In many studies of persons with developmental disabilities, researchers have noted significant benefits for both consumers and taxpayers when consumers move from sheltered work to supported employment (e.g., Rusch, Conley, & McCaughrin, 1993; Wehman, West, & Kane-Johnston, 1997). State developmental disabilities (MR/DD) agencies began providing long-term assistance for supported employment workers with developmental disabilities in the early 1980s. The 1984 Developmental Disabilities Act Amendments helped establish employment services for individuals with MR/DD as a national priority at that time, and then Assistant Secretary of Special Education and Rehabilitative Services Madeleine Will also provided critical leadership in developing and promoting the school-to-work transition and supported employment agendas.
In this summary of recent trends in employment services financed by state MR/DD agencies, we report on data emanating from the State of the States in Developmental Disabilities Project (Rizzolo, Hemp, Braddock, & Pomeranz-Essley, 2004). Supported employment includes work in small business enterprise, work crews, enclaves within industry, and individualized job placements (Mank, Rhodes, & Bellamy, 1986). Data emanating from supported employment programs administered by the state's vocational rehabilitation agency were not included, except in Arizona and California. These 2 states previously transferred administration of MR/DD agency work-related programs to their state vocational rehabilitation agencies, and these data were included for purposes of comparability to all other states.
Summary of Results
Individuals with MR/DD participating in supported employment as a percentage of all participants in work-related programs financed by state MR/DD agencies increased from 9% to 24% between 1988 and 2002. However, as shown in Figure 1, the percentage in supported work has grown at a substantially slower rate in recent years.
In 2002, 24% of vocational and day program participants in the United States worked in supported or competitive employment, and the remaining 76% of participants received services in sheltered employment, day activity, or day habilitation programs. The proportion of total day-work participants in supported or competitive employment in 2002 ranged from less than 10% in Alabama, Arkansas, the District of Columbia, and West Virginia to 40% or more in Alaska, Connecticut, Massachusetts, Oklahoma, Pennsylvania, Utah, Vermont, and Washington. Supported employment spending by state MR/DD agencies increased by only 3% in inflation adjusted terms between 2000 and 2002. Total spending was $663 million nationally in 2002 (see Table 1).
Most Growth in 1988–2002 Was in Segregated Employment Settings
The number of individuals in all state MR/DD agency-funded day-work programs (including supported/competitive employment) increased from 259,601 persons in 1988 to 482,814 persons in 2002 (see Figure 2). Fifty-eight percent of this growth was due to expansion of the number of segregated day program recipients. From 1988 to 2002, the number of individuals in segregated employment settings increased by 128,551 persons, from 236,614 to 365,165. During this same period, the number of workers in integrated settings (supported/competitive employment) increased by 94,662 persons, from 22,987 to 117,649. Supported employment exhibited rapid growth between 1988 and 2000, increasing by an average 15% each year. However, this growth rate dropped to 3% annually between 2000 and 2002.
Growing Role of Medicaid in Employment and Health Supports
Optional Medicaid programs are increasingly underwriting the costs of employment and day programs for persons with MR/DD in the states (see Figure 3). Home and Community Based Services (HCBS) Waiver spending for supported employment has grown significantly since the Balanced Budget Act Amendments of 1997 removed the requirement that HCBS Waiver-supported employment participants had to be previously institutionalized (West, Revell, Kregel, & Bricout, 1999). Two additional optional Medicaid programs—Clinic and Rehabilitative Services—continue to be the primary federal funding sources for day programs. In 2002, Medicaid funding for day activity and other segregated nonemployment programs totaled $488 million, more than four times the $108 million allocated that year for HCBS Waiver funding for supported employment.
The two most recent pieces of legislation aimed at improving work opportunities for people with developmental disabilities are the Balanced Budget Act of 1997 and the Ticket to Work and Work Incentives Improvement Act. Both laws were designed to reduce the barriers to work that people with disabilities confront as a result of the potential loss of publicly funded health care services when they become employed. These two acts may increase opportunities for persons with developmental disabilities to obtain employment in integrated settings.