The call for an “Employment First” executive order is not the answer
Madison, Wis., – On Monday, the Survival Coalition said Wisconsin should become an “Employment First” state in order to provide better job opportunities for people with disabilities and called upon the Walker administration to accomplish this by executive order. Rehabilitation for Wisconsin in Action (RFW in Action) believes that significant changes are needed in the way employment supports are delivered. Adopting a new policy for these services without restructuring them will not improve Wisconsin’s ranking in reports like the Case for Inclusion by United Cerebral Palsy (UCP).
Michigan is ranked first in the UCP report, while Wisconsin is 37th. Both states use managed care to fund long-term supported employment, but the UCP report shows a big difference in the way Michigan funds these employment opportunities for people with disabilities.
“Currently, long-term supported employment funded by the Department of Health Services (DHS) is pitted against other competing priorities that Managed Care Organizations (MCOs) deliver through Family Care. Reductions to funding and services made by MCOs in the areas of job coaching and related services have negatively impacted the retention of jobs developed with funding from the Wisconsin Division of Vocational Rehabilitation (DVR),” said Thomas Cook, executive director, RFW in Action.
RFW in Action is working with the legislature on an integrated employment proposal that will require DHS to transfer employment support funding to the Department of Workforce Development (DWD). This will increase the ability of Community Rehabilitation Programs (CRPs) to help individuals with disabilities find and keep jobs in the private business sector.
CRPs already provide 65 percent of the short-term supported employment opportunities funded by DVR, which ranks among the top five states in the country for short-term supported employment. RFW in Action believes they can increase participation in long-term employment if its legislative proposal is adopted.
“It takes years for a state to achieve the top ranking in the UCP report, and it would be disingenuous to suggest that Michigan’ s success is the result of their ‘Employment First’ policy, which was just adopted last year,” said Cook. “Wisconsin could improve its employment outcomes by emulating the ways in which Michigan operates its managed care programs. We have to recognize that making changes in the way Family Care works might take years to accomplish, however. That’s why we’re advocating a more immediate improvement – the transfer of funding from DHS to DWD in 2013 to administer long-term supported employment.”
Managed Care programs in Michigan vs. Wisconsin
1) Service providers in Michigan are welcomed members of the planning teams that assist individuals with disabilities to become employed. In Wisconsin, providers are excluded from these planning teams under the state’s Family Care and prevocational services guidelines. In some cases, MCOs do not even share the plans they develop with the CRPs, making efforts to achieve employment goals very difficult.
2) In Michigan, all of the employment services planned by interdisciplinary teams are funded. For example, if the plan calls for eight hours of job coaching a week, that’s what Michigan provides. In fact, stakeholders in Michigan regard this – and not the elimination of waiting lists – as a true entitlement. In Wisconsin, MCOs decide what they are willing or able to fund, regardless of the individual’s needs or preferences.
3) In Michigan there is a defined financial risk-sharing arrangement between the MCOs and the state. This ensures that the payments made by the state to the MCOs will match the financial risks of contracting for services. In Wisconsin, the rate-setting process does not reflect the actual cost of services, leading to shortfalls in the funding MCOs are able to devote to employment.
4) In Michigan, the MCOs are community-based mental health and developmental disability organizations that have a good understanding of best practices in service delivery, as well as state and federal laws concerning the rights of people with intellectual and developmental disabilities and are accountable to local taxpayers. In Wisconsin, the elimination of the Bureau of Developmental Disabilities and the high turnover rate of MCO care managers has resulted in a lack of employment expertise in the long-term care system as a whole, with virtually no accountability to taxpayers in the areas they serve.
5) Michigan’s employment policy also provides opportunities to participate in prevocational services. There is no question that Michigan has a goal to develop community-based, competitive employment, but the difference is that Michigan explicitly recognizes that some people will not reach that goal. That’s why they continue to offer prevocational services, which are considered training and habilitation and which may lead to employment. Many people receive these services in Michigan. In Wisconsin, although the practices of MCOs vary widely, referrals for prevocational services for “new entrants” to Family Care are prohibited in the state’s guidelines. If Michigan can operate both programs successfully and be ranked first, RFW in Action believes that Wisconsin can do the same. We recommend taking action to improve our supported employment program instead of continuing to propose projects or guidelines that seek to limit access to prevocational services as a means of “rebalancing” service utilization.
None of these facts are captured in the UCP rankings. The executive order sought by the Survival Coalition could actually limit the ability of people to be productive members in their local communities, as it has in other states. “Employment First” states like Washington and Vermont limit prevocational services just like Wisconsin has attempted to do. In those states, individuals with significant disabilities have already lost an opportunity to earn a fair wage and have been shifted to day programming, instead, with no opportunity to develop job skills. Wisconsin should not follow their example by adopting an “Employment First” policy.
There are more than 80 CRPs in Wisconsin; 56 of these organizations are members of RFW in Action. CRPs are the largest single group of employers of people with significant disabilities in the state. These providers offer a full range of community supports, from day habilitation, to prevocational services, to supported employment, and competitive job placements, making them the single best source of expertise in the employment of people with significant disabilities.