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| 93.768 MEDICAID INFRASTRUCTURE GRANTS TO SUPPORT THE COMPETITIVE EMPLOYMENT OF PEOPLE WITH DISABILITIES |
| (Ticket To Work Infrastructure Grants) |
| FEDERAL AGENCY |
| CENTERS FOR MEDICARE AND MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES |
| AUTHORIZATION |
| Ticket to Work and Work Incentives Improvement Act of 1999, Section 203, Public Law 106-170. |
| OBJECTIVES |
| To support State efforts to enhance employment options for people with disabilities by building Medicaid infrastructure. Funding may be used to develop a Medicaid buy-in, increase availability of Personal Assistance Services, or for State-to-State technical assistance. In addition, States may use funding to develop a comprehensive approach to bridge Medicaid services with other key supports and programs used by employed people with disabilities. |
| TYPES OF ASSISTANCE |
| Project Grants. |
| USES AND USE RESTRICTIONS |
| While the proposals submitted by the States may vary, States participating in this grant program will use the funds to remove the barriers to employment of persons with disabilities, by creating health systems change through the Medicaid program. The development or enhancement of certain core Medicaid components in each State would enable people with disabilities not only to work, but to sustain adequate health coverage if they find they need to relocate to another State for employment purposes. An adequate personal assistance services benefit and a Medicaid buy-in for employed people with disabilities are significant components of the Ticket to Work and Work Incentives Improvement Act. The infrastructure grants program provides money to the States to develop these core elements. In addition, States may use funding to develop a comprehensive approach to bridge Medicaid services with other key supports and programs used by employed people with disabilities. Funds may not be used for the direct provision of services to people with disabilities except on a one-time, last resort, emergency basis for the purpose of sustaining the individual's competitive employment. |
| Applicant Eligibility |
| Either of the following may apply: (a) the single state medicaid agency; or (b) any other agency or instrumentality of a state(as determined under State law) in partnership, agreement and active participation with the single state medicaid agency, the State Legislature, or the office of the Governor. |
| Beneficiary Eligibility |
| There are two groups of potentially eligible beneficiaries, as defined by the Ticket to Work and Work Incentives Improvement Act of 1999. The first group consists of persons with disabilities between the ages of 16 and 65 years old, employed, and who meet income, asset, and resource standards established by the State. The second group of potential beneficiaries consists of persons between the ages of 16 and 65 years old, employed, and who cease to be eligible for Medical Assistance because of medical improvements determined at the time of a regularly scheduled disability review, but who also continue to have a severe medically determinable impairment. |
| Credentials/Documentation |
| Federal funds must go to a designated State Medicaid Agency or its partner agencies or instrumentality's. Individuals must meet State requirements. Administrative cost will be determined in accordance with OMB Circular No. A-87, "Cost Principles for State and Local Governments." |
| Preapplication Coordination |
| No preapplications are required. This program is excluded from coverage under E.O. 12372. |
| Application Procedure |
| The standard application form SF-424 and related forms, as furnished by CMS, must be used for this program. Application forms are submitted to the Acquisition and Grants Group, CMS, C2-21-15 Central Building, 7500 Security Boulevard, Baltimore, MD 21244-1850. This program is subject to the provisions of OMB Circular No. A-102. |
| Award Procedure |
| Official notice of approved applications is made through the issuance of a grant award. |
| Deadlines |
| Established when program announcements are published in the Federal Register or transmitted to States. |
| Range of Approval/Disapproval Time |
| The range is from 100 to 150 days. |
| Appeals |
| There are no formal appeals procedures. If an application is disapproved, the reasons for disapproval will be fully stated. |
| Renewals |
| Extensions and continuations of projects are available if formally applied for and approved. If a grant application is recommended for approval for 2 or more years, the awardee must annually submit a formal request for continuation accompanied by a progress report that will be evaluated prior to a recommendation of continuation. |
| Formula and Matching Requirements |
| No State or local matching funds are required for the infrastructure grants. |
| Length and Time Phasing of Assistance |
| CMS announced the first round of infrastructure grant awards in October 2000. This grant program is authorized for 11 years beginning in fiscal year 2001. |
| Reports |
| Progress and expenditure reports are required on all projects. |
| Audits |
| All fiscal transactions identifiable to Federal financial assistance are subject to audit by the DHHS audit agency. |
| Records |
| Proper accounting records, identifiable by project number and including all receipts and expenditures, must be maintained for 3 years. Subsequent to audit, they must be maintained until all questions are resolved. |
| Account Identification |
| 75-0516-0-1-551. |
| Obligations |
| (Grants) FY 07 $37,074,935; FY 08 $40,200,000; and FY 09 est $45,500,000. |
| Range and Average of Financial Assistance |
| $500,000 to $2,750,000; $500,000. |
| PROGRAM ACCOMPLISHMENTS |
| Through FY 2007, a total of 50 entities (49 States and the District of Columbia) have been approved for funding from the Infrastructure Grant Program section 203 since its inception. There are 33 States with Medicaid buy-ins and one additional State has a plan amendment under review. As of September 30, 2006, there were just over 78,402 workers receiving Medicaid benefits under the buy-in options. A total of 26 States and the District of Columbia have applied for and will receive continuation grant awards in FY 2007. Nine States received new competitive grant awards in FY 2006. In addition, five States, South Carolina, Missouri, Iowa, Indiana and Arkansas will continue to carry out employment goals for the working disabled population by spending previous grant awards in FY 2007 through a no-cost extension of funding. Of the $42.8 million (FY 2007) that has been appropriated for the upcoming grant year, $34.7 million was granted to the States. The reason for the large discrepancy in the FY 2007 appropriation, and the funding amount is that States are enrolling fewer participants in Medicaid buy-in programs than Congress originally anticipated. Higher levels of funding are legislatively related to the yearly amount of Medicaid buy-in service costs expended by a State. |
| REGULATIONS, GUIDELINES, AND LITERATURE |
| Grants Administration policies (45 CFR 74 and 92) and application kits may be obtained from the Office of Acquisition and Grants Group, Centers for Medicare and Medicaid Services, Room C2-21-15, Central Building, 7500 Security Boulevard, Baltimore, MD 21244-1850. Grant applications forms are also available on the CMS website at http:www.cms.hhs.gov/twwiia/424forms.pdf. |
| Regional or Local Office |
| Contact the appropriate CMS Regional Administrator. (See Appendix IV for Regional Offices.) |
| Headquarters Office |
| Dennis Smith, Director, Center for Medicaid and State Operations, Centers for Medicare and Medicaid Services, Department of Health and Human Services, Room C5-21-17, Central Building, 7500 Security Boulevard, Baltimore, MD 21244-1850. Telephone: (410) 786-3870. |
| Web Site Address |
| http://www.cms.hhs.gov/contracts/ |
| RELATED PROGRAMS |
| 93.778, Medical Assistance Program; 93.769, Demonstration to Maintain Independence and Employment. |
| EXAMPLES OF FUNDED PROJECTS |
| For a description of State specific projects funded under this grant program. Please see our website at www.cms.gov/twwiia/inf_dmap.asp. |
| CRITERIA FOR SELECTING PROPOSALS |
| The major elements in evaluating proposals include: understanding the barriers that impede competitive employment of people with disabilities; the extent to which the proposed infrastructure development will offer enduring and significant improvement in the ability of the system to provide adequate health coverage for people with disabilities and are competitively employed; providing needed personal assistance and other supports, and/or removing other significant employment barriers; the appropriateness of the methods, work plan, budget, and timetable; the qualifications of key staff; and the State's plan for using its grant experiences to identify different or better ways to improve its buy-in or Medicaid services that support the competitive employment efforts of people with disabilities. |
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General Services Administration Office of Chief Acquisition Officer Regulatory and Federal Assistance Division (VIR) |
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