What Happened?
About 2 million American adults in the United States have intellectual or developmental disabilities (I/DD), such as Down syndrome and cerebral palsy, and many want to and can work, but a new federal review published on Sept. 23 finds that bureaucratic friction between two major funding programs is creating service gaps for some of them.
The two programs at issue are the Vocational Rehabilitation (VR) program, run by the U.S. Department of Education, and Medicaid home- and community-based services (HCBS) employment support, overseen by the U.S. Department of Health and Human Services (HHS).
Why Does it Matter to Me?
In the three states the U.S. Government Accountability Office examined, navigating two separate state agencies created administrative burdens and service gaps for people with intellectual or developmental disabilities seeking employment services.
In Pennsylvania, service coordinators were confused about whether a closure letter from the state's vocational rehabilitation agency was required before Medicaid home- and community-based services employment services could begin, creating what the GAO report calls "unnecessary service gaps for some individuals."
How providers get paid can affect how services are delivered. Under a fee-for-service model, providers are paid for time spent, which one provider told the U.S. Government Accountability Office (GAO) does not encourage reducing services as a person builds job skills. Under a milestone model, providers are paid when a person reaches goals like getting hired, but those payments may not cover actual costs, according to providers the GAO interviewed.
Both Sides, Now
The federal Departments of Education, Health and Human Services, and Labor issued a joint letter in 2022 encouraging state agencies to coordinate different funding streams and citing sequencing and braiding as specific strategies to increase employment for individuals with disabilities. State officials in Georgia, Pennsylvania, and Washington told the GAO that sequential funding was more common than braiding, citing administrative and policy reasons.
Supporters of the current structure say sequential funding is simpler to administer. Critics, including providers the GAO interviewed, say the handoff creates delays and confusion that fall hardest on people with I/DD. The GAO report carries no formal recommendations, and no specific member of Congress is identified as having requested it.
What Happens Next?
Because the GAO examined only three states, the full scope of coordination failures across the country remains unclear. The Departments of Education, Health and Human Services, and Labor have issued guidance and technical assistance on combining program funds, including a 2022 joint letter that encouraged state agencies to coordinate different funding streams.
Congress could direct the agencies to take specific steps through the annual spending process or new legislation, but no such action has been announced, and no vote is scheduled.
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