Employment Assistance and Supported Employment Versus Day Habilitation

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  • Employment Assistance (EA) is a service that helps people “obtain” competitive, integrated employment.
  • Supported Employment (SE) is a service that helps people “maintain” competitive, integrated employment.
  • Day habilitation (DH) is defined as a facility-based service provided in a group setting during weekday work hours.

In 2013, SB 45 defined these services in law and required them to be offered in all Medicaid community-based waivers. These programs include case management/service coordination, services specifically designed to assist people to be employed, and to get other services to help them meet their goals. The tables below demonstrate that although people want to work, competitive employment is not a goal reflected on service plans.

Supported Employment Utilization by Waiver FY 2015

Supported Employment Utilization by Waiver FY 2015
WaiverTotal People in WaiverNumber of People Approved for SEPercent of People Approved for SENumber of People Received SEPercent of People Received SE
CLASS5,169100.2%70.14%
DBMD24910.4%00.0%
HCS24,7785962.4%4201.7%
MDCP6,42300.0%00.0%
TxHmL8,1572112.6%1281.6%
Grand Totals44,7768181.83%5551.24%

Employment Assistance Utilization by Waiver FY 2015

Employment Assistance Utilization by Waiver FY 2015
WaiverTotal People in WaiverNumber of People Approved for EAPercent of People Approved for EANumber of People Received EAPercent of People Received EA
CLASS5,16930.06%20.04%
DBMD24900.0%00.0%
HCS24,7782210.9%1090.4%
MDCP6,42300.0%00.0%
TxHmL8,1571982.4%831.0%
Grand Totals44,7764220.94%1940.43%

Although individuals are not required to include DH on their service plans, Medicaid community-based waiver participants’ service plans typically include day habilitation (57%). Services offered in DH vary, but may include recreational activity, specialized therapy, and life skills training. It is widely accepted that DH programs require remediation for compliance with the HCBS Settings Rule.

Many DH programs are segregated, involve repetitive tasks rather than skill building activities or employment goals, and some are co-located with sheltered workshops where some workers are paid below minimum wage.

Day Habilitation Utilization by Waiver FY 2015

Day Habilitation Utilization by Waiver FY 2015
WaiverTotal People in WaiverNumber of People Approved for DHPercent of People Approved for DHNumber of People Received DHPercent of People Received DH
CLASS5,1693226.2%2825.6%
DBMD2492911.6%2710.8%
HCS24,77819,84880.1%18,18273.4%
TxHmL8,1574,32753.0%3,50943.0%
GRAND TOTALS38,35324,52663.9%22,00057.4%

Texas Employment First Task Force has begun discussions about system improvements, but without sustained agency commitment and effort, some are concerned that their work will stall. Best practices to consider include Oregon state agencies who strengthened collaboration by entering into a Memorandum of Understanding to support transitioning students with disabilities to enter the workforce. They were able to leverage new funding as well as sequence existing funding strategies to support their efforts. The MOU addressed reporting by streamlining agency data collection and making it available to stakeholders. Other states, like Vermont and New Hampshire, have also reduced duplication of effort by implementing effective strategies and partnerships to efficiently coordinate resources.

Recommended Actions for System Improvement

  • Expect that employment is the first and preferred option provided to working age adults who receive public benefits.
  • Designate employment supports as the primary method of funding state-financed day services.
  • Initiate day activity plans before high school graduation by offering comprehensive transition programs that give students credit for working in the community within multiple work settings to explore interests and skills.
  • Modify reimbursement methodologies because the current allocation supports segregated day options.
  • Prohibit the co-location of sheltered workshops and day habilitation facilities.
  • Ensure waiver participants know they may choose or decline to include day habilitation on their individual plans of care.
  • Assist employed persons who receive SSI to implement work incentives to exclude money, resources, and certain expenses from total earned income.