The Case for Medicaid Self-Direction: A White Paper on Research, Practice, and Policy Opportunities

Executive Summary

In recent years, self-direction has emerged as a game-changing strategy in organizing and delivering Medicaid funded services, a means of affording people with disabilities enhanced opportunities to live fulfilling lives of their own choice in local communities. Yet, despite the growth in self-directed services, many key questions remain to be answered about the most effective ways of promoting individual choice and control within a Medicaid funding environment.

a graphic of a piggy bank with the words 'my budget' and 'self directed supports'To assess the current state of knowledge and pinpoint remaining gaps that need to be filled, in the fall of 2011 the National Council on Disability commissioned a study of Medicaid-funded self-directed services.

This paper, dated May 2013, summarizes the key study findings, conclusions, and recommendations, and…

  • Traces the history of self-directed services in the US and its emergence and subsequent growth within the Medicaid policy arena
  • Examines the fundamental concepts that undergird a self-directed approach to organizing and delivering community-based long-term services and supports
  • Reviews the basic components of self-directed services as spelled out in federal Medicaid policy
  • Summarizes the findings and conclusions from existing studies of the cost- effectiveness of self-directed services
  • Explores the ramifications of the growing use of Medicaid managed care arrangements for the future of self-directed services and supports
  • Recommends strategies for improving the accessibility and quality of self- directed Medicaid services and supports

The National Council on Disability wishes to express its deep appreciation to the National Association of State Directors of Developmental Disability Services (NASDDDS) team that conducted the research and writing for this paper: Robert Gettings, Charles Moseley, and Nancy Thaler.

Click here to read the full report.

National Council on Disability logoNational Council on Disability (NCD) is an independent federal agency charged withadvising the President, Congress, and other federal agencies regarding policies, programs, practices, and procedures that affect people with disabilities. NCD is comprised of a team of fifteen Presidential appointees, an Executive Director appointed by the Chairman, and eleven, full-time professional staff.


Workforce of the future? Federal Bipartisan bill would overhaul job training

The Workforce Innovation and Opportunity Act, the result of months of negotiations, addresses everything from adult literacy and job training to preparing youths with disabilities for employment.

The nation’s workforce development system would receive a long-awaited overhaul under a bipartisan bill announced Wednesday by key committee leaders in both houses of Congress.

a graphic of the jobs section of a newspaperThe Workforce Innovation and Opportunity Act (WIOA) is the result of months of negotiations. It would finally reauthorize – for the next five years – a law passed in 1998 that has been getting by with year-to-year appropriations since it was originally due for reauthorization in 2003.

The WIOA updates two other laws and addresses adult literacy and job training to preparing youths with disabilities for employment. The goal is to streamline/coordinate programs and reflect changes in the field.

“We can’t expect a modern workforce to succeed with an outdated job training system. The current workforce development system is broken with too much bureaucracy, too many inefficiencies, and too little accountability,”

said Rep. John Kline (R) of Minnesota, chairman of the House Education and the Workforce Committee, in a statement Wednesday.

Sen. Patty Murray (D) of Washington, a senior member of the Senate Health, Education, Labor, and Pensions Committee (HELP), said in a statement that the bill will

“give workers and students the resources they need to succeed…. It’s a prime example of what’s possible when Republicans and Democrats in the House and Senate work together to write laws that help our economy grow.”

Here are some of the key ways the bill is intended to improve the current system:

  • It consolidates and streamlines programs. Fifteen programs will be eliminated, though some of them were defunded years ago. More than twice that number would have been axed under the SKILLS Act passed by the House in March. In addition, states, which receive funding based largely on levels of unemployment, will have to submit a strategic plan showing how they will coordinate training, education, and vocational rehabilitation (services for people with disabilities). The system will also become more tailored to individuals, instead requiring that everyone follow a rigid “sequence of services” before they are trained.
  • a chart with the word improvementIt requires all programs to show how they do on a common set of performance metrics, looking at outcomes such as employment, earnings, and postsecondary education. That means adult literacy programs can’t just focus narrowly on teaching people to read, but should align themselves with or even integrate into occupational training or paths to higher education. One big improvement to the performance metrics is that they would include retention for people in longer-term programs, who previously may not have been counted in the “success” column, says Jim Hermes, an associate vice president at the American Association of Community Colleges in Washington.
  • It improves outreach to disconnected youths: Seventy-five percent of youth funding under the bill must serve out- of-school youths. This is significantly higher than previously required, and will enable better support for the field’s growing emphasis on dropout recovery programs, says Andrew Moore, a senior fellow at the Institute for Youth, Education and Families based at the National League of Cities in Washington.

    “We’ve seen good examples in places such as Los Angeles and Boston… with partnerships between the local workforce board and the school district to get young people back to school,”

    he says. The bill also lends support to strategies that focus on getting youths not just back to school, but also on track for credentials for jobs and postsecondary education.

  • It boosts the preparation of young people with disabilities to work in competitive employment. States would have to set aside 15 percent of the relevant funds to help disabled youths transition to higher education or employment. And the bill assures them the opportunity to experience integrated employment. The WIOA includes various

    “groundbreaking changes that will raise prospects and expectations for Americans with disabilities, many of whom, under current law, are shunted to segregated, sub-minimum wage settings without ever receiving the opportunities and skills to succeed in competitive, integrated employment,”

    said the HELP Committee chairman, Sen. Tom Harkin (D) of Iowa, in a statement.

The compromise bill is more similar to a bill passed by the Senate HELP committee than the House’s SKILLS Act, in that it retains more guidelines for use of funds and more input for local elected officials rather than giving governors more control over how to spend the block grants, says Neil Bomberg, program director in federal advocacy at the National League of Cities.

“It’s been a long trail to get here. It’s almost surreal that it may actually be done in a manner of weeks,” says Mr. Hermes of the community colleges association.

Article reprinted in part from Stacy Teicher Khadaroo, Staff writer / May 21, 2014
(The Christian Science Monitor)

Transition to Integrated Employment: A 2014 Series of Trainings and Public Forums


June 19 & 20, 2014

the rhode island college logothe paul v. sherlock center logoRhode Island College and the Paul V. Sherlock Center on Disabilities, a federal University Center for Excellence in Developmental Disabilities, are hosting a series of public forums and workshops in 2014 focused on promoting a comprehensive approach to transition and integrated employment. The third series will be held on June 19 & 20. The details are provided below.


Workshop: Implementing the Discovery Process and Customized, Community Employment

Friday, June 20, 2014 8:15 AM – 4:00 PM
(8:15 AM Registration; 8:45 Start Time)

SAVE THE BAY, 100 Save the Bay Drive, Providence, RI  02905

Customized Employment is a strategy that provides persons with significant barriers to employment, with an alternative to traditional, competitive jobs. Customized Employment relies on a negotiated job development strategy rather than applying for competitive positions. This approach shifts the focus on a person fitting into an existing job and instead developing a customized position that fits an individual’s unique skills and support needs.   This workshop will provide an overview of proven customized employment strategies including Discovery to Customized Employment Planning, Employer Engagement and Individual Job Negotiation.

Who Should Attend:

Vocational assessment staff;  employment specialists, job developers,  DSP’s; vocational rehabilitation counselors, teachers and para-professionals, and anyone interested in understanding the strategies that support implementation of customized employment.

About the Presenter:

Michael Callahan has consulted throughout the US, Canada and Europe in the area of supported employment for the past twenty-three years. He has worked with Marc Gold & Associates (MG&A) since 1979 and has served as president of the organization since Marc Gold’s untimely death in 1982. He is an editor of a popular “how-to” book on employment for persons with severe disabilities, Getting Employed, Staying Employed (1987) and co-author of Keys to the Work Place (1997) a text on systematic instruction and natural supports in supported employment. He has written numerous articles, chapters, manuals and curriculums pertaining to employment of persons with disabilities. Michael is the vice-president of Employment for All.

Registration Fee: $15.00
Register by: June 13, 2014

(Late registrations accepted as space permits.)

Approved for CRC Credit

Public Forum: Introduction to the Discovery Process and Customized, Community Employment

Thursday, June 19, 2014
6:00 – 8:00 PM

Alger Hall, Room 110
Rhode Island College, Providence RI


Michael Callahan, President, Marc Gold & Associates
Colleen Moynihan, Director, Business Development Center, New England Business Associates (NEBA)

This forum offers an overview of customized employment as a means to engage individuals with significant disabilities into the workforce, including self -employment. Michael Callahan will highlight best practice strategies from discovery to business negotiation that support successful customized employment outcomes. Additionally, Colleen Moynihan, will discuss the pro’s and con’s to self-employment including strategies and resources that support developing a business concept to implementing the business plan.

This event is open to the public. There is no cost to attend. RSVP is requested by Monday, June 16. Directions and a parking pass will be emailed to people registering in advance. Please use the Online Registration Form to RSVP.

Approved for CRC Credit