NYAPRS Note: The Bazelon Center for Mental Health has just released a very timely report urging the federal and state governments to advance their efforts to promote employment for people with psychiatric disabilities. One recommendation in particular that is getting a lot of traction in New York and nationally is the adoption of the 1915.i Home and Community Based Services Waiver or Option that provides state with the flexibility to use Medicaid to fund a number of services it has not historically paid for, including employment. See the links that follow about the ‘i’ and where states were with adopting it at the time of Kaiser’s publication.
- http://kff.org/medicaid/state-indicator/section-1915i-home-and-community-based-services-state-plan-option/
- http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Home-and-Community-Based-Services/Home-and-Community-Based-Services-1915-i.html
Getting to Work: Promoting Employment of People with Mental Illness
Bazelon Center for Mental Health Law
Recommendations:
The Medicaid program is an important resource for states to expand the availability of supported employment services for individuals with serious mental illness. As we have described above, Medicaid dollars could be used to provide supported employment services to many more people with mental illnesses. Several key steps would advance this goal, including states covering a full array of supported employment services through their Medicaid programs, reallocating dollars from segregated day services to supported employment, and coordinating between mental health and vocational rehabilitation authorities to deliver supported employment services effectively.
Given the slow pace at which states have moved to expand Medicaid-financed supported employment services, Congress should incentivize the expansion of these services; it is in the federal government’s interest to ensure that federal Medicaid dollars are used for services that promote employment of people with disabilities and are consistent with the ADA. Accordingly, we recommend that:
� States cover a robust package of Medicaid-financed supported employment services for people with mental illness. The best avenues for accomplishing this are:
- Covering supported employment under the “home and community-based services” state plan option, known as the “Section 1915(i) option.” This option permits states to target a set of home and community-based services, including employment services, to a set of individuals using needs-based criteria (for example, individuals with serious mental illness who need supported employment services to secure and/or maintain work). States may choose to adopt a Section 1915(i) option for people with mental illness or for a broader group of people with disabilities including people with mental illness. This option gives states the flexibility to cover a broader array of services than other state plan options.
- Covering supported employment through a Medicaid demonstration waiver. Since the passage of the Affordable Care Act, many states have been applying for Medicaid demonstration waivers in order to facilitate better coordination of care for people with disabilities. These demonstration waivers afford states significant flexibility in choosing what services to cover, and may be used to cover a full array of supported employment services.
� States reallocate Medicaid and mental health funds from segregated day treatment services to pay for supported employment services instead.
� States coordinate the delivery of supported employment services between the state mental health authority and the state vocational rehabilitation agency.
� Congress amend the Medicaid statute to include incentives for states to expand their supported employment programs. For example, enhanced federal matching rates could be offered for states that expand the number of individuals with mental illness who receive supported employment services by a certain percentage.
http://www.bazelon.org/Where-We-Stand/Employment.aspx
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