DELIVERING ON THE PROMISE - REPORT OF FEDERAL AGENCIES' ACTIONS TO ELIMINATE BARRIERS AND PROMOTE COMMUNITY INTEGRATION
Overview: In February 2001, President Bush released the New Freedom Initiative, a comprehensive plan to tear down the barriers facing people with disabilities and preventing them from participating fully in community life. As part of that initiative, the President issued Executive Order 13217, "Community-Based Alternatives for Individuals with Disabilities," June 18, 2001. The order calls upon the federal government to assist states and localities to swiftly implement the decision of the United States Supreme Court in Olmstead v. L.C. In that case, the court found that, under certain circumstances, the Americans with Disabilities Act (ADA) requires states to provide community-based services for persons with disabilities and holds that unjustified institutionalization of a person with a disability is discrimination under the ADA.
More information on the New Freedom Initiative and Executive Order 13217 is available at www.hhs.gov/newfreedom.
BACKGROUND
Executive Order 13217 directs six federal agencies, including the departments of Justice (DOJ), Health and Human Services (HHS), Education (ED), Labor (DOL) and Housing and Urban Development (HUD) and the Social Security Administration (SSA) to evaluate their policies, programs, statutes and regulations to determine whether any should be revised or modified to improve the availability of community-based services for qualified individuals with disabilities and to report back to the President with their findings. The departments of Transportation (DOT) and Veterans Affairs (VA) and the Office of Personnel Management (OPM), though not named in the Executive Order, also joined in the implementation effort.
Together, the participating agencies formed the Interagency Council on Community Living (ICCL) under the leadership of HHS Secretary Tommy G. Thompson. The self-evaluation process represented an unprecedented government-wide effort to identify and find ways to remove barriers to community integration. The interagency collaboration it generated will serve as a model for future interagency efforts on disability and other issues.
President Bush directed that public input would be a central component of the federal review mandated by the order. To encourage the broad participation of people with disabilities, family caregivers, providers and advocates in the public input, the ICCL sponsored a national listening session in Washington, D.C., a national teleconference, and a Federal Register notice soliciting written public comments. More than 800 individuals and organizations provided comment.
On March 25, 2002, HHS presented President Bush with the reports of the nine agencies participating in the self-evaluation. Prior to delivering the full reports, Secretary Thompson presented the President with a preliminary report on Dec. 21, 2001. The reports will be available soon atwww.hhs.gov/newfreedom.
FINDINGS OF THE 'DELIVERING ON THE PROMISE' REPORTS
In their reports to the President, the participating federal agencies identified more than 400 steps to tear down barriers and improve community integration in a number of key areas. Following are a few highlighted recommendations in each of the barrier areas that were identified:
Health Care Structure and Financing: When the Medicaid program was created nearly 40 years ago, few community-based alternatives were available for people with disabilities who required health care services. Despite the expanded possibility of community alternatives available today, approximately 73 percent of Medicaid long-term care funding pays for institutional care while only 27 percent is directed toward home- and community-based services.
HHS will establish a Medicaid Community Services Reform Task Force with representatives from within the disability community and national, state and local organizations to advise the department on actions within the Medicaid program that may be advisable to remove barriers and promote community living for people with disabilities.
HHS will develop a strategy to address quality of care issues in home- and community-based settings, including: establishing defined expectations for home- and community-based services; assisting states in how to best use the results of HHS quality reviews of community placements; providing technical assistance to states in effective systems design or quality improvement strategies; and implementing new quality assurance and improvement systems for services in the home.
HHS is providing states with substantial resources to improve community-based services through Systems Change grants ($125 million in fiscal years 2001 and 2002), Medicaid Infrastructure grants to promote the employment of people with disabilities ($25 million in fiscal year 2002) and through the National Caregiver Support Program ($142 million in fiscal year 2002).
Housing: The lack of accessible, affordable housing continues to present a major barrier to the participation of people with disabilities in their communities and in the economic life of the nation. As more people with disabilities leave institutions for community life, this housing shortage will become more acute unless actions are taken.
HUD will provide technical assistance to local public housing authorities to improve information on the need and use of vouchers for people with disabilities. HUD will strongly encourage local authorities to consult with local disability organizations on how best to maximize the use of vouchers in their areas.
HUD will coordinate efforts with DOJ to devote substantial resources toward investigations and enforcement actions against developers, architects and site engineers who design or build multi-family housing that does not comply with the accessibility provisions of the Fair Housing Act.
HHS will provide technical assistance and clarification as to methods through which Medicaid is able to assist individuals in transitioning from institutional to community residence.
Personal Assistance, Direct Care Services and Community Workers: There is already a critical need for personal care assistants and other direct care staff to provide services to people with disabilities living in the community. The administration will work to increase the number of these workers through recruitment, training, and work-related benefits.
DOL's Office of Disability Employment Policy will work with other federal partners to identify and propose options for increasing the availability of personal assistants for people with disabilities and providing paths of career progression for personal assistants and other direct care staff.
HHS will work with a limited number of volunteer states to initiate a national demonstration to address workforce shortages of community service and direct care workers. The demonstration will test the extent to which workforce shortages might be addressed through better coordination with the Temporary Assistance for Needy Families program and the availability of vouchers to workers for health insurance or for tuition or day care credits.
Caregiver and Family Support: The vast majority of direct care for people with disabilities is provided by families, friends and neighbors. However, despite the enormous contribution of family and informal caregivers to the community integration of people with disabilities, these caregivers receive little direct assistance and often face great financial and emotional pressures.
HHS will seek authorization and funding from Congress for a demonstration to allow states to include respite care for adults. Unrelieved caregiver burden is a major contributing factor to institutionalization of individuals with disabilities; respite care is the service most often requested by families in order to keep a family member with a disability at home.
HHS will also seek authorization and funding from Congress to implement a 10-year demonstration to provide respite services to caregivers of children who have a substantial disability.
Transportation: Accessible transportation is necessary for people with disabilities to go to work, get an education, receive medical care and to have an active, inclusive role in society. Barriers to transportation include a lack of available transportation options such as public transportation and a lack of access to existing transportation services.
DOJ will look for opportunities to participate in private lawsuits as amicus curiae on issues involving paratransit services and accessible public transportation and will continue its efforts to expand the available modes of accessible transportation nationwide.
Employment: The dignity, responsibility and economic independence resulting from gainful employment is one of the most effective ways of enhancing self-reliance, changing attitudes, reducing dependency on public benefits and promoting community acceptance of people with disabilities.
DOL will undertake an Olmstead Community Empowerment Initiative, developing and implementing a coordinated strategy to ensure that all DOL policies and activities fully address the employment and training needs of people with disabilities who are at risk of institutionalization or who are transitioning from an institution to the workplace and community living.
DOL will award Olmstead Community Employment Planning and Implementation Grants to states that develop an employment focus for persons with disabilities in their Olmstead state implementation plans and incorporate activities coordinating employment and related supports at the state and local level.
ED will coordinate with state vocational rehabilitation agencies and state education agencies to evaluate and improve transition services provided to youth with disabilities who are making the transition from school to work or to postsecondary education.
Education: Young people with disabilities face particular barriers to succeeding in school and going to college. Low educational attainment and confusing government programs and benefits have resulted in many young people with disabilities not making successful transitions from school to post-secondary education, employment and independent living.
ED's Office for Civil Rights will prepare a resource document for nationwide distribution targeted to parents and students that clarifies the rights of students and the obligations of schools as students with disabilities transition from high school to postsecondary education and will carry out training and technical assistance initiatives in this area.
ED's Office of Special Education Programs will engage in activities to ensure compliance with requirements of federal special education laws for transition planning and transition services so that students and families may be better prepared for the challenges and complexities of the adult world.
Access to Technology: Assistive technological devices enable people with disabilities to live independently or reduce their need for other assistance services. Technology also provides a gateway to a wealth of information about employment opportunities, community events and educational forums and has fundamentally changed the skills and knowledge needed to fully participate in the 21st century workplace.
DOL will work with ED, HHS, the Department of Agriculture and other agencies to coordinate and implement a plan that improves the availability, affordability and accessibility of technology in the school, home and workplace for youth and adults with significant disabilities.
Accountability and Legal Compliance: There is a need for an array of activities to promote states' compliance with the Olmstead decision, including: greater federal oversight of programs that serve people with disabilities; stronger enforcement of laws that protect the rights of people with disabilities; guidance to states on effective planning to provide services in the most integrated setting; and greater and more effective outreach to assist individuals with disabilities and their family members in understanding the ADA and Olmstead's requirements.
DOJ will use its Fair Housing Testing program to identify patterns or practices of discrimination against individuals with disabilities by those who sell or rent housing.
DOJ will expand the use of its mediation program for Olmstead-related claims, including: providing additional training to mediators regarding the decision; investigating ways to train lay advocates; and working toward implementing a formal arrangement under which HHS' Office for Civil Rights would refer appropriate unresolved complaints to DOJ for mediation.
Public Awareness, Outreach and Partnerships: Many people with disabilities and their families are not aware of the full range of community services that are available to them. Outreach to provide information and incorporate the views of people with disabilities and other stakeholders into federal policy will help fill this knowledge gap.
DOL will launch a comprehensive public awareness campaign to decrease stigma, eliminate attitudinal barriers, and increase employment opportunities for adults and youth with significant disabilities. The campaign will target business and industry, lenders and families among others.
DOJ will develop technical assistance documents to educate people with disabilities living in institutions or at-risk of living in institutions about their rights and to assist states in implementing their community-integration responsibilities under the Olmstead decision.
Income Supports: Cash and medical benefits can be critical to an individual's ability to live in the community. Cash benefits, often in conjunction with food stamps and housing subsidies, can provide for basic needs such as food, clothing and shelter. Medical benefits can enable someone to obtain treatment that may be critical to his or her ability to function in a community setting. Of course, work also contributes significantly to an individual's ability to thrive in a community setting.
SSA is providing special training to agency staff who serve the public directly, emphasizing the importance of key policies and procedures to assist people with disabilities and promote the community-integration goals of the Olmstead decision.
Gathering, Assessment and Use of Data: The successful integration of people with disabilities into community settings requires consistent data collection to measure the progress of existing programs and initiatives and to determine the specific needs of people with disabilities.
HHS' Centers for Medicare & Medicaid Services will work with states, universities, foundations and others to ensure that there is an adequate base of knowledge to inform public policy-making regarding: the impact of the Medicaid and Medicare actions under the President's Executive Order; state initiatives to improve community living services; methods for designing long-term care systems so that they promote the ADA and can address the population growth expected due to demographic changes; and methods for designing quality assurance and improvement systems uniquely suited for services in one's own home.
HUD will conduct a "Housing Choice Voucher Tenant Accessibility Study" to assess the feasibility of conducting a nationwide mail survey of voucher program enrollees who have disabilities regarding their experiences in searching for accessible housing.
Cross-Agency Collaboration and Coordination: In order to effectively meet the needs of individuals with disabilities and to efficiently utilize federal resources, the various federal agencies that develop disability policy and provide, fund and support community-based services will communicate about and collaborate on their objectives.
HHS proposes that the President formalize and permanently establish the ICCL, which Secretary Thompson convened to accomplish the tasks set out in Executive Order 13217. The council would articulate a strategic interagency plan to expand and promote home- and community-based services as well as issues related to housing, employment, the long-term care workforce, assistive technology and education.
DOL's Office of Disability Employment Policy will work to develop a memorandum of understanding (MOU) with other federal agencies to work together to improve resources and employment opportunities for people with disabilities. The MOU will serve as a model for state-level coordination to ensure that employment becomes part of the planning process for people transitioning from institutional care into the community.
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Note: All HHS press releases, fact sheets and other press materials are available at www.hhs.gov/news.
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