MIG > Training Descriptions

Descriptive List of 2009 MIG Training Courses

Social Security Work Incentives

• Advanced Florida Benefits Resource Network training - (one 3-day session)
  A 3-day training conducted by national SSWI expert for anyone who is a member of FBIRN (and therefore has successfully completed the 10-day FBIRN requirements). This course will focus on network team building activities as well as the practical application of SSWIs rules to specific case scenarios.





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• Advanced Social Security Work Incentive training
  National SSWI expert will present five 1-day Advanced SSWI and Benefits training sessions with APD ECs and EL as co-trainers to a minimum of 120 persons.





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• FBIRN Membership Training (1 7-day Session)
  Florida Benefits Resource Network (FBIRN) - National expert will conduct one 7-day training and technical assistance course known as "The Changing Face of Benefits" for a new group of students in the F-BIRN, including members from DVR, APD, AWI, DCF, AHCA, among others. The course will include a new module "Asset Development." These sessions include students from various state and local agencies and organizations.

The dates for the 2009 10 days of training are:

• August 11 - 13
• September 14 - 17

All sessions will be held in central Florida with the nightly room charge of $98. You or your agency need to cover your travel costs (to and from, as well as hotel and food) BUT there is no charge for the 7 days of training. Once you have reviewed the agendas we're certain you will recognize how valuable this training is and how much it would enhance your professional development. Additionally we have arranged to provide CRC credits for VR counselors who attend. You must complete all homework and attend all 7 days to be a part of the network.

If you would like to participate, please email Melinda_Coulter@apd.state.fl.us or call (850) 488-9546.




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• Social Security Work Incentive training for Waiver Support Coordinators -(five 1-day sessions)
  National SSWI expert will conduct a 1-Day SSWI Training for Waiver Support Coordinators (WSCs) in five sites. WSCs will be more equipped to demand higher quality benefits services from benefits counselors increasing the rate of employment and the amount of income earned for people served.





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• Train the Trainer Supported Employment training – (two 2-day sessions)
  The purpose of this two-day course conducted by national SE expert is for the Agency to have staff in all Areas of the state who are certified to present the Supported Employment two-day portion of the four-day SECT, thus building the Agency's employment infrastructure and training expertise.

Supported Employment (SE) Training Courses

In addition to the above training courses offered, MIG is providing resources for the following activities in 2009:

MIG funded pilots and programs

• Employment First Initiative (Pilot program focusing on transitioning 22 year olds entering work force)
  Employment First is the Agency's initiative to focus on employment as the primary day activity for persons receiving services. As it relates to this contract it shall consist of development of a partnership with local school districts for preparation of graduates, school transition staff, families, vocational rehabilitation support, One-Stops and supported employment providers to provide accurate and reliable information regarding work and asset development. A national expert along with MIG Employment Coordinators will partner with local school districts to prepare graduates for competitive employment. Expert will serve as advisor and provide technical assistance to the MIG and APD staff for resolution on difficult issues that may arise. The MIG ECs and APD ELs shall utilize portions of the curriculum regarding Transition for Youth and Young Adults. All persons aged 22 located within the pilot sites will be contacted and provided guidance regarding competitive employment opportunities and preservation of Social Security benefits. Pilot sites to be announced.





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• Train the Trainer Medicaid Buy-In training (to be scheduled only upon passage and implementation of Medicaid Buy-In by Florida Legislature
  Also See Medicaid Buy-In - "Personal Stories"





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• Train the Trainer Medicaid Buy-In training
  The purpose of this two-day train-the-trainer course is to provide training and technical assistance to all Agency staff responsible for administering and/or assisting with the administration of the Medicaid Buy-In, and to provide training and assistance to all consumers, families, and stakeholders who will be participating in the Medicaid Buy-In program.

Medicaid Buy-In

At the Disability Policy Research Forum in Washington, D.C., three experts presented critical information in late March 2009 pertaining to the needs of working age people with disabilities. The Speakers were Dr. David Stapleton, Su Liu, and Peter Thomas, J.D. (Forum was presented by Mathematica Policy Research, Inc.)

Notes from the Forum

Medicaid Buy-In was described as an "Important Patch" needed for what are considered gaping holes in health care coverage suffered by most people with disabilities who want to work, live as independently as possible, and earn a living while doing so.

Cost to the States was discussed - There is no evidence of higher per member cost to Medicaid. In 2007 - the average cost to Medicaid of a Buy-In member was $984.00 vs. $1,583 of a non-Buy-In Medicaid member. Buy-In members cost less on average than other persons enrolled in Medicaid.

• Reported earnings of Medicaid Buy-In members in 2007 - $631,000,000.00.



• Premiums for coverage paid by Medicaid Buy-In members in 2007 - $ 27,000,000.00.



• 41 states currently offer Buy-In programs. 215,000 people are currently enrolled in a Medicaid Buy-In program.



• 1/3 of states passed and implemented Medicaid Buy-In through the Balanced Budget Act of 1997!



• 2/3 of the states passed Buy-In through the TWWIAA of 1999 (Ticket to Work). Florida's (if passed) will be through TWWIAA.

Positives: Buy-In is a Work Incentive - (the most powerful work incentive available). It incentivizes employment and increasing one's earnings - and is especially promising for younger people with disabilities. Studies have shown that younger people tend to increase earnings more significantly once enrolled in Buy-In than do other populations of people with disabilities. Experts recommend using this data to ensure that young people in transition are well educated about the benefits provided through Buy-In.

Earnings for enrollees increased 40% during their first year of enrollment, and 50% within 2 years of enrollment. Excellent results are evident but could be much improved with more education and information on how Medicaid Buy-In works and how it can remove the serious concerns regarding loss of benefits due to earning income.

States are provided great flexibility - some states have decided it best to have no income limitations. Florida's bill would set the income limit at $39K per year. Work is a requirement for participation of Medicaid Buy-In members.

The amount of resources/assets one is permitted is also a factor open to the states. Some states have no limits or very substantial assets are permitted, while others do not. Florida would increase from $2K up to $12K for an individual and from $3K up to $18K for a couple. This is a major difference for people who want to earn a living and develop assets - which is possible if permitted to earn the income that they should be able to earn through work.

The Mathematica expert reiterated that Medicaid Buy-In is currently under-utilized in most states. In 2007, the average earnings for Buy-In members was less than $9K. (70% reported earnings that year. - Other 30% probably "worked" in sheltered workshops, etc.) Clearly more citizens can earn much more and save much more by using this program.

Buy-In relates to other system wide changes such as implementation of WIPA (Work Incentive Program Assistance), (provides benefits counseling for SSA recipients to maximize all work incentives offered by SSA nationwide.)

Funds provided through the Medicaid Infrastructure Grant (MIG) can be utilized to implement Buy-In as well. Thereby reducing the overall cost for initial implementation and administration of the program.

For example, Wisconsin which has Buy-In and a comprehensive MIG, was awarded several million dollars in MIG funds in 2009 - for just this one year.

Wisconsin has been receiving MIG funds since 2001. Wisconsin is currently focusing on Long Term Care for persons with disabilities - and this NOT a reference to nursing home care. It is Long Term Services and Supports enabling people with disabilities to remain functional, independent and healthy throughout their lives.

I encourage you to view the slide presentations attached from the Forum held yesterday. I think you will see that Florida is behind in so many respects in this arena. There is much work to be done.

The forum presentation slides can be accessed here: http://www.disabilitypolicyresearch.org/Forums/20090326/

Additional Medicaid Buy-In Information can be found at www.Partnershipforwork.com

Also See "Medicaid Buy-In Personal Stories" Immediately Below.

Medicaid Buy-In Personal Stories

Shattered Dream

I came to Florida for my first time in December 2006. I came to work a racing trade show in Orlando and fell in love with Florida instantly. When I returned to New York State, where I worked full time and had the support of the state for my home care, I spent every night after work researching Florida. I wanted to live in Florida

I returned to Florida in February of 2007 to look over the area I wanted to move to and see what jobs might be available. I had a couple of leads on jobs and was fortunate enough to land the first full time job I applied for. So I returned to Florida in March of 2007 and started work full time at Space Coast Center for Independent Living on April 2, 2007. The only home care I had was the lady I lived with. She took care of me EVERY DAY and worked a full time job.

Before and after I moved to Florida I had been searching for home care options because my goal was to live by myself as soon as possible. Vocational Rehab introduced me to a program that offers some help to working quadriplegics financed through Able Trust. It wasn't much but it was progress. The program offered $2000.00 per-quarter to pay for home care. But I knew that wasn't going to be enough. $666.00 a month doesn't go far. A home care agency was out of the question because the cost was so high it would have used up that money in less than four days. So I had to hire privately. I needed some one to come early enough so that I could make it to work by 8am. Since my routine is 2-3hours long that meant I would need a nurse at 4:30am. In order to get help at those hours you have to pay them well. So $666.00 a month goes fast when you need an average of 20 hours a week of morning home care at $11-per hour. But that still meant the only help I had to get to bed every night was the person I was living with. That person also had to fill in on the morning a few times a month too. Remember she worked a full time job and had to help me.

I tried every which way to get help. The Medicaid system said "you must not need help because you are working". That was the most ridiculous statement I've ever heard! I tried to talk with a state legislator regarding home care one day after a forum. I told him my situation and the only thing he said to me was good luck. I couldn't believe that's all he had to say. I spoke with other organizations too, trying to find away to get help. But I had no luck. My supervisor and I talked with the Florida Association of Independent Living Centers (FACIL). I explained to FACIL my situation and who I had talked to over the past nine months about home care and they said I had exhausted every possibility of receiving home care and they had no other suggestions.

After nine months of trying to get help my dream of living in Florida was shattered. I was physically and emotionally drained. The person I was living with was drained too. She did more than should be expected of one person. That was much more than the state of Florida did for me! I couldn't keep going. I was forced to quit my full time job and move back to New York State because I couldn't get the help I needed in Florida. My physical and emotional well-being was in jeopardy and I was not going to wind up in a nursing home in Florida at the age of 41.

I am a quadriplegic from a spinal cord injury who already had full time employment in the state of Florida and no one would help me keep my job. You say you want people with disabilities to work and be productive. But you won't help them work or stay working. I paid all of my own bills. I just needed help with home care to stay working. Doesn't it make more sense to help those that are willing to help themselves?

The Medicaid buy in program would help those who want to work. It would have helped me keep my job by providing me with a way to access the services I needed in order stay working. Obviously the amount each working person with a disability pays into the program needs to be an amount that still allows the person with a disability to reap the financial and emotional rewards of working. It is important that the Medicaid buy-in program have an incentive and a safe guard to reassure the persons with a disability that they are not in danger of losing any thing, but instead they are gaining.

It is also important to be sure that enough community based services such as home care are available to persons with a disability at hours of the morning early enough so they too can hold jobs requiring them to be at work by 8 or 9 am. One program that has the capability to meet those needs and is more cost effective than a traditional agency is a Consumer Directed Personal Assistant Program, referred to in NYS as CDPAP. Under this program the consumer finds, interviews, hires, and trains, staff to care for them. This program saves NYS approximately $4 per-hour of home care service provided compared to a tradition home care agency cost per-hour. The flexibility and feasibility of this program deserves a very close look.

Helping people with disabilities who want to work by helping them get over that threshold of unsure-ness could open the doors to more than you can imagine. It did for me in New York State. I only wish I had that support from the state of Florida because I'd still be living in Florida.