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POVERTY BY THE NUMBERS U.S. Census Bureau (13 September 2011) 46.2 million Americans were living in poverty in 2010. Persons with Disabilities experienced the highest rates of poverty of any other subcategory of Americans for the tenth year in a row. SUBPOPULATION 2009 Poverty Rate 2010 Poverty Rate Children 20.7% 22.0% African-American 25.8% 27.4% Hispanic 25.3% 26.6% Disability 25.0% 27.9% Total U.S. Population 14.3% 15.1%
POVERTY AND DISABILITY: MONEY IS THE NOT ALWAYS THE PROBLEM; SOMETIMES IT’S AN ISSUE OF PRIORITY Figure 1. Percentage of Estimated Federal and State Expenditures for Working-Age People with Disabilities by Major Expenditure Category, Fiscal Year 2008   Adapted from Livermore, Stapleton and O’Toole (2011, Health Affairs) $357 Billion in FY2008
WHAT DOES $357 BILLION BUY US IN TERMS OF OUTCOMES?
WE HAVE PROOF THAT PEOPLE CAN WORK WHEN SERVICES FOCUS ON EMPLOYMENT 2009 – UMASS Boston ICI ID/DD Agency Survey Success in employment varies widely 2009 Washington State (88 %) Oklahoma (60%) Connecticut (54%) Louisiana (47%) New Hampshire (46%)
MEDICAID IS THE FOUNDATION OF STABILITY FOR PWD
There is no private insurance product to cover life long supports for people with significant disabilities
No one individual or family can bear the costs of supports for a life time
Until Medicaid HCBS, institutions were the only alternative for many PWD
TODAY’S FISCAL CRISES IS NOT JUST A MATTER OF NUMBERS, IT IS A MATTER OF PEOPLE. THE DIALOGUE WE MUST ENGAGE IN IS ONE OF EQUITY, ETHICS, AND ENGAGEMENT.
Live in their own home and enjoy the support of family and friends
Get a job
Enjoy good health
Be part of and contribute to their community
Achieve their personal potential for independence and self sufficiency
SELF-SUFFICIENCY IS NOT ONLY BETTER FOR PWD, IT ALSO MAKES ECONOMICAL SENSE SERVICE AREA CYCLICAL DEPENDENCY SELF-SUFFICIENCY MODEL Education Segregated: $25-45K/student/year Full Inclusion: $12-26K/student/year Employment Average annual costs of SW/individual: $19,388 SW is less cost-efficient to taxpayers : 0.83 SW is less cost-efficient to workers : 0.24 Ave annual costs of SE/individual: $6,619 SE is more cost-efficient to taxpayers : 1.21 SE is more cost-efficient to workers : 4.20
COMMUNITY SERVICES MAKE FINANCIAL SENSE Data Source: Lakin, K.C. MSIS and NCI data from 4 states (1,240 Individuals), 2009 Type of Service Cost per Person People Served with $5 M ICF/MR $128,275 39 HCBS Residential $70,133 71 Host/Foster Family $44,122 113 Own Family $25,072 200
REFORM REQUIRES BOLD AND COURAGEOUS LEADERSHIP BY THOSE WORKING DIRECTLY WITH PWD
CHANGED THINKING LEADS TO CHANGED PUBLIC POLICY
Assuming that PWD
Need to be taken care of
Need constant supervision
Are a burden to families
Discovering that PWD
Can be self sufficient
Can work and pay taxes
Don’t need constant supervision
Are valued family members
support that matches
their needs .
THEORETICAL FRAMEWORK : DIMENSIONS OF THE SOCIAL GUARANTEE APPROACH
Social guarantees are defined as legal and administrative mechanisms that determine entitlements and obligations related to certain rights and ensure the fulfillment of these obligations on the part of the state. While the social guarantee approach is still in its infancy, the social guarantees framework can be of benefit to the monitoring of public policy and progressive realization of social and economic rights in a range of contexts.