Sustainability

1. Sustainability Moving Infrastructure Development for the Employment of People with Disabilities Beyond MIG Funding

2. Background: Medicaid Infrastructure Grants (MIGs) • Created by the Ticket to Work & Work Incentives Improvement Act of 1999. • Funded from 2000-2011. • 2 types: • Basic: Focus placed upon development and improvement of Medicaid-specific supports and services, such as Medicaid Buy-in. • Comprehensive: creating greater framework around employment systems with a link back to Medicaid. • Both types emphasize systems change and infrastructure development that will have lasting impacts on employment of people with disabilities.

3. Medicaid Infrastructure Grant Funding MIG funding is: • Flexible within broad federal objectives. • Does not require a state or local match. • Time limited. • Directed to infrastructure development and system building. The nature of MIG funding adds additional elements to the sustainability principles.

4. Sustainability and MIGs Additional elements of sustainability for MIGs: • Policy development • Medicaid Buy-In; PAS; other Medicaid-funded employment supports • Other systems: DD (“employment first”), MH, workforce development, transportation, etc. • Capacity building • Infrastructure development (e.g. online tools) • Training, TA, staff development (e.g. training on supported/customized employment practices) • Coordination and collaboration (e.g., leveraging; blending and braiding resources; new partnerships and information sharing activities) • Benefits planning infrastructure (training, coordination, evaluation, quality assurance)

5. Sustainability and MIGsAlaska • Leveraging longer-term funding sources • Alaska Mental Health Trust Authority • Policy Development • Disability Employment Policy Summits • Capacity Building • Services integration (e.g. coordination between Behavioral Health and VR) • Customized employment and self-employment initiatives • Annual Full Lives conference for direct service workers; now includes an employment track and training options

6. Sustainability and MIGsChallenges • Sustainability for what? • MIG dollars support a broad and diverse array of activities. • Sustainability at multiple levels: • Federal – policy development; availability of resources; health care reform • State – policy/program development; Medicaid infrastructure; system building & collaboration; leadership activities • Local – MIG-funded initiatives; partnerships • Provider – capacity building; outreach efforts

7. Sustainability and MIGsDiscussion Topics Financing Strategies What financing strategies are MIGs using? How do we maximize existing resources? Funding Sources What types of resources can help us diversify our funding for disability employment efforts? Leadership How do we sustain and institutionalize leadership for employment of people with disabilities? Collaboration and Partner Engagement How do we build sustainable partnerships that continue beyond MIG funding? Next Steps What still needs to be done?

8. About the Center • CWD is a project of the National Association of State Medicaid Directors (NASMD). • NASMD represents the Medicaid Directors from every state and territory, and is an affiliate of the American Public Human Services Association (APHSA). • APHSA is an association comprised of state and local human services professionals from all states and territories. • Contact Information: • Nanette Relave, Director, CWD • (202) 682-0100; nrelave@aphsa.org • Damon Terzaghi, Policy Associate • (202) 682-0100; dterzaghi@aphsa.org