“Creating real opportunities for people with disabilities to engage in meaningful work while maintaining their health and wellness has been a pressing employment policy challenge of the last two decades. People with disabilities must plan around a major complicating factor: maintaining access to affordable healthcare and related necessary services. This briefing summarizes changes made in statutes and initiatives to reduce conflicts between healthcare and support service programs’ eligibility criteria, and society’s need to expand economic self-sufficiency. California is actively addressing the challenge by connecting activities across program lines. Two of the major state-level initiatives are Governor Davis’ Workforce Inclusion Initiative and the Department of Health Services’ California Health Incentives Improvement Project. This policy framework serves as an important backdrop in implementing employment strategies to serve people with complex career and life planning issues.”

--Herb K. Schultz, Undersecretary and Acting Secretary
California Labor and Workforce Development Agency

Background

About one million unemployed Californians with disabilities receive federal and state monthly disability cash benefits valued at nearly $9 billion annually. Most are abjectly poor or near poor. Of the 2.5 million working age Californians who report having a disability less than 50 percent reported being employed in 2000.¹

In the mid 1990s public policy began to shift towards restructuring workforce delivery programs, public health care coverage and disability cash benefit programs in order to better respond to the education, training and employment needs of all citizens, including individuals with disabilities. The new policy framework required and achieved statutory and regulatory changes that have begun to build, redesign and train local service providers on the infrastructures necessary to ensure the full inclusion of working individuals with disabilities.

Working with many state and local partners, the Social Security Administration will launch the Ticket to Work and Self-Sufficiency Program throughout California in November 2003 targeting an initial ten percent of the working age disability beneficiaries living in the State. In readiness for rollout of the Ticket to Work Program, California’s Governor Gray Davis signed the Workforce Inclusion Act (Assembly Bill 925) to optimize collaboration between state agencies, federal programs and grant opportunities.

In context with these new laws, Governor Davis announced the Governor’s Workforce Inclusion Initiative in January 2003. The Governor acknowledged with this Initiative that maximizing employment options for all Californians is the soundest long-term workforce and economic strategy for our state.

This policy and program framework outlines the restructuring of the workforce investment and health care systems at the federal level, and how policy and program is unfolding in California. Whether one grows up with a disability, becomes newly diagnosed while employed, experiences a sudden onset of disability from an accident or is entering the workforce with a disability, the level of support must be based upon assessment of the person to the program(s), not the reverse. By expanding collaboration between the human resource departments of employers, providers of public and private health care services, and generic employment programs such as One-Stop Career Centers, the policies and grants described in this brief will have a greater likelihood for success.

“These initiatives are ‘comprehensive’ and ‘person-centered’ in the sense that they must ensure that vocational rehabilitation, job-training, education, health, income assistance, housing, transportation and informal supports are responsive to the individualized goals and aspirations of each person with a disability and empowers each individual with information to make informed choices related to work.”²

Federal Overview

The federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) marked the beginning of a new series of federal changes to address the employment access of individuals with disabilities. HIPAA allows workers with disabilities who have had recent public or private health care to access most employer-based health insurance without long waiting periods.

The federal Balanced Budget Act of 1997 (Public Law 105-33) Section 4733 expanded allowable eligibility criteria, which allows states to provide Medicaid coverage to certain working disabled individuals. The intent of this provision is to promote self-sufficiency and encourage individuals with disabilities to seek employment opportunities without fear of losing essential health care benefits. Combined with HIPAA, a disabled worker can now use Medicaid (Medi-Cal in California) in the workplace to supplement employer-based health care plans for seamless coverage of disability related needs.

In July 1997 the U.S. Department of Labor (DOL) awarded nearly $5 million to 18 partners for planning and establishing a local One-Stop system in California. While the award of these funds certified the beginning of California’s One-Stop Career Center delivery system, policymakers and stakeholders at the federal, state and local levels continued working to design a workforce system that will offer equal economic opportunity for self-sufficiency to all job seekers in California.

The Workforce Investment Act (WIA) of 1998 provides the new framework for a national workforce preparation and employment system designed to meet the needs of the business community and all people wanting to obtain employment and advance their careers. California is strongly committed to the development of a statewide One-Stop system which promotes customer choice, offers integrated access to a full array of workforce preparation programs and provides universal access to individuals with disabilities without the need to request special accommodations.

The Ticket to Work and Work Incentives Improvement Act of 1999 (Ticket Act) removes barriers that have influenced disabled people’s decisions regarding health care coverage and work. The major goals of the Ticket Act are to increase a beneficiary’s choice in obtaining rehabilitation; vocational and employment services; remove barriers that require people with disabilities to choose between health coverage and work; and assure that more Americans with disabilities have the opportunity to participate in the workforce and lessen their dependence on public benefits. The Ticket to Work and Self-Sufficiency Program will be launched throughout California in November 2003. The program will provide almost a million disability beneficiaries with a “Ticket” for employment services from a widening range of service providers, called Employment Networks. These networks will expand service options for employment, vocational rehabilitation and other support services from public and private providers.

Grant and Program Support. The Ticket Act also authorized the Center for Medicaid and Medicare Services to award grants promoting system change and individual supportive services including Real Choices, Medicaid Infrastructure Grant and other resources for states to design, establish and coordinate infrastructures within their health, social service, and employment systems.

The Ticket Act authorized establishment of the Benefits Planning Assistance and Outreach (BPAO) Program by the Social Security Administration (Social Security). Under BPAO, California Independent Living Centers and other community-based organizations have received 13 grants to provide accurate information about federal work incentives to individuals with disabilities who receive Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). These organizations are responsible for informing SSI and SSDI beneficiaries of the advantages of using work incentives and providing them with benefits planning advice when they obtain employment.

Since 2001, nearly $25 million in federal grants have been announced to support Customized Employment Grants and the New Freedom Initiative goal of integrating Americans with disabilities into the workforce. Administered by the DOL Office of Disability Employment Policy, the grants provide for strategic planning and implementation activities designed to improve the employment and career advancement of people with disabilities. The awards support state efforts to develop model programs and innovative approaches for customized employment for adults with disabilities, innovative demonstration grants for youth with disabilities, high school program implementation for youth with disabilities, and technical assistance for community rehabilitation providers utilizing Special Minimum Wage certificates for people with disabilities.

To promote employment opportunities for people with disabilities the DOL and Social Security recently unveiled the following initiatives:

• The DisabilityInfo.gov is a one-stop informational portal to federal government websites relevant to people with disabilities, employers and service providers. Included is information on civil rights, education, employment, housing, health care, and transportation. For more information access http://www.disabilityinfo.gov.

• The National Center on Workforce and Disability for Adults is available to assist One-Stops, State and Local Workforce Investment Boards, agencies and employers. Information on improving customer services is available online at http://www.onestops.info or by telephone at (888) 886-9898.

• The National Collaborative on Workforce and Disability for Youth provides information and ensures that youth with disabilities receive full access to high quality services in integrated settings that will maximize their opportunities for employment and independent living. Information is available online at http://www.ncwd-youth.info.

• The DOL and Social Security have jointly formed the new position of Disability Program Navigator. Working in the One-Stop Career Centers, the Navigators will link people with disabilities to benefit planning resource assistance, employers and outreach organizations. Additionally, working with the new DOL Ticket-to-Hire Program, the Navigators will form a specialized network to link employers to job seekers with disabilities. The State Workforce Investment Boards in 17 states, including California, were invited to apply for cooperative agreements to establish Navigator positions in One-Stop Career Centers. California successfully received an award of $600,000.

United States Senator Tom Harkin, in a speech delivered in American Sign Language on July 26, 2000 commemorating the tenth anniversary of the Americans with Disabilities Act stated: “We expect people with disabilities to work.”

State Overview

Main elements of this emerging policy framework are evident in key California enacted legislation and successful competition at state and local levels for demonstration and systems change grants to implement those policies. Assembly Bill (AB) 155 (Chapter 820, Statutes of 1999) created the California Working Disabled Medi-Cal Buy-In Program (CWD) which provides Medi-Cal (the Medicaid program in California) coverage to certain working disabled individuals.

The CWD Program broadens the eligibility for Medi-Cal buy-in to include employed disabled individuals with countable income that is less than 250 percent of the federal poverty level. Under the CWD Program, Medi-Cal recipients with disabilities can earn up to $42,000 a year in gross wages. In response to a Medicaid Infrastructure Grant (MIG) application to the Center for Medicaid and Medicare Services (CMS), the Department of Health Services (DHS) received a $500,000 transitional grant in 2001, establishing the California Health Incentives Improvement Project. This project is designed to promote outreach for the buy-in program, expand In-Home Supportive Services (IHSS) and examine other health related benefit issues. An additional $500,000 was awarded for 2003 through 2006 to continue the work begun under the California Health Incentives Improvement Project.

Governor Gray Davis signed AB 925, widely referred to as the Workforce Inclusion Act, on September 29, 2002. The new law requires extensive intergovernmental collaboration to remove barriers to employment for people with disabilities:

“The Governor shall authorize the secretary of the Labor and Workforce Development Agency, in collaboration with the secretary of the California Health and Human Services Agency, to make available the expertise of state employees and programs to support the employment-related needs of individuals with disabilities.”

AB 925 (Chapter 1088, Statutes of 2002) Sec. 12803.6(a)

The five major provisions of the Workforce Inclusion Act:

1. Requires California’s new Labor and Workforce Development Agency, in collaboration with the Health and Human Services Agency, to implement a sustainable, comprehensive strategy to bring people with disabilities into employment at a rate comparable to that of the general adult population.

2. Allows state-funded personal assistance services to be available in the workplace as well as in the home.

3. Engages the newly empowered Governor’s Committee on Employment of People with Disabilities to increase and improve cooperation between the Department of Health Services, the Employment Development Department and other state agencies and private employers.

4. Requires State and Local Workforce Investment Boards to include people with disabilities, if permitted by federal law.

5. Provides for training in benefits planning to include the Departments of Health, Social Services and Rehabilitation as a means to foster self-sufficiency and improved employment outcomes for people with disabilities, when funds become available.

The California Workforce Investment Board (CalWIB) convened the Universal Access Work Group in early 2001 as a result of a multi-agency task force. With leadership from the Department of Rehabilitation, the Work Group, which includes public and private partners, was established to deal with issues related to assessment and standards and to provide resources, training, technical assistance, administration and monitoring within a framework of accessibility for all in the State’s One-Stop delivery system. The Work Group drafted and disseminated a comprehensive Physical and Program Access Self-Assessment Guide for use by all Local Workforce Investment Areas and One-Stop Career Centers.

In addition to the above, a consortium of state partners is supporting capacity building in the One-Stop system to serve people with disabilities. This group consists of the CalWIB, Governor’s Committee on Employment of People with Disabilities, Department of Rehabilitation (DOR), State Rehabilitation Council, the Employment Development Department (EDD), World Institute on Disability, San Diego State University and California Workforce Association. To augment federal funding, the consortium supported DOR’s successful application of a DOL grant for close to $1 million to operate the Workforce Investment Resources and Accommodations Project (WRAP). WRAP funds are earmarked to support the design and structure of services to customers with disabilities served through the One-Stop workforce system. WRAP will also fund a Benefits Planning Information Center (www.disabilitybenefits101.org) for provision of state-specific and updated benefits and resource information for persons with disabilities. Project activities are coordinated through the CalWIB Universal Access Work Group.

Grant and Program Support. In his 2000-2001 Budget announcement, Governor Davis dedicated $1.4 million from the WIA 15 Percent Discretionary Funds to improve access for persons with disabilities in One-Stop Career Centers. An interagency agreement for $900,000 was executed between the DOR and EDD to provide technical support, assistance and training to local areas and partners from the One-Stop Career Centers to address both the program and physical access of persons with disabilities as it pertains to service delivery, disability employment law and disability awareness. In January 2002, the EDD, in collaboration with the DOR, announced the availability of $500,000 from this grant to assist the local areas in the purchase or acquisition of auxiliary aid and services specifically for new, expanded or enhanced program access within the One-Stop system for persons with disabilities. At the recommendation of the Universal Access Work Group, 31 Local Areas received funding to make program and physical enhancements to One-Stop facilities that will ensure access for the disabled population.

Another $1.4 million from the WIA 15 Percent Discretionary Funds was appropriated in the Governor’s 2002-2003 Budget. These funds will target the continued expansion and improvements of statewide capacity building efforts involving customer access to facilities, information technology and program services, and for funding innovative projects through local organizations that will improve outreach, service delivery and outcomes for people with disabilities.

The California Department of Social Services was awarded a $1.3 million Real Choice Systems Change grant to make improvements to the State IHSS Program. The IHSS Program provides services to more than 275,000 disabled Medi-Cal beneficiaries with long-term care needs. The grant funds will be used to develop training and educational materials, identify support needs of IHSS providers and create materials, tools and work aids that will enable providers to improve the quality of care they provide.

The Governor’s Workforce Inclusion Act announced in January 2003, plans to provide a policy framework for leadership, program and service coordination and eventual inclusion of all state and local partners who have a role in training, educating, finding employment for, employing and supporting persons with disabilities.

The Governor’s Committee on Employment of People with Disabilities and other state partners was recently awarded a Work Incentive Grant from the DOL, Employment and Training Administration. The $500,000 award supports a strategy to address barriers to employment for people with disabilities that have been identified by One-Stop Career Center frontline staff. These barriers include the need (1) for well-trained, highly knowledgeable resource staff at One-Stop Career Centers to provide customers with disabilities comprehensive employment information regarding services and benefits; (2) to increase the employer community’s awareness of qualified job applicants with disabilities; and (3) for state and local partnerships to identify and implement innovative service strategies through assistive technology, and conduct outreach to disability communities to inform people with disabilities of available services. This plan is further supported by the DOL award of $600,000 to establish Disability Program Navigators in the State through a cooperative agreement. A local solicitation process resulted in nine Navigators being employed across the state through these funds.

California received a $500, 000 award from the DOL, Office of Disability Employment Policy to provide innovative services to youth with disabilities. The award will aid in conducting resource mapping to assess youth service delivery infrastructure, developing a unified State plan to improve transition outcomes for youth with disabilities, and in conducting local pilot demonstrations to determine how youths with disabilities can best obtain transition services. As a leader in the use of resource mapping, California will focus transition strategies, using existing intermediaries, to connect to youth councils and to partner with community organizations. The award of this grant will ensure continuity in building upon an extensive and strong history of innovative programs serving transition-age youth with disabilities and could result in successive grants of $500,000 annually for five years.

“I am proud to have been a part of the…development of an employment assumption for consumers – that those who can work should work, unless they are independently wealthy. Independent living is not the absence of supports, but the presence of supports that encourage independence and empowerment.”
--G. “Bud” Sayles, San Diego, CA, July 2002,
Executive Director, San Diego Public Authority and Past Chair, Steering Committee,
Health Incentives Improvement Project, DHS

Local Area Overview

California’s 50 Local Workforce Investment Areas have incorporated federal and state policy for the development of a workforce preparation and employment system that provides universal access. Several projects have been funded to promote access to services and the employability of individuals with disabilities. Examples include:

• The North Bay Employment Connection was formed to address the specific regional workforce development needs of four contiguous counties in the northern San Francisco Bay region: Marin, Napa, Solano and Sonoma. With a DOL Customized Employment Grant award, the I.N.C.L.U.S.I.O.N Project (Implementing the New Freedom Initiative through Customized employment and Linkages for Ultimately Seamless service In One-Stops Newly trained) outlines a system to better serve individuals with disabilities, increase access to services, provide higher wages for job seekers and an increased skilled labor pool for local employers. Additionally, the Napa Workforce Investment Board was awarded a $500,000 Innovative Demonstration Grant to develop a model program to serve youth with disabilities. In August 2003 the Board was awarded a $300,000 Work Incentive Grant to enhance services available in One-Stop Career Centers to people with disabilities.

• The San Diego Workforce Partnership was awarded a $750,000 Customized Employment Grant from the DOL, Office of Disability Employment Policy. The activities of the Customized Employment Project are to upgrade the physical and programmatic capacity of One-Stop Career Centers in order to increase access and provide seamless and quality employment services to people with disabilities. Collaborative partners in the project include governmental, private non-profit and community-based organizations. Additionally, the locally based Able-Disabled Advocacy organization received a $500,000 Innovative Demonstration Grant in 2002 to develop a model program to serve youth with disabilities.

• Goodwill Industries of the Redwood Empire and its partner agencies piloted the Disability Information Technology Initiative program. The project’s overall goal is to provide entry-level information technology training and employment services to persons with disabilities. Key activities include enhancing linkages between existing program services, developing new post-employment services and educating employers on reasonable accommodation strategies to employ individuals with disabilities. To date, the program has served over 200 individuals and placed over 80 of them in computer-related positions with an average hourly wage of $15.71. DOL has extended the program’s funding for a second year.

• The City of Los Angeles has launched the EmployABILITY Partnership program. The Partnership, a collaboration of both governmental and private sector organizations is working to improve services to the disabled within the Los Angeles WorkSource system. The consortium has assisted in the development of programs that include an EmployABILITY Network web site (http://www.employ-ability.org), an on-line LEGACY Training and Certification to tutor WorkSource staff in providing high quality services to customers with disabilities, and an EmployABILITY Hotline (888-226-6300) to provide disability related information and referrals to local resources.

• The South Bay Local Workforce Investment Board’s One-Stop Business and Career Centers received a DOL Job Training Grant for $864,000 to further enhance employment opportunities for people with disabilities. The main objectives are the development of competitive skills among the disabled population and improved hiring practices by employers. The City of Hawthorne, South Bay Board has also been awarded a $150,000 Work Incentive Grant to assist in meeting the needs of people with disabilities.

• Pride Industries in Roseville, California have been awarded $500,000 to create long-term jobs for people with disabilities and other barriers to employment.

• The Community Rehabilitation Industries (CRI) of Long Beach, California was awarded a $100,000 Customized Employment Grant for the period of October 2002 to September 2003 to address the employment and training needs of persons with disabilities. CRI conducts computer skill training utilizing adaptive equipment for deaf and hearing-impaired clients. Training is individually designed to meet the employment goals of the student. Additionally, the City of Long Beach Workforce Development Bureau in August 2003 was awarded $300,000 through the Work Incentive Grant program to expand employment and career opportunities for people with disabilities through services available at One-Stop Career Centers.

California Foundations

The Medi-Cal Policy Institute, funded by the California Health Care Foundation, has taken a proactive research interest in the intersection of health care, disability and employment. In April 2003, the Institute, in collaboration with The Lewin Group and a community advisory group, published the nation’s first detailed look at a Medicaid buy-in program for workers with disabilities: The California Work Disabled Program: Lessons Learned, Looking Ahead online at www.medi-cal.org.

The national non-profit Disability Funders Network has held several California forums informing foundations of their potential roles with the Ticket Act and the health and employment needs of workers with disabilities. As a result, a wider pool of California and local foundations are more knowledgeable and interested in supplementing rather than replacing State funds to foster new innovative programs and employment strategies for workers with disabilities.

Since early 2000, The California Endowment has funded the California Work Incentives Initiative (CWII), a community based collaboration at Oakland’s World Institute on Disability. The Initiative focuses on implementation of state and federal health and work incentive provisions for people with disabilities. The Initiative has been a forerunner for California infrastructures re-design, now expanding with MIG and the Health Incentives Improvement Project.

CWII provides staff support to the California Work Group on Work Incentives and Health Care (CWG). The CWG is a center for grass-roots efforts to develop public policy recommendations to improve program capacity for people with disabilities to gain access to full employment. CWG participants meet regularly to develop consensus-based agendas for implementation of new state and federal employment and health care legislation impacting workers with disabilities. The CWG is an open and accessible statewide disability network of ethnically and culturally diverse consumers, advocates, benefit planners and interested stakeholders in public programs, including staff at Social Security and state health and employment agencies. The CWG was an advocate for California’s application for the MIG and for policy adopted in AB 925, the Workforce Inclusion Act. In 2003, CWG activities are centered on a benefits planning curricula for training trainers, as well as training staff across multiple state programs and in One-Stop Career Centers. These trainings focus on state of the art benefits planning for California workers with disabilities. A Disability Benefits 101 training, funded in part by the Community Technology Foundation of California, will be launched by the end of the year. A preview site is available for review at www.preview.disabilitybenefits101.org.

CWII has also been awarded funds by the Alliance Health Care Foundation to conduct 6 health and benefits training sessions in San Diego in October 2003. Two prominent organizations, World Institute on Disability and Options: A Benefits Training Foundation will partner to conduct benefits training in 13 states. An evaluation of these trainings will be conducted and used to assist frontline staff in the support of expanded health and benefit trainings.

Conclusion

The design of public policy in California is to provide opportunities based on customer choice within a framework that can promote independence and financial stability. Major overseers of the workforce investment and health care systems have been defined in the Workforce Inclusion Act as the California Governor’s Committee on Employment of People with Disabilities, the California Workforce Investment Board, the Employment Development Department, and the Departments of Rehabilitation, Social Services and Health Services. Key private partners include employers, foundations and community-based disability advocacy and service organizations. Local and state entities continue to develop and design initiatives that can be enhanced with ongoing federal support.

Whether the field is health care, employment development or improved information systems, success for this policy framework rests on the consumer’s control of an informed decision making process. A comprehensive and coordinated reform to public and private programs that have traditionally been funded, charged and trained in “silos” is needed and is, in fact, underway in California, under the leadership of Governor Davis’ administration and in collaboration with federal agencies such as Social Security and the Department of Labor. Pivotal state and federal coordination and support to enhance program delivery at the local level is evident through the examples in this overview.

Elements of this policy framework have emerged in real time with real programs. This paradigm shift for public and private programs to sustain employment outcomes for people with disabilities does not come prepackaged with a ready-to-use blueprint or manual. Local and state initiatives should continue to inform and educate federal agencies such as the Departments of Labor and Education, Social Security, and the Center for Medicaid and Medicare Services as to the local solutions that can be effected with ongoing federal support.

For more information about the activities mentioned in this report, feel free to contact:

Megan Juring
California Workforce Investment Board
mjuring@cwib.ca.gov
777 12th Street, Suite 200
Sacramento, CA 95814
(916) 324-2886
(916) 324-3068 (fax)
(916) 324-6523 (TTY)

Bryon R. MacDonald
World Institute on Disability
bryon@wid.org
510 16th Street,
Oakland, CA 94612
510-251-4304
510-763-4109 (fax)
510-208-9493 (TTY)

Glossary of Terms

Federal

BPAO: Benefits Planning Assistance and Outreach Program

DOL: United States Department of Labor

HIPAA: Health Insurance Portability and Accountability Act of 1996

SSDI: Social Security Disability Insurance

SSI : Supplemental Security Income

SOCIAL SECURITY: Social Security Administration

TICKET ACT/TICKET PROGRAM: Ticket to Work and Work Incentives Improvement Act of 1999

State of California

Assembly Bill 925: Workforce Inclusion Act

CalWIB: California Workforce Investment Board

CWD: 250% California Working Disabled Program

CMS: Center for Medicaid and Medicare Services

DHS: Department of Health Services

DOR: Department of Rehabilitation

EDD: Employment Development Department

IHSS: In Home Supportive Services

MIG: Medicaid Infrastructure Grant

WRAP Workforce Investment Resources and Accommodations Project

Foundations

CWII: California Work Incentives Initiative

CWG: California Workgroup on Work Incentives and Health Care

Notes

1 US Census 2000 Supplemental Survey

2 The Emerging Disability Policy Framework: A Guidepost for Systems Change Through Collaboration, Robert Silverstein, 2002, Center for the Study and Advancement of Disability Policy