Everyone Works!
Outline of Presentation
• Introduction of Panel
• Aging and Disability Resources (ADRC)
• Children’s Long Term Support (CLTS)
• Managed Care/Family Care (MCO)
• IRIS (Include Respect I Self-Direct)
• Employment Data
• Questions
• Contact Information
• Resources
Aging and Disability Resources
Neal Minogue
By 2013 every county
in Wisconsin will
have an ADRC
.
Office of Resource
Center Development
The Office for Resource Center Development is housed within
the State of Wisconsin’s Department of Health Services, Division
of Long Term Care/ Bureau for Aging And Disability Resources.
The Office for Resource Center Development supports ADRC
staffs throughout our state.
ADRC Statistics
In 2010 ADRCs had 300,000 contacts with customers throughout the year and
we expect that number to reach 500,000 by the end of 2013.
We expect to have 70 counties and 9 tribes operating ADRCs by the end of this
year. (Oneida & Menominee Tribal start dates are unknown at present) The
ADRC of Dane County is expected to open before the end of this year. (Both
Door and Rock counties are expected to open ADRCs in 2013).
There are currently more than 600 Information and Assistance staff employed
by ADRCs both full and part-time and more than 70 Disability Benefit
Specialists.
Disability Benefits
Specialists
Each ADRC has an assigned Disability Benefit Specialists (DBS). DBS are able to
give basic information about work incentive benefits to ADRC customers. In
addition DBS will as needed connect people to local Work Incentive Benefits
Counselors and to DVR for the funding of the counseling service.
Examples of providers benefits counseling: Riverfront, ERI, and Independence
First.
DBS and ADRC Information and assistance staff will help people work through the
process of applying and if found eligible enrollment into the LTC program of their
choice. One of the benefits of LTC is employment services and support.
I addition DBS are tasked helping people apply for Social Security.
ARDC Resources
If you are interesting in finding an ADRC in
Wisconsin please look at or office website:
http://www.dhs.wisconsin.gov/ltcare/adrc/
Or simply type in “ADRC Wisconsin” in your
favorite web search engine
Children’s Long-Term Support
(CLTS) Waivers Overview
Jessica Thompson
Quick CLTS Waivers Overview
CLTS Waivers are:
• Medicaid Home and Community-Based Waivers
• Administered by each county
• Support children with long-term needs in their home
or community
• Family-centered planning and services
CLTS Waivers eligibility
• Developmental disabilities (DD)
• Severe emotional disturbances (SED)
• Physical disabilities (PD)
Service plan is an Individual Support Plan (ISP)
Eligibility
Eligible for Special Education
Eligible for CLTS Waivers
Role in Transition
County CLTS Waivers “Support and Service Coordinators”
can:
•Facilitate conversations with youth and families
• Explore hopes and dreams for adult life
•Encourage youth to practice self-determination by
participating in their ISP development
•Connect families with information and resources
•Communicate across systems
•Explore services to help youth develop and practice skills
that are valuable as employees and adults
• Daily Living Skills Training, Mentoring, Supported Employment…
Eligibility for Adult Long-Term Care
• Children enrolled in CLTS Waivers may not be eligible for
Adult Long-Term Care Waivers
• Especially youth who qualify for CLTS Waivers with an “SED
Level of Care”
• Youth with mental health disorders (EBD students) but no other
developmental or physical disabilities
BUT
Aging and Disability Resource Centers (ADRCs) can still provide
valuable information for these youth
AND
• Community mental health programs are available in each
county
Managed Care/Family Care
Integrated Employment
Tammy Hofmeister
Types of Supported
Employment
•Integrated Employment
•Group Supported
Employment
Integrated Employment
• Working for competitive wage
• Working in the community
• No more than two individuals
placed and supported to work
together
• Includes working from home
• Includes self-employment
Group Supported Employment
• Working for competitive wage
• Working in the community
• Three or more individuals
supported and working together
which is considered a work crew
or enclave
Vocational Futures Planning
Services (VFPS)
• (VFPS) is a person-centered, team
based comprehensive employment
planning and support service that
provides assistance for waiver
program participants to obtain,
maintain or advance in employment
or self-employment.
Service Strategies VFPS
1) Development of an employment plan based on an
individualized determination of strengths, needs and
interests of the individual with a disability, the barriers to
work, including an assistive technology prescreen or indepth assessment, and identification of the assets a
member brings to employment;
2) benefits analysis and support;
3) resource team coordination;
4) career exploration and employment goal validation;
5) job seeking support; and,
6) job follow-up and long-term support
Prevocational Services
• Prevocational services involve the provision of learning and
work experiences where a member can develop general, nonjob-task-specific strengths and skills that contribute to
employability in paid employment in integrated, community
settings.
• Services are expected to occur over a defined period of time
as determined by the member and his/her care planning
team in the ongoing member-centered planning process.
• Services are expected to specifically involve strategies that
enhance a participant's employability in integrated,
community settings.
• Competitive employment or supported employment are
considered successful outcomes of prevocational services.
Intent of
Prevocational Services
• Prevocational Services are intended to lead to
participation in integrated employment
• The integrated employment does not have to be
fulltime
• A member is not required to leave prevocational
services completely
• Prevocational services, if authorized, are
intended to help Family Care members make
reasonable and continued progress toward
voluntary participation in at least part-time
integrated employment
Intent of Prevocational
Services cont.
• Voluntary participation
• Good faith effort over sufficient period of
time by IDT and prevocational provider is
expected
• Good faith effort includes identifying and
addressing any concerns the member or
guardian may have about the member
participating in integrated employment
New entrant to
Prevocational Services
• All members enrolled as of September 1,
2010 who did not participate in
prevocational services prior to that date.
• Any member who enrolls after September
1, 2010 and did not participate in
prevocational services funded by the CIP
waiver, the IRIS waiver or a county human
service agency prior to that date.
New Entrant Guidelines
• Prevocational services in any setting can be authorized if
the purpose is to:
(1) Help the member achieve an integrated employment
outcome identified in the member’s plan;
(2) Provide additional “wrap-around” supports to a
member who is participating in part-time integrated
employment;
(3) Provide a temporary safety net to a member who may
lose an integrated job at some point and may need time
to find a new integrated job.
Family Care
Employment Resources
http://www.dhs.wisconsin.gov/l
tcare/programops/prevoc/index
.htm
IRIS
Participant Employment
John O’Keefe
IRIS Basics
• Serves as CMS required choice to
Family Care
• Participant self directs their IRIS plan
• Individual Budget based on acuity &
cost neutral to FC
• IRIS Consultant for each participant
• IRIS Financial Services Agency pays
invoices & worker wages
• 80% of participants hire their own
workers
IRIS Choosers
• 7,048 participants exceeds original
estimates (10/31/12)
• 44% Developmental Disability
• 40% Physical Disability
• 16% Frail Elders
Younger people choose IRIS
• Age 18-22 = 17%
• Age 23-29 = 13%
Family Care transfers = 18%
IRIS Employment Data (4/2012)
• IRIS Participant Employment (April, 2012
data)
• Integrated Employment (103)
• 11 hrs/week $7.51/hr
• Work Crew/Enclave (21)
• 9 hrs/week $3.87/hr
• Facility Based Employment (149)
• 13 hrs/week $2.09/hr
We can and must do much better!
Employment Services
in IRIS
• Supported Employment
• Vocational Futures Planning
Services
• Prevocational Services
• Customized Goods & Services
Customized Goods and Services
• IRIS Service Category definition approved by Federal Government:
•Help achieve outcome related to living arrangement OR
relationship OR community inclusion OR work, OR medical or
functional status.
•Listed on plan, allowable per Fed/State rule, no other fund
obligation, not experimental
•
AND also either
• Safety in home or community maintained or increased ;OR
• Reduce Medicaid service dependence or prevents increase,
OR
•
•
Skill improves or loss prevented, OR
Community access or involvement increased or
maintained.
Examples
• Andrew
• Small business related to anything worms
• Mother recruits, trains & supports 1:1 job
coaches
• Martha
• IRIS Self Directed Personal Care
• Hired Personal Care worker while at work
• Alexis
• AJ Special Services
• Video Support costs $5/hour
IRIS
Resources
http://www.dhs.wisconsin.gov/bdds/IRIS/
index.htm
1-866-515-4747
Employment Outcomes Data and
Services in Adult Long Term Care
Programs
Ellie Hartman
Wisconsin: Developmental Disabilities
Working Age (18 to 64)
Integrated Employment Rates
• Adult Long Term Care Functional Screen Federal Fiscal Year (FFY) 2011
• Dane County Supported Employment Summary (March 2011)
Individuals with Developmental Disabilities (18 to 64)
and Enrolled in Long Term Services based on Most
Recent Functional Screen
Distinct Count
Percent
Any Employment
8948
51%
Community Employment
2431
14%
75
<1%
Work Center Employment
5378
31%
Group Employment
1955
11%
17,469
100%
Home Employment
Total Individuals with Functional Screen
35
Wisconsin: Physical Disabilities
Working Age (18 to 64)
Integrated Employment Rates
• Adult Long Term Care Functional Screen
Count of Individuals with Physical Disabilities (18 to
64 and no co-occurring DD, MI, or TBI) and Enrolled
in Long Term Services based on Most Recent
Functional Screen (FFY2011)
Any Employment
Community Employment
Home Employment
Work Center Employment
Group Employment
Total Individuals with Functional Screen
Distinct Count
463
165
109
101
103
Percent
6%
2%
1%
1%
1%
7813
100%
36
Employment Status of
Transition Age Youth (18 to 24)
•
Number of individuals with an adult long
term care functional screen and number
of these individuals with integrated
employment (employed in community or
home)
•
Number of individuals in a mental health programs
with their employment status reported on the
Mental Health Status Report and number of these
individuals with integrated employment
(competitive, supported, and temporary
employment)
•
•
•
•
Total (any
disability)
Developmental
disabilities (DD)
Physical
Disabilities (PD)
Co-occurring
Mental Health
(MH) Disability
37
DEVELOPMENTAL DISABILITIES (18 TO 64):
LONG TERM CARE FUNDED EMPLOYMENT SERVICES
• Source Long Term Care Encounter Reporting (FFY2011), HSRS
(FFY 2011), and Dane County Supported Employment Report
(March 2011)
Individuals with
Developmental Disabilities and
Long Term Services (18 to 64) Count
Percent
Pre-Vocational Services
6013
31%
Supported Employment Services
Total with Long Term Care
Services
3061
16%
19,182
100%
38
PHYSICAL DISABILITIES (18 TO 64):
LONG TERM CARE FUNDED EMPLOYMENT SERVICES
• Source Long Term Care Encounter Reporting and HSRS (FFY
2011)
Employment Assistance Description as
Reported on the Functional Screen for
Individuals with Physical Disabilities
(no DD, MI, or TBI and 18 to 64)
Count
Pre-Vocational Services
Supported Employment Services
Vocational Futures Planning and
Support (VFPS) Services
Total with Long Term Care Services
Percent
122
1%
29
<1%
11
<1%
8420
100%
39
Employment Services of
Transition Age Youth (18 to 24)
• Different reporting systems (Encounter and
Human Services and Reporting System aka
HSRS) track the different services people
receive through these long term care and
mental health service systems, including
pre-vocational and supported employment
services.
•
The number of transition aged
youth (18 to 24) receiving any
services and employment specific
services through these programs
in state fiscal year 2011 are
reported in the following graph.
40
PRELIMINARY PPS EMPLOYMENT
OUTCOMES DATA FOR THOSE EMPLOYED
(18 TO 64)
• First Time Data Collected
• Family Care Members and IRIS Participants
• Employed according to most recent Adult Long Term Care
Functional Screen
• Employment Outcomes for April 2012
• 95% Response Rate
• 6,602 reported whether or not individual had integrated
employment goal
• 3,001 (45%) “yes”
• 2,235 (34%) “no”
• 1,366 (21%) “unknown”
• 5,879 of 6,572 (89%) Worked for at least one paid hour in April
2012
• Some were paid for activities they completed during day or
residential services. (These individuals will not be included next
reporting month.)
41
PRELIMINARY PPS EMPLOYMENT OUTCOMES
DATA FOR EMPLOYED LONG TERM CARE
PARTICIPANTS (18 TO 64)
1,510 (26%) Worked in Integrated Employment
 Average 43 Hours in April 2012
 Average Earnings of $351.48
 Average Hourly Wage of $8.01
277 (5%) Worked in Work Crew/Enclave Employment
 Average 40 Hours in April 2012
 Average Earnings of $252.93
 Average Hourly Wage of $6.39
4,542 (77%) Worked in Facility Based Employment
 Average 67 Hours in April 2012
 Average Earnings of $149.55
 Average Hourly Wage of $2.33
42
A Summary of the Vocational Service Costs in Wisconsin’s
Medicaid Funded Long-Term
Care System for Individuals with Developmental
Disabilities (Robert Cimera, Ph.D.)
• http://www.dhs.wisconsin.gov/WIpathways/pdf/ASummaryVo
cationalServiceCostsWisconsin.pdf
43
An Evaluation of the Costs and Outcomes Obtained by
Agency and Individual-Provided Follow Along Services
(Robert Cimera, Ph.D.)
• This study investigated outcomes achieved by two different methods of
providing follow along services to supported employees:
• (a) services provided by 31 agency-based personnel and
• (b) services provided by 19 individual-provided service providers (not
affiliated with adult service agencies)
• Comparable demographics across six variables.
• Individual-provided supported employees were more than twice as
likely to have autism and multiple disabilities than agency-provided
supported employees (26.3% versus 13.0% and 31.6% versus 14.4%,
respectively).
• Agency-provided supported employees were more likely to have
offensive and self-injurious behaviors (32.2% and 18.3%) than
individual-provided supported employees (26.3% and 10.5%).
44
Work Incentive Benefits Counseling (WIBC)
• http://www.percthinkwork.org/resources/item/workincentive
soverview
45
Questions???
Contact Information
Sarah Lincoln – General Contact
DHS/DLTC/BADR/OIE
Sarah.Lincoln@wisconsin.gov
608-266-7974
Jessica Thompson – Children’s Long Term Support
DHS/DLTC/BLTS/CSS
JessicaL.Thompson@wisconsin.gov
608 267-3377
Tammy Hofmeister – Managed Care Organizations
DHS/DLTC/OFCE
Tammy.Hofmeister@wisconsin.gov
608 266-7251
47
Contact Information Cont.
John O’Keefe– IRIS
DHS/DLTC/BLTS
John.OKeefe@wisconsin.gov
608 261-6749
Neal Minogue– Aging and Disability Resource Centers
DHS/DLTC/BADR
Neal.Minogue@wisconsin.gov
608 266-2036
Ellie Hartman– Employment Data Research
DHS/DLTC/BADR/OIE
Ellie.hartman@wisconsin.gov
608 266-2756