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CMS’ New HCBS Regulations Opens the Door to Competitive Employment for People with Disabilities

As we celebrate National Disability Employment Awareness Month (NDEAM), it is important that we take account of the incredible progress that has been made in the fight to ensure all people, including people with disabilities, have access to gainful and meaningful employment in their communities. We still have a long way to go, but there are signs of substantial change on disability issues. One recent policy change has the potential to significantly improve employment outcomes for people with disabilities: the Center for Medicare and Medicaid Services’ (CMS) final regulations on Home and Community-Based Services (HCBS).

CMS’ final regulations require states receiving HCBS Medicaid funding to use such funds for settings integrated into the broader community for people without disabilities, optimize individual initiative and personal independence and provide access to competitive integrated employment. A setting that fails to meet any of these requirements, including the integrated employment requirement, is ineligible for HCBS funding. Programs that segregate individuals with disabilities – such as sheltered workshops – also fail to promote competitive integrated employment; and thus, will no longer qualify as HCBS services. Additionally, states must develop transition plans for existing HCBS programs that do not meet the new requirements. Since the majority of state programs currently use HCBS funding, states now have an added incentive to develop services to support the competitive employment of people with disabilities and phase out services that warehouse people with disabilities into segregated environments. This will likely result in an increase in the number of people with disabilities living and working in the community and a decrease in the number of people working in segregated settings.

The regulations also require a person receiving Medicaid-funded HCBS services to have the same degree of access to the community and to competitive employment as those not receiving Medicaid-funded HCBS. Supervised group visits to the community from an isolated setting and sporadic, non-integrated, non-competitive work in the community will not suffice. Supported employment service providers must now truly consider what they must do in order to accommodate workers with significant disabilities.

Finally, CMS’ regulations will increase the quality and quantity of day services and other living assistance that can be provided at the person’s home - including services that people may need in order to maintain stable employment. These services, due to the person-centered planning requirements of the final regulations, must comply with the needs, goals, and preferences of the specific person with a disability rather than the ineffective “one-size-fits-all” services that prevailed in the past. People with disabilities who have effective support systems that allow them to live within the community are more likely to seek competitive employment and to have better employment outcomes. Further, the regulations encourage medical and supported employment service providers to coordinate with one another in order to meet the needs of their clients more effectively. The person-centered plan created as part of the planning process would require the input from multiple groups that are providing different services to the same person, so that the final plan both “reflects the services and supports that are important for the individual” and “prevents the provision of unnecessary or inappropriate services.”

CMS’ final regulations on HCBS, if implemented properly by state and local providers, have the potential to significantly improve employment outcomes for people with disabilities by providing them with the resources they need to successfully achieve independence. We hope to see the fruit of this newfound emphasis on the acceptance of people with disabilities as workers and community members in the weeks and months ahead, and certainly by this time next year.

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