Employment and Community First CHOICES Passes its First-Year Mark

/ August 22, 2017

By Janet Shouse

About the Author

Janet Shouse smiling outside

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@vumc.org.

I missed an important milestone a few weeks ago, and I want to acknowledge that milestone now. As many of you know, the Employment and Community First CHOICES waiver program had its first anniversary on July 1, 2017, and I had intended to provide an update on the program then. However, I got busy, and we had several time-sensitive issues that we wanted to share in this space.

Employment and Community First CHOICES launched on July 1, 2016, with individuals and families literally trying to log in at midnight to complete the “self-referral” form, because for so many years people had waited and waited for long-term supports and services.

At that time, some 6,000 were on the waiting list for services for people with intellectual disabilities. About 4,000 people said they needed services at that moment, and about 2,000 said they expected to need services in the future. ECF CHOICES began with 1,700 spots available, and it would serve not only individuals with intellectual disabilities, but also those with developmental disabilities who do not have an intellectual disability and who had never had a waiting list to wait on.

Tennessee, with the ECF CHOICES program, became the first state in the nation to implement an integrated, home- and community-based services program that aligned incentives toward promoting and supporting integrated, competitive employment and community living as the first and preferred option for individuals with intellectual and developmental disabilities. Learn more about ECF CHOICES here.

In a news release from the Division of Health Care Finance and Administration to mark the one- year anniversary, Patti Killingsworth, assistant commissioner and chief of Long-Term Services and Supports for TennCare, said:

“We created this program after several years of working with advocates, family members, providers and people with I/DD to determine how we could improve health and quality of life while also serving more people. And we are continuing to work with them to improve the new program going forward. We’ve learned a lot together this first year, and we are committed to using all we’ve learned to best position the program to support people and their families even better in the future.”

As of June 30, 1,400 people had enrolled in ECF CHOICES, and 300 were in the process of enrolling. So, all those initial 1,700 slots were taken in that first year. (Some in the advocacy community—including me—had been concerned that not all of the slots would be filled and that might send a message that these long-term supports and services weren’t as desperately needed as we thought.) But that fear turned out to be unfounded.

Actually, Group 4, the Essential Family Supports, which is primarily for children under 21, but can include adults who are still living with family, hit its maximum of 500 slots before June 30, and that group was temporarily closed to enrollment. So, the need was evident for that group. For this year (July 2017-June 2018), 300 new slots are available for Group 4.

Group 5, Essential Supports for Employment and Independent Living, which was initially for adults over age 21 but now includes those 18 and up, focuses on young adults aging out of school to support transition into employment and independent community living. The first year offered 1,000 slots, and this year will have 600 new slots available.

For Group 6, Comprehensive Supports for Employment and Community Living, for people over age 18 who have more intense needs and need more support, 200 slots were available the first year. For 2017-2018, 100 new slots are open.

One measure of ECF CHOICES’ success is that 82% of those enrolled who participated in “job exploration” decided to pursue an employment goal. This is a big deal! The service known as “job exploration” is designed to help a person make an informed choice about whether he or she wishes to pursue integrated employment or self-employment. This service helps identify a person’s specific interests and aptitudes for paid work, and may include business tours, informational interviews and/or job shadowing to learn about local opportunities that may be a good fit. This service also includes introductory education on numerous work incentives for individuals receiving publicly funded benefits (e.g. SSI, SSDI, Medicaid, Medicare, etc.).

“People in this (Employment and Community First CHOICES) program, including people with significant disabilities, want to work, are capable of working, and have so much to contribute to businesses that will want to hire them as well as to their communities,” Killingsworth said in the news release.  “Our challenge is to identify where each person’s strengths and interests meet a need that results in a win-win-win-win—for the person, the employer, the community, and the taxpayer.”

One other important thing happened on the one-year anniversary of the program, and that is TennCare’s third managed care organization, United Healthcare, joined BlueCare and Amerigroup in providing services through the ECF CHOICES program. (More on United Healthcare’s entry into the program in a later post.)

Many of you may already understand that this new, progressive program, which is helping many individuals and families get the supports they need to live and participate in the community and be employed in the community, is funded by Medicaid dollars. At this time, Tennessee pays about 35% of the costs of these supports and services, and the U.S. government pays about 65%. Over the past several months, there have been several federal proposals to impose “per-capita caps” or to create “block grants” for Medicaid. These proposals are often touted as a way to give states “flexibility” in how they use Medicaid dollars. The reality is these proposals would significantly limit the amount of money the federal government would give to states to fund these services and supports. These limits would force states to choose between spending more state dollars, cutting back on the types of services provided or cutting back on who would be eligible to receive services. I would encourage every individual with a disability and every family member to pay close attention in the coming months if new proposals about Medicaid are introduced.

Finally, I would love to hear your success stories with Employment and Community First CHOICES! If you or a family are willing to share your experiences with our readers, please email me at janet.shouse@vumc.org. I hope to be able, in a future blog post, to highlight some folks who are able to work or expand their horizons, courtesy of ECF CHOICES. I also want to hear about the challenges and glitches that you’ve encountered. I will likely share those experiences as well. If you have a story to tell, please email me. (I would rather have emails than just comments on the blog… it’s easier to keep track of emails, and I can ask questions, if need be.)

As always, if you have questions or concerns, please contact me.

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