Uncovering Some Myths about ECF CHOICES Program

By Janet Shouse

About the Author

Janet Shouse is a parent of a young adult with autism, and she is passionate about inclusion, employment of people with disabilities, medical issues related to developmental disabilities, supports and services, public policy, legislative initiatives, advocacy, and the intersection of faith and disability. She wears many hats at the Vanderbilt Kennedy Center, including one as a disability employment specialist for TennesseeWorks.
Our hope is that this weekly blog will offer information you want to know, so if you have a question you want answered about employment for people with disabilities or other mysteries of the world of work, please email me at janet.shouse@vanderbilt.edu.Our hope is that this weekly blog will offer information you want to know, so if you have a question you want answered about employment for people with disabilities or other mysteries of the world of work, please email janet.shouse@vanderbilt.edu.

I will just admit that much of today’s post is “borrowed” from a TennCare fact sheet that was created a few months back, but I’m borrowing because there’s important information to be shared.

As the Employment and Community First CHOICES waiver program rolled out last summer a great deal of attention was focused on the “employment” portion of the new waiver, and rightly so. Tennessee was the first in the nation to focus a waiver program on the idea of “Employment First,” which means that “integrated, competitive employment is the first and preferred outcome in the provision of publicly funded services for all working-age citizens with disabilities, regardless of level of disability.” So, while Tennessee has had home and community based services for a number of years, this was really the first time Medicaid-funded services have emphasized the value of work, the benefits of being part of a work environment, and the financial opportunities that integrated, competitive employment can have for an individual with disabilities. This was also the first time that supports and services were clearly targeted to supporting people so they could be employed out in the community.

BUT, the intense focus on employment has led some individuals with disabilities and their families to think that if the person isn’t looking for work or has significant disabilities, there simply are no longer services available to help them. Or that if the person is not employed already, he or she cannot receive Employment and Community First CHOICES supports and services. Here are some responses to those concerns.

Myth: “You have to be employed to get into Employment and Community First CHOICES.”

Reality: “People with an intellectual or developmental disability who have a job and need support to keep it, recently lost a job and need help to get a new one, or are finishing school and have a job or a commitment of a job are among the first groups that get to apply for enrollment in Employment and Community First CHOICES. But you don’t have to be employed to get into Employment and Community First CHOICES. Transition-age youth and adults with any level of intellectual or developmental disability who want to enroll in Employment and Community First CHOICES, and who qualify to enroll in the program, only have to be:

  • Interested in working, with supports they will get from the program
    OR
  • Open to exploring the option of employment or self-employment, with supports they will get from the program.

“Employment and Community First CHOICES is built on the belief that employment has many positive benefits for people. These include higher income, better health and quality of life, and greater opportunity to make friends and be part of their community. But, we recognize that sometimes people will need to experience those benefits first-hand in order to realize they exist. As long as people who qualify to enroll in the program aren’t fundamentally opposed to exploring the opportunity to work, with needed supports they will get from program, they may qualify for priority enrollment in Employment and Community First CHOICES.”

And priority categories have expanded since this was written. Click here for the list of priority categories.

Myth: “People with more significant disabilities can’t be served in Employment and Community First CHOICES.”

Reality: “Employment and Community First CHOICES is for people with intellectual and developmental disabilities, including people with significant medical and behavior support needs. The groups targeted for priority enrollment in Employment and Community First CHOICES include people who have complex health problems or who have behavior needs that place themselves or others at risk. Benefits in the new program offer an array of services, including residential supports, up to 24 hours a day based on the needs of each person. The total cost of services a person in Employment and Community First CHOICES can receive depends on the level of need they have. For people with complex medical or behavior support needs, the total cost of services a person can receive in the community is based on what it would cost to provide services in an institution (a nursing home or an intermediate care facility for individuals with intellectual disability). This helps to ensure that people with greater needs are able to access the level of support they need in the community. For residential and employment services, the rates paid to providers are also higher for people with greater needs to account for the higher intensity of services they will need to provide.”

The next myth is a biggie!

Myth: “People with more significant disabilities can’t work.”

Reality: Every person can be supported to work, regardless of their level of disability. No one is presumed ineligible for employment services or incapable of working—alongside people who don’t have disabilities and for the same wages. Groups that are able to enroll in the program first, based on interest, desire or need to obtain or maintain employment don’t exclude anyone, regardless of their level of disability. The array of employment services available in Employment and Community First CHOICES is extensive, and reflect what we know works for people with IDD. These services create a pathway to employment, even for people with the most significant disabilities. Making sure people at least explore employment, and learn about the employment supports available, before making a decision about whether to pursue work or not further helps to ensure that people don’t dismiss employment as a real option because they lack complete information and a vision for how employment could be possible for them. Providers are paid more to provide employment services like Job Development and Job Coaching for people with more significant disabilities to help cover the cost of additional supports the person may need to work.”

Myth: You can’t get residential services in Employment and Community First CHOICES.

Reality: “Benefits in the new program include residential supports, up to 24 hours a day, based on the needs of each person. The residential services are called Community Living Supports. These services offer support with activities of daily living and other tasks that help a person with IDD live in the community and engage in community life. The services are usually provided in a small, shared living arrangement or with a family (not the person’s own family) who will provide the supports the person needs. The person pays for their room and board. The rates paid to provide these services depend on the level of support the person needs. Providers are paid more to provide Community Living Supports for people who need more hours of support or have complex medical or behavioral needs. This helps cover the cost of additional supports the person may need to live and participate in their community.”

This next myth is one I’ve heard often. But I do want to mention one thing: the answer below refers to individuals with an intellectual disability. Since individuals with intellectual disabilities were the only ones eligible for the Home and Community Based waiver programs under the Department of Intellectual and Developmental Disabilities, this is an apple-to-apple comparison.

Myth: “You can’t get as much support in Employment and Community First CHOICES as you can get in the HCBS waiver programs that closed once the new program began.”

Reality: The total cost of services a person with ID who has complex medical or behavioral needs can receive in Employment and Community First CHOICES is the same as they would receive in the Statewide Waiver. The total cost of services a person in Employment and Community First CHOICES can receive depends on their level of need. For a person with ID who has complex medical or behavior support needs, the total cost of services they can receive in the community is based on the average cost of care in a private intermediate care facility for individuals with intellectual disability. This is the same whether the person is enrolled in Employment and Community First CHOICES or the Statewide HCBS Waiver.”

As I’ve mentioned previously, a number of us in the disability community advocated for years to expand home and community based services to individuals with developmental disabilities, and to provide services to more individuals with intellectual disabilities, many of whom had languished on the DIDD waiver waiting list for years. We want to make sure that all 1,700 slots in this first year of the Employment and Community First CHOICES waiver program are filled. Folks in the know keep assuring me that all 1,700 spots will be taken by June 30, and I sure hope so. Plus, 700 new slots have been added for next year! If you know of someone who might benefit from the Employment and Community First CHOICES waiver program, please share the information. The self-referral can be found here. We are trying to reach as many individuals with disabilities and their families as we can. There is help available.

As always, if you have questions or concerns, please email me at janet.shouse@vanderbilt.edu, and I will do my best to find an answer.

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