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By Athena Mandros

Recently we had a reader ask – how are supported employment services funded and delivered?

Supported employment provides services and supports to individuals with disabilities to gain and retain employment in a competitive integrated work environment. The main tenet behind supported employment is to find a job for consumers as quickly as possible without pre-vocational training or perquisites. An “integrated” work environment refers to an organization that employs both non-disabled and disabled workers – which is different than a sheltered workshop setting. Services that an individual might receive under supported employment include job placement, social skills training, special on the job training, and guidance and counseling.

There are two funding streams for supported employment – The Department of Education’s Vocational Rehabilitation Program and state Medicaid programs. The Department of Education provides funding to state vocational rehabilitation agencies for supported employment services through Title IV-B or Supported Employment for Individuals With the Most Significant Disabilities grants. The grants are formulaic, meaning they are non-competitive, and funding is determined by a state’s relative population size. State vocational rehabilitation agencies receive the funding and then distribute it to private agencies who then deliver supported employment services. In FY 2015, $27 million were awarded to states, to provide services to a projected 161,000 individuals.

Supported employment is also an optional Medicaid service, meaning states can choose to provide the service, but are not required to do so by the Centers for Medicare and Medicaid Services (CMS). States use a variety of policy mechanisms to provide supported employment services, including 1915(c) home and community based services (HCBS) waivers, 1115 waivers, behavioral health rehabilitation services, and 1915(i) state plan options.

If a state provides supported employment through a 1115 waiver, 1915(i) state plan option, or 1915(c) HCBS waiver, provider organizations can directly bill Medicaid for services under the supported employment benefit, such as job placement services, regular observation or supervision for individuals, and social skills training. In states without a supported employment benefit, provider organizations can use the rehabilitation option to indirectly bill for services related to supported employment, such as social skill building—but the state is barred by CMS from providing vocational or education services.

For more on supported employment services, check out these resources:

  1. Supported Employment Produces Positive Outcomes For Individuals With Serious Mental Illness
  2. Improving Employment Outcomes For People With Psychiatric Disorders & Other Disabilities
  3. Supported Employment: Building Your Program
  4. Scorecard Ranking for Supported Employment Provider Ranking
  5. Supported Employment: Where Mission And Opportunity Meet
  6. Evidence-Based Supported Employment Program Shows Significant Benefit For Veterans With PTSD

And to read our new research on supported employment services funding and regulations, see How Are Supported Employment Services Funded & Delivered?: An OPEN MINDS Market Intelligence Report. The report answers a number of questions, including:

  1. What is supported employment?
  2. How is supported employment funded in the U.S.?
  3. How does the U.S. Department of Education fund supported employment?
  4. How does Medicaid fund supported employment?

This report includes a state-by-state listing of Title IV-B grant funding, an estimated number of consumers who will receive supported employment services, and a state-by-state listing of individuals who qualify for supported employment services through the Department of Education. The report is free to all OPEN MINDS Circle premium members, and can be purchased in the OPEN MINDS e-Store for $495.

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