Reports

How can state developmental disabilities agencies minimize service interruptions while absorbing budget cuts? At a 2008 forum, directors of these agencies shared their strategies, experiences and thoughts on the topic. Those ideas are synthesized here.

This May 2008 presentation by Mary DeRoo of the Elder Services of Merrimack Valley in Massachusetts describes the risk management system they use that manages risk while maximizing consumer choice and control.

Recognizing caregivers' needs, many federal and state lawmakers have spent the past several years introducing legislation to provide supports to caregiving families. Unfortunately, fiscal crises and other pressing social concerns have meant that few of these proposals have actually passed or been enacted. Trends in caregiver legislation introduced in 2007 and 2008 are summarized and those that have been successful are highlighted.

CA’s In-Home Supportive Services (IHSS) aims to keep people in their homes by paying for personal care services approved by social workers. SB 1104 was introduced in 2004 to ensure and measure delivery of services and program integrity. The report examines whether the elements of the bill were enacted. It also describes alternative models for in-home service delivery, including the Cash & Counseling model and one wherein private companies provide IHSS. Sample timecards and handbooks are given.

In 2004, a task force reviewed Veterans Affairs’ Vocational Rehabilitation and Employment (VRE) program and recommended focusing on employment through a Five-Track service delivery model and increasing program capacity. Here, the GAO looks at how employment has been impacted, the extent to which steps have been taken to improve capacity, and how program outcomes are reported. The authors recommended adjusting financial incentives and to improve strategic planning and transparency of reporting.

The study compares monthly income for people receiving Supplemental Security Income (SSI) to local median incomes and Fair Market Rent rates for modest units across the U.S. In 2008, there were 219 housing markets in 41 states where recipients of SSI, people with long-term disabilities and virtually no assets, would have to pay 100% of their income for a modest one-bedroom unit. Ten years ago there were 44 such markets in 13 states. Policy recommendations are given to reverse this trend.

The Chartbook documents trends in enrollment, earnings, employment, medical expenditures, and consumer experiences and satisfaction since Kansas began its Buy-In program. Summarized are survey and administrative data that document increased earnings and taxes paid over time by participants, decreased medical expenditures for those continuously enrolled, and improved quality of life and financial status.

Here is a snapshot of the program , seven years after implementation. The report introduces the grants, their assessment process, profiles funding recipients, and measures how well the program protects workers’ benefits and increases employment. Finally, recommendations for improving outcomes are provided.

Via IHSS Plus, participants are able to receive certain expanded in-home services as part of Medi-Cal. Before, payments for these services were not matched by a federal contribution and were administered through a separate program. The analysis looks at implementation and service use in 2005, compares recipients’ outcomes and institutionalization rates to those in the original IHSS program, and complements the State’s evaluation and other research on paying family caregivers.

While progress is being made in finding meaningful jobs for individuals with developmental disabilities, an economic downturn makes it difficult to hold the focus on employment goals and maintain momentum within state agencies, services providers, and community employers. State officials offer talking points to guide and assist decision-making to maintain critical components of the service delivery system.