In 1998, the Nebraska Department of Health and Human Services (DDHHS), the single state Medicaid agency, enacted “Medicaid Insurance for Workers with Disabilities (MIWD) under the Balanced Budget Act 1997 legislation. This program is Nebraska’s Medicaid Buy–In, which allows people with disabilities who are working or want to work the opportunity to buy their health care coverage. Through Nebraska’s MIWD, people can earn more, save more and keep their health care coverage. This program allows employed people with disabilities to qualify for Medicaid even if they have exceeded the income rules that govern Medicaid.
In 2001, the Department was awarded a Medicaid Infrastructure Grant (MIG) to allow people with disabilities, advocates, service providers, employers, state agencies and other key stakeholders the opportunity to focus on developing the Medicaid infrastructure and enhancing employment related supports within the Department. With MIG resources, Nebraska has, through its State Plan as well as the Aged & Disabled Medicaid Waiver, strengthened a comprehensive Personal Assistance Services (PAS) program through better consumer direction opportunities and availability in the workplace and other community settings.
Each subsequent MIG has been used to build upon and continue the success of past efforts by addressing the barriers and enhancing the strengths previously identified. The success of the Nebraska MIG Project design, implementation and evaluation is due to the continuous, active involvement, expertise, and commitment of several state agencies and federal partners – including individuals with disabilities, advocates and contracted organizations. The MIG promotes action–oriented collaborative partnerships among the following state agencies: Department of Health and Human Services (DHSS); Vocational Rehabilitation (VR); Commission for the Blind and Visually Impaired (CBVI); Commission for the Deaf and Hard of Hearing (CDHH); Department of Education (DOE) and local school leadership; Department of Labor (DOL); Workforce Development One–Stop Centers and Dept. of Labor Disability Navigators (DPN); and multiple resources from the University of Nebraska systems. In addition, the MIG coordinates with the Social Security Administration (SSA), state and national disability advocacy organizations, and the Centers for Medicare and Medicaid Services (CMS).
Grant activities have focused on increasing the responsiveness of state and local service delivery systems to the diverse and complex needs of people with disabilities, especially youth and young adults in transition, as well as adults experiencing chronic pain as a barrier in the pursuit of competitive employment.
MIG activities are combating the general lack of knowledge or use of existing work incentive programs. Inter–agency community teams have improved the visibility for issues surrounding the transition of youth with disabilities from schools into the workforce or higher education.
By improving the level and channels of communication between various parties involved in transition efforts, we have been able to increase the awareness and consumer access of existing programs and services provided by other state agencies. In turn, this has influenced changes in policy, promotion of self–determination, higher employment expectations and incorporation of goals for employment of persons with disabilities into routine service delivery. Transition age pilot youth (18–24) are utilizing federal and state work incentives. They are receiving education about health care options, transportation services, job training, self–advocacy and independent living skills, providing them with a wide range of tools and knowledge about available resources for whatever supports they may need. Schools and services coordination staff report an increase in Individual Education Plans and Health Habilitation Plans that include competitive employment goals, even incorporating the tracking of earnings as an activity.
Sustainability continues to be a core message in the work of the MIG. One community’s local college has collaborated with the team to implement a mentoring program that includes benefits planning for at–risk young adults with disabilities aged 18–24 to support employment and self–sufficiency. Transition issues are being incorporated into the Special Education teacher preparation curriculum and college students serve as the Americorps volunteer mentors. The team is restructuring to merge with the creation of a steering committee comprised of local business and community leaders serving to support this community–based mentoring program.
As Nebraska implemented the MIWD program, we discovered there was limited information about number of people participating, length of enrollments and client demographic characteristics. Over the five–year course of the MIG, staff continually heard from consumers, other agencies and even workers themselves, that statewide knowledge of the MIWD program and how it worked was lacking. One implementation strategy was to evaluate the MIWD program by surveying Medicaid Eligibility Workers, current and former MIWD clients and conducting a consumer focus group, so that DDHHS would have better information on who was using the program and feedback on how the program worked for clients. The research results guided the content of nine one–day MIWD Awareness trainings statewide for 243 Medicaid Workers and SSA representatives. These research results provided impetus for policy clarifications, improved communication between DDHHS and the Social Security Administration, enhanced MIWD program utilization, more effective data collection of program participants, and exploration of strategies to increase statewide capacity for benefits planning.
MIG resources have been instrumental in enhancing existing data systems to track and evaluate employment outcomes. We continue to explore how to better involve the One–Stop centers in employment outcomes. The DOL Disability Navigators share a common vision and goals and are active partners as we reach out to employers, build benefits planning capacity and address barriers to employment for persons with disabilities.
Nebraska is on the cutting edge nationally as we use the emerging field of palliative care to combine the expertise of the medical community and human services resources to treat chronic pain while simultaneously addressing social and emotional barriers to move individuals with disabilities into the job market. Several participants of this project have succeeded in managing their pain which resulted in a return to the workforce. This proactive intervention model will continue to yield financial benefits to individual participants and the system.
MIG staff leveraged the support of another CMS grant to form a Young Adult Advisory Council (YAAC). YAAC members have provided feedback on current grant activities and materials and shared the perspective of young adults who have recently gone through the transition process.