Association for Public Policy Analysis & Management

As the U.S. undergoes major employment systems changes in the Medicaid Home and Community-Based Services (HCBS) environment, it is critical to use evidence to support future policy advancement and advocacy efforts. This presentation will describe the results of a study utilizing National Core Indicator data to understand the connection between service settings and often-overlooked outcomes, such as relationships and self-determination, for people with intellectual and developmental disabilities across the country.

State Developmental Disability agencies are currently in process of developing plans to ensure state Home and Community-Based Services (HCBS) meet the 2022 setting regulation deadline issued by CMS. In this process, with respect to employment services, states are forced to confront the role and purpose of the various types of employment services typically available via state Waivers, specifically, community-based individual, community-based group, and facility-based services. In addressing the setting regulations, it is critical for states and advocates to be using evidence to inform their direction, rather than rely solely on anecdotal evidence. To do this it is necessary to conduct and make available research comparing and contrasting the different employment service settings.

This presentation will provide attendees with findings about; how systemic and disability-related factors affect the type of employment services an individual receives; and, how different employment service settings relate to key life outcomes of people with disabilities. Rather than merely assessing how effective these settings are at achieve higher wages and hours, as is typical in employment research, it advances the field by providing a comparative assessment of different employment settings and key life outcomes, such as social relationships, loneliness, and self-determination, using a national dataset of HCBS service users. Findings specifically challenge the often-stated reason to retain more restricted employment settings, that people would not be able to develop friendships and other relationships. Findings also support the notion that people in less restricted settings experience higher levels of self-determination.

Additionally, the presentation will summarize, based on this research, key systemic features that are more likely to lead to more individualized (or more segregated) service utilization. For example, the study highlights the negative relationship that guardianship has on employment setting usage and the positive relationship that employment goals have on less restrictive setting access.