National Council on Disability

1331 F Street, NW, Suite 850

Washington, DC 20004

National Disability Policy: A Progress Report

National Council on Disability, October 31, 2014

Celebrating 30 years as an independent federal agency 

This report is also available in alternative formats on the National Council on Disability 

(NCD) Web Site (www.ncd.gov).

202-272-2004 Voice

202-272-2074 TTY

202-272-2022 Fax

The views contained in this report do not necessarily represent those of the 

Administration, as this and all NCD documents are not subject to the A-19 Executive 

Branch review process.
National Council on Disability

An independent federal agency making recommendations to the President and Congress to 

enhance the quality of life for all Americans with disabilities and their families.

Letter of Transmittal

October 31, 2014

President Barack Obama

The White House

1600 Pennsylvania Avenue, NW

Washington, DC 20500

Dear Mr. President:

The National Council on Disability (NCD) is pleased to present the 2014 edition of 

National Disability Policy: A Progress Report. This statutorily mandated report has 

significant meaning this year, as NCD celebrates 30 years as an independent federal 

agency. The report highlights progress that our country has made in promoting and 

protecting the rights of individuals with disabilities, and identifies opportunities to 

promote policy that will contribute to a more inclusive environment. It focuses on six 

topics: the Convention on the Rights of People with Disabilities (CRPD), employment, 

subminimum wage, education, Medicaid managed care, and mental health. 

In the report, NCD acknowledges the cultural context of the past while setting a vision 

for the future that is grounded in high expectations for people with disabilities and the 

policymakers who are responsible for shaping an inclusive society. NCD believes in the 

potential and strengths of all, including people with disabilities, and offers 

recommendations to build a nation that is prepared to benefit from the contributions of 

Americans with disabilities. 

NCD is grateful for the opportunity to share an objective assessment of issues of 

concern to Americans with disabilities, along with solutions for creating a more inclusive 

society. As NCD prepares for the 25th anniversary of the Americans with Disabilities 

Act, we urge Congress and the White House to address the issues and implement the 

recommendations raised in this 2014 annual Progress Report, thereby demonstrating 

our nation’s commitment to policies and laws that definitively include all Americans as 

equals. 

1331 F Street, NW ■ Suite 850 ■ Washington, DC 20004

202-272-2004 Voice ■ 202-272-2074 TTY ■ 202 -272-2022 Fax ■ www.ncd.gov
Respectfully,

Jeff Rosen

Chairperson

(The same letter of transmittal was sent to the President Pro Tempore of the 

U.S. Senate and the Speaker of the U.S. House of Representatives.)
National Council on Disability Members and Staff

Members

Jeff Rosen, Chair 

Kamilah Oni Martin-Proctor, Co-Vice Chair

Lynnae Ruttledge, Co-Vice Chair

Gary Blumenthal

Chester A. Finn

Sara Gelser

Captain Jonathan F. Kuniholm, USMC (Retired)

Janice Lehrer-Stein 

Ari Ne’eman

Benro T. Ogunyipe

Stephanie Orlando

Katherine D. Seelman

Clyde E. Terry

Royal P. Walker Jr.

Alice Wong

Staff

Rebecca Cokley, Executive Director

Phoebe Ball, Legislative Affairs Specialist 

Stacey S. Brown, Staff Assistant 

Julie Carroll, Senior Attorney Advisor 

Lawrence Carter-Long, Public Affairs Specialist 

Joan M. Durocher, General Counsel & Director of Policy 

Sharon M. Lisa Grubb, Management Analyst 

James Flakes, Financial Analyst 

Geraldine-Drake Hawkins, Ph.D., Senior Policy Analyst 

Robyn Powell, Attorney Advisor 

Anne Sommers, Director of Legislative Affairs & Outreach 

3 
4
ACKNOWLEDGMENTS

The National Council on Disability wishes to thank American Institutes for Research 

(AIR), particularly Cynthia Overton and her team—Mel Kutner, Dahlia Shaewitz, and 

Burhan Ogut—for the research conducted in developing this report.

5
6
CONTENTS

Letter of Transmittal ........................................................................................................ 1

National Council on Disability Members and Staff........................................................... 3

Acknowledgments ........................................................................................................... 5

Executive Summary ........................................................................................................ 9

Introduction ................................................................................................................... 13

Ratification of the Convention on the Rights of Persons with Disabilities...................... 15

Background............................................................................................................. 15

Driving Need Behind the CRPD.............................................................................. 16

CRPD Implications.................................................................................................. 17

Global Empowerment of People with Disabilities: The Future of the United States 

and CRPD............................................................................................................... 18

NCD CRPD Recommendations .............................................................................. 19

Increasing Employment Access and Inclusion .............................................................. 21

Background............................................................................................................. 21

Transportation......................................................................................................... 25

Universal Approach to Meeting Employee/Employer Needs................................... 28

Technology ............................................................................................................. 29

NCD Employment Recommendations .................................................................... 33

Reducing Subminimum Wage Options.......................................................................... 37

Background............................................................................................................. 37

Current Context of Subminimum Wage .................................................................. 39

NCD Subminimum Wage Recommendations......................................................... 41

Improving Education Experiences and Outcomes......................................................... 45

Background............................................................................................................. 45

Inclusive Classroom Settings.................................................................................. 48

High School Completion ......................................................................................... 51

NCD Education Recommendations ........................................................................ 55

Enhancing Medicaid Managed Care ............................................................................. 59

Background............................................................................................................. 59

Benefit Design ........................................................................................................ 59

Outcome Measures ................................................................................................ 60

7 
Due Process ........................................................................................................... 62

Stakeholder Involvement ........................................................................................ 62

NCD Medicaid Managed Care Recommendations ................................................. 64

Addressing Mental Health Needs.................................................................................. 69

Background............................................................................................................. 69

Stigma and Discrimination ...................................................................................... 70

Community-Based Mental Health Services............................................................. 71

Support for Veterans............................................................................................... 72

NCD Mental Health Recommendations .................................................................. 73

Data Trends in Disability ............................................................................................... 77

Employment and Earning........................................................................................ 77

Education................................................................................................................ 83

Health and Wellbeing.............................................................................................. 93

Civil Rights.............................................................................................................. 94

Voting...................................................................................................................... 97

Technology ............................................................................................................. 99

Conclusions................................................................................................................. 101

References.................................................................................................................. 103

8
EXECUTIVE SUMMARY

2014 marks a transformational period in time. Adults with disabilities who experienced a

pre-Americans with Disabilities Act (ADA) era now live and work alongside those with

disabilities who grew into adulthood with the rights afforded by this seminal legislation.

Society’s mindset of charity for “the disabled” has shifted to one that supports and

benefits from the full inclusion of people with disabilities. People with disabilities are

discovering work-arounds to limitations through advancements in technology, causing

the lines between people with disabilities and people without disabilities to blur.

For 30 years, the National Council on Disability (NCD) has been a powerful force behind

the fight for the rights of people with disabilities. It has promoted high expectations for

people with disabilities and the policymakers who serve them. Reports and letters from

NCD, available on http://www.ncd.gov/, provide critical guidance to develop sound

policy options that promote an inclusive society. This collection also keeps our nation

abreast of the issues that impact people with disabilities.

The 2014 edition of National Disability Policy: A Progress Report addresses six areas

that NCD identifies as timely and important to the wellbeing of people with disabilities:

Convention on the Rights of People with Disabilities (CRPD), employment, subminimum

wage, education, Medicaid managed care, and mental health.

The CRPD provides the guidance needed to create a global society in which people

with disabilities are empowered and live full and meaningful lives. To date, the United

States has neglected to ratify the CRPD, due in large part to misconceptions associated

with this international treaty. The NCD dispels myths associated with the CRPD in this

report and urges the full Senate to consider, vote on, and pass the ratification of the

CRPD when it reconvenes in 2014.

Employment is one of the most important pathways to economic self-sufficiency and

independence for Americans, yet people with disabilities experience higher

unemployment and lower pay rates than those without disabilities. NCD explores how

9
such factors as transportation, workplace culture, and technology impact employment

experiences and opportunities. The NCD advocates for an inclusive approach to these

(and other) factors so that people with disabilities can focus on pursuing employment

interests rather than on mediating obstacles that serve as barriers to employment.

Extending subminimum wage based on disability status has no place in American

culture. This policy option was introduced in an era lacking protective legislation, such

as the Rehabilitation Act and the ADA, and innovations in technology that now afford

greater opportunity for Americans with disabilities to engage prominently throughout

society. The NCD urges the U.S. Department of Labor to adopt its approach to phasing

out subminimum wage provisions as they relate to people with disabilities.

The Federal Government has offered states guidance on providing high-quality

education to students with disabilities for more than 35 years. This report cites

improvements in education experiences and outcomes for this population and also

acknowledges the need for improvement. NCD proposes recommendations that

promote education experiences that meet unique learning needs within an environment

of high expectations for students with disabilities.

State-sponsored Medicaid managed care addresses the physical and mental needs of

more than 9 million people with disabilities annually. NCD explores this multi-faceted

approach by highlighting benefit design, outcome measures, due process, and

stakeholder engagement. The Council advocates for system refinements, including

enhanced state monitoring and increased engagement with beneficiaries.

Concerns over stigma associated with mental health issues have led society to remain

relatively passive about this important topic. NCD asserts that silence is not an

acceptable response. This report proposes options to promote supports that address

mental health issues before they become debilitating conditions. It also includes options

for treatment and extended care to help individuals with mental health-related

disabilities live productive and meaningful lives.

10
As NCD celebrates the 30-year anniversary as an independent federal agency and 

prepares for the 25-year anniversary of the passage of the ADA, we urge Congress and 

the White House to address the issues and implement the recommendations raised in 

this 2014 annual Progress Report, thereby demonstrating our nation’s commitment to 

policies and laws that definitively include all Americans as equals.

11
12
INTRODUCTION

Our country has entered an exciting juncture for persons with disabilities, including

those who successfully fought for disability rights through the enactment of the

Americans with Disabilities Act (ADA) and the generation that has been raised with

those rights. The nation continues to strive for a more inclusive environment that

embraces and honors our diversity through the growing use of innovative technologies,

creative practices to enhance living and working opportunities, and relentless advocacy

for the rights of all Americans. These efforts have led to a cultural shift in our nation,

from an antiquated mindset of charity for “the disabled,” to a society that both supports

and benefits from the full inclusion of people with disabilities. For the past 30 years, the

National Council on Disability (NCD) has embraced, advocated for, and directed this

cultural shift. The Council has promoted high expectations for both people with

disabilities and the policymakers who serve them. The Council has also provided

policymakers with the critical guidance required to develop sound policy options that

promote inclusive experiences for people with disabilities. As our country prepares in

2015 for the 25-year anniversary of the passage of the ADA, the NCD urges Congress

and the White House to address the issues and implement the recommendations raised

in this 2014 annual Progress Report and to confirm the coming of age of enabling

policies and laws that definitively include all Americans as equals.

13
14
RATIFICATION OF THE CONVENTION ON THE RIGHTS

OF PERSONS WITH DISABILITIES

Background 

In 2006, the United Nations General Assembly adopted the Convention on the Rights of

Persons with Disabilities (CRPD) (2006). The CRPD, a non-legally binding treaty,

provides clear guidance for nations to promote, protect, and ensure the rights of people

with disabilities in order to realize a fully inclusive global society.

CRPD History

 1982 The United Nations (UN) declared 1983–1992 the Decade of Disabled Persons 

and adopted the World Programme of Action (WPA). 

 1987 Global experts recommended that the UN General Assembly draft an 

international convention on the elimination of discrimination against persons with 

disabilities. 

 2001 The General Assembly established an ad hoc International Disability Caucus 

to draft a treaty to promote and protect the rights and dignity of people with 

disabilities.

 2006 The CRPD was adopted by the UN General Assembly. 

As of August, 2014, the CRPD has been ratified by 147 countries, affecting an

estimated 1 billion people worldwide (see table 19 in the Data Trends in Disability

section for a list of the ratifying countries). As one of the world’s earliest civil rights laws

for people with disabilities, the ADA was influential in the creation of the CRPD and its

shift away from characterizing people with disabilities through a medical/charitable

model. This model has focused on how to “treat” or “cure” people with disabilities, or

isolate people with disabilities on the assumption that they cannot live successfully as

integrated citizens, but must instead be “cared for.” Instead, the ADA framed disabilities

rights as an issue of human rights in the prohibition of discrimination against people with

disabilities, similar to the Civil Rights Act of 1964’s protection of individuals based on

other characteristics. The ADA introduced regulations to public transportation and

building codes to ensure that persons with physical disabilities had access to the same

15
facilities and services as those without disabilities. The CRPD mirrors this shift by

focusing on both social attitudes toward people with disabilities as well as physical 

environments. Despite the central role of U.S. legislation in the development of the

CRPD, the United States has not yet ratified this international treaty. The U.S. Senate

fell five votes short of the required two-thirds majority vote when it was considered on

December 4, 2012, but is expected to take action again in fall, 2014. 

Driving Need Behind the CRPD 

The policy and practice guidance offered in the CRPD plays a critical role in paving the

way to a global society that is conducive to individuals who are empowered and able to

live full and meaningful lives. Millions of people with disabilities worldwide remain

abused, mistreated, and isolated. For example, in some parts of the world, children with

physical, mental, or sensory disabilities are “treated” with electro-shock therapy or

succumb to infanticide. Of those who survive, many are kept from school due to

misconceptions that they cannot learn. It is not uncommon for people with disabilities

transitioning into adulthood to experience seclusion in their homes due to a lack of basic

accessible facilities. In some cases, children and adults with disabilities are

institutionalized due to lack of family or infrastructural supports to keep them in their

homes. Once in an institution, they risk disappearing from institutions and becoming

victims of human trafficking. Of those who remain institutionalized, many are subjected

to deplorable and inhumane conditions in facilities that lack adequate resources, or staff

training and oversight. The most egregious examples include children and adults who

remained tied to cribs or beds for years on end or locked in small dark cells, without

clothes or access to bathrooms or showers (National Council on Disability [NCD], 2013). 

16
The CRPD in Action

 Canada and Russia have implemented CRPD principles to make public buildings 

and services more accessible to all people.

 United Arab Emirates, Kenya, and Nigeria have implemented CRPD principles to 

combat discrimination of persons with disabilities.

 India and Moldova have implemented CRPD principles to transition from models of 

institutionalization and charity to full social inclusion. 

The United States and other countries that have not ratified the CRPD such as Libya,

Sri Lanka, The Netherlands, and the Democratic People’s Republic of Korea have the

opportunity and obligation to take a stand against such violations and protect the rights

and dignity of people with disabilities by supporting the treaty. This highlights the

importance of the United States to ratify the CRPD, and signifies what this action will

mean for people with disabilities worldwide.

CRPD Implications 

Before the Individuals with Disabilities Education Act (IDEA), the Rehabilitation Act, and

the ADA were passed in the United States, many people with disabilities experienced

discrimination, social isolation, low expectations, inadequate education, and lack of

employment opportunities. The enactment of these laws has helped our nation shift

from a model of marginalization of people with disabilities to the expectation of

empowerment and full inclusion. Like the ADA and other U.S. legislation, the CRPD

treaty agreement offers the guidance that is needed to create an inclusive environment.

The 147 countries that have acted to affirmatively ratify the CRPD demonstrate their

commitment to protecting the rights of global citizens who either currently live with

disabilities, or will transition into disability later in life.

Realities of the CRPD

A misconception persists that the CRPD will interfere with home and family rights. This 

is false. Family rights such as homeschooling, discipline, right to life, and abortion will 

continue to be protected by state legislation. The CRPD does affect Americans by 

contributing to increased access to the global economy, international education, and 

worldwide culture and leisure. 

17
Despite the fact that the CRPD mirrors American legal precedents and societal values

that support the rights of people with disabilities, some have expressed resistance to its

ratification because of concerns from certain factions regarding potential interference

with U.S. sovereignty as well as the rights of individual American families. A recent

U.S. Supreme Court decision, Bond v. United States, allays concerns regarding state or

individual sovereignty, by confirming state and individual rights and causes of action in

circumstances where international treaty provisions coexist with applicable American

jurisprudence. These reservations, declarations and understandings (RUD’s) are used by

countries ratifying international treaties to exempt themselves from particular provisions in

a treaty, or to describe how they interpret specific language in a treaty. Included in these

reservations for ratification of the CRPD is the Federalism Reservation, which ensures

that state and local governments retain the same powers and authorities under the CRPD

as they do without it, and Private Conduct Reservation, which emphasizes that the

Federal Government has no obligation to interfere in the private lives of private citizens or

otherwise require individuals to comply with the CRPD (The White House 2012).

Global Empowerment of People with Disabilities: The Future of the United States 

and CRPD

The U.S. Senate Foreign Relations Committee voted to approve the CRPD and

successfully passed it out of committee in July 2014. NCD anticipates that the full

Senate may take action to ratify the CRPD in fall 2014. Ratifying the CRPD allows the

United States to sit on the Geneva Council that adjudicates complaints under the treaty,

allowing the United States to resume its role as a key leader in international

conversations on disability rights, supporting other nations in addressing human rights

issues for people with disabilities. U.S. involvement would shift from passive observer to

an active participant at the annual Conference of States Parties (COSP), a major

platform in which the global community discusses disability rights and exchanges ideas

on best practices. The United States could lend its experience and suggestions to

influence the creation of more accessible public spaces in other nations, which would

ultimately benefit all Americans with disabilities seeking to travel, work, and study

18
abroad, including more than 3.5 million veterans who live with service-related disabilities

(National Center for Veterans Analysis and Statistics 2014).

In addition, although no global data exists on the number of youth with disabilities,

estimates suggest that they constitute a significant group, with between 180 and 220

million youth with disabilities worldwide, nearly 80 percent of whom live in developing

countries (United Nations Secretariat 2014). Ratification of the CRPD by the United

States would serve to help reduce stigma associated with disability and ensure that

persons of all ages with disabilities, including youth with disabilities, are entitled to all

rights, including education, health care, employment, the right to vote, the right to a

family life and to participate fully in the communities in which they live.

The CRPD has the support of the White House, the Department of Justice, the Secretary

of State, bipartisan members of Congress, and more than 800 disability, veteran, faithbased, international development, humanitarian, and business organizations. Given the

enhanced access and opportunities that will become available for people with disabilities

worldwide coupled with the reality that the United States will be able to maintain domestic

policies and practices as governed by legislation such as the ADA, the Rehabilitation Act,

and IDEA, the NCD fully supports the ratification of the CRPD.

NCD CRPD Recommendations 

 The White House should continue to promote the CRPD through its outreach efforts, 

explicitly identify and address common misconceptions about the CRPD, and 

highlight the benefits of ratifying the treaty. Further, government agencies should 

post information on their websites about the implications of ratifying the CRPD for 

their stakeholders with disabilities. For example, the U.S. Departments of Veteran’s 

Affairs, Labor, and Commerce may highlight the benefits of enhanced access when 

expanding business to other nations.

 The full Senate should consider, vote on, and pass the ratification of the CRPD 

when it reconvenes in fall 2014. Ratification will enable the United States to resume 

19
its role as a key leader in international conversations on disability rights and 

contribute to a global society that is inclusive of people with disabilities.

NCD Resources Related to the CRPD

NCD Statement on the Convention on the Rights of Persons with Disabilities

(CRPD), (2014), http://www.ncd.gov/publications/2014/07142014/

NCD Education Forum Report: UN Convention on the Rights of Persons with

Disabilities, (2013), http://www.ncd.gov/publications/2013/12122013

NCD Letter to Senate Foreign Relations Committee Again Reaffirms Its Strong

Support of Ratification of the CRPD, (2013),

http://www.ncd.gov/publications/2013/11062013/

NCD Statement on Failed CRPD Ratification Vote in the Senate, (2012),

http://www.ncd.gov/publications/2012/120512

NCD Urges Expeditious Senate Approval of the Convention on the Rights of

Persons with Disabilities, (2012), http://www.ncd.gov/publications/2012/052512

Finding the Gaps: A Comparative Analysis of Disability Laws in the U.S. to the

U.N. Convention on the Rights of Persons with Disabilities, (2008),

http://www.ncd.gov/publications/2008/May122008

National Council on Disability Practical Discussions on Implementation in the

U.S. and Other Countries, (2006), http://www.ncd.gov/publications/2006/Oct242006

Update on the UN Convention on the Rights of People with Disabilities, (2006),

http://www.ncd.gov/publications/2006/04172006

National Council on Disability Commends Adoption of United Nations Convention

on the Rights of People with Disabilities, (2006),

http://www.ncd.gov/publications/2006/12182006

Update on the UN Convention on the Rights of People with Disabilities (November,

2004), http://www.ncd.gov/publications/2004/Nov242004

Update on the UN Convention on the Rights of People with Disabilities (July, 2004)

http://www.ncd.gov/publications/2004/July12004

20
INCREASING EMPLOYMENT ACCESS AND 

INCLUSION 

Background

People with a disability are employed at a lower rate and make less money than people 

without a disability:

 42.8% Rate of Employment Gap

 $6,000 Income Gap

NCD regards employment as one of the most important pathways to economic selfsufficiency and independence for Americans. A significant gap persists when comparing

employment outcomes of persons with a disability to those without. In 2012, only 33.5

percent of persons with a disability were employed compared to 76.3 percent of persons

without a disability (Disability Statistics n.d.). In the same year, the average income for

people with a disability was $36,400, while those without a disability earned $42,400 on

average. Employment rates for people with self-reported work-related disabilities have

fallen almost continuously since the 1990s, despite the passage of the ADA in 1990

(Americans with Disabilities Act 1990), and major investments in the workforce

development system since the enactment of the Workforce Investment Act of 1998

(Workforce Investment Act 1998). People with disabilities have historically constituted a

contingent labor force; and were more effected by the recent economic downturn than

peers without disabilities. Data reveals that on average persons with a disability were

about 1.36 times more likely to experience one of four major labor market problems

(unemployment, working part time for economic reasons, labor force reserve, or lowwage earners) compared to their counterparts without disabilities. As the economic

climate has improved overall, persons with disabilities have experienced stagnated

levels of employment and full time employment, compared to persons without

disabilities (exhibit 1) (Fogg and Harrington 2010).

21
Exhibit 1. Employment Trends of People with Disabilities Compared to People

Without a Disability, 2008–2012

In the United States, the employment rate of working-age people (ages 21 to 64)

2008 2009 2010 2011 2012

PWD 39.5 36 33.9 33.4 33.5

PWOD 79.9 76.8 70.4 75.6 76.3

In the United States, the percentage actively looking for work among people with 

disabilities who were not working

2008 2009 2010 2011 2012

PWD 8.7 11.6 12.3 11.7 10.8

PWOD 21.4 30.4 31.2 29.4 27.5

In the United States the percentage of working-age people with disabilities 

working full-time/full-year

2008 2009 2010 2011 2012

PWD 25.4 22.5 20.9 20.7 20.9

PWOD 60.4 57 55.3 55.5 56.4

Source: Erickson, W., C. Lee, and S. von Schrader. 2014. Disability Statistics from the 2012 American 

Community Survey (ACS). Ithaca, NY: Employment and Disability Institute, Cornell University. 

http://www.disabilitystatistics.org. 

People with disabilities are three times more likely to live in poverty than those without

disabilities (Rosen 2014), and 28 percent of all people with disabilities live in poverty.

People with work limitations live below the federal poverty line at significantly higher

rates than those who do not (exhibit 2) (Nazarov and Lee 2012).

22
Exhibit 2. Percentage of Adults, Aged 18-64 with and Without a Work Limitation in

the U.S. who Lived in Families with Incomes Below the Poverty Line, 2007– 2012

30.9

11.9

0

10

20

30

40

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Percentage of adults, aged 18-64 with and without a work 

limitation in the U.S. who lived in families with incomes below 

the poverty line, from 2007-2012

With a work limitation Without a work limitation

A number of federal initiatives have been instituted throughout the years to address

these trends. Subminimum wage for people with disabilities was made possible through

the Fair Labor Standards Act of 1938. Although it was designed to increase access to

employment settings for people with disabilities, this provision has led to segregated

work environments with unlivable wages based upon adherence to outdated and

discredited social models; other federal initiatives show great promise:

 Supported employment services offer competitive employment in an integrated 

setting with ongoing support services for persons with the most significant 

disabilities. 

 Executive Order 13548 issued in 2010 aims to make the Federal Government a 

model employer for people with disabilities. Through this order, the Government 

developed strategies to enhance recruitment, employment, and retention practices 

for people with disabilities with the stated goal of having an additional 100,000 

people with disabilities hired into federal positions (Executive Order no. 13,548. 

2010). 

 Regulations for Section 503 of the Rehabilitation Act require federal contractors to 

set a goal to hire a minimum of 7 percent of employees with disabilities. 

23
 Section 508 of the Rehabilitation Act requires federal employees with disabilities to 

have access to and use of information and data that is comparable to that of federal 

employees without disabilities, unless it creates an undue burden (Rehabilitation Act 

of 1973, amended 1998).

 Schedule A (5 C.F.R. § 213.3102(u)), a hiring authority for federal agencies, helps 

qualified people with disabilities pursue a federal appointment through a 

noncompetitive hiring process. 

 Both Executive Order 13518 (2009) and the website FedsHireVets.gov are federal 

hiring initiatives that support employment of veterans in the Federal Government.

 The "Add Us In" initiative sponsored by the U.S. Department of Labor’s Office of 

Disability Employment Policy helps identify and develop strategies to increase 

employment opportunities within the small business community for people with 

disabilities, with an emphasis on individuals from diverse backgrounds.

 The development and institution of affinity groups for employees with disabilities 

within the Federal Government offers staff an opportunity to identify strategies for 

establishing a more inclusive work environment.

 Executive Order 13658 (2014) increased the minimum wage paid for all workers 

employed by federal contractors. This increase applies to all their workers, including 

those with significant disabilities who may have previously been paid subminimum 

wages.

 The Job Accommodation Network (JAN) helps people with disabilities enhance their 

employability and provides employers with guidance on workplace accommodations 

and other disability employment issues. JAN is offered through the Office of 

Disability Employment Policy as a free consulting service for job seekers and all 

employers (public, private, non-profit), accessibility by telephone, email, online tools, 

publications, and resources.

24
 The Partnership on Employment and Accessible Technology (PEAT) is a national 

resource to facilitate and promote the use of accessible technology in the hiring, 

employment, retention, and career advancement of individuals with disabilities.

PEAT is offered through the U.S. Department of Labor's Office of Disability 

Employment Policy (ODEP) as a free resource for employers, job-seekers, and other 

stakeholder interested in the use of accessible technology in the employment 

setting.

 The Department of Labor and the Social Security Administration have created a 

partnership to expand the capacity of the American Job Center Network to serve 

persons receiving Social Security disability benefits and ultimately improve their 

employment outcomes, leading the way to economic self-sufficiency. A component 

of these efforts is the Workforce Investment Act Employment Network (EN) Payment 

Agreement, under its Ticket to Work and Self Sufficiency (TTW) Program. Most 

adults who receive Social Security benefits based on disability are eligible for the 

TTW Program. They may assign their Tickets to an Employment Network (EN) of 

their choice to obtain education, training, employment services, vocational 

rehabilitation, and other support services necessary to maximize their economic selfsufficiency through work opportunities.

Initiatives such as those described above provide a solid framework for improving

employment outcomes for people with disabilities—their success relies on inclusive

practices throughout society that make meaningful work experiences possible. This

section identifies opportunities to facilitate inclusive practices that maximize

employment opportunities in three illustrative areas: transportation, customized

employment, and accessible technology. Principles behind each of these areas are

enjoyed by many people without a disability; they are commonplace and overlooked

when considering facilitators to employment.

Transportation

Of the nearly 2 million people with disabilities who never leave their homes, 560,000 cite

transportation difficulties as the reason (American Association of People with

25
Disabilities n.d.). Accessible transportation is a basic necessity for many Americans to

secure and maintain employment. Regardless of the number or effectiveness of

programs and incentives designed to promote job opportunities for people with

disabilities, in most instances, workers cannot secure and maintain a job if they do

not have accessible transportation to get to it.

Accessibility barriers in transportation cannot be addressed without carefully planned

solutions that are supported through research, policy, funding, and action. Autonomous

vehicles offer great promise to transport people with disabilities to work. Such

technology is years away and will require a major shift in licensing vehicles and

passengers, including policy decisions regarding the degree of autonomy, licensing

requirements for passengers who might not otherwise qualify, and considerations

regarding interstate transportation.

The Generating Renewal, Opportunity, and Work with Accelerated Mobility, Efficiency,

and Rebuilding of Infrastructure and Communities throughout America Act (GROW

AMERICA Act) offers promise to enhance transit experiences for people with disabilities

(Federal Transit Administration n.d.). The Act includes provisions to promote mobility for

people with disabilities through increased funding to states for rail and transit systems.

The following examples highlight challenges that many people with disabilities face

when accessing transportation options as they commute to work:1

Rail Systems

Many major U.S. cities have rail systems capable of transporting hundreds of thousands

of people per day, making this an efficient option to get to work. Many people with

disabilities frequently face challenges that can interfere with getting to work. The New

York City subway system was constructed prior to the passing of the ADA and remains

largely inaccessible for people with mobility disabilities, because elevators in many

stations do not exist or are not functional, some elevators do not reach platforms, and

1 This section focuses accessible local travel for daily commutes. People with disabilities 

also face barriers to air travel required for professional obligations in other regions or 

countries. 

26

 
gaps between the platforms and the trains may prevent wheelchair riders from safely

boarding. Some rail systems that have elevators fail to keep them in working order,

which can lead to significant delays in getting to work. Many people with disabilities also

experience challenges accessing print-based information and independently purchasing

tickets from vending machines that operate with visible or touch screen controls.

Taxi Cabs 

Taxi cabs provide a flexible option for local transportation. Only a small percentage of

taxis are accessible, and people with disabilities often experience discrimination from

taxi services (American Association of People with Disabilities n.d.). Universal access in

taxi cabs is uncommon, but possible. In London, England, every cab is equipped to

accommodate wheelchairs. Following litigation, New York City has begun the transition

to equip more accessible medallion2 taxis and plans to have 50 percent of the fleet

equipped to accommodate wheelchairs and scooters by 2020 as part of its “Taxi of

Tomorrow” program (Mullin 2013). This is especially critical in a city with more than

889,000 people with disabilities (Dooha 2011) and a subway system that is inaccessible

to many people with disabilities due to the lack of elevators. New York has also

introduced a touch screen system for taxi riders that is accessible to people who are

blind or low-vision riders. This screen allows riders to monitor route and fees and to

hear charges and pay via credit card through auditory information and commands.

Transportation Network Companies (TNCs)

Accessibility issues are also a concern with the increase in popularity among

Transportation Network Companies (TNCs) (e.g., Uber or Lyft). Such companies offer

the convenience of ordering transportation through mobile technology. Their

applications are compatible with text-to-speech, which makes them viable options for

people who are blind or low-vision riders. Some riders have experienced resistance

from drivers to their service animals accompanying them in TNC vehicles. Further

problems that people with disabilities face with TNCs involve the dearth of vehicles

equipped to accommodate passengers using wheelchairs and scooters, which excludes

2 Medallion taxis are taxi’s painted yellow. 

27

 
the more than 3 million people who use mobility devices in America. In response to

these challenges, Uber announced that any driver who refuses to accept a service dog

will be dropped from their program. Uber is commencing pilot programs in cities such as

New York (Mikaela 2014) and Chicago (Mallory 2014) to increase vehicles that are

accessible to people with mobility issues.

TNCs have the potential for improving transportation options in urban cities across the

country, and increasingly, around the world. While issues related to regulation are

undetermined, and in progress, Americans with disabilities who can use such network

companies may greatly increase their access and efficiency to urban transit. If such

access becomes a reality, and with the increased convenience of cashless transactions,

and ease in contacting drivers, with guaranteed responses, TNCs may prove to be a

highly relevant addition to the way that Americans with disabilities move within cities.

Universal Approach to Meeting Employee/Employer Needs

In addition to meeting the transportation needs of people with disabilities to support their

ability to secure and maintain employment, legal developments such as the 1999 ruling

in the United States in Olmstead v. L. C. (1999) prohibited unnecessary segregation of

people with disabilities and created the obligation to ensure that people with disabilities

receive services in the most integrated setting appropriate to their needs. Since the

Olmstead ruling, customized employment has been used as a strategy to transition

individuals with complex needs from sheltered work environments into integrated

community settings in an effort to promote options for meaningful and nondiscriminatory

employment opportunities. These principles of customized employment are not

uncommon to the workforce. Employers increasingly offer flexible work arrangements

as a strategy to attract and retain a strong and diverse talent pool. This approach, which

prioritizes flexibility around job tasks rather than the job location or the schedule, is

reflected in a growing number of industries for greater numbers of workers. For

example, in 2012, approximately 24 percent of employed people with a disability and

20 percent of employed people without disabilities did some work at home. Forty-two

28
percent of people with a disability and 35 percent of people without a disability had

flexible work schedules.

Customized Employment

The customized employment process is a flexible blend of strategies, services, and 

supports designed to increase employment options for job seekers with complex needs 

through voluntary negotiation of the employment relationship. The job seeker is the 

primary source of information and drives the customized employment process.

—National Center on Workforce and Disability

Employees both with and without a disability seek flexible work arrangements as an

option for maximizing professional performance while balancing personal needs and

obligations. Many people with disabilities have looked to flexible work arrangements as

a necessary option for participation in the workforce. For example, some lack accessible

transportation to get to work, require personal assistance throughout the day that is not

always conducive to an office environment, or must negotiate health conditions that

make their schedule less predictable than those without a disability.

Studies show that flexible work environments lead to employees who are more satisfied,

committed, and engaged with their job, which can lead to increased innovation, quality,

productivity, and market share; increased financial performance and operational and

business outcomes; reduced unscheduled absences and increased productivity; and

enhanced retention and recruitment. The concepts of flexible work and customized

employment are organically converging, illustrating how best practices can have

universal applicability. This presents the U.S. labor force with a unique opportunity to

strengthen inclusive work environments by streamlining the way we speak about work

provisions that are ultimately designed to accomplish the same common goal of

meeting the needs of both employers and employees.

Technology 

Technology has significantly changed all aspects of employment, not only in content,

but also context. The mobile technology industry is among some of the fastest growing

29
sectors of the economy. With approximately 50 percent of individuals obtaining or

hearing about jobs through friends and family (National Council on Disability 2011), the

rapid rise of social networking can help individuals identify and obtain employment.

Advances in technology are also making employment more accessible than ever for

people with disabilities, and reducing the need for individual accommodations. There

are more opportunities for persons with mobility challenges to work from remote

locations. The development of accessibility standards and advances in computer

programming languages such as HTML5 have improved the accessibility of virtual

materials for persons with sensory disabilities, though the lack of universal design

standards continue to pose some difficulties. For example:

 Section 508 of the Rehabilitation Act requires federal agencies to provide employees 

with a disability (and members of the public) with access to information that is 

comparable to access available to others. Regulations on this issue are expected 

shortly from the U.S. Access Board and further engagement with technology industry 

companies may provide an opportunity for even more accessibility in this area

(Rehabilitation Act of 1973, amended 1998).

 The Twenty-First Century Communications and Video Accessibility Act (CVAA)

(2010) updates the Communications Act of 1934 to increase the access of people 

with disabilities to modern communications in 21st century technologies found in the 

workplace. The Act requires access to web browsers on mobile devices by people 

who are blind or visually impaired and FCC clearinghouse on accessible 

communications services and equipment; includes the application of the hearing aid 

compatibility mandates to telephone-like equipment used with advanced 

communications services; requires the inclusion of people who are deaf-blind in the 

definition of telecommunications relay services (TRS) to allow communication 

between and among different types of relay users (Federal Communications 

Commission 2014); and requires accessibility of Advanced Communication Services 

(ACS), facilitating two-way, interactive communication over the Internet by voice, 

text, or video (Twenty-First Century Communications and Video Accessibility Act 

30
2010). The Federal Communications Commission approved new rules in 2014 that 

will require closed captioning of video clips that are posted online. These 

requirements will enhance access to information for employees who are deaf or hard 

of hearing.

Despite these developments, barriers to technology access continue to serve as a

barrier to successful employment. People with disabilities experience significant

challenges to affordable and accessible technology that lead to low rates of broadband

adoption. According to Lyle (2010), only 42 percent of people with disabilities have

broadband in the home compared to the national average of 65 percent. Given the

centrality of Internet access to obtain employment in today’s workforce, this is an area

that must be remedied.

Problems of accessibility and inclusivity are also in danger of spreading and becoming

more complex as mobile technology increasingly makes social networking ubiquitous.

According to a report from NCD (2011), the cost of hardware and software was

identified as a major barrier for people with disabilities. One area of promise for

improving accessibility is the use of meta-design. Meta-design refers to a way of

developing software that is open to continual updates and changes. In this model, users

of software can act as contributors or editors to ensure that programs are able to

respond to changing contexts, emergent problems, and specific needs of communities

of users, such as people with disabilities.

In spring 2014, NCD and the U.S. Department of Labor, Office of Disability Employment

Policy co-hosted an online dialogue entitled, “Join the Conversation: Advancing

Accessibility and Inclusion in Social Media—The User Experience” (ePolicy Works

2014a). The first of a three-part series, participants were invited to provide solutions for

making social media more accessible. Respondents identified challenges that serve as

barriers to identifying and pursuing employment opportunities when using social media.

Two of the challenges identified could, if rectified, be of assistance to people with

disabilities seeking employment through social media:

31
 Employment Application Timeout—The typical timeout period of 30 minutes is often 

too brief to complete an online application.

 Non-image PDFs as Advertising for Jobs—Applications or job advertisements used 

to publicize a position on social media websites are often image-based portable 

document files (PDFs). This format makes it almost impossible to read for those who 

are blind, visually impaired, or print disabled 

The social media dialogue was followed up with, “Encouraging People with Disabilities

to Pursue Careers in STEM (Science, Technology, Engineering and Mathematics)”

(ePolicy Works 2014b). This dialogue solicited ideas to encourage people with

disabilities to pursue careers in the STEM fields and to support their success in the

workforce. Top ideas that emerged from the report include:

 Offering opportunities for job shadowing, internships, and work experiences, which 

would expose students with disabilities to professional options in the STEM field

 Promoting STEM schools, courses, and other experiences throughout middle school 

and high school, which would prepare youth for higher education and employment 

options 

 Encouraging peer mentoring, which would help youth with disabilities stay engaged 

in STEM disciplines 

 Increasing accessibility to technology resources used to facilitate STEM 

experiences, which is required for youth with disabilities to participate in STEM 

disciplines

 Enhancing collaboration between disability specialists and higher education 

professionals, which would help create more inclusive postsecondary environments

32
NCD Employment Recommendations

Transportation

 The U.S. Department of Transportation (DOT) should offer guidance to transit 

systems on reasonable accommodations (e.g., the reasonable amount of time an 

elevator may be out of order, reasonable alternatives during elevator outages, 

standards for providing accessible materials, etc.) and require recipients of GROW 

AMERICA funds to adhere to these standards in order to maintain good standing for 

grants.

 DOT should consider developing survey items addressing experiences of customers 

with disabilities for transit systems that solicit feedback to use in their efforts to 

understand accessibility trends.

 DOT should collaborate with private sector research and design and invest in 

autonomous vehicle research to help refine the technology that powers this initiative 

and explores the implications for people with disabilities.

 Congress should explore and support regulation and universal design and standards 

for accessible devices in taxicabs and transit provided through transportation 

network services to ensure maximum opportunities for design of emerging 

technologies that include accessibility for people with disabilities.

Universal Approach to Meeting Employee/Employer Needs 

 The Department of Labor (DOL) should encourage the workforce to adopt a 

universal language and understanding about flexible work arrangements and 

customized employment strategies. Eliminating the distinctions between flexible 

work arrangements and customized employment strategies would contribute to a 

more inclusive work environment. 

 DOL should provide guidance to employers on providing natural supports in the 

workplace. Such supports that occur through assistance, relationships, or 

interactions help facilitate typical social relationships in the work setting and 

contribute to a more inclusive environment for all employees.

33
Technology

 The Federal Communications Commission (FCC) and the U.S. Access Board should 

continue to identify barriers surrounding broadband access and build on policy that 

would result in broader use by people with a disability.

 Congress should conduct hearings with key business and industry leaders to help 

identify incentives that would reduce costs and increase availability of accessible 

technology for people with disabilities. One discussion point could involve adopting 

meta-design principles as a way of providing more cost-effective products for all 

users.

 Congress should consider a tax incentive for manufacturers of equipment that 

provide the latest assistive technologies to nongovernmental organizations (NGOs) 

for distribution to people with disabilities. Such manufacturers should also provide 

training to both the NGOs and clients on use and maintenance.

 DOL should consider developing and disseminating a tip sheet on developing 

accessible job announcements to be posted on social media sites and other online 

platforms. 

 DOL should explore and invest in employment opportunities for young people with 

disabilities to learn skills relevant to the technology industry, such as coding, early in 

their academic career, becoming accessibility testers, getting internship and 

mentorship experiences in the software game development industry and STEM 

careers, and creating their own companies.

 The FCC should provide the communications industry and device manufacturers 

with guidance on best practices to include people with disabilities in the research 

and development (R&D) process from ideation to pilot testing of new products. 

34
NCD Resources Related to Employment

Letter to House Senate Conference on Workforce Investment Act, (2014),

http://www.ncd.gov/publications/2014/03282014/

NCD Letter to Senate Finance Committee in Support of Amendment Language

Regarding Supported Employment, (2013),

http://www.ncd.gov/publications/2013/12112013/

National Council on Disability Report on Subminimum Wage and Supported

Employment, (2012), http://www.ncd.gov/publications/2012/August232012/

The Power of Digital Inclusion: Technology's Impact on Employment and

Opportunities for People with Disabilities, (2011),

http://www.ncd.gov/publications/2011/Oct042011

Federal Employment of People with Disabilities, (2009),

http://www.ncd.gov/rawmedia_repository/ccf09bbd_62bd_4043_b674_75ad5f37d237?d

ocument.pdf

Empowerment for Americans with Disabilities: Breaking Barriers to Careers and

Full Employment, (2007), http://www.ncd.gov/publications/2007/Oct2007

A Perspective from Youth with Disabilities: Benefits in a World of Employment,

(2007), http://www.ncd.gov/publications/2007/March2007

The Social Security Administration's Efforts to Promote Employment for People

with Disabilities: New Solutions for Old Problems, (2005),

http://www.ncd.gov/publications/2005/11302005

National Council on Disability Topical Overviews - An Overview of the Experience

of the United States with Employment and Right to Work Protections, (2005),

http://www.ncd.gov/publications/2005/08022005-Overview

Livable Communities for Adults with Disabilities, (2004),

http://www.ncd.gov/publications/2004/12022004

35
36
REDUCING SUBMINIMUM WAGE OPTIONS

Background 

The public policy choice of continuing to utilize subminimum wages to pay some people

with significant disabilities has been an ongoing concern of NCD. The issue stems from

Section 14(c) of the Fair Labor Standards Act (1938, sec. 14(c)). This provision permits

the Secretary of Labor to waive federal minimum wage standards for certain

populations, including some individuals whose earning or productive capacities for the

work to be performed are impaired by physical or mental disabilities, including those

related to age or injury (Fair Labor Standards Act 1938).

Competitive Wage Is an Issue of Equality & Economics

 For every $1 spent on employment programs, more than $1 is saved in taxes 

collected and savings from benefit programs.

 52 percent of primary income of people with supported employment comes from 

their paycheck, versus public assistance or disability benefits.

 Sheltered workshops can cost three times more than supported employment 

(Disability Rights Oregon n.d.)

Section 14 (c) was instituted to enhance employment opportunities for people with

disabilities and other populations, using a deficit model, together with the charitable

philosophy that was popular in the 1930s. Other populations exempted from minimum

wage requirements include felons, trainees, and youth. These groups were considered

to be in need of special protection, or incapable or undeserving of earning minimum

wages. Absent the developments of protective legislation like the Rehabilitation Act and

the ADA, and without the innovations of technology that now permit Americans with

disabilities to engage more prominently in everyday life, the Fair Standards Labor Act

(FLSA) (U.S. Department of Labor n.d.) was viewed as a protective and charitable

method of providing some employment opportunities to Americans with disabilities.

Incentivizing employers to provide work experiences through subminimum wages made

sense at the time. Even President Roosevelt, a man who lived with a disability, limited

his advocacy for fair wage protections to “able-bodied working men and women.” As

37
practices to include people with disabilities in the workforce have grown, so has

perception among our leadership. As addressed in the employment section, Executive

Order 13658 reflects an increase in the minimum wage paid for all workers employed by

federal contractors, including those with significant disabilities who may have previously

been paid subminimum wages.

On May 24, 1937, President Roosevelt sent the Fair Labor bill to Congress with a 

message that America should be able to give "all our able-bodied working men and 

women a fair day's pay for a fair day's work." 

While society has evolved since 1938, antiquated employment practices linked to

subminimum wages remain. Despite the spirit in which the provision was instituted more

than 75 years ago, it perpetuates the reality of a tiered wage system among people with

disabilities and serves as a significant deterrent to an inclusive society.

Steven Porcelli, 50, of North Providence, Rhode Island found employment at a 

hardware store following high school graduation. However, he was sent to a sheltered 

workshop run by a nonprofit company called Training Thru Placement. In the sheltered 

workshop, Porcelli assembled jewelry, packed medical supplies into boxes, grated 

cheese and stuffed peppers for about $2 an hour. Although Porcelli expected the 

experience to lead to another job since the program was supposed to provide training 

through placement, he remained in the sheltered workshop for 30 years. Porcelli 

described the experience by saying “I was doing piecework most of the time, which I 

didn’t like too much” (Barry 2014).

NCD opposes Section 14 (c). The Council also understands that an immediate repeal of

Section 14 (c) will be disruptive for many who have operated in this framework for

years. To account for systems changes to enhance existing resources and creating new

mechanisms for supporting individuals in obtaining integrated employment and other

nonwork services, the Council proposes a gradual phase-out approach rather than an

immediate repeal. This will allow those who have been in the program for many years

with time to transition to a supported employment environment. This approach is

outlined in NCD Report on Subminimum Wage and Supported Employment (National

Council on Disability n.d.) and also reflected in the recommendations section of this

section.

38
Current Context of Subminimum Wage

Sheltered Workshops 

Many entities that offer employment opportunities specifically for people with disabilities

do so in the context of a “sheltered workshop.” These facilities exclusively employ

people with disabilities and although sheltered workshops were created with the

intention of helping people with disabilities integrate into mainstream work

environments, they rarely do so. The Government Accountability Office (GAO) has

estimated that only 5 percent of sheltered workshop employees left to take jobs in the

community. The GAO has also estimated that 95 percent of workers with disabilities

who are paid less than minimum wage are employed by sheltered workshops.

Approximately 420,000 people with disabilities are in the 14(c) program (NCD, 2012).

Section 14(c) exemptions of the Fair Labor Standards Act created jobs that pay as little

as 10 percent of the minimum wage with most workers earning only 50 percent of the

minimum wage (Rosen 2014).

On the whole, many of the people NCD interviewed across the country in preparation of

its report on this issue opposed subminimum wages and sheltered workshops, and they

emphasized the inherent injustice of and flaws in the systems. Some people have

concerns about the availability of alternatives for themselves and/or their loved ones

should sheltered workshops and subminimum wage be abolished, such as access to

basic economic security provided by Supplemental Security Income (SSI) and daily

activities that include out-of-home supervised engagement. This is particularly true for

individuals who have been in sheltered workshop placements for many years.

Recent Changes to the Political Landscape

On April 8, 2014, the United States entered into the nation’s first statewide settlement

agreement with Rhode Island, following a ruling that the state service system over-relies

on segregated settings, including sheltered workshops and facility-based day programs,

to the exclusion of integrated alternatives, such as supported employment and

integrated day services (United States v. Rhode Island 2014; U.S. Department of

Justice, Office of Public Affairs 2014).

39
The recently enacted Workforce Innovation and Opportunity Act (WIOA) (2014)

continues a funding authority for a number of workforce training programs, including

those aimed specifically at supporting people with disabilities in finding meaningful

employment. Section 51 however perpetuates the regressive practice of subminimum

wage work environments for transitioning youth when no other options appear to be

viable. This provision in WIOA limits when employers can pay a person with a disability

at subminimum wage, although the limits do not affect those already employed at the

subminimum wage (Workforce Innovation and Opportunity Act 2014, § 794g, sec. 511).

This provision does address the youth population specifically, by requiring that

employers offering subminimum wage ensure that those individuals have received preemployment transition services as a part of the IDEA (29 U.S.C. § 733) and have

applied for vocational rehabilitation services and have been found ineligible for those

services. NCD opposed the Section 511 provisions citing the need instead to phase out

subminimum wage completely and shift funding, policy, and practice to competitive

integrated employment with necessary supports.

Integrated or Supported Employment

The antiquated models and outmoded approach of the FLSA, now almost 84 years old,

has given way to the modern model of promotion empowered by self-determination and

reasonable accommodations, allowing people with disabilities to make valuable

contributions to the workplace and society. Research shows overwhelmingly that a

majority of people with disabilities prefer employment outside of segregated settings

and that preference is not associated with severity of disability (Migliore 2007). An

alternative to subminimum wages that often accompany placement in sheltered

workshops is the use of “integrated” or “supported” employment. In these forms of

employment, people with disabilities work in community-based business settings

alongside coworkers without disabilities and earn a minimum wage or higher. A variety

of federal and state funds can be used to help mitigate concerns and provide training to

employers, community members, families of people with disabilities, and people with

disabilities to support this model.

40
Although people with disabilities and their families may prefer and benefit from job

placement in an integrated and competitive employment environment, the process of

transitioning out of subminimum wage settings brings with it many uncertainties,

including a common worry about the possible loss of SSI. The U.S. Social Security

Administration (SSA) has long-established work incentives that allow SSI beneficiaries

to accumulate income and/or resources without risking loss of benefits while working

toward a future occupational goal or maintaining self-employment. Historically, these

have included the Plans for Achieving Self-Support (PASS) Program, the Benefits

Planning, Assistance and Outreach Program (BPAO), Work Incentives Planning and

Assistance Program, and the Ticket to Work Program. Additionally, funding was

provided for Medicaid Infrastructure grants and state-based Medicaid buy-in programs.

Work incentive programs are underutilized and relatively unknown to agency personnel,

beneficiaries, and their families. Efforts are needed to provide knowledge about these

programs and how they can be used to assist people with disabilities to enter supported

employment. NCD has found that, once in the workplace, people with disabilities who

work in fully integrated settings reported that peer support was critical to their ability to

resolving workplace issues they encounter by, for example, providing guidance and

advice on how to speak with supervisors or customers. A holistic approach is needed

that promotes natural supports and provides information about federal assistance

programs to individuals, families, employers and also people with disabilities about

systems of peer support so that workers can successfully shift out of sheltered

workshop settings.

NCD Subminimum Wage Recommendations 

NCD’s Proposed 14 (c) Phase Out 

 DOL should adopt and implement NCD’s proposal to phase out 14(c) in reference to 

people with disabilities as reflected in the NCD 2012 Report on Subminimum Wage 

and Supported Employment. This transformation should be put in place gradually so 

that individuals who are currently in these settings are provided information and 

resources to continue to receive SSI and get connected to peer networks, and so 

entities that use it have time to adapt their practices. NCD recommends a cycle of 

41
phased closures and transitions from sheltered workshops at subminimum wages to 

supported or customized employment at fair wages. This multistep phase-out plan 

involves the following steps:

o Immediately: Congress should prohibit the Department of Labor from issuing

further 14(c) certificates.

o In the long term: The Department of Labor should require all providers who

administer 14(c) certificates to convert to supported employment, on a timed

basis:

 All individuals in certificate settings for 10 years or less shall be transitioned 

within 2 years.

 All individuals in certificate settings for 10 to 20 years shall be transitioned 

within 4 years.

 All certificates shall expire in 6 years, and all individuals in certificate settings 

longer than 20 years shall be transitioned within 6 years.

To support this shift, Congress should explore a “Money Follows the Person for

Integrated Employment” program, enabling the Federal Government to assume

100 percent of the costs of supported employment services for individuals leaving a

sheltered workshop or day habilitation setting for integrated employment.

Integrated Employment Settings

 DOL should develop policy requiring participants of 14(c) certificate programs to 

provide all of their workers with the opportunity and information on how to transfer 

into an integrated employment setting twice per year. Information provided to 

workers should include resources about benefit work incentive counseling and the 

availability of peer support.

 Congress should consider the following actions to build cultures of high expectations 

and support for people with disabilities in integrated employment settings:

42
o Prohibit any Individualized Education Plan (IEP) to list placement in a

subminimum wage program as an acceptable postsecondary transition service or

goal.

o Instruct the Centers for Medicare & Medicaid Services (CMS) to develop a

minimum standard definition for integrated employment settings aligned with

national best practices.

 The three partners authorized under the Developmental Disabilities Bill of Rights Act 

should coordinate and expand efforts to promote peer support to both families 

and people with intellectual developmental disabilities transitioning from the 

14(c) programs to integrated employment. The three partners include: (1) State 

Councils on Developmental Disabilities; (2) University Centers for Excellence in 

Developmental Disabilities Education, Research, and Service (UCEDDs); and 

(3) Protection & Advocacy Systems (P&As).

NCD Resources Related to Subminimum Wage

NCD Letter to the President and Labor Secretary Tom Perez on the Impending 

Minimum Wage Executive Order, (2014), 

http://www.ncd.gov/publications/2014/01302014/

NCD Letter to Senate Finance Committee in Support of Amendment Language 

Regarding Supported Employment (2013),

http://www.ncd.gov/publications/2013/12112013/

National Council on Disability Report on Subminimum Wage and Supported 

Employment, (2012), http://www.ncd.gov/publications/2012/August232012/

43
44
IMPROVING EDUCATION EXPERIENCES AND 

OUTCOMES

Background

For more than 35 years, federal legislation has provided guidance to states on offering

students with disabilities a high-quality education that is responsive to their unique

needs. Prior to the passing of the “Education for All Handicapped Children Act (EAHC)”

(1975), only one in five students with disabilities was educated in the public education

system—and many states had laws excluding certain students in the general setting,

including children who were deaf, blind, emotionally disturbed, or had a mental health

condition.

 1965 Elementary and Secondary Education Act passed to provide guidance on 

primary and secondary education.

 1973 Section 504 of the Rehabilitation Act took effect to prohibit the denial of 

public education participation, or enjoyment of the benefits due to a disability.

 1975 the Education for All Handicapped Children Act (EAHC) was enacted to 

provide a free and appropriate public education to students with disabilities. EAHC 

served as the precursor to IDEA.

 1990 the Americans with Disabilities Act (ADA) was passed, mandating public 

accommodation in private entities such as schools.

 1991 the Individuals with Disability Education Act (IDEA) replaced EAHC to 

govern education services for students with disabilities.

Practices have evolved and outcomes have improved since state and local education

systems implemented federal guidelines to serve students with disabilities. For

example, 61 percent of students with disabilities now spend more than 80 percent of

their day in general education classrooms, and the percentage of students with

disabilities completing high school increased from 53 percent in 1997 when IDEA was

reauthorized to 61 percent in the 2011–12 school year (U.S. Department of Education

2014). Although this number includes students who receive certificates of completion or

modified diplomas, new generations of people with disabilities have attended school in

45
the least restrictive environment and therefore leave school more prepared than earlier

generations.

In addition, data on the outcomes and achievements of students with disabilities is now

collected and reported, ensuring that the education of all students is taken into

consideration during program improvement efforts. In 2014 the U.S. Department of

Education announced a major shift in the way it oversees the effectiveness of states’

special education programs; rather than focusing primarily whether states are meeting

procedural requirements (e.g., timelines for needs evaluations, due process hearings),

the new Results-Driven Accountability framework will also include educational results

and outcomes. This change reflects rising expectations for educational attainment for

students with disabilities and is reflected in the statement by U.S. Secretary of

Education Arne Duncan that “every child, regardless of income, race, background, or

disability can succeed if provided the opportunity to learn” (U.S. Department of

Education 2014).

Despite these gains, students with disabilities lag behind their peers without disabilities

in performance on standardized tests, regular diploma attainment, and college

completion rates—all of which have implications for careers, lifelong earning potential,

and quality of life. For example:

 In 2013, Grade 8 students with disabilities scored an average of 40 points lower

than their peers without disabilities in both Reading and Math in the National 

Assessment of Educational Progress (NAEP).

 Students with disabilities have a dropout rate more than double that of the national 

average.

3 This number doesn’t include students who “age out” of services, these 

3 Rate of students with disabilities is taken from IDEA Part B Indicator data. The 2011–

2012 event dropout rate is 3.3 percent, and comes from National Center for Education 

Statistics, Common Core of Data (CCD). The 2012 status dropout rate is about seven 

percent and represents the percentage of 16- through 24-year-olds who are not enrolled 

in school and have not earned high school credentials, taken from the Census Bureau.

46

 
students leave school because they are over 21 years of age, but although they 

attended an educational institution, they do not receive high school credentials.

 Persons with a disability have almost 20 percent lower rates of completing a 

bachelor’s degree than those without a disability (12.4 percent with, compared to 

31.7 percent without) (Erickson et al. 2014). This trend does not appear to be 

changing, as youth with disabilities continue to enroll in postsecondary educational 

opportunities at 17 percent lower rates, including 2-year colleges and vocational or 

technical schools, at a lower rate than students without disabilities (Newman et al. 

2010).

Many students from diverse backgrounds who also have a disability have continued to

face poorer outcomes in K–12 settings when compared to their majority peers as

reflected in NAEP Reading and Mathematics Scores (exhibit 3). Further, Black and

Hispanic students with disabilities experience much higher rates of school disciplinary

actions, higher rates of drop out and lower rates of graduation (Cortiella and Horowitz

2014). Understanding that multiple factors influence outcomes for students with

disabilities, NCD has identified current academic climates and academic milestones that

are especially pertinent to improving outcomes and opportunities for students with

disabilities.

Exhibit 3. NAEP Grade 8 Reading and Mathematics Scores by Race/Ethnicity and

Disability Status, 2013

Race/Ethnicity and Disability Status Reading Mathematics

White students with a disability 242 259

Black students with a disability 218 232

Hispanic students with a disability 221 238

Asian/Pacific Islander students with a disability 239 254

American Indian students with a disability 218 240

47
Inclusive Classroom Settings

Research demonstrates that fully inclusive settings lead to higher academic

performance for students with disabilities and their classmates than segregated settings

(Freeman and Alkin 2000; Jackson et al. 2008; Wagner et al. 2006). Fully inclusive

classrooms go beyond a setting that is simply amenable to accepting students with

disabilities and actively engage students in the general setting with accessible

instruction and curriculum. Data and current practices suggest that many students with

disabilities are placed in general education settings under the auspices of inclusion;

however, evidence also shows that education staff are not fully trained in creating

inclusive classrooms and meeting the diverse learning needs of their students. For

example:

 General education teachers consistently report that they do not have the skills 

necessary to effectively instruct diverse learners, including students with disabilities

(Blanton et al. 2011).

 Many general and special education teachers do not have the knowledge and skills 

necessary to use assistive technology to support students with disabilities

(Alkahtani 2013).

 504 plans, which are used to ensure that students who have physical disabilities 

receive accommodations necessary for them to access a learning environment, but 

who may not need an IEP. 504 services (Rehabilitation Act of 1973) are not covered 

under IDEA and lack monitoring by state school personnel, placing the 

implementation primarily in the hands of the school district. The U.S. Department of 

Education has started collecting and reporting basic 504 data nationally and by 

school district. Currently the only publically available data available is for the 2009–

2010 school year, reflecting 554,028 students with 504 plans nationally.

In order to ensure academic success for students with disabilities in the general setting,

it is critical that education professionals receive the training and resources required to

support students with disabilities. Universal Design for Learning (UDL) is an approach to

48
designing instructional strategies, materials, assessments, and tools in a varied and

flexible way to reach and teach students with diverse needs, and emphasizes the

integration of technology into curricula.

The Higher Education Opportunity Act (HEOA) (2008), passed with strong bipartisan

support, defines UDL as a “scientifically valid framework for guiding educational practice

that provides flexibility in the ways information is presented, in the ways students

respond or demonstrate knowledge and skills, and in the ways students are engaged;

and reduces barriers in instruction, provides appropriate accommodations, supports,

and challenges, and maintains high achievement expectations for all students, including

students with disabilities and students who are limited English proficient.” This approach

not only supports students with disabilities, but also students without disabilities who

have different learning styles.

Another key component to ensuring that students with disabilities are served in the least

restrictive environment is the availability of accessible instructional materials for

students with disabilities. Public schools have a responsibility under Section 504 of the

Rehabilitation Act to provide students with disabilities an opportunity to participate in

academic and nonacademic activities in a manner equivalent to the participation of their

peers without disabilities. The school may provide this opportunity through the use of

supplementary aids and services, commonly referred to as “accommodations” and

“modifications,” based upon the individual student’s needs, such as Braille or audio

books for students with print disabilities, including students with intellectual disabilities.

In 2004, the reauthorization of the IDEA (2004) created the National Instructional

Materials Access Center (NIMAC), a national center that stores and distributes

accessible files and instructional materials. Districts and states are required to provide

such materials to students within a “timely manner,” the definition of which is set by

each individual state.

49
Discipline and Behavior of Students with Disabilities

Managing student behavior is essential in creating successful learning environments.

Empirically tested methods exist which can be used to guide decision making around

behavior management policies and practices to support appropriate student behavior for

students with disabilities, such as Positive Behavior Intervention and Supports (PBIS)

and Functional Behavior Assessments (FBAs). Within both of these structures, effective

classroom management strategies exist that present evidence of changing student

behavior, which should allow students with disabilities to be fully included in general

education settings.

For example, Freeman and colleagues (2006) found that within a three-month period,

12 of 19 students originally identified as at risk of more restrictive school placements

due to behavior problems were no longer rated at risk following PBIS implementation,

and measures of student strengths, lifestyle, and progress in social skills improved.

Large-scale studies of the effects of SWPBIS on office-discipline referrals, in and out-ofschool suspensions, academic achievement, teachers perception of overall student

behavior have demonstrated improved outcomes for all measures when the approach is

implemented with fidelity (Freeman et al., 2006, Bradshaw et al., 2010, Warren et al.,

2006). In addition, Lo and Cartledge (2006) have found that individualized interventions

written into FBAs successfully reduce student problem behaviors and produce positive

outcomes for their alternative replacement behavior. Moreover, Lo and Cartledge (2006)

and Trussell and colleagues (2008) have shown that FBAs improve student outcomes

and have the potential to prevent disproportionate representation of minority students in

special education.

Students who are served under IDEA are more than twice as likely to be given out-ofschool suspensions than those who are not (U.S. Department of Education, Office for

Civil Rights 2014). In addition, the practice of secluding and restraining students using

mechanical, physical, and chemical (e.g., locked rooms, duct tape, medication), remains

much more prevalent for students with disabilities. Nationwide, there were 2.6 cases of

restraint for every 100 students with disabilities during the 2009–2010 school year

50
compared to 0.1 instances for every 100 typically developing students (Gagnon et al.

2013). A recent Senate investigation, led by Senator Harkin, found that widespread use

of restraint and seclusion in the nation’s schools is putting kids with disabilities at risk.

There is currently little oversight or restrictions on how these practices are used and

little recourse for parents to respond when students are harmed (U.S. Senate, Health,

Education, Labor, and Pensions Committee 2014).

Factors associated with the disproportionate representation of youth with disabilities

who receive corporal punishment or enter juvenile corrections are complex. Available

information suggests that school failure, poorly developed social skills, and inadequate

school and community supports greatly increase the risks for discipline, arrest, and

incarceration (National Council on Disability 2003). Consequently:

 Students with disabilities are corporally punished at disproportionately high rates in 

almost every state that uses paddling (American Civil Liberties Union 2009).

 Youth with learning, cognitive, behavior, or emotional disabilities are entering the 

correctional system at rates four to five times those of youth in the general 

population; one study showed that an estimated 37 percent of youth in state juvenile 

corrections facilities are eligible for special education and related services under 

IDEA (Newman et al. 2009). 

High School Completion

Researchers project that 63 percent of all U.S. jobs by 2018 will require some

postsecondary education and that 90 percent of new jobs in growing industries with high

wages will require, at a minimum, some postsecondary education (Carnevale et al.

2010). The dropout rate for students with disabilities is already very high, but even for

those students who do finish high school, a portion of them do not do so with an

accredited high-school diploma. Students who do not receive an accredited diploma are

ineligible to receive federal financial aid for any postsecondary educational

opportunities, including career and technical certificates in the occupations and trades—

such as childcare, auto repair, culinary arts. This practice locks students without a

51
regular high school diploma out of almost any opportunity for workforce training that will

allow them to build an independent life outside of poverty. For example, students with

Specific Learning Disabilities (SLD) made up 41 percent of all students served by IDEA

in 2011, and numbered more than 2.2 million. Among them, only 68 percent of students

graduated with a regular diploma, meaning approximately 704,000 students with

learning disabilities were ineligible for federal financial aid as they entered the

workforce. Students with intellectual or developmental disabilities in particular are either

unlikely to receive a diploma, or are likely to receive an unaccredited diploma.4

Figure 4. Students with Disabilities who 

Exited School, by Reason or Manner, 

2011–2012, All Students with Disabilities

Figure 5. Students with Disabilities who 

Exited School, by Reason or Manner, 

2011–2012, All Students with Intellectual 

Disabilities

Under the HEOA (1965), students with intellectual disabilities can receive Federal Pell

Grants, Federal Supplemental Educational Opportunity Grants, or Federal Work-Study.

To receive this funding, each individual must attend a federally approved

“comprehensive transition and postsecondary program” as defined by U.S. Department

of Education (2009). There are only 35 such programs across the country, in 15 states, 

many of which are located in the same city (see table 17 in the Data Trends in Disability

section for full list) (U.S. Department of Education, Federal Student Aid n.d.). 

4 Generated from 2011-12 IDEA Part B Exiting Data

52
Certificates of high school completion are determined on a state-by-state basis

(Cortiella 2013). For example, New York administers different Regents diplomas or local

diplomas or nondiploma completion certificates (Career Development and Occupational

Studies Commencement Credentials) for some students with disabilities. Only one

state, Oregon, has statewide standards for a modified diploma. Because it is considered

an approved diploma by the state, the Department of Education just this year clarified

that Oregon students who earn the Oregon Modified Diploma are eligible for federal

financial aid. In addition, 17 states offer only one diploma for all of their high school

graduates, with special allowances for students with disabilities to receive a regular

diploma, such as:

 Reducing the number of credits required to obtain a regular diploma, 

 Substituting alternative courses, 

 Lowering performance criteria,

 Granting extensions, and

 Using the student’s IEPs to set terms for graduation requirements.

Twenty-six states have an exit exam that students must pass to graduate, and four

more have plans to implement this requirement. There are vast differences in the

administration of these tests (e.g., what grad students first take, what academic content

tested, number of times students can retake exams) and the types of allowances

available to students (e.g., accommodations allowed during test taking, remediation

available to students failing, use of differentiated tests or passing scores for students

with disabilities).

53
Categories of High School Diplomas or Certificates

 Standard diploma

 Honors or college prep diploma

 Technical diploma

 IEP/special education diploma

 Certificate of attendance or achievement in lieu of diploma

 Other

A challenge to fully understanding the graduation rates of students with disabilities lies

in the fact that each state has its own definition of which students will be included in

their reporting to calculate the Four Year Adjusted Cohort Graduation Rate. States may

define a student with disability as anyone who ever had an IEP or designation as a

student with disability between high school and graduation, only those students who

had an IEP upon graduation, or some other method of definition (Cortiella 2013).

Students with Intellectual and Developmental Disabilities

Among all students, those with the most significant cognitive disabilities are the least

likely to graduate with a regular high school diploma (National Council for Disability

2012a). Of additional concern is the high rate of students with emotional disturbance

(38% in 2011) that exit school without receiving either a certificate of completion or a

diploma. The number of postsecondary education (PSE) programs designed for

students with Intellectual Disabilities or Developmental Disabilities (ID/DD) has

increased exponentially in recent years, and today there are approximately 250 PSE

programs for students with intellectual disabilities in 37 states. It is important to note that

these PSE programs are not necessarily inclusive postsecondary programs, such as

2-year universities, and can be self-contained settings. Research has demonstrated that

comprehensive transition and postsecondary programs have a positive impact on

student rates of employment, wages, social networks, and self-determination skills. In

addition, recent studies indicate that the strengths of this model of service delivery are

54
employment training and community participation (National Council for Disability

2012b).

NCD Education Recommendations

Higher Education Opportunity Act 

 Congress should increase funding to support the expansion of the Department of 

Education's Transition and Postsecondary Programs for Students with Intellectual 

Disabilities, which were authorized as part of the Higher Education Opportunity Act

(HEOA). 

 U.S. Department of Education should take steps to simplify the administration of the 

provisions authorized in HEOA that allow ID/DD students who did not receive a 

traditional diploma to receive federal student grants and access work–study options.

The Department should also certify additional comprehensive transition and 

postsecondary programs

Inclusive Learning Environments

 Permanently fund the Advanced Research Projects Agency for Education 

(ARPA-ED) to, in part, provide research grants that address the unique learning 

needs of students who are children with disabilities. 

 Include specific reference to the use of research-validated educational 

methodologies that improve inclusion of students with disabilities inside the general 

education classrooms, such as Universal Design for Learning and Response to 

Intervention and positive behavior intervention and supports or other multitiered 

systems of support. Provide federal funding for the development of instructional 

materials in various content areas and levels that are accessible to students with 

print disabilities, and which are designed with the principles of UDL in mind.

Discipline and Behavior

 Require states and districts to publicly report disaggregated data on number of 

students suspended, reasons for out-of school suspensions, and days of instruction 

55
lost. In addition, include suspension rates among the factors schools and districts 

use to measure performance.

 Provide funding and incentives for evidence-based changes to improve school 

climate, reduce the use of exclusionary discipline, and limit the flow of students from 

schools to the juvenile and criminal justice systems. 

 Facilitate the reenrollment, reentry, and proper education of students returning to 

school from expulsion and juvenile justice system placements. 

High School Completion

 The reauthorization of Elementary and Secondary Education Act (ESEA) should 

include a uniform definition of ‘student with disability’ that is used in data collection 

for the Adjusted Cohort Graduate Rate. In addition, information should be collected 

and reported on disaggregated by disability type, rather than status. 

 Congress and the U.S. Department of Education should support states to create 

statewide standards for modified diplomas and extended diplomas similar to those in 

Oregon.

Student Achievement

 Require states to set achievement and inclusion targets for students with disabilities, 

and report on achievement data for these students.

 At the state level with federal oversight, require more comprehensive data collection, 

institute monitoring, initiate research and demand accountability of services provided 

to students with 504 plans, including the educational and transition outcomes 

achieved by these students. 

 Consider expanding the measures of teacher quality to include supplemental 

measures (aside from student growth) that include the use of research-based 

instructional practices, teacher performance, and contribution to student learning.

56
NCD Resources Related to Education

 NCD Letter Requesting Meeting with U.S. Secretary of Education Arne Duncan, 

(2014), http://www.ncd.gov/publications/2014/03212014/

 A Promising Start: Preliminary Analysis of Court Decisions Under the ADA 

Amendments Act, (2013), http://www.ncd.gov/publications/2013/07232013/

 Rising Expectations: The Developmental Disabilities Act Revisited, (2011), 

http://www.ncd.gov/publications/2011/Feb142011

 Issues in Creating Livable Communities for People with Disabilities: 

Proceedings of the Panel, (2007), http://www.ncd.gov/publications/2007/Oct12007

 National Council on Disability Topical Overviews - Access to Education by 

People with Disabilities Illustrations of Implementation from the United States 

- Quick Reference Guide, (2005), http://www.ncd.gov/publications/2005/08022005-

AccessEd

 National Council on Disability Topical Overviews - Lessons for All of Us: 

Protecting the Right to Education for Persons with Disabilities, (2005), 

http://www.ncd.gov/publications/2005/08022005-Lessons

 Same Struggle, Different Difference: Civil Rights Policy Forum Summary 

Paper, (2005), http://www.ncd.gov/publications/2005/06092005-1

 Individuals with Disabilities Ed Act Burden of Proof: On Parents or Schools?, 

(2005), http://www.ncd.gov/publications/2005/08092005

 Summary of the Native American Forum: Disability Matters in Tribal 

Communities, (2004), http://www.ncd.gov/publications/2004/June212004

 Improving Educational Outcomes for Students with Disabilities, (2004),

http://www.ncd.gov/publications/2004/Mar172004

 Higher Education Act Fact Sheet, (2004), 

http://www.ncd.gov/publications/2004/Mar32004

57
58
ENHANCING MEDICAID MANAGED CARE

Background

Medicaid accounts for 16 percent of total health care spending and provides coverage for

one out of every six Americans. Among the more than 60 million citizens who rely on

Medicaid, 9 million are non-elderly people with disabilities, including 1.4 million children.

While people with disabilities constituted 16.5 percent of Medicaid enrollees in FY 2008,

expenditures on their behalf represented 44 percent of total Medicaid outlays. In FY 2010,

Medicaid beneficiaries utilizing long-term services and supports constituted 6 percent of

all beneficiaries, but 43 percent of all Medicaid expenditures (Henry J. Kaiser Family

Foundation 2013). Over the course of the last several decades, managed care has

emerged as a mechanism to assist states in controlling costs and, when implemented

properly, improving quality in state Medicaid systems. While more than two-thirds of

Medicaid beneficiaries receive at least a part of their services via managed care payment

delivery models, the vast majority are children without disabilities and working-age adults.

It has only been comparatively recently that Medicaid managed care has been applied to

people with disabilities and to long-term services and supports.

Medicaid managed care can be a positive force for controlling costs and improving

outcomes; however, it must be implemented with good program design and the

necessary safeguards to ensure beneficiary rights. Failure to appropriately implement

managed care frameworks can result in significant declines in quality in Medicaidfinanced long-term services and supports (National Council on Disability 2013). While

Medicaid managed care is a multifaceted approach, NCD recommends that

policymakers extend special consideration to certain issues in program design,

including benefit design, outcome measures, due process, and stakeholder

engagement.

Benefit Design

Managed Care Organizations (MCOs) have comparably little experience in operating

long-term services and supports systems. Furthermore, state Medicaid agencies, which

59
are often the primary entity within state government preparing an application to move a

state Medicaid system into managed care, often have limited long-term services and

supports competency as well. As a result, many managed care systems seek to apply

models geared toward acute care, with disastrous results. Managed Care contracts and

Requests for Proposals must specifically articulate expectations for long-term services

and supports. Service definitions must clearly distinguish between not only institutional

and community-based service-provision, but between types of community-based

service provision (i.e., supported living, residential services, supported employment, day

services, etc.). A clear expectation in favor of community integration must be built into

the capitated payment provided to the MCO, taking into account the need for a payment

structure that acknowledges the varying complexity and real costs of serving people

with disabilities who have complex needs. Contracts should communicate how MCOs

will interact with non-Medicaid state systems that are vital for the effective coordination

of services to people with disabilities, such as school systems, vocational rehabilitation

agencies, and others. In addition, states should ensure that MCOs do not face adverse

incentives by making certain that in any circumstance under which a home and

community based service (HCBS) system for a population is placed into managed care,

the corresponding institutional benefit is also placed into managed care. Unfortunately,

a growing number of states have carved out their nursing homes or public and/or private

Intermediate Care Facilities, resulting in an incentive on the part of the MCO to offload

high-cost beneficiaries into institutional settings. This also deprives the state of the

opportunity to use managed care as a mechanism to reduce reliance on institutional

models.

Outcome Measures

As states contract with private companies and nonprofit organizations to manage

aspects of their Medicaid system, the issue of accountability is absolutely vital. Even

when its operation is contracted to an outside entity, Medicaid remains a public program

which should be managed through a process of democratic accountability to the public.

States typically approach accountability through the use of quality measures designed

to hold MCOs, the entities contracted with to manage Medicaid operations, accountable

60
to specific benchmarks in quality delivery of Medicaid services. These outcome

measures serve as the framework for quality management systems that guide managed

care. The needs of persons with disabilities can vary from those of the general

population, which often guides the development of such measures. Managed care has

historically been applied primarily to the population without disabilities, meaning many of

the quality measures states and MCOs are most used to making use of have limited

applicability for the services most important to people with disabilities.

Many people with disabilities require both acute health care services as well as

extended supports that may be linked to a disability or chronic condition. Thus, NCD

supports the development and use of outcome measures specific to the health and

long-term support needs of people with disabilities, such as measures to assess factors

that contribute to quality of life, autonomy, relationships, compassion, social supports,

and emotional wellbeing, such as the measures utilized in the National Core Indicators

project, a collaboration of the Human Services Research Institute and the National

Association of State Directors of Developmental Disability Services. Such data must be

collected by an independent entity with expertise in accessible means of surveying

people with disabilities and reporting directly to state government, rather than selfreported by the MCOs themselves. At the same time, states should explore the use of

more quantitative measures focused specifically on data which can be identified through

claims data. For example, the State of Tennessee has utilized enrollment targets for

participant-directed services as a quality benchmark incorporated into the MCO

contracts for MCOs serving the state’s Medicaid beneficiaries using long-term services

and supports (Sciegaj et al. 2013). Other states have tied quality measures to a

reduction in the use of nursing homes, institutions, and other facility-based programs.

The use of outcome measures determined both by independent surveys of beneficiaries

and claims data ensures that both qualitative and quantitative inputs inform the state’s

assessment of the MCO’s performance. This approach would account for the full range

of services and supports offered to people with disabilities, and data gathered would

lead to improved care and services for patients with disabilities.

61
Due Process 

Medicaid beneficiaries in managed-care-based systems are entitled to procedural due

process rights before benefits can be terminated, reduced, or denied. The procedures,

technical language, and paperwork involved with due process can be overwhelming,

especially when focusing on one’s own needs. In order for managed care systems to

operate within the spirit in which due process is defined and intended, a need exists to

ensure that managed care plan enrollees and potential enrollees have accessible

information concerning the services and support available under the plan and how they

may be accessed. Information must be given in an accessible fashion, taking into

account cognitive accessibility as well as more traditional forms of sensory access.

Furthermore, beneficiaries require the assistance of a robust Ombudsman program,

familiar with the needs of people with disabilities, tasked with representing them in

disputes with MCOs. Wisconsin's Ombudsman program may also serve as a good

model—it sets a goal of one advocate for every 2,500 beneficiaries under the age of

60 (enrollees 60 or older are covered through a separate Ombudsman program focused

on the needs of older adults). The Ombudsman program is operated through the state’s

protection and advocacy system, ensuring that disability expertise is available in its

operations (Disability Rights Wisconsin n.d.).

Stakeholder Involvement

Establishing an effective service delivery system that meets the needs of people with

disabilities requires ongoing stakeholder engagement. Many states engage only

provider stakeholders or provide for only minimal stakeholder engagement through the

use of town halls or an open comment period without adequate outreach and direct

discussion with community leaders. Stakeholder engagement means including

stakeholders in designing, implementing, and monitoring the outcomes and

effectiveness of Medicaid managed care services and service delivery systems.

Advantages of stakeholder engagement include:

 Generating insights into the strengths and weaknesses of existing payment and 

service delivery arrangements

62
 Explaining the vision behind a restructured service delivery system as well as the 

benefits to enrollees with disabilities and their families

 Gaining consumer insight on inefficiencies associated with existing service delivery 

practices that serve as barriers to adequate health care and service

 Identifying effective practices and existing service delivery practices that should be 

retained 

 Generating buy-in for a proposed restructured service delivery system 

 Supporting stakeholders in future planning by explaining how and when changes in 

service delivery and payment practices are likely to occur and how stakeholders are 

likely to be affected

 Establishment of ongoing relationships with stakeholder groups leading to allies in 

resolving roadblocks that will surface during the implementation of the planned 

managed care program

Medicaid Managed Care Stakeholders

 Enrollees with disabilities

 Family members

 Support agency representatives 

 Advocates

 Medical care providers

 Trade associations

 Unions

 County governments

63
NCD Medicaid Managed Care Recommendations 

Benefit Design

 States should ensure that any population that has its HCBS system placed into 

managed care has the corresponding institutional benefit placed within the same 

managed care framework, offering an opportunity to reduce institutional placement 

and avoid adverse incentives for the MCO.

 Capitated payment rates should be structured so as to incentivize community 

integration and should take into account the differing costs and complexity of 

different populations.

 Managed Care contracts should clearly spell out the difference between different 

types of service categories, to ensure that MCOs are promoting true community 

integration in residential, day, and employment services.

 Managed Care contracts should articulate how MCOs will interact with non-Medicaid 

state systems, such as vocational rehabilitation agencies and the public school 

system.

Outcome Measures

 The Department of Health and Human Services’ (HHS) Administration for 

Community Living, in collaboration with CMS, the Agency for Healthcare Research 

and Quality (AHRQ), the Long-Term Quality Alliance, the National Core Indicators 

Project, and leaders of the aging and disability communities, should spearhead 

efforts to develop disability-specific outcome standards to measure access to, and 

the quality of, health care and long-term supports for people with disabilities. Specific 

emphasis should be given to issues associated with community integration, selfdirection and other dimensions of quality more typically associated with long term 

services and supports rather than acute care. Quality measures should incorporate 

both those collected via independent surveys of beneficiaries and those determined 

via analysis of claims data.

64
 The State Medicaid agency must exercise overall responsibility for monitoring 

system performance and individual outcome measures and make the information on 

MCO performance available in a timely fashion in a public website, providing 

individuals with the ability to analyze the data on the basis of MCO, region, race, 

gender, disability status and other relevant demographic characteristics. 

Due Process 

 CMS should make available funds for State Protection and Advocacy systems to 

assist people with disabilities in navigating Managed Care systems, with particular 

emphasis on assisting people with disabilities through grievance and appeals 

procedures and ensuring that the due process rights of beneficiaries are 

implemented in a meaningful fashion. Resources should be made available for both 

individual assistance of beneficiaries and for systemic oversight, litigation and 

advocacy on the design and operation of Medicaid Managed Care. Funding should 

be allocated with the goal of allowing a ratio of at least one Ombudsman for every 

2,500 beneficiaries, consistent with the Wisconsin model, with sufficient remaining 

funds to allow for systemic work focused on the broader structure of the managed 

care model.

 States should develop and implement an aggressive education and outreach 

strategy to ensure that all managed care plan enrollees (and potential enrollees) 

have accessible information concerning the services and supports available under 

the plan and how they may be accessed. The state’s strategy should include the 

following tactics:

o Enlisting community-based disability organizations in developing and

implementing the outreach plan.

o Developing accessible multimedia educational materials and training sessions

geared to the various learning styles and comprehension levels of plan enrollees.

Such sessions should be held across the state.

o Providing plan participants with accessible, meaningful, and clear notices about

programs, services, and their rights, including enrollment rights and options, plan

65
benefits and rules, coverage denials, appeal rights and options, and potential

conflicts that may arise from relationships among providers, suppliers, and

others. This should be written at the comprehension level of the typical plan

enrollee and provided in first languages of enrollees.

o Providing information that represents all service options available to the enrollee.

 States should provide managed care enrollees with ample opportunity to seek 

second opinions or appeal service decisions. While appeals are ongoing, service 

plans should remain unchanged and beneficiaries should face no liability for costs 

incurred by the state during the appeals process.

Stakeholder Engagement

 Centers for Medicare & Medicaid Services (CMS) prepare and disseminate a suite of 

resources for states to reference as they develop and implement a plan for 

stakeholder engagement. The suite should include a sample stakeholder plan with 

objectives, strategies, tactics, a timeline, and an approach to evaluation, as well as a 

companion guide to support the development and execution of the plan.

 CMS should specifically solicit feedback from key stakeholders in the state, including 

self-advocates, family members, and the state’s Protection and Advocacy system, 

on the degree to which the state has included them within the stakeholder 

engagement process. This feedback should form a critical component of the 

approval process for a state application for managed long-term services and 

supports.

66
NCD Related Resources on Medicaid Managed Care

NCD Letter to CMS Soliciting Its Participation at Upcoming NCD Medicaid

Managed Care Forums, (2014), http://www.ncd.gov/publications/2014/02032014/

Medicaid Managed Care for People with Disabilities: Policy and Implementation

Considerations for State and Federal Policymakers, (2013),

http://www.ncd.gov/publications/2013/20130315/

NCD Letter to CMS about Amendment to Kancare Medicaid Section 1115, (2013),

http://www.ncd.gov/publications/2013/12132013/

A Medicaid Block Grant Program: Implications for People with Disabilities, (2013),

http://www.ncd.gov/publications/2013/05222013/

The Case for Medicaid Self-Direction: A White Paper on Research, Practice, and

Policy Opportunities, (2013), http://www.ncd.gov/publications/2013/05222013A/

Medicaid Managed Care for People with Disabilities, (2013),

http://www.ncd.gov/publications/2013/20130315/

Analysis and Recommendations for the Implementation of Managed Care in

Medicaid and Medicare Programs for People with Disabilities, (2012),

http://www.ncd.gov/publications/2012/CMSFebruary272012/

67
68
ADDRESSING MENTAL HEALTH NEEDS

Background

American living with mental illness:

 1 in 4 adults

 1 in 5 teens

Mental health issues affect millions of Americans. Approximately 61.5 million adults

experience mental illness in their lifetime, 13.6 million of whom live with a serious

mental illness such as schizophrenia, major depression, or bipolar disorder. Similarly,

approximately 20 percent of teens aged 13 to 18, and 13 percent of children aged 8 to

15 experience severe mental disorders in a given year (National Institute of Mental

Health. n.d.). Despite these high numbers, many individuals do not receive treatment for

their condition, which makes them more susceptible to developing a debilitating

condition. Approximately 60 percent of adults (Substance Abuse and Mental Health

Services Administration 2012), and 50 percent of youth aged 8 to 15 with a mental

illness received no mental health services in the previous year (National Institute of

Mental Health n.d.). People with mental illness from diverse backgrounds are less likely

to access mental health services. African American and Hispanic Americans use mental

health services at approximately one-half the rate of whites, while Asian Americans

access mental health services at about one-third the rate of whites (Agency for

Healthcare Research and Quality 2013).

The impact of mental illness can be devastating. Those with serious mental illness face

an increased risk of having a chronic medical condition (Colton and Manderscheid

2006) and adults living with serious mental illness die on average 25 years earlier than

other Americans, largely due to treatable medical conditions (Parks et al. 2006). With a

dropout rate of more than 50 percent, students with a mental health condition quit

school at a higher rate than any other disability group served by special education

(U.S. Department of Education 2006). Of the 1 in 10 adults and 1 in 3 young people

69
aged 15 to 24 who die each year by suicide, more than 90 percent lived with one or

more mental disorders (American Association of Suicidology 2012).

Trends surrounding mental health demonstrate that this area warrants considerable

attention from policymakers. In December, 2013, the Administration pledged

$100 million to strengthen mental health services in America. This commitment offers

significant promise to improve the quality, availability, and affordability of mental health

services and supports required to pursue full and productive lives. As funds are

allocated, NCD urges policymakers to consider opportunities to invest in addressing

stigma and discrimination against people with mental health issues, community-based

treatment options, and programs to address the unique and urgent needs of veterans,

many of whom experience mental health conditions as a direct result of serving and

protecting our country.

Stigma and Discrimination

Stigma and discrimination surrounding mental illness can serve as a significant barrier

to community integration and life satisfaction. While stigma focuses on attitudes, it is

operationalized through discrimination “when a person who is otherwise qualified is not

offered a job or an apartment, for example, because he or she belongs to a group about

which negative attitudes are held, despite his or her individual qualifications” (National

Council on Disability 2008).

Stigma is described as a “cluster of negative attitudes and beliefs that motivate the 

general public to fear, reject, avoid, and discriminate against people with mental 

illnesses.” Stigma is widespread in the United States and other Western nations. Stigma 

leads others to avoid living, socializing, or working with, renting to, or employing people 

with mental disorders—especially severe disorders, such as schizophrenia. It leads to 

low self-esteem, isolation, and hopelessness (Thornicroft 2006).

The common misconception that people with mental illness are dangerous contributes

to stigma and discrimination throughout society (Corrigan et al. 2002). One study of

Americans’ attitudes on mental health between 1950 and 1996 found that most

Americans believe that people with mental illnesses pose a threat for violence

70
(Pescosolido et al. 1999). In reality, people with mental illnesses contribute only to a

small portion of the overall rates of violence and statistically, people with disabilities are

much more likely to be victims than perpetrators of violent acts (Pescosolido et al. n.d.).

Most people who are violent do not live with mental illness (American Psychiatric

Association 1994). Therefore, initiatives to profile individuals who experience symptoms

of mental illness can be counterproductive. For example, provision S. 436 of the Fix

Gun Checks Act amends the Higher Education Act to require colleges and universities

to outline procedures for the involuntary referral of students with perceived psychiatric

disabilities for evaluation and institutionalization. Such a policy that broadly targets

individuals who have not demonstrated a threat of harm could discourage students from

seeking the very mental health services they need in times of distress and interfere with

the existing progress that universities have made developing and implementing mental

health programs.

Stigma and discrimination can also have an adverse effect on people with mental illness

in institutional settings. With no established correlation between psychiatric diagnosis

and violent behavior, institutions lack a system capable of reliably identifying people

who are likely to become dangerous. Thus, practices including forced medication or

treatment as a preventative strategy to control aggressive behavior would restrict the

fundamental civil rights of people with psychiatric disabilities.

Community-Based Mental Health Services 

Community-based health services and supports are critical in meeting the treatment

needs of people living with mental health illness or disability. In recent years, the

Federal Government has launched several initiatives to support community-based

mental health services. For example,

 The Strengthening Mental Health in Our Communities Act was introduced in 2014 to 

reform mental health systems, create opportunities for people with mental illnesses 

to succeed in integrated settings, and to promote access to the community services 

that have been shown to lead to recovery. 

71
 The Affordable Health Care Act has community-based mental health services with 

new and improved options for expanding home and community-based services. 

 The implementation and enforcement of provisions associated with the Olmstead 

ruling has led Department of Justice entered Olmstead settlements that require 

significant expansions of mental health services and housing in New York and New 

Hampshire, and is implementing Olmstead settlements in North Carolina, Delaware, 

and Georgia. Private litigants are also implementing Olmstead settlements that 

expand mental health services in a variety of other states, including Illinois, 

Connecticut, New Jersey, New York, California Massachusetts, Washington, and 

other states.

Available federal research reveals a profound shortage of community-based services,

including mobile crisis services, peer supports, supported housing, and supported

employment. Because of stigma, many in society feel as though people with mental

illness are not capable of making decisions about their own care and that they are best

served by large systems. Community mental health programs that are sufficiently

funded and supported can provide excellent comprehensive services that offer those

with mental illness a greater voice throughout the treatment process. Many people wish

to pursue such programs, but experience barriers to access due to an emphasis on

hospitalization and more restrictive mental health interventions. The severe deficiency in

current resources means that these services are often available only to those who are in

immediate crisis and who have already endured multiple hospitalizations. Recently, pilot

programs have been developed across the country to better meet the needs of people

when they have their first psychotic episode. These programs are community based and

help to address critical unmet needs and hold great promise for effective and low-cost

treatment options (Young 2013).

Support for Veterans

Veterans face unique circumstances that can contribute to mental health issues, such

as separation from family and support systems, traumatic experiences during times of

war, and multiple and extended deployments. Of the active duty and reserve military

72
personnel deployed to the wars in Iraq and Afghanistan, 30 percent are expected to

have a mental health condition in 2014 (National Council for Behavioral Health 2012).

As with other populations, fear of stigma can serve as a barrier to seeking treatment

options for mental health issues. One survey found that more than 40 percent of Iraq

and Afghanistan war veterans said that they did not seek mental health care due to a

perceived negative impact on their careers (Iraq and Afghanistan Veterans of America

2014). This can have dire consequences. Military members comprise less than

1 percent of the U.S. population (Martinez and Bingham 2011) but represent 20 percent

of suicides nationally (Kemp and Bossarte n.d.). A 2013 study found that mental health

problems are significantly associated with an increase in the risk of suicide among

members of the military (LeardMann et al. 2013). The effects of health issues extend to

families of service members as well. Research demonstrates that children of military

parents have greater emotional and behavioral challenges than the national average

(Substance Abuse and Mental Health Services Administration 2013).

NCD Mental Health Recommendations

Stigma and Discrimination

 Policymakers should consider provisions to ensure that identification and isolation of 

individuals who have harmed others or are at risk of committing acts of violence do 

not lead to unnecessary expansion in institutionalization, involuntary commitment,

and forced treatment for individuals who may benefit from mental health services 

and supports but pose no risk of violence and have a basic human right to make 

independent decisions. 

 Congress should avoid any proposal comparable to the provision of S. 436, the Fix 

Gun Checks Act, which amends the Higher Education Act to require colleges and 

universities to outline procedures for the involuntary referral of students with 

perceived psychiatric disabilities for evaluation and institutionalization. Further, NCD 

recommends provisions for programs that support peer-to-peer support and 

campus-based counseling programs, and encourages campus policies that focus on 

making these resources more broadly available.

73
 Congress should invest in research to further understand mental health issues and 

effective strategies to address mental health issues early before they escalate into 

debilitating conditions.

Community-Based Mental Health Services

 The Obama Administration should consider a framework to invest in communitybased mental health supports and programs for both civilians and veterans, 

including provision of services at university and college campuses, without adverse 

impact or involuntary hospitalization or commitment for those who seek assistance. 

Recently, pilot programs have been developed across the country to better meet the 

needs of people when they have their first psychotic episode. These programs are 

community based and help to address critical unmet needs.

 NCD encourages the advancement of policy recommendations in line with these 

models and the principles upon which they are based.

 Congress should support the Strengthening Mental Health in Our Communities Act 

to reform mental health systems, create opportunities for people with mental 

illnesses to succeed in integrated settings, and to promote access to the community 

services that have been shown to lead to recovery. 

Support for Veterans

 Congress should continue to make mental health issues among veterans and their 

families a priority by enhancing resources to support increased counseling, 

improvements to in the reporting systems at Veteran Affairs, and more crisis centers 

to address suicide rates among this population. 

 Congress should continue and intensify efforts to reduce and eliminate the backlog 

of veteran’s disability claims.

74
NCD Resources Related to Mental Health

NCD Letter to Vice President Biden Regarding Anticipated Taskforce 

Recommendation, (January, 2013), http://www.ncd.gov/publications/2013/Jan142013/

NCD Letter to President Obama Regarding Mental Health Funding, (December, 

2013), http://www.ncd.gov/publications/2013/12202013/

NCD Letter to House Energy and Commerce Subcommittee on Oversight on 

Mental Health, Lack of Representation of People with Psychiatric Disabilities at 

Roundtable, (2013), http://www.ncd.gov/publications/2013/031413/

Clearing the Backlog and Facilitating Benefits for Veterans with Disabilities,

(2013), http://www.ncd.gov/publications/2013/11122013/

Inclusive Livable Communities for People with Psychiatric Disabilities, (2008),

http://www.ncd.gov/publications/2008/03172008/

75
76
DATA TRENDS IN DISABILITY

In the 30 years since the establishment of the NCD and nearly 25 years since the

enactment of the ADA, many changes have occurred to improve and enhance the lives

of people with disabilities that have also improved the lives for all Americans. As we

consider how far we have come and ponder the future and the many challenges that

remain, NCD recognizes the importance of using data as evidence to provide insight on

progress to date. This report retained this tradition within the report’s main narrative by

drawing on the literature base and including previous NCD work.

In addition, the 2014 annual Progress Report revisits data tables offered in the 2011

NCD annual report. This section provides updates to the 2011 data tables and also

introduces new data tables relevant to some of the topics addressed in this report.

Tables are organized by the following broad topics: employment and earnings,

education, health and wellbeing, civil rights, voting, and technology.

Employment and Earning

Table 1 reflects employment trends of people between people with a disability and

people without a disability. The employment rates and percentage of full-time

employment for people with a disability has decreased in recent years, while remaining

significantly lower than rates for people without a disability. This has also resulted in

lower numbers of people with a disability actively searching for work among those

without a job.

77
Table 1. Employment Trends of People with a Disability (PWD) Compared to

People Without a Disability (PWOD), 2008–2012

In the United States, the employment rate of working-age people (ages 21–64)

2008 2009 2010 2011 2012

PWD 39.5 36 33.9 33.4 33.5

PWOD 79.9 76.8 70.4 75.6 76.3

In the United States, the percentage actively looking for work among people with disabilities who 

were not working

2008 2009 2010 2011 2012

PWD 8.7 11.6 12.3 11.7 10.8

PWOD 21.4 30.4 31.2 29.4 27.5

In the United States, the percentage of working-age people with disabilities working full-time/fullyear

2008 2009 2010 2011 2012

PWD 25.4 22.5 20.9 20.7 20.9

PWOD 60.4 57 55.3 55.5 56.4

Source: Erickson, W., C. Lee, and S. von Schrader. 2014. Disability Statistics from the 2012 American 

Community Survey (ACS). Ithaca, NY: Employment and Disability Institute, Cornell University. 

http://www.disabilitystatistics.org.

Table 2 reflects the number of federal employees with targeted disabilities by type and

federal pay grade. In 2010, there were less than 16,000 federal employees with a 

targeted disability (15,659). The most prevalent disability among federal employees

across all pay grades is mental illness (27%). Partial paralysis (15%), blindness (14%), 

and deafness (13%) are also relatively common. Nearly all employees with an

intellectual disability are in the lowest pay grade. However, for all other disability types,

most employees fall in the GSR-6 to 15 range, with over 40 percent of employees with

the following targeted disabilities in the GSR-11 to 15 range: blindness, missing

extremities, complete paralysis, convulsive disorders, and distortion of limb/spine. This

reflects a trend showing the advancement of persons with disabilities in the federal

workforce.

78
Table 2. Number of Federal Employees With Targeted Disabilities by Type and

Federal Pay Grade, 2010

Disability by Type GSR-1 to 5 GSR-6 to 10 GSR-11 to 15

Senior Pay and 

Senior Executive 

Service

Deafness 620 782 0584 01

Blindness 384 838 0975 24

Missing extremities 117 250 0434 15

Partial paralysis 490 747 1117 26

Complete paralysis 178 286 0523 23

Convulsive disorders 391 707 0921 15

Intellectual disability 431 114 0017 00

Mental illness 1127 1523 1491 27

Distortion of limb/spine 093 177 0205 06

Source: U.S. Equal Employment Opportunity Commission’s Annual Report on the Federal Workforce, 

2010, http://www.eeoc.gov/federal/reports/fsp2010/table_a_6_a.cfm

Table 3 reflects employment settings for workers with intellectual disabilities in the labor

force. The employment rate for this population is 34 percent, and while most of those

who work are in a competitive setting, sheltered work settings are also prevalent. 

Table 3. Employment Status and Type of Employment Setting for Adults Aged 21–

64 with Intellectual Disabilities in the Labor Force, 2011–2012. 

Employment Status Percentages

Labor Force Participation Rate 44%

Employment Rate 34%

Competitive setting 18%

Sheltered setting 13%

Other setting 3%

Unemployment Rate 21%

Source: Siperstein, G. N., Parker, R. C., & Drascher, M. L. (2013). National Snapshot of Adults with 

Intellectual Disabilities in the Labor Force. Journal of Vocational Rehabilitation, 39 (3), 157-165.

Table 4 reflects the percentage of federal workers by race/ethnicity and disability. In

addition to being clustered with the lower federal pay grades, individuals with targeted

disabilities make up less than 1 percent of the federal workforce. 

79
Table 4. Percentage of the Federal Workforce* by Selected Characteristics, 2000–

2010

2000

CLF* 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Hispanic or 

Latino (%)

10.70 06.94 07.10 07.22 07.46 07.61 07.68 07.79 07.94 07.90 07.90

White (%) 72.70 67.52 67.31 67.17 66.91 66.49 66.16 65.76 65.39 65.59 65.46

Black or 

African 

American 

(%)

10.60 18.74 18.63 18.56 18.18 18.29 18.36 18.43 18.3 18.03 17.94

Asian (%) ** 03.60 05.32 5.45 05.54 05.79 05.94 05.89 05.95 05.87 05.84 05.90

Native 

Hawaiian/ 

Other Pacific 

Islander 

(%)***

00.20 00.17 00.21 00.31 00.33 00.36

Alaska 

Native (%)

01.00 01.48 01.50 01.50 01.67 01.67 01.68 01.65 01.64 01.65 01.60

Two or more 

races (%)

00.90 00.06 00.21 00.56 00.66 00.84

Individuals 

with 

targeted 

disabilities 

(%)

CLF not 

available

01.10 01.07 01.05 00.99 00.96 00.94 00.92 00.88 00.88 00.88

Includes September 30, 2010 agency data as reported in CPDF plus AAFES, FERC, Foreign Service, 

NIGC, TVA and USPS; does not include data for intelligence gathering agencies.

* CLF: Civilian Labor Force

**The numbers for 1998-2005 include totals for "Native Hawaiian or Other Pacific Islanders".

***Separate data became available in 2006. Percentages may not add to 100% due to rounding and the 

additional "Two or More Races" category in the 2000 Census Special EEO file.

Source: U.S. Equal Employment Opportunity Commission’s Annual Report on the Federal Workforce, 

2010, http://www.eeoc.gov/federal/reports/fsp2010/table_a_1.cfm

Tables 5a, 5b, 5c, and 5d reflect the median household income among households

inclusive of a person with a work limitation and those without a person with a work

limitation. The gap between the median income among households with an individual

with and without a work limitation persists across years and the income of those without

a work limitation is almost double that of those in households that do not contain an

individual with a work limitation.

80
Table 5a. Median Household Income Among Households with Individuals with

and Without a Work Limitation, 1980–1988

1980 1981 1982 1983 1984 1985 1986 1987 1988

No person with 

work limitations in 

house

51,500 50,500 50,100 49,900 51,500 52,800 55,000 55,700 56,100

Person with work 

limitations in 

house

32,300 31,900 31,800 31,300 31,900 32,200 32,000 32,700 31,500

Source: Nazarov, Z., & Lee, C. G. (2012). Disability Statistics from the Current Population Survey (CPS).

Ithaca, NY: Cornell University Rehabilitation Research and Training Center on Disability Demographics 

and Statistics (StatsRRTC). Retrieved April 16, 2014 from www.disabilitystatistics.org

Table 5b. Median Household Income Among Households with Individuals with

and Without a Work Limitation, 1989–1997

1989 1990 1991 1992 1993 1994 1995 1996 1997

No person with 

work limitations in 

house

57,100 55,900 55,400 55,600 55,300 56,100 57,500 58,600 59,500

Person with work 

limitations in house

33,500 32,900 32,800 30,700 31,000 31,600 32,400 31,800 32,200

Source: Nazarov, Z., & Lee, C. G. (2012). Disability Statistics from the Current Population Survey (CPS).

Ithaca, NY: Cornell University Rehabilitation Research and Training Center on Disability Demographics 

and Statistics (StatsRRTC). Retrieved April 16, 2014 from www.disabilitystatistics.org

Table 5c. Median Household Income Among Households with Individuals with

and Without a Work Limitation, 1998–2006

1998 1999 2000 2001 2002 2003 2004 2005 2006

No person with 

work limitations in 

house

61,700 63,300 63,400 62,600 61,700 61,300 61,300 61,300 61,900

Person with work 

limitations in house

32,700 34,600 33,200 33,300 32,200 32,600 31,700 32,400 32,400

Source: Nazarov, Z., & Lee, C. G. (2012). Disability Statistics from the Current Population Survey (CPS).

Ithaca, NY: Cornell University Rehabilitation Research and Training Center on Disability Demographics 

and Statistics (StatsRRTC). Retrieved April 16, 2014 from www.disabilitystatistics.org

81
Table 5d. Median Household Income Among Households with Individuals with

and Without a Work Limitation, 2007–2012

2007 2008 2009 2010 2011 2012

No person with work limitations in 

house

62,300 62,200 64,200 63,200 61,400 62,000

Person with work limitations in house 32,100 32,500 32,900 31,400 31,300 30,200

Source: Nazarov, Z., & Lee, C. G. (2012). Disability Statistics from the Current Population Survey (CPS).

Ithaca, NY: Cornell University Rehabilitation Research and Training Center on Disability Demographics 

and Statistics (StatsRRTC). Retrieved April 16, 2014 from www.disabilitystatistics.org

Tables 6a and 6b reflect the percentage of men and women with and without a work

limitation who lived in families with incomes below the poverty line. The percentage of

people living in poverty has increased slightly since 2000 and these increases are

reflected in the population of individuals with and without a work limitation. 

Table 6a. Percentage of Men and Women, Aged 18–64 with and Without a Work

Limitation in the United States Who Lived in Families with Incomes Below the

Poverty Line, 2000–2006

2000 2001 2002 2003 2004 2005 2006

With a work limitation 27.0 26.8 28.2 28.0 27.8 28.0 28.0

Without a work limitation 07.9 08.5 09.0 09.2 09.7 09.4 09.2

Source: Nazarov, Z., & Lee, C. G. (2012). Disability Statistics from the Current Population Survey (CPS). 

Ithaca, NY: Cornell University Rehabilitation Research and Training Center on Disability Demographics 

and Statistics (StatsRRTC). Retrieved April 16, 2014 from www.disabilitystatistics.org

Table 6b. Percentage of Men and Women, Aged 18–64 with and Without a Work

Limitation in the United States Who Lived in Families with Incomes Below the

Poverty Line, 2007–2012

2007 2008 2009 2010 2011 2012

With a work limitation 28.6 28.1 28.6 31.0 30.4 30.9

Without a work limitation 09.2 10.0 11.4 11.9 12.0 11.9

Source: Nazarov, Z., & Lee, C. G. (2012). Disability Statistics from the Current Population Survey (CPS).

Ithaca, NY: Cornell University Rehabilitation Research and Training Center on Disability Demographics 

and Statistics (StatsRRTC). Retrieved April 16, 2014 from www.disabilitystatistics.org

82
Education

Table 7 reflects the education environment of students with disabilities. The percentage

of students with disabilities who spend 80 percent or more of their time in the regular

environment has increased significantly since 1989. 

Table 7. Individuals with Disabilities Education Act (IDEA), Part B, by Educational 

Environment, Selected School Years, 1989–2011

Year

Regular: 

Less 

Than 40 

Percent

Regular: 

40–79 

Percent

Regular: 

80 

Percent 

or More

Separate 

School for 

Students 

With 

Disabilities

Separate 

Residential 

Facility

Parentally 

Placed in 

Regular 

Private 

Schools1

Homebound/ 

Hospital 

Placement

Correctional 

Facility

1989 24.9 37.5 31.7 4.5 1.0 — 0.6 —

1990 25.0 36.4 33.1 4.2 0.9 — 0.5 —

1994 22.4 28.5 44.8 3.0 0.7 — 0.6 —

1995 21.5 28.5 45.7 3.1 0.7 — 0.5 —

1996 21.4 28.3 46.1 3.0 0.7 — 0.5 —

1997 20.4 28.8 46.8 2.9 0.7 — 0.5 —

1998 20.0 29.9 46.0 2.9 0.7 — 0.5 —

1999 20.3 29.8 45.9 2.9 0.7 — 0.5 —

2000 19.5 29.8 46.5 3.0 0.7 — 0.5 —

2001 19.2 28.5 48.2 2.9 0.7 — 0.4 —

2002 19.0 28.7 48.2 2.9 0.7 — 0.5 —

2003 18.5 27.7 49.9 2.8 0.7 — 0.5 —

2004 17.9 26.5 51.5 3.0 0.6 — 0.4 —

2005 16.7 25.1 54.2 2.9 0.6 — 0.4 —

2006 16.4 23.8 54.8 2.9 0.4 1.0 0.4 0.4

2007 15.4 22.4 56.8 3.0 0.4 1.1 0.4 0.4

2008 14.9 21.4 58.5 2.9 0.4 1.1 0.4 0.4

2009 14.6 20.7 59.4 3.0 0.4 1.2 0.4 0.4

2010 14.2 20.0 60.5 3.0 0.4 1.2 0.4 0.3

2011 14.0 19.8 61.1 3.0 0.3 1.1 0.4 0.3

1 Students who are enrolled by their parents or guardians in regular private schools and have their basic 

education paid through private resources, but receive special education services at public expense. 

These students are not included under "Regular school, time inside general class" (columns 3 through 5).

83
Source: U.S. Department of Education, Institute of Education Sciences, Digest of Education, Table 204.60, 

http://nces.ed.gov/programs/digest/d13/tables/dt13_204.60.asp compiled from U.S. Department of 

Education, Office of Special Education Programs, Individuals with Disabilities Education Act (IDEA) database.

Table 8 reflects the percentage of students with a disability in regular schools by

percentage in general classes. Students with speech or language impairments, hearing

or visual impairments, or specific learning disabilities are most likely to be included in

general classrooms, whereas those with intellectual disabilities or multiple disabilities

are least likely to be included. Note that students with specific learning disabilities make

up approximately 40 percent of all students with disabilities. 

Table 8. Percentage of Students With Disabilities in Regular Schools by

Percentage of Time in General Classes by Disability Type, 2011

Disability Type (IDEA)

Regular: Less 

Than 40 percent

Regular: 

40–79 Percent

Regular: 

80 Percent or More

Autism 33.7 18.2 39.0

Deaf-blindness 32.5 10.5 27.0

Developmental delay 16.3 19.6 62.5

Emotional disturbance 20.6 18.0 43.2

Hearing impairments 13.0 16.8 56.7

Intellectual disability 48.8 26.6 17.0

Multiple disabilities 46.2 16.4 13.0

Orthopedic impairments 22.2 16.3 54.0

Other health impairments2 10.0 22.7 63.5

Specific learning disabilities 6.8 25.1 66.2

Speech or language impairments 4.5 05.5 86.9

Traumatic brain injury 20.5 22.8 48.5

Visual impairments 11.3 13.1 64.3

Source: U.S. Department of Education, Institute of Education Sciences, Digest of Education, Table 

204.60, http://nces.ed.gov/programs/digest/d13/tables/dt13_204.60.asp compiled from U.S. Department 

of Education, Office of Special Education Programs, Individuals with Disabilities Education Act (IDEA) 

database.

84
Table 9 reflects school exit rates of 14- to 21-year-old students served under IDEA, Part

B, by exit reason and disability type. When aggregating the data on number of students

with disabilities who exit high school with a diploma, the higher rates of graduation with

a high school diploma for students with certain disabilities can mask the very low rates

for students with other disabilities. For example, almost 20 percent of students with

ID/DD aged out of IDEA services, and a very low percentage of these students received

a high school diploma, which in turn means that they are not eligible for federal financial

aid to pursue postsecondary opportunities.

Table 9. Percentage of 14- to 21-Year-Old Students Served Under IDEA, Part B, 

Who Exited School by Exit Reason and Type of Disability, 2011

Type of Disability

Graduated 

With 

Diploma

Received a 

Certificate of 

Attendance

Dropped 

out

Reached 

Maximum 

Age Died

Autism 65% 24% 5% 06% 0%

Deaf-blindness 52% 23% 9% 15% 2%

Emotional disturbance 52% 10% 1% 37% 0%

Hearing Impairments 73% 16% 1% 10% 0%

Intellectual disability 40% 36% 5% 18% 1%

Multiple disabilities 47% 29% 8% 13% 3%

Orthopedic impairments 62% 19% 5% 12% 3%

Other health impairments 70% 11% 0% 18% 1%

Specific learning disabilities 68% 12% 0% 19% 0%

Speech or language 

impairments 73% 11% 0% 16% 0%

Traumatic brain injury 68% 17% 3% 11% 1%

Visual impairments 79% 11% 2% 09% 1%

Source: U.S. Department of Education, Institute of Education Sciences, Digest of Education, Table 

204.60, http://nces.ed.gov/programs/digest/d13/tables/dt13_219.90.asp compiled from U.S. Department 

of Education, Office of Special Education Programs, Individuals with Disabilities Education Act (IDEA) 

database.

85
Table 10 reflects National Assessment of Educational Progress (NAEP) grade 8 

reading scores by race/ethnicity and disability status. Table 11 reflects NAEP grade 8 

mathematics scores by race/ethnicity and disability status. Significant academic

achievement gaps exist between students with disabilities and students without

disabilities at the 8th-grade level for reading and mathematics. The gap widens

significantly when taking race into account with disability. NAEP is often referred to as

the “Nation’s Report Card.” 

Table 10. NAEP Grade 8 Reading Scores by Race/Ethnicity and Disability Status,

2002–2013

Race/Ethnicity and Disability Status 2013 2011 2009 2007 2005 2003 2002

All students with a disability 232 231 230 227 227 225 228

All students without a disability 272 269 267 266 266 267 268

White with a disability 242 240 241 238 237 235 238

Black with a disability 218 216 213 209 208 208 212

Hispanic with a disability 221 219 212 212 213 209 211

Asian/Pacific Islander with a disability 239 233 233 230 228 227 225

American Indian with a disability 218 217 216 213 219 205 216

Two or more races with disability 236 235 237 225 234 232 227

White without a disability 280 277 276 275 274 276 275

Black without a disability 256 253 251 249 247 249 249

Hispanic without a disability 259 256 252 250 249 250 250

Asian/Pacific Islander without a disability 282 278 276 272 272 272 269

American Indian without a disability 256 258 257 252 253 253 254

Two or more races without disability 276 273 269 268 269 268 268

Source: U.S. Department of Education, Institute of Education Sciences, National Center for Education 

Statistics, National Assessment of Educational Progress (NAEP), NAEP Data Explorer, April 2014.

86
Table 11. NAEP Grade 8 Mathematics Scores by Race/Ethnicity and Disability

Status, 2000–2013

Race/Ethnicity and Disability Status 2013 2011 2009 2007 2005 2003 2000

All students with a disability 249 250 249 246 245 242 230

All students without a disability 289 288 287 285 283 282 276

White with a disability 259 261 260 258 255 253 240

Black with a disability 232 231 229 227 223 219 207

Hispanic with a disability 238 237 235 231 229 228 218

Asian/Pacific Islander with a disability 254 261 254 249 250 252 ‡

American Indian with a disability 240 232 233 233 233 233 ‡

White without a disability 251 251 258 253 248 240 ‡

White without a disability 298 297 296 294 292 292 287

Black without a disability 269 267 265 263 259 257 248

Hispanic without a disability 276 274 270 268 265 263 255

Asian/Pacific Islander without a disability 309 305 303 299 297 293 289

American Indian without a disability 275 270 271 268 269 269 261

Two or more races without disability 293 293 289 288 283 285 274

‡ Reporting standards not met.

Source: U.S. Department of Education, Institute of Education Sciences, National Center for Education 

Statistics, National Assessment of Educational Progress (NAEP), NAEP Data Explorer, April 2014.

Table 12 reflects the total number of students by gender and race/ethnicity served

under IDEA and Section 504 in 2009–2010. Students served under IDEA have an IEP,

which is a written statement of the educational program designed to meet a child's

needs that includes specific learning goals for that student and the services he or she 

will receive to help meet those goals. A 504 plan details accommodations that will

ensure a student’s academic success and access to the learning environment but does

not include specialized instruction or learning targets. The number of students who had 

504 plans across the country was not identified before 2009–2010. 

87
Table 12. Total Number of Students Served Under IDEA and Section 504 and

Percentages of These Students by Gender and Race/Ethnicity, 2009–2010

Demographics Gender Total

American 

Indian

Asian/ Pacific 

Islander Hispanic Black White

IDEA M 3,791,523 1.601 2.39 18.38 19.76 56.82

F 1,916,377 1.77 2.46 18.08 17.70 55.51

T 5,707,900 1.66 2.41 18.28 19.07 56.38

Section 504 M 346,292 1.151 1.89 13.15 12.38 67.66

F 207,736 1.32 2.45 14.02 12.91 67.23

T 554,028 1.21 2.10 13.47 12.58 67.50

1 Interpret data with Caution. Estimate presented is a subtotal associated with a grand total that has been 

flagged for being different from other U.S. Department of Education data sources. The number of 

students with 504 plans is an estimate that was calculated by the U.S. Department of Education’s Civil 

Rights Data Collection based upon self-reported counts of 7,000 school districts across the nation. 

Source: Civil Rights Data Collection, 2009-10 National Estimates. Available at 

http://ocrdata.ed.gov/StateNationalEstimations/Projections_2009_10. 

Table 13 reflects the enrollment of individuals with disabilities in postsecondary education

at any institution by disability type. The percentage of students with disabilities who

pursue higher education has steadily increased. In fact, postsecondary enrollment

increased among most categories of individuals with disabilities. The average increase by

disability type was more than 20 percentage points from 2003 to 2009. 

Table 13. Enrollment of Individuals with Disabilities in Postsecondary Education

at Any Institution, by Disability Type, 2003–09

2003 2005 2007 2009

Total 27.2% 42.2% 51.7% 57.0%

Learning disability 29.5% 45.2% 58.1% 63.3%

Emotional disturbance 19.3% 30.7% 42.3% 51.3%

Speech impairment 36.5% 53.8% 58.9% 65.2%

Hearing impairment 57.5% 69.7% 68.2% 72.9%

Visual impairment 63.6% 70.6% 65.2% 66.7%

Autism 40.4% 49.7% 33.1% 37.9%

Mental retardation 11.0% 23.9% 26.6% 27.9%

Deaf/blindness 47.7% 40.9% 51.2%

Multiple disabilities 19.0% 32.8% 24.8% 28.4%

Orthopedic impairment 32.2% 51.2% 54.1% 58.9%

Traumatic brain injury 23.4% 51.0% 53.8% 59.5%

Other health impairment 33.4% 53.0% 55.6% 64.1%

Source: Years 2-5 NLTS data, compiled from http://www.nlts2.org/data_table. 

88
Table 14 reflects students with disabilities who exited special education by reason.

States show significant variation in the percentage of students with disabilities who exit

high school with a diploma.

Table 14. Percentage of Total Students Aged 14–21 with Disabilities Served Under

IDEA, Part B, Who Exited Special Education, by Exit Reason and State, 2010–2011

State

Graduated 

with

Diploma

Received a 

Certificate of 

Attendance

Dropped 

Out

Reached 

Maximum 

Age Died

Alabama 44 35 16 3 0 

Alaska 48 15 35 0 0

Arizona 80 20 0 0 

Arkansas 81 01 14 0 0

BIE schools

California 54 25 17 3 0

Colorado 66 01 30 1 0 

Connecticut 80 00 16 2 0

Delaware 69 2 26 1 0 

District of Columbia 52 05 38 0 0

Florida 53 26 20 0 

Georgia 41 30 28 0

Hawaii 78 09 09 1 0 

Idaho 32 47 04 1 0

Illinois 79 01 18 2 0 

Indiana 75 12 11 1 0

Iowa 77 21 0 0 

Kansas 79 18 1 1

Kentucky 74 10 14 1 0 

Louisiana 28 33 37 0 0

Maine 76 02 20 0 0 

Maryland 64 11 24 1 0

Massachusetts 68 05 22 3 0 

Michigan 67 06 27 0

Minnesota 88 10 1 0 

Mississippi 27 60 11 0 0

Missouri 79 00 18 1 0 

Montana 74 25 0 0

Nebraska 78 02 17 0 0 

Nevada 23 39 34 1 0

New Hampshire 78 06 12 1 0 

89
State

Graduated 

with

Diploma

Received a 

Certificate of 

Attendance

Dropped 

Out

Reached 

Maximum 

Age Died

New Jersey 83 15 1 0

New Mexico 51 15 32 0 0 

New York 59 19 20 1 0

North Carolina 64 06 29 0 0 

North Dakota 69 11 2 0

Ohio 51 30 19 0 0 

Oklahoma 80 19 0 0

Oregon 45 23 24 4 0 

Pennsylvania 87 00 11 1 0

Puerto Rico 46 06 43 3 0 

Rhode Island 78 00 15 3 0

South Carolina 39 01 52 5 0 

South Dakota 67 23 8 0

Tennessee 75 17 7 0 0 

Texas 54 29 17 0 0

Utah 13 00 76 5 0 

Vermont 74 00 20 1 0

Virginia 51 38 10 0 0 

Washington 67 03 28 0 0

Source: Numbers are computed from Historical State-Level IDEA Data Files, Exiting 2010-2011, 

http://tadnet.public.tadnet.org/pages/712

Table 15 reflects comprehensive transition and postsecondary (CTP) programs

approved to participate in the following federal student aid programs: Federal Pell

Grant, Federal Supplemental Educational Opportunity Grant, and Federal Work Study

programs. Under the Higher Education Opportunity Act, students with ID/DD who attend

a federally approved CTP are eligible to receive financial support under the Federal

Student Aid Program.

Table 15. CTP Programs Approved to Participate in the Federal Student Aid

Program as of July 1, 2014

Institute of Higher Education Location

California State University Fresno, California

University of California Los Angeles, California

San Diego City College San Diego, California

San Diego Mesa College San Diego, California

90
Institute of Higher Education Location

Santa Rosa Junior College Santa Rosa, California

Taft College Taft, California

Southeastern University Lakeland, Florida

Kennesaw State University Kennesaw, Georgia

Elmhurst College Elmhurst, Illinois

Heartland Community College Normal, Illinois

Bluegrass Community and Technical College Lexington, Kentucky

Spalding University Louisville, Kentucky

Murray State University Murray, Kentucky

Rochester Community and Technical College Rochester, Minnesota

University of Central Missouri Warrensburg, Missouri

Camden County College Blackwood, New Jersey

The College of New Jersey Ewing, New Jersey

New York Institute of Technology Old Westbury, New York

Monroe Community College Rochester, New York

Roberts Wesleyan College Rochester, New York

Appalachian State Boone, North Carolina

Western Carolina University Cullowhee, North Carolina

UNC – Greensboro Greensboro, North Carolina

Kent State University Kent, Ohio

Arcadia University Glenside, Pennsylvania

College of Charleston Charleston, South Carolina

Clemson University Clemson, South Carolina

University of South Carolina Columbia, South Carolina

Coastal Carolina University Conway, South Carolina

Winthrop University Rock Hill, South Carolina

University of Tennessee Knoxville, Tennessee

Lipscomb University Nashville, Tennessee

Vanderbilt University Nashville, Tennessee

Federal Student Aid, United States Department of Education. July, 2014. Retrieved from: 

https://studentaid.ed.gov/eligibility/intellectual-disabilities

Table 16 reflects the number of students with disabilities who received some type of

disciplinary action, also broken down by gender and race/ethnicity. Like all students,

those with disabilities can be suspended or expelled for violating the school's code of

conduct. However, the 2004 reauthorization of IDEA enacted measures to prevent

schools from suspending or expelling students without considering the effects of the

child's disability, even if that building follows a zero-tolerance policy. In addition, as table

18 shows, Black students and male students receive disciplinary actions at much higher

91
rates than female students across all measures. Table 18 also shows that over 23,000

students with disabilities received school-related arrests in the 2009–2010 school year, 

and nearly 59,000 were referred to law enforcement agencies. These figures highlight

the school-to-prison pipelines for students with disabilities.

Table 16. Number of Students with Disabilities Who Received Disciplinary Actions

by Gender, Race/Ethnicity, 2009–2010

Demographics

American 

Indian

Asian/

Pacific 

Islander Hispanic Black White Total IDEA

Section 

504

Corporal 

Punishment 

M 737 (1) 94 1,979 9,331 14,729 . 26,872 1,216

F ‡ ‡ 369 1,996 2,498 . 4,946 252

T -- -- 2,348 11,327 17,227 . 31,819 1,468

One or more 

in-school 

suspensions 

M 9,841 (1) 8,221 96,885 170,674 242,402 . 518,751 28,453

F 3,400 2,686 32,863 63,498 71,373 . 161,156 8,853

T 13,242 10,908 129,748 234,171 313,775 . 679,908 37,306

One out of 

school 

suspension 

M 9,220 (1) 7,113 55,654 87,965 128,644 . 275,314 14,488

F 4,076 2,613 (!) 17,420 32,770 33,984 . 81,800 3,895

T 13,295 9,725 73,074 120,735 162,628 . 357,114 18,383

More than one 

out of school 

suspension 

M 12,936 (1) 5,815 56,991 117,408 122,853 . 296,432 13,859

F 1,615 1,535 13,838 37,344 27,876 . 72,461 2,375

T 14,551 7,350 70,830 154,752 150,729 . 368,892 16,234

Expulsions 

with services 

M 391 (1!) ‡ 2,443 4,745 5,708 . 13,083 429

F 63 43 353 916 (!) 1,273 (!) . 3,931 84

T 454 -- 2,796 5,661 6,981 . 17,014 513

Expulsions 

without 

services 

M 96 (1!) 92 (!) 500 1,587 (!) 1,814 . 4,055 172 (1)

F ‡ ‡ 63 (!) 368 (!) 441 (!) . 889 19

T -- -- 563 1,955 2,255 . 4,944 191

Expulsions 

under zero 

tolerance 

policies 

M 351 (1) 725 983 1,611 2,708 (!) . 5,397 ‡

F 23 ‡ 134 363 136 (!) . 1,085 ‡

92
Demographics

American 

Indian

Asian/

Pacific 

Islander Hispanic Black White Total IDEA

Section 

504

T 374 -- 1,117 1,974 2,844 . 6,481 --

Referrals to 

law 

enforcement 

M 1,341 (1) 1,609 8,984 14,274 27,586 . 46,849 1,568

F 348 124 2,184 3,589 5,606 . 11,845 412

T 1,690 1,733 11,168 17,863 33,193 . 58,695 1,980

Schoolrelated 

arrests 

M 433 (1) 283 3,753 5,867 8,272 . 18,608 756

F ‡ 156 (!) 944 1,859 2,684 . 4,712 237

T -- 439 4,697 7,726 10,955 . 23,320 993

‡ Estimate has been suppressed. Associated standard error exceeds 50 percent of the estimate. 

! Associated standard error exceeds 30 percent of the estimate. Interpret data with caution.

¡ Interpret data with caution. Estimate has been flagged for large differences from other reported data 

sources from the U.S. Department of Education.

1 Interpret data with caution. Estimate presented is a subtotal associated with a grand total that has been 

flagged for being different from other U.S. Department of Education data sources.

Source: Civil Rights Data Collection, 2009-10 National Estimates. Available at 

http://ocrdata.ed.gov/StateNationalEstimations/Projections_2009_10. 

Health and Wellbeing

Table 17 reflects the Medicaid long-term care dollars spent on home- or communitybased services versus institutional care. The results show that the percentage of longterm care dollars spent on home-and community-based care increased from 13 percent

in 1990 to 45 percent in 2012. 

Table 17. Medicaid Long-Term Care Dollars (Billions) Spent on Home- or

Community-Based Services vs. Institutional Care, 1990–2012

1990 1995 2000 2002 2004 2006 2008 2009 2010 2011 2012

Total spent on 

LTC (billions)

32 54 75 92 100 109 113 120.2 120.7 123 123

Total spent on 

home- and 

communitybased care 

(billions)

4.16 10.8 22.5 29.44 37 44.69 47 52 54.1 55 55

Total spent on 

institutional 

care (billions)

27.84 43.2 52.5 62.56 63 64.31 66 68.2 66.6 68.1 67

93
Source: The Kaiser Family Foundation’s State Health Facts. Data Source: Urban Institute estimates 

based on data from CMS (Form 64).

Tables 18a and 18b reflect the percentage of people who are obese by disability

status. Health care remains a concern for all Americans, including people with

disabilities. Notably, the percentage of people with disabilities who are obese is much

higher than the percentage of obese people without disabilities (table 18a). Also, the

percentage of persons with disabilities who smoke is much higher than the percentage

of people without disabilities who smoke (table 18b). 

Table 18a. Percentage of People Who Are Obese by Disability Status, 2004–2011

2004 2005 2006 2007 2008 2009 2010 2011

No disability 20.4 21.1 21.3 22.8 22.9 23.8 23.8 23.7

Any disability 33.1 33.9 35.2 36.2 36.2 37.6 38.2 37.6

Source: Centers for Disease Control and Prevention, Disability and Health Data System (DHDS).

Table 18b. Percentage of People Who Use Cigarettes by Disability Status, 2004–

2011

2004 2005 2006 2007 2008 2009 2010 2011

No disability 19.3 18.8 18 17.6 16.7 16.1 15.2 17.8

Any disability 29.8 29.7 27.9 28.9 27 28.3 26.7 29.2

Source: Centers for Disease Control and Prevention, Disability and Health Data System (DHDS).

Civil Rights

Table 19 reflects nations that have taken a stand to protect the rights of people with

disabilities by ratifying the CRPD. By ratifying the CRPD, these nations are able to be

active members and hold a global leadership position on the annual Conference of

State Parties, which is a major platform to discuss best practices and influence disability

rights.

94
Table 19. Nations that Have Ratified the CRPD as of July 2014

Afghanistan Burundi Estonia Japan Morocco Qatar Sweden

Albania Cambodia Ethiopia Jordan Mozambique Republic of 

Korea

Switzerland

Algeria Canada European 

Union

Kenya Myanmar Republic of 

Moldova

Syria

Andorra Cape 

Verde

France Kiribati Namibia Romania Thailand

Angola Chile Gabon Kuwait Nauru Russian 

Federation

The former 

Yugoslav 

Republic of 

Macedonia

Argentina China Georgia Lao Peoples 

Democratic 

Republic

Nepal Rwanda Togo

Armenia Colombia Germany Latvia New Zealand San Marino Tunisia

Australia Cook 

Islands

Ghana Lesotho Nicaragua Saudi 

Arabia

Turkey

Austria Costa Rica Greece Liberia Niger Senegal Turkmenistan

Azerbaijan Cote 

d’Ivoire

Guatemala Lithuania Nigeria Serbia Tuvalu

Bahrain Croatia Guinea Luxembourg Norway Seychelles Uganda

Bangladesh Cuba Haiti Malawi Oman Sierra 

Leone

Ukraine

Barbados Cyprus Honduras Malaysia Pakistan Singapore United Arab 

Emirates

Belgium Czech 

Republic

Hungary Maldives Palau Slovakia United 

Kingdom

Belize Denmark India Mali Panama Slovenia United 

Republic of 

Tanzania

Benin Djibouti Indonesia Malta Papua New 

Guinea

South 

Africa

Uruguay

Bolivia Dominica Iran Mauritania Paraguay Spain Vanuatu

Bosnia and 

Herzegovina

Dominican 

Republic

Iraq Mauritius Peru St. Vincent 

and the 

Grenadines

Venezuela

Brazil Ecuador Israel Mexico Philippines State of 

Palestine

Yemen

Bulgaria Egypt Italy Mongolia Poland Sudan Zambia

Burkina 

Faso

El 

Salvador

Jamaica Montenegro Portugal Swaziland Zimbabwe

Source: United Nations, http://www.un.org/disabilities/countries.asp?navid=12&pid=166

95
Tables 20a and 20b reflect the number of charges toward the ADA. According to the

Equal Employment Opportunity Commission, disability discrimination charges rose from

18,108 in 1997 to 25,957 in 2013. This increase may reflect increased discrimination,

increased awareness of discrimination, or both.

Table 20a. Number of Charges Toward the Americans with Disabilities Act of

1990, 1997–2005

1997 1998 1999 2000 2001 2002 2003 2004 2005

ADA charges 18,108 17,806 17,007 15,864 16,470 15,964 15,377 15,376 14,893

Source: U.S. Equal Employment Opportunity Commission, Charge Statistics, 

http://www.eeoc.gov/eeoc/statistics/enforcement/charges.cfm 

Table 20b. Number of Charges Toward the Americans with Disabilities Act of

1990, 2006–2013

2006 2007 2008 2009 2010 2011 2012 2013

ADA charges 15,575 17,734 19,453 21,451 25,165 25,742 26,379 25,957

Source: U.S. Equal Employment Opportunity Commission, Charge Statistics, 

http://www.eeoc.gov/eeoc/statistics/enforcement/charges.cfm 

Table 21 reflects how inaccessible affordable housing can be for people with

disabilities. Housing discrimination complaints based on disability have been the most 

frequent—more than twice than those based on sex between 2005 and 2011. 

Table 21. Bases of Housing Discrimination Complaints, 2005–2011

2005 2006 2007 2008 2009 2010 2011

Disability 3,766 4,110 4,410 4,675 4,458 4,839 4,498

Race 3,472 4,043 3,750 3,669 3,203 3,483 3,025

Retaliation 452 577 588 575 654 707 856

Familial status 1,414 1,433 1,447 1,690 2,017 1,560 1,425

National origin 1,225 1,427 1,299 1,364 1,313 1,177 1,195

Sex 961 997 1,008 1,133 1,075 1,139 1,033

Religion 218 258 266 339 302 287 262

Color 142 154 173 262 251 219 185

Source: U.S. Department of Housing and Urban Development, The State of Fair Housing Report, FY 2011.

96
Voting

Table 22a reflects the percentages of people voting in national elections, and table 22b

reflects this information by state. The Help America Vote Act (HAVA) of 2002 includes

provisions that support the participation of people with disabilities in the voting process. 

Table 22a. Percentage of People Voting in National Elections, 2008–2012

Voter 

Turnout 2008

Voter

Turnout 2010

Voter 

Turnout 2012

Number of Voters 

(millions) 2012

No disability 64.50% 45.90% 62.50% 117.3

Any disability 57.30% 42.80% 56.80% 15.6

Disability gap -7.20% -3.10% -5.70%

Type of disability

Hearing impairment 63.10% 50.00% 63.20% 5

Visual impairment 56.80% 39.50% 57.30% 2.4

Cognitive impairment 46.10% 29.60% 44.80% 3.7

Mobility impairment 56.80% 43.50% 56.30% 9.3

Difficulty dressing or bathing 46.40% 32.40% 46.70% 2.2

Difficulty going outside alone 45.70% 32.90% 47.30% 4.6

Source: Schur, L., Adya, M., & Kruse, D. (2013). Disability, Voter Turnout, and Voting Difficulties in the 

2012 Elections. Report to the U.S. Election Assistance Commission and Research Alliance for Accessible 

Voting. 

97
Table 22b. Percentage of People Voting in National Elections by State, 2012

State Disability No Disability State Disability No Disability

Alabama 57.8% 62.7% Nebraska 62.2% 61.5%

Alaska 59.1% 58.3% Nevada 58.5% 57.9%

Arizona 48.1% 56.9% New Hampshire 59.0% 70.8%

Arkansas 46.2% 54.7% New Jersey 56.8% 62.5%

California 50.4% 58.4% New Mexico 57.7% 62.1%

Colorado 65.6% 71.1% New York 50.2% 59.7%

Connecticut 52.7% 63.8% North Carolina 62.5% 69.8%

Delaware 71.1% 66.8% North Dakota 57.2% 64.7%

Florida 62.0% 60.7% Ohio 58.3% 63.9%

Georgia 54.9% 62.9% Oklahoma 49.4% 53.0%

Hawaii 51.4% 51.7% Oregon 66.6% 67.8%

Idaho 56.6% 64.9% Pennsylvania 54.9% 62.6%

Illinois 60.4% 61.6% Rhode 61.0% 62.7%

Indiana 54.8% 59.9% South Carolina 59.8% 65.5%

Iowa 63.9% 70.2% South Dakota 64.7% 60.4%

Kansas 63.0% 63.3% Tennessee 47.9% 57.4%

Kentucky 48.5% 61.4% Texas 55.8% 53.5%

Louisiana 58.7% 67.6% Utah 59.8% 56.7%

Maine 55.9% 71.0% Vermont 62.1% 63.4%

Maryland 58.3% 66.0% Virginia 57.1% 68.2%

Massachusetts 59.7% 72.3% Washington 63.6% 66.0%

Michigan 60.7% 68.0% Washington, DC 63.8% 77.6%

Minnesota 65.7% 74.2% West Virginia 42.9% 48.8%

Mississippi 67.9% 75.9% Wisconsin 66.5% 74.7%

Missouri 53.5% 65.8% Wyoming 59.7% 58.7%

Montana 64.9% 65.8% New Hampshire 59.0% 70.8%

Source: Schur, L., Adya, M., & Kruse, D. (2013). Disability, Voter Turnout, and Voting Difficulties in the 

2012 Elections. Report to the U.S. Election Assistance Commission and Research Alliance for Accessible 

Voting. 

98
Technology

Table 23 reflects the rate of computer and Internet use by age and disability status. 

Technology is an important resource for communication, work, and daily interactions

such as placing an order or applying for a job online. The results show a gap between

people with and without disabilities in their use of technology and access the Internet.

The gap is particularly large for those individuals with significant disabilities.

Table 23. Computer and Internet Usage by Age and Disability Status, 2002 and

2010

2010: 

15–64 Years

2010:

65 Years and

Older

2002: 

15–64 Years

2002:

65 Years and 

Older

No disability

Uses a computer at home 75.9 52.2 60.7 28.6

Uses a computer at school/work 57.2 14.3 51.1 07.8

Uses the Internet at home 61.3 39.2 50.9 21.2

Uses the Internet at school/work 43.8 09.6 34.8 003.8

Uses the Internet at other place 20.1 07.1 13.2 02.5

Nonsevere disability

Uses a computer at home 70.1 40.0 56.4 23.9

Uses a computer at school/work 50.6 07.5 46.3 4.7

Uses the Internet at home 58.8 29.2 46.7 17.5

Uses the Internet at school/work 39.1 04.7 30.1 02.3

Uses the Internet at other place 24.6 06.2 14.3 02.9

Severe disability

Uses a computer at home 53.4 25.8 35.9 11.7

Uses a computer at school/work 20.7 02.8 17.8 01.3

Uses the Internet at home 40.4 17.1 28.5 07.5

Uses the Internet at school/work 14.3 01.6 09.9 00.4

Uses the Internet at other place 14.1 02.8 08.4 00.8

Source: U.S. Census Bureau, Disability Reports and Briefs, Americans with Disabilities Report Series 

(based on SIPP data), http://www.census.gov/people/disability/publications/reports_briefs.html

99
100
CONCLUSIONS

The United States has experienced a significant cultural shift since the NCD became an

independent federal agency 30 years ago. Our society has transitioned from one that

took a charity approach to meeting the needs of people with disabilities to one that

promotes inclusion through policies and programs that are responsive to the needs of

people with disabilities. This shift in approach reduces many of the social and physical

barriers that once served as obstacles to productive life outcomes. It has also

empowered those with disabilities to capitalize on their own strengths and make greater

contributions to society.

The NCD has made significant progress in leading our country in a direction that affords

opportunities for all citizens to contribute to and benefit from diverse ideas, collaborative

decision-making processes, and innovative approaches to solutions that make our

nation great; yet much work remains. As the NCD looks to the future, we are especially

focused on opportunities for the social and economic mobility of youth with disabilities.

To this end, we will focus on enhancing the educational and professional experiences

that are required to create positive outcomes for youth with disabilities. In recent

months, NCD has been in conversation with colleagues from the White House,

Congress, and the general public. Based on these discussions, we have decided to

tailor our FY 2015 policy focus on youth-related outcomes as they pertain to achieving

the goals of the ADA: full participation, economic self-sufficiency, independent living,

and equality of opportunity. The unifying theme will incorporate this focus and be

addressed in the coming year. The NCD is also exploring more opportunities for using

technologies, such as autonomous vehicles and voice recognition software, that

contribute to enhanced independence, flexibility, and quality of life. Health care, both

physical and mental, is also a priority, as we aspire to a health care system that offers

high-quality care and collaboration between people with disabilities and health care

providers to identify the best treatment options for better health outcomes. Employment

is also a priority, as NCD makes recommendations regarding sheltered work settings

and increasing the number of people with disabilities in competitive work environments.

101
The NCD is optimistic about the future for our citizens with disabilities. This is due, in

large part, to the progress that our society has already made in policies, programs, and

mindsets that empower people with disabilities to live independent, successful, and full

lives. As our country prepares for the 25-year anniversary of the passage of the ADA in

2015, it is critical that Congress and the White House continue to support Americans

with disabilities as a top priority. In doing so, NCD urges Congress, the White House,

and other influencers to address the issues and implement the recommendations raised

in this 2014 annual Progress Report and to confirm the coming of age of policies and

laws that definitively include all Americans as equals.

102
REFERENCES

Agency for Healthcare Research and Quality. 2013, January. 2010 National Healthcare 

Disparities Report. Rockville, MD: Agency for Healthcare Research and Quality. 

http://www.ahrq.gov/research/findings/nhqrdr/nhdr10/index.html.

Alkahtani, Keetam D. F. 2013. “Teachers’ Knowledge and Use of Assistive Technology 

for Students with Special Education Needs.” Journal of Studies in Education 3:65–

86. http://www.macrothink.org/journal/index.php/jse/article/view/3424/2906.

American Association of People with Disabilities. n.d. Equity in Transportation for 

People with Disabilities. Accessed July 29, 2014, 

http://www.aapd.com/resources/publications/transportation-disabilities.pdf.

American Association of Suicidology. 2012. Suicide in the USA Based on 2010 Data.

Washington, DC: American Association of Suicidology.

American Civil Liberties Union. 2009, August. Impairing Education: Corporal 

Punishment of Students with Disabilities in U.S. Public Schools.

http://www.hrw.org/sites/default/files/reports/us0809web_0.pdf.

American Psychiatric Association. 1994. Fact Sheet: Violence and Mental Illness.

Washington, DC: American Psychiatric Association.

Americans with Disabilities Act, 1990. Title I, 42 U.S.C § 12101–12117.

Barry, D. 2014, April 8. “Rhode Island Settles Case on Jobs for the Disabled.” New York 

Times. http://www.nytimes.com/2014/04/09/us/developmentally-disabled-get-moreworkplace-protections.html?_r=0.

Blanton, Linda P., Marleen C. Pugach, and Lani Florian. 2011. Preparing General 

Education Teachers to Improve Outcomes for Students with Disabilities.

Washington, DC: American Association of Colleges for Teacher Education and the 

National Center for Learning Disabilities. 

http://ncld.org/images/stories/OnCapitolHill/policyinaction/policybriefs/aacte_ncld_re

commendation.pdf.

Bradshaw, Catherine P., Mary M. Mitchell, and Philip J. Leaf. 2010. “Examining the 

effects of schoolwide positive behavioral interventions and supports on student 

outcomes: Results from a randomized controlled effectiveness trial in elementary 

schools.” Journal of Positive Behavior Interventions 12(3):133.

Carnevale, Anthony P., Nicole Smith, and Jeff Strohl. 2010. Help Wanted: Projects of 

Jobs and Education Requirements Through 2018. Washington, DC: Georgetown 

University Center on Education and the Workforce. 

http://www.adheperkins.com/resources/Help%20Wanted.pdf.

103
Colton, C. W., and R. W. Manderscheid. 2006. “Congruencies in Increased Mortality 

Rates, Years of Potential Life Lost, and Causes of Death among Public Mental 

Health Clients in Eight States.” Preventing Chronic Disease: Public Health 

Research, Practice and Policy 3:1–14. 

Convention on the Rights of Persons with Disabilities. 2006, December 13. United 

Nations Treaty Series 15, p. 3. 

http://www.un.org/disabilities/convention/conventionfull.shtml. 

Corrigan, Patrick et al. 2002. “Challenging Two Mental Illness Stigmas: Personal 

Responsibility and Dangerousness.” Schizophrenia Bulletin 28:293–309.

Cortiella, Candace and Sheldon H. Horowitz. 2014. The State of Learning Disabilities: 

Facts, Trends and Emerging Issues. 3rd ed. New York, NY: National Center for 

Learning Disabilities. 

http://www.ncld.org/images/content/files/stateofld2014/2014%20State%20of%20LD

%20FINAL%20FOR%20RELEASE.pdf.

Cortiella, Candace. 2013, May. Diplomas at Risk: A Critical Look at the Graduation Rate 

of Students with Learning Disabilities. New York, NY: National Center for Learning 

Disabilities. http://www.ncld.org/images/content/files/diplomas-atrisk/DiplomasatRisk.pdf.

Disability Rights Oregon. n.d. “Lane v. Kitzhaber: Fact Sheet.” Accessed September 2, 

2014, http://www.droregon.org/results/results-documents/Lane%20v.%20KitzhaberFact%20Sheet.pdf.

Disability Rights Wisconsin. n.d. Wisconsin’s Family Care & IRIS Ombudsman Program.

Accessed September 2, 2014, http://www.disabilityrightswi.org/wpcontent/uploads/2009/10/fcop-fc-iris-brochure-08-09.pdf.

Disability Statistics. n.d. Disability Statistics. Accessed July 29, 2014, 

http://www.disabilitystatistics.org.

Dooha, Susan M. 2011, June. Disability Matters: Unequal Treatment and the Status of 

People with Disabilities in New York City and New York State. New York, NY: Center 

for Independence of the Disabled, New York. 

http://www.cidny.org/resources/News/Reports/Disability%20Matters.pdf.

Education for All Handicapped Children Act of 1975. Public Law 94-142.

Electronic and Information Technology. 29 U.S.C. § 794d.

ePolicy Works. 2014a. NCD-ODEP National Online Dialogue: Advancing Accessibility 

and Inclusion in Social Media—The User Experience.

https://www.digitalgov.gov/files/2014/06/NCD-ODEP-Online-Dialogue-ParticipationMetrics-Report.pdf.

104
ePolicy Works. 2014b. NCD-ODEP National Online Dialogue: Encouraging People with 

Disabilities to Pursue Careers in STEM (Science, Technology, Engineering and 

Mathematics), July 28–August 8, 2014 Participation Metrics.

http://stemcareersforpwd.epolicyworks.org/communitylibrary/accounts/90/909643/NCD-ODEP-Online-Dialogue-3---Metrics-ReportFinal.docx.

Erickson, W., C. Lee, and S. von Schrader. 2014. Disability Statistics from the 2012 

American Community Survey (ACS). Ithaca, NY: Employment and Disability 

Institute, Cornell University. http://www.disabilitystatistics.org.

Executive Order no. 13,518. 2009, November 13. “Employment of Veterans in the 

Federal Government.” Federal Register 74, no. 218:58,533, codified at 38 U.S.C. § 

4214.

Executive Order no. 13,548. 2010, July 30. “Increasing Federal Employment of 

Individuals with Disabilities,” Federal Register 75, no. 146:45039.

Executive Order no. 13,658. 2014, February 20. “Establishing a Minimum Wage for 

Contractors.” Federal Register 79, no. 34:9851–9854. http://www.gpo.gov/fdsys/FR2014-02-20/pdf/2014-03805.pdf. 

Fair Labor Act of 1938, 29 U.S.C. § 214(c). 

Federal Communications Commission. 2014, updated May 27. “Guide: 21st Century 

Communications and Video Accessibility Act (CVAA), Public Law 111-260.” 

http://www.fcc.gov/guides/21st-century-communications-and-video-accessibility-act2010.

Federal Transit Administration. n.d. GROW AMERICA Act: Surface Transportation 

Reauthorization: Public Transpiration Priorities. Accessed August 29, 2014, 

http://www.fta.dot.gov/documents/Grow_America_Act_Public_Presentation_(FTA_fi

nal)_May14.pdf.

Fogg, Neeta P. and Paul E. Harrington. 2010. Disability and the Great Recession: The 

Labor Market Impacts of the Economic Recession on Persons with Disabilities.

Boston, MA: Center for Labor Market Studies, Northeastern University. 

http://www.drexel.edu/provost/clmp/docs/clmp_disabilityandthegreatrecession.pdf.

Freeman, Rachel et al. 2006. “Building inclusive school cultures using school-wide 

positive behavior support: Designing effective individual support systems for 

students with significant disabilities.” Research and Practice for Persons with Severe 

Disabilities 31(1):4–17.

Freeman, Stephany F. N., and Marvin C. Alkin. 2000. “Academic and Social 

Attainments of Children With Mental Retardation in General Education and Special 

Education Settings.” Remedial and Special Education 21:2–18.

105
Gagnon, Douglas J., Marybeth Mattingly, and Vincent J. Connelly. 2013, December 17. 

Variation Found in Rates of Restraint and Seclusion Among Students with a 

Disability. National Issue Brief no. 67. Durham, NH: Carsey Institute, University of 

New Hampshire. http://scholars.unh.edu/carsey/206.

Henry J. Kaiser Family Foundation. 2013, October 17. “Medicaid Long-Term Services 

and Supports (LTSS) Users Accounted for Nearly Half of Medicaid Spending, FY 

2010.” http://kff.org/medicaid/slide/medicaid-long-term-services-and-supports-ltssusers-accounted-for-nearly-half-of-medicaid-spending-fy-2010/.

Higher Education Opportunity Act of 1965. Public Law 89-329, 20 U.S.C. §§ 1091(s), 

1140.

Higher Education Opportunity Act of 2008. Public Law 110-315, 20 U.S.C. § 1003(24).

Iraq and Afghanistan Veterans of America. 2014, July 27. “2013 Member Survey.” 

Accessed July 27, 2014, 

http://iava.org/files/2013survey/IAVAMemberSurvey2013.pdf.

Jackson, Lewis B., Diane L. Ryndak, and Michael L. Wehmeyer. 2008. “The dynamic 

relationship between context, curriculum, and student learning: A case for inclusive 

education as a research-based practice.” Research & Practice for Persons with 

Severe Disabilities 33/34(4-1):175–195.

Kemp, Janet, and Robert Bossarte. n.d. Suicide Data Report, 2012. Washington, DC: 

U.S. Department of Veterans Affairs, Mental Health Services, Suicide Prevention 

Program. Accessed September 2, 2014, http://www.va.gov/opa/docs/Suicide-DataReport-2012-final.pdf.

LeardMann, Cynthia A. et al. 2013. “Risk Factors Associated with Suicide in Current 

and Former U.S. Military Personnel.” Journal of the American Medical Association

310:496–506.

Lo, Y., and G. Cartledge. 2006. “FBA and BIP: Increasing the Behavior Adjustment of 

African American Boys in Schools.” Behavioral Disorders 31(2):147–161.

Lyle, Elizabeth E. 2010. A Giant Leap and a Big Deal: Delivering on the Promise of 

Equal Access to Broadband for People with Disabilities. Washington, DC: Federal 

Communications Commission. http://transition.fcc.gov/national-broadbandplan/equal-access-to-broadband-paper.pdf.

Mallory. 2014, September 2. “Uberaccess: Expanding Transportation Options.” Uber 

Blog. http://blog.uber.com/UberACCESSChi.

Martinez, Luis, and Amy Bingham. 2011, November 11. “U.S. Veterans: By the 

Numbers.” http://abcnews.go.com/Politics/us-veterans-numbers/story?id=14928136. 

106
Migliore, Alberto et al. 2007. “Integrated Employment or Sheltered Workshops: 

Preferences of Adults with Intellectual Disabilities, Their Families, and Staff,” Journal 

of Vocational Rehabilitation 26:5–19. 

http://www.inclusionbc.org/sites/default/files/Research_paper_-

_Integrated_Employment.pdf.

Mikaela. 2014, August 7. “Wheelchair Accessible Rides with Uberwav.” Uber Blog.

http://blog.uber.com/nyc-uberwav.

Mullin, Sheppard. 2013, December 6. “City of New York and Disability Advocates 

Announce Landmark Settlement to Dramatically Increase NYC Taxicab 

Accessibility.” Press release. http://www.sheppardmullin.com/newsroompressreleases-376.html.

National Center for Learning Disabilities. n.d. “Effective Teachers.” Accessed July 29, 

2014, http://ncld.org/disability-advocacy/where-we-stand-policies/effective-teachers.

National Center for Veterans Analysis and Statistics. 2014, February. Trends in 

Veterans with a Service-Connected Disability: FY1985 to FY2012.

http://www.va.gov/vetdata/docs/QuickFacts/SCD_quickfacts_FY2012.pdf.

National Council for Behavioral Health. 2012, November. Meeting the Behavioral Health 

Needs of Veterans: Operation Enduring Freedom and Operation Iraqi Freedom.

Washington, DC: National Council for Behavioral Health. 

http://www.thenationalcouncil.org/wp-content/uploads/2013/02/Veterans-BH-NeedsReport.pdf. 

National Council on Disability. n.d. “NCD Report on Subminimum Wage and Supported 

Employment.” Accessed September 2, 2014, 

http://www.ncd.gov/publications/2012/August232012/.

National Council on Disability. 2013, March 18. Medicaid Managed Care for People with 

Disabilities. Washington, DC: National Council on Disability. 

http://www.ncd.gov/publications/2013/20130315/.

National Council on Disability. 2012a. Exploring New Paradigms for the Developmental 

Disabilities Assistance and Bill of Rights Act: Supplement to the 2011 NCD 

publication Rising Expectations: The Developmental Disabilities Act Revisited. 

Washington, DC: National Council on Disability.

http://www.ncd.gov/rawmedia_repository/2ea83e7a_c83b_43a1_9840_9559a2496cf

3?document.pdf.

107
National Council on Disability. 2012b. “Section 2: Cross-System Focus to Improve 

Outcomes across the Lifespan for People with ID/DD,” in Exploring New Paradigms 

for the Developmental Disabilities Assistance and Bill of Rights Act: Supplement to 

the 2011 NCD Publication Rising Expectations: The Developmental Disabilities Act

Revisited. Washington, DC: National Council on Disability. 

http://www.ncd.gov/publications/2012/Apr222012/section2/#S221.

National Council on Disability. 2008, March 17. Inclusive Livable Communities for 

People with Psychiatric Disabilities. Washington, DC: National Council on Disability. 

http://www.ncd.gov/publications/2008/03172008. 

National Council on Disability. 2011, October 4. The Power of Digital Inclusion: 

Technology's Impact on Employment and Opportunities for People with Disabilities.

Washington, DC: National Council on Disability. 

http://www.ncd.gov/publications/2011/Oct042011.

National Council on Disability. 2003, May 1. Addressing the Needs of Youth with 

Disabilities in the Juvenile Justice System: The Current Status of Evidence-Based 

Research. Washington, DC: National Council on Disability. 

http://www.ncd.gov/publications/2003/May12003.

National Institute of Mental Health. n.d. “Any Disorder among Adults.” Accessed July 30, 

2014, http://www.nimh.nih.gov/statistics/1ANYDIS_ADULT.shtml.

National Institute of Mental Health. n.d. “Use of Mental Health Services and Treatment 

among Children.” Accessed July 30, 2014, 

http://www.nimh.nih.gov/statistics/1NHANES.shtml.

Nazarov, Z., and C. G. Lee. 2012. Disability Statistics from the Current Population 

Survey (CPS). Ithaca, NY: Rehabilitation Research and Training Center on Disability 

Demographics and Statistics, Cornell University.

Newman, Lynn et al. 2009. The Post-High School Outcomes of Youth with Disabilities 

up to 4 Years after High School: A Report from the National Longitudinal Transition 

Study-2 (NLTS2). NCSER 2009-3017. Menlo Park, CA: SRI International. 

http://ies.ed.gov/ncser/pdf/20093017.pdf.

Newman, Lynne et al. 2010. Comparisons Across Time of the Outcomes of Youth with 

Disabilities up to 4 Years After High School: A Report of Findings from the National 

Longitudinal Transition Study (NLTS) and the National Longitudinal Transition Study2 (NLTS2). NCSER 2010-3008. Menlo Park, CA: SRI International. 

http://files.eric.ed.gov/fulltext/ED512149.pdf.

Olmstead v. L. C. 1999. 527 U.S. 581.

108
Parks, Joe et al. 2006. Morbidity and Mortality in People with Serious Mental Illness.

Alexandria, VA: National Association of State Mental Health Program Directors 

Medical Directors Council. 

http://www.nasmhpd.org/docs/publications/MDCdocs/Mortality%20and%20Morbidity

%20Final%20Report%208.18.08.pdf.

Pescosolido, Bernice A. et al. n.d. Americans’ Views of Mental Health and Illness at 

Century’s End: Continuity and Change. Bloomington, IN: The Indiana Consortium of 

Mental Health Services Research, Indiana University. Accessed July 20, 2014, 

http://www.indiana.edu/~icmhsr/docs/Americans%27%20Views%20of%20Mental%2

0Health.pdf.

Pescosolido, B. A. et al. 1999. “The Public’s View of the Competence, Dangerousness, 

and Need for Legal Coercion of Persons with Mental Health Problems.” American 

Journal of Public Health 89:1339–1345.

Reauthorization of the Individuals with Disabilities Education Act of 2004. 20 U.S.C. § 

1412(a)(23). 

Rehabilitation Act of 1973. 34 C.F.R. § 104.35, sec. 504.

Rehabilitation Act of 1973, amended 1998. “Electronic and Information Technology,” 29 

U.S.C. § 794d. 

Rosen, J. 2014, January 30. NCD Letter to the President and Labor Secretary Tom 

Perez on the Impending Minimum Wage Executive Order. Washington, DC: National 

Council on Disability. http://www.ncd.gov/publications/2014/01302014/.

Sciegaj, Mark et al. 2013, August 23. “Appendix C. Tennessee Enrollment Targets and 

PD-MLTSS Performance Measures” in Participant-Directed Services in Managed 

Long-Term Services and Supports Programs: A Five State Comparison.

Washington, DC: U.S. Department of Health and Human Services, Assistant 

Secretary for Planning and Evaluation, Office of Disability, Aging and Long-Term 

Care Policy. http://aspe.hhs.gov/daltcp/reports/2013/5LTSS.shtml#appendC.

Substance Abuse and Mental Health Services Administration. 2013. Behavioral Health, 

United States, 2012. HHS Publication no. (SMA) 13-4797. Rockville, MD: Substance 

Abuse and Mental Health Services Administration. 

http://www.samhsa.gov/data/2012BehavioralHealthUS/2012-BHUS.pdf.

Substance Abuse and Mental Health Services Administration. 2012. Results from the 

2010 National Survey on Drug Use and Health. Mental Health Findings. NSDUH 

Series H-42, HHS Publication no. (SMA) 11-4667. Rockville, MD: Substance Abuse 

and Mental Health Services Administration. 

http://www.samhsa.gov/data/nsduh/2k10MH_Findings/2k10MHResults.htm.

109
The White House. 2012, May 17. “Letter of Transmittal.” U.N. Convention on the Rights 

of Persons with Disabilities. http://www.gpo.gov/fdsys/pkg/CDOC112tdoc7/pdf/CDOC-112tdoc7.pdf.

Thornicroft, Graham. 2006. Shunned: Discrimination against People with Mental Illness.

New York, NY: Oxford University Press.

Trussell, R. P., T. J. Lewis, and J. P. Stichter. 2008. “The impact of targeted classroom 

interventions and function-based behavior interventions on problem behaviors of 

students with emotional/behavioral disorders.” Behavioral Disorders 33:153–166.

Twenty-First Century Communications and Video Accessibility Act (CVAA) of 2010. 47 

U.S.C. §§ 153, 303, 330, 610, 611, 613, 615c, 616–620. 

U.S. Department of Education, Federal Student Aid. n.d. “Students with Intellectual 

Disabilities May Be Able to Get Certain Types of Federal Student Aid.” Accessed 

September 2, 2014, https://studentaid.ed.gov/eligibility/intellectual-disabilities.

U.S. Department of Education, Office for Civil Rights. 2014, March. Civil Rights Data 

Collection Data Snapshot: School Discipline.

http://www2.ed.gov/about/offices/list/ocr/docs/crdc-discipline-snapshot.pdf.

U.S. Department of Education. 2014, June 24. “New Accountability Framework Raises 

the Bar for State Special Education Programs.” Press release. 

http://www.ed.gov/news/press-releases/new-accountability-framework-raises-barstate-special-education-programs.

U.S. Department of Education. 2006. Twenty-Eighth Annual Report to Congress on the 

Implementation of the Individuals with Disabilities Education Act, Volume 2.

Washington, DC: U.S. Department of Education.

U.S. Department of Education. 2009, October 29. “Subpart O—Financial Assistance for 

Students with Intellectual Disabilities.” Federal Register 74, no. 208: 55947–55948. 

http://www.gpo.gov/fdsys/pkg/FR-2009-10-29/pdf/E9-25373.pdf#page=46.

U.S. Department of Justice, Office of Public Affairs. 2014, April 8. “Department of 

Justice Reaches Landmark Americans with Disabilities Act Settlement Agreement 

with Rhode Island.” Press release. http://www.justice.gov/opa/pr/2014/April/14-crt350.html.

U.S. Department of Labor. n.d. “Fair Labor Standards Act (FLSA).” Accessed 

September 2, 2014, http://www.dol.gov/compliance/laws/comp-flsa.htm.

U.S. Senate, Health, Education, Labor, and Pensions Committee. 2014, February 12. 

Dangerous Use of Seclusion and Restraints in Schools Remains Widespread and 

Difficult to Remedy: A Review of Ten Cases.

http://www.help.senate.gov/imo/media/doc/Seclusion%20and%20Restraints%20Fin

al%20Report.pdf.

110
United Nations Secretariat. 2014, April 1. Youth with Disabilities. 

http://www.un.org/disabilities/documents/COP/COP7/CRPD.CSP.2014.4.E.pdf.

United States v. Rhode Island. 2014 (D.R.I). 1:14-cv-00175. 

http://www.ada.gov/olmstead/documents/ri-olmstead-statewide-agreement.pdf.

Wagner, Mary et al. 2006. An Overview of Findings From Wave 2 of the National 

Longitudinal Transition Study-2 (NLTS2). NCSER 2006-3004. Menlo Park, CA: SRI 

International. 

http://www.nlts2.org/reports/2006_08/nlts2_report_2006_08_complete.pdf. 

Warren, Jared S., et al. 2006. “School-wide positive behavior support: Addressing 

behavior problems that impede student learning.” Educational Psychology Review

18(2):187–198. 

Workforce Innovation and Opportunity Act. 2014. Public Law 113-128, 29 U.S.C. §§ 

3101–3361. 

Workforce Investment Act of 1998, 29 U.S.C. § 2801–2945.

Young, Jonathan M. 2013, January 11. “Letter to Vice President Biden Regarding 

Anticipated Taskforce Recommendations.” Washington, DC: National Council on 

Disability. http://www.ncd.gov/publications/2013/Jan142013/. 

111
112
APPENDIX A: SUMMARY OF RECOMMENDATIONS

NCD CRPD Recommendations 

 The White House should continue to promote the CRPD through its outreach efforts, 

explicitly identify and address common misconceptions about the CRPD, and 

highlight the benefits of ratifying the treaty. Further, Government Agencies should 

post information on their websites about the implications of ratifying the CRPD for 

their stakeholders with disabilities. For example, the U.S. Departments of Veteran’s 

Affairs, Labor, and Commerce may highlight the benefits of enhanced access when 

expanding business to other nations. 

 The full Senate should consider, vote on, and pass the ratification of the CRPD 

when it reconvenes in fall 2014. Ratification will enable the United States to resume 

its role as a key leader in international conversations on disability rights and 

contribute to a global society that is inclusive of people with disabilities. 

NCD Employment Recommendations

Transportation

 The U.S. Department of Transportation (DOT) should offer guidance to transit 

systems on reasonable accommodations (e.g., the reasonable amount of time an 

elevator may be out of order, reasonable alternatives during elevator outages, 

standards for providing accessible materials, etc.) and require recipients of GROW 

AMERICA funds to adhere to these standards in order to maintain good standing for 

grants. 

 DOT should consider developing survey items addressing experiences of customers 

with disabilities for transit systems that solicit feedback to use in their efforts to 

understand accessibility trends. 

 DOT should collaborate with private sector research and design and invest in 

autonomous vehicle research to help refine the technology that powers this initiative 

and explores the implications for people with disabilities. 

113
 Congress should explore and support regulation and universal design and standards 

for accessible devices in taxicabs and transit provided through transportation 

network services to ensure maximum opportunities for design of emerging 

technologies that include accessibility for people with disabilities.

Universal Approach to Meeting Employee/Employer Needs 

 The Department of Labor (DOL) should encourage the workforce to adopt a 

universal language and understanding about flexible work arrangements and

customized employment strategies. Eliminating the distinctions between flexible 

work arrangements and customized employment strategies would contribute to a 

more inclusive work environment. 

 DOL should provide guidance to employers on providing natural supports in the 

workplace. Such supports that occur through assistance, relationships, or 

interactions help facilitate typical social relationships in the work setting and 

contribute to a more inclusive environment for all employees. 

Technology

 The Federal Communications Commission (FCC) and the U.S. Access Board should 

continue to identify barriers surrounding broadband access and build on policy that 

would result in broader use by people with a disability. 

 Congress should conduct hearings with key business and industry leaders to help 

identify incentives that would reduce costs and increase availability of accessible 

technology for people with disabilities. One discussion point could involve adopting 

meta-design principles as a way of providing more cost-effective products for all 

users.

 Congress should consider a tax incentive for manufacturers of equipment that 

provide the latest assistive technologies to nongovernmental organizations (NGOs) 

for distribution to people with disabilities. Such manufacturers should also provide 

training to both the NGOs and clients on use and maintenance. 

114
 DOL should consider developing and disseminating a tip sheet on developing 

accessible job announcements to be posted on social media sites and other online 

platforms. 

 DOL should explore and invest in employment opportunities for young people with 

disabilities to learn skills relevant to the technology industry, such as coding, early in 

their academic career, becoming accessibility testers, getting internship and 

mentorship experiences in the software game development industry and STEM 

careers, and creating their own companies.

 The FCC should provide the communications industry and device manufacturers 

with guidance on best practices to include people with disabilities in the research 

and development (R&D) process from ideation to pilot testing of new products. 

NCD Subminimum Wage Recommendations 

NCD’s Proposed 14 (c) Phase Out 

 DOL should adopt and implement NCD’s proposal to phase out 14(c) in reference to 

people with disabilities as reflected in the NCD Report on Subminimum Wage and 

Supported Employment. This transformation should be put in place gradually so that 

individuals who are currently in these settings are provided information and 

resources to continue to receive SSI and get connected to peer networks, and so 

entities that use it have time to adapt their practices. NCD recommends a cycle of 

phased closures and transitions from sheltered workshops at subminimum wages to 

supported or customized employment at fair wages. This multistep phase-out plan

involves the following steps:

o Immediately: Congress should prohibit the Department of Labor from issuing

further 14(c) certificates.

o In the long term: The Department of Labor should require all providers who

administer 14(c) certificates to convert to supported employment, on a timed

basis:

115
 All individuals in certificate settings for 10 years or less shall be transitioned 

within 2 years.

 All individuals in certificate settings for 10 to 20 years shall be transitioned 

within 4 years.

 All certificates shall expire in 6 years, and all individuals in certificate settings 

longer than 20 years shall be transitioned within 6 years.

To support this shift, Congress should explore a “Money Follows the Person for

Integrated Employment” program, enabling the Federal Government to assume 100

percent of the costs of supported employment services for individuals leaving a

sheltered workshop or day habilitation setting for integrated employment.

Integrated Employment Settings

 DOL should develop policy requiring participants of 14(c) certificate programs to 

provide all of their workers with the opportunity and information on how to transfer 

into an integrated employment setting twice per year. Information provided to 

workers should include resources about benefit work incentive counseling and the 

availability of peer support.

 Congress should consider the following actions to build cultures of high expectations 

and support for people with disabilities in integrated employment settings:

o Prohibit any Individualized Education Plan (IEP) to list placement in a

subminimum wage program as an acceptable postsecondary transition service or

goal.

o Instruct the Centers for Medicare & Medicaid Services (CMS) to develop a

minimum standard definition for integrated employment settings aligned with

national best practices.

 The three partners authorized under the Developmental Disabilities Bill of Rights Act 

should coordinate and expand efforts to promote peer support to both families and 

people with intellectual developmental disabilities transitioning from the 14(c) 

116
programs to integrated employment. The three partners include: (1) State Councils 

on Developmental Disabilities; (2) University Centers for Excellence in 

Developmental Disabilities Education, Research, and Service (UCEDDs); and 

(3) Protection & Advocacy Systems (P&As). 

NCD Education Recommendations

Higher Education Opportunity Act 

 Congress should increase funding to support the expansion of the Department of 

Education's Transition and Postsecondary Programs for Students with Intellectual 

Disabilities, which were authorized as part of the Higher Education Opportunity Act

(HEOA). 

 U.S. Department of Education should take steps to simplify the administration of the 

provisions authorized in HEOA that allow ID/DD students who did not receive a 

traditional diploma to receive federal student grants and access work–study options. 

The Department should also certify additional comprehensive transition and 

postsecondary programs

Inclusive Learning Environments

 Permanently fund the Advanced Research Projects Agency for Education (ARPAED) to, in part, provide research grants that address the unique learning needs of 

students who are children with disabilities. 

 Include specific reference to the use of research-validated educational 

methodologies that improve inclusion of students with disabilities inside the general 

education classrooms, such as Universal Design for Learning and Response to 

Intervention and positive behavior intervention and supports or other multitiered 

systems of support. Provide federal funding for the development of instructional 

materials in various content areas and levels that are accessible to students with 

print disabilities, and which are designed with the principles of UDL in mind.

117
Discipline and Behavior

 Require states and districts to publicly report disaggregated data on number of 

students suspended, reasons for out-of school suspensions, and days of instruction 

lost. In addition, include suspension rates among the factors schools and districts 

use to measure performance.

 Provide funding and incentives for evidence-based changes to improve school 

climate, reduce the use of exclusionary discipline, and limit the flow of students from 

schools to the juvenile and criminal justice systems. 

 Facilitate the reenrollment, reentry, and proper education of students returning to 

school from expulsion and juvenile justice system placements. 

High School Completion

 The reauthorization of Elementary and Secondary Education Act (ESEA) should 

include a uniform definition of ‘student with disability’ that is used in data collection 

for the Adjusted Cohort Graduate Rate. In addition, information should be collected 

and reported on disaggregated by disability type, rather than status. 

 Congress and the Department of Education should support states to create 

statewide standards for modified diplomas and extended diplomas, like the ones in 

Oregon. 

Student Achievement

 Require states to set achievement and inclusion targets for students with disabilities, 

and report on achievement data for these students.

 At the state level with federal oversight, require more comprehensive data collection, 

institute monitoring, initiate research and demand accountability of services provided 

to students with 504 plans, including the educational and transition outcomes 

achieved by these students. 

118
 Consider expanding the measures of teacher quality to include supplemental 

measures (aside from student growth) that include the use of research-based 

instructional practices, teacher performance, and contribution to student learning.

NCD Medicaid Managed Care Recommendations 

Benefit Design

 States should ensure that any population that has its Home and Community Based 

Service (HCBS) system placed into managed care has the corresponding

institutional benefit placed within the same managed care framework, offering an 

opportunity to reduce institutional placement and avoid adverse incentives for the 

Managed Care Organization (MCO).

 Capitated payment rates should be structured so as to incentivize community 

integration and should take into account the differing costs and complexity of 

different populations.

 Managed Care contracts should clearly spell out the difference between different 

types of service categories, to ensure that MCOs are promoting true community 

integration in residential, day, and employment services.

 Managed Care contracts should articulate how MCOs will interact with non-Medicaid 

state systems, such as vocational rehabilitation agencies and the public school 

system.

Outcome Measures

 The Department of Health and Human Services’ (HHS) Administration for 

Community Living, in collaboration with CMS, the Agency for Healthcare Research 

and Quality (AHRQ), the Long-Term Quality Alliance, the National Core Indicators 

Project, and leaders of the aging and disability communities, should spearhead 

efforts to develop disability-specific outcome standards to measure access to, and 

the quality of, health care and long-term supports for people with disabilities. Specific 

emphasis should be given to issues associated with community integration, 

119
self-direction and other dimensions of quality more typically associated with long 

term services and supports rather than acute care. Quality measures should 

incorporate both those collected via independent surveys of beneficiaries and those 

determined via analysis of claims data.

 The state Medicaid agency must exercise overall responsibility for monitoring 

system performance and individual outcome measures and make the information on 

MCO performance available in a timely fashion in a public website, providing 

individuals with the ability to analyze the data on the basis of MCO, region, race, 

gender, disability status and other relevant demographic characteristics. 

Due Process 

 CMS should make available funds for State Protection and Advocacy systems to 

assist people with disabilities in navigating Managed Care systems, with particular 

emphasis on assisting people with disabilities through grievance and appeals 

procedures and ensuring that the due process rights of beneficiaries are 

implemented in a meaningful fashion. Resources should be made available for both 

individual assistance of beneficiaries and for systemic oversight, litigation and 

advocacy on the design and operation of Medicaid Managed Care. Funding should 

be allocated with the goal of allowing a ratio of at least one Ombudsman for every 

2,500 beneficiaries, consistent with the Wisconsin model, with sufficient remaining 

funds to allow for systemic work focused on the broader structure of the managed 

care model.

 States should develop and implement an aggressive education and outreach 

strategy to ensure that all managed care plan enrollees (and potential enrollees) 

have accessible information concerning the services and supports available under 

the plan and how they may be accessed. The state’s strategy should include the 

following tactics:

o Enlisting community-based disability organizations in developing and

implementing the outreach plan.

120
o Developing accessible multimedia educational materials and training sessions

geared to the various learning styles and comprehension levels of plan enrollees.

Such sessions should be held across the state.

o Providing plan participants with accessible, meaningful, and clear notices about

programs, services, and their rights, including enrollment rights and options, plan

benefits and rules, coverage denials, appeal rights and options, and potential

conflicts that may arise from relationships among providers, suppliers, and

others. This should be written at the comprehension level of the typical plan

enrollee and provided in first languages of enrollees.

o Providing information that represents all service options available to the enrollee

 States should provide managed care enrollees with ample opportunity to seek 

second opinions or appeal service decisions. While appeals are ongoing, service 

plans should remain unchanged and beneficiaries should face no liability for costs 

incurred by the state during the appeals process.

Stakeholder Engagement

 Centers for Medicare & Medicaid Services (CMS) prepare and disseminate a suite of 

resources for states to reference as they develop and implement a plan for 

stakeholder engagement. The suite should include a sample stakeholder plan with 

objectives, strategies, tactics, a timeline, and an approach to evaluation, as well as a 

companion guide to support the development and execution of the plan.

 CMS should specifically solicit feedback from key stakeholders in the state, including 

self-advocates, family members, and the state’s Protection and Advocacy system, 

on the degree to which the state has included them within the stakeholder 

engagement process. This feedback should form a critical component of the 

approval process for a state application for managed long-term services and 

supports.

121
NCD Mental Health Recommendations 

Stigma and Discrimination

 Policymakers should consider provisions to ensure that identification and isolation of 

individuals who have harmed others or are at risk of committing acts of violence do 

not lead to unnecessary expansion in institutionalization, involuntary commitment, 

and forced treatment for individuals who may benefit from mental health services 

and supports but pose no risk of violence and have a basic human right to make 

independent decisions. 

 Congress should avoid any proposal comparable to the provision of S. 436, the Fix 

Gun Checks Act, which amends the Higher Education Act to require colleges and 

universities to outline procedures for the involuntary referral of students with 

perceived psychiatric disabilities for evaluation and institutionalization. Further, NCD 

recommends provisions for programs that support peer-to-peer support and 

campus-based counseling programs, and encourages campus policies that focus on 

making these resources more broadly available.

 Congress should invest in research to further understand mental health issues and 

effective strategies to address mental health issues early before they escalate into 

debilitating conditions. 

Community-Based Mental Health Services

 The Obama Administration should consider a framework to invest in communitybased mental health supports and programs for both civilians and veterans, 

including provision of services at university and college campuses, without adverse 

impact or involuntary hospitalization or commitment for those who seek assistance. 

Recently, pilot programs have been developed across the country to better meet the 

needs of people when they have their first psychotic episode. These programs are 

community based and help to address critical unmet needs.

 NCD encourages the advancement of policy recommendations in line with these 

models and the principles upon which they are based.

122
 Congress should support the Strengthening Mental Health in Our Communities Act 

to reform mental health systems, create opportunities for people with mental 

illnesses to succeed in integrated settings, and to promote access to the community 

services that have been shown to lead to recovery. 

Support for Veterans 

 Congress should continue to make mental health issues among veterans and their 

families a priority by enhancing resources to support increased counseling, 

improvements to in the reporting systems at Veteran Affairs, and more crisis centers 

to address suicide rates among this population.

 Congress should continue and intensify efforts to reduce and eliminate the backlog 

of veteran’s disability claims.

123
124
125