Direct Care Workforce

State Medicaid agencies fund supports & services for individuals with disabilities. As national public policy recognizes & emphasizes the ability of individuals with disabilities to work, states are integrating employment supports into the continuum of long-term care in Medicaid. This brief discusses federal legislative & regulatory framework for funding employment supports in Medicaid, highlights examples of state innovations & best practices to promote positive employment outcomes.

Wider Opportunities for Women’s (WOW) database provides information on how much it costs for families & older adults to cover their most basic expenses: housing, food, and transportation. The Basic Economic Security Tables (BEST) Index and the Elder Economic Security Standard Index (Elder Index) measure the incomes workers & retired adults need to achieve economic security. Both measures use comprehensive definitions of economic security, presented at the state, county & city levels.

In 2008, Congress revised the regulations for Ticket to Work, a federal program created to improve incentives and supports for people who receive disability benefits to seek employment. This issue brief discusses how Ticket to Work participation by service providers and beneficiaries has changed under the revised regulations. It also describes providers' early experiences with these regulations.

The Affordable Care Act requires the Office of Inspector General to submit a report to Congress evaluating the law’s Nationwide Program for National & State Background Checks on Direct Patient Access Employees of Long Term-Care (LTC) Facilities within six months of the program’s completion. OIG recently conducted a survey of LTC provider administrators, & asked them about current practices regarding background checks on potential employees, & the effects of such programs on the LTC workforce.

As state and federal agencies strive to meet the growing needs of people with disabilities while using fewer resources, better disability data are needed for monitoring and improving the health, economic status, and overall well-being of this population. The report identifies limitations in national survey data on disability and outlines a wide range of potential short- and long-term options for addressing them, including developing and fielding a national disability survey.

Two reports look at costs, services, characteristics, and impacts of the Work Incentives Planning and Assistance program, which aims to inform beneficiaries with disabilities about work incentive programs, help them increase employment, and reduce their dependence on benefits. The program is serving a select group of beneficiaries who are actively working, seeking employment, using the SSA work incentive provisions, and leaving the disability rolls at relatively high rates.

Research from Mathematica's disability experts offers findings on programs to help move people with disabilities off the beneficiary rolls & into employment. As part of the 7-year evaluation of the Ticket to Work program, a recent report looks at the experiences of employment service providers after the Social Security Administration revised regulations to address challenges in the original program. The SSA successfully educated providers about revised regulations & instituted related supports.

These Guiding Principles were developed to help to preserve the rights of individuals under participant direction, no matter what form or model, if and when workers choose to form a union. The NRCPDS cover letter, Guiding Principles, and NRCPDS Director Kevin Mahoney's signing ceremony remarks are available here.

This survey contains daily private-pay rates for private & semi-private rooms in licensed nursing homes, monthly base rates for assisted living communities, hourly rates for home health aides from licensed agencies & agency-provided homemaker companion services, & daily rates for adult day services across the US. Costs for this survey were calculated for each service provider in an area & were aggregated across all providers to compute a statewide average cost.

Despite more than $428 billion in spending in FY2008 to assist working-age people with disabilities, services provided are often fragmented, confusing, & less effective than they could be. This brief explains how the government serves a caretaker role. Authors point out that this model runs contrary to the goal of maximizing self-sufficiency embraced by the Americans with Disabilities Act & fails to direct funds to help those with disabilities join, remain in, or return to the workforce.