Policy alerts, briefs, letters & papers

A final rule that would allow more Medicaid beneficiaries to be in charge of their own personal assistance services, including personal care services, instead of having those services directed by an agency, was published in the Oct 3, 2008 Federal Register. The rule, effective Nov. 3, 2008, guides states that wish to allow beneficiaries who need help with activities of daily living to hire, direct, train or fire their own personal care, workers including qualified family members.

Direct care worker (DCW) training and education are challenging issues in all states. Iowa set up a taskforce to review existing requirements, streamline the process of training and education, and to establish a DCW registry by expanding the Iowa Nurse Aide Registry. The taskforce recommends classifying DCWs by function (rather than setting or population served) and developing a governing body, a single approved curriculum, and a certification system for all DCWs.

This report offers recommendations to increase opportunities for people with disabilities to become fully involved in the economic mainstream of society. It presents research findings in key areas such as education and health care. It also describes selected state-level innovations affecting asset development and wealth accumulation. Finally, the report makes policy recommendations for securing meaningful employment, career advancement, and benefits needed for daily living and accommodations.

A recent trend in health care has been the increasing integration of behavioral health services into primary care settings. This paper discusses the benefits of such integration and the role of safety net primary care providers as behavioral health providers within the Medicaid program. The authors focus on organizational structure and reimbursement models in analyzing how four state programs achieve this integration.

The Americans with Disabilities Act (ADA) does NOT affect an employer's right to hold all employees to performance and conduct standards. It does mandate that employers make reasonable accommodations so individuals with disabilities can meet those standards. This guide explains how and when employees should request these accommodations and how employers should handle such requests. The Equal Employment Opportunity Commission periodically updates the guide on their website.

Using information from published literature, interviews and focus groups, this review covers a wide variety of characteristics of the jobs of direct care workers in the behavioral health field. It also looks at the prospects and requirements for developing more effective career paths that recognize and reward quality workers. It concludes with 12 policy recommendations.

Wisconsin used MIG funds to increase self-directed supports within a managed care framework in their state. Find here a set of policy recommendations used for setting the stage for this effort as well as a qualitative study outlining the implementation process. There are also several presentations focused on training support workers to understand and facilitate self-direction, using Cash & Counseling to support employment, and helping people with traumatic brain injuries return to work.

Find here examples of communications used to answer questions about eligibility and the application process for waiver programs. The first handout summarizes the three levels of financial eligibility and strategies for helping an individual maintain benefits. The second resource, a training presentation, provides this information in more detail and uses an anecdotal character to walk through the requirements. Finally, the chart illustrates basic eligibility requirements in a simple chart.

The Center for Workers with Disabilities prepared this report for the Virginia MIG advisory committee. It contains an analysis of the ways states provide personal assistance services (PAS) through a personal care Medicaid State Plan Option (SPO) to persons in Buy-In programs. It looks at specific legislation, State Plans and amendments, administrative rules, and implementation manuals. It ends with recommendations from an analysis conducted for Iowa on whether to implement this option there.

Since 2001, the U.S. Department of Labor has funded 20 Customized Employment and 6 Workforce Action demonstration projects to identify policy mechanisms that effectively support customized employment. This report gives the background, key findings, successful strategies, obstacles, and analysis of the different projects. The main work product is a set of local, state, and federal policy recommendations generated by the initiative.