2013 National Disability Policy:

A Progress Report: “Strength in Our Differences”

October 31, 2013

National Council on Disability
National Council on Disability

1331 F Street, NW, Suite 850

Washington, DC 20004

2013 National Disability Policy: A Progress Report: “Strength in Our Differences”

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.
1 

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, 2013

President Barack Obama

The White House

1600 Pennsylvania Avenue, NW

Washington, DC 20500

Dear Mr. President:

Pursuant to its statutory mandate, the National Council on Disability (NCD) provides an 

annual report on the nation’s progress in achieving the ADA goals of equality of 

opportunity, independent living, full participation and economic self-sufficiency for an 

estimated 57 million Americans with disabilities. NCD is pleased to present the 2013 

Report on National Disability Policy: Strength in Our Differences. This report highlights 

recent federal achievements from August 2012 to September 2013 and identifies areas 

where changes in public policy and additional steps are needed. 

The report information results from its outreach to stakeholders—including people living 

with disabilities—and the analysis of data on indicators of the status of disability policy 

in federally funded programs and supports in the United States and abroad. NCD 

consulted with diverse voices from the broad disability community in determining its 

findings and their views provided the basis for its recommendations. 

The report culminates in recommendations to improve federal collaborative efforts in 

ways which benefit people with disabilities and families, including the following:

1. The 113th Congress should ratify the Convention on Rights of Persons (CRPD) 

with disabilities. CRPD offers a vital framework for other nations to create and 

enact legislation and policies that recognize and embrace the human rights and 

dignity of all people – including people with disabilities; 

2. An Executive Order should be issued to create a federal interagency workgroup 

on financial incentives for full community participation and economic selfsufficiency for people with disabilities and their families, which includes the 

identification of policy barriers and efficient, consistent, coordinated, 

comprehensive, and consumer-friendly approaches;

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

202-272-2004 Voice ■ 202-272-2074 TTY ■ 202 -272-2022 Fax ■ www.ncd.gov
2 

3. The Departments of Defense and Veterans Affairs, and other relevant federal 

agencies, are directed to coordinate in implementing secure, private, on-line 

information sharing for all veterans’ health and benefit record —for the efficient 

provision and processing of each veteran’s healthcare needs and to end the

backlog of veterans; claims; The DOJ and DOT implement a Project Civic 

Access program targeting public transportation and paratransit systems that have 

high rates of complaints from local citizens for inaccessibility, for the purpose of 

bringing transportation providers into compliance; and 

4. The US Election Assistance Commission and Research Alliance for Accessible 

Voting identify and provide technical assistance including small grant amounts to 

state and local governmental entities in high poverty areas to create accessible 

polling sites.

NCD appreciates the opportunity to present an independent and nonpartisan 

assessment of progress in national disability policy. As we approach the 25th 

anniversary of the ADA, NCD intends this annual report as a resource to support our 

nation’s continuing progress toward achieving the four goals of the ADA 

NCD stands ready to work with you, the administration, Congress and Americans to 

ensure that we realize the promise of the ADA for all of us. 

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.) 
3 

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

Matan Aryeh Koch

Captain Jonathan F. Kuniholm, USMC (Retired)

Stephanie Orlando

Ari Ne’eman

Janice Lehrer-Stein 

Clyde E. Terry

Fernando M. Torres-Gil, Ph.D.

Alice Wong

Pamela Young-Holmes 

Staff

Rebecca Cokley, Executive Director 

Stacey S. Brown, Staff Assistant

Julie Carroll, Senior Attorney Advisor

Lawrence Carter-Long, Public Affairs Specialist

Joan M. Durocher, General Counsel & Director of Policy

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

Sylvia Menifee, Director of Administration

Robyn Powell, Attorney Advisor

Anne Sommers, Director of Legislative Affairs & Outreach
4 

ACKNOWLEDGMENTS 

The National Council on Disability wishes to express its appreciation to William N. 

Myhill, M.Ed., J.D. for his work in researching and preparing the final draft of this 

document. Mr. Myhill is Director of Legal Research and Writing at the Burton Blatt 

Institute and Adjunct Professor of Law at Syracuse University in Syracuse, New York.

In addition, appreciation is extended to NCD staff for arduous work throughout the 

process and to council members who provided guidance and direction for development 

of the 2013 report on the status of national disability public policy. 
5 

TABLE OF CONTENTS

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

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

ACKNOWLEDGMENTS ................................................................................................. 4

EXECUTIVE SUMMARY ................................................................................................ 7

CHAPTER ONE: RATIFICATION OF THE CONVENTION ON THE RIGHTS OF

PERSONS WITH DISABILITIES......................................................... 13

Summary and Recommendation ......................................................... 14

CHAPTER TWO: ECONOMIC EMPOWERMENT: EMPLOYMENT AND 

WORKFORCE PARTICIPATION ........................................................ 15

Supported Employment ....................................................................... 17

Vocational Rehabilitation ..................................................................... 19

Workforce Investment and American Job Centers............................... 22

Tax Credits and Incentives .................................................................. 26

Federal Employment / Executive Order 13548 .................................... 29

Disability-Owned Businesses............................................................... 30

Attitudinal and Practice Barriers and Facilitators to Meaningful 

Employment................................................................................. 32

Veterans Employment ......................................................................... 36

Summary and Recommendations........................................................ 38

CHAPTER THREE: HEALTH CARE AND ACCESS TO MEDICAL TREATMENT ..... 43

Patient Protection and Affordable Care Act ......................................... 45

Medicaid Managed Care...................................................................... 49

Mental Health Care.............................................................................. 51

Health Care for Veterans ..................................................................... 55

Summary and Recommendations........................................................ 57

CHAPTER FOUR: COMMUNITY INTEGRATION........................................................ 61

Education............................................................................................. 61

K–12 Education ........................................................................... 62

Transition of Youth with Disabilities ............................................. 64

Higher Education and Training .................................................... 65

Housing ............................................................................................... 68

Transportation...................................................................................... 70

Voting Participation.............................................................................. 73

Accessibility ................................................................................. 74

Specific Populations .................................................................... 75
6 

Home- and Community-Based Long-term Services and Supports ...... 76

Information and Communications Technology..................................... 78

Accessible Currency ............................................................................ 79

Summary and Recommendations........................................................ 80

CONCLUSION ............................................................................................................. 83

APPENDIX ............................................................................................................. 85

ENDNOTES ............................................................................................................. 89
7 

EXECUTIVE SUMMARY

The National Council on Disability (NCD) is privileged to present Strength in Our 

Differences, NCD’s 2013 Progress Report summarizing the status of federal laws and 

programs serving an estimated 57 million Americans with disabilities, their families, and 

the diverse segments of the disability community in fulfillment of NCD’s statutory 

mandate to annually report and make recommendations concerning the state of disability 

policy in the United States. Consistent with the tradition begun in NCD’s seminal report 

from 1986, Toward Independence: An Assessment of Federal Laws and Programs 

Affecting Persons with Disabilities, the 2013 Progress Report is derived from the diverse 

voices of the disability community, including interviews with knowledgeable consumers, 

advocates, and experts on disability programs, supports, and services from across the 

nation. 

The title, Strength in Our Differences, symbolizes the diversity of experiences and 

abilities within the US disability community, consistent with the diversity of experiences 

and abilities among all Americans. Strength in Our Differences also represents the fact 

that as a nation we are stronger, and as a people we are more able to respond to the 

challenges in the ever-changing world that we share, because of our diversity.

In preparing this report, NCD sought a cross-section of views from the diverse disability 

community. NCD conducted outreach to different populations within the disability 

community including parents, those seeking to be parents, veterans, youth and young

adults with disabilities from diverse cultures, as well as family members and service 

providers. Several people interviewed fit more than one of these designations. Interviews 

were conducted by telephone, in person, through video systems, and by print 

communication.

The interview process was designed to capture the lived experience of participants, 

through their responses to the guiding question: “What do you think is the single most 

important public policy issue for Americans with disabilities and their families as we move 
8 

toward 2014?” Participants were given the opportunity to interpret, respond to, and 

elaborate on the question. NCD used optional follow-up questions for clarification and to 

account for variations in the depth of understanding, topic significance, and wide-ranging 

recommendations for collaboration to address specific concerns or problems.

The excerpts compiled from these interviews were not aggregated. They were collected

to ensure the diverse voices of the disability community are heard and represented, as 

anecdotal examples of the most significant, heartfelt, and practical concerns of the 

community itself, capturing the unique insights, experiences, and expertise of the 

dedicated individuals with whom NCD conversed.

The review and analysis of these interviews revealed three major characteristics: 

• The interdependent nature of some issues impacting people with disabilities 

makes it difficult to isolate and discuss one issue at a time;

• Deep concerns remain about prospects for withstanding the economic 

recession, given the unique challenges that the majority of people with 

disabilities face; and 

• The disability rights movement has yet to meet critical and unmet needs. 

To organize and address the concerns, observations, and opportunities available for 

progress, this report presents information under four broad subject areas: 

(1) Ratification of the Convention on Rights of Persons with Disabilities (CRPD) 

(2) Economic Empowerment; 

(3) Health Care and Access to Medical Treatment; and 

(4) Community Integration. 

Other topics addressed within these primary subject areas include employment, 

vocational rehabilitation, mental health care, education, housing, transportation, voting, 

and veteran-specific issues. Where available, data is included to inform and supplement 

the observations, discussion, and recommendations.
9 

The narrative, data, and recommendations of the 2013 Progress Report are neither 

exclusive nor comprehensive, but should be viewed as opportunities to identify work yet 

to be done, in conjunction with NCD’s ongoing policy outreach and research, and in 

collaboration with the Administration, Congress, and other agencies that seek fulfillment 

of the Americans with Disabilities Act. 

NCD will continue to make recommendations and seek partnerships with other branches 

of government to create and reform federal programs serving Americans with disabilities, 

and advise the Administration and Congress of its findings. 

Although measurable progress has been achieved in many areas, including employment, 

education, and community living, resulting in an overall state of the disability union that is 

more robust with increased opportunities and greater accessibility overall, critical 

challenges remain. In order to make the most of the advances our nation has made, 

these challenges must remain urgent and be met and overcome with focused attention 

and prompt and effective action.
10
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INTR ODUCTION

Strength in Our Differences is NCD’s 2013 Progress Report summarizing the status of 

federal laws and programs serving an estimated 57 million Americans with disabilities, 

their families, and the diverse segments of the disability community, in fulfillment of 

NCD’s statutory mandate to annually report and make recommendations concerning the 

state of disability policy in the United States. Consistent with the tradition begun in NCD’s 

seminal report from 1986, Toward Independence: An Assessment of Federal Laws and 

Programs Affecting Persons with Disabilities, the 2013 Progress Report is derived from 

the diverse voices of the disability community, including interviews with knowledgeable 

consumers, advocates, and experts on disability programs, supports, and services from 

across the nation. 

The title, Strength in Our Differences, symbolizes the diversity of experiences and 

abilities within the US disability community, consistent with and reflective of the diversity 

of experiences and abilities among all Americans. Strength in Our Differences also 

represents the fact that as a nation we are stronger, and as a people we are more able 

to respond to the challenges in the ever-changing world that we share, because of our 

diversity.

This report consists of four chapters covering the major issues that Americans with 

disabilities face toward reaching a goal of full integration and participation in all aspects 

of life. The concepts of full integration and participation truly have become more 

achievable goals, since the concept of disability is increasingly understood as an everevolving interaction between people with physical, sensory, developmental, or 

psychological impairments and the attitudinal or environmental barriers that hinder their 

full and effective participation in society on an equal basis with others.

Chapter 1 leads the report with NCD’s strong recommendation that for the United States

to maintain its position as a world leader on civil rights, the Convention on the Rights of 

Persons with Disabilities must be ratified by this nation. Chapter 2 presents the status of 
12

economic empowerment for people with disabilities through a vision of self-determined 

employment in an integrated workforce with reasonable accommodations, equal pay, 

and opportunities for advancement, and further supported by access to quality 

educational opportunities, health care, and asset development. Chapter 3 reviews the 

current and shifting debate of health care in the United States, especially in light of 

further implementation of the Patient Protection and Affordable Care Act (ACA), as these 

initiatives present meaningful opportunities to resolve health disparities and lower or 

erase barriers to essential health care, wellness, and illness prevention for people with 

disabilities. 

Chapter 4 analyzes the remaining barriers to full participation for people with disabilities 

in the community, especially education, housing, transportation, voting, home- and 

community-based long-term services and supports, information and communications 

technology, and accessible currency. When barriers to civic inclusion are removed and 

people with disabilities are empowered to participate fully in the community, the entire 

community benefits. Viewed from this larger perspective, that equal opportunity and 

greater accessibility benefit society as a whole, NCD closes this report with focused 

recommendations for the President and Congress to consider and address in the months 

ahead.
13

CHAPTER ONE: RATIFICATION OF THE CONVENTION ON THE RIGHTS 

OF PERSONS WITH DISABILITIES 

NCD anticipates that the Senate may again consider ratification of the UN Convention on 

the Rights of Persons with Disabilities (CRPD) this year. NCD strongly supports 

ratification because the CRPD offers a vital framework for creating legislation and 

policies around the world that embrace the human rights and dignity of all people with 

disabilities. 

The CRPD1 is an international treaty that was inspired by the Americans with Disabilities 

Act (ADA) in recognizing the rights of people with disabilities across the globe. To date, 

156 countries have signed the treaty and 133 have ratified it.2 President Obama signed 

the treaty in 2009 and sent it to the Senate for ratification.3 Support for ratification by the 

United States comes from all corners of the country, including more than 600 disability 

organizations, 40 leading faith-based organizations, more than 20 veterans’ service 

organizations, and key leaders from the business community.4 More than a decade ago, 

NCD kicked off consideration by the US disability community of an international treaty by 

publishing a white paper titled “Understanding the Role of an International Convention on 

the Human Rights of People with Disabilities.”5 Since that time, NCD has been at the 

forefront, publishing numerous analyses and reports in support of the development, 

signature, ratification, and implementation of the disability treaty.

Ratification is critical to maintaining our global leadership role and taking the next step in 

helping eliminate discrimination throughout the world. With more than a decade of 

careful analysis of the CRPD and related discussions, and 35 years as a trusted expert 

in disability policy concerns, NCD is ready to provide advice and counsel to the Senate 

as it deliberates ratification. Once ratified, NCD will proudly work with partners to ensure 

that the United States has a strong voice in bringing the world closer to a time when all 

people with and without disabilities are treated equally.

When interviewed for this report, Rep. Tammy Duckworth—a former helicopter pilot in 

the Army who lost both legs and severely and permanently injured her right arm as a 
14

result of injuries received in combat—identified ratification of the CRPD as the most 

pressing issue for people with disabilities going into 2014. Ratification of the CRPD, said 

Representative Duckworth, 

would help guarantee access and protections for disabled persons worldwide—

the same protections that Americans earned under ADA in 1990. The Convention 

on the Rights of Persons with Disabilities will help millions of Americans gain the 

same rights overseas that they have at home.

Summary and Recommendation

In light of an increasingly global economy, and proliferating opportunities to travel, work, 

and live abroad to an unprecedented degree, ratification of the CRPD both reaffirms the

nation’s commitment to the principles of the ADA at home and extends these protections 

to Americans and others with disabilities abroad. NCD firmly recommends prompt 

ratification of the CRPD during the 113th Congress.
15

CHAPTER TWO: ECONOMIC EMPOWERMENT: EMPLOYMENT AND 

WORKFORCE PARTICIPATION 

Economic empowerment for people with disabilities—as defined similarly for other 

groups6—envisions economic independence arising from self-determined employment in 

an integrated workforce with reasonable accommodations, equal pay, and opportunities 

for advancement, and further supported by access to quality educational opportunities, 

health care, and asset development.

7

 This chapter focuses principally on employment 

and workforce participation. Other contributing factors to economic empowerment are 

discussed in Chapter 3 “Health Care and Access to Medical Treatment” and Chapter 4 

“Community Integration.” 

Employment plays many roles in the lives of individuals; employment provides 

income and contributes to financial security, it enables individuals to explore and 

grow their skills and potential, integrated employment supports community living, 

and, through competitive employment, individuals are taxpayers and may reduce 

use of public benefits over time. Persistent unemployment creates barriers to 

reaching these outcomes. 

– Nanette Relave, director of the Center for Workers with 

Disabilities at the American Human Service Association

People with disabilities encounter difficulties, challenges, and barriers that their peers 

without disabilities rarely experience when seeking employment, job retention, and 

promotion. Impediments to meaningful employment include concerns by potential 

employers and coworkers, and the influence of common misconceptions about what a 

person with a disability is capable of. These challenges also include attitudinal, 

environmental, and financial aspects of the workplace and often create barriers to selfsufficiency and inclusion. 

Hindered by an economy in recession, census data collected by the American 

Community Survey revealed that in 2011, an estimated 33.1 percent of people with 

disabilities (ages 18–64) were employed, compared with 73.2 percent of those without 

disabilities.

8

 Employed individuals with disabilities, ages 21–64, earned on average 

$36,700 per year compared with $42,800 of their peers without disabilities.9 
16

Employment numbers for Americans with disabilities have not changed much since 

passage of the ADA, which was intended to increase civil rights protections for millions of 

Americans with disabilities and to guarantee their equal opportunity in employment.10

The 40 percent chasm between the employment rates for Americans with and without 

disabilities is inarguably disparate and unacceptable. It should come as no surprise that 

the number one topic on the minds of those that NCD interviewed for the 2013 Progress 

Report was employment and workforce participation.

As the ADA quarter-century mark nears, continued improvement of the rate of employed 

Americans with disabilities remains a critical focus.

11 This 40 percent gap is a target for 

correction through government incentive programs, the elimination of stereotypical 

assumptions regarding costs and capabilities, and a concerted effort across the nation, 

in public and private sectors, to ensure full integration of workers with disabilities. This 

may be achieved with comprehensive, inclusive, and integrated employment, and full 

and fair opportunities and wages for every segment of American society. For the first 

time, a brighter future appears possible for American workers with disabilities. 

Annually, on behalf of all people with disabilities, the US Department of Labor’s (DOL’s)

Office of Disability Employment Policy (ODEP) selects a National Disability Employment 

Month theme to reflect that people with disabilities have the desire, education, training, 

and experience to be successful in the workplace.12 ODEP’s Assistant Secretary Kathy 

Martinez announced the October 2013 theme as “Because We Are EQUAL to the Task.” 

She also urged “all employers to benefit from the skills of workers with disabilities by 

giving them, including our returning veterans, a chance to show that they, too, are 

equal to the task.”13 

This chapter focuses on factors directly impacting employment and workplace 

participation; that is, a supported inclusive model of employment, workforce investment 

and the American Job Centers, tax credits and incentives to support people with 

disabilities in the workforce, federal employment initiatives, disability-owned business 
17

opportunities, attitudinal and workplace barriers, veterans’ employment rights, and 

initiatives of the National Governors Association.

Supported Employment 

Supported employment is a model of employment for the broad spectrum of people with 

physical, sensory, and psychosocial disabilities, and particularly with regard to 

intellectual and developmental disabilities. It occurs in integrated work settings at equal 

pay, and receiving natural supports from others in the work environment and/or from a 

job coach (as needed).14 A June 2013 article in the journal Inclusion provides a concise 

overview of continuing issues and needs: 

While supported employment has expanded little in the last decade, there is a 

renewed investment nationwide and in some other countries. The renewed 

developments include improvements in supported employment methods, interest 

in funding based on outcomes rather than services, concern about the persistence 

of segregated workshops, the need for qualified supported employment 

personnel, investment in Employment First policies in states, the emergence of 

litigation promoting integrated employment over segregation, renewed investment 

in transition, investments in other countries, and the increasingly clear voice of 

self-advocates with intellectual and developmental disabilities calling for 

community jobs and fair pay.

15 

Likewise, the August 2012 NCD report on Subminimum Wage and Supported 

Employment emphasized the need for increased benefits planning, work incentive 

counseling, peer support, notification of services, infrastructure, education systems 

change, enforcement, and phasing out of the Fair Labor Standards Act (FLSA) 14(c) 

subminimum wage program (which permits workers to be paid less than federal 

minimum wage in certain circumstances).

16

Approximately 420,000 workers with disabilities are employed under a 14(c) program.

17

Started in 1938 when Congress enacted federal minimum wage legislation,18 the 

program permits employers to pay workers less than minimum wage, based on the 

portion of work a given employee can perform in comparison to a typical employee.19

The initial intent of the 14(c) program was to employ people with disabilities, who due to 
18

disability could not perform at competitive levels. Over time, these employees were to be 

trained and demonstrate improvements in performance toward acquiring a greater 

proportion of the minimum wage, and for the majority to be transitioned into the 

competitive workforce.20 Unfortunately, only about 5 percent of all employees with 

disabilities in 14(c) sheltered workshop programs ever transition out.21

Nonetheless, NCD recognizes that “any statement of public policy or recommendation 

simply to eliminate all Section 14(c) certificates would jeopardize the livelihood and 

security of many individuals who are currently part of the program.”22 NCD thus 

recommends a phase-out of the 14(c) program over a period of six years, utilizing 

personalized employment programs and other outreach that facilitates and provides 

stability and support to those who have been in the program for a long time, recognition 

of the fact that it will take time to transition to a supported employment environment.23

Many states have resolved to implement “Employment First” policies that promote 

integrated employment with earnings at or above the minimum wage as the first option of 

service for individuals with intellectual and developmental disabilities.24 The state of 

Washington is a notable example where policy and practice have merged to establish 

integrated employment as the primary goal for all people with intellectual and 

developmental disabilities of working age. “In 2009, over 3,000 Washingtonians with 

developmental disabilities earned over $24 million in wages in integrated, individual 

community jobs.”25

In contrast, some parts of the nation have reversed course. On April 1, 2013, the US

Department of Justice (DOJ) joined a class-action lawsuit filed against Gov. John 

Kitzhaber and the state of Oregon, demanding changes to the state’s sheltered 

workshop system.26 The DOJ stated that 61 percent of Oregon residents with significant 

disabilities work in sheltered workshops, and that only 16 percent work at businesses 

with integrated workforces.27 As recently as the 1990s, Oregon was considered a 

national leader in providing workplace support. Since then, the number of Oregon 

residents in sheltered workshops has doubled to approximately 2,600.28
19

Finally, NCD’s February 2013 statement on sequestration called attention to several risk 

factors. The sequester places “tens of thousands of Americans with disabilities at greater 

risk for hunger and homelessness, endanger[s] the education of millions of children with 

disabilities and delay[s] employment services and disability benefits for scores of people 

with disabilities—including disabled veterans—who are, on average, already at greater 

risk of poverty.”29

Vocational Rehabilitation

While the [perception is the] Americans with Disabilities Act has given us a boost 

... In a wider range of employment in the private and public sectors, we still 

experience barriers—attitudinal, technological, financial, and educational that 

prevent us from getting jobs that match the training, education and work 

experience we have. ... We have some employers (or even some fellow 

employees) that still think we cannot do the jobs we are capable of doing. They 

choose not to change their mindset to give us the chance to succeed in the 

workplace or even move up the career ladder as managers or executives.

– Claude Stout, executive director for TDI 

(formerly known as Telecommunications

for the Deaf and Hard of Hearing, Inc.)

Established and authorized under the Rehabilitation Act, the public vocational 

rehabilitation (VR) program is the federal-state partnership that funds the primary service 

delivery system for assisting individuals with disabilities, particularly individuals with the 

most significant disabilities, to prepare for, obtain, or retain employment. Its focus is “to 

empower individuals with disabilities to maximize employment, economic self-sufficiency, 

independence, and inclusion and integration into society.”30

In 1998, the Rehabilitation Act was incorporated into the broader Workforce Investment 

Act (WIA) with the expectation that Congress would reauthorize this important legislation 

every five years. That has not happened despite bills that have been offered in previous 

Congressional sessions. The 113th Congress is again expected to consider WIA 

reauthorization with bills in the Senate and House. The Senate bill was developed with 
20 

bipartisan support and emphasizes high expectations and competitive integrated 

employment as the outcome for youth and adults with disabilities, with services to reflect 

21st century workforce needs.31 The proposed provisions also include the establishment 

of a new Independent Living Administration, separate from the Rehabilitation Services 

Administration and moved to the Administration on Community Living at the Department 

of Health and Human Services.32 As the legislation moves forward, NCD will play a role 

in assessing the impact of these and other proposed changes.

Each year, about 1 million individuals with disabilities are served by VR.33 For the first 

time in many years, fiscal year 2011 data (the most current information available) shows 

a modest increase (in comparison to the previous year) of 3.7 percent in the number of 

individuals who achieved a successful employment outcome.34 NCD recommends that

the Rehabilitation Services Administration (RSA) proactively seek stakeholder input and 

update VR program performance evaluation standards and indicators to reflect 21st 

century program expectations. 

Both professionals with disabilities, Kevin Irvine and Karen Tamley have a daughter 

with a disability. They emphasized lost opportunities and the importance of developing 

and supporting skills to help teens with disabilities transition to adulthood and become 

part of the workforce. These parents told NCD, 

There are wasted opportunities with all the thousands of young people in school 

with identified disabilities; and yet many of them (even if receiving transitional 

services) leave the educational system without basically having a résumé, or 

knowing how to create one, without having actual job experience, or an 

apprenticeship or structured employment or being involved in a job interview or 

receiving feedback from employers.

The lingering effects of the economic recession continue to affect many state VR 

programs. In fiscal year 2012, 16 of the 80 state VR programs relinquished a portion of 

their federal allotment of funds because they were unable to make the required 21.3

percent state match. A total of $143 million was relinquished.35 In addition, a total of 22 

states and territories did not meet their fiscal year 2011 maintenance of effort 
21

requirement, resulting in $42.6 million in penalty reductions taken from fiscal year 2012 

funds.36 NCD recommends that the Department of Education provide targeted technical 

assistance to states that continue to return significant portions of their federal allocation 

each year.

Regardless of the fiscal challenges, youth and adults with disabilities have a right to 

expect that the VR services they receive prepare them for the 21st century workplace, 

with the skills to compete in an increasingly global economy and to meet their career 

aspirations. Various strategies are demonstrating a positive return on investment and 

provide a sound foundation for further research, collaboration, and innovation.37

Using a significant portion of the fiscal year 2012 relinquished VR funds, the Department 

of Education is partnering with the Social Security Administration and the Departments of 

Health and Human Services and Labor on the PROMISE initiative.38 This joint initiative is 

designed to improve the education and employment outcomes of children receiving 

Supplemental Security Income program benefits and their families. The Obama

Administration has proposed similar uses of the funds in fiscal years 2013 and 2014.39 

The Wisconsin Vocational Rehabilitation Division is implementing a transition initiative

that emphasizes the positive impact of community-based, integrated, paid work at or 

above minimum wage prior to high school graduation. Wisconsin VR has instituted a 

statewide Youth On-the-Job Training (Y-OJT) initiative in which VR is providing up to 100 

percent of wages for up to 500 hours for high school students that qualify for VR.40

During federal fiscal year 2012, 1,443 students with disabilities participated in a Y-OJT or 

paid internship prior to high school graduation. The results tell the story—34 percent of 

Wisconsin VR’s successful employment outcomes for 2012 were for transition-age 

youth.41 

The Project SEARCH High School Transition program is a unique, business-led, oneyear school-to-work program that takes place entirely at the workplace.42 Total workplace 

immersion facilitates a seamless combination of classroom instruction, career 
22

exploration, and hands-on training through workplace rotations.

43 Started at Children’s 

Hospital in Cincinnati, Ohio, Project SEARCH workplace sites can be found in hospitals, 

county and Federal Government agencies, colleges, and banks.44 A recent Virginia 

Commonwealth University research study of Project SEARCH workplace sites shows 

that intensive internship training, in conjunction with an engaged business such as a 

hospital, can lead to high levels of competitive employment for youth with autism in areas 

such as cardiac care, wellness, ambulatory surgery, and pediatric intensive care units.45

Since 2009, the Southeast TACE (Technical Assistance and Continuing Education 

Center)46 has partnered with state VR agencies in their region to pilot and integrate 

innovative customized employment (CE) and asset development practices that positively 

affect employment and self-sufficiency outcomes for people with disabilities.47 CE has 

proven to be an effective strategy for providing integrated employment with equal pay for 

individuals with complex barriers to employment, including significant disabilities.48 CE 

begins by using a discovery process to identify the skills, abilities, and interests of the 

jobseeker and matching them to the unmet business needs of an employer by crafting a 

unique job designed specifically for the individual.49

NCD recommends that the Departments of Education, Labor, and Health and Human 

Services jointly collaborate on further research and demonstration projects that 

showcase evidence-based practices such as internships, work experiences, mentoring, 

and family engagement in ensuring more effective educational and employment 

outcomes for youth and adults with disabilities. 

Workforce Investment and American Job Centers

The US workforce investment system is “an integrated national ... system that supports 

economic growth and provides workers with the information, advice, job search 

assistance, supportive services, and training in demand industries and occupations 

needed to get and keep good jobs. [It] also helps employers acquire skilled workers.”50

The workforce investment system uses approximately 3,000 American Job Centers 
23

(AJCs) funded under the Workforce Investment Act, as well as other public and private 

entities that provide employment and related services to jobseekers with and without 

disabilities.51

The AJCs (previously known as Career One-Stop centers) provide jobseekers of all skill 

and experience levels access to a comprehensive range of services and tools in a single 

convenient location. Services commonly include career counseling and planning, 

education and training referrals, training on résumé building, job search strategies, 

interviewing skills and computer basics, job search assistance, connections to hiring 

employers, direct job placement, information about the labor market and unemployment 

compensation, and access to telephones, fax machines, computers, and copiers.52

Extending the reach of the workforce investment system, ODEP is working to increase 

successful, integrated employment outcomes and financial stability for people with 

disabilities through new capacity-building and employment initiatives throughout the

system. Both previous and current ODEP initiatives demonstrate that with capacitybuilding, training, and technical assistance, AJCs can serve a broad range of individuals 

with significant barriers to employment, including a disability.53

For instance, ODEP’s National Center on Leadership for the Employment and 

Advancement of People with Disabilities (LEAD)54 is working with many AJCs across the 

nation to implement a recently developed process of group discovery for jobseekers with 

and without disabilities and other barriers to employment.55 Group discovery allows AJCs 

to move individuals through the process in small groups rather than individually. The 

group discovery process can result in either wage or self-employment, which allows for 

more flexibility and increased productivity in deciding when and how work is performed in 

order to accommodate the needs of jobseekers with disabilities and to maximize 

potential placements.56 Group discovery further benefits AJCs by using staff time more 

efficiently. 
24

The LEAD Center also provides technical assistance to the AJCs on developing, 

promoting, and bringing to a national scale evidenced-based policies and innovative 

practices to improve service delivery. The policies and practices include CE, selfemployment, the use of workplace flexibility,57 and other strategies.58 Utilization of these 

and other interventions within the AJCs bolsters opportunities for youth and adults with 

disabilities to find and retain jobs. 

ODEP is also using AJCs to implement the Customized Employment Demonstration 

Initiative.59 These initiatives have shown that to fully meet the needs of jobseekers with 

disabilities, it is important for AJCs to partner with other agencies (both general as well 

as disability-specific) that provide employment-related services. Partnering better 

facilitates changes in the way decisions are made by leveraging policies and linking 

funding and services to facilitate improved collaboration.60 By coordinating resources 

and funding of partner agencies, an AJC can expand its menu of services to respond to 

the employment needs of jobseekers with disabilities in an individualized and 

comprehensive manner. 

Building on these initiatives, ODEP and DOL’s Employment and Training Administration 

(ETA) jointly fund the Disability Employment Initiative (DEI) for the purpose of 

“improv[ing] educational, training and employment outcomes of youth and adults with 

disabilities who are unemployed, underemployed and/or receiving Social Security 

disability benefits.”61 Through DEI, these agencies have awarded grants to 23 states to 

validate effective practices identified in previous DOL initiatives.62 

Among the practices being validated through the DEI are partnerships and collaborations 

between state agencies to coordinate policies and funding streams to support innovative 

AJC practices, self-employment supports, CE, and the youth-focused Guideposts for 

Success.

63 DEI has created the Promising Practices series containing “videos and 

information briefs ... [that] promote positive employment outcomes of people with 

disabilities.”

64 Topics address at-risk youth, subsidized employment opportunities for lowincome parents, re-employment strategies for current and former welfare recipients, and 
25

moving people with disabilities into state government careers, among other things.65

NCD recommends funded implementation of validated, successful DEI strategies, and 

funding for the validation of additional DEI strategies such as for partnerships and 

collaborations between state agencies, self-employment supports, customized 

employment, re-employment strategies, and moving people with disabilities into state 

government careers. 

On March 18, 2013, ODEP released its training and employment notice to announce the 

availability of “What’s My Next Move?”—a guide to exploring careers online using 

electronic tools from the DOL.

66 The guide supports high school students in developing

their education and career plans by walking them through seven steps of career 

inquiry.67 The toolkit information includes self-paced courses and resources for seeking 

additional help in workplace preparation.68 A corollary source is the “My Next Move” 

portal at http://www.mynextmove.org/. 

Amid these many initiatives, it is not evident that the workforce investment system has 

included benefits planning services for workers with disabilities and others who must 

carefully balance federal and state benefits with income or risk losing important supports 

such as Medicaid and personal assistance services.69 Chacku Mathai, Associate 

Executive Director of New York Association of Psychiatric Rehabilitation Services, 

emphasized that: 

[. . . the AJCs] should also include benefits advisement so that people can find 

out more information about how much they can earn to retain benefits.

The New York Makes Work Pay (NYMWP) project explains that “Benefits and Work 

Incentives Planning and Assistance [WIPA] is a critical employment support for 

individuals with disabilities who receive public entitlements.”70 NYMWP established 

seven WIPA programs in New York equipped to “provide work incentives planning and 

assistance; help beneficiaries and their families determine eligibility for Federal or State 

work incentives programs; refer beneficiaries with disabilities to appropriate Employment 

Networks or State VR agencies based on individual needs and impairment types;
26

provide general information about potential employer-based or federally subsidized 

health benefits coverage available to beneficiaries once they enter the workforce; and

inform beneficiaries with disabilities of further protection and advocacy services available 

to them.”71

NYMWP provides additional resources on “Self-Employment and the Benefits Planning 

Process”72 and “developed a Work Incentives Information Network to increase the 

number of certified benefits and work incentives specialists available statewide.”73 NCD 

recommends the inclusion of benefits planning as a component of the American Job 

Centers.

Tax Credits and Incentives

Current provisions in the federal tax code are available to support and incentivize 

employment for people with disabilities. These include: Household and Dependent Care 

tax credit, Impairment-related Work Expenses (IRWEs) tax deduction, Flexible Spending 

Arrangement (FSA) tax exclusion, and Dependent Care Assistance Program (DCAP) for 

workers with disabilities or with family members who have disabilities. The Disabled 

Access Credit was designed to encourage employers to hire workers with disabilities. 

This section examines Work Opportunity Tax Credit, American Taxpayer Relief Act of 

2012, and Expanded Tax Credit for Hiring Unemployed Veterans74 as well as statespecific provisions.

Household and Dependent Care is a “tax credit to assist household taxpayer to engage 

in gainful work while affording necessary care for a dependent. The credit is available for 

costs incurred to care for a family member so that another family member may work.”75

An IRWE is an “itemized tax deduction for workers with disabilities and family members, 

who incur disability-related costs in order to work. It covers attendant care services at the 

individual’s place of employment and other expenses in connection with employment.”76

An FSA is an “exclusion from taxable income of medical expenses not covered by 

employer’s insurance plan. The employee sets aside a predetermined amount from 
27

paycheck, which the employer uses to pay the employee’s non-covered costs.”77 The 

DCAP is an “exclusion from taxable income of up to $5,000 of qualifying costs for 

dependent care assistance” under an employer-elected DCAP that is made “available to 

employees with dependents who have disabilities.”78 

The Disabled Access Credit will “reimburse accommodation costs paid by small 

businesses that employ workers with disabilities and/or serve customers with disabilities. 

Costs include purchase and use of communication assistance and accommodations 

such as a Braille printer, voice recognition software, or large print emergency exit 

signage.”79 Though a significantly underutilized provision,80 the Disabled Access Credit

can be a valuable asset to small and medium-sized businesses in increasing 

employment opportunities for people with disabilities.

The Work Opportunity Tax Credit promotes the hiring of people who qualify as having 

barriers to employment, including veterans, VR referrals, and recipients of Temporary 

Assistance to Needy Families, the Supplemental Nutrition Assistance Program, and 

Supplemental Security Income.81 The American Taxpayer Relief Act of 2012 and the 

Expanded Tax Credit for Hiring Unemployed Veterans also positively affect the disability 

community.82 The expansion of tax credits to taxpaying employers and nonprofit 

organizations that hire veterans with service-connected disabilities acquired before 

January 2014 is a viable example of the commitment of the Obama Administration to 

American veterans, including those with disabilities.83

Tax incentives are also available on the state level. The New York State Department of 

Labor’s Economic Development Services offers the “Workers with Disabilities Tax 

Credit,” providing employers $2,100 for every person with a disability they hire.84 The 

Pennsylvania Department of Labor and Industry and the Department of Community and 

Economic Development provide grants to small businesses with 100 employees or fewer 

through the ICAN Fund administered by the state VR. The ICAN Fund provides grants of 

up to 80 percent of the total cost (up to $40,000) for small businesses to make workplace 
28

accommodations and site modifications, provide specialized or adapted machinery, or 

provide specialized training for employees with disabilities.85 

NCD recognizes there remain significant federal financial disincentives to employment 

impacting the disability community, often arising from competing purposes within federal 

statutes and agencies.86 In the August 2008 report, The State of 21st Century Financial 

Incentives for Americans with Disabilities, NCD explained, “No single agency or policy 

solution can produce the comprehensive reforms needed to align financial incentives that 

directly and indirectly will support the range of choices people with disabilities desire to 

be fully productive, independent, and active participants in the economic mainstream.”87

In 2008, NCD called for collaborative actions involving the Administration, Congress, and 

interagency partners to eliminate financial barriers and align financial incentives that 

support employment for greater numbers of people with disabilities.88 NCD again 

recommends that the President “create a federal interagency workgroup[89] on financial 

incentives for people with disabilities and their families; develop an Executive [O]rder 

calling for all agencies to identify policy barriers; and create a time-limited body to 

facilitate a consistent, coordinated, comprehensive, and consumer-friendly approach to 

advance opportunities for full community participation and economic self-sufficiency.”90

NCD further recommends that the federal interagency workgroup specify outcome-based 

tasks for each participating entity, which include developing a national awareness and 

technical assistance outreach campaign to raise public awareness of tax provisions that 

support employment opportunities for Americans with disabilities. NCD further 

recommends that the Internal Revenue Service report annually to the federal interagency 

workgroup on the number of individuals and businesses utilizing tax provisions that 

support employment opportunities for Americans with disabilities, the amount of tax 

credits and deductions claimed, and the numbers of workers that benefit. 
29

Federal Employment / Executive Order 13548

In July 2010, President Obama issued Executive Order 13548 with the goal of hiring 

100,000 people with disabilities in the federal workforce by 2015 and holding federal 

agencies accountable for their progress.91 In addition to re-establishing the goal 

originally set during the Clinton Administration, the Executive Order created specific 

deadlines and requirements of federal agencies to recruit, hire, train, and retain workers 

with disabilities.92 In fiscal year 2011, “people with disabilities composed 14.7 percent of 

newly hired, full-time, permanent federal employees. Almost 19,000 newly hired federal 

employees had a disability, reversing the long-term trend of a shrinking federal workforce 

with disabilities.”93 As of 2012, 11 percent of all federal employees identify as having 

disabilities.94 

On March 25, 2013, the Office of Personnel Management (OPM) published new final 

regulations to streamline the federal employment process for people with disabilities.

95

Federal civilian jobs are part of the competitive civil service workforce; however, OPM 

provides hiring authority to fast-track the filling of jobs in special or unusual 

circumstances.96 Under Schedule A, one of four such exceptions, the new regulations 

clarify that for temporary appointments, people with intellectual disabilities, severe 

physical disabilities, and psychiatric disabilities who apply for “excepted” federal jobs can 

be appointed without the burden of providing a third-party certification of readiness for 

temporary appointment.97 OPM explained that now “agencies have the option of giving 

individuals with disabilities, who do not have work, educational, or other relevant 

experience, a temporary appointment that will allow them to establish their job 

readiness.”98 Schedule A also permits hiring without posting and publicizing the 

position.99

These federal employment initiatives are positive trends that serve as an important 

model for state and local governments and all kinds and sizes of businesses across the 

nation.100
30

Disability-Owned Businesses

Entrepreneurs with disabilities have more opportunities in 2013 than ever before for selfemployment. Federal and state programs are increasing in number and reach to 

incentivize doing business with disability-owned businesses. Disability-owned 

businesses are well positioned to bid on federal contracts. Section 503 of the 

Rehabilitation Act of 1973 requires employers with federal contracts or subcontracts that 

exceed $10,000 to take affirmative action to hire, retain, and promote qualified 

individuals with disabilities.101 NCD supports modernization of the Section 503 

regulations including the proposed 7 percent utilization goal for employment of 

individuals with disabilities as a benchmark for each job group in a federal contractor’s 

workforce.102

The Small Business Administration (SBA; a federal agency) promotes business

ownership for people with disabilities as a means of creating work flexibility and financial 

stability. Though not directly involved in assisting people with disabilities to start or 

finance a small business, SBA has developed a list of resources on these topics and 

others. See: http://www.sba.gov/content/people-with-disabilities. 

State initiatives in support of disability-owned businesses are becoming more common. 

The Mississippi Capital Access Contract Loan Program “assists socially and 

economically disadvantaged businesses as designated by the U.S. Small Business Act 

by providing loans to borrowers with contracts with public entities who, for various 

reasons, might have difficulty in obtaining conventional loans.”103 Also, the Illinois 

Minority, Women, and Disabled Participation Loan Program for Minority / Women / 

Disabled / Veteran-Owned Businesses category is “designed to enable small businesses 

to obtain medium to long-term financing ... in the form of term loans, to help them grow 

and expand their businesses.”104

A highly successful alternative program facilitating small business ownership by veterans 

with disabilities is the Entrepreneurship Bootcamp for Veterans with Disabilities (EBV). 
31

EBV began at the Whitman School of Management at Syracuse University in 2007.

Since then, EBV has been expanded to seven other national business and management 

schools. EBV “offers cutting edge, experiential training in entrepreneurship and small 

business management to post-9/11 veterans with service-connected disabilities.”

105 EBV 

has graduated 618 veterans with disabilities since 2007.106 Among the training outcomes 

for these veterans, 16 percent are in the business planning stage, 65 percent have a 

current business venture in operation, 13 percent returned to school, and 5 percent are 

employed by someone else.107 Further, 91 percent of graduates use the EBV-TAP 

(technical assistance program), which provides ongoing, free access to experienced 

business mentors.

During NCD’s January 2013 quarterly meeting, Jill Houghton, executive director of the 

US Business Leadership Network (USBLN) confirmed that business-to-business 

networking is alive and well: “promoting disability inclusion in the workplace, in the 

marketplace, and in the supply chain.”108 Prompted by inquiries from IBM and Wal-Mart,

the USBLN set out to create a disability-owned business certification on par with those 

for businesses owned by women, veterans, and people of diverse racial/ethnic 

backgrounds. Ms. Houghton explained: 

Back in 2008, two corporations, IBM and Wal-Mart, came to the USBLN and they 

asked us why there wasn’t an entity out there that was certifying businesses as 

being 51 percent owned, operated, controlled, and managed by a person or 

people with disabilities. And the reason why they asked ... was because they 

were thinking seriously about beginning to include doing business with disabilityowned businesses in what’s called their supplier diversity program. It wasn’t 

something that the government said they had to do. It’s something that they 

believed made good business sense.109

In 2013, the USBLN has certified the first 40 disability-owned businesses, ranging in size 

and revenue from 1 to 80 employees and from $10,000 to $580 million, respectively. 

Presently, the USBLN has recruited 30 corporations including Ernst & Young, 

Walgreens, and OfficeMax, who recognize this certification and are doing business with 

disability-owned businesses.110 
32

NCD recommends that stakeholder dialogue focus on strategies for federal and state 

governments to implement preferred contractor programs for disability-owned 

businesses. The existing federal set-aside contracts using designated diversity factors 

(e.g., gender, race/ethnicity, veteran status) for identifying business ownership should be 

expanded specifically to include disability-owned business. NCD stands ready to engage 

as a facilitator with the US Business Leadership Network and federal partners starting 

with the Departments of Labor, Commerce, Health and Human Services, and Education 

and the Small Business Administration.

Attitudinal and Practice Barriers and Facilitators to Meaningful Employment

Among the greatest barriers to workplace success are unfavorable attitudes toward the 

employment of people with disabilities.111 Barriers may be linked to job applicants as well 

as potential employers. “A common and not unfounded fear that continues to be 

widespread is that disclosing a disability may lead to not being selected for a position or 

result in differential treatment in the workplace. Concerns also include lowered 

expectations, lack of respect, isolation from co-workers, decrease in job responsibility, 

and being passed over for promotion.”112 

Claude Stout, executive director for TDI (formally known as Telecommunications for the 

Deaf and Hard of Hearing, Inc.) expressed that unexamined attitudes and stereotypical 

assumptions are key barriers to employment. Just as innovative ideas can expand 

opportunities for aspiring workers without disabilities, a lack of understanding is often the 

most deciding factor in holding people back: 

While the [perception is the] Americans with Disabilities Act has given us a boost

... in a wider range of employment in the private and public sectors, we still 

experience barriers—attitudinal, technological, financial and educational that 

prevent us from getting jobs that match the training, education and work 

experience we have. ... We have some employers (or even some fellow 

employees) that still think we cannot do the jobs we are capable of doing. They 

choose not to change their mindset to give us the chance to succeed in the 

workplace or even move up the career ladder as managers or executives.
33

Michael Zelly, president of the Disability Network in Flint, Michigan, links a shift in 

attitude to a shift in results:

Educating employers of the benefits of hiring persons with disabilities is important.

Businesses need to discover that most people who are disabled are so thankful to 

be working that they work very hard and it rubs off on the other employees. 

Walgreens South Carolina distribution center of 600 employees has 40 percent 

workers with disabilities. Businesses need to align with state vocational 

rehabilitation agencies that have high expectations for their clients. VR agencies 

could collaborate with businesses like Walgreens in raising awareness of the 

benefits of hiring workers with disabilities.

Findings and recommendations from the Interagency Committee on Disability Research 

for changing employer and workplace attitudes include (1) exploring how the dynamics of 

corporate culture (espoused policies, everyday practices, and supervisor and coworker 

attitudes) influence the hiring, integration, and career advancement of people with 

disabilities;

113 (2) encouraging disability awareness and ADA and job accommodations 

training to improve managers’ attitudes toward people with disabilities; and (3) focusing 

on interventions at the senior management level that change company policies to include 

disability as part of the company’s diversity efforts.114 

Efforts to promote an inclusive workplace culture may have a long-term impact on 

employer hiring and retention practices that positively impact people with disabilities. 

Corporate culture research using large data sets acquired through surveys among 

Fortune 500 companies has made several key findings.115

When workers with disabilities experience the benefits of an inclusive culture, they 

are likely to be more satisfied with the job, and often [are] correspondingly more 

loyal and invested in the work product and performance. In addition, a disabilityinclusive culture often will provide positive results for overall employee satisfaction 

and productivity among workers with and without disabilities. This occurs because 

when an organization commits to equity, flexibility, and professional development 

for workers with disabilities, it frequently will generate more employer 

responsiveness to the individual capacities, health needs, or varying work 

preferences of employees who may not identify as people with disabilities. In 

other words, inclusive cultures promote healthy and functional organizational 

environments.

116
34

Additionally, “the quality of the relationship between management and employees with 

disability has been identified as a critical factor in developing an inclusive workplace 

culture.”117

means to draw attention to and debunk stereotypical assumptions about the capabilities, 

independence, and skill sets of people with disabilities.”

Providing inclusive culture training for middle managers “is a critical 

118 Moreover, an understanding 

of the role for inclusive workplace practices, and the resources available to implement 

them, can have a real impact on the cost of doing business. For further resources on 

implementing an inclusive workplace, see 

http://bbi.syr.edu/projects/Demand_Side_Models/Toolkit.html. 

NCD recommends that by March 3, 2014, the Departments of Labor, Commerce, and 

Education, and the Small Business Administration initiate dialogue with higher education 

and disability stakeholders, including the Association to Advance Collegiate Schools of 

Business and the Association of Higher Education and Disability, regarding the 

implementation of inclusive corporate culture coursework in business and management 

schools. Existing examples of inclusive corporate culture might serve as models for 

consideration during discussions.119 The intent is to equip the next generation of 

business leaders, employers, and managers with essential knowledge and skills for 

creating inclusive workplaces that hire, accommodate, pay, and promote individuals with 

disabilities at rates comparable to other traditionally underrepresented groups in the 

workforce. 

Andrew Phillips, policy attorney for the National Association of the Deaf, suggested that 

in order to remove barriers to employment and implement expanded use of appropriate 

accommodations, certain economic disincentives need to be removed. Although

centralized funding in the workplace has not gained consensus, this approach is being 

advocated in a variety of circles: 

 

The National Association of the Deaf recommends that businesses and 

governments centralize all funding of accommodations for employees with 

disabilities. When managers have to pay for the cost of accommodations out of 
35

their division budget there is a disincentive to hiring people with disabilities and 

especially those who need ongoing accommodations. When the accommodation 

funds are centralized and not a part of the division budget, managers and hiring 

officials are more likely to hire a person with a disability since there would be no 

economic disincentive within the division.

In a July 2012 Senate Committee on Health, Education, Labor, and Pensions report, the 

committee chair, Senator Tom Harkin, recalls positive responses to change by private 

employers and governors: “In April 2011, at a disability employment summit hosted by 

the US Chamber of Commerce and the US Business Leadership Network, I challenged 

the employer representatives in the room to work to increase the size of the disability 

workforce from under five million to six million by 2015. This goal was quickly endorsed 

by the US Chamber of Commerce. This private business endorsement in partnership 

with the President’s initiatives is the type of collaboration we need to move the needle on 

disability employment. Governors also have an important role to play in elevating this 

issue, which affects every state budget and every state’s economy.”

120 

In April 2013, the National Governors Association (NGA), a bipartisan organization 

composed of the governors of the 55 states, US territories, and commonwealths—which 

promotes state leadership, shares best practices, and seeks to speak with a collective 

voice on national policy—made a commitment to the employment of people with 

disabilities.

121 Delaware Gov. Jack Markell announced that the NGA will focus attention 

on boosting disability employment as a signature initiative for the duration of his 

chairmanship of the organization. During his one-year term as chair, Governor Markell 

promised to create a “blueprint for businesses and states that identifies best practices 

and outlines steps that can be put in place to increase economic opportunity and 

heighten awareness. It will provide governors and state policymakers with more policy 

options to assess the environment in their state and specific strategies designed to 

support this population. It doesn’t matter whether someone was born with additional 

challenges to face or—in the case of our wounded veterans, for example—acquired 

them later in life. There are so many people with disabilities who have the time, talent 

and desire to make meaningful contributions to interested employers. What matters is 
36

what they have to offer and the tremendous impact this will have on their overall wellbeing and on the bottom line of the businesses that employ them.” 

Veterans Employment

Federal law provides important protections for veterans with disabilities who are looking 

for jobs or are in the workplace. ADA Title I and the Uniformed Services Employment 

and Reemployment Rights Act (USERRA) protect veterans from employment 

discrimination. Title I, which is enforced by the US Equal Employment Opportunity 

Commission (EEOC), prohibits private and state and local government employers with 

15 or more employees from discriminating against individuals on the basis of 

disability.122 Under USERRA, service members who leave their civilian jobs for military 

service are permitted to perform their duties with the knowledge that they will be able to 

return to their jobs with the same pay, benefits, and status they would have attained had 

they not been away on duty. USERRA also prohibits employers from discriminating 

against these individuals in employment because of their military service.123

Ron Drach, president of Drach Consulting and founding board member of Wounded 

Warrior Project, stressed the importance of vocational rehabilitation and training for 

veterans with disabilities: 

Employment continues to be my primary concern for [people with disabilities] and 

wounded warriors and disabled veterans. We need a strong National employment 

policy that is all inclusive and avoids tokenism. ODEP is doing a great job in 

leading this effort. As part of that larger concern is the issue of training for careers 

that are in the civilian labor force and not provide training for non-existent jobs or

skill sets that might be nice to have but don’t lead to employment. We need a 

robust vocational rehabilitation program at the state and Veterans Affairs level. 

There is a critical skills shortage that contributes significantly to high 

unemployment and drop out of the labor force among PWD and wounded 

warriors.

The unemployment rate for all veterans “ages 18 and over in the civilian labor force”

124 is 

6.3 percent compared with 7.5 percent for nonveterans in the same group.125 However, 

the current unemployment rate of veterans of the wars in Afghanistan and Iraq is 7.2 
37

percent, compared with 4.9 percent for veterans of the first Gulf War. A slightly greater 

proportion of veterans of the first Gulf War (81.4 percent) are working or seeking a job, 

than veterans of the wars in Afghanistan and Iraq (79.7 percent).

126

Edwin J. Salau, a health services integrator in North Carolina and a veteran working 

with former service members, told NCD about the effects of stigma and attitudes on the 

employment of veterans: 

The most important issue is the hiring barrier facing combat veterans (“disabled” 

or otherwise), especially those who have multiple tours of duty. Hiring managers 

and HR professionals fear hiring veterans because of the stigma associated with 

psychiatric and neurotic diagnoses (whether real or perceived). Subjective 

evidence is prevalent in Google searches and casual browsing of all news media.

This is an insurmountable barrier because job applicants are seldom able to prove 

discrimination in these situations. This is the single most important public policy 

issue for Americans because the rejection resulting from such actions, coupled to 

the expected deterioration of the applicants’ optimism and self-worth, creates a 

generation of dependent, unemployed citizens who become perpetually disabled 

instead of gainfully employed and productive. Tie this “doom and gloom” scenario 

to the families directly involved, and it(s) not hard to see the impact on 

communities, nationwide.

Another concern for veterans is that although military pay is exempt under sequestration, 

cuts to other programs and services affecting the employment of veterans, including 

those with disabilities, place military families at risk. Programs such as TRICARE,127

tuition assistance, and family support are not exempt and do fall under sequestration.128

In support of working veterans and veteran spouses, NCD recommends that Congress 

enact a budget or bill to restore funding to the Army Community Service, Fleet and 

Family Support Centers, Airman and Family Service Centers, Marine Corps Community 

Services, Child Development Centers, and Child and Youth Services in order for them to 

provide counseling, financial advice, new parent support programs, survivor outreach, 

and victim advocate services.
38

Rory Cooper, distinguished professor of the Department of Rehabilitation Science and 

Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, 

illustrates a comprehensive approach to finding solutions to improve outcomes for all 

people with disabilities: 

Without employment people with disabilities will continue to have limited voice in 

government, the economy, and in their communities. Further, employment 

provides economic freedom which leads to far greater autonomy. ... This is a 

complex problem, but progress can be made. State vocational rehabilitation 

agencies need to be more focused on helping people with disabilities gain and 

retain employment. Rehabilitation counselors need to be better trained in assistive 

technology to promote employment. State and Federal governments need to hire 

more people with disabilities, and require government contractors to hire [people]

with disabilities. The Department of Justice needs to be more aggressive about 

ADA compliance in the workplace. Programs are needed to help people with 

disabilities learn jobs skills and successful workplace behavior. More grants are 

needed to fund college, especially in STEM fields. Public sector has to hire people 

with disabilities and promote them. There should be real incentives to do so. 

Government needs to identify and publicize successful people with disabilities 

who are working and their employers such as ODEP is doing. More research is 

needed to identify barriers and facilitators to employment.

Summary and Recommendations

As emphasized by the interviews conducted for this Progress Report, employment is the 

key to lifting millions out of poverty, and achieving fulfillment, independence, and 

success for Americans with disabilities who desire to be part of the American dream.129

Among the benefits to Americans with disabilities, their families, and the nation are full 

and fair employment opportunities and advancement, clear participation in the 

marketplace as contributing workers and consumers, enriched education, life comforts, 

civic participation, and full integration into the fabric of American society. 

Despite significant progress in several areas, including a move away from segregated 

employment and an increase in federal hiring, numerous barriers continue to limit full 

inclusion and participation of most Americans with disabilities in the workforce. NCD 

makes the following recommendations. 
39

• 2.1 NCD recommends that the Department of Labor begin a phase-out the FLSA 

14(c) program over a period of six years, using personalized employment 

programs and other outreach that facilitates and provides stability and support to

those who are or have been in the program for a long time and who will need time 

to transition to a supported employment environment.

• 2.2 NCD recommends that RSA proactively seek stakeholder input and update 

VR program performance evaluation standards and indicators to reflect 21st 

century program expectations by December 31, 2015. Specifically, NCD 

recommends increasing the federally required minimum expectation related to the 

successful rehabilitation rate (reflecting the rate of successful employment plans 

completed, compared with the rate of employment plans initiated) from 55.8

percent to 80 percent.

• 2.3 NCD recommends that the Department of Education provide targeted 

technical assistance to those states that continue to return significant portions of 

their federal VR allocation each year.

• 2.4 NCD recommends that the Departments of Education, Labor, and Health and 

Human Services jointly collaborate on further research and demonstration 

projects that showcase evidence-based practices such as internships, work 

experiences, mentoring, and family engagement in ensuring more effective 

education, transition, and employment outcomes for youth and adults with 

disabilities.

• 2.5 NCD recommends the Department of Labor fund implementation of validated, 

successful Disability Employment Initiative strategies, and fund the validation of 

additional DEI strategies such as partnerships and collaborations between state 

agencies, self-employment supports, customized employment, re-employment 

strategies, and moving people with disabilities into state government careers.

• 2.6 NCD recommends the inclusion of benefits planning as a component of the 

American Job Centers.

• 2.7 NCD recommends that by January 1, 2014, the President create a federal 

interagency workgroup on financial incentives for people with disabilities and their 

families; develop an Executive Order calling for all agencies to identify policy 
40

barriers; and create a time-limited body to facilitate a consistent, coordinated, 

comprehensive, and consumer-friendly approach to advance opportunities for full 

community participation and economic self-sufficiency.

• 2.8 NCD recommends that the federal interagency workgroup specify outcomebased tasks for each participating entity, which include developing a national 

awareness and technical assistance outreach campaign to raise public awareness 

of tax provisions that support employment opportunities for Americans with 

disabilities. 

• 2.9 NCD recommends that the Internal Revenue Service report annually to the 

federal interagency workgroup on the number of individuals and businesses 

utilizing tax provisions that support employment opportunities for Americans with 

disabilities, the amount of tax credits and deductions claimed, and the numbers of 

workers that benefit.

• 2.10 NCD recommends that stakeholder dialogue focus on strategies for federal 

and state governments to implement preferred contractor programs for disabilityowned businesses. The existing federal set-aside contracts using designated 

diversity factors (e.g., gender, race/ethnicity, veteran status) for identifying 

business ownership should be expanded specifically to include disability-owned 

business. NCD stands ready to engage as a facilitator with the US Business 

Leadership Network and federal partners starting with the Departments of Labor, 

Commerce, Health and Human Services, and Education and the Small Business 

Administration.

• 2.11 NCD recommends that by March 3, 2014, the Departments of Labor, 

Commerce, and Education, and the Small Business Administration initiate

dialogue with higher education and disability stakeholders, including the 

Association to Advance Collegiate Schools of Business and the Association of 

Higher Education and Disability, regarding the implementation of inclusive 

corporate culture coursework in business and management schools.

• 2.12 In support of working veterans and veteran spouses, NCD recommends that

Congress enact a budget or bill to restore funding by June 30, 2014, to the Army 

Community Service, Fleet and Family Support Centers, Airman and Family 
41

Service Centers, Marine Corps Community Services, Child Development Centers, 

and Child and Youth Services in order for them to provide counseling, financial 

advice, new parent support programs, survivor outreach, and victim advocate 

services.
42
43

CHAPTER THREE: HEALTH CARE AND ACCESS TO MEDICAL 

TREATMENT 

People with disabilities experience both health disparities and specific problems in 

gaining access to appropriate health care, including wellness and illness prevention 

programs and services.130 Compared with peers without disabilities, Americans with 

disabilities frequently lack either health insurance or coverage for essential services like 

specialty care, long-term care, services coordination, prescription medications, durable 

medical equipment, and assistive technologies.131 People with disabilities therefore tend 

to be in poorer health and use health care at a significantly higher rate than those without 

disabilities.132 They also experience a higher prevalence of secondary conditions and 

use preventive services at a lower rate than those without disabilities.

133

People with disabilities are affected disproportionately by barriers to services that 

prevent them from accessing appropriate, timely, preventative, and affordable health 

care. These barriers include employer practices,134 health care provider stereotypes 

about disability, lack of appropriate health provider training, lack of access to medical 

care and information,135 lack of accessible medical facilities and examination equipment, 

and lack of access to sign language interpretation and other crucial individualized 

accommodations.136

For instance, people with disabilities often question whether their potential employer will 

offer an insurance package that meets their needs. Betsy Barkley Valnes, independent 

contractor and executive director of the National Youth Leadership Network, offered this 

perspective: 

More and more employers are offering positions just under the number of hours 

in which a benefits package would be provided, part-time positions rather than 

full-time or contract positions with no benefits included, for example. While 

limitations such as these, in part, may be related to budget shortfalls, the number 

of jobs that people with disabilities would be inclined to apply for because of the 

dependence on coverage would be limited nonetheless. 
44

Furthermore, people with hidden disabilities often experience additional barriers to health 

care arising from public stigma toward their conditions, including those with mental 

health and chemical sensitivity impairments.137 

Mary Lamielle, executive director of the National Center for Environmental Health 

Strategies, who has worked for over three decades to protect public health and improve 

the lives of people who have been affected by chemical and environmental exposures, 

explained the attitudes that create barriers and hinder implementation of more inclusive 

policies: 

People with chemical and electrical sensitivities are frequently not treated with 

respect. They are not understood. ... They frequently face discrimination whether 

at work, at school, in the community, in their families. They are mocked, ridiculed 

and face active and subtle harassment every day that keeps them from 

conducting anything that might be considered a “normal” lifestyle. People with 

these hidden disabilities have reported hostility or discrimination from being 

intentionally exposed to pesticides, perfumes, air fresheners, or deodorizers; to 

being taunted by neighbors, coworkers or family members—you mean we can’t 

spray a pesticide here?

Additionally, federal health care funding agencies such as the Centers for Medicare & 

Medicaid Services (CMS) neither conduct oversight of ADA architectural and 

programmatic accessibility compliance by states, health plans, and medical providers, 

nor assess health providers’ disability cultural competence. Few professional health care

training programs have disability as part of their curricula, and most federally funded 

health disparity research does not recognize or include people with disabilities as a 

distinct population.138 For instance, Teresa Pichardo, a member of the National Youth 

Leadership Network’s Volunteer Team and a person who is deaf, explains: 

Doctors and hospitals need to have a better understanding and incentive to 

provide interpreters for deaf and hearing impaired people at medical 

appointments.

These challenges affect overall quality of life, productivity and well-being of greater 

numbers of Americans as the general population ages, and veterans with disabilities 
45

returning to civilian life—logically increasing the number of people with disabilities.139

Given these challenges, it is especially important to understand the complex and 

interrelated factors that contribute to health and health care inequities for people with 

disabilities, and to identify practical solutions.

Kathleen Downes, a University of Illinois Community Health student at the California 

Foundation for Independent Living, expressed the need for greater awareness among 

the general population of the health care needs of people with disabilities. 

Disabled people have been vocal about healthcare concerns especially during the 

election season and that’s a good beginning, but we sometimes forget that the 

non-disabled population needs to be better educated about how healthcare 

legislation affects us all. The exclusion of personal care services from coverage 

threatens independent and community living options. Anyone could become 

disabled themselves at any time and we need to plan for it now. The notion that 

“this doesn’t concern me” is an illusion that no one can afford, personally or 

socially. Short term solutions that haven’t been properly thought through can 

cause serious—maybe irreversible long term damage. It is better to avoid a 

problem than to repair something later. 

This chapter reviews the status of health care services for people with disabilities, as the 

nation enters into a new era of care under the Patient Protection and Affordable Care Act 

and increasing Medicaid managed care. Analysis of services and challenges in providing 

mental health care and health care for veterans are areas of separate attention. 

Patient Protection and Affordable Care Act 

In the March 19–20, 2013, newsletter from the Department of Health and Human 

Services (HHS), Secretary Kathleen Sebelius wrote: “Enacted three years ago, the 

health care law is making the insurance market work better for you by prohibiting some 

of the worst insurance industry practices that have kept affordable health coverage out of 

reach for millions of Americans.”140 

Starting in 2014, the ACA guarantees that all Americans (regardless of their health status 

or preexisting conditions) finally will have access to quality, affordable health care 
46

coverage. Open enrollment to choose among a selection of these health plans begins on 

October 1, 2013, and coverage begins January 1, 2014.141 Nonetheless, many people 

with disabilities are confused or have concerns about the changes to public and private 

health care. Amy Doherty, currently serving as the president of the National Youth 

Leadership Network Governing Board, expressed the kinds of concerns many people 

share about health care reform: 

People with disabilities need to be involved in the transformation discussions that 

affect their lives, but it is difficult to understand all the ins and outs of healthcare 

reform. It is complicated and has not been explained clearly enough. There are so 

many agencies involved, state and federal regulations, qualifications and 

requirements to digest. People are expected to understand the changes but many 

lack opportunities for access to resources to learn more.

Few resources for understanding the complexity of the new health care provisions are 

simple. The Kaiser Family Foundation provides a useful and balanced overview of the 

changes with their seven-minute, close-captioned video, “The YouToons Get Ready for 

Obamacare: Health Insurance Changes Coming Your Way Under the Affordable Care 

Act” (see http://kff.org/health-reform/video/youtoons-obamacare-video/). 

The ACA promises new benefits and improved health care services that will have a 

direct impact on the disability community. These include the lifting of lifetime caps, 

elimination of preexisting condition exclusions, preventative care for seniors, punitive 

actions against hospitals for “rebounding” senior admissions, more people covered by 

Medicaid managed care, and additional services for people with mental health 

conditions.142 

Beginning January 1, 2014, the ACA requires all individual plans (for those who are not 

eligible for a group plan or public program), small group plans (businesses with up to 50 

or 100 employees, varies by states),143 and large employer plans (more than 50)144 to

limit consumers’ out-of-pocket costs and provide a set of essential benefits.145 The ACA 

defines “employee” for the purpose of determining employer requirement, as any fulltime equivalent (130 hours/month) employee.146 Essential benefits include ambulatory 
47

patient services (e.g., doctor’s visits, outpatient services), emergency services, 

hospitalization, maternity and newborn care, mental health and substance use disorder 

services (including behavioral health treatment, prescription drugs, rehabilitative and 

habilitative services and devices), laboratory services, preventive and wellness services 

and chronic disease management, pediatric services, and oral and vision care.147 The 

essential benefits guarantee a minimum of services that also specifically benefit all 

people with disabilities to not delay seeking treatment and to proactively avoid 

unnecessary exacerbations of conditions.

Further, all plans are prohibited from imposing lifetime or annual benefit limits, and must 

cover adult children until age 26.

148 All plans except self-insured plans “must provide 

rebates to consumers if the percentage of premiums spent on medical services falls 

below 85 percent for large group plans or 80 percent for small group and individual 

plans. ...”149 All plans, except those grandfathered in, are prohibited from having 

copayments and deductibles for some preventive services, “from requiring a referral to 

see an OB-GYN and from requiring prior authorization or higher cost sharing for out-ofnetwork emergency services.”150 Out-of-pocket expenses must be limited to $6,400

(single coverage) and $12,800 (family coverage).151 Small group exchange plans and 

new employer-sponsored plans “must limit deductibles to $2,000 for single coverage and 

$4,000 for family coverage.”152 People without employer health plans will be required to 

have an individual plan that provides all essential benefits through either a market 

exchange plan or government-sponsored program (e.g., Medicaid, CHIP, and 

TRICARE).153 These benefits are extremely valuable to many Americans with 

disabilities, who previously have been denied health care due to a preexisting condition 

or because they could not afford the plans that permitted preexisting conditions, or who 

have declined treatments or received incomplete treatments due to annual and lifetime 

caps. 

The US Supreme Court’s decision in National Federation of Independent Business v. 

Sebelius upheld the ACA’s individual mandate—that is, that everyone will be required to 

have health insurance, lest they be subject to a fine in the form of a tax.154 However, the 
48

Court struck down the provision that threatened to cut all of a state’s Medicaid funding if 

it refused to expand Medicaid to a wider range of low-income adult Americans (i.e., living 

with incomes between 100 and 138 percent of the federal poverty level), many with 

disabilities. The Court left in place the expansion of Medicaid to a wider range of lowincome children (ages 6 to 18).155 The Court’s decision also did not impact the ACA’s 

new options for states “to provide home and community-based long-term services and 

supports for people with disabilities,” and “to coordinate care for people with chronic 

conditions.”156

NCD recommends that CMS and HHS develop short, closed-captioned informational 

videos (with text transcript and MP3) using visual representations and a low reading 

level, on a variety of topics, addressing the opportunities and challenges of the ACA for 

people with disabilities.

Regarding adults in states that do not expand Medicaid coverage to 138 percent, there 

will be an unintended gap in coverage under the ACA.157 However, the ACA does 

provide tax credits and cost-sharing reductions for people with household income 

between 100 and 400 percent of the federal poverty level in order to buy qualified health 

plans on the insurance exchanges.158 When the new health insurance marketplace

begins open enrollment October 1, 2013, at present count 25 states will open their own 

exchanges, and the Federal Government will be operating exchanges for all others.159 In 

contrast, 28 states presently are moving toward expanding coverage to adults up to the 

138 percent of the federal poverty rate.

160

NCD recommends that CMS and affiliates within HHS implement a public awareness 

campaign. The purpose will be to provide simple and accurate explanations about the 

benefits of state implementation of expanded Medicaid coverage in nonparticipating 

states. 
49

Medicaid Managed Care

As the numbers of people with disabilities in the United States have steadily increased

over the past two decades, so have the number of individuals enrolled in Medicaid 

managed care plans.161 Today, more than two-thirds of the 70 million Medicaid 

beneficiaries receive at least a portion of their services through a managed care plan.162

In addition, the number of states using Medicaid managed care for long-term services 

and supports (LTSS) jumped “from 8 in 2004 to 16 in 2012.”

163 This acceleration in 

Medicaid managed care is attributed to three factors: anticipated Medicaid expansion in 

2014 under the ACA, the economic recession and state budget shortfalls, and “the need 

to control outlays on behalf of the most expensive segment of the Medicaid population—

seniors and people with chronic diseases and disabilities.”164 

Until recently, the vast majority of Medicaid managed care enrollees had been 

comparatively healthy children and working-age adults.165 NCD recently reported that 

more than half of US states are now enrolling senior citizens and people with disabilities, 

as well as children with specialized medical needs, in Medicaid managed care plans.166

A growing number of states also are offering dental care, behavioral health care, 

transportation, and pharmacy services through managed care plans.167 These increases, 

though beneficial to many Americans with disabilities, are placing further strain on 

already limited state budgets.168

One common concern with implementation of the ACA is the bureaucracy being built 

around changes to Medicaid Managed Care. Bob Harris, president of CLASS in 

Massachusetts, an organization that serves 400 people with developmental and 

intellectual disabilities, described it this way: 

Private insurers will be totally overseeing long-term care, including healthcare, 

such as day habilitation (a long-term Medicaid-funded program) for people with 

intellectual disabilities. ... Insurers do not necessarily understand the nature and 

importance of how to fund, think and provide services for people with 

developmental and intellectual disabilities. ... Potential benefits in healthcare 
50

coordination for people with developmental and intellectual disabilities exist, but 

there needs to be better clarification of the process. 

Specifically, stakeholders and their families are concerned about proposed changes in 

state Medicaid systems that may detrimentally affect the quality and availability of 

LTSS.

169 Information often is overwhelming or scarce, and people are frightened by what 

changes might mean to them personally.

170 

In a July 3, 2013, letter to Dr. Bruce Chernof, chair of the Federal Commission on LongTerm Care, NCD expressed concern about the lack of a coherent national LTSS public 

policy for all people with disabilities, the absence of a “single federal or Congressional 

program or committee responsible for LTSS management, funding, and oversight; 

fragmented and uneven nature of LTSS; absence of a single community point of access 

to LTSS for individuals with disabilities and seniors; and no clear portability across 

states.”171

NCD recognizes that managed care implementation systems have the potential to “lead 

to important efficiencies in the delivery and financing of health care services,” and to 

create a pathway toward higher-quality services and more predictable costs, but only if 

service delivery policies are well designed and effectively implemented.172 Cost savings

may vary.

173

Managed care requires the state Medicaid agency to robustly engage with people with 

disabilities, family members, and provider networks. To ensure accountability, states 

must work in conjunction with the stakeholder community to develop quality measures 

relating to outcomes desired by home- and community-based services (HCBS) 

programs. To date, most quality measures used in managed care demonstrations have 

focused on acute care outcomes, rather than those relating to LTSS.174 The National 

Quality Forum has the lead responsibility for endorsing health care quality measures.

175

Among the more than 1,500 measures approved to date, only a handful are related to 

disability services; they are related to behavioral health and early childhood 

development.176 The lack of quality measurement for LTSS may severely affect the most 
51

vulnerable members of the disability community. NCD urges CMS to prioritize this issue 

within the context of its reviews of managed care waiver and demonstration requests.

NCD recognizes there are substantial concerns in the disability and aging communities 

regarding DOL’s proposed changes to the Companionship Exemption to overtime 

compensation under the Fair Labor Standards Act. Working in concert with the broad 

disability community, service providers, and DOL including ODEP, NCD facilitated 

meetings and discussion around this subject in August 2012 and January 2013. NCD 

recommends that the Office of Management and Budget (OMB) re-engage in further 

discussion in order to fairly balance the important and complex needs of both the service 

providers and the disability and aging communities, before proceeding with the final 

steps of the proposed rulemaking process affecting the Companionship Exemption.

177

NCD welcomes dialogue with the disability community, service providers, and OMB on 

these issues. 

Mental Health Care 

The United States is awakening to the realization that the infrastructure that maintains 

mental health services is in need of modernization. Stigma toward people with mental 

health impairments is commonplace,178 and the overall shortage of quality mental health 

services to meet the needs of middle-aged Americans enduring the nation’s slow 

economic recovery, people with more serious mental illness,179 service members, and 

veterans is pervasive.180 Progressively, the ACA will require all plans to include mental 

and behavioral health care.181

On June 3, 2013, NCD participated in a National Conference on Mental Health at the 

White House. The event brought together stakeholders from around the nation, including 

mental health advocates, educators, health care providers, faith leaders, members of 

Congress, representatives from local governments, and individuals who have dealt with 

mental health challenges. The focus of the conference was to discuss how to 

collaboratively reduce stigma and help the millions of Americans struggling with mental 
52

health issues recognize the value of reaching out for assistance.182 The President 

opened the proceedings stating: “The brain is a body part too; we just know less about it. 

And there should be no shame in discussing or seeking help for treatable illnesses that 

affect too many people that we love. We’ve got to get rid of that embarrassment; we’ve 

got to get rid of that stigma.”183

Health care reform has been overshadowed by public and political responses to the 

tragic gun incidents in Connecticut and Colorado over the past year. There is great 

concern in the mental health advocacy and treatment fields “about the tendency to link 

mental illness and violence and about the further stigmatizing of people who have a 

psychiatric diagnosis.”

184 Critical information that Americans with mental health 

disabilities are members of the larger community, who, with access, attention, and 

treatment, pose no greater threat to the community than any other segment of society, 

was the core message of a January 2013 NCD letter to Vice President Biden and his

Task Force on Gun Control and Violence.185 NCD affirmed its support for and 

recommended improved availability, quality, and affordability of mental health services 

and supports: “The principal challenge is that access to mental health services is already 

compromised by deep and enduring stigma about seeking and receiving mental health 

treatment. ... A basic fact endures: people with psychiatric disabilities are more often the 

victims of violence than they are the perpetrators of violence. We must recognize the risk 

of increasing one type of violence while we seek to reduce another type. ... [P]ilot 

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 Taskforce to advance policy 

recommendations in line with these models and the principles undergirding them.”186

Furthermore, President Obama’s 2013 plan to improve school environments includes 

quality coverage of mental health treatment, particularly for young people, but with 

recognition of the unfounded public fear of people with mental health impairments.

Recently, the White House explained: “Though the vast majority of Americans with a 

mental illness are not violent, we need to do more to identify mental health issues early 
53

and help individuals get the treatment they need before dangerous situations develop. 

As President Obama has said, ‘We are going to need to work on making access to 

mental health care as easy as access to a gun.’ The Administration is proposing steps to 

identify mental health issues early and help individuals get the treatment they need 

before these dangerous situations develop.”187 The Administration is calling on Congress 

to help schools hire up to 1,000 more school resource officers, school psychologists, 

social workers, and counselors, as well as make other investments in school safety. We 

also need to make sure every school has a comprehensive emergency management 

plan so they are prepared to respond to situations like mass shootings. In addition, the 

Administration is proposing to help 8,000 schools put in place proven strategies to 

prevent violence and improve school climate by reducing bullying, drug abuse, violence, 

and other problem behaviors.

188

Though there has been growing awareness of the impact of stigma on access to 

services, greater attention is needed on the availability of quality services. A May 2013

report from the Centers for Disease Control and Prevention (CDC) found that suicide 

rates in the general population have surpassed motor vehicle accident deaths, and have

increased to record highs among white Americans ages 35 to 64.189 Dr. Ileana Arias, 

CDC deputy director, “noted that the higher suicide rates might be due to a series of life 

and financial circumstances that are unique to the baby boomers. Men and women in 

that age group are often coping with the added stress of caring for aging parents while 

still providing financial and emotional support to adult children.”190 Another factor 

contributing to this increase has been a sharp rise in overdoses of prescription painkillers 

among women ages 45 to 54.191 

The nation has significant shortages in specialized mental health services, “communitybased services, including mobile crisis services and peer supports” for people with 

serious mental illnesses.192 This profound deficiency “means that these services are 

often available only to people who are in immediate crisis and who have already endured 

multiple hospitalizations.”193 The National Alliance on Mental Illness (NAMI), in its 

“Grading the States 2009” report card, in part, found (1) states insufficiently address 
54

wellness and survival for people with serious mental illness; (2) public health insurance

plans are inadequate for meeting the needs of people with serious mental illness(es); (3) 

private insurance plans often provide insufficient coverage for mental health and 

substance use disorders; and (4) most states lack plans for developing or maintaining 

the mental health workforce, critical data on mental health services, access to 

information for the general public, and long-term housing for people with serious mental 

illnesses.

194 

NCD recommends HHS’s Substance Abuse and Mental Health Services Administration 

(SAMHSA) invest in and award “system of care” expansion grants to improve the

availability, quality, and affordability of community mental health services, mobile crisis 

services, housing, and peer supports for people with serious mental illnesses, and to

extend mental health preventative and maintenance care access and options for the 

general population. 

Improved services and changes to state law are needed to prevent inappropriate 

involuntary commitment. In the often misunderstood area of psychiatric disability, Tina 

Minkowitz, president and founder of the Center for the Human Rights of Users and 

Survivors of Psychiatry and blogger on the “Mad in America” Web site, detailed what 

happens to underserved communities and people with disabilities who “fall through the 

cracks”: 

Efforts to end involuntary commitment and forced mental health treatment are not 

getting better. States adding outpatient commitment laws suggest that in many 

ways things are getting worse. The United Nations Special Rapporteur on Torture 

has called for an absolute ban on nonconsensual psychiatric interventions, and 

there is abundant evidence of the harm done by these practices. There are 

numerous alternatives to the medical model of mental health, including Soteria, 

Intentional Peer Support, and the Eindhoven model which is based on Family 

Group Conferencing. Resources need to be shifted to make these human rightscompliant models widely and commonly available; and we need to repeal laws 

that allow psychiatrists to incarcerate people and force them to take toxic drugs 

against their will.
55

NCD further recommends SAMHSA, the Task Force on Gun Control and Violence, and 

stakeholders with disabilities including NAMI, develop a joint policy statement addressing 

the issues of gun violence, involuntary commitment, forced mental health treatment, and 

others, which balances the individual freedoms and civil rights of people with 

psychosocial disabilities with society’s obligation and responsibility to protect all people. 

Health Care for Veterans

The significant issues of health care for veterans presently overlap substantially with the 

mental health issues of the general public. However, because veterans ordinarily receive 

health care services from public veteran-specific programs195—how their health 

requirements are being met merits unique attention. Most veterans and their families 

receive health services from the Department of Veteran’s Affairs (VA) or under the 

Department of Defense’s (DOD’s) TRICARE managed health care program.196

Nationwide, 1 in 10 veterans under the age of 65 (1.3 million), however, does not have 

health insurance coverage.

197 One reason for this is that VA services are available only 

through VA providers, which are concentrated in urban areas and often are a great 

distance from veterans in rural communities.198

The ACA may provide coverage for many of these veterans who otherwise are uninsured 

or cannot avail themselves of VA services without health insurance.

199 A 2013 study 

from the Robert Wood Johnson Foundation concluded that approximately “535,000 

uninsured veterans ... could be eligible for Medicaid under the ACA if their state 

participates in the Medicaid expansion.”

200 An eligible 174,000 spouses and 78,000 

children of veterans may also qualify.201

Another access barrier to health care for veterans is the VA initial claims backlog. 

Lengthy waiting periods for VA decisions and ratings result in veterans delaying 

decisions about their health care, declining physical and mental health status, or being 

denied benefits in the absence of any decision.

202 DOD and VA have a lot of critical 

health information to communicate to one another, because of the substantial overlap 
56

between TRICARE and VA services. Though they recognize the long-overdue need for a 

single electronic health record system, the two agencies have not been able commit to a 

system capable of handling integrated information needs.203 NCD recommends that the 

President direct deliberate coordination and collaboration among the Departments of 

Defense and Veterans Affairs, and other relevant federal agencies, to implement a 

superstructure of secure, private, online information sharing for all veterans’ health and 

benefit records—for the efficient provision and processing of each veteran’s health care 

needs and to end the backlog of veterans’ claims.

To date, the TRICARE and VA systems have been called upon to treat and manage the 

health care of 1.6 million veterans who served in Afghanistan or Iraq, and who are 

returning to civilian life with hearing and vision loss, mobility impairments, traumatic brain 

injury (TBI), post-traumatic stress disorder (PTSD), depression, anxiety disorder, and 

alcohol and substance abuse disorders. Rates for these injuries tend to be higher than in 

previous wars, primarily due to advances in lifesaving medical emergency treatments 

and improved equipment (e.g., protective body armor), which contribute to improved 

survival rates.204 Hearing loss and PTSD are the top two disabilities in this population.205

There have been high rates of vision impairments often simultaneously co-occurring with 

TBI.206 Spinal cord and brain injuries account for about 20 percent of all injuries, and the 

number of amputations (about 6 percent of injuries)207 exceeds that of the Vietnam 

War.208

In all, about 25 percent of veterans returning from service since 9/11 meet the criteria for 

mental health conditions, including diagnoses of PTSD, TBI, and other mental health 

difficulties:209 39 percent with likely alcohol abuse;

210 253,330 cases of TBI (about 19 

percent) as of August 20, 2012; 131,341 cases of PTSD (about 14 percent) as of 

December 7, 2012;211 14 percent with major depression; and 5 percent with TBI, PTSD, 

and major depression.212 More troubling is data indicating 57 percent of those with 

probable TBI have “not been evaluated by a physician for brain injury,” and only 53 

percent of those with PTSD or major depression have sought mental health services.213

A 2008 report from the RAND Center for Military Health Policy Research concluded that: 
57

“[e]ven when individuals receive care, too few receive quality care. Of those who have a 

mental disorder and also sought medical care for that problem, just over half received a 

minimally adequate treatment.”214

Moreover, suicide rates among both active-duty service members (who have and have 

not deployed overseas) and veterans have reached alarming levels. Among active-duty 

troops, there is on average one suicide per day.215 Among veterans, that rate is about 22 

suicides per day.216 Notably, however, veterans committing suicide tend to be 50 years 

or older.

217

NCD acknowledges the efforts of many federal partners to address the unmet mental 

health needs of America’s veterans. Appropriate and effective health care is essential to 

full recovery and successful integration into the workplace, and for families that have 

been disrupted during service far from home. RAND recommends improving access to 

mental health services for veterans, recruitment and retention of mental health 

professionals, and encouraging both veterans and active-duty service members to seek 

care.218 

Likewise, NCD recommends increasing the cadre of providers who are trained and 

certified to deliver evidence-based health care services to meet current and future health 

care needs of active-duty personnel and veterans, whenever and wherever they are 

needed; and to effectuate policies that encourage active-duty personnel and veterans to 

seek needed care.

Summary and Recommendations

Passage of the Affordable Care Act on March 23, 2010, and the Supreme Court decision 

upholding most provisions of the Act on June 28, 2012, combined with ongoing debates 

and concerns over the cost of Medicare and Medicaid have brought increased attention 

to health care coverage and services. Much fear and confusion remains within the 

disability community as to what expected changes in health care will mean with regard to 
58

the supports and services that people rely on to live and work in their communities. NCD 

makes the following recommendations regarding health care concerns and issues; 

• 3.1 NCD recommends that the Centers for Medicare and Medicaid Services and 

affiliates within the Department of Health and Human Services implement a public 

awareness campaign to simply and accurately explain the business case (i.e., the 

benefit to business) for state implementation of expanded Medicaid coverage in 

nonparticipating states. HHS should publicize its targeted time frame for beginning 

the campaign.

• 3.2 NCD recommends that CMS and HHS develop short, closed-captioned 

informational videos (with text transcript and MP3) using visual representations 

and a low reading level, on a variety of topics, addressing the opportunities and 

challenges of the ACA for people with disabilities by January 1, 2014.

• 3.3 NCD recommends that the Office of Management and Budget re-engage in 

further discussion with stakeholders and service providers within the disability and 

aging communities, in order to fairly balance the important and complex needs

within these communities, before proceeding with the final steps of the proposed 

rulemaking process affecting the Companionship Exemption.

• 3.4 NCD recommends HHS’s Substance Abuse and Mental Health Services 

Administration invest in and award “system of care” expansion grants by June 30, 

2014, to improve the availability, quality, and affordability of community mental 

health services, mobile crisis services, housing, and peer supports for people with 

serious mental illnesses, and to extend mental health preventative and 

maintenance care access and options for the general population.

• 3.5 NCD recommends SAMHSA, the Task Force on Gun Control and Violence, 

and stakeholders with disabilities including the National Alliance on Mental Illness, 

develop a joint policy statement addressing the issues of gun violence, involuntary 

commitment, forced mental health treatment, and other issues, which balances 

the individual freedoms and civil rights of people with psychosocial disabilities with 

society’s obligation and responsibility to protect all people.
59

• 3.6 NCD recommends increasing the cadre of providers who are trained and 

certified to deliver evidence-based health care services to meet current and future 

health care needs of active-duty personnel and veterans, whenever and wherever 

they are needed; and to effectuate policies that encourage active-duty personnel 

and veterans to seek needed care by January 1, 2015.

• 3.7 NCD recommends the President direct deliberate coordination and 

collaboration among the Departments of Defense and Veterans Affairs, and other 

relevant federal agencies, to implement a superstructure of secure, private, online 

information sharing for all veterans’ health and benefit records—for the efficient 

provision and processing of each veteran’s health care needs and to end the 

backlog of veterans’ claims—by June 30, 2014.
60
61

CHAPTER FOUR: COMMUNITY INTEGRATION 

Barriers to participation for people with disabilities take a variety of forms in all aspects of 

society—in some cases this might mean access to the physical environment, but 

increasingly it also means subtle and less obvious barriers to information such as the 

lack of accommodations in using communications technology. Other areas of concern 

stem from policy gaps to discrimination resulting in Americans with disabilities having 

less than equal access to education, transportation, political participation, or justice 

within the legal system.

Accessibility and inclusion of people with disabilities are not only objectives, but 

ultimately prerequisites for the enjoyment and application of other fundamental rights in 

bedrock areas like voting, participating in civil society, community living, and life activities 

from childhood to adulthood. When barriers to civic inclusion are removed and people 

with disabilities are empowered to participate fully in the community, the entire 

community benefits.219 When viewed from this larger perspective, equal opportunity and 

greater accessibility benefit society as a whole.

Education 

Given the relationship between education and the greater likelihood of 

employment, ensuring that students with disabilities receive a high-quality 

education has the potential to affect, not only the millions of students with 

disabilities currently being served by the K-12 educational system, but also those 

who subsequently exit the special education system. It is particularly important to 

ensure that students with disabilities who are “in the margins”—e.g., those with 

more significant intellectual disabilities and those identified as having emotional 

disabilities—are provided high-quality learning opportunities, consistent with UDL 

principles and effective use of technology.

– Joint statement of CAST leadership, Founder and Chief 

Education Officer David Rose, Ed.D., Chief of Policy & 

Technology Chuck Hitchcock, M.Ed., and Policy Analyst/ 

Research Scientist Joanne Karger, J.D., Ed.D.
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K–12 Education

Decades after the passage of the Individuals with Disabilities Education Act (IDEA), 

many students with disabilities are still struggling in school. The doors to the 

schoolhouse have been opened, but public school systems have been resistant to 

changes that support all students in making progress in the general curriculum and 

ultimately graduating from high school with a diploma, not to mention prepared to enter 

the adult world of higher education and employment.

However, younger students, particularly those with intellectual and multiple disabilities, 

continue to be denied access to the general curriculum. Persistent use of self-contained 

classrooms keeps too many students out of general education classes, making it difficult 

for students to access grade-level subject matter and build relationships with peers.220

Exclusion compounds this problem as students are denied the ability to engage in the 

same curriculum as their peers without disabilities year after year.

As a result, graduation outcomes for students with disabilities remain poor. According to 

2008–09 data, only 10 states graduated more than 50 percent of their students with 

disabilities with a standard diploma. In 27 states, less than 40 percent of students with 

disabilities earned a standard diploma.

221 Failure to earn a high school diploma makes it 

difficult for students with disabilities to pursue postsecondary education and significantly 

undermines their ability to compete in the workplace for jobs that pay living wages. NCD 

recommends the Department of Education fund state demonstration projects that use 

evidence-based pedagogical practices and transition planning to increase the state 

graduation rate of students with disabilities who receive a standard high school diploma.

The challenge of postsecondary access for students with disabilities worsened in 2012 

with the passage of federal legislation that prohibits students graduating with modified 

diplomas from receiving federal Pell Grants and federal student loans even for trade and 

career programs.

222 Under the new law, only students with regular diplomas or GEDs are 

eligible for federal financial aid. This locks many of these students who do not have the 
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resources to independently pay for vocational training (e.g., welding, child care, culinary 

arts) into a lifetime of poverty-level wages.

The implementation of the Common Core State Standards223 represents new 

opportunities for public schools to redesign the general curriculum to be accessible to all 

students. According to the states engaged in developing and implementing the 

standards, “Common Core State Standards provide a consistent, clear understanding of 

what students are expected to learn, so teachers and parents know what they need to do 

to help them.”224 By adopting appropriate technology and adhering to the principles of 

Universal Design for Learning (UDL), schools have the opportunity to provide students 

with disabilities the ability to access grade-level curriculum, in regular classrooms, 

alongside their peers.

David Rose, Ed.D., founder and chief education officer, Chuck Hitchcock, M.Ed., chief 

of policy and technology, and Joanne Karger, J.D., Ed.D., policy analyst/research 

scientist at CAST, expressed in their joint response to our query: 

What is needed is radical change to the educational system. In order for the goal 

of increased college and career readiness to be realized for all students, attention 

needs to be paid to addressing the needs of learners, including students with 

disabilities, who traditionally find themselves in the margins. Motivation to change 

the system is greatest at these edges, and the resistance to it, weakest. Most 

importantly, the same innovations that these students require will benefit the 

entire culture.

The upcoming reauthorization anticipated in 2013 of the IDEA and the Elementary and 

Secondary Education Act (ESEA)225 create new opportunities for the Federal 

Government to develop plans that expand access to standard diplomas and develop 

standards for rigorous, meaningful modified diplomas that provide eligibility for 

postsecondary training and financial aid. In addition, a shift in accountability systems to 

focus on student learning outcomes and general education access may enhance 

learning experiences for students with disabilities at little extra expense. The focus must 

shift to what works for students, and how they can flourish as elementary, middle, and 
64

high school students who are prepared to transition into adulthood, postsecondary 

education, and the workforce. 

NCD recommends the Department of Education work with Congress to reauthorize the 

IDEA and the ESEA, and to work with state departments of education to develop 

standards for rigorous, meaningful, modified diplomas that provide eligibility for 

postsecondary training and financial aid.

Transition of Youth with Disabilities

Transition services are required under the IDEA for all eligible students with disabilities. 

Their purposes are to “promote movement from school to post-school activities, including 

postsecondary education; vocational education; integrated employment (including 

supported employment); continuing and adult education; adult services; [and into]

independent living or community participation.”226 By the time that the first Individualized 

Education Program (IEP) takes effect during the student’s 16th year, the IEP must 

include appropriate, measurable postsecondary transition goals; a course of study; and a 

coordinated set of activities.227 The goals, based upon the student’s preferences, 

strengths, and interests, must succinctly describe what students would like to achieve 

once they exit high school, articulated in terms of education, training, employment, and

independent living skills.228 The development of a coordinated set of activities is 

designed to provide a long-range educational plan with specific strategies to help

students move from school into the community.229 These activities may include 

instruction, related services, community experiences, employment, postsecondary adult 

living, daily living, and functional vocational evaluation.230

Judy York, director of the Resource Office on Disabilities at Yale College, detailed how 

the snowball effect brought about by the lack of transition planning can disrupt life 

outside the classroom or workplace: 
65

Transition planning is weak, at best, from high school to college, especially ... the 

student plans to live on a campus (away from home and parents). I know it is 

supposed to be an agreement between vocational rehabilitation [and] local 

schools within their outreach but it is inconsistent. Training is needed for 

vocational rehabilitation counselors and special education teachers and 

administrators on what should be considered to forward plan when exiting high 

school and entry to college. It goes beyond the classroom needs—living needs 

are equally important and are often overlooked or assumed.

Section 504 of the Rehabilitation Act also requires the local educational agency to 

provide accommodations for students with disabilities who qualify for services under 

Section 504, and who otherwise are not eligible for IDEA services.231 While the 

Department of Education (DOE) Office for Civil Rights is responsible for the civil rights 

enforcement of Section 504 with state and local educational agencies, DOE leaves 

implementation and compliance to the state level.232 Consequently, there is no federal or 

state oversight, monitoring, or accountability for the services provided to students with a 

disability who have a 504 plan.233 NCD recommends that the DOE Office for Civil Rights 

develop a framework for oversight, monitoring, and accountability of these services. 

Higher Education and Training 

People with disabilities including veterans continue to face integration barriers in their 

efforts to pursue higher education, which has become almost essential to open doors for 

full participation in society. Common barriers found on both public and private college 

and university campuses across the United States include the lack of accessible paths 

onto campus and to, into, and through buildings; failure of prompt snow removal; delay in 

providing accessible textbooks and readings; absence of closed captioning video 

materials and screen-reader-accessible documents; delivery of instruction in online 

formats without access to real-time captioning; lack of opportunities for participation of 

students with speech and fine motor impairments; delay in faculty providing 

accommodations; absence of visual and auditory alarms; absence of accessible 

workspaces in libraries, classrooms, and computer and science labs; segregated 

assistive technology devices such as computer magnifiers and screen-readers; class 

materials and university documents not in formats easily modified to large text, Braille, 
66

text to speech, etc.; required university policies on inaccessible websites; lack of 

accessible restrooms, cafeterias, and dormitories; stigma and attitudes of faculty, staff, 

and other students, and more.

The availability of accessible learning materials, especially those presented 

electronically, is a central issue facing students with sensory and print disabilities in 

higher education. The Higher Education Opportunity Act234 established the Advisory 

Commission on Accessible Instructional Materials for Post-Secondary Education 

Students with Disabilities (AIM Commission), and charged it with studying the barriers 

and providing recommendations for the improved accessibility of materials in 

postsecondary education.235

The AIM Commission’s final report identified barriers, challenges, and suggested steps—

including law and policy recommendations, market and technology solutions, and 

capacity building and demonstration projects—to remove obstacles that deny students 

with disabilities complete and equal access to higher education.

236 NCD recommends 

that the DOJ and DOE implement a Project Civic Access–like program237 targeting 

inaccessibility in higher education, and entering into short-term settlement agreements 

for each institution to come into compliance.

Two high-profile law suits in 2013 also have taken up these issues. On May 7, 2013, the 

University of California, Berkeley and disability rights advocates announced they had 

reached a settlement agreement to “improve information access for students with print 

related disabilities.”

238 Similarly, in Authors Guild, Inc. v. HathiTrust, addressing 

allegations of copyright violation brought by the Authors Guild, a Federal District Court 

ruled that the systematic digitization of copyrighted books owned by universities without 

authorization was protected by the fair use doctrine, in part, to provide access to people 

with print disabilities.239 Facing an appeal in the Second Circuit, disability advocates filed 

an amicus (Friend of the Court) brief on June 3, 2013, in support of HathiTrust, in part 

relying on the AIM Commission’s report: 
67

. . . [P]rint-disabled students and scholars do not currently have the equal access 

to university library programs, including instructional and research materials as 

required by the ADA. In the absence of comprehensive digitization, such students 

and scholars will not be able to freely identify and peruse research sources, use 

tables of contents to navigate materials, or have access to resources with the 

same speed and efficiency as nondisabled peers. Rather, they will be stranded in 

the existing ad hoc system, depending on readers or narrated and unnavigable 

audiobooks, or waiting for item-by-item scanning and optical character recognition 

processing while their peers quickly assess, review, and absorb necessary 

research materials.240

The outcome of the case is pending, but clear opportunity remains for progressive 

changes, including promotion of full integration during education and training and 

incorporation of accessibility features in technologies used in postsecondary settings. 

The AIM Commission’s recommendations urge Congress to take action on key issues to 

“facilitate the incorporation of accessibility features in technologies used in 

postsecondary settings,” including: 

• establishing a process for creating uniform accessibility guidelines for industry and 

consumers; 

• revisiting the components of existing copyright exception; 

• assessing AIM’s relationship to current research and instructional materials 

access, taking into account the rights of content owners; and 

• re-emphasizing the importance of compliance with civil rights laws for institutions 

of higher education so that the needs of students with disabilities are more 

adequately addressed.241

A second significant issue in higher education involves the large influx of veterans with 

disabilities into college programs.242 In a survey conduct by AHEAD of Disability Service 

Offices (DSO) across the United States, the 237 completed surveys identified 1,202 

“Wounded Warriors” on their campuses.243 Psychological and emotional disabilities 

accounted for the largest percentage of Wounded Warriors (34 percent of males, 11 

percent of females). Students with health-medical (e.g., diabetes, epilepsy, AIDS),244

burn, and mobility impairments accounted for 25 percent of male students and 5.2 
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percent of females. Learning disabilities accounted for 9 and 7 percent of male and 

female students, respectively.245 Surprisingly, only 5 percent of males and less than 1 

percent of female students were hard of hearing, and no students were reported to have 

visual impairments.246

Sarah Helm, Ph.D., coordinator of the Disability-Careers Office, University of Tennessee 

(Knoxville), spoke to NCD about some of the unmet needs of veterans with disabilities 

who use the GI Bill for higher education and training that can help them prepare for the 

modern workplace: 

We need to do a better job of being proactive [for] student veterans with visible 

and invisible disabilities. On average there can be 400 students on campus [who 

are] coming to school on the GI bill. They need to know [the Office of Disability 

Services is] here. Students need to see something ... more outreach ... career 

development [options]. People want to work, be part of society, [and] earn a 

paycheck. 

A 2009 journal article identified additional unique challenges for DSOs in serving 

veterans with disabilities, namely involving disclosure, documentation, and 

accommodation. These issues include failure to self-identify, invisible disabilities, 

sources of documentation, and significant delays in acquiring documentation from the VA 

and other federal agencies. Veterans may be more reluctant to disclose their disability to 

the DSO than other students.247 NCD recommends that the DOE and VA prepare best 

practice technical assistance resources for disability service offices in higher education 

that address the challenges of disclosure, documentation, and accommodation in serving 

veterans with disabilities and eliminate delays in acquiring documentation from the VA 

and other federal agencies.

Housing

Housing options for approximately 20 percent of all Americans with disabilities pose 

problems including poverty, accessibility, and even safety. Among 57 million Americans 

with disabilities, federal estimates indicate at least 500,000 are homeless including 

children, and perhaps 80 percent of them may be staying in homeless shelters or on the 
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streets.248 National data also estimates that about 35.1 million households (one-third of 

all households) include one or more person with a disability.249 Common characteristics 

of these households include that they are: most likely to be headed by someone age 65 

years or older (60 percent) and to only include one or two people (75 percent), and 2.5 

times more likely to be living near or below the federal poverty level.250

An estimated 3.4 million households that include a person with a disability are deemed 

“worst-case housing needs”—defined as “unassisted renters with very low incomes who 

have one of two ‘priority problems’ either paying more than half of their income for 

housing (‘severe rent burden’) or living in severely substandard housing.”251 Households 

that spend more than 30 percent of their income on housing (40 percent of households 

with disability, or 14.4 million)—a rate indicating the unaffordability of the housing—and 

considered worst-case are at increased risk of becoming homeless.252

Compared with a 70 percent homeownership rate among Americans generally, only 

about 10 percent of homeowner household heads have a disability.253 Poverty and low 

income are key barriers to homeownership for people with disabilities, especially those 

with severe disabilities, which can be explained in significant part by higher rates of 

unemployment and underemployment.254 Among homeowners 65 to 85 years of age, 94 

percent have a disability.255 Nursing and group home facilities house 2.2 million people 

with disabilities, including an estimated 125,000 people with severe mental illness (ages 

22 to 64).256 More than 300,000 people with psychiatric disabilities live in segregated

housing.257

Among all people with disabilities, hundreds of thousands do not have full access to their 

home for lack of grab bars or handrails (788,000 households), accessible bathrooms 

(566,000), ramps (612,000), elevator or lifts to access (309,000), and inaccessible 

interior path and doorways (297,000).

258 About 11 percent of Americans have a chemical 

sensitivity that requires housing free of disabling environmental triggers.259 NCD 

recommends that the Department of Housing and Urban Development (HUD) create 

small, low-interest loans and mini-grant opportunities for people with disabilities who 
70

require home modifications such as grab bars, handrails, ramps, lifts, doorframe 

widening, and bathroom accessibility in order to continue living in their home, to move 

into housing, or to get in and out of the home safely.

On June 4, 2013, HUD issued guidance encouraging “public housing agencies ... and 

other housing providers receiving federal financial assistance from HUD to partner with 

state and local governments to provide additional community-based, integrated housing 

opportunities for individuals with disabilities transitioning out of, or at serious risk of 

entering, institutions or other segregated settings.”260 While the new guidance does not 

outline specific requirements for federally funded housing programs, HUD stresses the 

“acute” need for community-based options for people with disabilities, as the effort to 

transition people with disabilities away from institutional settings and into community 

housing gains both momentum and acceptance.261 

Transportation 

Savannah Logsdon-Breakstone, a disability rights advocate, underscored the 

interconnected ways that multiple areas influence one’s community involvement and 

overall quality of life:

It is hard to untangle issues like housing, transportation, and employment. They 

are so interrelated. Too often, Employment becomes even more of a challenge 

because the accessible transportation doesn’t reach certain areas where there is 

affordable accessible housing. This also becomes a difficulty when talking about 

the other ways that people become involved in our communities—community 

clubs, faith communities, entertainment events, and volunteering opportunities all 

can become more difficult to attain when there is no transportation. Seeing as how 

the linking issue here appears to be transportation, I will focus on that.

In some areas of our country, accessible transport—particularly for those who 

cannot drive and therefore cannot work to acquire an adapted vehicle—doesn’t 

exist beyond medical appointments. The difficulties that isolation due to a lack of 

access to community events and interaction are, I believe, fairly well documented 

both within and without the population in question. This is a serious concern—our 

population tends to have difficulties with feelings of isolation and difference 

around the lack of access/welcoming attitudes within our communities even 

without the added difficulties of transportation access.
71

A 44-year-old wheelchair user with spina bifida, who wished to remain anonymous, 

stressed the importance of accessible (and available) transportation options: 

Though many cities have a paratransit system available as a result of Americans 

with Disabilities Act of 1990, there are many places where public transportation is 

lacking or inadequate. This is particularly true in suburban or rural communities.

For example, if a paratransit system only runs from Monday to Friday between 8 

am and 6 pm, this generally prevents people with disabilities from participating in 

their communities in the evening, weekends and on holidays. We need to create 

and prioritize public policies with broader mandates for transportation systems. 

The federal government might establish pilot programs on which states can build.

Guidelines need to be more realistic in accommodating the transportation needs 

of people with disabilities. Funding could come from federal, state and local 

government and utilize local private contractors. There should also be greater 

support for new technology which utilizes the driverless car as is being pioneered 

in California and Oregon.

Equal access, treatment, and independence are long-standing transportation issues. The 

failure of bus companies to provide people with disabilities bus service on equal terms as

others without disability has been an issue for many people with disabilities across the 

nation. NCD recommends that the Departments of Justice and Transportation implement 

a Project Civic Access–like program targeting public transportation and paratransit 

systems that have high rates of complaints from local citizens for inaccessibility, for the 

purpose of entering into short-term settlement agreements for each transportation 

provider to come into compliance.

In June 2013, the DOJ and the US Attorney’s Office for the District of New Jersey 

determined that DeCamp Bus Lines violated the ADA by requiring that passengers with 

disabilities provide 48 hours of advance notice to secure a wheelchair-accessible bus.262

Passengers without disabilities did not have to provide any advance notice. The 

settlement agreement requires DeCamp to comply with all ADA requirements for 

accessible service, and not exclude people with disabilities from its transportation 

services.263 
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In June 2012, however, the US Court of Appeals for the Second Circuit overturned a 

Federal District Court decision that had required New York City taxi drivers to provide 

accessible vehicles. The Appeals Court held that ADA Title II “does not obligate the [Taxi 

& Limousine Commission] to use its licensing and regulatory authority over the New York 

City taxi industry to require that taxi owners provide meaningful access to taxis for 

[people] with disabilities.”

264 The Court did rule that the Commission may not 

discriminate against people with disabilities seeking a license to drive a cab.265 

Independent operation of motor vehicles has made headlines with regard to a 21st 

century opportunity for access to transportation for people with mobility and sensory 

disabilities. The Department of Transportation (DOT) released its current policy on 

automated vehicles on May 30, 2013, and identified actions at the state level to make 

autonomous vehicles accessible to passengers with disabilities. DOT’s policy addresses 

the potential of this technology for people with disabilities: “Mobility for those with a range 

of disabilities will be greatly enhanced if the basic driving functions can be safely 

performed by the vehicle itself, opening new windows for millions of people.”266

DOT also indicates that several states, including Nevada, California, and Florida, have 

enacted legislation that expressly permits operation of self-driving (sometimes called 

“autonomous”) vehicles under certain conditions. These experimental vehicles are at the 

highest end of a wide range of automation including some safety features already in 

vehicles, such as electronic stability control.267 The policy will provide states interested in 

passing similar laws with assistance to ensure that their legislation does not inadvertently 

affect current vehicle technology and that the testing of self-driving vehicles is conducted 

safely. DOT’s National Highway Traffic Safety Administration plans to conduct research 

to support the development of potential technical requirements for automated vehicle 

systems. However, the feasibility of the research depends on receipt of new funding.268
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Voting Participation

More than fifteen (15.6) million people with disabilities voted in the November 2012 

elections.269 Voter turnout was 5.7 percentage points lower than turnout for voters 

without disabilities, equal to about 3 million fewer voters with disabilities.

270 The rate of 

voter registration among people with disabilities was 2.3 percentage points lower.

271

Among employed voters, voting rates were the same for people with and without 

disabilities, “suggesting that employment helps bring people with disabilities into 

mainstream political life.”

272

Brad Williams, executive director of the New York State Independent Living Council 

(NYSILC), believed the greatest policy issue for Americans with disabilities is ensuring 

that people were afforded their civil right to vote. After the 2012 Presidential election, 

NYSILC conducted a post-election survey in which they concluded 30 percent of New 

Yorkers still faced challenges voting and 20 percent reported architectural barriers to 

voting at polling places. Williams recommended better training for poll workers and 

recruitment of people with disabilities as poll workers. He added: 

If people with disabilities had full voting rights then we would not be facing [a] 31.2 

percent employment rate ... and a 28.6 percent poverty rate. ... If the disability 

community was an organized voting bloc, then perhaps these issues would be 

addressed. Instead, we continue to be left out of the conversation and ignored by 

pollsters. ... It would appear as though people with disabilities in our state are only 

seen as those that have special needs, are considered a vulnerable population

and need protecting.

Williams described how NYSILC has tried to work with pollsters to get a disability 

question added and has not been successful. In addition, he described NYSILC’s two 

years of unsuccessful advocacy to have a bill introduced that would acknowledge 

disability-run businesses as minority owned. He felt strongly that this lack of response 

was due to the disability community not being seen as a voting bloc.
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Accessibility

Despite the passage of the Help America Vote Act (HAVA) in 2002, current data on 

voting accessibility shows slow and limited improvement for people with disabilities.273

People with physical, sensory, or intellectual disabilities or mental illnesses/psychiatric 

disabilities, and veterans with acquired disabilities remain among those most vulnerable 

to voting accessibility issues, along with those in racial and ethnic minorities and people 

who are aging.274

Testimony provided at NCD’s Policy Forum, “The Help America Vote Act Ten Years 

Later: Has the Law Accomplished Its Aim?” held April 23, 2013, clarified that voting 

accessibility challenges and concerns were still apparent during the 2012 presidential 

election.275 NCD found that “just over a quarter of polling places [were] accessible [in 

2012].”

276 The report to the US Election Assistance Commission and Research Alliance 

for Accessible Voting found 30.1 percent of voters with disabilities had difficulty voting at 

a polling place, compared with only 8.4 percent of voters without disabilities.

277 The most 

common issues were difficulties understanding how to use the voting equipment (68 

percent) and reading or seeing the ballot (59 percent).278 More than one-fourth of voters 

with disabilities (28 percent), compared with one-sixth of voters without disabilities (17 

percent), cast their votes by mail.279

Random samplings of New York City polling places in 2012 found widespread 

inaccessibility, “and that disability relevant criteria were not used for polling place 

selection and ... training for poll workers was inadequate to comply with [federal] law.”

280

South Carolina polling place surveys attest to ongoing problems with access to curbside 

voting, parking, signage, entrance to polling places, and access to assistance when 

required.281 Doug Lewis, executive director of the National Association of Election 

Officials, commented that polling center accessibility is better today than in the past. “But 

are we fully compliant with the law all over the country? No,” he said. “There is a money 

crunch right now. When that happens, progress stops.”

282 
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NCD recommends that the US Election Assistance Commission and Research Alliance 

for Accessible Voting identify and provide technical assistance including small grant 

amounts to ADA Title II entities in high-poverty areas that have inaccessible polling 

sites—in order to create accessible sites.

Just prior to the 2012 election, the United Spinal Association and Disabled in Action won 

a major battle on behalf of voters who use wheelchairs and scooters or who have vision 

impairments. On October 19, 2012, a federal judge ordered the New York City Board of 

Elections to adopt and implement an effective barrier removal plan at polling sites.

283 On 

July 25, 2013, a class action lawsuit was filed under HAVA alleging that the County of 

Alameda, California, discriminates against voters who are blind and visually impaired.284

Specific Populations 

The American Civil Liberties Union (ACLU) reports that prior to the 2012 federal election, 

“states across the country passed measures to make it harder for Americans—

particularly African-Americans, [people who are aging], students and people with 

disabilities—to exercise their fundamental right to cast a ballot.”285 The ACLU cited 

examples among more than 30 states whose legislatures considered laws that would 

require shortened early voting periods, curtail assistance at the polls for people who 

indicate that need, and/or require voters to present government-issued photo ID in order 

to vote.286 

In a related report, Kimberly Leonard’s 2012 article in The Atlantic, “Keeping the Mentally 

Incompetent from Voting,”287 on “mental competency” laws raises additional concerns 

about whether such laws are outdated.

Voting accessibility problems and challenges can be magnified for veterans who are 

rehabilitating from the impact of combat injuries. Recently injured veterans may 

experience difficulty with inaccessible polling places, overly complex ballot design and 

voting technology, keeping track of progress while engaged in voting tasks, and grasping 
76

and manipulating technology due to TBI, PTSD, upper and lower body injuries, and 

spinal cord injuries.288 

The need to improve voting access transcends vulnerable populations, disability types, 

and civilian or military status. Funding is needed for HAVA compliance monitoring, 

education, and training of voters and poll workers. 

Home- and Community-Based Long-term Services and Supports 

Home- and community-based long-term services and supports provide people with 

disabilities and chronic health conditions with choices, control, and access to quality 

community services that support their independence, health, and quality of life.289

Without these services, many people with disabilities are unnecessarily confined to 

institutional long-term care settings often at a distance from their community, family, and 

friends. The US Supreme Court’s Olmstead decision requires states to provide these 

services “in the most integrated setting appropriate to the needs of qualified individuals 

with disabilities.”290

For all people with disabilities who age at home, the sustainability of long-term supports 

and services merits careful consideration. Our nation has a long-standing commitment to 

ensuring that individuals are afforded the opportunity to live in the community with the 

appropriate supports, while addressing the growing costs associated with long-term 

service and supports.291 NCD acknowledged the many complex issues in its report, "The 

State of 21st Century Long-Term Services and Supports: Financing and Systems 

Reform for Americans with Disabilities.”292

NCD believes that America needs a coherent and comprehensive framework for

its LTSS policies, programs, and funding based on five interrelated assumptions. 

First, that people who are elderly and people with disabilities both desire and 

deserve choices when seeking assistance with daily living that maintains their 

self-determination and maximum dignity and independence. Second, the current 

financing mechanisms (public and private) will become unsustainable in the near 

future without significant reform. The system must be affordable to all Americans 

regardless of income levels and must consider opportunities to leverage public 
77

and private support in new ways without impoverishing beneficiaries. Third, there 

is an opportunity with the changing demographic picture of the United States to 

explore the possibilities of a universal approach to the design and financing of 

supports that is responsive to individuals under the age of 65, as well as 

Americans over 65 who may or may not have disabilities, without sacrificing 

individual choice and flexibility. Fourth, formal and informal caregiving must be 

sustained, including examination of family needs and workforce recruitment and 

retention challenges. Fifth, the approach to quality must examine consumer 

direction and control of resources in addition to traditional external quality 

assurance mechanisms.293 

Reinforcing the point that you don’t have to be the person with a disability to have 

disability affect you, Katie Arnold, executive director of the Sibling Leadership Network, 

stressed the key role siblings often play in providing natural supports for people with 

disabilities throughout their life span:

Siblings often play a key role in providing natural supports for people with 

disabilities throughout their life. Yet, navigating the disability service system and 

getting support for themselves as siblings can be difficult and overwhelming. 

Addressing the needs of siblings will lead to better outcomes for families and 

people with disabilities. Siblings often have the longest relationship of their lives 

with each other and greatly impact each other. Siblings are uniquely positioned in 

the family to support their brothers and sisters with disabilities to lead selfdetermined lives. The peer nature of their relationship makes them well-suited to 

support each other throughout life in many areas including employment, voting, 

transportation, relationships and sexuality, health care, housing supports, and 

more.

NCD takes seriously the challenges and the opportunities inherent in achieving viable 

and sustainable home- and community-based long-term services and supports that fulfill 

the promise of the ADA and the Olmstead decision. NCD looks forward to the work that 

will be accomplished by the recently created Commission on Long Term Care, and the 

role of member Henry Claypool of the American Association of People with Disabilities. 

NCD recommends that public and private agencies and partners work together to 

articulate a coherent and comprehensive framework for America's LTSS policies, 

programs, and funding.
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Information and Communications Technology

The accessibility of information and communications technology (ICT) for users with 

disabilities, especially those with sensory, reading, fine motor, intellectual, attention, 

concentration, and speech impairments, has become essential for community 

inclusion.294 These technologies are already or rapidly are becoming integrated into 

every aspect of American society.295 Disability civil rights attorneys, who as members of 

the Disability Rights Bar Association share successful legal strategies,296 have 

collaborated with the National Federation of the Blind, National Association of the Deaf, 

and other advocacy groups to win far-reaching settlements and class actions.297 These 

legal initiatives are positively directing the application of ADA Title III and Section 504 to 

higher education, online public accommodations, and e-readers and other smart ICT 

devices.298 It reasonably may be expected that the DOJ’s proposed ADA Title II and III 

Web site accessibility regulations and the DOL’s airport Web site and kiosk accessibility 

regulation will be issued as final regulations in the year ahead.299 NCD recommends DOJ 

and DOT publication of the final rules for Title II and III Web and airport Web and kiosk 

accessibility within the next year.

New challenges and opportunities lay ahead for the disability community in this field. The 

proliferation of free massive online open courses (MOOCs), which have not been 

assessed for their accessibility, now is moving into the for-profit education realm.300 On 

June 27, 2013, the United Nations (UN) reached another significant development to the 

benefit of people who are blind, visually impaired, and print-disabled.301 An agency of the 

UN, the World Intellectual Property Organization (WIPO)—“dedicated to the use of 

intellectual property (patents, copyright, trademarks, designs, etc.) as a means of 

stimulating innovation and creativity”302—approved a landmark treaty in Marrakesh, 

Morocco, to facilitate access to published works by people with visual impairments and 

people with print disabilities.

303 The treaty addresses the territorial laws applying to 

copyright as they affect accessible formats and sharing of works across national 

borders.304 The United States has been a member of WIPO since 1970, and is eligible to 

become a signatory member of the treaty.305
79

Accessible Currency 

In American Council of the Blind (ACB) v. Paulson, the DC Circuit Court of Appeals ruled 

that American currency discriminates against Americans with vision, learning, and other 

disabilities.306 The Court remanded the case to develop a solution. Since that time, the 

Bureau of Engraving and Printing (BEP) has been working in concert with the 

Department of Justice and the Federal Reserve to devise a solution that will enable all 

Americans to use paper currency with facility, security, and confidence.

Unprecedented increases in the number of Americans with vision disabilities, due to the 

aging demographics of American society and significant increases in combat injuries 

affecting sight among American veterans, make this an issue of pressing urgency.307

The US Department of the Treasury, DOJ, and BEP have been working through the 

intricacies of producing tactile US currency.308 In its 2012 Progress Report, NCD 

reported that BEP “anticipates finalization within the near future of the shape and type of 

tactile symbol to be affixed”309 on bills larger than one dollar. NCD recommends that 

BEP complete its research and set a timetable for commencement of production of 

tactile currency.310 

BEP has commenced a three-pronged approach to render currency accessible, including 

continued use of contrasting inks and raised numeric features, development of a tactile 

symbol to be affixed to bills after completion of the anticipated redesign of the 100 dollar 

bill, and development and distribution of currency readers.311 While little progress toward 

introduction of tactile currency has been made, a recent publication by the BEP suggests 

that that the redesign of the 10 dollar bill, slated for introduction in 2019, may contain the 

first tactile feature.312

The reason for the delay in producing tactile currency thus far has been attributed to 

many factors. Despite collaborative efforts and willing engagement among the relevant 

agencies, BEP recently informed NCD that they still are exploring various options for a 
80

tactile feature on US currency.

313 BEP provided NCD with details regarding the 

complexity of the task and the steps involved in currency redesign, including 

collaboration with the Federal Reserve, Anti-counterfeiting Commission, and the Secret 

Service, among other challenges involved in rendering an estimated 32.6 billion pieces 

of American currency tactile. BEP referred to standards for manufacturing, processing, 

and production, and coordination with manufacturers of cash handling equipment and 

the Federal Reserve Board to limit disruption to banking and other cash handling and 

processing operations, among other detailed consideration.314 Efforts to produce and 

distribute currency readers are ongoing, and the currency reader program is expected to 

launch shortly. 

While the challenges and complexities of adjusting American currency continue, other 

countries are succeeding in making meaningful transitions,315 and the number of 

Americans who cannot use money continues to grow. NCD anticipates continued 

collaboration with the BEP, Federal Reserve, and other agencies in an effort to seek 

meaningful progress toward actual transition to fully tactile currency in the foreseeable 

future, and to assist in the introduction of the first fully tactile currency.

Summary and Recommendations

Americans with disabilities continue to face barriers to community participation in all 

aspects of society. When barriers to inclusion are removed and people with disabilities 

are empowered to participate fully in the community, the entire community benefits.

Viewed from this larger perspective, NCD makes the following recommendations:

• 4.1 NCD recommends the Department of Education fund state demonstration 

projects that use evidence-based pedagogical practices and transition planning to 

increase the state graduation rate of students with disabilities who receive a 

standard high school diploma by 10 percent over three years.

• 4.2 NCD recommends the Department of Education work with Congress to 

reauthorize the IDEA and the ESEA by June 30, 2014, and to work with state 
81

departments of education to develop standards for rigorous, meaningful, modified 

diplomas that provide eligibility for postsecondary training and financial aid.

• 4.3 NCD recommends that DOE Office for Civil Rights develop a framework for 

oversight, monitoring, and accountability of the services provided to students with 

a disability who have a 504 plan by June 30, 2014.

• 4.4 NCD recommends that the DOJ and DOE implement a Project Civic Access–

like program targeting inaccessibility in higher education, and entering into shortterm settlement agreements for each institution to come into compliance.

• 4.5 NCD recommends that the DOE and Department of Veterans Affairs prepare 

best practice technical assistance resources for disability service offices in higher 

education that address the challenges of disclosure, documentation, and 

accommodation in serving veterans with disabilities and eliminate delays in 

acquiring documentation from the VA and other federal agencies.

• 4.6 NCD recommends that the Department of Housing and Urban Development 

create small, low-interest loans and mini-grant opportunities for people with 

disabilities who require home modifications such as grab bars, handrails, ramps, 

lifts, doorframe widening, and bathroom accessibility in order to continue living in 

their homes, to move into housing, or to get in and out of the home safely.

• 4.7 NCD recommends that the DOJ and DOT implement a Project Civic Access

program targeting public transportation and paratransit systems that have high 

rates of complaints from local citizens for inaccessibility, for the purpose of 

entering into short-term settlement agreements for each transportation provider to 

come into compliance.

• 4.8 NCD recommends that the US Election Assistance Commission and 

Research Alliance for Accessible Voting identify and provide technical assistance, 

including small grant amounts to ADA Title II entities in high-poverty areas that 

have inaccessible polling sites—in order to create accessible sites.

• 4.9 NCD recommends that public and private agencies and partners work 

together to articulate a coherent and comprehensive framework for America's 

LTSS policies, programs, and funding.
82

• 4.10 NCD recommends DOJ and DOT publish the final rules for Title II and III 

Web and airport Web and kiosk accessibility by June 30, 2014.

• 4.11 NCD recommends that the Bureau of Engraving and Printing complete its 

research and set a timetable for commencement of production of tactile currency 

by June 30, 2014.
83

CONCLUSION

Strength in Our Differences summarizes the status of federal laws and programs serving 

an estimated 57 million Americans with disabilities, their families, and the diverse 

segments of the disability community. Strength in Our Differences acknowledges the fact 

that as a nation we are stronger, and as a people we are more able to respond to the 

challenges in the ever-changing world that we share, because of our diversity.

This report is derived from the diverse voices of the disability community, including 

interviews with knowledgeable consumers, advocates, and experts on disability 

programs, supports, and services from across the nation. The review and analysis of 

these interviews revealed three major characteristics: 

• The interdependent nature of some issues affecting people with disabilities 

makes it difficult to isolate and discuss one issue at a time;

• Deep concerns remain about prospects for withstanding the economic 

recession, given the unique challenges that the majority of people with 

disabilities face; and 

• The disability rights movement has yet to meet critical and unmet needs. 

The narrative, data, and recommendations of the 2013 Progress Report are neither 

exclusive, nor comprehensive, but should be viewed as opportunities to identify work yet 

to be done, in conjunction with NCD’s ongoing policy outreach and research, and in 

collaboration with the Administration, Congress, and other agencies that seek fulfillment 

of the Americans with Disabilities Act. 

Although measurable progress has been achieved in many areas, including employment, 

education, and community living, resulting in an overall state of the disability union, 

which is more robust with increased opportunities and greater accessibility overall, 

critical challenges remain in order to make the most of the advances our nation has 

made. Effective implementation and enforcement of the ADA requires thorough, 
84

sustained monitoring, evaluation, and interagency collaborations to ensure that full civic 

and social participation, equal opportunity, independent living, and economic selfsufficiency are achievable for all Americans, including those with disabilities now and in 

the future so that the strengths present in our differences can be both realized and 

utilized for the benefit of all.
85

APPENDIX 

Supplemental information in this section represents the broad array of topics and 

perspectives covered by participants in NCD’s interviews. These are excerpts primarily 

selected as examples of further comments on “What is the single most important public 

policy issue for Americans with disabilities in 2013?”

Marian Vessels, director, Mid-Atlantic ADA Center, serving Delaware, the District of 

Columbia, Maryland, Pennsylvania, Virginia, and West Virginia, stated that the primary 

public policy issue is the lack of full enforcement and education on the Americans with 

Disabilities Act (ADA). 

Increased education and enforcement of the ADA is needed to assure that the 

goal of the ADA is realized, full inclusion of people with disabilities (PWDs) into 

American society. As a PWD and an educator on the ADA, I am too keenly aware 

that there is much to be done to assure that the ADA goals are realized.

Vessels also mentioned the role of information in self-advocacy and partnerships at the 

federal level as examples of strategies to foster improvement. 

Many individuals with disabilities, their families and advocates still do not know of 

their rights, and responsibilities under the ADA. These individuals are still not 

confident and knowledgeable enough to self-advocate, which is required for 

enforcement. ... More collaboration of federal agencies with their state 

counterparts is needed to enhance the local entities ability to enforce and or 

educate about the issues surrounding the ADA. EEOC should work more closely 

with the state human relations commissions. Assistant Attorney Generals should 

be working with ADA educators and advocates; Disability Rights Networks, CILs 

and SILCs, human relations agencies in ADA Centers—former [Disability and 

Business Technical Assistance Centers] (DBTACS)—and so forth to address

regional ADA compliance issues.
86

Aaron T. Baier, consumer and systems advocacy coordinator, Access to Independence 

of Cortland County, New York, spoke with an NCD member. His summary comments 

focused on the need for individual supports during various transitional periods. These 

periods may include the transition into and out of the various levels of service as well as 

the transition to adulthood, with challenges affecting all people with disabilities, across 

systems, and may require the coordination of services. Among critical relationships 

needed to improve collaboration and coordination strategies—involving the exchange of 

information that will benefit people with disabilities—are several examples identified by 

Baier: federal and state-level partnerships; schools and CILs with child welfare entities; 

special education and related service provider entities, and residential living facilities 

connecting with schools and community-based programs as transition supports.

Ann Hardiman, executive director, New York State Association of Community and 

Residential Agencies, for provider member agencies serving people with intellectual and 

developmental disabilities (IDD) stated: 

The most important challenge is how agencies can help [people] with IDD to 

become integrated and accepted in the community. The economy has 

significantly impacted services. A crucial issue is the recruitment and maintenance 

of direct support services who are capable, skilled workers. Another important 

issue is employment for people with disabilities that fosters self-esteem and 

productivity. Communities need additional capacity to provide special services for 

special needs such as persons with autism or forensic backgrounds. ... Respect 

and recognition in the community for people with IDD is important. We need to 

keep a high level, a campaign almost, to educate and bring awareness to the 

public, using legal tools already in place, if necessary, to make sure this happens. 

... Partnerships are all important. There should be support for states that need to 

transition away from congregate programs that have been developed as a step 

away from institutions. States need room to be innovative, thoughtful (not 

rushing), and money to invest. Incentives could be developed for independent 

living and capacity building around person-centered planning.

Darrell Simmons, former diversity manager, currently in human resources organization 

development, MD Anderson Center, Houston, Texas, called the most important public 

policy issue the allocation of the US budget, including austerity measures also known as 

sequestration. 

The vast majority of Americans with disabilities are among the poorest Americans 

due to unemployment, low employment [and] wages and/or in many cases a poor 
87

quality of life as it relates to health and the ability to keep up the pace of living and 

working in America. African Americans, Latinos, Asians/[Pacific Islanders] and

American Indians/Alaska Natives with disabilities are the poorest of poor 

Americans with disabilities as evidenced by employment rates since the recession 

hit the US and global economies. Even those who enjoy decent wages, and good 

living conditions and quality of life are also impacted by budget allocations which 

affect the level and amount of assistance available for securing housing, 

transportation, health care, food, and other human services. ... Federal budget 

allocations directly or indirectly affect the above populations because they 

critically impact the level and quality of assistance available at the local, state and 

national levels since many of these jurisdictions depend on federal dollars to 

boost funding levels for state citizens. 

Mike Collins, disability consultant and former executive director for NCD, identified the 

most important 2013 issue as diminishing access to, and the increasing costs of, health 

care for people with chronic disabilities. Furthermore, Collins explained:

This is exemplified by CMS policies regarding provision of durable Medical 

Equipment and its so-called competitive bidding process that has put many local 

providers out of business and routinely denies necessary Medical Devices and 

supplies to those who need them most. ... Many people with disabilities need to 

focus on their daily needs for Health Care Services and don’t have the time nor 

the knowledge to get deeper into the policies that drive the increases in cost that 

they experience. If denied a particular product, or service, they often struggle to 

pay it out of pocket rather than trying to appeal the decision. This failure to appeal 

becomes part of the cost-saving philosophy in place for Health Care providers, as 

many of them routinely approve the initial denials once appealed. If Congress 

understood the full scope and impact of this problem, and would be willing to set 

aside the partisan bickering that consumes their time, there would be a possibility 

that many of the restrictive policies could be eliminated and approvals could return 

to the same level as was in place 10 years ago. 

Katy Beh Neas, Easter Seals senior vice president, government relations, described key 

policy areas and issues for that organization. 

The most important policy issue for Americans with disabilities in 2013 is 

increasing early and ongoing access to community-based services and long-term 

supports, such as health care, education, job training, housing, transportation, 

respite and transition services. Past policy decisions to address the country’s 

fiscal challenges have eroded access to critical support services for individuals 

with disabilities. As you know, people with disabilities disproportionately rely on 

government services to live, learn and work in their communities. These services

were created by government because the private marketplace had not met the 

unique needs of people with disabilities. ... Overall, funding for key discretionary 

programs that provide individuals with disabilities with the tools and supports they 

need to succeed have been cut or at best received stagnant funding over many 
88

fiscal years. The across-the-board sequestration cuts will further limit access to 

and effectiveness of these critical programs. Future policy decisions related to 

both entitlement programs and discretionary spending could further damage the 

progress the disability community has achieved to ensure early and ongoing 

access to services and long-term supports. Easter Seals strongly believes deficit 

reduction proposals must take a balanced approach to prevent further harm to 

people with disabilities across this country. ... We especially encourage 

policymakers to target services to very young children with disabilities at a critical 

time in their lives and also to students with disabilities as they prepare for 

adulthood to ensure they receive the training and experience they need to be 

successful during their transition and throughout their lives.
89

ENDNOTES 

1 Convention on the Rights of Persons with Disabilities. December 13, 2006. 2515 

United Nations Treaty Series 3. 

2 United Nations Enable. “Convention and Optional Protocol Signatures and 

Ratifications.” Accessed August 12, 2013.

http://www.un.org/disabilities/countries.asp?navid=12&pid=166. 

3 Bristo, Marca, and David Morrissey. “America and the CRPD: Editorial,”

Rehabilitation International Journal, August 3, 2009. 

http://www.usicd.org/detail/news.cfm?news_id=26&id=92. 

4 Letter from Kenneth Roth, Human Rights Watch, to Honorable Robert Menendez 

and Honorable Bob Corker, Senate Committee on Foreign Relations. “US Ratification of 

the Convention on the Rights of Persons with Disabilities,” July 26, 2013. 

http://www.hrw.org/news/2013/07/26/us-ratify-disability-rights-treaty. 

5 National Council on Disability. Understanding the Role of an International 

Convention on the Human Rights of People with Disabilities, White Paper. Washington, 

DC: NCD, 2002. 

http://www.ncd.gov/rawmedia_repository/fab40111_e273_4616_b451_d7c642b3b42b?d

ocument.pdf. 

6 Conference of States Parties to the Convention on the Rights of Persons with 

Disabilities, CRPD/CSP/2013/2, Sixth Session, New York, July 17–19 2013; Golla, Anne 

Marie, Anju Malhotra, Priya Nanda, and Rekha Mehra. Understanding and Measuring 

Women’s Economic Empowerment: Definition, Framework and Indicators. Washington, 

DC: International Center for Research on Women, 2011. 

http://www.icrw.org/files/publications/Understanding-measuring-womens-economicempowerment.pdf. 

7 Murray, Barbara. “Empowering People with Disabilities to Emerge from Poverty,”

presentation at Geneva Leonard Cheshire Disability/UNESCAP conference, “Disabilityinclusive MDG’s and Aid Effectiveness,” March 14–16, 2012; Tsengu, Daniel V., Svein 

Brodtkorb, and Torild Almnes. “CBR and Economic Empowerment of Persons with 

Disabilities.” In CBR as Part of Community Development: A Poverty Reduction Strategy, 

edited by Sally Hartley, 49–63. London: University College, 2006.

http://www.asksource.info/cbr-book/cbraspart_book.pdf. 

8 Erickson, W., C. Lee, and S. von Schrader. “Disability Statistics from the 2011 

American Community Survey (ACS).” Ithaca, NY: Cornell University Employment and 

Disability Institute, 2013. Accessed July 29, 2013. www.disabilitystatistics.org. 

9

 Ibid.
90

10 Blanck, Peter, Bruce Goldstein, and William N. Myhill. Legal Rights of Persons 

with Disabilities: An Analysis of Federal Law. 2nd ed. Horsham, PA: LRP Publications, 

2013. 

11 Ibid.

12 Office of Disability Employment Policy. “National Disability Employment 

Awareness Month: Because We Are Equal to the Task.” Accessed June 3, 2013. 

http://www.dol.gov/odep/topics/ndeam/. 

13 Ibid. 

14 Challenge Work Solutions. “Supported Employment.” Accessed August 13, 2013. 

http://www.challengeworkforcesolutions.org/?action=supported_employment. 

15 Mank, David M., and Teresa A. Grossi. “Employment: Renewed Investments.” 

Inclusion 1, no. 1 (2013): 7–16. http://aaiddjournals.org/doi/abs/10.1352/2326-6988-

1.1.007. 

16 National Council on Disability. Report on Subminimum Wage and Supported 

Employment. Washington, DC: NCD, 2012.

http://www.ncd.gov/publications/2012/August232012/. NCD’s recommendations address 

benefit planning, work incentive counseling, peer support, notification of services, 

infrastructure, and transformation of the 14(c) program, education systems change, and 

enforcement. 

17 Ibid.

18 Schecter, Ann, and Monica Alba. “Disabled Workers Paid Just Pennies an 

Hour—And It's Legal.” NBC News Investigations.com. June 25, 2013. 

http://investigations.nbcnews.com/_news/2013/06/25/19062348-disabled-workers-paidjust-pennies-an-hour-and-its-legal?lite. 

19 Shaheen, Gary, Thomas Golden, Pat Dowse, William N. Myhill, Eve L. Hill, David

Hoff, Cindy Thomas, and Chip Kenney. Transformation of Center-based Work into 

Integrated Opportunities for People with Disabilities in New York: Analysis and 

Recommendations for Center-Based Employers. New York: Employment and Disability 

Institute and Burton Blatt Institute, 2011. http://ilr-edir1.ilr.cornell.edu/nymakesworkpay/docs/Transformation%20White%20Paper.pdf. 

20 Ibid.

21 General Accounting Office. Special Minimum Wage Program: Centers Offer

Employment and Support Services to Workers with Disabilities, But Labor Should

Improve Oversight. GAO-01-886. Washington, DC: GAO, September 2001, 4. 

http://www.gao.gov/new.items/d01886.pdf.
91

22 National Council on Disability. Report on Subminimum Wage and Supported 

Employment. 

23 Ibid.

24 Office of Disability Employment Policy. “Integrated Employment Toolkit: 

Advancing Integrated Employment in Washington State.” Accessed August 13, 2013.

http://www.dol.gov/odep/ietoolkit/index_video.htm. 

25 Ibid. 

26 Complaint in Intervention of the US in Lane v. Kitzahber, No. 3:12-cv-00138-ST 

(March 27, 2013 D. Or.). http://www.ada.gov/olmstead/documents/lane_complaint.pdf. 

27 Ibid, #63.

28 Denson, Bryan. “U.S. Department of Justice Accuses Oregon of Segregating 

Disabled in Sheltered Workshops.” The Oregonian, April 1, 2013.

http://www.oregonlive.com/portland/index.ssf/2013/04/us_department_of_justice_accus.

html. 

29 National Council on Disability. “What Will Sequestration Mean for People with 

Disabilities?” Accessed August 13, 2013. http://www.ncd.gov/newsroom/022813. 

30 29 U.S.C.A. 701(b) (1) (West 2013).

31 Senate Report No. 113-71. July 11, 2013. http://www.gpo.gov/fdsys/pkg/CRPT113srpt71/pdf/CRPT-113srpt71.pdf. 

32 S. 1356, 113th Congress. Accessed August 14, 2013. 

http://www.gpo.gov/fdsys/pkg/BILLS-113s1356is/pdf/BILLS-113s1356is.pdf. 

33 US Department of Education. Rehabilitation Services and Disability Research: 

Fiscal Year 2014 Budget Request. Washington, DC: DOE, 2013. 

http://www2.ed.gov/about/overview/budget/budget14/justifications/k-rehabilitation.pdf. 

34 Ibid.

35 Ibid.

36 Ibid.

37 Ibid.

38 Ibid.
92

39 US Department of Education. Rehabilitation Services and Disability Research. 

40 State of Wisconsin Department of Workforce Development. “DVR Youth On-theJob Training Hiring Initiative.” April 2013. 

http://dwd.wisconsin.gov/dvr/ppg/procedures/yojt.pdf. 

41 Email from Michael Greco, Wisconsin DVR Director, to Lynnae Ruttledge, CoVice Chairperson, National Council on Disability, August 9, 2013. 

42 Project SEARCH. “High School Transition Program.” Accessed August 13, 2013.

http://projectsearch.us/OurPROGRAM/HighSchoolTransition.aspx.

43 Ibid.

44 Project SEARCH. “About Project SEARCH.” Accessed August 13, 2013.

http://projectsearch.us/About.aspx. 

45 Ibid.

46 Southeast TACE. “Summary of Innovation Projects.” Accessed August 13, 2013.

http://tacesoutheast.org/innovations3.php; Southeast TACE. “Southeast TACE 

Webinars: Customized Employment.” Accessed August 13, 2013.

http://www.tacesoutheast.org/network/jdx/docs/customized_employment_series_archive.

pdf. 

47 Greene, Deborah, and Chip Kenney. Southeast TACE: Impact of Innovations 

Projects on VR Adoption of Emerging Practices (2009-2012). Atlanta, GA: Burton Blatt 

Institute, October 2012. 

http://www.tacesoutheast.org/publications/impact_of_innovations_2012.pdf. 

48 Office of Disability Employment Policy. “The Case for Customized Employment.”

Accessed August 13, 2013.

http://www.dol.gov/odep/categories/workforce/CustomizedEmployment/case/index.htm. 

49 National Center on Workforce and Disability. “Customized Employment.”

Accessed August 13, 2013. http://www.onestops.info/i.php?i=1. 

50 Employment and Training Administration. “About the Office of Workforce 

Investment.” Accessed August 13, 2013.

http://www.doleta.gov/etainfo/wrksys/WIOffice.cfm. 

51 American Job Center. “About Us.” Accessed August 13, 2013.

http://jobcenter.usa.gov/about-us. 
93

52 CareerOneStop. Accessed August 13, 2013. http://www.careeronestop.org/; 

District of Columbia Department of Employment Services. “American Job Center.” 

Accessed August 13, 2013. http://does.dc.gov/service/american-job-center. 

53 CareerOneStop. “Workers with Disabilities.” Accessed August 13, 2013.

http://www.careeronestop.org/businesscenter/recruitandhire/hiringadiverseworkforce/wor

kers-with-disabilities.aspx?ES=Y&EST=disability. 

54 Lead Center. Accessed August 13, 2013. http://www.leadcenter.org/. 

55 Callahan, Mike, and Abby Cooper. “Group Discovery: A Cost-Effective Strategy 

for Guiding Employment Services.” LEAD Center E-Newsletter, no. 2, March 2013.

http://www.leadcenter.org/news/newsletters/lead-center-e-newsletter-march-2013#4. 

56 Ibid.

57 US Department of Labor, Office of Disability Policy. “Workplace Flexibility 

Toolkit.” Accessed August 14, 2013. http://www.dol.gov/odep/workplaceflexibility/. 

58 “Blending and Braiding Resources—Building on a Best Practice.” LEAD Center 

E-Newsletter, no. 1, December 2012. http://www.leadcenter.org/news/newsletters/leadcenter-e-newsletter-dec-2012#5. 

59 Office of Disability Employment Policy. “ODEP-Funded Customized Employment 

Materials and Other Technical Assistance Resources.” Accessed August 13, 2013. 

http://www.dol.gov/odep/categories/workforce/CustomizedEmployment/deliverables/.

60 Nicholas, Robert, Ronnie Kauder, and Kathy Krepcio. Using Braided Funding 

Strategies to Advance Employer Hiring Initiatives that Include People with Disabilities. 

New Brunswick, NJ: NTAR Leadership Center, September 2011. 

http://www.dol.gov/odep/pdf/BraidedFSReport.pdf. 

61 Office of Disability Employment Policy. “Research.” Accessed August 13, 2013. 

http://www.dol.gov/odep/topics/Research.htm. 

62 US Department of Labor. Disability Employment Initiative Fact Sheet. 

Washington, DC: DOL, November 2012. 

http://www.doleta.gov/disability/pdf_docs/nov12FactSheet.pdf. 

63 National Collaborative on Workforce and Disability. “Guideposts for Success.”

Accessed August 13, 2013. http://www.ncwd-youth.info/guideposts. 

64 Disability and Employment Community of Practice. “Promising Practices.”

Accessed August 13, 2013. 

https://disability.workforce3one.org/page/tag/promising_practices. 
94

65 Ibid.

66 Employment and Training Administration. What’s My Next Move? Washington, 

DC: Department of Labor. Accessed August 13, 2013. 

http://www.careeronestop.org/TridionMultimedia/WMNM%20FINAL%20JAN%2007%202

013_tcm24-13704.pdf. 

67 Ibid.

68 Disability Employment Initiative. “American Job Center Toolkit Table of 

Contents.” March 22, 2013. http://www.deiideas.org/chapter4_2013/row_2013_03_22_public.cfm.

69 Mendelsohn, Steven, William N. Myhill, and Michael Morris. “Tax Subsidization of 

Personal Assistance Services.” Disability and Health Journal, 5, no. 2 (2012): 75–86.

70 New York Makes Work Pay. “Connect with a Work Incentives Planner.”

Accessed August 13, 2013. http://ilr-edi-r1.ilr.cornell.edu/nymakesworkpay/rsp-wip.cfm.

71 Ibid.

72 New York Makes Work Pay. “Self-Employment and the Benefits Planning 

Process.” Policy to Practice Brief #13. New York: Employment and Disability Institute 

and Burton Blatt Institute. Last updated July 2012. http://ilr-edir1.ilr.cornell.edu/nymakesworkpay/docs/Self%20Employment%20Brief%202012.pdf. 

73 Ibid.

74 Internal Revenue Service. “Work Opportunity Tax Credit Extended.” Last 

updated July 17, 2013. http://www.irs.gov/Businesses/Small-Businesses-&-SelfEmployed/Expanded-Work-Opportunity-Tax-Credit-Available-for-Hiring-QualifiedVeterans. 

75 Mendelsohn, Myhill, and Morris. “Tax Subsidization of Personal Assistance 

Services.” 

76 Ibid, 78.

77 Ibid.

78 Ibid.

79 Ibid.

80 Mendelsohn, Myhill, and Morris. “Tax Subsidization of Personal Assistance 

Services.” 
95

81 New York State Department of Labor. “Work Opportunity Tax Credit.” Accessed

August 13, 2013. http://www.labor.ny.gov/businessservices/edsu/edsu%20wotc.shtm. 

82 Internal Revenue Service. “Work Opportunity Tax Credit Extended.” 

83 Internal Revenue Service. “Work Opportunity Tax Credit—Frequently Asked 

Questions and Answers.” Last updated July 17, 2013. 

http://www.irs.gov/Businesses/Small-Businesses-&-Self-Employed/VOW-to-Hire-HeroesAct-Frequently-Asked-Questions-and-Answers. 

84 New York State Department of Labor. Tax Incentives Fact Sheet. Albany, NY: 

NYSDOL, September 2011. http://www.labor.ny.gov/businessservices/PDFs/p438.pdf. 

85 Pennsylvania Department of Labor and Industry. “The Independence Capital 

Access Network Fund (ICAN).” Accessed August 13, 2013. 

http://www.portal.state.pa.us/portal/server.pt?open=514&objID=552240&mode=2. 

86 National Council on Disability. The State of 21st Century Financial Incentives for 

Americans with Disabilities. Washington, DC: NCD, August 11, 2008.

http://www.ncd.gov/rawmedia_repository/c6532f97_fbb7_42dd_a2e9_e361967b5c76?do

cument.pdf. 

87 Ibid, 18.

88 Ibid.

89 The federal interagency workgroup might be comprised of cabinet-level 

representatives of HHS (including CMS), DOL, HUD, DOT, DOE, Department of the 

Treasury (including IRS), and Social Security Administration. 

90 National Council on Disability. The State of 21st Century Financial Incentives for 

Americans with Disabilities, 211.

91 “Executive Order 13548 of July 26, 2010: Increasing Federal Employment of 

Individuals with Disabilities.” Federal Register, 75, no. 146 (July 30, 2010): 45,039–

45,041. http://www.gpo.gov/fdsys/pkg/FR-2010-07-30/pdf/2010-18988.pdf. 

92 Ibid.

93 US Senate Committee on Health, Education, Labor and Pensions. Unfinished 

Business: Making Employment of People with Disabilities a National Priority. 

Washington, DC: US Senate, July 2012, 13. 

http://www.harkin.senate.gov/documents/pdf/500469b49b364.pdf. 

94 Ibid, 14.
96

95 Memorandum from John Berry, Director, Office of Personnel Management. 

“Excepted Service—Appointment of Persons with Disabilities.” February 20, 2013. 

http://www.chcoc.gov/transmittals/TransmittalDetails.aspx?TransmittalID=5333. 

96 Office of Personnel Management. “Hiring Authorities: Excepted Service.”

Accessed August 13, 2013. http://www.opm.gov/policy-data-oversight/hiringauthorities/excepted-service/. 

97 Memorandum from John Berry. “Excepted Service—Appointment of Persons 

with Disabilities.” 

98 Ibid.

99 Equal Employment Opportunity Commission. “The ABCs of Schedule A for the 

Human Resource Professional.” February 2008. 

http://www.eeoc.gov/eeoc/initiatives/lead/upload/abc_hr_prof.pdf. 

100 US Senate Committee on Health, Education, Labor and Pensions. Unfinished 

Business. 

101 US Department of Labor. “The Rehabilitation Act of 1973, Section 503.” 

Accessed August 13, 2013. http://www.dol.gov/compliance/laws/comp-rehab.htm. 

102 “Affirmative Action and Nondiscrimination Obligations of Contractors and 

Subcontractors Regarding Individuals with Disabilities.” Federal Register, 76 (December

9, 2011): 77,099; National Council on Disability. National Disability Policy: A Progress 

Report. Washington, DC: NCD, September 18, 2012. 

http://www.ncd.gov/rawmedia_repository/7f96ce1b_6ab9_45e0_8bfc_adbeaa29412b?do

cument.pdf. 

103 Mississippi Development Authority. “Capital Access Contract Loan Program.” 

Accessed August 13, 2013. http://www.mississippi.org/index.php?id=278. 

104 Illinois Department of Commerce and Economic Opportunity. “Advantage

Illinois: Illinois Participation Loan Program.” Accessed August 13, 2013. 

http://www.ildceo.net/dceo/Bureaus/Advantage+Illinois/Participation+Loan+Program/. 

105 Institute for Veterans & Military Families. “About the EBV.” Accessed August 13, 

2013. http://whitman.syr.edu/ebv/About/. 

106 Institute for Veterans and Military Families. IVMF at One Year: Celebrating Our 

One-Year Anniversary. Syracuse, NY: IVMF, 2012.

107 Institute for Veterans and Military Families. Entrepreneurship Bootcamp for 

Veterans with Disabilities: Have You Ever Dreamed of Starting Your Own Business?

Syracuse, NY: IVMF, 2013.
97

108 Houghton, Jill. “U.S. Business Leadership Network Presentation.” National 

Council on Disability Quarterly Meeting Transcript. Washington, DC: NCD, January 22–

23, 2013.

109 Ibid.

110 Ibid.

111 von Schrader, Sarah, Valerie Malzer, William Erickson, and Susanne Bruyere. 

Emerging Employment Issues for People with Disabilities. Ithaca, NY: Employment and 

Disability Institute, December 7, 2011.

http://digitalcommons.ilr.cornell.edu/cgi/viewcontent.cgi?article=1288&context=edicollect. 

112 Ibid.

113 Interagency Committee on Disability Research. Employer Perspectives on 

Workers with Disabilities: A National Summit to Develop a Research Agenda. 

Washington, DC: DOE, September 2007. http://www2.ed.gov/rschstat/research/pubs/isereport--employer-perspectives.pdf. 

114 Chan, F., D. Strauser, P. Maher, E. Lee, R. Jones, and E. T. Johnson, 

“Demand-side Factors Related to Employment of People with Disabilities: A Survey of 

Employers in the Midwest Region of the United States.” Journal of Occupational 

Rehabilitation, 20, no. 4 (2010): 412–419.

115 Disability Case Study Research Consortium. Conducting & Benchmarking 

Inclusive Employment Policies, Practices, and Culture. Syracuse, NY: Burton Blatt 

Institute, 2008. 

116 Burton Blatt Institute. What Is an Inclusive Culture? Syracuse, NY: Burton Blatt 

Institute, March 2011, 2. 

http://bbi.syr.edu/projects/Demand_Side_Models/docs/a_inclusive_culture.pdf. 

117 Burton Blatt Institute. Inclusive Policies & Practices: What Do We Know?

Syracuse, NY: Burton Blatt Institute, March 2011, 3. 

http://bbi.syr.edu/projects/Demand_Side_Models/docs/b_inclusive_policies.pdf. 

118 Ibid.

119 Two programs at the Whitman School of Management may serve as models for 

such a course: the Inclusive Entrepreneurship initiatives at the South Side Innovation 

Center, and the Entrepreneurship Bootcamp for Veterans with Disabilities curriculum. 

Whitman School of Management. “South Side Innovation Center.” Accessed August 13, 

2013. http://whitman.syr.edu/programs-and-academics/centers-andinstitutes/falcone/programs/ssic.aspx; Whitman School of Management. “South Side 

Innovation Center Nominated for Prestigious National Awards.” March 12, 2012. 
98

http://whitman.syr.edu/Newsroom/News.aspx?id=1748 (twice nominated for awards from 

the National Business Incubator Association including “Incubator of the Year” and the 

“Incubator Innovation” Award); Institute for Veterans & Military Families. “About the 

EBV.”

120 US Senate Committee on Health, Education, Labor and Pensions. Unfinished 

Business. 

121 National Governors Association. “About.” Accessed August 14, 2013.

http://www.nga.org/cms/about. 

122 Equal Employment Opportunity Commission. “Understanding Your Employment 

Rights Under the Americans with Disabilities Act (ADA): A Guide for Veterans.”

Accessed August 13, 2013. http://www.eeoc.gov/eeoc/publications/ada_veterans.cfm;

Equal Employment Opportunity Commission. “Veterans and the Americans with 

Disabilities Act (ADA): A Guide for Employers.” Accessed August 13, 2013. 

http://www.eeoc.gov/eeoc/publications/ada_veterans_employers.cfm.

123 20 C.F.R. pt. 1002, app. 2008.

124 The law requires an individual to be 18 years of age to enlist in the military. The 

Bureau of Labor Statistics uses the age description included here for consistency. 

125 Bureau of Labor Statistics. “Economic News Release: Table A-5. Employment

status of the civilian population 18 years and over by veteran status, period of service, 

and sex, not seasonally adjusted.” Last updated August 2, 2013.

http://www.bls.gov/news.release/empsit.t05.htm. 

126 Ibid.

127 TRICARE is the health care program for approximately 9.6 million active-duty 

service members, National Guard and Reserve members, retirees, their families, 

survivors, and certain former spouses worldwide. TRICARE. “Welcome to TRICARE.” 

Accessed August 13, 2013. www.tricare.mil/Welcome.aspx. 

128 National Military Family Association. “Rumor Has It ... Sequestration and 

Military Families.” Accessed August 13, 2013. http://www.militaryfamily.org/featurearticles/sequestration-rumor-fact.html. 

129 National Council on Disability. Keeping Track: National Disability Status and 

Program Performance Indicators. Washington, DC: NCD, April 21, 2008. 

http://www.ncd.gov/rawmedia_repository/3cf968b2_341c_4dfb_ad70_bcd01ed7472a?do

cument.pdf. 

130 National Council on Disability. The Current State of Health Care for People with 

Disabilities. Washington, DC: NCD, September 30, 2009. 
99

http://www.ncd.gov/rawmedia_repository/0d7c848f_3d97_43b3_bea5_36e1d97f973d?do

cument.pdf. 

131 Ibid.

132 “Across the world, more often than their non-disabled peers, people with 

disabilities do not receive the health care they need and have poorer health. People with 

disabilities are more than twice as likely to find healthcare providers’ skills and facilities 

inadequate; nearly three times more likely to be denied health care; and four times more 

likely to be treated badly.” World Health Organization. “66th Assembly Adopts Resolution 

Calling for Better Health Care for People with Disabilities.” May 29, 2013.

http://www.enil.eu/news/66th-world-health-assembly-adopts-resolution-calling-for-betterhealth-care-for-people-with-disabilities/. 

133 Ibid.

134 National Council on Disability. The Current State of Health Care for People with 

Disabilities. Washington, DC: NCD, September 30, 2009.

135 Baylor College of Medicine Center for Research on Women with Disabilities. 

“Health Disparities Between Women with Physical Disabilities and Women in the 

General Population.” May 2005. http://www.bcm.edu/crowd/?PMID=1331. 

136 Yee, Sylvia. “Health Disparities Research at the Intersection of Race, Ethnicity, 

and Disability: A National Conference.” Paper presented at the Disability Rights 

Education and Defense Fund National Conference Washington, DC: DREDF, April 25–

26, 2013. http://dredf.org/2013-documents/Yee-Intersections-Conf-disability-healthdisparities-101-April-2013.pdf. 

137 National Council on Disability. The Current State of Health Care for People with 

Disabilities. Washington, DC: NCD, September 30, 2009.

138 Ibid.

139 Myhill, William N., and Peter Blanck. “Disability and Aging: Historical and 

Contemporary Challenges.” The Marquette Elder's Advisor Law Review, 11 (2009): 47–

80.

140 Sebelius, Kathleen. “Affordable Care Act at 3: Holding Insurance Companies 

Accountable.” The White House Blog. March 19, 2013.

http://www.whitehouse.gov/blog/2013/03/19/affordable-care-act-3-holding-insurancecompanies-accountable. 

141 Ibid.
100

142 University of California Berkeley Labor Center. Affordable Care Act: Summary of 

Provisions Affecting Employer-Sponsored Insurance. Berkeley, CA: CBLC, April 2013, 4.

http://laborcenter.berkeley.edu/healthpolicy/ppaca12.pdf. 

143 State Health Access Data Assistance Center. “ACA Note: Defining ‘Small 

Employer’ Under the Affordable Care Act.” March 9, 2011. 

http://www.shadac.org/blog/aca-note-defining-%E2%80%9Csmallemployer%E2%80%9D-under-affordable-care-act. 

144 Merlis, Mark. The Affordable Care Act and Employer-Sponsored Insurance for 

Working Americans. Washington, DC: Academy Health, June 2011.

http://www.academyhealth.org/files/nhpc/2011/AH_2011AffordableCareReportFINAL3.p

df. 

145 Community Catalyst & Georgetown University Health Policy Institute. “ACA 

Provisions: Essential Benefit Package.” Accessed August 14, 2013.

http://101.communitycatalyst.org/aca_provisions/essential_benefit_package. 

146 University of California Berkeley Labor Center. Affordable Care Act: Summary of 

Provisions Affecting Employer-Sponsored Insurance. Berkeley, CA: CBLC, April 2013, 2.

147 Community Catalyst & Georgetown University Health Policy Institute. “ACA 

Provisions.”

148 University of California Berkeley Labor Center. Affordable Care Act: Summary of 

Provisions Affecting Employer-Sponsored Insurance. Berkeley, CA: CBLC, April 2013, 4. 

149 Ibid.

150 Ibid.

151 Ibid.

152 Ibid.

153 State Health Access Data Assistance Center. “ACA Note.”

154 National Federation of Independent Business v. Sebelius, 132 S.Ct. 2566 

(2012).

155 Musumeci, MaryBeth. “Implementing the ACA’s Medicaid-Related Health 

Reform Provisions After the Supreme Court’s Decision.” Focus on Health Reform. Menlo 

Park, CA: Kaiser Family Foundation, August 2012. 

http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8348.pdf. 

156 Ibid, 3.
101

157 Ibid, 5.

158 Ibid, 5.

159 Centers for Medicare and Medicaid Services. “State Health Insurance 

Marketplaces.” Accessed August 13, 2013. http://www.cms.gov/cciio/resources/factsheets-and-faqs/state-marketplaces.html. CMS has granted conditional approval to the 

“state marketplaces” being setup by California, Colorado, Connecticut, the District of 

Columbia, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New 

Mexico, New York, Oregon, Rhode Island, Utah, Vermont, and Washington; and to state 

partnership marketplaces in Arkansas, Delaware, Illinois, Iowa, Michigan, New 

Hampshire, and West Virginia. 

160 Advisory Board Company. “Beyond the Pledges: Where the States Stand on 

Medicaid.” July 26, 2013. http://www.advisory.com/DailyBriefing/Resources/Primers/MedicaidMap#lightbox/2/. Nonparticipating states include

Alabama, Alaska, Georgia, Idaho, Kansas, Louisiana, Maine, Mississippi, Montana, 

Nebraska, North Carolina, Pennsylvania, South Carolina, Texas, Wisconsin, and 

Wyoming; and states leaning toward nonparticipation are Florida, Missouri, New 

Hampshire, South Dakota, Tennessee, Utah, and Virginia. 

161 Centers for Medicare and Medicaid Services. National Summary of Medicaid 

Managed Care Programs and Enrollment. Washington, DC: CMS, July 1, 2010. 

http://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-andSystems/MedicaidDataSourcesGenInfo/Downloads/2010Trends.pdf. 

162 National Council on Disability. Medicaid Managed Care for People with 

Disabilities. Washington, DC: NCD, March 15, 2013. 

http://www.ncd.gov/rawmedia_repository/20ca8222_42d6_45a5_9e85_6bd57788d726?d

ocument.pdf. 

163 Centers for Medicare and Medicaid Services. Guidance to States Using 115 

Demonstrations or 1915(b) Waivers for Managed Long Term Services and Supports 

Programs. Washington, DC: CMS, May 20, 2013. http://www.medicaid.gov/MedicaidCHIP-Program-Information/By-Topics/Delivery-Systems/Downloads/1115-and-1915bMLTSS-guidance.pdf. 

164 National Council on Disability. Medicaid Managed Care for People with 

Disabilities, 9. 

165 Ibid.

166 Ibid.

167 Centers for Medicare and Medicaid Services. “National Summary of State 

Medicaid Managed Care Programs: Program Descriptions as of July 1, 2010.” July 1, 
102

2010. http://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-andSystems/MedicaidDataSourcesGenInfo/Downloads/2010NationalSummaryPub.pdf. 

168 National Council on Disability. Medicaid Managed Care for People with 

Disabilities. 

169 Ibid.

170 Ibid.

171 Letter to Bruce A. Chernof, Chair of the Federal Commission on Long-Term 

Care, from Jeff Rosen, NCD Chair. “NCD Sends Recommendations to Long Term Care 

Commission.” July 3, 2013. http://www.ncd.gov/publications/2013/07032013.

172 National Council on Disability. Medicaid Managed Care for People with 

Disabilities, 9.

173 Ibid.

174 National Council on Disability. Medicaid Managed Care for People with 

Disabilities. 

175 National Quality Forum. “What We Do.” Accessed August 3, 2013. 

http://www.qualityforum.org/what_we_do.aspx. The NQF determines the measures that 

should be recognized as national standards.

176 Ibid.

177 Letter to Brenda Aguilar, Office of Management and Budget, from Jeff Rosen, 

National Council on Disability. “OMB Review of Department of Labor’s Proposed 

Changes to the Application of the Fair Labor Standards Act to Domestic Service, RIN 

1235-AA05.” March 19, 2013. http://www.ncd.gov/publications/2013/03192013/. 

178 National Alliance on Mental Illness. Report Card 2009: The State of Public 

Mental Health Services Across the Nation. Arlington, VA: NAMI, 2009, 23–26. 

http://www.nami.org/gtsTemplate09.cfm?Section=Findings&Template=/ContentManage

ment/ContentDisplay.cfm&ContentID=75255. 

179 Ibid.

180 Gugliotta, Guy. “VA Drive to Hire 1,600 Mental Health Professionals Hits 

Community Clinics’ Supply.” Kaiser Health News, April 7, 2013. 

http://www.kaiserhealthnews.org/stories/2013/april/07/va-hiring-mental-healthprofessionals-impact-on-community-health-centers.aspx (“Some experts say the pool of 

qualified candidates is too small and the federal effort could jeopardize alreadyunderstaffed community health organizations.”). 
103

181 University of California Berkeley Labor Center. Affordable Care Act: Summary of 

Provisions Affecting Employer-Sponsored Insurance. Berkeley, CA: CBLC, April 2013, 4.

182 Compton, Matt. “The National Conference on Mental Health.” White House Blog. 

June 3, 2013. http://www.whitehouse.gov/blog/2013/06/03/national-conference-mentalhealth. 

183 Ibid.

184 National Association of Social Workers. “NASW Meets with Vice President 

Biden’s Task Force.” January 10, 2013. 

http://www.socialworkblog.org/advocacy/2013/01/nasw-meets-with-vice-presidentbidens-task-force/. 

185 Letter to Vice President Joseph Biden, from Jonathan M. Young, Chairman, 

National Council on Disability. “Letter to Vice President Biden Regarding Anticipated 

Taskforce Recommendations.” January 11, 2013. 

http://www.ncd.gov/publications/2013/Jan142013/. 

186 Ibid.

187 White House. “The President’s Plan to Reduce Gun Violence: Ensure Quality 

Coverage of Mental Health Treatment, Particularly for Young People.” January 16, 2013. 

http://www.whitehouse.gov/issues/preventing-gun-violence. 

188 White House. “The President’s Plan to Reduce Gun Violence: Make Our 

Schools Safer with New Resource Officers and Counselors, Better Emergency 

Response Plans, and More Nurturing School Climates.” January 16, 2013.

189 Centers for Disease Control and Prevention. “Suicide Among Adults Aged 35–

64 Years—United States, 1999–2010.” Morbidity and Mortality Weekly Report, May 3, 

2013. http://www.cdc.gov/mmwr/pdf/wk/mm6217.pdf. 

190 Parker-Pope, Tara. “Suicide Rates Rise Sharply in U.S.” NY Times, May 2, 

2013. http://www.nytimes.com/2013/05/03/health/suicide-rate-rises-sharply-inus.html?_r=0. 

191 Tavernise, Sabrina. “Sharp Rise in Women’s Deaths from Overdose of 

Painkillers.” NY Times, July 2, 2013. http://www.nytimes.com/2013/07/03/health/rate-ofpainkiller-overdose-deaths-rises-among-women.html. Women are more likely than men 

to be prescribed pain drugs, to use them chronically, and to get prescriptions for higher 

doses.

192 Moseley, C., J. Shen, and C. Cochran. “Mental Health Services Availability and 

Admission of the Seriously Mentally Ill from the Emergency Department.” Journal of 

Health Human Services Administration, 31, no. 3 (2008): 292–308; Letter to Vice 
104

President Joseph Biden, from Jonathan M. Young. “Letter to Vice President Biden 

Regarding Anticipated Taskforce Recommendations.” 

193 Letter to Vice President Joseph Biden, from Jonathan M. Young. “Letter to Vice 

President Biden Regarding Anticipated Taskforce Recommendations.”

194 National Alliance on Mental Illness. Report Card 2009. 

195 Haley, Jennifer, and Genevieve M. Kenney. Uninsured Veterans and Family 

Members: State and National Estimates of Expanded Medicaid Eligibility Under the ACA. 

Princeton, NJ: Robert Wood Johnson Foundation, March 2013. 

http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf405143. 

196 TRICARE. “TRICARE and VA Benefit Comparison.” Accessed August 13, 2013. 

http://www.tricare.mil/LifeEvents/InjuredonAD/TransitionVA/BenefitComparison.aspx. 

197 Haley and Kenney. Uninsured Veterans and Family Members. 

198 Ibid.

199 Ibid.

200 Ibid, 2.

201 Ibid.

202 US Department of Veterans Affairs. “VA to Expedite Claims Decisions for 

Veterans Who Have Waited a Year or More.” April 19, 2013. 

http://www.va.gov/opa/pressrel/pressrelease.cfm?id=2436. 

203 Johnson, Nicole Blake. “DoD, VA Have Spent $1B Trying to Build Joint Health 

Records System.” Federal Times, June 12, 2013. 

http://www.federaltimes.com/article/20130612/IT03/306120010/DoD-VA-spent-1B-tryingbuild-joint-health-records-system. 

204 Church, Thomas E. “Returning Veterans on Campus with War Related Injuries

and the Long Road Back Home.” Journal of Postsecondary Education and Disability, 22, 

no. 1 (2009): 43–52; Myhill and Blanck. “Disability and Aging.”

205 Briggs, Bill. “Hearing Loss the Most Prevalent Injury Among Returning 

Veterans.” U.S. News on NBC News.com, November 13, 2012. 

http://usnews.nbcnews.com/_news/2012/11/13/14728839-hearing-loss-the-mostprevalent-injury-among-returning-veterans?lite. 
105

206 “In Combat Vets and Others, High Rate of Vision Problems After Traumatic 

Brain Injury.” Science News, February 4, 2013. 

http://www.sciencedaily.com/releases/2013/02/130204130038.htm. 

207 Fischer, Hannah. “U.S. Military Casualty Statistics: Operation New Dawn, 

Operation Iraqi Freedom, and Operation Enduring Freedom.” Washington, DC: 

Congressional Research Service, February 5, 2013.

http://www.fas.org/sgp/crs/natsec/RS22452.pdf. “The total number of amputations in 

OIF/OND and OEF as of December 3, 2012 is 1,715.” Ibid, 9.

208 Church, Thomas E. “Returning Veterans on Campus with War Related Injuries

and the Long Road Back Home.” Journal of Postsecondary Education and Disability, 22, 

no. 1 (2009): 43–52.

209 Tanielian, Terri, Lisa H. Jaycox, Terry L. Schell, Grant N. Marshall, M. Audrey

Burnam, Christine Eibner, et al. Invisible Wounds of War: Summary and 

Recommendations for Addressing Psychological and Cognitive Injuries. Santa Monica, 

CA: RAND Corporation, 2008. http://www.rand.org/pubs/monographs/MG720z1. 

210 Eisen, S. V., M. R. Schultz, D. Vogt, M. E. Glickman, A. R. Elwy, M. L. Drainoni, 

P. E. Osei-Bonsu, and J. Martin. “Mental and Physical Health Status and Alcohol and 

Drug Use Following Return from Deployment to Iraq or Afghanistan.” American Journal 

of Public Health, 102 Supplement (March 2012): 1:S66–73. 

211 Fischer, Hannah. “U.S. Military Casualty Statistics”; Tanielian, Terri, and Lisa H. 

Jaycox, eds. Invisible Wounds of War: Psychological and Cognitive Injuries, Their 

Consequences, and Services to Assist Recovery. Santa Monica, CA: RAND Corporation, 

2008. http://www.rand.org/content/dam/rand/pubs/monographs/2008/RAND_MG720.pdf. 

212 Tanielian and Jaycox. Invisible Wounds of War. 

213 Ibid, xxi.

214 Ibid, xxii.

215 Williams, Timothy. “Suicides Outpacing War Deaths for Troops.” New York 

Times, June 8, 2012. http://www.nytimes.com/2012/06/09/us/suicides-eclipse-wardeaths-for-us-troops.html?_r=0. 

216 Newhouse, Eric. “Invisible Wounds: What Stress Does to the Soul.” Psychology 

Today, March 6, 2013. http://www.psychologytoday.com/blog/invisiblewounds/201303/soaring-vets-suicide-rates. 

217 Ibid.

218 Tanielian and Jaycox. Invisible Wounds of War. 
106

219 National Council on Disability. Empowerment for Americans with Disabilities: 

Breaking Barriers to Careers and Full Employment. Washington, DC: NCD, October 1, 

2007. 

http://www.ncd.gov/rawmedia_repository/d87db786_9053_49c2_8032_092dddde6752?d

ocument.pdf. 

220 Ryndak, Diane, Terr Ward, Sandra Alper, Jill F. Storch, and Jennifer Wilson

Montgomery. “Long-term Outcomes of Services in Inclusive and Self-Contained Settings 

for Siblings with Comparable Significant Disabilities.” Education and Training in Autism 

and Developmental Disabilities, 45, no. 1 (2010): 38–53.

221 National Council on Disability. National Disability Policy: A Progress Report. 

Washington, DC: NCD, October 2011. 

http://www.ncd.gov/rawmedia_repository/9f8821fb_3747_43d1_a5e3_197440aa7296?d

ocument.pdf. 

222 US Department of Education. Federal Student Aid Handbook. Washington, DC: 

NCD, January 2012. http://ifap.ed.gov/fsahandbook/attachments/1213FSAHbkVol1.pdf.

223 Common Core State Standards Initiative. “Implementing the Common Core 

State Standards.” Accessed August 13, 2013. http://www.corestandards.org/. 

224 “Forty-five States Plus the District of Columbia and the Department of Defense 

Education Activity Have Adopted the Common Cores State Standards.” Common Core 

State Standards Initiative. “In the States.” Accessed August 14, 2013. 

http://www.corestandards.org/in-the-states. 

225 Learning Disabilities Association of America. “LDA Public Policy Committee 

Platform for the Reauthorization of the Individuals with Disabilities Education Act (IDEA) 

March 28, 2012.” Last updated August 13, 2013. 

http://www.ldanatl.org/legislative/pubs/LDA-IDEA-Reauthorization-Policy-Platform.asp. 

226 34 C.F.R. § 300.43(a)(1) (2012).

227 US Department of Education. “My Child’s Special Needs, A Guide to 

Individualized Education Program, Transition Services.” Accessed August 25, 2013. 

http://www2.ed.gov/parents/needs/speced/iepguide/index.html#process. 

228 Ibid. 

229 Ibid.

230 Ibid.
107

231 US Department of Education. Disability Rights: Enforcement Highlights. 

Washington, DC: DOE, October 2012. http://www2.ed.gov/documents/news/section504.pdf. 

232 Ibid.

233 Ibid. 

234 Higher Education Opportunity Act. Public Law 110-315, 122 Stat. 3078 (August 

14, 2008). Accessed July 31, 2013. http://www.gpo.gov/fdsys/pkg/PLAW110publ315/pdf/PLAW-110publ315.pdf. 

235 US Department of Education. “Advisory Commission on Accessible Instructional 

Materials in Postsecondary Education for Students with Disabilities.” December 6, 2011.

http://www2.ed.gov/about/bdscomm/list/aim/publications.html. 

236 Ibid.

237 US Department of Justice. “Project Civic Access Fact Sheet.” Accessed August 

13, 2013. http://www.ada.gov/civicfac.htm. Project Civic Access is “a wide-ranging effort 

to ensure [Title II entities] comply with the ADA by eliminating physical and 

communication barriers that prevent people with disabilities from participating fully in 

community life.” 

238 “Settlement Agreement between the Regents of the University of California and 

Disability Rights Advocates.” May 6, 2013.

http://dralegal.org/sites/dralegal.org/files/casefiles/settlement-ucb.pdf. 

239 Authors Guild, Inc. v. HathiTrust, 902 F. Supp. 2d. 445, 459-61 (S.D.N.Y. 2012).

240 Brief in Amici Curae in Support of Intervenor Defendants-Appellees National 

Federation of the Blind, et al. Case 12-4547 (June 4, 2013). 

http://www.ahead.org/uploads/News%20and%20Notes/2013-06-

04%20Amicus%20for%20AHEAD,%20et%20al%20(filed).pdf. 

241 AIM Commission. Report of the Advisory Commission on Accessible 

Instructional Materials in Postsecondary Education for Students with Disabilities. 

Washington, DC: DOE, December 6, 2011, 13. 

http://www2.ed.gov/about/bdscomm/list/aim/meeting/aim-report.pdf. 

242 Madeus, Joseph W., Wayne K. Miller II, and Mary Lee Vance. “Veterans with

Disabilities in Postsecondary Education.” Journal of Postsecondary Education and 

Disability, 22, no. 1 (2009): 10–17.

243 Vance, Mary Lee, and Wayne K. Miller II. “Serving Wounded Warriors: Current 

Practices in Postsecondary Education.” Journal of Postsecondary Education and 
108

Disability, 22, no. 1 (2009): 18–35. “For the purpose of this study, the term ‘wounded 

warriors’ refers specifically to students enrolled at postsecondary institutions that served 

active duty in the Middle East wars, specifically Iraq, Afghanistan, or Kuwait.” Ibid, 19.

244 Ibid, 34.

245 Ibid, 20–21.

246 Ibid, 20. 

247 Shackelford, Allan L. “Documenting the Needs of Student Veterans with 

Disabilities: Intersection Roadblocks, Solutions, and Legal Realities.” Journal of 

Postsecondary Education and Disability, 22, no. 1 (2009): 36–42.

248 National Council on Disability. The State of Housing in America in the 21st 

Century: A Disability Perspective. Washington, DC: NCD, 2010.

http://www.ncd.gov/rawmedia_repository/cdd1f2d8_ae1e_44ed_b016_938405e73a26?d

ocument.pdf. 

249 Ibid, 27–28.

250 Ibid, 27–28.

251 Ibid, 30.

252 Ibid, 9 and 30.

253 Montana Home Choice Coalition. “New Freedom Homeownership Initiative.”

Accessed August 13, 2013. https://www3.awareinc.org/awareinc/montanahomechoice/MHCPDF/Final%20Home%20Choice%20Homeo

wnership%20Services%20PDF.pdf. 

254 National Council on Disability. The State of Housing in America in the 21st 

Century, 29.

255 Ibid, 166.

256 Ibid, 29.

257 Ibid, 10.

258 Ibid, 32.

259 Ibid, 10.
109

260 US Department of Housing and Urban Development. Statement of the 

Department of Housing and Urban Development on the Role of Housing in 

Accomplishing the Goals of Olmstead. Washington, DC: HUD, June 4, 2013, 2. 

http://portal.hud.gov/hudportal/documents/huddoc?id=OlmsteadGuidnc060413.pdf. 

261 Ibid.

262 US Department of Justice. “Justice Department Settles with New Jersey Bus 

Company Over Unequal Treatment of Passengers with Disabilities.” Press Release, 

June 12, 2013. http://www.justice.gov/opa/pr/2013/June/13-crt-614.html. 

263 Ibid.

264 Noel v. New York City Taxi and Limousine Comm'n, 687 F.3d 63, 74 (2d Cir. 

2012).

265 Ibid, 69–70.

266 US Department of Transportation. “Department of Transportation Releases 

Policy on Automated Vehicle Development.” Press Release, May 30, 2013. 

http://www.dot.gov/briefing-room/us-department-transportation-releases-policyautomated-vehicle-development. 

267 Ibid.

268 Ibid.

269 Schur, Lisa, Meera Adya, and Douglas Kruse. “Disability, Voter Turnout, and 

Voting Difficulties in the 2012 Elections.” Report to the US Election Assistance 

Commission and Research Alliance for Accessible Voting. July 18, 2013, 3. 

http://smlr.rutgers.edu/disability-and-voting-survey-report-2012-elections. 

270 Ibid, 7.

271 Ibid, 26.

272 Ibid, 4.

273 Congressional Research Service. The Help America Vote Act and Elections 

Reform: Overview and Issues. Washington, DC: CRS, January 13, 2011. 

http://fpc.state.gov/documents/organization/155625.pdf. 

274 Ibid.
110

275 National Council on Disability. NCD Policy Forum: “The Help America Vote Act 

Ten Years Later: Has the Law Accomplished Its Aim?” Washington, DC: NCD, April 23, 

2013. http://www.ncd.gov/events/OtherEvents/04232013/. 

276 Terry, Clyde. “To Matter, Your Right to Vote Requires Access.” Accessed 

August 13, 2013. http://www.ncd.gov/newsroom/PolicyCorner/Voting2012. 

277 Schur, Adya, and Kruse. “Disability, Voter Turnout, and Voting Difficulties in the 

2012 Elections,” 6.

278 Ibid, 7.

279 Ibid, 5.

280 Waterstone, Michael. “Disability and Voting.” Michael Waterstone Blog, October 

29, 2012. http://llsblog.lls.edu/faculty/2012/10/by-associate-dean-michael-waterstone2.html. 

281 Protection and Advocacy for People with Disabilities, Inc. Polling Place 

Accessibility: Ensuring Access for Voters with Disabilities—Election Day Survey. 

Columbia, SC: Protection and Advocacy, December 2012. http://pandasc.org/wpcontent/uploads/2012/12/SURVEY-ACCESS-REPORT-2012.pdf. 

282 Kavilanz, Parija. “Disabled Voters Face Election Day Challenges.” CNNMoney, 

October 11, 2012. http://money.cnn.com/2012/10/11/smallbusiness/disabled-voterselection/index.html. 

283 Disability Rights Advocates. “Federal Court Orders NYC Board of Elections to 

Adopt a Plan to Eliminate Voting Barriers for New Yorkers with Disabilities.” October 19, 

2012, http://www.dralegal.org/pressroom/press-releases/federal-court-orders-nyc-boardof-elections-to-adopt-a-plan-to-eliminate; Disability Rights Advocates. “United Spinal 

Association, et al. v. Board of Elections (BOE).” Accessed August 13, 2013,

http://www.dralegal.org/impact/cases/united-spinal-association-et-al-v-board-ofelections-boe. 

284 Disability Rights Advocates. “Blind and Visually Impaired Voters Face Barriers to 

Voting on Election Day.” July 25, 2013, http://www.dralegal.org/pressroom/pressreleases/blind-and-visually-impaired-voters-face-barriers-to-voting-on-election-day. 

285 American Civil Liberties Union. “Voter Suppression in America.” Accessed 

August 13, 2013. http://www.aclu.org/voter-suppression-america. 

286 Ibid.
111

287 Leonard, Kimberly. “Keeping the ‘Mentally Incompetent’ from Voting.” The 

Atlantic, October 17, 2012. http://www.theatlantic.com/health/archive/2012/10/keepingthe-mentally-incompetent-from-voting/263748/. 

288 US Election Assistance Commission. Making Voting More Accessible for 

Veterans with Disabilities. Washington, DC: EAC, July 24, 2012, 3–5.

http://www2.itif.org/2012-making-voting-accessible-vets-disabilities.pdf. 

289 Centers for Medicare & Medicaid Services. “Long-Term Services and Supports.” 

Accessed August 13, 2013. http://www.medicaid.gov/Medicaid-CHIP-ProgramInformation/By-Topics/Long-Term-Services-and-Support/Long-Term-Services-andSupport.html. 

290 Olmstead v. L.C. ex. Rel. Zimring, 527 U.S. 581, 598 (1999).

291 Letter to Brenda Aguilar, Office of Management and Budget, from Jeff Rosen, 

National Council on Disability. “Letter to OMB about the Companionship Exemption.” 

March 19, 2013. http://www.ncd.gov/publications/2013/03192013/. 

292 National Council on Disability. The State of 21st Century Long-Term Services 

and Supports: Financing and Systems Reform for Americans with Disabilities. 

Washington, DC: NCD, December 2005. 

http://www.ncd.gov/publications/2005/12152005. 

293 Ibid.

294 National Council on Disability. The Power of Digital Inclusion. Washington, DC: 

NCD, 2011. 

http://www.ncd.gov/rawmedia_repository/c0d43e56_63e1_42a3_bcf7_2c8c99c4d462?d

ocument.pdf. 

295 Baker, Paul M.A., Jarice Hanson, and William N. Myhill. “The Promise of 

Municipal WiFi and Failed Policies of Inclusion: The Disability Divide.” Information Polity, 

14, nos. 1–2 (2009): 47–59; Myhill, William N., Derrick L. Cogburn, Deepti Samant, 

Benjamin Addom, and Peter Blanck. “Developing Accessible Cyberinfrastructureenabled Knowledge Communities in the Disability Community.” Assistive Technology 

Journal, 20, no. 3 (2008): 157–174; Myhill, William N., Deepti Samant, David Klein, 

Shelley Kaplan, Maria Veronica Reina, and Peter Blanck. “Distance Education Initiatives 

and Their 21st Century Role in the Lives of People with Disabilities.” In Focus on 

Distance Education Developments, edited by E. P. Bailey, 1–38. London: Nova Science 

Publishers, 2007; Samant, Deepti, Rebecca Matter, and Mark Harniss. “Realizing the 

Potential of Accessible ICTs in Developing Countries. Disability and Rehabilitation: 

Assistive Technology, 8, no. 1 (2013): 11–20.

296 Disability Rights Bar Association. “Welcome to the Disability Rights Bar 

Association.” Accessed August 13, 2013. http://disabilityrights-law.org/. DRBA 
112

membership currently includes more than 200 disability civil rights attorneys across the

nation, who mentor new attorneys and collaborate extensively for the benefit of plaintiffs 

with disabilities.

297 Settlement Agreement in the case of National Federation of the Blind v. Target 

Corp., No.: C 06-01802 MHP (N.D. Cal. Aug. 27, 2008). 

http://www.dralegal.org/sites/dralegal.org/files/casefiles/settlementagreement_2.pdf; 

National Association of the Deaf v. Netflix, Inc., 869 F.Supp.2d 196 (D. Mass. June 19, 

2012).

298 Goldstein, Daniel, and Gregory Care. “Disability Rights and Access to the Digital 

World: An Advocate’s Analysis of an Emerging Field.” Federal Lawyer, 59 (2012): 54–59. 

http://www.browngold.com/wbcntntprd1/wp-content/uploads/Disability-Rights-andAccess-to-the-Digital-World.pdf. 

299 “Nondiscrimination on the Basis of Disability; Accessibility of Web Information 

and Services of State and Local Government Entities and Public Accommodations.” 

Federal Register, 75 (July 26, 2010): 43,460-01; “Nondiscrimination on the Basis of 

Disability in Air Travel: Accessibility of Web Sites and Automated Kiosks at U.S. 

Airports.” Federal Register, 76 (November 21, 2011): 71,914-01. 

300 “The Attack of the MOOCs.” Economist. July 20, 2013. 

http://www.economist.com/news/business/21582001-army-new-online-courses-scaringwits-out-traditional-universities-can-they. 

301 World Intellectual Property Organization. “Historic Treaty Adopted, Boosts 

Access to Books for Visually Impaired Persons Worldwide.” June 27, 2013. 

http://www.wipo.int/pressroom/en/articles/2013/article_0017.html. 

302 World Intellectual Property Organization. “What Is WIPO?” Accessed August 13, 

2013. http://www.wipo.int/about-wipo/en/. 

303 “Marrakesh Treaty to Facilitate Access to Published Works for Persons Who Are 

Blind, Visually Impaired, or Otherwise Print Disabled.” Marrakesh, June 17–28, 2013. 

http://www.wipo.int/edocs/mdocs/diplconf/en/vip_dc/vip_dc_8_rev.pdf. 

304 Ibid.

305 World Intellectual Property Organization. “Members and Observers.” Accessed 

August 13, 2013. http://www.wipo.int/members/en/details.jsp?country_id=179. 

306 American Council of the Blind (ACB) v. Paulson, 525 F, 3d 1256 (DC. Cir. 

2008).

307 According to the American Academy of Ophthalmology, there are approximately 

160,000 veterans considered legally blind in the United States. When you factor in the 
113

number of veterans diagnosed with low vision, the number jumps to more than one 

million veterans. American Academy of Ophthalmology. “VA Increases Services for 

Veterans with Vision Loss.” Accessed August 13, 2013. 

http://www.aao.org/veterans/news/low-vision.cfm. 

308 US Department of Justice. “Justice Department Obtains Comprehensive ADA 

Agreement Regarding the Commonwealth of Virginia’s Developmental Disabilities 

System.” Press Release, January 26, 2012.

http://www.justice.gov/opa/pr/2012/January/12-crt-111.html. 

309 Ibid.

310 National Council on Disability. National Disability Policy: A Progress Report. 

Washington, DC: NCD, September 18, 2012. 

311 Bureau of Engraving and Printing. “Meaningful Access: Meaningful Access 

Recommendations Approved by the Secretary.” May 31, 2011. 

http://www.moneyfactory.gov/uscurrency/meaningfulaccess.html. 

312 Bureau of Engraving and Printing. White Paper Regarding Meaningful Access to 

U.S. Currency for Blind and Visually Impaired Individuals. Washington, DC: BEP, June

27, 2013. http://www.moneyfactory.gov/images/Meaningful_Access_White_Paper_06-

25-13.pdf. 

313 Email from Sabra Pressman, External Relations Specialist, Bureau of 

Engraving, to Joan Durocher, Executive Director, National Council on Disability, April 11, 

2013.

314 Ibid.

315 Bank of Canada. “Bank Note Videos.” Accessed August 13, 2013. 

http://www.bankofcanada.ca/banknotes/bank-note-videos/.