Long-Term Supports and Services (LTSS): Supportive Employment for Adults with Disabilities

Federal mandates and initiatives (e.g., Americans with Disabilities Act, Olmstead Decision) provide an impetus for states to pursue community integration for all individuals. As states continue to reform their long-term supports and services (LTSS) systems, there is a growing interest in determining their success in providing a balance between home and community-based services (HCBS) and institutional alternatives, specifically supportive employment options for adults with disabilities. Objectives: The purpose of this study is to evaluate the LTSS systems of ten states through the NBIP. Despite substantial research efforts to study rebalancing, a gap remains in the availability of common indicators to measure rebalancing efforts. To address this gap, the NBIP is assisting the Centers for Medicare & Medicaid Services (CMS) in the development and refinement of several indicators to assess states' progress towards a balanced and person-driven LTSS system. One area of interest that is being examined is the extent to which states support individuals' integration and inclusion in the community across disability types through supportive employment options. Findings: States' efforts to support employment options for persons with disabilities were one aspect of community integration that was explored. This was measured by examining whether a State offered a Medicaid Buy-In to support working-aged adults with disabilities in seeking and maintaining employment. Seven of the ten States surveyed had such programs. Another measure evaluated employment rates of working-age adults with disabilities using American Community Survey (ACS) data. Employment rates in the disability community ranged from 30.2% (Kentucky) to 51.6% (Iowa).