State Projects to be Awarded

California - Lead Agency: Department of Rehabilitation (DR)

Project Name: Individual Self-Sufficiency Planning (ISSP)

Initial Year Funds Approved: $509,887

Target Population: People with severe psychiatric disabilities

Abstract: The Individual Self-Sufficiency Planning project will involve three of the 28 existing DR/Mental Health Cooperative Project sites; and it will add services for at least 200 individuals with severe psychiatric disabilities each year at sites that have One-Stop Career Centers. The sites will enhance services through adding two staff positions: a Benefits Coordinator and a Service Coordinator. The service delivery to the individual will use a team approach with representatives of SSA, State Rehabilitation, State Mental Health, and other relevant agencies. At the State level, a State Coordinating Council will seek waivers from SSA, HCFA, and perhaps others (i.e., HUD). The waivers will be used to pilot ways to encourage adults with disabilities to work and be less dependent on public assistance. They propose to seek Medicare, Medicaid and SSI waivers to extend Medicare beyond the Extended Period of Eligibility, to allow Medical income limits for SSI recipients and to define property essential to self support more broadly.

Sites: To be determined from the 28 project sites.

Minnesota -- Lead Agency: Department of Economic Security, Rehabilitation Services Branch

Project Name: Making Work Pay: Reducing Medicaid and Social Security Barriers to Employment

Initial Year Funds Approved: $517,243

Target Population: SSA beneficiaries who are VR consumers (with mental illness, mental retardation, physical impairments)

Abstract: The project will address barriers created by the fear beneficiaries have of losing public health insurance and income supports. Barriers will be addressed through education on available work incentives, promotion of VR services, and the use of waivers pertaining to Medicaid Earned Income Disregard and suspending the Extended Period of Eligibility (EPE). Minnesota is expecting approval of an 1115 waiver in October 1998. This waiver includes the "Medicaid Earned Income Disregard Waiver" which will give employed persons on SSDI who require personal care assistance access to continued Medicaid coverage. The project involves good employment and health care agency coordination and addresses major health care concerns and long-term care needs. It also reflects strong involvement and commitment of consumers and advocates.

Sites: Primarily Minneapolis and St. Paul with consultation with individuals available statewide.

New Hampshire -- Lead Agency: Division of Behavioral Health

Project Name: Project Dollars and Sense

Initial Year Funds Approved: $464,284

Target Population: SSI/SSDI beneficiaries with serious mental illness

Abstract: This project will integrate current workforce development efforts in ways that increase efficiency of operations, enhance program quality and outcomes, and ultimately increase the number and wages of individuals with disabilities in meaningful jobs. The project will request waivers from HCFA, SSA, and HUD. Employment services will be integrated through One-Stop Career Centers, a centralized location that can simplify the service interface for consumers. The project will also explore new structures such as "Consumer Credit Unions" to help solve the complicated financial problems of consumers and establish a Statewide management information system. The project will culminate in two regional pilots (in Keene and Manchester) to test employment vouchers in years 3-5 of the funding. New Hampshire will pursue a Medicaid buy-in Option and waivers from HUD, and SSA (if waiver authority is restored).

Sites: State wide with two pilots for employment vouchers in the last 3 years in Manchester and Keene.

New Mexico -- Lead Agency: Department of Rehabilitation, Division of VR

Project Name: Succeed

Initial Year Funds Approved: $660,690

Target Population: SSI/SSDI beneficiaries with disabilities, especially those with mental illness.

Abstract: This project is an interagency cooperative project that coordinates and links systems among the various agencies and service providers through coordinating agreements and memoranda of understanding at the State and local level. The project will provide training and employment support for professionals, agency staff, employers, and consumers. It will also involve professional peer employment liaisons who are people with disabilities who have completed college and/or successfully entered careers. New Mexico will develop new job opportunities through educating employers about tax incentives, supported employment, and natural supports. They will also request a Medicaid waiver.

Sites: Albuquerque and Roswell

North Carolina -- Lead Agency: Department of Health and Human Services, Division of VR Services (DVR)

Project Name: Alliance for Employment Enhancement (AEE)

Initial Year Funds Approved: $290,549

Target Population: SSI/SSDI beneficiaries who have severe and persistent mental illness and are served by DVR; beneficiaries who are blind or visually impaired and are served by the Division of Services for the Blind; and consumers who have physical disabilities who might be able to transition to employment through the North Carolina Independent Living Program.

Abstract: The project will use interventions in two cities, Raleigh and Charlotte, to increase employment and decrease reliance on public supports. Asheville will be selected to collect control group data. The project will reduce uncertainty about the effect of increased wages on benefits and streamline access to employment supports and services. It will do this by: using benefit counselors; increasing incentives for working via waivers to raise the SSI earned income disregard; and ensuring health care by increasing the SSI 1619 threshold, targeting employers who provide health benefits, and providing specific training to make participants attractive to those employers. For one group of clients, they would also provide funds for child care and transportation. North Carolina will seek waivers to increase the SSI section 1619(b) threshold; and raise the SSI earned income disregard.

Sites: Raleigh and Charlotte, Asheville will be control group site

Ohio -- Lead Agency: Department of Mental Health

Project Name: Jobs Incentive Focus (JIF)

Initial Year Funds Approved: $349,980

Target Population: People with serious mental illness

Abstract: JIF will achieve significant increases in employment among people with serious mental illness through 4 strategies that will focus on the Department of Mental Health's (DMH)own leadership. DMH will collaborate with the Ohio Rehab Services Commission and providers to educate consumers and providers about benefits; increase employment opportunities available to clients through Employer Liaisons in the demo sites; and develop a research-based job taxonomy to improve providers' capacity to make successful job matches. DMH will collaborate with other State agencies, including Medicaid, to ensure that current work incentives are fully used and to modify eligibility criteria where necessary to reduce barriers to financial independence. They plan to seek waivers for Medicaid (to implement section 4733 of the Balanced Budget Act on a less than Statewide basis) and for SSDI (similar to section 1619 for SSI), if waiver authority is restored.

Sites: Franklin County (includes Columbus), Portage County (borders Lake Erie), Montgomery County (includes Dayton), Western Ohio Rural Federation (a coalition of local mental health boards in mostly rural and some suburban communities)

Oklahoma -- Lead Agency: Department of Rehabilitation Services

Project Name: Oklahoma Keys to Increasing Employment

Initial Year Funds Approved: $292,625

Target Population: Consumers of mental health services who are SSI or SSDI beneficiaries/applicants.

Abstract: In the Keys project, the Department of Rehabilitation Services will collaborate with the Departments of Mental Health and Substance Abuse Services and the Oklahoma Health Care Authority to focus on creating an integrated service delivery system with special emphasis on incentives for effective long term support and job retention. The project will compare the existing employment model with an enhanced employment model, called the KEYS model, using consumer choice of providers and a combined milestone/voucher payment system. The model will emphasize work incentive education and will enhance long term support by adding job retention vouchers, similar to that described in the Ticket to Work and Self Sufficiency legislation. Milestone payments would be paid to providers with a higher rate of payment for placement in jobs with medical benefits. It will be tested at 6 sites, at least 2 rural. Oklahoma will request a Medicaid waiver.

Sites: First Year, Tulsa and Oklahoma City with 2 sites in each city; Future, 2 rural (one with a minority focus)

Vermont -- Lead Agency: Division of Vocational Rehabilitation

Project Name: Work Incentive, Counseling and Assistance Program for SSI Recipients

Initial Year Funds Approved: $341,481

Target Population: SSI recipients in Mental Health Centers and those working with VR

Abstract: This project, run by Division of Vocational Rehabilitation (VR), in cooperation with Division of Mental Health (MH), will provide SSI recipients in MH Centers and those working with VR with improved access to vocational services and employment outcomes, and improved benefits counseling on the impact that work will have on their benefits. The project will document the impact of these improved benefits, and compare the costs of providing these benefits with the savings that Federal and State governments will realize if these individuals go to work in much larger numbers than previously. It includes consumers as benefit counselors and evidence of good intra-agency collaboration.

Sites: Statewide

Wisconsin -- Lead Agency: Department of Health and Family Services

Project Name: Pathways to Independence

Initial Year Funds Awarded: $946,525

Target Population: Individuals with physical disabilities, mental illness, developmental disabilities and AIDS/HIV

Abstract: This project is the product of 5 years of study and pre-testing. It will provide 1800 SSI/SSDI beneficiaries in four target groups with comprehensive help in securing and maintaining gainful employment in 15 to 20 sites. It will make better use of existing work incentives, and add new assurances of health and long term care coverage regardless of earnings. It will reduce fragmentation and assure participants are better off as a result of employment. The two lead agencies, The Department of Health and Family Services and the Department of Workforce Development will solicit proposals from local public or private organizations to serve as the Pathways access points, establish local networks and provide services. The services will include health and employment consultation to "pull all the pieces together" by involving vocational rehabilitation counselors, representatives from housing and transportation, prospective employers, mental health professionals and case managers for long term care services. The local organizations will also give advice about use of work incentives (1619, Impairment Related Work Expenses, PASS, etc.), help develop employment goals, assess skills, recruit employers and match employees to jobs. The project reflects significant outreach, coordination of services, counseling, follow-on support. Wisconsin will pursue a Medicaid buy-in under section 1733 of the Balanced Budget Act and combine several data bases to house all data in a single data base. If SSDI waiver authority is restored, they will seek a waiver to freeze trial work period for the 5 year duration of the project and elimination of the SSDI payment "cliff".

Sites: Fifteen sites to be determined by competition after award.