdue Higher Standards

For nearly 35 years, the federal Medicaid program has given states the opportunity to provide services and supports outside of institutions to individuals with disabilities who would otherwise be eligible for institutional care.  Despite the fact that entitlement to institutional care remains a feature of the modern-day Medicaid program, many state Medicaid agencies have reached a point where they serve far more people with disabilities in non-institutional services (called “home and community services” or “HCBS”) than are served in institutional settings.  Spending patterns have followed, despite the fact that the per-person cost of institutional care rises exponentially as states reduce the numbers of people served in these settings. There is irrefutable and long-standing evidence demonstrating that, on the whole, serving individuals with disabilities in home and community based services and settings costs less than serving those same individuals in institutional settings. Read more…

Policy Brief: Can Supported Employment Flourish in a Medicaid Fee for Service System?


As states adopt Employment First policy and seek to increase the percentage of working-age individuals with disabilities who are participating in integrated employment at competitive wages, reimbursement methodologies for Supported Employment and related services become a core consideration for ensuring successful outcomes.  This policy brief discusses the issues with current approaches to funding Supported Employment services and explores the concept of outcome-based reimbursement for long-term (sometimes called “extended”) Supported Employment services in particular.  By way of illustration, the longest-standing models of outcome based reimbursement for Supported Employment is briefly described, including its impressive track record of success over nearly two decades. Read more…

Is Supported Employment a Good Investment for Taxpayers?

Or Are Sheltered Workshops Cheaper to Operate?

In this economic climate, vocational programs for adults with disabilities have to compete for the limited funds available.  In order to obtain these funds, services providers have to demonstrate the fiscal merits of their programs.  For instance, proponents of facility-based programs, such as sheltered workshops, might indicate that their services are better investments for taxpayers because they work with groups of people while supported employment only works serves person at a time.   Advocates of supported employment, on the other hand, might counter that their programs are better because they facilitate independence whereas sheltered workshops create dependence.  Which program is the best investment for taxpayers?  Several recent studies have attempted to answer this question. Read more…

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