Narrative: l. 6.

The Division of Developmental Disabilities currently administers four Medicaid Home and Community Based (HCB) Waiver programs delivering employment supports and services for individuals with intellectual or other developmental disabilities. The four waivers are the Comprehensive Waiver; Missouri Children with Developmental Disabilities Waiver; Community Support Waiver; and the Partnership for Hope Waiver. The partnership with DMH has resulted in a referral process between agencies that maximizes the availability of services to individuals with the most significant disabilities. A description of services available under each waiver can be found at https://dmh.mo.gov/dev-disabilities/programs/waiver/medicaid-hcb.

Division of Developmental Disabilities has a statewide employment initiative, Employment First, for working age citizens with disabilities. Employment services include job preparation, job discovery, and community employment in a competitive integrated work setting that may include ongoing supports. The Division of Behavioral Health provides employment services to individuals with mental illnesses, histories of substance abuse, and/or criminal backgrounds.

Clinical and vocational employment services are integrated through state-wide partnerships to help individuals who are interested in employment participate in the competitive labor market with the appropriate level of supports and services to be successful. RSB partners with DMH-DD on the National Expansion of Employment Opportunities Network (NEON) and is developing a tiered benefits planning training to provide benefits counseling services to those in need.  RSB will continue to partner and collaborate with DMH programs in the delivery of employment services.

The development of the Tiered Benefits Planning Model is to increase the capacity for benefits planning services in Missouri.  It will also provide opportunities for RSB staff working in employment to get training and assistance on benefits and work appropriate to their roles.  There are four Tiers for employment professionals, each building upon the previous level:

• Tier 1 – Benefit Ambassadors
  • • Understands very basic concepts about eligibility for SSDI, SSI, SSDI-based Medicare and SSI-based MO HealthNet;  and the impact of earnings on each benefit
    • Tier 1 benefits training – “Dispelling Benefit-to-Work Myths”
• Tier 2 – Benefit Navigators
  • • Verifies Social Security Disability and SSI benefits through BPQY’s.  Provides basic explanation of work incentives that may benefit particular individuals.
    • Demonstrates impact of earnings and work incentives to individuals using estimators on mo.db101.org and refers individuals to relevant articles on the site.
    • Advises individuals about reporting earnings to agencies that administer benefits.
    • VCU National Training and Data Center’s Introduction to Social Security Disability Benefits, Work Incentives, and Employment Support Programs web course
• Tier 3 – Benefit Planners
  • • Appropriate for staff for whom benefits advisement is a primary focus
    • Develops benefits analyses and work incentive plans to individuals
    • national training and certification from Cornell or VCU
    • Continuing education credits needed to maintain Cornell or VCU certification
    • Encourages individuals who are working or considering work to focus on their overall financial outcomes, rather than on keeping benefits at all cost
    • Consults/collaborates with tier 4 professionals to serve individuals with more complex situations (see Referrals below)
    • Cornell or VCU training and national certification
• Tier 4 – Community Work Incentive Coordinators (CWICs)
  • • Sole or primary focus is benefits advisement.
    • Has detailed knowledge of eligibility for SSDI, SSI, Medicare, MO HealthNet, Medicare Savings Programs, Medicare Part D Low Income Subsidy; impact of earnings on each benefit; work incentives for each benefit; and tools and articles on mo.db101.org. 
    • Receives referrals from tier 1, 2 and 3 professionals.  In many cases, consults/collaborates with tier 3 professionals on situations with which they need assistance.
    • Training from VCU

There are myths that if individuals with disabilities make too much money they’ll lose cash benefits, lose their health/medical insurance, or that it’s difficult to get those benefits back if they lose their jobs. The Tiered Benefits Planning model will allow agencies to provide an appropriate level of information and resources to clients in need of information on how work may affect their benefits.  The goal is to dispel the myths that too often discourage individuals with disabilities from seeking competitive integrated employment.