For Most of the twentieth century it was assumed that people with significant developmental disabilities could not be employed in regular jobs at reasonable wages. In recent decades, we have demonstrated that people with developmental disabilities can be productive and valuable employees if they have specialized training and workplace supports. Community Supported Employment (CSE) services are intense, often one to one, on the job training and workplace assistance that can create real employment opportunities. CSE is the only Medicaid funded service that promotes employment for people with disabilities. It is available to people who qualify for the Developmental Disabilities Home and Community Based Services waiver.
In Idaho, Medicaid services for adults with developmental disabilities are allocated according to individual services budgets. The amount of a person’s budget is determined by a formula. The formula uses assessment scores, medical diagnoses and other factors to predict the cost of the services a person needs. The participant decides the types and amounts of each Medicaid service they want within the formula based budget. However, the formula does not always work. Individual circumstances and issues sometimes require that the budget be modified to meet the person’s basic needs.
In 2011 the legislature passed H260 to implement $113,000,000 in Medicaid cuts ($34,000,000 General Fund). One of the changes limited a person’s ability to modify the budget to changes necessary to protect the person’s health or safety. Employment is not a health or safety issue. This had the unintended consequence of seriously reducing access to community supported employment (CSE). From 2011 to 2013, the number of people getting or maintaining jobs through CSE dropped from 275 to 182. I believe that the trend is continuing and there are fewer people receiving these services today.
H476 would allow people to request modification of their individual service budget if the modification is needed to obtain or maintain employment. It does not restore the statute to the language before 2011. Employment is merely added to health and safety as a basis for requesting a budget Modification. Any modification requested would still have to be reviewed and granted or denied by Medicaid case managers.
If we could instantly develop a hundred jobs for people with developmental disabilities and return the program to 2010 levels, the impact to the state general fund would be about $235,000 (see Fiscal Note). It will probably take several years to return to that level of participation.
Passing H476 will open the door to real world work opportunities for hundreds people who have no other way to experience the benefits of employment. It is also an opportunity to demonstrate to employers the benefits of hiring people with disabilities and to show them how to support and accommodate these employees.