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Why Not

I am a husband, father, son, brother, uncle and friend. I believe in sharing my talents and experiences by giving back to the community by giving my time to coaching, church and especially to the disability community. I truly believe that all men and women are created equally.

Clearing Up Misinformation Surrounding CMS Rule Changes to Home and Community Based Services Part 2

Q. Isn’t facility-based employment or sheltered workshop employment more cost-effective?

Several studies using Wisconsin employment data and comparing people with the same disability types, including individuals with significant disabilities, have shown community employment is not more costly than facility-based employment. A 2008 study demonstrates that while supported employment has an initial higher cost than sheltered workshops, over the entire lifetime employment cycle, supported employment is 65.9% cheaper to fund than sheltered workshops. The current system promotes dependence and will continue to strain Wisconsin’s Medicaid budget.

The Department of Health Services December 2013 report on long-term care states: “Members involved in community-based and meaningful employment have better health outcomes which reduce expenditures for long-term supports and medical care. This increases the cost-effective management of long-term care programs.” The report cites specific data indicating that community-based, integrated employment are more cost-effective than services that support facility-based employment and notes that paid employment is found to be significantly related to low per person per month Medicaid expenditures.

This data sheet describes the policy and wage implications of the sheltered workshops in Wisconsin compared with the advantages and possibilities offered by prioritizing integrated employment.http://wi-bpdd.org/whoweare/2013wipolicystatements/Employment.pdf

Q. I have heard the proposed change will make providers and businesses shut down or close their doors.

DHS' plan gives five years plus technical assistance to providers to help them meet the letter of this (federally required) change. Individuals will not lose their supports and DHS’ plan articulates assurances for individuals in this regard. If a person has an employment goal in their individual plan, the Managed Care Organization (MCO) must ensure continued employment supports. Wisconsin sheltered workshops have had 15 years to change their business model since the Olmstead (Supreme Court) decision requiring more integration for people with disabilities. (This DHS change is based upon stronger enforcement of the Olmstead ruling.) During that time, the state of Wisconsin invested $75 million over ten years (ending in 2011) to build integrated employment capacity, including specific efforts to help providers change their business models. While some providers did change, others benefited from the funding, but chose to continue business as usual.

This Wisconsin video features interviews with providers who were originally resistant, but then embraced the change: https://www.youtube.com/watch?v=xd3qgUwLHbw&feature=youtu.be

Q. Aren’t there some people with significant disabilities who just cannot work in the community? Don’t we need a place for them?

The average wage in sheltered work in WI is currently $2.40 an hour, compared with nearly $9 for people with the SAME DISABILITIES in integrated employment. Again, this includes people with all disabilities, including significant impairments.

For several years Dane County has been offering a different model of employment supports than the rest of the state – focusing on securing community employment for youth exiting high school. Their model demonstrates that people with significant disabilities can be employed in the community at much greater rates than what providers in other areas are claiming. Dane County phased out most of its sheltered workshops over the last 20 years and now has an employment rate for people with the most significant disabilities of more than 80%: nearly the same rate as the general population (although most people are not working full time).

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