State progress in expanding workplace PAS

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State progress in expanding workplace personal assistance services (PAS): A state-by-state summary, with examples of state reports on workplace PAS

November 2006

Susan Stoddard, Tanya Temkin, Lita Jans, and Allen Jensen

Introduction

Since 2001, the Medicaid Infrastructure Grant (MIG) program has provided federal funding for state initiatives to support the competitive employment of people with disabilities. States can use MIGs to develop Medicaid supports for working people with disabilities, such as Medicaid Buy-In programs, and greater availability of personal assistance services. In addition, states may use funding to develop a comprehensive approach to bridge Medicaid services with other key supports that enable people with disabilities to obtain and keep employment. The Ticket to Work and Work Incentives Act of 1999 (TWWIIA; PL 106-170) authorized the MIG program for 11 years. The program is administered by the Center for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services.

TWWIIA makes specific mention of workplace PAS, defining PAS as those services necessary to assist an individual with a disability to perform daily activities on and off the job that the person would perform if she or he did not have a disability. CMS has developed a multi-level eligibility structure that allows states to qualify for MIGs while making improvements to their statewide PAS systems. To be fully eligible for multi-year MIG funding, a state must offer PAS statewide within and outside the home at a level sufficient to support an individual in full-time competitive employment. Specifically,

A state's personal care benefit must be sufficient in amount, duration, and scope such that an individual with a moderate to severe level of disability would be able to obtain the support needed to live, get to and from the worksite, and perform at the worksite. This does not mean, however, that a state is responsible for providing personal assistance services at the worksite to the degree that they go beyond the scope of the Medicaid program and subsume an employer's responsibility under the ADA.

(from: Center for Medicare and Medicaid Services, 2005 edition-announcement modification: Medicaid Infrastructure Grant to support the competitive employment of people with disabilities.))

A state that cannot meet these requirements may still be "conditionally" eligible for MIG funding provided it can offer, or make a commitment to offer, PAS inside and outside the home at a level sufficient to support an individual working at least 40 hours per month.

MIG activity is contributing to public knowledge about the extent of workplace personal assistance services and the barriers to its provision and use, and to innovative ideas for expanding the availability of PAS at work. This paper summarizes activities of the MIGs with respect to workplace PAS, and includes examples of publications that have been developed through this process. We have developed this information using two key resources: for the summary of state progress we have worked with material from the Center for Workers with Disabilities and Allen Jensen (Jensen, 2006) and from our own literature review research (Stoddard et al., in press).

Status of states with Medicaid Infrastructure Grants (as of June, 2006)

The Center for Workers with Disabilities (http://www.aphsa.org/disabilities/home/index.htm) provides technical assistance to states in enhancing or developing employment supports for working persons with disabilities, including the Medicaid Infrastructure Grants. Using quarterly report data submitted to CMS by the MIG grantees, Allen Jensen has developed a series of tables summarizing the status of grantee states in

Development of Medicaid Buy-In
Consumer Information and Employer Outreach
Employment Related Support Services
Personal Assistance Services
Data and Research

These are updated periodically to track implementation progress and are available at http://www.aphsa.org/disabilities/home/index.htm and also at http://disability.law.uiowa.edu/lhpdc/rrtc/mig/.

The fourth table focuses on the initiatives in each MIG grantee state with respect to workplace personal assistance services. For our project state-level PAS data, we have adapted this table to show a side-by-side comparison of MIG activities in planning and implementing PAS-related policies for each sub-area of policy development and program planning, which states have progressed in these activities, which states are planning or beginning such activities, and technical assistance and policy tools produced. A description of each activity is included in the footnotes.

As of June 2006, states have progressed in their planning and implementation efforts for employment-related PAS on several fronts:

Planning programs and estimating costs of PAS to support employment, including workplace PAS: Through Arkansas’ Independent Choices Cash and Counseling Program and 1115 waiver, Medicaid recipients (including those who are working) are eligible for self-directed state plan personal care and receive a monthly allowance to hire attendants. Kansas made a decision to submit a State Plan Amendment under the Deficit Reduction Act to provide PAS to people with disabilities who wish to enroll in its Working Healthy program. Michigan provided draft language to amend the State Plan Amendment to allow PAS to be used in the workplace. Their work included review of other state’s models, gathering data on participant’s experiences, analyzing options, and developing recommendations for implementation. Minnesota completed a survey of enrollees in its Medicaid Buy-In program, including workplace PAS users. New Hampshire implemented a certification process for Other Qualified Agencies (OQAs) to provide personal care services and started a process of hiring 4 nurses to monitor the quality of personal care services. North Carolina developed a PAS work group that developed definitions, conducted a survey of PAS users, and developed a service delivery strategy that is now beginning implementation.
Developing amendments to Medicaid waivers and state plans to include workplace PAS and other PAS services to support employment: Maryland conducted literature reviews on other state’s personal care programs, the feasibility of paying family members as PAs, network adequacy and backup systems, and PA training. Maryland also conducted focus groups with employed and unemployed people with disabilities to provide recommendations for improving PAS in the workplace. Oklahoma developed and passed a state plan amendment that provides PAS coverage for previously ineligible working disabled people; the Oklahoma legislature also passed a Self-Directed Care Act to provide more choice and control of service providers, to allow for money to follow the person, as well as other PAS related changes.
Tracking use of workplace PAS, identifying barriers to its use, and improving policy and practice of workplace PAS. Oregon developed a survey to determine how PAS can better meet the needs of employed people with disabilities, and trained staff based on the report’s results. West Virginia created a Personal Care Employment Support Services (PCES) team that trains state employees in human resources, social services, rehabilitation and other programs. Virginia surveyed participants in its HCBS waivers to determine need for PAS use at home and at work and disseminated information about the costs and services in other states in order to support a proposal for a State Plan Amendment. In 2005, the Virginia General Assembly increased payment levels for providers of PAS waiver services.
Developing the PAS workforce Connecticut developed the RewardingWork project to address workforce barriers for personal assistance, including a web site, training curriculum and self-direction manual for employers of PAs, The MIG also works with the Connecticut Association of Personal Assistants to increase awareness of PAS issues. South Carolina developed a voluntary registry of personal care workers and successfully worked to implement changes to make the Nurse Practice Act and waiver policies and procedures consistent.
Conducting outreach, training, and technical assistance to consumers and agencies California created a brochure about using PAS at work, which was translated into multiple languages, distributed in hard copy and posted on its web site. Iowa conducted a series of statewide trainings on self-directed PAS at home and the workplace and has prepared a social marketing effort on a self-direction option for the HCBS waiver program. Missouri piloted a project that allowed people to use state and local resources for PAS at work, and drafted a web site to promote awareness of existing resources. Utah developed statewide service network for the Employment Personal Assistance Services (EPAS) program that included a PAS training curriculum for consumers with serious mental illness. Vermont piloted and evaluated a training program for working PAS users, leading to the production of a training curriculum and toolkit for consumers.
Developing the PAS workforce Connecticut developed the RewardingWork project to address workforce barriers for personal assistance, including a web site, training curriculum and self-direction manual for employers of PAs. The MIG also works with the Connecticut Association of Personal Assistants to increase awareness of PAS issues. South Carolina created a voluntary personal care registry and evaluated its use. South Carolina also improved access to PAS for workers and work seekers by revising waivers to include PAS at work and improving tools to assess the PAS needs of people seeking work.

Examples of workplace PAS studies funded through Medicaid Infrastructure Grants

The literature on workplace personal assistance services includes many publications that have resulted from the efforts of these grantees. These are some examples of reports resulting from MIG efforts, which provide information on state efforts and results.

Maine

Vaughn, L., Evans, L., & Gray, C. (2004). Personal assistance services for workers with disabilities: Case studies. Portland, ME: University of Southern Maine, Muskie School of Public Service.

Maine's Medicaid Infrastructure Grant supported the development of this report on the experience of individuals with disabilities in using PAS to enable them to work. In-depth interviews with five workers with a variety of disabilities yielded personal stories about interviewees' needs and supports, experiences in accessing PAS services, challenges and needs before and during employment, and needed improvements in the PAS system. All interviewees reported using home-based PAS for bathing, dressing, house cleaning, or personal care; none received PAS at a worksite outside the home.
Gray, C., & Salley, S. (2004). MaineCare Personal Assistance Services in the Workplace. Portland, ME: University of Southern Maine, Muskie School of Public Service
This report presents findings from Maine's CHOICES Project, funded by a Medicaid Infrastructure Grant, as well as a preliminary analysis of MaineCare (Medicaid) policies related to people with disabilities. As the report notes, "the focus of this report is personal assistance services through MaineCare funding, with a specific focus on services in the workplace. This preliminary report is designed to provide a basis for further research needed to determine personal assistance needs, demand, cost, benefit, or the impact of policies or practices."

A 2003 survey of enrollees in MaineCare's Workers with Disabilities Option (Maine's Medicaid Buy-In program) showed that most PAS users relied on help from unpaid workers; less than one percent relied on a paid personal assistant at work or to get to work. An even smaller number said they needed but were not getting PAS at the workplace. While a small number of non-working enrollees said they would need workplace PAS if they got a job, many more identified other workplace supports--such as ability to take unscheduled time off or control over work place--as essential to keeping a job.
Salley, S.T., & Glantz, L. (2004). MaineCare enrollees with disabilities work experience: Results from a 2002 survey. Portland, ME: University of Southern Maine, Muskie School of Public Service.
This report presents results of a survey of work experiences of people with disabilities enrolled in Maine's Medicaid program who had never been enrolled in the state's Buy-In program. Findings are compared to those of a similar survey conducted in 2001 with participants in the state's Medicaid Buy-In program.

Of the 524 people interviewed in the 2002 survey, only 12% were working for pay, though over half of those not working said they wanted to work. Working respondents most frequently reported using unscheduled time off and control over pace and schedule as work supports. Though a very small percentage of workers reported using paid PAS at the workplace or at home, 23% said they used unpaid PAS. Sixteen percent of non-workers said they would need workplace PAS in order to work, 22% said they would need PAS at home or to get ready for work, and 45% said they would require a job coach or help with work tasks.

Earnings and number of hours worked by MaineCare recipients were similar to those of Medicaid Buy-In participants. Over a third of MaineCare recipients were worried about losing their Medicaid benefits, and most working respondents did not have access to employer-provided health insurance. Findings suggest the need for more outreach and education on the Medicaid Buy-In option and other work incentives.

Minnesota

Bailey, C.L. (2004). Minnesota’s 2003 PCA consumer survey. Minnesota Department of Human Services. Available at: http://www.dhs.state.mn.us/main/groups/disabilities/documents/pub/dhs_id_029338.pdf

This study examined the experiences and views of 455 participants in Minnesota’s Medicaid-funded personal care assistance (PCA) program. PCA consumers could opt to receive services from an agency that hired and managed the PAS workers or consumers could opt to do these tasks themselves. PCA services include assistance with activities of daily living, health-related functions, redirection and intervention for behavior, and instrumental activities of daily living, including assistance at the place of employment. Forty-six percent of respondents said PAS services enabled them to do paid or volunteer work, though only 31% of working-age consumers did such work. About 22% of consumers with paid or volunteer jobs received PCA services at work. The most common type of assistance was with eating or meals, followed by help with job-related tasks such as filing or communicating. About three-fourths of consumers with worksite PAS had it paid for by Medicaid, and 18% had it paid for by their employers. Among those who said they did not have PAS at work, most said they did not need it, but others reported not having enough service hours and not knowing how to set up PAS at work. Most working-age respondents were not enrolled in the state's Medicaid Buy-In program, and most were not aware of it.

Nebraska

University of Nebraska Public Policy Center. (2002). The impact of earnings of Nebraskans with disabilities on their eligibility for selected services and programs. Lincoln, NE: Author.

Nebraska's Medicaid Infrastructure Grant program supported the development of this report on policy alternatives for making Medicaid and other publicly-funded programs more responsive to the needs of working people with disabilities. Four possible policy goals are outlined and assessed in terms of potential benefits to people with disabilities and costs/benefits to the state. The report includes an array of policy strategies for the state to consider for Medicaid, food stamps, low income energy assistance, Section 8 rental housing and housing vouchers, TANF, and other federally-supported programs administered by the state.

South Dakota

Rudrud, E. (2002). St. Cloud University. South Dakota Medicaid Infrastructure Grant. South Dakota Freedom to Work Survey Report. Black Hills Special Services through contract with the South Dakota Department of Human Services, Division of Rehabilitation Services. Centers for Medicare and Medicaid Services, Project Number P-91485/8.

According to the South Dakota Medicaid Program, two major employment barriers for people with disabilities are the lack of comprehensive PAS, and the lack of Medicaid buy-in for employed people with disabilities. The Freedom to Work Survey, supported by the state's Medicaid Infrastructure Grant, assessed the needs and opinions of over 1,000 South Dakotans with disabilities regarding employment, health insurance, current services, and additional services. The survey included individuals who had been employed during the last two years and experienced difficulties at their workplace, and individuals who had not worked during that time.

The survey reports information on recipients’ health insurance and employment status, the funding and source of home and workplace PAS (if used), the types of services or supports used and/or needed in the workplace, and reasons for not working. Among other findings, one-third of unemployed respondents reported fear of losing their disability cash benefits and/or health insurance as the major reason for not working, and 57% said they would consider working if their current health care benefits would not be lost. One third of working PAS users said that PAS at the workplace was provided through an agency, and 29% said they needed additional PAS at work.

The Freedom to Work Project planned to further analyze the results in preparation for expanding PAS in South Dakota and developing a Medicaid Buy-In program.

Utah

Sheen, J., Barkdull, C., & Holt, J. (2005). Employment Personal Assistance Services (EPAS) evaluation report. Salt Lake City, UT: Utah Department of Health.

Utah's Medicaid Infrastructure Grant enabled the evaluation of the EPAS program, a Medicaid-linked PAS program designed to support working individuals with disabilities at home and in the workplace. The purpose of this evaluation was to provide a description of the 35 participants in EPAS, to understand their perceptions of the program, and to identify strengths and weaknesses in program implementation. The study used state administrative data and interviews with service brokers and participants to develop preliminary findings and recommend improvements. Over three-fourths of participants required help with transportation; about one-fourth required PAS in the workplace. In general, participants felt that the program had positive impacts on their work situation, capacity to work, and work attitudes. Although EPAS contributed to participants' increased earnings and ability to maintain employment, many still had concerns about how work would impact their Social Security benefits and Medicaid coverage. The study's recommended that EPAS provide additional training for participants in managing PAs, expand the number of fiscal employer agents, develop targeted outreach efforts, set up a pool of personal assistants for back-up support, and continue information and referral activities.

Vermont

Keller, J. (2003). Using PAS service in Vermont to support employment. Burlington, VT: Keller & Fuller, Inc.

Part One: Current programs, promising practices and next steps for study.

Part Two: Gaps in current programs and possible remedies.

Part Three: Eligibility, Services, Utilization, and Costs.

Vermont's Medicaid Infrastructure Grant supported this series of studies on ways to improve employment-related PAS for people with cognitive disabilities. Gaps in the state's current Medicaid plan and waiver programs include restrictive eligibility standards and lack of coverage of PAS services relevant to people with cognitive disabilities, such as cuing and help with life skills. Drawing on the experiences of states that have initiated PAS programs that include people with cognitive, psychiatric, or developmental disabilities, the reports present various policy options for making workplace PAS available to Vermonters with cognitive disabilities. The study proposes developing a new category of PAS apart from the existing state Medicaid plan, similar to Utah's EPAS program, to support employment of these individuals.

The MIG grants have resulted in a number of initiatives that have contributed to changes in workplace PAS information and opportunity in states. Our policy tracking will continue to update this information as it becomes available. Selected MIG grant products and initiatives will be included as candidates for best practices in improving employment outcomes through workplace PAS.

**State planning and development of PAS programs through Medicaid Infrastructure Grants**. Adapted from Allen Jensen (2006). Personal assistance services. Retrieved October 31, 2006 from: http://disability.law.uiowa.edu/lhpdc/rrtc/mig/
	PAS program planning & fiscal estimating	PAS State plan policy development & implementation	PAS & HCBC waiver policy development & implementation	PAS & employers and the workplace studies & policy	PAS & Self directed programs	PAS workforce	Improve consumers' and others' understanding of PAS options for improving employment	Improve PAS program administration with eligibility & case management data systems
Alabama					Beginning¹
Alaska		Experience²		Planning³
Arizona
Arkansas	Planning⁴
California		Experience⁵		Experience⁶			Experience⁷
Colorado	Planning⁸	Planning⁹	Experience¹⁰		Experience¹¹
Connecticut			Experience¹²			Experience¹³
Delaware					Experience¹⁴
District of Columbia					Planning¹⁵
Florida	Planning¹⁶
Georgia
Hawaii	Planning¹⁷					Experience¹⁸
Idaho
Illinois			Planning¹⁹
Indiana	Planning²⁰
Iowa	Planning²¹				Experience²²
Kansas	Planning²³				Planning²⁴
Kentucky
Louisiana		Experience²⁵			Experience²⁶
Maine				Experience²⁷			Experience²⁸
Maryland		Experience²⁹				Experience³⁰
Massachusetts				Planning³¹
Michigan	Planning³²
Minnesota	Experience³³
Mississippi
Missouri	Planning³⁴						Planning³⁵
Montana
Nebraska
Nevada		Planning³⁶
New Hampshire				Experience³⁷	Experience³⁸
New Jersey		Planning³⁹
New Mexico							Experience⁴⁰
New York
North Carolina	Planning⁴¹
North Dakota	Experience⁴²
Ohio	Planning⁴³
Oklahoma	Experience⁴⁴		Experience⁴⁵		Planning⁴⁶
Oregon				Experience⁴⁷
Pennsylvania			Experience⁴⁸	Beginning⁴⁹
Rhode Island
South Carolina			Planning⁵⁰			Experience⁵¹
South Dakota		Experience⁵²
Tennessee
Texas
Utah				Experience⁵³	Experience⁵⁴	Experience⁵⁵
Vermont	Experience⁵⁶				Experience⁵⁷	Experience⁵⁸		Experience⁵⁹
Virginia			Planning⁶⁰	Experience⁶¹
Washington						Experience⁶²
West Virginia				Experience⁶³	Planning⁶⁴		Experience⁶⁵
Wisconsin	Experience⁶⁶			Experience⁶⁷	Experience⁶⁸
Wyoming	Planning⁶⁹

Footnotes

¹ Alabama – PAS and self-directed programs

1st Q 2005 - Developing a PAS Consumer/Provider Utilization Training Module/Pilot to train providers maximizing availability of PAS providers and train consumers increasing awareness and self-determination choices regarding PAS providers and utilizing options to access employment. The State has collaborated with Alabama Department of Rehabilitative Services to complete this project. The State will develop an RFP by 03/31/05, to complete development of the Attendant Training Registry/Network. The Project staff will complete the development of the PAS Utilization Training for consumers.

2nd Q 2004 – Developing a training module for consumers and providers including increasing awareness and self-determination choices regarding PAS providers and utilizing options to access employment.

² Alaska – PAS state plan policy development & implementation

Initial - Clarified Medicaid regulations that transportation to and from work is a covered service for both consumer-directed and agency-based PAS services.

³ Alaska – PAS and employers and the workplace studies and policy

4th Q 2004 - The survey of PAS recipients of working age regarding their interest in working and identification of the supports needed for them to go to work has been completed and analyzed. Project staff also participated in a December 3 Think Tank to streamline the program and make it more cost-effective.

⁴ Arkansas – PAS program planning and fiscal estimating

2nd Q 2005 - MIG PAS committee has reviewed current services and barriers to PAS in workplace, in preparation for preparing recommendations. Division of Development Disabilities Services is preparing an amendment to the MR/DD HCBS waiver that includes adding Buy-In eligibility. Still reviewing options, including adding Buy-In eligibility to PD waiver as well as DD/MR waiver, amending State Plan personal care, and role of cash-and counseling 1115 waiver.

1st Q 2005 – Formed a PAS committee and will be studying other states' workplace PAS services and utilization, developing a proposal, and submitting the proposal to the Medicaid agency.

⁵ California – PAS state plan policy development & implementation

4th Q 2004 - Working with Social Services Department to finalize tracking system and educate county staff as to availability of IHSS in the workplace.

3rd Q 2004 – MIG staff helped finalize regulations on new PAS program for additional PAS in the workplace.

⁶ California – PAS and employers and the workplace studies and policy Initial - Interagency agreement created to allow for modification of State data system for PAS to track individuals who utilize PAS in the workplace.

⁷ California – Improve consumers’ and others’ understanding of PAS options for improving employment

1st Q 2005 - First draft of ‘IHSS at Work' (PAS program) brochure completed. Distributed approximately 93,000 brochures & made all brochures & language translations available on our website. San Diego county developed an 8-minute outreach video.

⁸ Colorado – PAS program planning and fiscal estimating

Initial - Policy task force on Personal Care Services is working with policy consultant to examine state’s current policies and Federal regulations.

⁹ Colorado – PAS state plan policy development & implementation

1st Q 2004 – Report developed recommended that state maintain personal care as a home health and waiver based service or implement a state plan benefit in addition to waiver.

Initial - Subcommittee of New Employment Incentives for Independence (NEII) Advisory Committee will form a subcommittee to act as personal care policy task force to determine the feasibility of implementing personal care as a Medicaid state plan benefit.

¹⁰ Colorado – PAS and HCBC waiver policy development and implementation

4th Q 2004 - Development of the self-assessment tool is complete after obtaining input from navigators and a variety of audiences. The Department trained a total of 75 PASS Navigators across 16 Single Entry Point (SEP) regions. Navigators completed outreach to people with disabilities in the community.

Initial - State has hired a PAS Navigator to assist Medicaid recipients in assessing accurate and individualized information on their PAS options. A consultant will develop a self-serve needs assessment tool and a group of Medicaid clients to serve as volunteer PAS Navigators.

¹¹ Colorado – PAS and self-directed programs

2nd Q 2004 – The Technical PASS Navigator began training case managers on PASS programs to transition the position’s function to traditional points of contact for Medicaid service information. The Department trained Community-Based PASS Navigators in four Single Entry-Point regions.

1st Q 2004 – Personal Assistance Services and Supports (PASS) Navigators assist Medicaid recipients in assessing their PASS options. State has developed materials to train Community-Based PASS Navigators and developed a self-assessment tool.

¹² Connecticut – PAS and HCBC waiver policy development and implementation

2nd Q 2005 - State legislation to modify Medicaid waivers include continuing Personal Care Assistance (PCA) for persons currently on the PCA and ABI waivers who age into the home care program for elders program. Cost analysis initiated.

¹³ Connecticut - PAS Workforce

2nd Q 2005 - Connecticut Association of Personal Assistants is working with the MIG staff on a series of activities to increase awareness of PAS issues. Members of the group participate in steering committee events.

4th Q 2004 - RewardingWork website is online, with 12 registered employers and 116 applications from Personal Assistants.

3rd Q 2004 – MIG project purchased site license for Rewardingwork.org and now has an active Connecticut page on website. Registration has begun with 50 personal assistants and 10 employers registered by September 30, 2004. A training manual has been developed.

2nd Q 2004 – Developing training curriculum and stand alone self direction manual for employers of personal assistants. Began developing web-based reporting tool.

Initial - MIG staff participating in steering committee related to addressing workforce barriers for personal assistants.

¹⁴ Delaware - PAS and self-directed programs

4th Q 2004 - CMS approved Delaware's Independence Plus Medicaid Home & Community-Based Services Waiver request on 11/18/04, thus further expanding the availability of consumer directed PAS in and out of the home, statewide.

1st Q 2004 – State is working on developing a consumer-directed PAS waiver program. Medicaid waiver would build on current state funded PAS consumer directed program.

¹⁵ District of Columbia - PAS and self-directed programs

2nd Q 2005 - Executed a contract for the development of a consumer-directed PAS option.

1st Q 2005 - Planning to execute a contract for the development of a consumer-directed PAS option.

¹⁶ Florida – PAS program planning and fiscal estimating 1st Q 2006 - State MIG will contract to conduct a study to increase understanding of the strengths and weaknesses of current coverage of Personal Assistance Services (PAS) under Florida’s HCBS waivers. Study will explore expansion options, impact on Medicaid expenditures, and produce a report with findings and recommendations.

¹⁷ Hawaii – PAS program planning and fiscal estimating

1st Q 2006 - After evaluation of situation it was determined that Hawaii had sufficient availability of PAS services statewide under Medicaid waivers.

2nd Q 2005 – Developing plans to gather input from stakeholders on improving PAS program through focus groups to be held in August – October 2005.

¹⁸ Hawaii – PAS workforce

1st Q 2006 - Initiated discussion/planning of training academy for certification/standardization of PAS providers to support competitive employment.

¹⁹ Illinois – PAS and HCBC waiver policy development and implementation

4th Q 2005 - Have completed the training manual development, mentor training implementation and "matching" components of the program. Currently the mentors are working with their "mentorees" to help them understand how to approach finding the right job, and what they need to do to become employed.

Plans for 2006 - Planning to develop an Advisory Committee from the Network of Centers for Independent Living to serve in an advisory role for the peer mentoring project.

3rd Q 2005 – Sending information on peer mentoring program to current Buy-In enrollees who are potential volunteer mentors and to those in the HCBW program in attempt to "match" the HBWD enrollees with volunteer mentors. Also developing and implementing a training curriculum for both components, to track the communication between the mentors and their peers, and to track eventual outcomes of the peer mentoring project

2nd Q 2005 - Bids were developed and distributed to vendors to provide the technical components of the peer mentoring program, i.e, recruitment letter, the matching process, training materials and the tracking components. Proposals were received and reviewed and a vendor selected.

1st Q 2005 - Developing plans to create a peer mentoring program, linking current Buy-In enrollees with individuals with college education in the Home and Community Based Waiver personal assistance program, with the intent of getting them (HCBW recipients) employed.

²⁰ Indiana – PAS program planning and fiscal estimating

2nd Q 2005 - PAS needs assessment and feasibility study with recommendations was completed and is being distributed.

1st Q 2005 – Entering the final phase of the needs assessment

1st Q 2004 – State entered into contract with Indiana University to conduct a needs assessment and feasibility study for expanding PAS capacity.

Initial - State is assessing the capacity to provide PAS and the unmet need.

²¹ Iowa – PAS program planning and fiscal estimating

1st Q 2004 –Governor’s Budget included funds for PAS state plan amendment contingent on tax increase – Tax increase not approved by legislature.

²² Iowa – PAS and self-directed programs

3rd Q 2005 - Preparation/planning for social marketing on self direction option for the HCBS waiver programs began.

4th Q 2004 - 12 statewide trainings were held on how to self direct your personal care services currently available under the waiver. How to access these services to assist people with working was the focus. 75 people received this training.

3rd Q 2004 – Nine statewide trainings were held on how to self-direct your services including PAS at work and home with 95 attendees.

Initial - A consumer workgroup completed a manual for consumers, providers and service workers/case managers on the HCBS service of consumer directed attendant care.

²³ Kansas – PAS program planning and fiscal estimating

1st Q 2006 - Kansas has made the decision to pursue an alternative option to the Independence Plus Waiver in order to provide personal assistance services to individuals with developmental and physical disabilities. State plans to submit a State Plan Amendment, Optional Choice of Self-Directed Personal Assistance Services (Cash and Counseling), available under the Deficit Reduction Act, to provide personal assistance and related services to individuals with physical and developmental disabilities who wish to enroll in Working Healthy.

1st Q 2004 – State has applied for RWJ Foundation Cash and Counseling grant to help fund planned PAS program. Using MIG funds to design changes in MMIS and eligibility computer system in anticipation of implementing new PAS program.

Initial - State is nearing completion of a Section 1115 Independence Plus Waiver sufficient to support work and to demonstrate combined benefits for employment of PAS and a Medicaid Buy-In program. Involved consumers and advocates with state staff.

²⁴ Kansas – PAS and self-directed programs

1st Q 2004 – Planning to develop Self –Direction and Fiscal Management training for consumers to assist them in self directing their services and managing their funds in a manner that best meets their needs.

²⁵ Louisiana – PAS state plan policy development & implementation

1st Q 2004 – PAS – employment support PAS state plan approved by CMS in March 2004.

²⁶ Louisiana – PAS and self-directed programs

4th Q 2004 - Consumer directed PAS training continued statewide through December 2004.

Initial - Consumer direction volunteers were trained to train consumers.

²⁷ Maine – PAS and employers and the workplace studies and policy

2nd Q 2004 – Developing chart book on "Using Personal Assistance Services to Support Work."

Working closely with Real Choices grant on PAS policy review and recommendations to include employment-related issues.

²⁸ Maine – Improve consumers’ and others’ understanding of PAS options for improving employment

4th Q 2004 - PAS Services Chart Book completed, titled "MaineCare Personal Assistance Services in the Workplace." Also, PAS Case Studies. both final reports available online at http://choices.muskie.usm.maine.edu/PAS.htm

3rd Q 2004- MIG Project developing a PAS Chartbook incluing case stories which is intended to improve policy makers and other stakeholders understanding of PAS services under an array of options under Medicaid state plan and waivers which can improve employment.

²⁹ Maryland – PAS state plan policy development & implementation

1st Q 2006 – PAS Final report received

4th Q 2005 – State received draft report from contractor and is awaiting final report.

2nd Q 2005 - Focus groups with employed and unemployed people were conducted in four different sites in Maryland. The write-up is expected to be completed in August 2005.

1st Q 2005 - Request for proposals to conduct PAS studies have been issued; Completion dates for studies projected to be August – September 2005. Will include conducting focus groups to examine personal care services in the workplace for 1619 (b), SSDI working disabled. Will include developing a report highlighting Maryland’s program in comparison with other states and providing recommendations for improvement.

4th Q 2004 – Personal Care regulations changes finalized; effective date of 1/31/2005. In addition, changes to regulations (based on public comment) also include: 1) allowing public & private agencies to conduct criminal background checks & 2) allow the waiver of the English language requirement for personal care workers

4th Q 2004 – Maryland has issued an RFP for a vendor to conduct research and analysis to examine the role of personal care in other states’ Buy-In programs, the feasibility/fiscal impact of paying family members as caregivers, access standards for personal care services, network adequacy/backup systems, and training of personal care workers. The study will also involve conducting focus groups on these issues.

4th Q 2004 - Maryland will also conduct a separate study with focus groups to determine the personal care needs of individuals with disabilities in the workplace and better understand how personal care will assist individuals in achieving employment goals. The focus groups will examine personal care services in the workplace for 1619 (b), SSDI working disabled.

2nd Q 2004 – Personal care regulations to expand personal care services to the workplace were published in the Maryland Register on April 30, 2004

1st Q 2004 – Amended and asked for comment on proposed personal care regulations to expand services to the workplace – currently only available in home.

³⁰ Maryland – PAS Workforce

4th Q 2004 - Maryland's provider network for individuals with disabilities has not been updated in recent years. Updating the provider network to be current and determining a way to bolster the provider network will be key to improving personal assistance services. The updated directory of providers will be published on the Maryland Department of Health and Mental Hygiene website for individuals to access (indicating providers who are willing to care for more recipients).

³¹ Massachusetts – PAS and employers and the workplace studies & policy

1st Q 2006 – Goal is to increase by 20 the number of individuals using PCA (Personal Care Attendants) in the workplace and/or for work readiness. Assessing and implementing interventions related to PCA in the workplace including promoting a PCA pool on www.RewardingWork.org. Literature review on Workplace PCA use is being completed.

³² Michigan – PAS program planning and fiscal estimating

4th Q 2005 - Medicaid office provided draft language to amend State Plan Amendment for review by partners. Mid-January meeting set for further discussion.

3rd Q 2005 – State will initiate the State process needed to change the personal care services language to allow these services to be used in the workplace.

1st Q 2005 - MIG project is beginning discussions with other state agencies related to changes in Personal Care benefits. Strategy involves: 1) Develop beneficiary data collection system, 2) Research other state's models & results, 3) Gather data on participant's experiences, 4) Analyze program options & limits and 5) Recommend implementation.

³³ Minnesota – PAS program planning and fiscal estimating

1st Q 2004 – Completed survey of PAS Consumers including employment.

³⁴ Missouri – PAS program planning and fiscal estimating 4th Q 2005 - Research conducted on PCA infrastructure; needs assessment underway; preliminary plans developed. Needs assessment conducted of advocacy and self-advocacy groups in four Missouri regions. Plans developed to replicate PCA pilot project in four additional communities.

³⁵ Missouri – Improve consumers’ and others’ understanding of PAS options for improving employment

4th Q 2005 – Personal Care Assistance pilot project conducted in southwest Missouri (2004) that allowed individuals to use PCA services through the State of Missouri in partnership with local resources to support access to employment. Needs assessment conducted of advocacy and self-advocacy groups in four Missouri regions. Plans developed to replicate PCA pilot project in four additional communities.

³⁶ Nevada – PAS state plan policy development & implementation

4th Q 2005 - Development was started on the Scope of Work to be used for the RFP to hire a contract researcher to evaluate the effectiveness of Nevada's Personal Assistance Services.

3rd Q 2005 – State plans to enter into a contract to evaluate existing Personal Assistance Services system for effectiveness of support for employment of persons with disabilities.

1st Q 2005 - Coordinated with contractor responsible for PAS needs assessment intake process to include capturing work information on participant needs assessment surveys to begin collecting data for the PAS Evaluation. Conducted training with needs assessment staff members.

³⁷ New Hampshire – PAS and employers and the workplace studies and policy

3rd Q 2004 – Work plan and budget costs developed for Employer Guide for individuals participating in consumer-directed PAS to assist individuals to minimize employment interruptions and problems due to workforce shortages. Also intended to provide assistance related to consumer training related to developing job descriptions and supervisory skills.

³⁸ New Hampshire – PAS and self-directed programs

Initial - To address service capacity for consumer-directed personal care services in the state, two pilot sites were contracted with to establish the infrastructure needed. (One at a Lutheran Community Services and one at an Independent Living Center.)

³⁹ New Jersey – PAS state plan policy development & implementation

4th Q 2005 - Submitted plan to the State and are waiting on CMS approval.

1st Q 2005 – State has a Medicaid State Plan Amendment, to permit personal care services in workplace settings. "Public Notice placed in the New Jersey Register by March 31st, 2005"

⁴⁰ New Mexico – Improve consumers’ and others’ understanding of PAS options for improving employment

4th Q 2004 - Goal was to increase the number of those who are benefiting and using personal assisted services, especially those who are working. As part of the marketing plan, information about these services was provided and success stories written up about individuals using these services (especially if employed). The number of individuals using PAS increased from 40 (3rd qtr) to 75 (4th qtr). Of this number 24 are working.

⁴¹ North Carolina – PAS program planning and fiscal estimating

4th Q 2005 - Data is currently being compiled from the survey created to identify consumer needs. A strategy for service delivery was developed. The workgroup is now focused on implementation.

3rd Q 2005 The Advisory Council has now reached a consensus of what constitutes PAS. Survey used to conduct consumer survey of needs should be completed by the end of October 2005.

1st Q 2005 - PAS Workgroup met four times to discuss definitions & decide on approach for enhancing services. Members decided that Medicaid State Plan amendment was a preferable avenue for enhancing services compared to waiver options. Agreement upon what constitutes PAS continues to evade the group.

4th Q 2004 - PAS work group includes members of all North Carolina PAS related projects. To increase PAS services a State Plan Amendment change will be submitted to Department of Medical Assistance by 11/1/2005. Focus groups planned for the spring and summer to ensure consumer input and suggestions identified and included in amendment.

3rd Q 2004 – PAS Work Group formed. Coordinating with other PAS related projects in state.

2nd Q 2004 – Designing a research plan to identify PAS needs, barriers and preferences of people with disabilities who work or want to work.

⁴² North Dakota – PAS program planning and fiscal estimating

1st Q 2005 – MIG is developing an initiative to improve PAS services and attempt to become fully eligible under MIG requirements.

Initial - Developing PAS as a State Plan amendment – Implementation delayed.

⁴³ Ohio - PAS program planning and fiscal estimating

1st Q 2005 - A personal assistance study including focus groups with consumers and interviews with state officials is underway and is planned to be completed in summer 2005.

4th Q 2004 - A project manager was hired 11/04 and is in the process of writing the proposal for the PAS study.

3rd Q 2004 – Plan to conduct a PAS study to develop ideas to improve availability of PAS to working people with disabilities.

⁴⁴ Oklahoma – PAS program planning and fiscal estimating

2nd Q 2005 - Self-Directed Care Act - SB 1015 passed. When implemented to allow for community based services over Long Term Care facilities; to provide choice and control of service providers; to allow for money to follow the person; and to establish a fiscal intermediary system within the 1915c Waiver.

4th Q 2004 - PAS has been a part of Oklahoma's approved State Plan. Oklahoma's Premium Assistance Program went into effect on 1-1-05, providing coverage for previously ineligible working disabled persons who earned over the limit. Personal care assistants are available in the home, and to assist in situations involving transportation for health care purposes. HIFA Waiver passed to allow for coverage of low income.

2nd Q 2004 – Developing a state plan amendment to provide personal care assistance in a work or educational setting.

⁴⁵ Oklahoma – PAS & HCBC waiver policy development and implementation

4th Q 2005 - An amendment request for the Home & Community Based waiver, along with Consumer-Directed Personal Assistance Services as a service under the waiver, was approved by CMS.

⁴⁶ Oklahoma – PAS and self-directed programs

Initial - Examining various alternatives to offer flexibility and consumer direction for Personal Assistance Services.

⁴⁷ Oregon – PAS and employers and the workplace studies and policy

4th Q 2004 - Personal Assistance Services/In-Home Services Survey Description: The two main objectives of the survey are: 1) to evaluate consumer satisfaction with PAS in Oregon and 2) to find out how to improve PAS to it can better meet the needs of persons with disabilities who are employed. Report Location: report is pending post to the Oregon DHS website. Oregon ACCESS enhancements released 12/20/04. Staff training on updated Oregon ACCESS will continue to occur.

Initial - PAS survey developed to document, evaluate, enhance and report use of PAS at home and work site. Survey completed.

⁴⁸ Pennsylvania – PAS and HCBC waiver policy development and implementation

Initial - State Medicaid agency sent Operations Memo to inform county eligibility workers that individuals enrolled in Medicaid Buy-In can apply for Home and Community Based waiver services and those in waivers can apply for Medicaid Buy-In. The AIDS waivers were amended to include workers with disabilities.

⁴⁹ Pennsylvania – PAS and employers and the workplace studies and policy

4th Q 2004 - Proposals from PAS providers were not awarded; required additional negotiation with providers to effectively address project areas of interest.

3rd Q 2004 – Final report with recommendations received from contractor. Implementation of backup structure is being coordinated in two target communities.

2nd Q 2004 – Using local pilot demonstration projects to pilot a structure for back-up attendant care services for who are employed. The pilots are part of state MIG project established pilot demonstration project. One is in a rural area and one is in an urban area. They are to work with One Stop employment centers (called Career Links in Pennsylvania).

Initial - In an attempt to develop "promising practices” for back-up attendant care services, 4,148 surveys were mailed to consumers of PAS to determine the reliability and effectiveness of their backup PAS as it relates to employment. 22 surveys mailed to providers of PAS.

⁵⁰ South Carolina - PAS and HCBC waiver policy development and implementation

1st Q 2006 - The state's waiver renewal request has been submitted proposing to combine the Elderly disabled and SC Choice waivers. Combining the waivers will allow personal assistance services to be provided in the home and work place.

2nd Q 2005 - Request to amend the MR/RD waiver to add adult attendant services was approved in May 2005 and forwarded to the CMS regional office for approval.

3rd Q 2004 - Discussing waiver changes to allow family members to provide PAS.

⁵¹ South Carolina – PAS Workforce

4th Q 2005 - Goal is to improve accessibility to personal assistance services for consumers who are employed or seeking employment. Identify & provide assistance to waiver consumers who are employed or interested in seeking employment. Voluntary registry of personal care workers has been posted on SC Access. Registration form is available on-line.

2nd Q 2005 - H3646, which supported the necessary changes to the Nurse Practice Act, passed. Changes to the family caregiver policy continue to be distributed through the disability organizations.

2nd Q 2004 – State planning on working with stakeholders to improve workforce available for direct service. Including making changes in waiver policies and procedures consistent with the Nurse Practice Act

⁵² South Dakota – PAS state plan policy development & implementation

3rd Q 2005 – South Dakota currently has a consumer using PAS at least 40 hours/month in a competitive employment setting. The Career Development Team design team met in August with a training consultant about the concept & how to implement it. Presented it to the Steering Committee in September with favorable approval.

2nd Q 2005 - Goal of new interagency “Career Development Team Model” is that at least 12 South Dakotans with disabilities will receive assistance in obtaining employment and other support services, including PAS through the career development team model. The career-development team model to include Dept. of Labor, VR staff, BPAO staff, an employed person with a disability, a human resource person and a job coach/developer that will meet with consumers who wish to utilize this effort to assist them in successfully obtaining employment. The planning team met in June to outline the process by which a team operates. This process will be reviewed by the MIG Project Steering Committee in September. The MIG staff is in the process of informing potential consumers about the team model concept in order to recruit them into the process.

4th Q 2004 – MIG staff provided training on new PAS program to 10 provider agencies.

2nd Q 2004 – Developing draft interagency agreement related to expansion of PAS to include workplace. Working with Home Health Care Association on expansion of PAS to the workplace and dealing with issues on employer-employee relationships. Developing necessary changes to collect data through MMIS for expanded PAS.

1st Q 2004 – Training provided to Dept of Social Services, VR and employment specialist on new expanded PAS program.

Initial - Developed, submitted and received CMS approval of a Medicaid state plan amendment for expanded PAS.

⁵³ Utah – PAS and employers and the workplace studies and policy

4th Q 2005 - EPAS specialist is developing a procedure manual. There are currently 47 active participants who are employed in competitive, integrated employment. An additional 11 applicants are in process.

3rd Q 2005 - 68 individuals are employed in competitive integrated employment this quarter and using EPAS services ; 16 new participants were enrolled this quarter.

2nd Q 2005 - The EPAS Specialist is completing a Medicaid provider manual for EPAS. She is also conducting outreach presentations to inform individuals with disabilities about the program. 50 individuals are employed in competitive integrated employment and receiving EPAS services.

1st Q 2005 - 41 individuals with significant disabilities receive EPAS and are employed in integrated, competitive employment - an increase of 6 from last quarter.

Initial - MIG project made presentations at all Voc Rehab offices to inform them of Employment Personal Assistance Services (EPAS) program. Utah has Employment Supports Group to advise UWIN about expansion of personal assistance services to support working people with disabilities.

⁵⁴ Utah – PAS and self-directed programs

3rd Q 2005 - 15 individuals with serious mental illness received assistance with Instrumental Activities of Daily Living (IADL) through consumer directed personal assistance. Assessment tools, planning tools, consumer-training procedures were tested, refined and adopted by the EPAS program.

3rd Q 2004 – Service broker has enrolled 21 individuals. Demonstration of EPAS for those with mental illness has enrolled 17 individuals and 11 are working. Has decreased use of mental health services and enabled maintaining employment.

2nd Q 2004 – 18 persons with mental illness are employed and receiving EPAS services. Evaluation data shows demographic characteristics and types of services they receive. Average age is 45 and mean years receiving mental health service is 15.

2nd Q 2004 – State has Employment Personal Assistance Service (EPAS) program. MIG staff has developed role of service broker to facilitate entry into EPAS program. Provider manual has been developed and have developed training for consumers and personal assistants.

Initial - Conducting demonstration project on use of PAS to support working people with mental illness. Training curriculum was developed to inform consumers about how to hire and direct their own personal assistants.

⁵⁵ Utah – PAS Workforce

2nd Q 2004 – State has Employment Personal Assistance Service (EPAS) program. Provider manual has been developed and have developed training for consumers and personal assistants.

Initial - State cites difficulty in hiring and retaining PAS workers for both consumer-directed and agency model.

⁵⁶ Vermont – PAS program planning and fiscal estimating

Initial - A study was completed related to PAS for people with mental illness.

⁵⁷ Vermont – PAS and self-directed programs

4th Q 2004 - Training curriculum, toolkit & bibliography, and resumes of training staff received. Toolkit is available to consumers for self-study through VT Center for Independent Living. Four group pilot trainings were completed. Final report available at http://www.dad.state.vt.us/dvr/vocrehab/vwii/s5_reports.htm

2nd Q 2004 – Developing a pilot and evaluating a training program for users of Medicaid participant-directed- attendant care program to increase the accessibility and effectiveness for employment support. Training curriculum, toolkit, and bibliography has been developed and is available for self-study and group trainings is beginning.

Initial - A training program for PAS users will be conducted by the Vermont Center for Independent Living.

⁵⁸ Vermont – PAS Workforce

2nd Q 2004 - Recommendations for establishing a registry for providers of Personal Assistance Services (PAS) in Vermont: http://www.dad.state.vt.us/dvr/vocrehab/vwii/s5_reports.htm.

Initial - A study was completed regarding the formation of an attendant registry and is now under consideration by the Department.

⁵⁹ Vermont – Improve PAS program administration with eligibility & case management data systems

4th Q 2004 - Supported creation of in-house payroll capabilities for State of Vermont Personal Assistance Services to enhance the reliability of that employment support service system. Completed a substantial prerequisite data-entry and data migration project, moving all VT PAS eligibility and PAS case management data from paper forms and isolated desktop database applications to a common, networked SQL Server case-management database system.

⁶⁰ Virginia – PAS and HCBC waiver policy development and implementation

1st Q 2005 - 2005 Virginia General Assembly increased payment levels for providers of waiver services, including PAS, which should serve to expand availability and community capacity.

1st Q 2004 Survey has been completed.

Initial - Conducting survey of recipients in Home and Community Based waivers regarding utilization of services, need for services, availability of PAS providers, use in home and use at work.

⁶¹ Virginia – PAS and employers and the workplace studies and policy

4th Q 2005 – Department of Rehabilitative Services conducted in depth survey of its working PAS clients. Report is nearing completion.

Initial - PAS survey completed related to provision of PAS for potential Medicaid Buy-In participants. Report accepted by MIG staff.

⁶² Washington – PAS Workforce

4th Q 2004 - 994 PAS providers certified for services at home and at work; trained as employers. Successfully met requests for back up, 202 out of 218. PARR registry transferred to Home Care Quality Authority (HCQA). HCQA using success of PARR model to obtain funding for statewide implementation in 2007.

2nd Q 2004 – Groundwork has been laid for future statewide registry. The Home Care Quality Authority (HCQA) will carry forward these activities in 2005. Evaluation of effort is underway.

Initial - Personal Assistant Recruitment and Retention Project (PARR). Over 600 new PAS providers now trained to provide services in and out of home. Enhanced training for consumers as employers and PAS plan managers.

⁶³ West Virginia – PAS and employers and the workplace studies and policy

2nd Q 2005 - Conducted 11 outreach training activities to DHHR regional office staff and Rehabilitation Regional Office staff during this reporting period.

1st Q 2005 -Project staff conducted 25 dissemination activities regarding PCES through outreach trainings and meetings reaching over 600 individuals across the state.

4th Q 2004 - New PCES information flyers disseminated and technical assistance provided to 169 individuals and service providers.

2nd Q 2004 – MIG staff conducted 31 training, technical assistance and dissemination activities this quarter related to PCES reaching over 600 individuals.

Initial - Personal Care Employment Support Services (PCES) began in 2003. Outreach awareness training and public awareness activities are planned. Program is limited to qualified individuals based on ADL needs and to those who work or are seeking work of at least 40 hours per month.

⁶⁴ West Virginia – PAS and self-directed programs

1st Q 2005 – MIG is beginning to work with Real Choice grant and other state agencies to address consumer directed PAS.

⁶⁵ West Virginia – Improve consumers’ and others’ understanding of PAS options for improving employment

2nd Q 2005 - Updated/created the first state personal care provider directory and posted it on our web site in order to inform consumers and others about their potential choices of personal care providers.

⁶⁶ Wisconsin – PAS program planning and fiscal estimating

4th Q 2004 - Despite very wide publicity, survey and funding pilot found little unmet need for workplace PAS funding. Completed workplace PAS issue paper demonstrating probable low cost of including workplace PAS under MA state plan.

2nd Q 2004 – PAS in the Workplace study. Survey of existing funding and arrangements for workplace PAS under way.

1st Q 2004 – Developing a cost estimate for including workplace PAS in the Medicaid state plan by funding three consumers’ PAS under a funding agreement with VR and collecting data on their use of PAS.

⁶⁷ Wisconsin – PAS and employers and the workplace studies and policy

Initial (2003) - State is conducting survey of people with disabilities using workplace PAS to develop cost estimate from workplace PAS in the Medicaid State plan.

⁶⁸ Wisconsin – PAS and self-directed programs

2nd Q 2005 - Provided training and TA to service providers on person centered planning and self directed supports. Goal was to develop capacity for self-directed vocational supports in the redesign of the Wisconsin Family Care long-term care system. Staff has been trained, web warehouse in place, curriculum and video available and policies and procedures available.

Initial - Planning to conduct an analysis of self directed PAS.

⁶⁹ Wyoming – PAS program planning and fiscal estimating

2nd Q 2005 - Developmental Disabilities Department has agreed to take a front seat in crafting a follow-on PAS measurement process.

1st Q 2005 - Committee formed and initial assessment findings, along with focus group report findings, is being analyzed and compared to similar surveys in attempt to enhance focus of subsequent surveys.

4th Q 2004 - Focus Group meetings scheduled and held in 20 towns across WY. 29 respondents participated. Summary report of findings & trends completed. Mail survey instrument reproduced and mailed to 1706 persons. 299 completed surveys returned. Data extracted and summary report of findings and trends was created.

3rd Q 2004 – Organized an advisory group to work with U of Wyoming and contracted to gather data and conduct focus groups.

1st Q 2004 – Developing a system to assess use and need for PAS services by people with disabilities who desire employment. 3rd Q 2004 – Organized an advisory group to work with U of Wyoming and contracted to gather data and conduct focus groups.

References

Bailey, C.L. (2004). Minnesota’s 2003 PCA consumer survey. Minnesota Department of Human Services. Retrieved October 16, 2006 from http://www.dhs.state.mn.us/main/groups/disabilities/documents/pub/dhs_id_029338.pdf

Department of Health and Human Services, Center for Medicare and Medicaid Services (n.d.) PAS eligibility criteria: Technical assistance for the Medicaid Infrastructure Grants. Retrieved June 8, 2006, from http://www.cms.hhs.gov/twwiia/paseligcriteria.pdf

Department of Health and Human Services, Center for Medicare and Medicaid Services (2004). 2005 edition-announcement modification: Medicaid Infrastructure Grant. Funding opportunity Number CMS-2183-N. Retrieved June 6, 2005, from http://www.communitylivingta.info/files/34/1662/migsol05.pdf

Gray, C., & Salley, S. (2004). MaineCare Personal Assistance Services in the Workplace. Portland, ME: University of Southern Maine, Muskie School of Public Service.

Center for Workers with Disabilities (2006, July). Transition for youth with disabilities: A look at state programs, progress, and promising practices. Retrieved November 1, 2006 from http://www.aphsa.org/disabilities/home/index.htm

Center for Workers with Disabilities (2006, November). 1st and 2nd Quarter Highlights of Medicaid Infrastructure Grant Activities.http://www.aphsa.org/disabilities/home/index.htm

Jensen, A. (2006, June). Personal assistance services. In Improving Employment Outcomes for Persons with Disabilities: A Resource Guide to State Medicaid Infrastructure Grant (MIG) Initiatives. Center for Workers with Disabilities and Law, Health Policy and Disability Center at the University of Iowa’s College of Law. Retrieved October 31, 2006 from: http://disability.law.uiowa.edu/lhpdc/rrtc/mig/

Keller, J. (2003). Using PAS service in Vermont to support employment-Part One: Current programs, promising practices and next steps for study. Burlington, VT: Keller & Fuller, Inc.

Keller, J. (2003). Using PAS service in Vermont to support employment-Part Two: Gaps in current programs and possible remedies. Burlington, VT: Keller & Fuller, Inc.

Keller, J. (2003). Using PAS service in Vermont to support employment-Part Three: Eligibility, Services, Utilization, and Costs. Burlington, VT: Keller & Fuller, Inc.

Lida, K. (2006). Highlights of 4th quarter MIG activities. Center for Workers with Disabilities. Retrieved August 9, 2006 from http://www.aphsa.org/disabilities/home/index.htm

Rudrud, E. (2002). St. Cloud University. South Dakota Medicaid Infrastructure Grant. South Dakota Freedom to Work Survey Report. Black Hills Special Services through contract with the South Dakota Department of Human Services, Division of Rehabilitation Services. Centers for Medicare and Medicaid Services, Project Number P-91485/8.

Salley, S.T., & Glantz, L. (2004). MaineCare enrollees with disabilities work experience: Results from a 2002 survey. Portland, ME: University of Southern Maine, Muskie School of Public Service.

Sheen, J., Barkdull, C., & Holt, J. (2005). Employment Personal Assistance Services (EPAS) evaluation report. Salt Lake City, UT: Utah Department of Health.

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Stone, D. (2006). Providing personal assistance services through a Medicaid State Plan Option. Center for Workers with Disabilities. Retrieved August 9, 2006 from http://www.aphsa.org/disabilities/home/index.htm

Ticket to Work and Work Incentives Improvement Act of 1999, 42 USC 1305 Sec. 203 et. seq.

University of Nebraska Public Policy Center. (2002). The impact of earnings of Nebraskans with disabilities on their eligibility for selected services and programs. Lincoln, NE: Author.

Vaughn, L., Evans, L., & Gray, C. (2004). Personal assistance services for workers with disabilities: Case studies. Portland, ME: University of Southern Maine, Muskie School of Public Service.

White, J.S., Black, W.E., & Ireys, H.T. (2005). Explaining enrollment trends and participant characteristics of the Medicaid Buy-In program, 2002-2003. Washington, D.C.: Mathematica Policy Research, Inc.

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