Addressing workforce issues is critical to successful compliance with the Olmstead decision and to the Promoting Independence Initiative (Initiative) because a stable direct service workforce (workforce) is necessary for individuals who choose to live in the community. The issue of retaining a trained and tenured workforce is a national problem as well as one confronting Texas.
Community-based Services Workforce Council
The Health and Human Services (HHSC) Executive Commissioner directed the Department of Aging and Disability Services (DADS) to convene a Community-based Workforce Advisory Council (Council). The Council's duties were to:
- identify and study direct care workforce issues, including wages and benefits, turnover, recruitment, training and skill development, and retention of personal attendants; and
- review the current and anticipated need in Texas for home and community-based services and workforce available in this state to meet that need.
A preliminary report by the Council was completed by May 1, 2010. The final report includes:
- an analysis of the current and anticipated funding needs for home and community-based services in the state in the workforce available to meet that need;
- identification of significant problems in the home and community based services workforce; and
- policy and funding recommendations.
The final report and other information may be found at: http://www.dads.state.tx.us/hcbscouncil/index.cfm.
Through the Money Follows the Person Demonstration (see Grants/Innovations Supporting Promoting Independence section for more information regarding the Money Follows the Person Demonstration), DADS will contract for a staff person to focus on the continuation of the Council and other workforce related policy.
Adding Medicaid Buy-In (Buy-In) eligibility to the waivers
The Buy-In program allows individuals with disabilities, who are working and earning more than the allowable limits for regular Medicaid, the opportunity to retain health care coverage through Medicaid, thus allowing them to earn more income without the risk of losing vital health care coverage. Buy-In provides Medicaid benefits to working individuals with disabilities, regardless of age, who apply for Medicaid and meet the requirements established by HHSC. An individual may be required to pay monthly premiums, based on the amount of the individual's earned and unearned income.
HHSC approved adding Buy-In eligibility to the Medicaid 1915(c) waivers and that process is complete. HHSC and the Department of Assistive and Rehabilitative Services (DARS) received a 2008 Medicaid Infrastructure Grant (MIG) (see Grants/Innovations Supporting Promoting Independence section) from the Centers for Medicare and Medicaid Services (CMS) in the amount of $500,000. The MIG program was created by The Ticket to Work & Work Incentives Improvement Act of 1999, which makes funds available through 2011. Texas is using the MIG award to enhance its Buy-In program. Additional information about the Buy-In program may be found on HHSC’s website at: http://www.hhsc.state.tx.us/mbi.html.
S.B. 187, 81st Legislature, Regular Session, 2009, creates the Medicaid Buy-In Program for Disabled Children which allows families whose income does not exceed 300 percent of federal poverty level to buy-in to the Medicaid program for their child with a disability. This program should be operational in fiscal year 2011.
DADS works with providers, individuals, parents, and other stakeholders who have identified the need for information and training to successfully support individuals with intellectual and developmental disabilities (IDD) to find and maintain competitive employment. DADS will continue to regularly solicit stakeholder input on a plan to improve employment outcomes for persons receiving DADS services.
Staff has continued working on DADS Employment Services Training and Technical Assistance Initiative. The purpose of this initiative is to improve employment outcomes for individuals with IDD receiving services in DADS programs. As part of this initiative, staff hosted regional forums on employment for providers and other stakeholders. Forums were held in Fort Worth (June 22), Houston (June 24), and San Antonio (September 14).
Another activity of this initiative, the Employment First pilot, began in April, 2010 with a voluntary group of state supported living centers and Home and Community-based Services waiver providers. Participants in the pilot will form a partnership locally with other organizations involved in employment services, and will utilize the resources and expertise of the partnership to assist at least three individuals interested in working to gain and maintain competitive, integrated employment. DADS will also offer sometime next year, technical assistance grants for providers towards increasing the number of consumers in integrated, competitive employment.
Demonstration to Maintain Independence and Employment (DMIE) - Working Well
CMS awarded Texas a $21.1 million grant to determine whether providing health coverage and employment supports would keep working individuals with mental and physical disabilities from depending on federal benefits, such as Medicaid, SSI, or SSDI. Texas received CMS approval to implement the DMIE study in February 2007. Federal disability programs provide financial and medical assistance to workers who become disabled, however there are no federal programs designed to prevent workers with significant health problems from becoming disabled and dependent on federal assistance. Working Well was authorized under the Ticket to Work and Work Incentives Improvement Act of 1999.
Working Well interventions included: case management (health and employment navigation, motivational interviewing, advocacy and empowerment), employment services, expedited clinic appointments, substance abuse services, dental benefits, vision benefits, prescriptions, and waived co-payments for health services. DMIE interventions ended on September 30, 2009 with the evaluation of the post-intervention phase to conclude in December 2010.
Working Well is administered by the Texas Department of State Health Services Mental Health and Substance Abuse Division, operated locally by the Harris County Hospital District, and independently evaluated by the University of Texas at Austin Addiction Research Institute (see Grants/Innovations Supporting Promoting Independence section for more detailed information).
Realistic Job Preview
DADS developed two twenty minute realistic job preview (RJP) videos of the direct service worker position to be made available to agencies and individuals considering this career. Studies have shown RJPs to positively affect employee retention rates. These videos will educate job applicants about the rewards and challenges of direct support work in order to help individuals decide if this is the type of work best suit for them.
One video targets applicants seeking to work with individuals with developmental disabilities; the other will target those interested in working with individuals with physical disabilities. The goal in producing these videos is to reduce turnover among direct service workers. These videos were produced with funding from the Money Follows the Person Demonstration and are on the federal CMS website. The videos may be found on DADS website at: http://www.dads.state.tx.us/providers/jobpreview/index.html.
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May 24, 2011