Provide Supported Employment to Texans with Disabilities The State of Texas should provide more people with disabilities the opportunity for supported employment. Background Until about ten years ago, the only employment opportunities for people with severe mental and physical disabilities were in sheltered workshops doing piece work such as folding rags, usually at marginal salaries. Many people, even some vocational experts, believed that people with severe disabilities were incapable of participating in competitive employment-that is, working alongside individuals without disabilities, while earning equal wages. The advent of supported employment in recent years has allowed individuals with disabilities to move into the competitive workplace. At least one poll has indicated that as many as 80 percent of people with disabilities would go to work if some of the barriers to their participation in the work force were removed.1 "Supported employment" is competitive work that provides support services, such as a job coach, to assist an individual in obtaining and maintaining employment. Nationally, thousands of people with severe disabilities have entered the competitive work force with the help of employment specialists and supportive co- workers and employers. The Arc, a national advocacy organization for people with developmental disabilities (formerly the Association for Retarded Citizens), published data in October 1993 that ranked states on supported employment efforts. Texas ranked last among states.2 In its supported employment programs in fiscal 1993, the Texas Commission for the Blind (TCB) served 144 clients and placed 28 in the work force, while the Texas Rehabilitation Commission (TRC) served 1,102 clients and placed 585 in the work force. Both commissions obtain funds for supported employment through the Federal Rehabilitation Act. In fiscal 1993, the Texas Department of Mental Heath and Mental Retardation (TxMHMR), acting through community centers, served 487 clients in supported employment, but the number placed in the work force was not reported.3 TPR's preliminary analysis of supported employment programs for clients in institutions and in the community indicates that such programs produce substantial and quantifiable benefits. Costs for supported employment are greater on average than those for sheltered workshops. In five supported employment programs examined for a five-year period, costs per client ranged from $2,032 to $23,511, averaging $6,478. By contrast, the average client cost for sheltered workshops was $4,045. However, measurable benefits from supported employment also are significantly higher than those resulting from segregated employment programs. These include indicators of increased potential for client self- sufficiency and lower institutional costs, which can be as high as $80,000 per client per year in mental health institutions. Case studies identified significant benefits to clients from supported employment, including greater integration into the community, higher functioning levels and, over time, greater client independence and autonomy. Overall, Texas prospers from the contributions to the economy by persons in supported employment. A Supported Employment Summit sponsored in 1994 by the Comptroller's office brought together representatives of clients and their family members, advocacy groups, state agencies, service providers and employers. An action plan was developed to assist persons with disabilities to obtain jobs in competitive employment with non-subsidized pay. The summit produced a "vision statement" outlining the participants' ultimate goals: The State of Texas shall ensure that all Texans with disabilities have the opportunity and support necessary to work in individualized, competitive employment in the community and have choices about their work and careers. The substance of the summit's action plan focused on client choice; no new funding for segregated employment; increasing the funds and number of people served through supported employment by 50 percent in five years; requiring all special education students to develop individual educational goals for future integrated employment; and using more untapped funding sources for supported employment.4 Transition from School to Work Students receiving special education services are required by the federal Individuals with Disabilities Education Act (IDEA) to have an Individual Transition Plan (ITP) in place by the age of 16. The ITP can be prepared as early as the age of 12 if the child is at high risk of dropping out of school. It is designed to allow special education students a transition into employment and community living without a break in continuity and loss of support. The Texas Education Code has adopted the age of 16 as the requirement unless the child is at high risk. The question of whether the age of 16 is too late to start an ITP was one concern addressed at the Supported Employment Summit. Another concern was that the ITP form does not list competitive employment as an option, indicating that educators may not fully appreciate the importance of preparing special education students for competitive employment. The Texas Education Agency (TEA), TRC, TCB, TxMHMR, the Texas Department of Human Services and the Texas Employment Commission have signed a memorandum of understanding on transition planning for special education students. The understanding is intended to establish the responsibility of each agency for the provision of services necessary to prepare students enrolled in special education for a successful transition to life outside the public school system. TRC provides for continuation after high school of services such as evaluation, planning, counseling, job training, job placement, transportation, job coaches and other needed supports. TRC budgeted $407,000 in fiscal 1995 for such transition services. In fiscal 1995, TRC plans to serve just 405 students in transition planning services, although 2,425 are expected to be referred by school districts.5 However, if TRC plans to drop these services in fiscal 1996, as it has indicated in the agency's request for legislative appropriations, it will create a break in the continuity of services after graduation.6 For example, if a school district provides a job coach for a student working in supported employment, the job coach services would cease upon graduation. The job might, too. Work Incentives The primary sources of currently untapped funding for Texans with disabilities are the U.S. Social Security Administration (SSA) work incentive programs. According to SSA, 370,719 Texans with disabilities received monthly income support and medical coverage under Medicaid from SSA's Supplemental Security Income (SSI) program in December 1993.7 SSI, a federal income support program based on disability and need, was enacted by Congress in 1972.8 The program provides cash payments up to $446 per month, plus medical support under the state-administered Medicaid program, to people who are disabled, aged or blind. "Disabled" under SSI means that a person has a severe physical or mental impairment expected to last for more than one year or result in death, and the impairment prevents him or her from doing substantial work.9 SSI support is available to adults and children. SSA estimates that many people eligible for SSI are unaware of the disability benefit programs or have not applied for the support programs.10 The determination of disability for Social Security purposes is delegated to the individual states, on the assumption that states will refer individuals to appropriate rehabilitation assistance within their state vocational rehabilitation programs. In Texas, this determination is made by TRC's Disability Determination Service. SSA continually looks for ways to move people with disabilities from dependence on income support programs to self-support through work. A number of current work incentive programs are designed for people with disabilities who would like to return to or attempt work. These "work incentives" are little known to the public and are not widely promoted by SSA or TRC. As a result, they are not widely used by people with disabilities or rehabilitation service providers. The original SSI statute provided a way for people with disabilities to pay for rehabilitation programs, either through private programs or state vocational rehabilitation programs. The Plans for Achieving Self Support (PASS) allows individuals to purchase employment-related goods and services with SSI that they would otherwise lose as a result of work activity. This provision is vastly underused as a funding source for rehabilitation services. As of June 1994, in Texas, there were only 154 PASS users, as compared to 1,411 in California.11 In 1980, Congress amended the Social Security Act to remove some of the barriers preventing people from working. The fear of losing benefits before becoming self-supporting is the primary impediment to seeking self-supporting work. To overcome this barrier, the amendment changed the way SSI benefits are calculated when beneficiaries begin earning income, allowing them to earn more without losing all SSI benefits. Another change was the clarification against the loss of Medicaid. Many people with disabilities and their advocates still believe that work will result in the loss of support and medical care. This misconception is a major obstacle to seeking and securing work. The amendments allow people effectively to recover 50 percent of their work-related expenses from SSI through a program referred to as Impairment-Related Work Expenses (IRWES).12 Last year, 354 Texans took advantage of the IRWES work incentives. SSI work incentives allow people with disabilities to purchase the work-related services they need (as opposed to the state purchasing them) and receive a rebate from SSI, maintaining Medicaid eligibility as they work to become self- supporting. These programs are excellent funding sources for people with disabilities who require support. TRC should help its clients obtain these funds. The federal Rehabilitation Services Administration, the primary funding source for state VR programs, pays states based on the number of people with disabilities who are "successfully rehabilitated" (on the job for 60 days). Consequently, TRC counselors have incentives to concentrate on easier clients-those they can move quickly through the system. An individual counselor's performance is measured primarily by the number of cases closed under TRC's definition of "successfully rehabilitated." What is not measured is the number of people with more severe disabilities who do not get added to TRC caseloads because they would not produce a quick "successful rehabilitation." According to a private funding policy specialist, "creaming" the client caseload basically serves people who could usually pay for their own programs; altering the present system would free state resources for people with severe disabilities in supported work environments.13 The Texas Committee The Texas Committee on Purchases of Products and Services of Blind and Severely Disabled Persons (the Texas Committee), created by the Legislature in 1975, assists disabled persons in achieving independence through work and allows state agencies to meet affirmative-action requirements concerning the employment of disabled persons.14 Under the state set- aside program, state agencies are encouraged to buy products and services produced by persons with disabilities. As TRC, TCB and TxMHMR move toward more competitive employment for people with disabilities, the Texas Committee has not put forward an initiative on supported employment, even though the statute gives it the authority to do so. The Texas Committee designated a central nonprofit agency, Texas Industries for the Blind and Handicapped (TIBH), to provide administrative assistance for the set-aside program. TIBH is paid a 6 percent to 7 percent commission based on the gross sales of the products sold and services provided to state agencies, regardless of the amount of assistance from TIBH. For fiscal 1993, TIBH received about $1.6 million in commissions; projected commissions for fiscal 1994 are $1.8 million. At a TxMHMR vocational administrators' workshop in August 1993, representatives of MHMR centers and state facilities voiced concerns about TIBH's role. One such concern was that TIBH's commission is based on gross revenue, not net revenue; therefore, no incentive exists to evaluate contracts for profitability.15 Recommendations A. Texas' health, human services and work force development agencies should adopt the vision statement of the Supported Employment Summit: "The State of Texas shall ensure that all Texans with disabilities have the opportunity and support necessary to work in individualized, competitive employment in the community and have choices about their work and careers." B. The Texas Department of Mental Health and Mental Retardation (TxMHMR), Texas Rehabilitation Commission (TRC) and Texas Commission for the Blind (TCB) vocational funds, as well as any additional funding, should be redirected to increase the number of persons with disabilities employed in integrated settings by 50 percent by the year 2000. This would ensure that any new funds for vocational services would be spent on supported employment instead of sheltered workshops or segregated employment. C. A work group of TxMHMR, TRC, TCB and the Texas Education Agency (TEA) should be required to implement the action plan of the Comptroller's Supported Employment Summit. The Comptroller's office should monitor the implementation of this plan and prepare a progress report to the Legislature by November 15, 1996. D. TEA's Individual Transition Plans should be changed to include a goal for competitive employment. TEA should study the effects of changing the Education Code to require the initiation of transition planning at age 14 for students with disabilities. The change to Individual Transition Plans should be implemented for school year 1995-96. TEA should report the results of the study for changing the age to 14 for transition planning to the Legislature by November 15, 1996. E. The Texas Legislature should fund at its current level the TRC strategy to provide a Transition Planning Program for Students with Disabilities. F. TRC should create a position at its central office to train counselors to understand and use work incentives; review cases to ensure that SSI and work incentives are offered when applicable; and help clients through the SSI determination process. TRC should be required to provide this training to other state agencies along with training materials. MHMR community centers' contracts with TxMHMR should include a provision that center staff determine the eligibility of their clients for SSI and work incentives. The contracts should require the training of counselors on Social Security work incentives to fund supported employment, and require related information be presented to clients and their families. The counselors should determine if the client is a candidate for SSI or work incentives and assist their clients through the SSI determination process. People with cognitive difficulties require such assistance because they often cannot understand or work themselves through the complicated maze of determination, redetermination and appeals. G. The Texas Committee on Purchases of Products and Services of Blind and Severely Disabled Persons (the Texas Committee) should be active in the area of supported employment. Instead of designating a central nonprofit agency to administer the state set-aside program, the Texas Committee should contract directly for these services. The commission from the producers of services and goods should be limited to 4 percent, instead of the existing 6 percent, and that amount should go to the Texas Committee. This would require one or two staff positions to carry out administrative functions for the Texas Committee. The salaries of these administrative personnel would be paid from the limited 4 percent commission. Any additional earnings should be directed to supported employment endeavors in the state. Implications Supported employment gives people with disabilities the opportunity to become independent. These recommendations should help the state encourage supported employment initiatives by requiring agencies to work together and continue to increase the number of people in supported employment. By obtaining SSI and SSI work incentives for more people with disabilities, more vocational funds will be made available to help people with severe disabilities move into supported work environments. Fiscal Impact The cost of creating a social services administrator position at TRC's central office, including salary, associated costs, capital equipment and electronic data processing, would be as follows: Fiscal Cost to the Change Year General Revenue Fund in FTEs 1996 $51,000 +1 1997 47,000 +1 1998 47,000 +1 1999 47,000 +1 2000 47,000 +1 The other recommendations would have no impact on general revenue. 1 Texas Planning Council for Developmental Disabilities, "Studies show accessibility and equality slowly improving," Highlights, Austin, Texas, July-September 1994, p. 4. 2 The Arc, A Status Report to the Nation on Inclusion in Employment of People With Mental Retardation,by Dr. Sharon Davis (October 1993), pp. 16-17. 3 Texas Comptroller of Public Accounts, "Supported Employment Summit," July 21 and 22, 1994. (Handout materials.) 4 "Supported Employment Summit." 5 Texas Rehabilitation Commission, Request for Legislative Appropriations, Submitted to the Governor's Office of Budget and Planning and the Legislative Budget Office for Fiscal Year 1996 and 1997, (Austin, Texas, August 3, 1994), pp. 47-48. 6 Texas Rehabilitation Commission, Request for Legislative Appropriations. 7 U.S. House of Representatives, Committee on Ways and Means, 1994 Green Book: Overview of Entitlement Programs (Washington, D.C.: U.S. Government Printing Office, 1994), p. 249. 8 U.S. Congress, Social Security Act, Title VI, 1972. 9 U.S. Congress, Social Security Act, Title XVI, 1972. 10 Interviews with Daniel Scarborough, funding policy specialist, Texas Assistive Technology Partnership, The University of Texas at Austin, June 21, July 25 and August 16, 1994. 11 Interview with Jim Carey, Office of Supplemental Security Income, Social Security Administration, Baltimore, Maryland. August 3, 1994. 12 U.S. Congress, Social Security Act Amendments,1980. 13 Interviews with Daniel Scarborough. 14 V.T.C.A., Human Resources Code 122.001. 15 Letter from Addie Drury, Standards and Quality Assurance, Texas Department of Mental Health and Mental Retardation, to the Texas Committee on Purchases of Products and Services of Blind and Severely Disabled Persons, August 6, 1993, p. 2. -- END --