National Disability Policy: 

A Progress Report

National Council on Disability

October 26, 2017
National Council on Disability (NCD)

1331 F Street NW, Suite 850

Washington, DC 20004

National Disability Policy: A Progress Report

National Council on Disability, October 26, 2017

Celebrating 30 years as an independent federal agency

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

(NCD) website (www.ncd.gov) or contact NCD to request an alternative format using the following 

information:

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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.
Letter of Transmittal

October 26, 2017

President Donald J. Trump

The White House

1600 Pennsylvania Avenue NW

Washington, DC 20500

Dear Mr. President:

The National Council on Disability (NCD) is pleased to present the 2017 edition of National Disability 

Policy: A Progress Report. Each year, NCD submits a statutorily mandated report to the White 

House and Congress to offer recommendations on new and emerging issues affecting the lives 

of people with disabilities. NCD identified one central topic as the theme for the 2017 Progress 

Report—poverty. The Council focused on poverty because it is the common thread that continues 

to compound many of the core concerns for people with disabilities. The report focuses on seven 

factors that are crucial for enhancing the economic independence of people with disabilities in 

our society: education, employment, financial assistance and incentives, health care, long-term 

services and supports, transportation, and housing.

NCD submits this report at a time when an increasing number of plans and initiatives to 

combat poverty have been announced. Poverty among people with disabilities has reached 

epidemic proportions. As a result, existing programs and policies must be revised to address the 

circumstances that keep Americans with disabilities from achieving economic self-sufficiency. This 

report addresses why people with disabilities are often destined to live in poverty and experience 

high unemployment despite existing federal regulations and public policies that are geared toward 

improving the lives of people with disabilities.

Issues reflected in the 2017 Progress Report have implications for our society as a whole. With 

continuous advances in technology, health care, and education and ever-changing attitudes toward 

people with disabilities in society, there has never been a better time for Americans with disabilities 

to achieve economic independence. This report highlights the opportunities to improve existing 

policy as well as the need for forethought to ensure that any proposed policy changes in the fight 

against poverty do not inadvertently cause harm to people with disabilities but rather further our 

common goal of achieving economic self-sufficiency for all.

NCD appreciates the efforts of policymakers who continue to promote policies and practices that 

affect the economic self-sufficiency and independence of all people with disabilities. We invite 

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.

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

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Congress and the White House to continue this momentum by carefully considering the concerns and 

recommendations reflected here.

Respectfully,

Clyde E. Terry

Chairperson

(The same letter of transmittal was sent to the President Pro Tempore of the U.S. Senate and the Speaker of the 

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

Members

Clyde E. Terry, Chairperson

Benro T. Ogunyipe, Vice Chairperson

Billy W. Altom

Rabia Belt

James T. Brett

Bob Brown

Daniel M. Gade

Wendy S. Harbour

Neil Romano

Staff

Vacant, Executive Director

Joan M. Durocher, General Counsel & Director of Policy

Amy Nicholas, Attorney Advisor

Amged Soliman, Attorney Advisor

Ana Torres-Davis, Attorney Advisor

Anne Sommers, Director of Legislative Affairs & Outreach

Phoebe Ball, Legislative Affairs Specialist

Lisa Grubb, Director of Operations and Administration

Stacey S. Brown, Staff Assistant

Keith Woods, Financial Management Analyst

National Disability Policy: A Progress Report 3
4 National Council on Disability
Acknowledgments

The National Council on Disability wishes to thank American Institutes for Research (AIR), 

particularly Mona Kilany and her team—Kaylie Clark, Tsion Ghedamu, Rose Belanger, and Natanee 

Thawesaengskulthai—as well as Nanette Goodman and Michael Morris from the National Disability 

Institute, for the research conducted in developing this report. NCD also thanks those who shared their 

personal experiences and offered expert input to inform this report.

National Disability Policy: A Progress Report 5
6 National Council on Disability
Contents

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  

Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Collaboration and Data Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

Financial Assistance and Incentives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

Transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

Acronym Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2

Cinda’s Story . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2

The 2017 NCD Progress Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2

Chapter 1: How Public Policies, Programs, and Practices Help People 

with Disabilities Achieve Economic Self-Sufficiency . . . . . . . . . . . . . . . . . . . . . . . . . .  2

Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2

Michael’s Story . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2

Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  3

Health and Well-Being . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  3

Financial Assistance and Incentives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  3

Social Security Disability Insurance (SSDI) 

and Supplemental Security Income (SSI) . . . . . . . . . . . . . . . . . . . . .  3

Earned Income Tax Credit (EITC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  3

Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

Transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

National Disability Policy: A Progress Report 7
Chapter 2: Barriers to Achieving Economic Self-Sufficiency for People 

with Disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

Barriers to Adequate Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

Barriers Related to the Transition to Employment . . . . . . . . . . . . . . . . . . .  4

Barriers Related to Complex Eligibility and Enrollment Procedures . . . .  4

Barriers Related to Program Income and Asset Limits . . . . . . . . . . . . . . .  5

Barriers Related to Transportation in Rural Areas . . . . . . . . . . . . . . . . . . . .  5

Barriers Related to Attitudes and Stereotypes . . . . . . . . . . . . . . . . . . . . . .  5

Chapter 3: Emerging and Promising Practices for Achieving Economic 

Self-Sufficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  5

Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  5

Financial Assistance and Incentives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

Underutilized Policies, Programs, and Practices . . . . . . . . . . . . . . . . . . . . .  6

Chapter 4: Recommendations to Promote Economic Self-Sufficiency 

for People with Disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

Collaboration and Data Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

Financial Assistance and Incentives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

Transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

Appendix A: Focus Group Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

Focus Group Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

Recruitment and Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

Relevant Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

Lessons from Focus Group Discussions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

8 National Council on Disability
Appendix B: Policies, Poverty, and People with Disabilities . . . . . . . . . . . . . . . . . . . .  7

Americans with Disabilities Act (ADA)...

Title I: Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

Title II: State and Local Governments . . . . . . . . . . . . . . . . . . . . . . . . .  7

Title III: Public Accommodations and Commercial Facilities . . . . . . .  7

Individuals with Disabilities Education Act (IDEA) . . . . . . . . . . . . . . . . . . .  7

Workforce Innovation and Opportunity Act (WIOA) . . . . . . . . . . . . . . . . . .  7

Supplemental Security Income (SSI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

Social Security Disability Insurance (SSDI) . . . . . . . . . . . . . . . . . . . . . . . . .  8

Ticket to Work and Work Incentives Improvement Act . . . . . . . . . . . . . . . .  8

Work Incentives Planning and Assistance (WIPA) . . . . . . . . . . . . . . . . . . .  8

Medicaid Buy-In . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  8

Achieving a Better Life Experience Act of 2013 (ABLE Act) . . . . . . . . . . . .  8

Patient Protection and Affordable Care Act (ACA) . . . . . . . . . . . . . . . . . . .  8

Appendix C: Select NCD Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  8

2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  8

2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  8

2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  8

2013 and Earlier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  8

Appendix D: Institutions of Higher Education with Transition and Postsecondary 

Programs for Students with Intellectual Disabilities . . . . . . . . . . . . . . . . . . . . . . . . . .  8

Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  8

National Disability Policy: A Progress Report 9
10 National Council on Disability
T

he National Council on Disability (NCD) 

recognizes that all Americans have 

the right to pursue lives with equal 

opportunity, full community participation, 

independent living, and economic self-sufficiency. 

However, people with disabilities live in poverty 

at more than twice the rate of people without 

disabilities. It is imperative that we examine the 

interconnected nature of poverty and the barriers 

that people with disabilities face in order to 

determine how existing programmatic structures 

can be improved to better meet the needs of 

people with disabilities. NCD has committed 

the 2017 Progress Report to poverty. The report 

examines public policies, programs, and practices 

across the areas of education, employment, 

financial assistance and incentives, health care, 

long-term services and supports, transportation, 

and housing, as access to each of these areas 

is necessary in order for people with disabilities 

to achieve independent living and inclusion in all 

aspects of society.

The 2017 Progress Report offers insight 

into how existing public policies and programs 

are designed to provide economic support 

for people with disabilities, but often create 

barriers that impede upward mobility. The report 

begins with a review of how existing public 

policies, programs, and practices can assist 

people with disabilities in achieving economic 

self-sufficiency. Next, the report identifies and 

describes the common barriers that perpetuate 

the cycle of poverty for people with disabilities. 

The report then looks at a number of promising 

practices that lift people with disabilities out 

of poverty. It discusses how these practices 

address barriers that people with disabilities 

experience with the goal of improving the lives 

of people with disabilities. Finally, the report 

offers recommendations that help ensure 

people with disabilities are able to achieve 

economic self-sufficiency.

A summary of recommendations to promote 

economic self-sufficiency and lift people with 

disabilities out of poverty follows:

Collaboration and Data Collection

■ Congress should appropriate funds for 

the creation of a coordinated review of all 

federal disability programs to enhance the 

efficiency and ability of existing structures to 

break down silos between federal agencies 

in order to improve the economic picture for 

people with disabilities.

❍ The Office of Management and Budget 

(OMB) should direct all cabinet-level 

federal agencies to submit their Agency 

Reform Plans pertaining to their disability 

programs to NCD for review.

Executive Summary

National Disability Policy: A Progress Report 11
❍ All federal agencies should be directed 

to include measures of cross-agency 

collaboration within their Government 

Performance and Results Act (GPRA) 

performance measurement standards. 

OMB should report on measures of 

cross-agency collaboration in its annual 

reports on agency performance.

❍ All federal agencies, including but 

not limited to the U.S. Departments 

of Education, Labor, Health and 

Human Services, and Housing and 

Urban Development, should improve 

data collection related to people 

with disabilities in order to enhance 

knowledge of how people with disabilities 

are assisted by existing programs. Data 

collection should include information 

about people with disabilities who use 

federally funded programs to determine 

where programs can be modified and 

improved to promote employment and 

economic self-sufficiency.

■ Congress should continue investments in 

the U.S. Census Bureau’s development 

of the Supplemental Poverty Measure 

and annual reports to ensure an adequate 

assessment of how the cost of necessary 

expenses that people with disabilities face 

(like medical or long-term services and 

support expenses) affects their opportunities 

and ability to achieve economic 

self-sufficiency.

Education

■ Congress should reauthorize the Individuals 

with Disabilities Education Act (IDEA) in 

a manner that facilitates the meaningful 

inclusion of all students with disabilities. 

Reauthorization should reinforce the 

assertions under IDEA to provide a free 

and appropriate education to students 

with disabilities, including language to 

ensure that students with disabilities from 

diverse ethnic backgrounds and students 

who exhibit challenging behaviors are not 

disproportionately placed outside of the 

least restrictive environment.

■ The U.S. Department of Education (ED) 

should issue guidelines to local education 

agencies and state education agencies on 

the inclusion of universal design for learning 

(UDL) principles and recommend giving 

teachers flexibility to implement UDL with 

state and district curricula and lesson plans 

to promote broader integration of students 

with disabilities in the classroom.

■ ED and state education agencies should 

issue guidelines to local school districts 

to give all students with disabilities an 

opportunity to obtain a standard high school 

diploma. The guidelines should reinforce that 

the use of alternative high school diplomas 

or certificates of completion should be 

considered a last resort for students with 

disabilities.

■ ED Institute on Education Sciences should 

fund national research that explores the 

educational and employment outcomes of 

alternative high school diplomas for students 

with individualized education programs 

(IEPs) and Section 504 plans as well as the 

demographic characteristics of students 

receiving these alternative diplomas.

■ ED should continue funding for model 

programs like the Transition and 

12 National Council on Disability
Postsecondary Programs for Students with 

Intellectual Disabilities (TPSID) program, 

which can help reduce poverty among 

people with intellectual disabilities.

■ Congress should amend the Higher 

Education Act to modify existing 

higher education financial assistance 

program guidelines so that they are 

adequately accessible and students with 

disabilities are not penalized when a 

qualifying disability limits their ability to 

maintain a full course load or work-study 

requirements as determined by campus 

disability services programs. This should 

include but not be limited to Pell grants, 

federal work-study programs, and student 

loan repayment.

■ The Internal Revenue Service (IRS) should 

provide guidance that waives the tax debt 

on student loan forgiveness for students 

with disabilities so that they do not incur a 

tax debt from a forgiven loan.

Employment

■ The U.S. Department of Labor (DOL), the 

U.S. Access Board, the U.S. Department of 

Justice (DOJ), and the Equal Employment 

Opportunity Commission (EEOC) should 

dictate that all policies and regulations 

related to Sections 503 and 511 of the 

Rehabilitation Act of 1973 be prioritized for 

nationwide enforcement. This includes an 

annual report to Congress on activities and 

the impact on employment for people with 

disabilities.

■ Congress should amend the Small 

Business Act to expand the Small Business 

Administration’s 8(a) Business Development 

Program to include people with disabilities 

as a presumed socially disadvantaged 

group to be in line with the findings in the 

Americans with Disabilities Act (ADA), 

which states that people with disabilities 

are disadvantaged socially, economically, 

vocationally, and educationally.

■ The U.S. DOL and Education should issue 

guidelines to develop partnerships across 

state vocational rehabilitation agencies, local 

education agencies, institutes of higher 

education, and employers that promote 

paid internships for college graduates and 

students with disabilities in postsecondary 

education as a gateway to full-time 

employment.

■ All federal agencies should be the model 

in hiring, retention, and integration of 

people with disabilities in the workplace. 

In accordance with the U.S. Office of 

Personnel Management (OPM), all federal 

agencies should increase coordination 

between their Selective Placement Program 

Coordinators (SPPCs). This will bridge the 

gap between managers and employees 

with disabilities and enhance understanding 

of reasonable accommodations and their 

effect on productivity and retention of 

people with disabilities. To attain this goal, 

mandatory training for human resources 

staff, managers, and supervisors should be 

required.

■ States should mandate Employment First 

initiatives to reflect stronger legislative and 

policy support of competitive integrated 

employment to increase opportunities for 

economic independence for youth and 

adults with disabilities.

National Disability Policy: A Progress Report 13
Financial Assistance and Incentives

■ Congress should expand opportunities for 

people with disabilities who need to pay for 

personal care services to benefit from tax 

deductions when medical expenses are less 

than 10 percent of adjusted gross income or 

deductions cannot be itemized.

■ Congress should approve three amendments 

to the Achieving a Better Life Experience 

(ABLE) Act:

❍ The ABLE Financial Planning Act, which 

would allow 529 educational savings 

accounts to be transitioned to qualifying 

people with disabilities without incurring 

penalties or taxes.

❍ The ABLE Age Adjustment Act, which 

would increase the qualifying age 

threshold for eligibility for an ABLE 

account from 26 to 46.

❍ The ABLE to Work Act, which would 

allow employed people with disabilities 

to contribute funds to an ABLE account 

in an amount above the $14,000 per year 

cap. Additional contributions would not 

exceed the equivalent of the determined 

federal poverty level for that year (the 

maximum allowable amount was 

$26,060 in 2017).

■ All states should implement ABLE programs 

and actively inform people with disabilities 

and their caregivers of this legislation in 

order to provide people with disabilities the 

opportunity to build individual savings and 

invest their money in ways that will enhance 

their economic self-sufficiency.

■ The IRS should issue final regulations to 

Section 529A of the Internal Revenue 

Code on how states or state agencies can 

establish a qualified ABLE program.

■ Congress should pass legislation that 

decouples eligibility for health care benefits 

from eligibility for cash benefits like 

Supplemental Security Income (SSI) and 

Social Security Disability Insurance (SSDI) to 

prevent people with disabilities from being 

forced to choose between getting a job or 

having access to health care.

■ Congress should amend the Earned 

Income Tax Credit (EITC) to lower the age 

of eligibility from 25 to 18 years old and 

increase the benefit for childless adults 

to provide greater incentive to work and 

advance self-sufficiency.

Health Care

■ Congress should maintain protections that 

prohibit insurance companies from denying 

coverage because of preexisting conditions 

to ensure affordable health insurance 

coverage for people with disabilities.

■ Congress should ensure that Medicaid 

reforms, including but not limited to block 

grants or per capita caps, will be robust 

enough to: a) prevent dramatic cutbacks in 

services and prevent lower reimbursement 

rates for providers and limits on Medicaid 

eligibility; and b) safeguard access to 

home and community-based services 

waivers, which are essential to promoting 

independent living, employment, and 

economic self-sufficiency for people 

with disabilities. Any increases to state 

flexibility through block grants or per 

capita caps should include meaningful 

accountability to the Centers for Medicare 

14 National Council on Disability
and Medicaid Services (CMS) to ensure 

a minimum level of coverage, services, 

and consistency are provided across state 

Medicaid programs.

■ Congress should maintain Medicaid 

expansion for individuals whose conditions 

did not meet the severity requirements for 

disability-based Medicaid prior to passage 

of the Patient Protection and Affordable 

Care Act (ACA) and those falling within the 

two-year waiting period before qualifying for 

disability-based Medicare.

■ Congress should remove the 18 to 64 

age limits for buy-in options in Medicaid 

to promote work among people with 

disabilities after age 65 without requiring 

them to spend down to be eligible for 

Medicaid or exclude their buy-in assets from 

being counted for eligibility purposes.

Housing

■ The U.S. Department of Housing and 

Urban Development (HUD) should require 

that all federally assisted housing units 

follow universal design principles and 

ensure that accessible housing units are 

in line with the percentage of people with 

disabilities requesting federal housing 

assistance. This goal can be achieved by 

increasing the percentage of required 

new housing units that are accessible 

for people with mobility disabilities 

and accessible for people with sensory 

disabilities from the current rate of 

5 percent and 2 percent, respectively.

■ Local communities should enact 

ordinances requiring developers to include 

a percentage of accessible homes of 

varying price in any new development, 

similar to Montgomery County, Maryland’s 

Moderately Priced Housing law, which 

requires 12.5 to 15 percent of the total 

number of units in a new development 

to be moderately priced. HUD should 

provide guidance to local communities to 

promote greater investment in housing 

developments incorporating universal 

design, to ensure greater availability of 

accessible housing units, and to promote 

opportunities for aging in place.

Transportation

■ DOJ should issue regulations that require 

privately funded transit agencies to provide 

accessible transportation options for people 

with disabilities in all communities. This 

includes but is not limited to taxicabs and 

transportation arranged through smartphone 

applications.

■ Local municipalities should require taxicab 

authorities to provide mandatory training 

for taxicab operators about the proper ramp 

deployment and securement policies and 

procedures so that people with mobility 

disabilities can safely and effectively use 

privately funded transit options.

■ Local communities should provide 

guidance that clarifies and bolsters the 

ADA nondiscrimination standards in order 

to address issues faced by people with 

disabilities who require assistance to use 

transportation services because of their 

disability. This includes but is not limited to 

refusal to accommodate service animals, 

claims of broken lifts and ramps, and late 

pickup or no shows.

National Disability Policy: A Progress Report 15
■ The U.S. Department of Transportation’s 

(DOT) Federal Transit Administration should 

work with local communities so that the DOT 

ADA regulations are followed to guarantee 

that all public transit stations and bus stops 

are accessible. This includes but is not 

limited to ensuring the detectability of bus 

stops through tactile signage or unique bus 

stop pole designs for people who are blind or 

have visual impairments, and installation and 

maintenance of shelters and level concrete 

pads for people with mobility disabilities.

■ Congress should place greater emphasis 

on funding transportation programs in rural 

areas to address minimal or nonexistent 

public and privately funded accessible 

transportation options for people with 

disabilities.

■ Neighboring paratransit agencies should 

coordinate with each other to eliminate 

the arbitrary line between paratransit 

jurisdictions, which would provide people 

with disabilities with increased job 

opportunities in major business hubs.

16 National Council on Disability
Acronym Glossary

ABLE Achieving a Better Life Experience Act

ACA Affordable Care Act

ADA Americans with Disabilities Act

AJC American Job Centers

BPAO Benefit Planning, Assistance, and Outreach

CDR continuing disability reviews

CWIC Community Work Incentives Coordinators

DOJ U.S. Department of Justice

DOT U.S. Department of Transportation

ED U.S. Department of Education

EEOC Equal Employment Opportunity Commission

EITC Earned Income Tax Credit

EN employment network

FPL federal poverty level

GAO Government Accountability Office

GPRA Government Performance and Results Act

HCBS home and community-based services

HUD U.S. Department of Housing and Urban Development

IDEA Individuals with Disabilities Education Act

IEP individualized education programs

IEEI Initiative for Empowerment and Economic Independence

IRS Internal Revenue Service

IRWE impairment-related work expense

MPH moderately priced housing

NCD National Council on Disability

NCI National Core Indicators

ODIC Office of Disability Integration and Coordination

OMB Office of Management and Budget

OPM U.S. Office of Personnel Management

PASS plans for achieving self-support

PHA public housing authority

RSA Rehabilitation Services Administration

SGA substantial gainful activity

SPPC Selective Placement Program Coordinator

SSA Social Security Administration

National Disability Policy: A Progress Report 17
SSI Supplemental Security Income

SSDI Social Security Disability Insurance

TANF Temporary Aid to Needy Families

TPSID Transition and Postsecondary Programs for Students with Intellectual Disabilities

TTW Ticket to Work

UDL universal design for learning

USDA U.S. Department of Agriculture

VR vocational rehabilitation

WIOA Workforce Innovation and Opportunity Act

18 National Council on Disability
People with disabilities make up approximately 

12 percent of the U.S. working-age population; 

however, they account for more than half of those [ living in long-term poverty.

National Disability Policy: A Progress Report 19
20 National Council on Disability
Background

Disability and poverty are inextricably tied 

together. Poverty causes disability by 

exacerbating physical and mental health 

issues, while people with disabilities achieve 

lower rates of education, employment, and 

financial independence, resulting in a scarcity 

of resources. In fact, people with disabilities 

live in poverty at more than twice the rate of 

people without disabilities (29 percent compared 

to 12 percent).1 While people with disabilities 

continue to seek 

economic self-sufficiency, 

independent living, 

and integration into all 

aspects of society, public 

policies need to better 

meet the challenges 

faced by people with 

disabilities to break the 

link with poverty.

People with disabilities make up approximately 

12 percent of the U.S. working-age population;2

however, they account for more than half of 

those living in long-term poverty.3 In addition 

to exacerbating poor physical or mental health, 

poverty can lead to disabling chronic health 

conditions including childhood asthma, heart 

disease, and obesity in situations characterized 

by limited basic supports and long-term exposure 

to environmental stressors.4 At the same time, 

some current public policies and attitudes about 

disability lead to poverty among people with 

disabilities. The impact of these public policies 

and attitudes is illustrated by data showing that 

17.5 percent of people with disabilities participate 

in the workforce compared to 65 percent of 

people without disabilities, directly resulting in 

higher rates of poverty for this population.5

Public policies like the ADA, the IDEA, and 

the Rehabilitation Act of 1973 (as amended) set 

standards for protecting civil rights for people 

with disabilities so that 

they may enjoy the 

benefit of full access 

and inclusion throughout 

society. However, people 

with disabilities often 

encounter significant 

obstacles in their quest 

toward these goals including physical access 

barriers, lack of available programs, complex 

relationships between programs and eligibility 

requirements, and inaccurate perceptions of their 

capabilities.

The complex relationship between poverty 

and disability can lead to obstacles that affect 

people with disabilities throughout their lives. 

For example, students with disabilities often 

graduate from high school at rates nearly 

Introduction

People with disabilities make up 

approximately 12 percent of the U.

working-age population; however, 

they account for more than half of 

those living in long-term poverty

National Disability Policy: A Progress Report 21
20 percentage points lower than students 

without disabilities.6 Postsecondary education 

is important for employment, with estimates 

indicating that 56 percent of workers need at 

least some college education for their jobs.7

Yet only 55 percent of students with disabilities 

enroll in postsecondary education, compared 

with 62 percent of students without disabilities, 

while students with disabilities graduate from 

postsecondary schools at a rate of 38 percent 

compared to a 41 percent graduation rate for the 

general population.8 Disparities are compounded 

for people with disabilities who are from diverse 

backgrounds. For example, only 50.6 percent 

of African Americans with disabilities enroll in 

postsecondary education 

within six years of high 

school graduation.9

Even after obtaining a 

postsecondary education, 

people with disabilities 

earn 38 percent less 

than their peers without 

disabilities.10

Established public programs seek to address 

the challenges of poverty and disability. More 

than 65 percent of the 17.9 million working-age 

adults with disabilities participate in at least one 

safety net or income support program such as 

SSI, SSDI, Medicaid, Medicare, Supplemental 

Nutrition Assistance Program (SNAP), or 

Temporary Assistance for Needy Families (TANF), 

and many participate in multiple programs.11

They may also get job search support from 

the vocational rehabilitation system, the DOL’s 

Office of Workforce Investment, or their state’s 

developmental disabilities or mental health 

systems. However, these programs are not well 

integrated with each other and may work at cross 

purposes. Although some programs support 

work goals, other programs penalize people with 

disabilities who attempt to find work by basing 

access to housing, food, and medical care on 

maintaining a very low income.

Similarly, some existing policies may interact 

with needed public services in ways that 

perpetuate a cycle of poverty among people with 

disabilities. The lack of health insurance coverage, 

long-term supports and services, and reliable 

transportation can hinder participation in the labor 

force, thus disconnecting people with disabilities 

from the primary strategy (i.e., employment) that 

is most effective in combating poverty.12 Policies 

intended to economically support people with 

disabilities must consider 

both the opportunities 

and barriers to public 

assistance so that 

effective and improved 

programs can be put 

into place to create a 

better path to economic 

self-sufficiency. This is imperative if people with 

disabilities are to achieve independent living and 

inclusion in all aspects of society.

To fully understand how to modify existing 

programs and create new ones that can 

address the disability-poverty link, it is helpful 

to understand the history of poverty measures 

and how these measures affect supports for 

people with disabilities. The official measure of 

poverty in the United States was developed in 

the 1960s. It estimates poverty rates by looking 

at an individual’s or a family’s cash income from 

wages, salaries, or Social Security benefits or 

interest. The amount of cash income that people 

have is then used to calculate the poverty line. 

Specifically, the poverty line is based on the 

More than 65 percent of the 

17.9 million working-age adults with

disabilities participate in at least 

one safety net or income support 

program

22 National Council on Disability
minimum level of cash resources people would 

need to meet their basic needs. In the official 

poverty measure, basic needs are measured by 

a formula that calculates three times the cost 

of a minimum diet in 1963, adjusted for current 

prices.13 In 2016, the poverty line for a family of 

four was $24,300.14 This definition of poverty 

is used most often to determine eligibility for 

participation in public programs.

However, Cinda’s story highlights how 

the basic needs for people with disabilities 

go beyond what is covered in the official U.S. 

definition of poverty. In addition, the official 

U.S. definition of poverty does not account 

for geographic differences in the cost of food, 

Cinda’s Story

What kind of supports do people with disabilities need to achieve economic selfsufficiency? Consider this example:

Cinda, 55, has been quadriplegic since birth. She lives in Alexandria, Virginia. She currently 

works part-time with a contracting firm to conduct training and makes $36,000 per year. 

Cinda uses a power wheelchair to get around and has a personal care assistant to help with 

her daily living needs. Her power wheelchair costs $30,000 and needs to be replaced every 

four to five years. Additionally, ongoing needed repairs to her power wheelchair cost $1,900 

per year. She is currently uninsured, so she pays for all her wheelchair repairs out of pocket. 

She does not qualify for Medicaid because her income is too high. She also pays $500 per 

month for a family member to serve as her personal care attendant. Cinda completed three 

years of college, but she was unable to finish college because she frequently missed classes 

because of her personal care attendants showing up late or not showing up at all. She 

received $700 per month in SSI from age 14 to 32, but her SSI payments stopped as soon as 

she began earning a living wage. Additional costs for Cinda include $60 to $80 per month for 

public transportation and $1,560 per month in rent, which she only can afford with help from 

her church. She does not live in an accessible apartment because it would cost an extra $500 

per month. Cinda has never had a savings account because her day-to-day costs related to 

her disability regularly exceed her income.

National Disability Policy: A Progress Report 23
housing, or utilities or the value of public 

benefits. As a result, an interagency technical 

working group that includes the U.S. Census 

Bureau and the Bureau of Labor Statistics 

developed a supplemental poverty measure.15

The working group defined poverty as the lack 

of economic resources for the consumption 

of basic needs. This supplemental poverty 

measure considers the value of cash income 

from all sources plus the value of nutritional 

assistance, subsidized housing, and home 

energy assistance. The supplemental poverty 

measure subtracts expenses like income taxes, 

Social Security payroll 

taxes, child care and other 

work-related expenses, 

child support payments to 

another household, and 

contributions toward the 

out-of-pocket costs for 

medical care and health 

insurance premiums.

Unfortunately, neither 

poverty definition addresses 

the additional costs 

associated with having 

a disability as described in Cinda’s story, such 

as medical care, accessible transportation, 

home modifications, and personal assistants. 

One recent study estimated that 40 percent 

of people with disabilities experience material 

hardship because of the extra costs of living with 

a disability.16 Such material hardship means that 

many people with disabilities cannot meet daily 

living expenses, do not experience sustained 

food security, are unable to get needed medical 

care, or live in housing that is below acceptable 

housing quality standards.17

NCD recommends that Congress continue 

investment in the U.S. Census Bureau’s 

development of the supplemental poverty 

measure and annual report to ensure an 

adequate assessment of how the cost 

of necessary expenses that people with 

disabilities face (like medical or long-term 

services and support expenses) affects their 

opportunities and ability to achieve economic 

self-sufficiency. People with disabilities tend 

to have higher unmet basic needs than people 

without disabilities. Basic needs include 

adequate education, health care, long-term 

services and supports, technology, housing, 

and transportation. People with disabilities may 

need medications, home 

health care, personal care 

attendants, and assistive 

technologies. A new 

definition of poverty could 

help highlight the financial 

challenges facing people 

with disabilities and 

influence changes in policy. 

Changes to the definition of 

poverty in existing policies 

could give people with 

disabilities a better chance 

of having enough resources to achieve economic 

self-sufficiency.

For people with disabilities, poverty affects 

all areas of life from access to education, 

employment, health care, and long-term services 

and supports to housing and transportation. 

To provide people with disabilities with every 

opportunity to achieve economic self-sufficiency 

and independence requires an understanding 

of the interconnected nature of poverty and the 

barriers that people with disabilities experience 

across these areas. There is an urgent need to 

look at which policies and practices work and 

which do not and how existing programmatic 

[T]he basic needs for people 

with disabilities go beyond what 

is covered in the official U.

definition of poverty. A new

definition of poverty could 

help highlight the financial 

challenges facing people with 

disabilities and influence 

changes in policy

24 National Council on Disability
structures can be improved to better meet the 

needs of people with disabilities.

The 2017 NCD Progress Report

NCD affirms the need to reorient public policies 

and programs in order to dismantle the poverty 

trap associated with disability and public program 

participation. This need is reflected throughout 

this report, which focuses on how existing public 

policies and programs are designed to help 

people with disabilities achieve economic selfsufficiency but often create barriers that impede 

upward mobility for this population.

The 2017 Progress Report benefited from 

the input of people with disabilities who have 

experience with the policies and programs that 

provide economic support. NCD solicited these 

perspectives through focus groups with people 

with a variety of disabilities. Select responses 

from focus group participants appear throughout 

the report to illustrate the effects of poverty 

and disability. A synthesis of the focus group 

discussions appears in Appendix A.

The 2017 Progress Report updates the 

Administration and Congress on policy 

issues related to people with disabilities and 

those related to poverty. NCD expects the 2017 

Progress Report also to be relevant to people 

with disabilities and advocates who have direct 

experience with both the challenges of poverty 

and opportunities for economic self-sufficiency. 

Uses for the report include:

■ Providing insight and guidance to federal 

policymakers on reauthorizing existing 

legislation and initiating and supporting new 

legislation.

■ Giving federal policymakers a deeper 

understanding of the challenges people with 

disabilities face while also clarifying and 

reversing stereotypes and misinformation 

about people with disabilities.

■ Providing ideas and opportunities to federal 

policymakers, employers, and people with 

disabilities to initiate new policies or amend 

existing policies to increase the number of 

people with disabilities in the workplace, 

leading to economic self-sufficiency for this 

population.

Appendix B includes an overview of select 

policies and programs and the way they apply 

to poverty and disability throughout the 2017 

Progress Report. Appendix C contains select 

NCD resources that address the topics discussed 

in this report.

National Disability Policy: A Progress Report 25
26 National Council on Disability
T

his chapter illustrates the importance of 

public policies, programs, and practices 

in helping people with disabilities achieve 

economic self-sufficiency across education, 

employment, health care, financial assistance 

and incentives, housing, and transportation. 

Addressing all of the aspects that drive poverty 

and disability extends beyond the reach of this 

report; instead, the topics covered here are 

intended to help illustrate how existing public 

policies, programs, and practices can assist 

people with disabilities. NCD’s website contains 

a comprehensive list of topic areas that readers 

can reference for more information about 

economic self-sufficiency and poverty among 

people with disabilities. Appendix B contains an 

overview of select legislation and how it relates 

to economic self-sufficiency.

Education

People with disabilities can work if the proper 

supports and accommodations are in place. 

In today’s world, an effective education is 

also essential for preparing people with 

disabilities for jobs. Sixty years ago, 73 percent 

of jobs in the United States were classified 

as “unskilled,” requiring no more than a high 

school diploma. By 2002, the number of 

jobs that were defined as “skilled” jobs or 

professions reached 70 percent.18 In other 

words, the statistics have reversed. Access 

to quality education is more important than 

ever. People with disabilities often need 

accommodations and services to access 

the same level of education as their peers 

without disabilities and to be prepared for 

higher education and the workforce. When 

accommodations and services are effective, 

people with disabilities can use their education 

to achieve gainful employment and economic 

self-sufficiency, thus avoiding poverty.

Several pieces of legislation prohibit 

discrimination and address the disability-related 

needs of students. The IDEA (P.L. 108-446) 

mandates that students with disabilities who 

attend public schools receive a free appropriate 

public education in local schools with nondisabled 

peers to the maximum extent possible, 

with needed accommodations and services. 

However, the reauthorization of IDEA has been 

delayed and it has never been fully funded. To 

continue protecting the rights of students with 

disabilities, NCD recommends that Congress 

make reauthorization of IDEA a priority.

In addition to IDEA, the ADA and Section 

504 of the Rehabilitation Act of 1973 prohibit 

discrimination against people with disabilities in 

educational settings, including private schools 

Chapter 1: How Public Policies, Programs, and 

Practices Help People with Disabilities Achieve 

Economic Self-Sufficiency

National Disability Policy: A Progress Report 27
and postsecondary education settings. There 

are also many state laws that reinforce and 

strengthen federal disability antidiscrimination 

laws in education.

Public policy has already made a significant 

impact on the education of students with 

disabilities. For example, the number of students 

with disabilities who spend 80 percent or 

more of their time inside a general education 

classroom has been rising over time.19 From 1989 

to 2013, the percentage rose from 32 percent 

to nearly 62 percent.20 Spending as much time 

in the general education classroom as possible 

gives students with disabilities access to the 

general curriculum while holding them to the 

same standard as students without disabilities. 

This approach better prepares students with 

disabilities for success in future postsecondary 

education and work, and also prepares students 

without disabilities to expect the inclusion of 

people with disabilities in the community and 

workforce.

Another strategy designed to help students 

with disabilities achieve educational success 

Michael’s Story

What kind of supports do people with disabilities need to achieve economic selfsufficiency? Consider this example:

Michael, 57, has a degenerative eye condition and has been visually impaired since childhood. 

He lives in Baltimore, Maryland. Michael completed three years of college with support 

from Pell grants and financial aid but left college because of insufficient funding. He took 

disability retirement from a 20-year career with the Federal Bureau of Investigation in 2011 

and currently hosts an independent radio talk show. Michael made $85,000 per year in 

his Federal Government job. After his disability retirement, he depleted his saving while 

waiting nine months for his SSDI application to be approved. His current monthly income 

is $3,135 per month after taxes and paying for health care ($2,088 from SSDI and $1,047 

from disability retirement). Michael uses software to magnify and read documents on the 

computer ($500–$600 initial purchase, $100 for software upgrades), a CCTV magnifier 

($1,700 bought used, but usually $3,400 brand new), a note taker (hardware, $2,500), ID 

Mate bar code reader ($600 refurbished), and a color identifier ($200). He purchased these 

devices on his own or with help from the Maryland Division of Rehabilitation Services. At 

home, family members helped him identify appliances to show start or stop buttons or 

numbers so he can do daily household tasks on his own. Michael uses paratransit services 

to get around within Baltimore. If he needs to travel outside of Baltimore, he takes taxicabs, 

Uber, or has a family member drive because the paratransit system does not take him across 

counties. Michael owns his own condo and pays $953 per month for mortgage payments 

and condo fees. Michael has a checking account, and he tries to save a few hundred dollars 

per month to build up his savings again.

28 National Council on Disability
is the multiple diploma option. States are 

responsible for determining the types of 

diplomas that are available to students. They have 

experimented with a variety of diploma options, 

including honors diplomas, standard diplomas, 

certificates of completion, special education 

diplomas, and others.21 Most states offer diploma 

options to students completing less rigorous 

coursework or students with disabilities who are 

unable to complete the standard coursework, 

even with accommodations. Multiple diploma 

options may provide another path to graduation 

and reduce drop-out rates for these students. The 

multiple diploma option may also allow states to 

maintain high standards for the standard diploma 

while also allowing students with less ability to 

graduate.22 However, NCD recommends that 

the U.S. Department of Education Institute 

on Education Sciences fund more research 

to better understand how multiple diploma 

options affect students’ inclusion in schools 

and their ability to find gainful employment 

after graduation.

The evolution of technology and its use in 

the classroom has been especially beneficial for 

students with disabilities. Technology has allowed 

teachers to customize classroom materials 

to meet the unique needs of students with 

disabilities. For example, electronic textbooks 

that are compatible with screen-readers make 

it easier for a student who may be blind or have 

low vision to be independent in the classroom. 

One focus group participant who was blind 

throughout his childhood said that when he was 

in school, he would often have his mother or 

sisters sit with him and read him his textbooks. 

National Disability Policy: A Progress Report 29
With digital textbooks, students today do not 

have the same limitations or dependencies. 

Making course materials such as syllabi, reading 

lists, and assignments available in an electronic 

format is an easy way to customize these 

materials for students who require different types 

of access.23 This also prepares students with 

disabilities for the continued use of technology, 

assistive and otherwise, that they will use 

throughout their education and careers.

The transition from high school to 

postsecondary education, training, or work is a 

critical time in which schools can provide support 

for students with disabilities. Transition planning 

services provided by schools may address many 

paths and opportunities, including transitioning 

to college and other postsecondary education 

settings, career and technical education 

programs, vocational rehabilitation services 

(when needed), supported living arrangements, 

or behavioral health services.24

Although IDEA mandates transition planning 

services for all students with an IEP (i.e., 

students with disabilities), local communities 

and businesses can also play an important role 

by offering summer employment, internships, 

service learning, and part-time work. These 

opportunities can help students with disabilities 

gain work experience and experience advocating 

for their own needs and accommodations in the 

workplace.25 For some students with disabilities, 

services that help them acquire daily living 

skills are also a central part of transitioning 

from high school and beyond, but skills like 

using transportation, working with money, and 

following a schedule can all be acquired in work 

settings within the community.

Public policies and programs have also 

resulted in more opportunities for students with 

disabilities to pursue postsecondary education. 

In 2012, the most recent year for which data 

is available, 11.1 percent of undergraduate 

students who were enrolled in postsecondary 

institutions had a disability (Exhibit 1.1). Although 

the number of students with disabilities in 

postsecondary programs remains low compared 

with the number of students without disabilities, 

this data underscore the importance of 

supportive educational policies at the national 

and state level, as the educational attainment 

of students with disabilities at the high school 

and community college levels is now equivalent 

to or greater than the levels of peers without 

disabilities.

As students with disabilities move into higher 

education, cost becomes a factor in whether they 

can pursue a postsecondary degree and enter the 

labor market with competitive skills. Pell grants 

and other federal aid programs have played a 

major role in expanding access to postsecondary 

education for all students, including people with 

disabilities.27 The federal work-study program 

provides part-time jobs for any undergraduate 

or graduate student who has financial need, 

including students with disabilities, who can earn 

money to help with their education expenses. 

On average, undergraduate students earn $2,400 

per academic year in wages.28 Also, under the 

Federal Supplemental Educational Opportunity 

Grant program, any student with financial 

need can apply for grants between $100 and 

$4,000 a year to support additional educational 

expenses. The amount of the award depends 

on their financial need, the amount of other 

aid they receive, and the availability of school 

funds.29 All federal work-study opportunities 

must be accessible to students with disabilities. 

However, there is no available data that provides 

30 National Council on Disability
Exhibit 1.1. Postsecondary Education by Disability Status and Select Characteristics

Selected Student Characteristics 

(as of 2012 Unless Otherwise Stated) Students with Disabilities Students Without Disabilities

Percentage of students 11% 89%

Educational attainment*

■ High school diploma 34% 25%

■ Some college or associate’s degree 32% 32%

■ Bachelor’s degree or higher 14% 33%

Sex

■ Male 11% 89%

■ Female 11% 89%

Race/ethnicity

■ White 11.1% 89

■ African American 12.2% 88

■ Hispanic 10.4% 90

■ Asian 8.0% 92

Veteran 20.6% 79

Sources: Data from Snyder et al. (2016); Erickson et al. (2017).26

*Based on 2015 data for noninstitutionalized persons aged 21 to 64 years from Erickson et al. (2017).

a breakdown of students with and without 

disabilities who participate in these programs. 

NCD recommends that the U.S. Department 

of Education collect data on the participation 

of students with and without disabilities in 

these programs. Furthermore, many students 

with disabilities do not know how to disclose 

disability-related expenses to financial aid 

officers, which means that these expenses are 

not considered when determining financial aid 

packages. Many financial aid options also require 

students to attend school full time, although 

some disabilities make this difficult. NCD 

recommends that Congress amend the Higher 

Education Act to modify financial assistance 

program guidelines so that students with 

disabilities are not penalized if they cannot 

maintain a full course load.

Students with intellectual disabilities have 

traditionally been excluded from postsecondary 

education opportunities. One promising 

initiative that is addressing the needs of 

students with intellectual disabilities is the 

TPSID program. TPSID, which is funded by 

ED, provides grants to institutions of higher 

education for model comprehensive transition 

and postsecondary programs for students 

with intellectual disabilities. Through these 

programs, students with intellectual disabilities 

learn academic, career, and independent living 

skills while auditing classes on university 

campuses. Between 2012 and 2015, the 

National Disability Policy: A Progress Report 31
program expanded to 45 colleges and 

universities and has served 1,379 students with 

intellectual disabilities across 24 states (see 

Appendix D for a list of participating colleges 

and universities). The TPSID program offers 

structured academic advising and curriculum 

for students with intellectual disabilities. While 

in the program, many students with intellectual 

disabilities at certain institutions have access 

to paid internships and participate in career 

development activities. After leaving their 

college-based programs, 36 percent of the 

students secured paid jobs, of which 89 percent 

paid minimum wage or higher.30 To ensure the 

quality of these programs, Think College, a 

project of the Institute for Community Inclusion 

at the University of 

Massachusetts Boston, 

provides support, 

coordination, training, 

and evaluation services 

to TPSID grantees 

and others.31 TPSID 

is an example of a disability-specific program 

that can help reduce poverty and increase 

opportunities for students with disabilities to 

obtain jobs.32 Therefore, NCD recommends 

that the U.S. Department of Education 

continue funding for model programs like 

TPSID to provide students with disabilities 

with the opportunity to attain economic 

independence.

Employment

Employment is the most direct and cost-effective 

way to empower all individuals, including those 

with disabilities, to achieve independence 

and economic self-sufficiency. Although many 

adults and youth with disabilities have the 

desire and willingness to work, only 32 percent 

of working-age people with disabilities are 

employed compared with 73 percent of those 

without disabilities. This employment rate varies 

by disability type. For example, 52 percent 

of people with hearing impairments and 

24 percent of people with ambulatory difficulties 

are employed.33 For people with intellectual 

disabilities, the disparity in employment 

participation is even more dramatic. Data from 

the National Core Indicators (NCI) project 

suggests that in 2014–2015, only 15 percent of 

working-age adults who were supported by state 

intellectual disability agencies and who lived in 

the community were employed in a paid job in 

the community.34

For people with 

disabilities, barriers to 

joining the labor force 

include the belief that 

employment is not 

a viable option given 

their disability or fear of 

losing public benefits like SSDI, SSI, or enhanced 

disability compensation (unemployability benefits) 

available to some veterans. Many simply give up 

after unsuccessfully searching for a job; for this 

reason, this population is often referred to as 

“discouraged workers.” For those that do persist, 

their employment options are often limited to 

jobs with low pay, few or no benefits, and no 

career opportunities.36

Job training and job placement services can 

help to address the employment disparities for 

people with disabilities. In 2010, the Government 

Accountability Office (GAO) identified 45 federal 

programs that supported employment for 

people with disabilities.37 Although some of 

the policies and programs serve people with 

[O]nly 32 percent of workingage people with disabilities are 

employed compared with 73 percent 

of those without disabilities

32 National Council on Disability
Exhibit 1.2. Employment Rate of Working-Age Adults (18–64), by Disability Status 

and Selected Socioeconomic Characteristics

Selected Student 

Characteristics With Disabilities Without Disabilities

Total 32% 73%

Sex

■ Male 34% 78%

■ Female 31% 69%

Race/Ethnicity

■ White 34% 76%

■ African American 24% 66%

■ Hispanic 34% 71%

■ Asian 38% 71%

Veteran 35% 77%

Source: Data from U.S. Census Bureau (2015).35

disabilities exclusively, others serve a broader 

population. GAO concluded that the number of 

programs resulted in a fragmented system of 

services. Others described the system similarly: 

“The current national approach involves various 

agencies administering 

multiple funding streams 

at a federal, state, and 

local level. Each service 

delivery system was 

created in response 

to varying public 

policy priorities and is 

governed by separate 

federal statutes and 

regulations. Each system has a specific set of 

rules to determine eligibility for services and 

support, define scope of services, and allocate 

resources. No single source of funding or 

resource is able to respond effectively to all the 

diverse needs of people with disabilities who 

often face multiple barriers to employment and 

economic advancement.38

The Workforce Innovation and Opportunity 

Act (WIOA) (P.L. 113-128) reaffirmed the role 

of a customer-focused, one-stop delivery 

system for job seekers 

and expanded the 

responsibility of the 

system to serve job 

seekers with disabilities. 

WIOA was designed to 

increase access to and 

opportunities for the 

employment, education, 

training, and support 

services that people with disabilities need to 

succeed in the labor market.

The workforce system made up of 

approximately 3,000 One-Stop Centers (also 

known as American Job Centers) brings 

resources from multiple agencies under one 

... [T]he Government Accountabili

Office (GAO) identified 45 federal 

programs that supported 

employment for people with 

disabilities... GAO concluded th

the number of programs resulted in 

a fragmented system of services

National Disability Policy: A Progress Report 33
roof. As a result, One-Stop Centers are wellpositioned to address the fragmentation of 

employment services and to serve people with 

disabilities who may have multiple barriers to 

employment. In 2014, the system served 494,413 

people with disabilities. WIOA includes provisions 

specifically designed to enhance opportunities 

for job seekers with disabilities. In addition to 

specific antidiscrimination language included 

in Section 188 that prohibits the exclusion of 

job seekers with disabilities from full access to 

services, WIOA specifies that: (1) local workforce 

development boards must ensure that there are 

sufficient service providers in the local area with 

expertise in assisting people with disabilities 

with their career and 

training needs; (2) state 

workforce development 

boards must develop 

strategies to support 

career pathways for 

people with disabilities to 

enter and retain employment; and (3) the general 

workforce system has an obligation to serve 

youth with disabilities.

WIOA legislation also provides guidance 

to the vocational rehabilitation (VR) system, 

which is funded by the Rehabilitation Services 

Administration (RSA) in the ED. State VR 

agencies receive funding from RSA and state 

governments and serve as one of the largest 

state–federal partnerships, offering employment 

services and supports for people with disabilities 

with nearly 506,000 annual applicants.39 In fiscal 

year 2016, expenditures for the program were 

$3.2 billion.40

Although the VR system is effective for at 

least some clients,41 the level of effectiveness 

varies by state, client characteristics, and the 

definition of “effective.” VR’s primary outcome 

is competitive employment, defined as full-time 

or part-time employment for at least 90 days, 

during which the individual is compensated at or 

above the minimum wage. However, VR agencies 

do not often consider longer term outcomes 

or whether the job provides a sustainable 

income given individual client characteristics. 

NCD recommends that the U.S. Department 

of Education’s Rehabilitation Services 

Administration collect data on long-term 

outcomes and income levels of clients they 

serve. In evaluating the VR system for SSI/SSDI 

beneficiaries, GAO found that earnings increased 

for many Social Security beneficiaries. However, 

few earned above the set monthly amount that 

is based on the nature 

of a person’s disability 

(i.e., substantial gainful 

activity).42

Recent changes 

enacted under Title IV 

of the WIOA of 2014 

seek to bolster the VR system by strengthening 

the alignment of core state agencies, such as 

VR, labor, and adult education agencies, and 

advocating for partnerships with other state 

human services agencies, local workforce 

investment boards, and employers.43 WIOA has 

specifically focused on youth with disabilities 

by requiring that 15 percent of VR funds be 

spent on this population. Overall, strengthening 

the alignment of public service agencies and 

businesses increases the opportunities for 

transition-age youth and emphasizes competitive 

integrated employment. NCD will be issuing a 

report with more detailed recommendations 

about pre-employment transition services in the 

fall of 2017.

Self-employment is another viable option for 

people with disabilities to earn an income that 

WIOA has specifically focused on 

youth with disabilities by requiring 

that 15 percent of VR funds be spent 

on this population

34 National Council on Disability
can lift them out of poverty. Self-employment 

provides flexibility through customized work 

requirements and settings that meet the needs 

of the person with a disability. Self-employment 

is an especially valuable option for rural residents 

with disabilities who face additional barriers to 

employment through limited transportation and 

a narrower range of competitive employment 

options.44

The availability and accessibility of support 

for entrepreneurs with disabilities who wish 

to establish small businesses varies and relies 

on a mix of resources. The Small Business 

Administration’s 8(a) Business Development 

program provides a vehicle through which 

federal agencies can 

use set-asides and sole 

source awards to small 

businesses owned and 

controlled by individuals 

certified as socially 

and economically 

disadvantaged.45 The 

8(a) Business Development program is 

geared toward African Americans, Hispanic 

Americans, Asian Pacific Americans, Native 

Americans, and Subcontinent Asian Americans 

presumed to be socially disadvantaged. 

However, people with disabilities need 

to show through a preponderance of the 

evidence that they are socially disadvantaged 

because of their disability. The absence of 

disability as a presumed group in the 8(a) 

program limits this important program for 

small business owners with disabilities. NCD 

recommends that Congress amend the 

Small Business Act to include disability as 

one of the presumed socially disadvantaged 

groups.

Health and Well-Being

People with disabilities are not a homogenous 

group. With varying types of disabilities, their 

needs for health care and support services to 

address medical concerns are wide ranging. 

Historically, health insurance in the United States 

has been primarily tied to employment, which 

limits the availability of health care for people 

with disabilities who are not employed or who 

have little or no benefits through their work. In 

addition, working-age people with disabilities 

have higher expenditures than people without 

disabilities and experience higher out-of-pocket 

costs.46 The kinds of long-term services and 

supports that enable people with disabilities to 

work and fully participate 

in society are generally 

expensive and almost 

never covered through 

private health insurance 

policies. This serves as 

a catch-22 for people 

with disabilities who 

have significant health care issues: if they are 

not receiving health care services, then they 

cannot work, and if they do not have jobs, then 

they cannot access or afford health care. For 

some, the only way they can access the health 

care services they need is through Medicaid, 

which is tied to having a low income. Again, the 

challenges are interconnected as both health care 

and employment are essential for people with 

disabilities to attain economic self-sufficiency and 

maintain their independence.

For millions of people with disabilities, 

Medicaid and Medicare are essential health 

insurance programs. Medicaid serves lowincome children, seniors, adults, and people 

with disabilities; it is funded at both the federal 

NCD recommends that Congress 

amend the Small Business Act to 

include disability as one of the 

presumed socially disadvantaged 

groups

National Disability Policy: A Progress Report 35
and state level. There are more people with 

disabilities on Medicaid than are privately insured 

and, in comparison with people with private 

insurance, those receiving Medicaid are more 

likely to report fair or poor health and are unable 

to work or have a limited ability to work because 

of their health.47 As of fiscal year 2011, 10 million 

adults and children with disabilities were covered 

by Medicaid. Although the share of adults with 

disabilities accounts for 12 percent of Medicaid 

enrollment, they account for 36 percent of 

Medicaid spending, largely because of higher 

health care and long-term services and support 

needs.48

The path to Medicaid coverage for 

people with disabilities is through SSI. In 

addition, people who are deemed “medically 

needy” but who have countable income 

and nonexempt property (e.g., cash, bank 

accounts, and stocks) that disqualify them 

from Medicaid may be considered for health 

coverage by “spending down.” The spenddown process involves deducting medical 

expenses from the individual’s countable 

income until they reach the eligible income 

level for Medicaid. Once they “spend down” 

to the eligibility level, the individual’s medical 

bills will be covered for a set three or six 

month period. However, this process can 

be complicated and can leave individuals 

impoverished in order to qualify for Medicaid.

Medicare is the federal health insurance 

program for seniors and people with disabilities. 

Those who receive SSDI benefits are eligible 

for Medicare. To qualify for SSDI and Medicare, 

people with disabilities under the age of 65 

must not be able to participate in “substantial 

gainful activity” because of a medical condition 

for a period of at least 12 months and must be 

on SSDI for 24 months before they are eligible 

for Medicare.49 In addition, Medicare provides 

limited access to durable medical equipment and 

does not provide long-term care services that 

are often critical for people with disabilities to 

maintain their independence. (For more detailed 

analysis of Medicaid and Medicare policies, see 

Appendix C for NCD’s work in this area.)

There are many cases in which people with 

disabilities are still not able to afford health 

care coverage or receive all the services they 

need with Medicare alone. These individuals 

may be eligible for assistance from their state’s 

Medicaid program. People who are dually 

eligible for Medicare and Medicaid often have 

higher medical costs and needs. In fiscal year 

2010, about 9.6 million Americans were covered 

under both Medicare and Medicaid. People 

with disabilities under the age of 65 constituted 

40 percent (3.9 million) of these dual eligible 

beneficiaries. However, 60 percent of Medicaid’s 

adult enrollees with disabilities were not eligible 

for Medicare coverage and a number of these 

enrollees were still in the two-year waiting 

period to receive Medicare based on their SSDI 

eligibility.50

The existing eligibility criteria for SSDI and 

SSI may force people with disabilities to choose 

between getting a job and taking care of their health. 

“Everything is about cost . . . all of the 

things that we have talked about, there has 

always been a cost issue involved. And it 

costs twice as much for us to live as it does 

anybody else.”

—Focus Group Participant

36 National Council on Disability
NCD recommends that Congress decouple 

eligibility for health care benefits from 

eligibility for cash benefits like SSI and 

SSDI. (For more information, see Appendix C, 

which provides a link to NCD’s report, Securing 

the Social Contract: Reforming Social Security 

Disability.) This is a disincentive to work, and it 

can be addressed through changes to federal 

policy. For example, prior to passage of the 

ACA, people with disabilities were more likely 

to be uninsured even if they were employed, 

with only 22 percent of people with disabilities 

having private insurance coverage compared 

with 70 percent of people without disabilities.51

The ACA created new ways for working-age 

adults to obtain public 

assistance for health 

care coverage and also 

prohibited discrimination 

based on disability. The 

ACA expanded Medicaid 

eligibility for workingage adults with incomes 

up to 138 percent of the federal poverty level 

(FPL) and provides subsidies for people with 

incomes up to 400 percent of the FPL to buy 

health insurance on a state health insurance 

exchange. It also changed the enrollment rules 

to make eligibility determinations much easier.52

The expansion of Medicaid eligibility up to 

138 percent of the FPL allowed more people 

in poverty, including those with disabilities, to 

work more and gain an income without being 

penalized by losing their health care benefits. 

This change provides a stronger start toward 

financial independence for people with disabilities 

while allowing them to retain their health care 

coverage. Under the current system, Medicaid 

guarantees federal matching dollars to states 

with no waiting list or caps;53 however, the 2012 

Supreme Court decision in National Federation of 

Independent Business (NFIB) v. Sebelius decided 

that states were not mandated to expand 

Medicaid coverage.54 As a result, 18 states 

opted not to expand the program. Recent data 

shows that people with disabilities in Medicaid 

expansion states are more likely to be employed 

versus people living in non-Medicaid expansion 

states.55 NCD recommends maintaining 

the Medicaid expansion for individuals 

whose conditions did not meet the severity 

requirements for pre-ACA disability-based 

Medicaid, as well as for those falling within 

the two-year waiting period before qualifying 

for disability-based 

Medicare. NCD 

also recommends 

maintaining protections 

that prohibit insurance 

companies from 

denying coverage 

because of preexisting 

conditions. (See Appendix C for more 

information about NCD’s analysis of current 

health reform plans.)

Long-term services and supports are another 

vital aspect of health care for people with 

disabilities, and advances in medical knowledge 

and technology have allowed this population to 

live more independently with these services. 

This is important for an aging population as 

data shows that, between the ages of 40 

and 50, almost one in 10 people will have a 

disability that may require long-term services 

and supports.56 Many people with disabilities are 

able to access these services through Medicaid 

home and community-based services (HCBS) 

waivers. These waivers allow states to provide 

Recent data shows that people with 

disabilities in Medicaid expansion 

states are more likely to be 

employed versus people living in 

non-Medicaid expansion states

National Disability Policy: A Progress Report 37
nonmedical services such as personal care 

services and habilitation services. Without these 

HCBS services, many beneficiaries would be at 

risk of becoming institutionalized in a nursing 

home or hospital facility. NCD recommends that 

Congress expand opportunities for people 

with disabilities who need to pay for personal 

care services in order to benefit from tax 

deductions. The ACA also gives states the option 

to include home and community-based services 

as part of their benefits instead of providing 

them through a waiver. HCBS waivers can cover 

important services such as case management, 

personal care, adult day health services, 

habilitation, and respite care, which often are 

not available through private insurance plans. 

The kinds of HCBS services states offer varies 

greatly, with 17 states offering targeted HCBS 

services to those at risk of future institutional 

care, 32 states offering personal care services, 

and eight states offering Community First Choice 

attendant care services and supports.57 These 

services support people with disabilities in their 

home and/or community instead of in institutional 

settings.

Current health care reform discussions will 

have a greater impact on people with disabilities 

than any other group because of the major role 

both Medicaid and Medicare play in covering 

their health care costs. Per capita caps would 

reduce the amount that states receive from 

the Federal Government for Medicaid and, in 

many cases, states would reduce the amount 

of the state’s share of spending on Medicaid. 

The proposed per capita caps are estimated to 

reduce federal Medicaid support by $149 billion 

by 2026 to states that would have used the 

funding to support Medicaid programs.58 These 

reductions would have a significant impact on 

people with disabilities, many of whom rely on 

this safety net system and who have, on average, 

higher health care costs and long-term support 

needs. NCD recommends that any changes to 

federal and state funding for Medicaid should 

consider how to safeguard health care for 

this population.59 (See Appendix C for more 

information about NCD’s analysis of current 

health reform plans.)

Financial Assistance and Incentives

Social Security Disability Insurance 

(SSDI) and Supplemental Security 

Income (SSI)

In addition to serving as an entry point for federal 

health insurance (i.e., Medicare and Medicaid), 

SSDI and SSI provide essential cash supports for 

more than 13 million Americans with disabilities 

and their families.60 These programs offer financial 

support to help cover living expenses and other 

costs when individuals are “unable to work due 

to severe physical and/or mental limitations.” 

Although the average benefit is modest, without 

it, many individuals and families would be in 

deep financial distress. Both programs provide 

cash payments to engage in “substantial gainful 

activity” because of one or more severe physical 

or mental impairments that are expected to 

last at least a year or result in death. In 2017, 

substantial gainful activity was defined as the 

ability to earn $1,170 per month ($1,950 per 

month for blind individuals).

In 2015, 8.9 million SSDI beneficiaries received 

an average of $1,166 per month or less than 

$14,000 per year—marginally above the poverty 

guideline for individuals living alone ($11,771 in 

2015).61 Although this seems like a small sum, the 

program provides crucial economic support for 

people with disabilities. Approximately 80 percent 

38 National Council on Disability
of beneficiaries get at least half of their income 

from the SSDI program, while 36 percent of 

beneficiaries rely on SSDI benefits as their sole 

source of income.62 Estimates suggest that SSDI 

pulled 2.7 million households out of poverty in 

2015 (calculation based on Bailey and Hemmeter 

(2015).63 In that same year, 4.9 million working-age 

SSI beneficiaries received an average of $561 per 

month.64 Estimates suggest that SSI payments 

pulled one million households out of extreme 

poverty, yet most remain 

within 150 percent of 

the poverty threshold 

(calculation based on 

Bailey and Hemmeter, 

2015).65 The Social 

Security Administration 

(SSA) publishes program 

statistics about the characteristics of SSI and 

SSDI beneficiaries by age, sex, and type of 

disability. However, SSA discontinued publication 

of beneficiary characteristic by race for the SSI 

program after 2002 and after 2009 for the SSDI 

program largely because of the challenge of 

collecting race information when Social Security 

numbers are assigned.66

Despite the importance of SSI and SSDI 

in providing a safety net for people with 

disabilities, these programs can keep people 

in poverty or near poverty by setting up low 

expectations and perverse economic incentives. 

The disability determination process is often 

so long and daunting that, after becoming 

eligible, beneficiaries begin to believe that they 

cannot work and they fear running afoul of the 

complicated rules and losing their benefits. In 

discussions with stakeholders, the situation has 

been described as follows: “We teach a group of 

people that they cannot work and cannot build 

assets and that they shouldn’t even try.”

Earned Income Tax Credit (EITC)

The EITC is the largest cash assistance program 

in the United States. For the general U.S. 

population, the EITC has become the centerpiece 

of antipoverty initiatives. In 2016, 27 million 

eligible workers and families received more than 

$67 billion in the form of reduced taxes and tax 

refunds. Speaker Paul Ryan’s antipoverty plan 

recommends increasing 

the EITC.67

Although more 

than 10 percent of 

working-age adults 

with disabilities take 

advantage of the tax 

credit,68 the structure 

of the EITC does not serve the needs of lowincome people with disabilities as well as it 

serves low-income people without disabilities. 

In 2012, adults with disabilities were nearly 

equally as likely to claim the EITC as those 

without disabilities, but they received a much 

lower average benefit. The average annual tax 

credit benefit for people without disabilities 

was $2,072, while the average for people 

with disabilities was $1,301, and more than 

60 percent of people with disabilities received 

less than $500 from the EITC benefit.69 This 

disparity is the result of a mismatch between 

“No one enjoys having to be on one of those 

programs [SSDI or SSI]. And yet, it is a vital 

survival tool.”

—Focus Group Participant

Estimates suggest that SSI payments 

pulled one million households out 

of extreme poverty, yet most remain 

within 150 percent of the poverty 

threshold

National Disability Policy: A Progress Report 39
the structure of the program and two important 

socioeconomic characteristics of people with 

disabilities: (1) being older and (2) having no 

qualifying children. The EITC is designed to 

reduce poverty, especially childhood poverty, 

and discourage the use of welfare programs 

such as TANF. As a result, the EITC offers a 

much larger benefit for workers with “qualifying 

children” than for those with either no children 

or children who are older than 19. Because 

people with disabilities tend to be older and 

are less likely to have qualifying children, 

the EITC has limited benefits for them. 

NCD recommends 

increasing the EITC for 

individuals and families 

without qualifying 

children to help lowincome workers 

with disabilities lift 

themselves out of poverty.

Housing

Housing is one of the largest budgetary 

expenditures for most households and is 

strongly linked to overall health and well-being. 

Housing also serves as a mechanism for 

accumulating personal wealth. Access to 

stable, safe, appropriate, and affordable 

housing can provide the foundation for the 

layers of activities and services necessary 

to promote health, educational attainment, 

employment, economic mobility, and improved 

quality of life for low-income individuals or 

households, including people with disabilities.70

An integrated policy approach to housing and 

service provision is thought to reduce the cost 

of addressing multiple needs and challenges 

(e.g., poverty, health care utilization, economic 

mobility) that affect individuals, families, and 

communities.71 However, current federal 

housing assistance programs are substantially 

underfunded, and only one in four incomeeligible families receive any form of housing 

assistance.

Several programs available through HUD 

provide rental assistance for low-income 

households. These programs serve approximately 

90 percent of the five million low-income 

households receiving federal rental assistance. 

The median annual income for households 

receiving federal rental assistance from the three 

primary HUD programs is 

$13,500.

HUD housing 

programs are operated 

through local public 

housing authorities 

(PHAs). Two of the three 

primary HUD programs provide funding for 

multifamily, apartment complex-, or house-based 

rental units. Project-Based Section 8 is a voucher 

program in which rental units for low-income 

households are included in an apartment house 

or development that is privately owned. Private 

companies and development corporations can 

apply for subsidies in the form of tax credits or 

other cost-offsets when they include a certain 

number of units in their developments that 

are designated as affordable. In addition to the 

offsets for including affordable units, developers 

can receive contracts for ongoing monthly rental 

assistance subsidies. Another HUD program is 

the Housing Choice Voucher Program, which 

consists of buildings or housing developments 

that are HUD-owned or operated. Individuals or 

households that are eligible and awarded federal 

rental assistance funds are then assigned to 

The median annual income for 

households receiving federal rental 

assistance from the three primary 

HUD programs is $13,500

40 National Council on Disability
a specific rental subsidized unit in a specific 

HUD-owned building. Renters are assigned 

a unit (1-, 2-, or 3-bedroom) in one of these 

buildings based on family composition and 

HUD guidelines. People with disabilities may 

also qualify for housing choice vouchers. These 

vouchers are portable in that eligible renter 

households can use them to find housing in 

any unit that meets HUD occupancy standards 

where the property landlord agrees to accept the 

voucher and comply with HUD standards and 

regulations.

HUD also offers Section 811 funds, which 

are targeted to both develop and then subsidize 

rental units that specifically address the needs 

of low-income people with disabilities who 

require additional supports and services to live 

independently in the community. Prior to 2010, 

Section 811 housing was not working as needed 

for people with disabilities because it was 

creating fewer than 1,000 new housing units 

per year.72

The Frank Melville Supportive Housing 

Investment Act of 2010, signed into law in 2011, 

served to reform the Section 811 program. In 

the long term, the law will fund the development 

of thousands of permanent supportive housing 

units integrated within affordable housing 

properties each year. Further, the law supports 

and promotes a community integration model for 

people with significant and long-term disabilities 

with the stipulation that no more than 25 percent 

of units in properties funded through Section 

811 be set aside for people with disabilities, 

which seeks to expand the supply of long-term 

affordable, integrated housing. In 2011, the Frank 

Melville Act statutes were amended and HUD 

developed guidance for housing authorities 

to address turnover of Section 811 as well as 

Section 8 vouchers. The guidance focused on 

ensuring that the Section 811 and Section 8 

vouchers would continue to be made available 

to people with disabilities and not awarded 

on a first-come, first-served basis. By 2013, 

13 state housing finance agencies received 

funding from HUD for the development of 3,006 

housing units.73

The U.S. Department of Agriculture (USDA) 

also provides housing assistance through its 

Rural Development program. This program 

funds housing and rental assistance programs 

for rural and farmworker households. In 2016, 

approximately 46 million Americans lived in 

rural areas. The USDA Rural Development 

program was established in the 1990 farm 

bill amending the previous Farm and Rural 

Development Act of 1972. The program 

focuses on the needs of rural areas, particularly 

impoverished and remote communities, 

through various initiatives that are targeted 

toward strengthening rural communities. USDA 

Rural Development’s low-interest home repair 

loans and grants enable seniors and people 

with disabilities to remove health and safety 

hazards, perform necessary repairs, improve 

or modernize a home, make homes accessible 

for people with disabilities, or make homes 

more energy efficient so these very-low-income 

families use less of their income on utility 

“I can’t afford to live in accessible housing. 

It costs up to $500 more. I have to use a 

regular apartment and use a bench to use 

the bathroom.”

—Focus Group Participant

National Disability Policy: A Progress Report 41
bills, allowing them to live independently and/

or age in place. USDA Rural Development has 

also developed collaborations across 19 other 

federal agencies to target high-poverty tribal 

communities, both urban and rural. These 

collaborations address housing, education, 

health care, and other critical needs for tribal 

communities.

The HUD and USDA rental and housing 

assistance programs help lift low-income 

households out of poverty, including the 

approximately 1.1 million households that have 

an adult between the ages of 18 and 62 with 

a disability and approximately 73,000 veterans 

with disabilities that 

receive housing or rental 

assistance benefits. In 

addition, the programs 

reduce homelessness 

and housing instability 

among vulnerable 

families.74 There is 

growing evidence that 

access to decent, stable, 

affordable housing 

may be the platform or 

intersection for better outcomes in economic 

mobility, educational attainment, and quality of 

life, including better physical and mental health.75

Housing plays a substantial role in improving 

outcomes at all levels from the individual to 

the community at large. As first noted in our 

2010 “The State of housing in America in the 

21st Century” report,76 NCD recommends 

the implementation of integrated housing 

policies, which can be critically instrumental 

in addressing the economic well-being 

of the increasing number of low-income 

households.77

Transportation

Accessible transportation options, including 

accessible buses, ADA complementary 

paratransit (paratransit), taxicabs, and railway 

systems provide people with disabilities with 

opportunities to participate in employment, 

education, health care, housing, and other 

community activities. The passage of the ADA led 

to major improvements in transit systems across 

the United States. Nationwide, approximately 

6,800 agencies provide bus and rail services or 

other modes of transportation.78

Title II of the ADA prohibits discrimination 

based on disability in public transportation 

services such as city 

buses and public 

rail (e.g., subways, 

commuter trains, and so 

forth). Under the ADA, all 

new fixed-route vehicles 

used in public transit 

must be accessible. In 

addition, existing rail 

stations that were altered 

after the passage of 

the ADA must be made 

accessible if technically feasible and all new 

rail stations and facilities must be accessible. 

Paratransit (on-demand, door-to-door) services 

are required for noncommuter fixed-route bus or 

rail services.79

With the enactment of the ADA, accessible 

transportation options for people with disabilities 

using fixed-route transportation, including public 

buses and rail systems, have increased. Bus 

service has also improved. For example, lowfloor buses with ramps, floor markings, and 

other design features, such as additional grab 

bars, audible stop announcements when more 

There is growing evidence that 

access to decent, stable, affordable 

housing may be the platform or 

intersection for better outcomes 

in economic mobility, educational 

attainment, and quality of life, 

including better physical and mental 

health

42 National Council on Disability
than one route is served at the same location, 

larger destination signs, and monitors that show 

upcoming stops have significantly bolstered bus 

accessibility.80 Paratransit transportation is often 

provided by minibuses and door-to-door shared 

rides upon request for eligible people with 

disabilities who cannot use fixed-route services. 

Although the use of paratransit among people 

with disabilities has increased consistently in 

the past 20 years, a 2009 analysis of ridership 

from seven selected systems showed that, 

on average, fixed-route ridership by people 

with disabilities was higher than paratransit 

ridership.81 Use of public transit is increasing 

and playing a major role in providing increased 

independence and mobility to people with 

disabilities. One concern regarding paratransit 

service is DOT’s ADA regulations for passenger 

pickup. According to these standards, paratransit 

service is only provided within a three-quartermile radius of a fixed-route bus stop, to be 

comparable to fixed-route transit. This limitation 

places a burden on people with disabilities who 

depend on paratransit service and may cause 

them to have difficulty finding employment as 

well as access to the community.82

Private transportation 

is another important 

alternative that provides 

people with disabilities 

with greater flexibility 

and independence than 

public transportation. 

This is particularly true for 

people with disabilities who live in areas where 

public transit is unavailable or inaccessible. Many 

people with disabilities who cannot drive or afford 

a car use taxicab services. Furthermore, some 

cities such as New York City, Chicago, Boston, 

Las Vegas, San Francisco, Seattle, and Portland 

have made improvements to their accessible 

taxicab programs.83 For example, a settlement 

agreement in New 

York City is expected 

to phase in wheelchairaccessible taxicabs, via 

attrition of old vehicles, 

so that, by 2020, 

50 percent of taxicabs 

will be accessible to 

people who use wheelchairs and scooters.84

Although, as the option of using taxicabs 

increases, greater attention is needed for training 

taxicab operators about ramp deployment and 

securement procedures. NCD recommends 

[A] 2009 analysis of ridership from 

seven selected systems showed that, 

on average, fixed-route ridership by 

people with disabilities was higher 

than paratransit ridership

National Disability Policy: A Progress Report 43
local municipalities require taxicab authorities 

to provide mandatory training for taxicab 

operators on these issues so that people with 

mobility disabilities can safely and effectively 

use privately funded transit options.

However, access to affordable and accessible 

transportation can be especially challenging for 

people with disabilities 

living in rural areas. 

Grants from the Federal 

Transit Administration 

provide funding to create 

or enhance local public 

transit systems, which can 

be useful for people with 

disabilities, particularly 

in rural communities. For 

example, Job Access and Reverse Commute 

activities are eligible for funding under the 

Urbanized Area Formula Funding program 

(Section 5307)85 and Formula Grants for Rural 

Areas (Section 5311).86 These activities provide 

funding to states for transportation to and from 

jobs for low-income people and people who 

receive government assistance, as well as people 

with disabilities. In addition, grants from the 

Enhanced Mobility for Seniors and Individuals 

with Disabilities program (Section 5310) enable 

states to support private 

nonprofit groups in 

providing transportation 

to people with disabilities 

and seniors when 

public transportation is 

insufficient, inappropriate, 

or unavailable to meet 

the needs of these 

populations.87 These 

federally funded grant programs play a major role 

in engendering more opportunities for people 

with disabilities to access employment and 

achieve economic self-sufficiency.

[A] settlement agreement in New 

York City is expected to phase in 

wheelchair-accessible taxicabs, via 

attrition of old vehicles, so that, by 

2020, 50 percent of taxicabs will 

be accessible to people who use 

wheelchairs and scooters

44 National Council on Disability
As discussed in Chapter 1, a variety 

of policies and programs exist to 

economically support people with 

disabilities. However, achieving economic selfsufficiency is not without its challenges. Many 

public policies were developed during a time 

when it was assumed that people with disabilities 

could not work and therefore needed permanent 

assistance from federal, state, and local public 

agencies. This has led to the unintended 

consequence of creating dependence on public 

programs for many people with disabilities. 

This chapter reviews the common barriers that 

perpetuate the cycle of poverty for people with 

disabilities. These include barriers to education, 

labor force participation, and health benefits as 

well as an ongoing battle against stereotypes that 

limit the potential of these citizens.

Barriers to Adequate Education

Setting people with disabilities on the path to 

achieving economic self-sufficiency in adulthood 

requires a strong foundation of knowledge and 

skills that must be laid in school. Currently, there 

are at least six million students with disabilities in 

the United States, but the high school graduation 

rate for students with disabilities is 63.1 percent 

nationwide compared with an 82.3 percent 

graduation rate for students without disabilities.88

Drop-out rates among students with disabilities 

further limit their employment options.89 Children 

from diverse racial backgrounds, specifically 

African American, Hispanic, and American 

Indian children, including those from lowincome communities and those who are English 

language learners, are overrepresented in special 

education programs.90

The challenges that students with disabilities 

experience in obtaining an education are 

compounded for those who also grow up 

in poverty. Common challenges of poverty 

include trauma, hunger, and family difficulties, 

which can lead to behavioral problems in 

school or create ongoing health conditions and 

disabilities. Children with disabilities growing up 

in these adverse circumstances face additional 

obstacles because schools have limited funding 

for programs that could provide services and 

resources to support these children.91 Parents 

living in poverty and struggling to meet the 

economic needs of their families often have little 

time to adequately meet all of the additional 

needs of a child with a disability.92 In addition, 

they are required to navigate a complex health 

system, find time to address school-related 

issues, and serve as a strong advocate for their 

child’s needs. Parents may turn to charter schools 

or private schools to ensure their children get 

the education and supports needed. NCD is 

undertaking a study of school choice in the fall 

Chapter 2: Barriers to Achieving Economic 

Self-Sufficiency for People with Disabilities

National Disability Policy: A Progress Report 45
of 2017 with an anticipated release date of 2018. 

(For more information, see Appendix C for a 

link to NCD’s 2003 report, School Vouchers and 

Students with Disabilities.)

The special education systems’ segregation 

of children with disabilities often leads to poorer 

outcomes for students with disabilities than for 

their peers without disabilities. One example 

is the school-to-prison 

pipeline, which refers to 

policies and practices 

that push children out 

of classrooms and into 

the juvenile and criminal 

justice systems. Students 

with disabilities and 

students from diverse racial backgrounds with 

disabilities in particular are disproportionately 

affected by these policies. Data shows that 

some states suspend and expel students with 

disabilities who have IEPs at more than twice 

the rate of students without disabilities, including 

28 percent of all African American students 

with disabilities. Improvements to the special 

education enforcement systems are needed 

to better meet the needs of students with 

disabilities who are at risk for the school-to-prison 

pipeline.93 (For more information, see Appendix C 

for a link to NCD’s report, Breaking the School-toPrison Pipeline for Students with Disabilities.)

In addition, restrictive, segregated special 

education placement often leads to a larger 

number of students with disabilities being 

awarded alternative high school diplomas. 

Pursuing an alternative diploma track is a decision 

that needs to be carefully considered, as it 

can impede adequate preparation for higher 

education and employment because alternative 

diplomas are awarded for completion of less 

rigorous academic coursework. As a result, 

employers and institutions of higher education do 

not view them as equal to standard high school 

diplomas.94 As many as 85 percent of students 

in special education are capable of meeting the 

same educational standards as other students 

when given the right type of instruction, access, 

and supports required by IDEA.95 Unnecessary 

placement into an 

alternative diploma track 

has a lasting impact on 

future economic selfsufficiency for students 

with disabilities. Because 

children from diverse 

racial backgrounds are 

overrepresented in special education, they are 

more likely to earn alternative diplomas and suffer 

the lasting consequences of fewer employment 

and educational opportunities. Therefore, NCD 

recommends that the U.S. Department of 

Education issue guidelines that gives students 

with disabilities the opportunity to obtain a 

standard high school diploma and only use 

alternative diplomas as a last resort.

Unnecessary placement into an 

alternative diploma track has a 

lasting impact on future economic 

self-sufficiency for students with 

disabilities

46 National Council on Disability
The DOL recommends that IEP teams 

begin to investigate graduation options no 

later than middle school because this decision 

will determine the courses that students with 

disabilities take in both middle school and high 

school. The IEP team must also ensure that the 

core course of study is consistent with students’ 

goals after high school graduation. NCD echoes 

this recommendation. Students with disabilities 

should be meaningfully involved in the 

development and planning of their IEP goals 

to ensure that these goals accurately reflect 

their capabilities and 

keep future educational 

and employment 

opportunities open to 

them.96 To ensure that 

only students with the 

most significant cognitive 

disabilities are put on 

an alternative diploma 

track, the Every Student Succeeds Act of 2015 

requires that parents provide informed consent to 

and understand the implications of an alternative 

diploma track. It also requires states to establish 

clear guidelines about placement in an alternative 

track and to be more transparent about the 

process of alternative testing.

Barriers Related to the Transition 

to Employment

Moving students with disabilities into the right 

career path, which may include postsecondary 

education, training, or work, is key to ensuring 

that they have access to opportunities 

that will lead to financial success and selfsufficiency. IDEA mandates that transition 

planning be provided for all students with an 

IEP and this includes concrete post-high school 

graduation goals (e.g., education, training, or 

employment). In practice, transition planning for 

students with disabilities is often inadequate. 

Preparing students without disabilities for skills 

development and economic independence 

often includes early opportunities such as 

job shadowing, internships, part-time jobs, 

and volunteer work. However, students 

with disabilities are less likely to have these 

opportunities, which sets them further behind 

their peers when they enter the competitive job 

market and postsecondary application process.97

Being from a diverse 

racial background has 

a further impact on 

entering the competitive 

job market—while 

the employment rate 

for white youth with 

disabilities is 34 percent, 

it is only 24 percent 

for African American youth with disabilities 

(Exhibit 1.2).98

To ensure full participation in postsecondary 

education, students with disabilities, particularly 

those in poverty, often need federal student 

aid. However, they face challenges in obtaining 

financial support from federal resources including 

Pell grants, Federal Supplemental Educational 

Opportunity Grants, and federal work-study 

programs.99 The Common Core Standards forbid 

students who graduate with alternative high 

school diplomas or trade and career program 

degrees from obtaining federal Pell grants and 

federal scholarships. This limits federal financial 

aid to those students with disabilities who 

receive standard high school diplomas and 

GEDs. As noted in our 2015 briefing paper on the 

reauthorization of the Higher Education Act,100

The Common Core Standards 

forbid students who graduate with 

alternative high school diplomas or 

trade and career program degrees 

from obtaining federal Pell grants 

and federal scholarships

National Disability Policy: A Progress Report 47
NCD recommends that the U.S. Department 

of Education revise guidelines to allow 

students who graduate with alternative high 

school diplomas or trade and career program 

degrees to be eligible to obtain federal Pell 

grants and federal scholarships if they meet 

all other qualifications for financial support 

from federal sources.

As noted earlier, students with disabilities 

are often tracked into alternative diploma 

programs, which limits their options for entry 

into postsecondary education, including 

eligibility for federal financial aid. Students are 

also often required to take a full course load as 

a condition of receiving financial aid; however, 

some students with 

disabilities are unable 

to meet this condition. 

As a result, students 

with disabilities who 

cannot obtain federal 

financial aid are left to 

figure out how to pay 

for college or vocational 

training programs; like 

most students, they frequently take out private 

loans to pay for postsecondary education or 

vocational training, even though these loans have 

higher interest rates than federal student loans 

and no grace periods, which federal student 

loans provide.101 In 2014, student loans totaled 

$1.4 billion.102 Recent action by the ED has led 

to student loan debt forgiveness for qualified 

students with disabilities; however, at this 

time, debt forgiveness does not include a tax 

waiver.103 Thus, students with disabilities may 

end up paying taxes on loans that they no longer 

owe. NCD recommends that the IRS provide 

guidelines that waive taxes on student loan 

forgiveness for students with disabilities.

Veterans with mental health issues or other 

disabilities resulting from their deployments face 

unique challenges in higher education. Many 

veterans enter institutions of higher education 

to improve their ability to work. However, 

they enroll in college with physical wounds, 

posttraumatic stress disorder, depression, 

anxiety, and traumatic brain injuries, which 

require accessibility and accommodations on 

campus and in classrooms.104 As a result of their 

injuries, veterans may find themselves struggling 

with problems related to attention, concentration, 

processing new information, and other cognitive 

functions central to obtaining a quality education. 

Many veterans do not use the traditional services 

that institutions of higher 

education provide to 

students with disabilities. 

Colleges and universities 

need to engage with 

veterans in ways that are 

more in tune with their 

needs and work with 

the U.S. Department 

of Veterans Affairs to 

communicate with veterans about disability 

services.105 Veterans need unique attention to 

ensure they can complete school successfully. 

(For more information, see Appendix C, 

which provides a link to NCD’s report, Mental 

Health on College Campuses: Investments, 

Accommodations Needed to Address Student 

Needs.)

Barriers Related to Complex 

Eligibility and Enrollment Procedures

When people apply for disability insurance 

benefits through SSDI, they must demonstrate 

to the SSA that they cannot work. However, a 

significant portion of people with disabilities can 

During the crucial time immediately 

after the onset of disability, when 

they may still have some attachment 

to the labor force, the current 

[Social Security] system encourages 

applicants not to work, which often 

leads to poverty

48 National Council on Disability
and want to work as long as they have adequate 

health care and long-term support services, 

reasonable accommodations, and sometimes, 

additional training. Support in the form of cash 

assistance from SSDI or SSI helps people 

with disabilities attain or maintain a reasonable 

standard of living. However, due to the “all or 

nothing” requirement of the SSA, people with 

disabilities are faced with choosing between 

working or receiving needed cash, medical, and 

other in-kind support. If they choose to work, 

then they often find themselves in low-paying 

jobs with little or no benefits.106 If they select 

needed benefits, they cannot work and are often 

faced with the further challenge of navigating 

a complex system to 

obtain needed supports.

The disability 

determination process, 

which determines SSDI 

and SSI eligibility, has 

multiple steps and can 

often be lengthy. During 

the SSDI application 

and appeals processes, 

people with disabilities do not receive any 

income support or medical benefits. They 

must disconnect from the workforce to obtain 

financial assistance. During the crucial time 

immediately after the onset of disability, when 

they may still have some attachment to the labor 

force, the current system encourages applicants 

not to work, which often leads to poverty.

In fact, the application process can take 

many months or even years while people 

with disabilities provide medical information 

to prove their inability to work. After people 

with disabilities qualify for SSDI benefits, they 

must continue to meet strict disability eligibility 

requirements, which SSA periodically reassesses 

as part of its continuing disability reviews 

(CDRs). Those who show medical improvement 

through a CDR could face the prospect of losing 

their benefits. Throughout the application and 

benefit process, SSA disability participants 

must continually prove an inability to perform 

substantial gainful activity (SGA) or risk losing 

their benefits.107

Eligibility for SSDI and SSI benefits is 

interconnected with health care and longterm services and supports, which are also 

important for people with disabilities to maintain 

their independence. SSDI beneficiaries qualify 

for Medicare after 24 months of enrollment. 

People with disabilities with limited income and 

assets (e.g., cash, bank 

accounts, stocks, U.S. 

savings bonds, land, 

vehicles, or personal 

property) can also qualify 

for SSI and therefore 

qualify for Medicaid. 

Through Medicaid HCBS 

waivers under Section 

1915(c) of the Social 

Security Act, people with disabilities can access 

services such as case management, personal 

care, adult day health services, habilitation, and 

respite care. Medicaid services provide important 

additional supports for people with disabilities 

by allowing them to remain independent in their 

homes and/or communities instead of forcing 

them into institutional settings. These services 

are often necessary for people with disabilities 

to successfully attain and maintain employment; 

however, the services available under HCBS 

waivers are generally not available from private 

insurance plans and are too expensive to afford 

out of pocket. As a result, people with disabilities 

frequently stop working in order to maintain the 

[HCBS] services are often necessary 

for people with disabilities to 

successfully attain and maintain 

employment; however, [they] ...

are generally not available from 

private insurance plans and are too 

expensive to afford out of pocket

National Disability Policy: A Progress Report 49
low income levels that are required by SSI, SSDI, 

Medicare, and Medicaid to ensure they received 

much-needed benefits.

Barriers Related to Program Income 

and Asset Limits

Eligibility for SSI and SSDI is based on the 

inability to earn an income which is referred to 

as SGA. In 2017, SGA was $1,170 per month 

for nonblind beneficiaries and $1,950 for blind 

beneficiaries. SSDI beneficiaries who earn above 

SGA can lose all of their SSDI cash benefits. 

Several work incentive programs exist to reduce 

or forestall the risk of losing cash benefits. For 

example, beneficiaries can earn an unlimited 

amount for nine months during a “trial work 

period” without losing benefits. Nevertheless, 

SSDI beneficiaries face a “cash cliff” where 

earnings that exceed the SGA level result in the 

loss of the full amount of the cash benefit. The 

loss of SSDI income for people with disabilities 

may be greater than their earnings and result in a 

situation where they have insufficient income to 

cover all of their expenses.

SSI beneficiaries face a different penalty when 

their incomes rise. Specifically, after earnings 

reach $65 per month, SSI benefits are reduced 

by one dollar for every two dollars of additional 

earnings. In addition to penalizing people with 

disabilities who want to work, eligibility for SSI 

requires that people with disabilities have very 

limited assets. Personal savings and assets 

enable people to weather financial shocks and 

emergencies and make long-term investments 

that will help them in the long term. Prior 

to passage of the ABLE Act in 2014, people 

with disabilities receiving these benefits were 

significantly limited in what they could save for 

emergencies or even large disability-related 

expenses. (For more information about the ABLE 

Act, see Appendix B.)

The complexities of public benefits programs 

are exacerbated by concerns and confusion 

about paying back those benefits. SSI benefits 

are adjusted based on earnings; however, 

the adjustments are often delayed by several 

months because the level of benefits are 

adjusted retroactively. If SSA determines that a 

person received an overpayment, beneficiaries 

must reimburse SSA for the overpaid amount. 

Unfortunately, the agency can take months or 

years to determine the necessary adjustments 

to SSI benefits and will continue to overpay the 

beneficiary. The need to pay back overpayments 

can lead to financial turmoil and reinforce the idea 

that any kind of work can lead to more harm than 

good for people with disabilities.

Work incentives such as expedited 

reinstatement, trial work periods, extended 

periods of eligibility, and continuation of 

Medicare coverage can help people with 

disabilities on SSDI reduce the risk of losing 

benefits. In addition, SSI recipients can use 

incentives such as the earned income exclusion, 

impairment-related work expense (IRWE), plans 

for achieving self-support (PASS), and continued 

Medicaid eligibility (1619b) (see Appendix B 

for more information.). Through the Ticket to 

“He’s almost forced into poverty. For every 

extra dollar of income he gets, he seems 

to lose a benefit. If that happens, he’s 

essentially in the same spot. He can never 

better his condition.”

—Parent of Focus Group Participant

50 National Council on Disability
Work Program, the SSA funds work incentives 

planning and assistance projects in each state. 

Community work incentive coordinators provide 

in-depth counseling about benefits and the 

effect of work on those benefits to people with 

disabilities using the work incentives. The SSA’s 

Protection and Advocacy for Beneficiaries of 

Social Security programs in each state build 

on these services by providing additional help 

with accessing supports that will facilitate 

work. Despite these supports, the rules for 

these incentives are complicated and many 

beneficiaries have reported difficulty accessing 

high-quality information about these projects. 

Among the 328,000 SSI recipients who work, 

only 821 have PASS plans that enable them to 

set aside money for items or services needed 

to achieve a specific employment goal without 

that money counting against their asset limit. 

Only 3,188 use the IRWE, which allows them 

to deduct the out-of-pocket costs of certain 

expenses from the amount of earnings SSA uses 

to calculate the SSI benefit.108

Overall, individuals whose ability to work 

may be limited or fluctuate over time face a 

complicated system where they must calculate 

whether their long-term earnings can cover their 

loss of benefits. Some beneficiaries are put in a 

difficult position where, if they work and earn too 

much, they may lose the long-term care supports 

they need to work. Others face the stark 

option of full dependency on needed benefits 

without the option of financial independence. 

NCD recommends the President establish 

collaboration by federal agencies in forming 

an interagency work group to propose rule 

changes in federal benefit programs and 

reduce work disincentives linked to federal 

program conflicts. This effort should begin 

with SSA, Centers for Medicare and Medicaid 

Services, and Department of Labor programs.

Housing is another significant cost factor for 

people with disabilities that requires thoughtful 

public policy. HUD takes a more flexible approach 

than other agencies when it comes to income 

requirements for people with disabilities to 

maintain eligibility for program support, such 

as HUD housing or rental assistance programs. 

In general, a person’s household income 

must be at 50 percent or below of the area 

median income. People with disabilities who 

rely on SSI or SSDI income may also be eligible 

for housing assistance under the Section 811 

Supportive Housing Program. These options 

reduce the barriers to adequate low-cost housing. 

Also, household income and asset limits for 

HUD housing assistance programs are more 

generous than those for SSI and other assistance 

programs. For people with disabilities who have 

either not been previously employed or who have 

been out of the workforce for at least a year, 

there are HUD programs designed specifically 

to help incentivize work and the move toward 

economic self-sufficiency. These federal rental 

assistance programs build in room for the 

household income to increase within certain 

parameters.

In addition, HUD does not place limits 

on assets for people who receive support 

from housing or rental assistance programs. 

Households can have bank accounts, and only 

the interest from a savings, checking, or other 

account counts toward income. HUD also has 

a disability assistance allowance for additional 

costs that exceeds 3 percent of the household 

income. These costs can include paying for 

personal care attendant services, a wheelchair, 

and assistive technology. For an expense to be 

National Disability Policy: A Progress Report 51
allowable, it must help people with disabilities 

work or free another member of the household 

to work. Anticipated medical expenses in 

combination with any disability assistance 

allowance exceeding 3 percent of the household 

income can also be considered allowable.109

The differences in both income and asset limits 

across programs from federal agencies such 

as HUD and SSA create a complex system that 

people with disabilities must navigate to obtain 

these much needed services.

Barriers Related to Transportation 

in Rural Areas

Lack of transportation options for people with 

disabilities in rural areas creates serious, ongoing 

barriers to employment, 

accessible health care, 

and full participation in 

society for this population. 

According to the 2010 

Census, 19 percent of the U.S. population lives in 

rural areas,110 but only 6 percent of federal transit 

funds are allocated to serve rural communities.111

This means that there is minimal or nonexistent 

transportation services in many rural areas. 

NCD recommends that Congress place 

greater emphasis on federally funded grant 

programs for rural areas to address publicly 

and privately funded accessible transportation 

options for people with disabilities.

Providing transportation to people with 

disabilities in rural areas is often complicated by 

small populations and long distances between 

communities, which make it difficult for rural 

areas to provide services such as fixed-route or 

ADA paratransit services. Additionally, a lack of 

coordination between services in rural areas is 

a significant problem for people with disabilities 

living in these areas. For 

example, transportation 

that stops at a county 

line is an artificial barrier 

that limits employment 

opportunities for people with disabilities. 

NCD recommends that states and counties 

increase coordination between jurisdictions 

in rural areas and regional transit planning 

authorities to overcome these barriers.

Barriers Related to Attitudes 

and Stereotypes

The ADA represented a major shift in social 

policy by focusing on integrating people with 

disabilities into the workforce and moving them 

away from dependence on disability benefits. 

However, 27 years after its passage, people with 

disabilities still face many outdated attitudes and 

stereotypes. For example, some believe that 

people with disabilities cannot live independently 

or contribute meaningfully to the workforce or 

their communities.112

“If you have a paratransit system that 

operates in just one county within your state, 

that is going to narrow the opportunities for 

somebody with a disability to go look for a 

job. You don’t have any kind of connection 

between the counties and paratransit 

systems, because each county might have 

their own paratransit system, but they might 

not be linked together. If I have to go to a 

job 30 minutes from my house I can’t do it 

because I can’t drive.” 

—Focus Group Participant

[O]nly 6 percent of federal transit 

funds are allocated to serve rural 

communities

52 National Council on Disability
Starting in childhood, family and teacher 

expectations play an important role in the 

academic achievement of all children, regardless 

of abilities or disabilities.113 One of the best 

ways that educators and families can help 

children with disabilities succeed is to set 

high standards.114 The success of students 

with disabilities can be negatively impacted 

if their teachers do not feel that they should 

play a central role in their education. Research 

shows that teachers who see themselves as 

responsible for the success of all students 

regardless of ability engaged in more prolonged 

interactions with students with special 

educational needs than teachers who regard 

support staff (i.e., teacher aides) as having 

primarily responsibility for students with 

disabilities.115 Families of Hispanic students with 

disabilities are less likely than those of peers to 

have home-based education-related activities. 

African American students with disabilities have 

families that are more likely to be involved at 

home than white students with disabilities, but 

they are less likely to 

attend IEP meetings and 

be involved at school.116

At the university level, 

faculty sometimes do 

not have an adequate 

understanding of the 

specific needs of students with disabilities. 

Faculty may question the nature of reasonable 

accommodations and whether students 

with disabilities need accommodations at 

all and doubt their own ability to effectively 

teach students with disabilities.117 In addition, 

some universities do not provide adequate 

accommodations and assistive devices.118 Poor 

attitudes, lack of understanding, and inadequate 

access to assistive technology can impede 

postsecondary achievement and success as well 

as economic self-sufficiency among students 

with disabilities.

Employer attitudes often limit job 

opportunities. Despite the fact that these 

myths have been debunked, some employers 

believe that people 

with disabilities lack the 

necessary knowledge 

and skills to work, are 

less productive, or can 

only do light, repetitive, 

and simple jobs. 

They may also believe that accommodations 

are expensive or that workers’ compensation 

insurance and health care costs will increase.119

Federal agencies can be the model for hiring and 

integration as a way to exemplify the capabilities 

of people with disabilities. NCD recommends 

that all federal agencies increase coordination 

with their SPPCs to improve understanding of 

reasonable accommodations and their effect 

One of the best ways that educators 

and families can help children with 

disabilities succeed is to set high 

standards

National Disability Policy: A Progress Report 53
on productivity and retention of people with 

disabilities in the workplace.

Earning a living wage can serve as a 

road out of poverty. Currently, an estimated 

228,600 people with intellectual/developmental 

disabilities and other significant disabilities 

work for subminimum wage under special 

certificates issued by the DOL Wage and 

Hour Division.120

These certificates are 

allowed under Section 

14(c) of the Fair Labor 

Standards Act, which 

permits employers to 

pay wages less than the 

federal minimum wage 

to workers who have disabilities that affect 

productive capacity. The DOL’s definition of 

which disabilities may affect productive capacity 

includes blindness, mental illness, intellectual 

disability, cerebral palsy, alcoholism, and drug 

addiction. Paying people with disabilities 

subminimum wage 

serves to perpetuate the 

belief that people with 

disabilities cannot work 

in the same kinds of 

jobs as people without 

disabilities.

Most people currently 

working under Section 

14(c) subminimum wage certificates are working 

in sheltered workshops (also called community 

rehabilitation programs or work centers). These 

are segregated facilities that exclusively or 

primarily employ people with disabilities.121

Sheltered workshops typically receive public 

funding, including federal funding through 

Medicaid and VR, to provide employmentrelated habilitation and rehabilitation services to 

people with disabilities.122 Although the Centers 

for Medicare and Medicaid Services specifies 

that sheltered workshops should only be used 

as a time-limited service, one study found 

that only five percent of sheltered workshop 

employees left to take a job in the community.123

Some suggest that sheltered workshops are a 

critical component of 

employment systems 

because they provide 

people with significant 

disabilities who may 

have no other options 

with the option to work. 

However, sheltered work 

has not been shown to be effective in moving 

people with disabilities to an integrated work 

environment.124

NCD believes that no person with a 

disability should be discriminated against in an 

employment setting by receiving less than the 

minimum wage available 

to all other citizens. 

NCD also recognizes 

that eliminating all 

of the Section 14(c) 

certificates would 

jeopardize the security 

of many people who are 

currently involved with 

the program. Therefore, as we first noted in our 

2012 report on the topic,125 NCD recommends 

a transformation strategy to phase out the 

14(c) model in favor of one of empowerment 

and self-determination. (See Appendix C for a 

link to NCD’s Report on Subminimum Wage and 

Supported Employment, with more information 

about the transformation strategy.)126

Currently, an estimated 228,600 

people with intellectual/

developmental disabilities and 

other significant disabilities work for 

subminimum wage...

Although [CMS] specifies that 

sheltered workshops should only be 

used as a time-limited service, one 

study found that only five percent of 

sheltered workshop employees left 

to take a job in the community

54 National Council on Disability
In recent years, several government agencies 

have sought to limit the use of subminimum 

wages. Under Section 511 of the Rehabilitation 

Act of 1973, a series of steps must be taken 

before an individual under the age of 24 can 

be placed in a job paying less than minimum 

wage. Section 511 also prohibits schools from 

contracting with subminimum wage providers. 

WIOA established the Advisory Committee on 

Increasing Competitive Integrated Employment 

for Individuals with Disabilities. The advisory 

committee made recommendations to Congress 

on how to strengthen competitive integrated 

employment opportunities for individuals with 

intellectual or developmental disabilities or 

other individuals with 

significant disabilities. 

Finally, the Department 

of Justice entered into 

settlement agreements 

with Rhode Island and 

Oregon to address the 

rights of people with 

disabilities to receive 

state-funded employment and daytime services 

in the broader community, rather than in 

segregated sheltered workshops and facilitybased day programs.127 NCD recommends 

that all federal agency annual reports to 

Congress regarding Section 503 and 511 

of the Rehabilitation Act of 1973 include 

information on enforcement activities and 

the impact of employment on people with 

disabilities.

Attitudes and stereotypes about people with 

disabilities also create barriers for this population 

when it comes to using fixed-route public transit 

providers, paratransit, and private transportation 

providers. For example, bus drivers may not stop 

their buses to pick up people with disabilities, 

paratransit staff do not provide friendly customer 

service and may fail to respond to complaints, 

and paratransit drivers lack respect for users of 

their services and transit agencies often use 

punitive cancellation policies for people with 

disabilities.128 NCD recommends that DOT 

Federal Transit Administration work with 

local communities to provide guidance that 

clarifies and bolsters ADA nondiscrimination 

standards. This will address issues faced by 

people with disabilities and ensure accessibility 

of all public transportation options.

Although the ADA prohibits discrimination 

by private entities, companies that provide 

smartphone 

transportation 

applications have failed 

to provide accessible 

services for people with 

disabilities. For example, 

a recent lawsuit claims 

that the UberX service, 

which is basic doorto-door service, inhibits access to people with 

mobility limitations.129 In Washington, DC, Uber 

users with mobility limitations can use Taxi WAV, 

which hails a DC cab, but some reports find that 

wait times are longer and fares are higher with 

this service.130 NCD recommends that DOJ 

issue regulations for privately funded transit 

to provide accessible transportation options 

for people with disabilities. It is important to 

overcome the attitudinal and physical barriers that 

people with disabilities face when it comes to 

accessible transportation. Reliable transportation 

is necessary for people with disabilities to be able 

to hold a job and reach the goal of economic selfsufficiency.

Although the ADA prohibits 

discrimination by private entities, 

companies that provide smartphone 

transportation applications have 

failed to provide accessible services 

for people with disabilities

National Disability Policy: A Progress Report 55
Many of the same attitudinal barriers affect 

people with disabilities who are looking for 

accessible housing. Deaf and Hard of Hearing 

have reported experiencing adverse treatment 

in approximately half (49.5 percent) of their 

attempts to secure a rental unit and wheelchair 

users were reported to have experienced 

adverse treatment in approximately one-third 

(32.3 percent) of their attempts to secure rental 

housing.131 Some of the adverse experiences 

people with disabilities face when trying to 

secure housing include refusal of calls made by 

or for TTY users, refusal to allow inspection of 

rental units, and housing managers or landlords 

failing to provide information regarding available 

units or requirements for completing a rental 

application. Being an active and independent 

member of the community requires that people 

with disabilities can secure accessible housing 

free of discrimination and stereotypes.

56 National Council on Disability
NCD recognizes that there have been a 

number of efforts to address the barriers 

described in this report that prevent 

people with disabilities from achieving economic 

self-sufficiency. This chapter focuses on policies, 

programs, and practices that demonstrate 

promise in lifting people with disabilities out of 

poverty by addressing barriers that people with 

disabilities experience. These ideas provide a 

basis for the development of future policies that 

can further support the achievement of economic 

self-sufficiency for people with disabilities.

Education

Students with disabilities often do not have the 

same access to internship and work experience 

opportunities as other students during high 

school and college. NCD notes some promising 

initiatives and recommends that model programs 

be duplicated or tested as potential ways to 

increase the economic prospects for people 

with disabilities. For example, the Initiative for 

Empowerment and Economic Independence 

(IEEI) at Eskenazi Health in Indiana is a rigorous 

internship program for college students with 

physical and sensory disabilities. The program 

seeks to remove the barriers that normally 

prevent students with disabilities from pursuing 

gainful employment, such as logistical issues 

with transportation and employer reluctance to 

invest in accommodations in the workplace. It 

prepares students by building skills, confidence, 

and a work history that better enables them 

to find full-time employment after college. The 

program is committed to creating a rigorous, 

real-world experience for their students, through 

a 40-hour work week (with flexibility for students 

who cannot do a full-time internship), high work 

standards, and pay equal to their peers, at about 

$15 per hour. The students must apply to and 

qualify for the internship, and if they are not 

quite ready, the program offers guidance on how 

they can improve their application. The program 

is also effective at influencing the perspectives 

of employers, supervisors, and peers about 

working with someone who has a disability. 

Through the internship program, employers 

learn that accommodations are often much more 

doable and less costly than expected and their 

preconceived ideas about what people with 

disabilities are capable of accomplishing are 

challenged and transformed.132 In the coming 

years, IEEI hopes to increase the number of 

interns it employs and to continue working with 

employers to educate them about working with 

people with disabilities, establishing a center and 

website to serve as resources for connecting 

individuals and companies, and expanding their 

program for implementation at other sites in 

the United States. NCD recommends the 

Chapter 3: Emerging and Promising Practices 

for Achieving Economic Self-Sufficiency

National Disability Policy: A Progress Report 57
development of partnerships across 

vocational rehabilitation agencies, local 

education agencies, institutes of higher 

education, and employers to promote similar 

internship opportunities for students with 

disabilities.

Similar to TPSID programs, the InclusiveU 

program at Syracuse University supports 

students with intellectual disabilities who may 

otherwise not have access to postsecondary 

education. InclusiveU is a flexible program 

individualized to each student. Students with 

intellectual disabilities audit classes and receive 

a certificate of completion from InclusiveU. 

Participating students can also be matched up 

with a Syracuse University student mentor to 

receive academic and social support. Although 

TPSID has made similar programs possible at 

other universities, they should continue to be 

developed and made available to more students 

with intellectual disabilities.

UDL is a set of principles to guide curriculum 

design to meet the needs of diverse students. 

Curricula designed under the UDL framework 

are more flexible and can accommodate learning 

differences that exist among students by adjusting 

to each student’s strengths and needs. Students 

with disabilities can benefit from UDL-based 

curriculum because it is more capable of meeting 

their needs from day one in the classroom, 

and fewer special supports may be required 

for each child. For example, UDL classrooms 

can present information in visual, auditory, or 

interactive ways rather than only relying on 

textbooks. UDL can be applied to assessments 

(formative and summative) as well, allowing 

students the opportunity to show what they have 

learned through a variety of methods including 

tests, presentations, group projects, and other 

evaluative activities. Perhaps most importantly, 

UDL works because it keeps students with 

disabilities and those without disabilities in the 

classroom together, which benefits all students 

socially and educationally. However, to date, UDL 

is more widely used within special education 

classrooms than general education classrooms.133

One study of five high-performing schools 

in Texas highlights the use of UDL practices 

to improve education for students in poverty, 

including those with disabilities.134 In these 

schools, the focus was on fully integrating 

students with disabilities into the regular 

education program and embracing the idea that 

all students can be academically successful 

when the talents and experiences of teachers 

58 National Council on Disability
are put to their best use. Regular communication 

between faculty and administrators across 

teaching areas made this program work as it 

provided opportunities for teachers to learn 

from one another. This created an environment 

where teaching strategies were adjusted to each 

student’s needs and teachers collaborated with 

colleagues to identify solutions to barriers and 

participate in schoolwide intervention strategies 

for all students. These schools focused on a 

culture of student-centered learning where 

separate special education services (e.g., those 

outside the general 

education classroom), 

although valued and 

supported, were 

considered a referral of 

last resort. The results 

from the Texas study 

showed that students 

with disabilities could 

meet or surpass high 

standards in state assessments.135 Broader use 

of these types of UDL and inclusion practices can 

help students with disabilities succeed in school 

and improve their chances for attending college 

or accessing other career opportunities after they 

graduate. NCD recommends that ED issue 

guidelines on the inclusion of UDL principles 

to promote integration of students with 

disabilities in the classroom.

The Center for Attachment and Family 

Development in Decatur, Alabama, is another 

example of promising educational practices that 

address the social and emotional learning needs 

of students with disabilities living in poverty. This 

Center aims to improve the behavior of children 

and encourage functional behavior that helps 

children succeed by addressing the community 

system around the child in addition to the childcentered components of the behavior.136 Their 

four-pronged approach is central to the success 

of the program as it takes a comprehensive view 

to treatment and intervention to help children 

with behavior problems that result from living in 

poverty. Another example is a preschool social 

and emotional learning intervention that is part 

of the Foundations of Learning demonstration. 

The intervention improved the ability of preschool 

teachers to address children’s behavior problems 

and had positive outcomes on teacher practices 

when they worked with 

students with behavioral 

problems. It also resulted 

in lower levels of 

conflictual interactions 

among children and 

a higher level of 

engagement in classroom 

activities.137 These locallevel demonstrations 

can be valuable for informing policy changes that 

will positively affect the educational outcomes of 

students with disabilities.

In addition to school-based approaches 

to addressing the needs of students with 

disabilities, professional development 

opportunities geared toward preparing teachers 

to work with students with disabilities have 

shown promise. Some of these approaches 

include supporting general education teachers in 

their efforts to effectively instruct students with 

disabilities in their general classrooms.138 In one 

example, teachers used problem-solving teams 

that focused on teachers providing social support, 

learning new instructional approaches, obtaining 

practical help with problems, and improving 

practice through reflection.

Broader use of these types of UDL 

and inclusion practices can help 

students with disabilities succeed in 

school and improve their chances 

for attending college or accessing 

other career opportunities after they 

graduate

National Disability Policy: A Progress Report 59
Financial Assistance and Incentives

Another challenge for people with disabilities 

who receive public assistance is to stay within 

the asset limits (capped at just $2,000 total under 

SSI). The recent ABLE Act of 2013 addresses this 

barrier and promotes economic independence 

and self-sufficiency among people with 

disabilities. The ABLE Act amends Section 529 

of the Internal Revenue Code, which establishes 

tax-free savings accounts for qualified individuals 

to save money to pay for qualified disability 

expenses. Under the 

ABLE Act, each state 

develops and operates 

its own ABLE program. 

Individuals are limited 

to one account and the 

individual must have a 

qualified disability that 

occurred prior to the 

age of 26, meaning 

either they must be 

eligible for SSI or have a 

permanent disability with 

marked and severe functional limitations. NCD 

recommends that Congress approve the ABLE 

Age Adjustment Act to increase the qualifying 

age limit for an ABLE account to occurring 

prior to their 46th birthday. ABLE accounts 

can function as both savings accounts and 

investment accounts for people with disabilities 

with differing allocations based on risk tolerance. 

To incentivize the use of these accounts, some 

states provide a tax deduction for state taxpayer 

contributions to an ABLE account.

Consistent with federal gift tax law, $14,000 

per year from all sources may be deposited into 

ABLE accounts. Additionally, each individual may 

save up to $100,000 without the amount in the 

account counting against the $2,000 resource 

limit of SSI. Funds in the account can be used 

tax free to purchase qualified disability expenses 

such as housing, food, transportation, medical 

care, education, employment support, legal 

fees, health and wellness services, assistive 

technology, financial management, and other 

expenses that increase the beneficiary’s health, 

independence, and quality of life. However, NCD 

recommends that Congress approve the ABLE 

to Work Act to allow people with disabilities 

who are employed 

to contribute funds 

above the $14,000 

per year cap to an 

ABLE account (the 

maximum allowable 

amount is $26,060 

in 2017). People with 

disabilities who establish 

ABLE accounts but 

do not receive SSI are 

allowed to save up to the 

amount permitted in each 

state’s 529 education savings plan to pay 

for qualified disability expenses. The limits 

for state 529 education savings plans range 

from $260,000 to $550,000 depending on 

the state. NCD recommends that Congress 

approve the ABLE Financial Planning Act to 

allow 529 educational savings accounts to 

be transitioned to qualifying people with 

disabilities without incurring penalties 

or taxes.

Currently, 18 states have ABLE programs 

and 28 states are developing their programs. 

NCD recommends that all states implement 

ABLE programs and actively inform people 

with disabilities and their caregivers of this 

Funds in the [ABLE] account can be 

used tax free to purchase qualified 

disability expenses such as housing, 

food, transportation, medical care, 

education, employment support, 

legal fees, health and wellness 

services, assistive technology, 

financial management, and other 

expenses...

60 National Council on Disability
important new legislation. In addition, the IRS 

should issue final regulations to Section 529A 

of the Internal Revenue Code on how states 

can establish a qualified ABLE program. The 

ABLE Act allows people with disabilities to build 

individual savings and invest their money in ways 

that will enhance their self-sufficiency.

Employment

NCD is a strong proponent of employment 

that pays a competitive wage to people with 

disabilities. Work is the first and preferred 

outcome in the provision of publicly funded 

services for all working-age 

people with disabilities, 

regardless of their level of 

disability. As of January 

2017, 46 states have 

undertaken some activity 

to support employment for their citizens with 

disabilities, and 32 states have passed legislation, 

issued Executive Orders, or established policy 

directives to promote competitive integrated 

employment.139

Importantly, work for people with disabilities 

should be in jobs that pay a competitive 

wage and offer adequate benefits and 

accommodations. This includes moving 

people from sheltered workshops and other 

segregated settings to integrated employment 

and completely removing subminimum wage 

jobs. These ideas have been supported through 

federal policies and resulted in improved 

practices in the disability field. In 2001, RSA 

prohibited placement in sheltered workshops or 

other segregated settings from counting as an 

employment outcome for purposes of the VR 

program.140 In 2011, the Centers for Medicare and 

Medicaid Services specified that prevocational 

services provided under HCBS waivers are 

considered a time-limited service while services 

that support work in the community are long 

term. DOJ reached settlement agreements in 

2014 and 2015 with Rhode Island and Oregon 

to promote integrated employment.141 Finally, 

WIOA established the Advisory Committee on 

Increasing Competitive Integrated Employment 

for Individuals with Disabilities to advise the 

U.S. Secretary of Labor on ways to increase 

competitive integrated employment and improve 

the use and oversight of 14(c) certificates.142

WIOA promotes a focus on transition-age 

youth, moving people 

with disabilities into 

postsecondary training, 

education, and employment 

opportunities as early as 

possible.

States have followed this trend by 

implementing an Employment First model, 

which requires federal, state, and local agencies 

to modify their policies and funding structures 

to promote integrated employment. At the 

same time, VR service providers must retool 

and retrain their staff to provide supports geared 

toward integrated rather than segregated 

employment. Recognizing this challenge, 

DOL’s Office of Disability Employment Policy 

provides technical assistance to cross-agency 

teams of state government leaders through 

its Employment First State Leadership Mentor 

Program. However, in many states to date, 

Employment First initiatives have resulted in 

proclamations rather than binding mandates.143

NCD recommends that states mandate 

the development of Employment First 

initiatives to reflect stronger legislative and 

policy support for competitive integrated 

[I]n many states to date, 

Employment First initiatives have 

resulted in proclamations rather 

than binding mandates

National Disability Policy: A Progress Report 61
employment opportunities, which will 

increase opportunities for economic 

independence for youth and adults with 

disabilities.

Housing

People with and without disabilities want to 

be part of a safe, integrated, and inclusive 

community, where they can live independently 

with reasonable access to educational 

institutions, jobs, and services. Communities 

need to promote investments in infrastructure 

and developments that include diverse yet 

integrated housing and transportation that will 

allow access to jobs, schools, and stores to 

promote economic opportunity for all residents. 

In some communities, there is a move toward 

using collaborative 

partnerships that include 

federal, state, local, private, 

and nonprofit organizations 

to address the needs of 

people with disabilities along 

with the needs of the entire 

community.144 There are a number of promising 

programs and practices that address the need 

for affordable housing for low-income individuals 

and families across the United States, including 

people with disabilities.

Universal design for housing has been used 

in home construction since the 1980s. It seeks 

to create accessible and barrier-free housing and 

exceeds the minimum legislated specifications 

for accessible and barrier-free housing. 

Accessibility and usability is a goal of design 

from the start. One of the main concepts behind 

universal design is that it includes features that 

help people with disabilities live independently 

but are also useful to people without disabilities. 

Universal design for housing makes homes 

easier for people to use throughout their lifetime, 

supporting independent living and aging in place 

for everyone. Homes are built with adaptable or 

adjustable features and have products that are 

universally usable and commonly available.145 The 

Fairfax County, Virginia, Board of Supervisors is 

an example of a community-based group that has 

made a commitment to supporting housing that 

will benefit all residents. The Board of Supervisors 

created the Fairfax County Coalition on Housing 

and Universal Design, which is a public-private 

partnership between contractors, remodelers, 

interior designers, occupational and physical 

therapists, area agencies on aging, advocates 

for older adults and people with disabilities, and 

Fairfax County government representatives.146

The coalition promotes the 

incorporation of universal 

design features into new 

single family homes and 

encourages the Multiple 

Listing Services Database 

to include information about 

universal design features in homes for sale.147

The National Association of the Remodeling 

Industry and the National Association of Home 

Builders also offer certifications to support the 

integration of universal design concepts into 

residential construction.148 Despite this example, 

universal design for housing has not been widely 

adopted in the design community (e.g., among 

designers and builders) because it is perceived 

as a design solely for people with disabilities or 

as cost-prohibitive. However, new homes that are 

built with universal design in mind can be built 

at a cost similar to that of other new homes.149

In addition, universal design allows people to 

age in place and potentially reduces the need 

[N]ew homes that are built with 

universal design in mind can be 

built at a cost similar to that of 

other new homes

62 National Council on Disability
for community services and nursing home care. 

NCD recommends that HUD require that all 

federally assisted housing units are designed 

following universal design principles and that 

local communities support greater investment 

in housing developments incorporating 

universal design.

Affordable housing should be available to 

all people regardless of disability or income. In 

Montgomery County, Maryland, the Moderately 

Priced Housing (MPH) Law passed in 1974 

addressed the need for affordable housing 

among Montgomery County, Maryland, 

residents. The law requires that 12.5 to 

15 percent of the total number of units in any 

new development with 20 or more units include 

”moderately priced dwelling units,” and that 

40 percent of the moderately priced units be 

made available to housing agencies for families 

with low and moderate income.150 Between 1974 

and 2004, 11,000 affordable housing units were 

built in Montgomery County because of the 

MPH law.151 Policies like this should be expanded 

to include requirements for affordable, accessible 

housing in new communities so that there is 

an adequate supply of affordable, accessible 

housing available to people with disabilities. NCD 

recommends that local communities pass 

ordinances like the MPH law that, along with 

affordability guidelines, include requirements 

for accessible housing in new developments

The Democracy Collaborative supports 

collaborative efforts to address economic and 

health disparities in economically struggling 

metropolitan areas through the Anchor Institution 

Initiative. Anchor institutions are defined as 

universities, hospitals, public utilities, municipal 

governments, foundations, and faith-based 

institutions—all organizations or entities that are 

“rooted” in the community.152 Anchor institutions 

collaborate on issues such as affordable housing, 

job training and job creation, investment in 

transportation, and supporting small businesses 

and businesses owned by people from diverse 

racial backgrounds. These efforts are geared 

toward all residents but can support people 

with disabilities to live independently and fully 

participate in their community.

Similarly, the Sustainable Communities 

Initiative is an interagency partnership between 

HUD, DOT, and the Environmental Protection 

Agency that is implemented by the HUD Office of 

Economic Resilience. The initiative encompasses 

two competitive grant programs: (1) the 

Sustainable Communities Regional Planning 

Grant Program, and (2) the Community Challenge 

Grant Program.153 The goals of the initiative are 

to address environmental, social, and economic 

challenges faced by regions and communities in 

a time of growing need and tightening budgets 

at all levels. In recent years, communities around 

the country have taken a new collaborative 

approach to community planning, recognizing 

that they need to have a broader understanding 

of the needs of in the community when making 

future infrastructure investments.

In 2010, the Federal Emergency Management 

Agency created the Office of Disability 

Integration and Coordination (ODIC) in an effort 

to improve access to emergency preparedness 

information and ensure that the needs of 

people with disabilities are met in times of 

emergencies. People with disabilities experience 

a variety of challenges during an emergency, 

including accessible transportation during an 

evacuation, maintaining their independence in 

a shelter, finding accessible housing if theirs 

has been destroyed, and accessing services 

National Disability Policy: A Progress Report 63
to enable them to return to work.154 Although 

ODIC has improved the outcomes of people 

with disabilities before, during, and after 

an emergency, people with disabilities and 

emergency managers need to build on existing 

emergency management efforts to foster 

inclusive disaster planning and fully accessible 

disaster services. It is imperative that people 

with disabilities are included in the development 

and implementation of these initiatives to ensure 

that their accessible and affordable housing and 

transportation needs are fully considered and 

addressed.

Underutilized Policies, Programs, 

and Practices

In addition to the promising policies and 

programs described previously, there are 

existing programs that could be effective if 

they were implemented 

fully. Programs like the 

SSA’s Ticket to Work 

(TTW) program and the 

Medicaid Buy-In programs 

were created to promote 

employment for people 

with disabilities while recognizing the importance 

of maintaining health benefits. However, both 

programs are currently underutilized by people 

with disabilities.

Established in 1999, the SSA’s TTW program 

is a voluntary program designed to promote 

employment among SSI and SSDI beneficiaries 

and reduce their dependence on benefits. 

TTW expands people with disabilities’ choice 

of employment support providers beyond 

VR and other public providers. Nonprofit, forprofit, and government agencies can become 

an employment network (EN) by entering an 

agreement with SSA to provide employment and 

other services to people with disabilities. People 

with disabilities in the TTW program are given a 

“ticket” that allows them to contact any EN in 

their area or nationally to find the services and 

supports that meet their needs. For a ticket to 

be activated, the person with a disability must 

engage an EN or VR agency for services. SSA 

then provides payments to the EN based on 

specific employment milestones or outcomes.

Despite providing people with disabilities 

with additional choices for employment support 

providers, TTW and related programs have had 

a limited effect on the employment outcomes 

of SSDI beneficiaries.155 As of 2013, of the 

13.5 million tickets issued by SSA, 316,575 (or 

approximately 2.3 percent) of the tickets issued 

were activated. Of all tickets in use, 87 percent 

were assigned to state VR agencies rather than 

other ENs. Through the 

TTW program, 23,785 

SSDI beneficiaries 

were placed in a job or 

supported on a job by an 

EN, and 7,835 were able 

to earn enough income 

to leave SSDI.156 Two of the reasons for low 

participation in TTW to date are confusion about 

how TTW works and concerns about losing SSDI 

benefits. In addition, ENs only receive payments 

if the employment outcome is at the SGA level, 

which may result in ENs only selecting to work 

with clients who need the least amount of 

assistance.157

The legislation that created the TTW program 

also created the Medicaid Buy-In program, which 

provides additional Medicaid eligibility options for 

people with disabilities whose income is higher 

than the allowable substantial gainful activity 

As of 2013, of the 13.5 million

tickets issued by SSA, 316,575 

(or approximately 2.3 percent) of

the tickets issued were activated

64 National Council on Disability
levels. Currently, 45 states offer a Medicaid Buyin program for people with disabilities who do 

not qualify for Medicaid through SSI eligibility. 

This program encourages 

people with disabilities 

to seek or return to 

employment without 

fear of losing health 

care benefits such as 

personal care attendants. 

From 2010 to 2011, the 

Medicaid Buy-In program 

grew 10 percent to a 

total of 192,946 enrollees nationally; however, 

the size of Medicaid Buy-In programs varies 

significantly across states. The number of 

enrollees in each state ranges from 50 to 20,000 

participants. Also, from 2010 to 2011, the average 

earnings among Medicaid Buy-In enrollees were 

$9,135 per year.158

These examples 

show that continued 

support from the Federal 

Government to remove 

barriers to employment 

for people with 

disabilities is needed. 

People with disabilities 

can achieve economic 

self-sufficiency with the 

necessary accommodations across education, 

employment, financial assistance and incentives, 

health care, long-term services and supports, 

transportation, and housing.

45 states offer a Medicaid Buy-in 

program for people with disabilities 

who do not qualify for Medicaid 

through SSI eligibility... [F]rom 2010 

to 2011, the average earnings among 

Medicaid Buy-In enrollees were 

$9,135 per year

National Disability Policy: A Progress Report 65
66 National Council on Disability
All Americans have the right to lead lives 

with equal opportunity, full community 

participation, independent living, and 

economic self-sufficiency. A variety of federal 

policies and programs provide economic support for 

people with disabilities, but many programs hinder 

the ability of people with disabilities to achieve this 

goal. NCD proposes the following recommendations 

to help ensure that people with disabilities are able 

to achieve economic self-sufficiency:

Chapter 4: Recommendations to Promote Economic 

Self-Sufficiency for People with Disabilities

Collaboration and Data Collection

1. Congress should appropriate funds for the creation of a coordinated review of all federal 

disability programs to enhance the efficiency and ability of existing structures to break 

down silos between federal agencies in order to improve the economic picture for people 

with disabilities.

a. OMB should direct all cabinet-level federal agencies to submit their Agency Reform 

Plans pertaining to their disability programs to NCD for review.

b. All federal agencies should be directed to include measures of cross-agency collaboration 

within their GPRA performance measurement standards. OMB should report on 

measures of cross-agency collaboration in its annual reports on agency performance.

c. All federal agencies, including but not limited to the U.S. Departments of Education, 

Labor, Health and Human Services, and Housing and Urban Development, should 

improve data collection related to people with disabilities in order to enhance 

knowledge on how people with disabilities are assisted by existing programs. Data 

collection should include information about people with disabilities who use federally 

funded programs to determine where programs can be modified and improved to 

promote employment and economic self-sufficiency.

2. Congress should continue investments in the U.S. Census Bureau’s development of the 

Supplemental Poverty Measure and annual reports to ensure an adequate assessment 

of how the cost of necessary expenses that people with disabilities face (like medical or 

long-term services and support expenses) affect their opportunities and ability to achieve 

economic self-sufficiency.

National Disability Policy: A Progress Report 67
Education

1. Congress should reauthorize the IDEA in a manner that facilitates the meaningful inclusion 

of all students with disabilities. Reauthorization should reinforce the assertions under 

IDEA to provide a free and appropriate education to students with disabilities, including 

language, to ensure that students with disabilities from diverse racial backgrounds and 

students who exhibit challenging behaviors are not disproportionately placed outside of 

the least restrictive environment.

2. ED should issue guidelines to local education agencies and state education agencies on 

the inclusion of UDL principles and recommend giving teachers flexibility to implement 

UDL with state and district curricula and lesson plans to promote broader integration 

of students with disabilities in the classroom. (See Chapter 3, for more information 

about UDL.)

3. ED and state education agencies should issue guidelines to local school districts to give 

all students with disabilities an opportunity to obtain a standard high school diploma. The 

guidelines should reinforce that the use of alternative high school diplomas or certificates 

of completion should be considered a last resort for students with disabilities.

4. ED Institute on Education Sciences should fund national research that explores the 

educational and employment outcomes of alternative high school diplomas for students 

with IEPs and Section 504 plans, as well as the demographic characteristics of students 

receiving these alternative diplomas.

5. ED should continue funding for model programs like the TPSID program, which can help 

reduce poverty among people with intellectual disabilities.

6. Congress should amend the Higher Education Act to modify existing higher education 

financial assistance program guidelines so that they are adequately accessible and 

students with disabilities are not penalized when a qualifying disability limits their ability 

to maintain a full course load or work study requirements as determined by campus 

disability services programs. This should include but not be limited to Pell grants, federal 

work-study programs, and student loan repayment.

7. The IRS should provide guidance that waives the tax debt on student loan forgiveness 

for students with disabilities so that they do not incur a tax debt from a forgiven loan.

68 National Council on Disability
Employment

1. DOL, the U.S. Access Board, DOJ, and the EEOC should dictate that all policies and 

regulations related to Sections 503 and 511 of the Rehabilitation Act of 1973 be prioritized 

for nationwide enforcement. This includes an annual report to Congress on activities and 

the impact on employment for people with disabilities.

2. Congress should amend the Small Business Act to expand the Small Business 

Administration’s 8(a) Business Development Program to include people with disabilities 

as a presumed socially disadvantaged group to be in line with the findings in the ADA, 

which states that people with disabilities are disadvantaged socially, economically, 

vocationally, and educationally.

3. DOL and ED should issue guidelines to develop partnerships across state 

vocational rehabilitation agencies, local education agencies, institutes of higher 

education, and employers that promote paid internships for college graduates and 

students with disabilities in postsecondary education as a gateway to full-time 

employment.

4. All federal agencies should be the model in hiring, retention, and integration of people 

with disabilities in the workplace. In accordance with OPM, all federal agencies 

should increase coordination between their SPPCs. This will bridge the gap between 

managers and employees with disabilities and enhance understanding of reasonable 

accommodations and their effect on productivity and retention of people with disabilities. 

To attain this goal, mandatory training for human resources staff, managers, and 

supervisors should be required.

5. States should mandate Employment First initiatives to reflect stronger legislative and 

policy support of competitive integrated employment to increase opportunities for 

economic independence for youth and adults with disabilities.

National Disability Policy: A Progress Report 69
Financial Assistance and Incentives

1. Congress should expand opportunities for people with disabilities who need to pay for 

personal care services to benefit from tax deductions when medical expenses are less 

than 10 percent of adjusted gross income or deductions cannot be itemized.

2. Congress should approve three amendments to the ABLE Act:

a. The ABLE Financial Planning Act, which would allow 529 educational savings accounts 

to be transitioned to qualifying people with disabilities without incurring penalties or 

taxes.

b. The ABLE Age Adjustment Act, which would increase the qualifying age threshold for 

eligibility for an ABLE account from 26 to 46.

c. The ABLE to Work Act, which would allow employed people with disabilities to 

contribute funds to an ABLE account in an amount above the $14,000 per year cap. 

Additional contributions would not exceed the equivalent of the determined federal 

poverty level for that year (the maximum allowable amount was $26,060 in 2017).

3. All states should implement ABLE programs and actively inform people with disabilities 

and their caregivers of this legislation in order to provide people with disabilities with the 

opportunity to build individual savings and invest their money in ways that will enhance 

their economic self-sufficiency.

4. The IRS should issue final regulations to Section 529A of the Internal Revenue Code on 

how states or state agencies can establish a qualified ABLE program.

5. Congress should pass legislation that decouples eligibility for health care benefits from 

eligibility for cash benefits like SSI and SSDI to prevent people with disabilities from being 

forced to choose between getting a job or having access to health care.

6. Congress should amend the EITC to lower the age of eligibility from 25 to 18 years old 

and increase the benefit for childless adults to provide greater incentive to work and 

advance self-sufficiency.

70 National Council on Disability
Health Care

1. Congress should maintain protections that prohibit insurance companies from denying 

coverage because of preexisting conditions to ensure affordable health insurance 

coverage for people with disabilities.

2. Congress should ensure that Medicaid reforms, including but not limited to block grants 

or per capita caps, will be robust enough to prevent dramatic cutbacks in services and 

prevent lower reimbursement rates for providers and limits on Medicaid eligibility. 

Medicaid reforms should also safeguard access to home and community-based services 

waivers, which are essential to promoting independent living, employment, and economic 

self-sufficiency for people with disabilities. Any increases to state flexibility through block 

grants or per capita caps should include meaningful accountability to the Centers for 

Medicare and Medicaid Services to ensure a minimum level of coverage and services and 

consistency are provided across state Medicaid programs.

3. Congress should maintain Medicaid expansion for individuals whose conditions did not 

meet the severity requirements for disability-based Medicaid prior to passage of the ACA 

and those falling within the two-year waiting period before qualifying for disability-based 

Medicare.

4. Congress should remove the 18 to 64 age limits for buy-in options in Medicaid to promote 

work among people with disabilities after age 65 without requiring them to spend down 

to be eligible for Medicaid or exclude their buy-in assets from being counted for eligibility 

purposes.

Housing

1. HUD should require that all federally assisted housing units follow universal design 

principles and ensure that accessible housing units are in line with the percentage of 

people with disabilities requesting federal housing assistance. This goal can be achieved 

by increasing the percentage of required new housing units that are accessible for people 

with mobility disabilities and people with sensory disabilities from the current rate of 

five percent and two percent, respectively. (See Chapter 3, for more information about 

universal design.)

(continued)

National Disability Policy: A Progress Report 71
2. Local communities should enact ordinances requiring developers to include a percentage 

of accessible homes of varying price in any new development, similar to Montgomery 

County, Maryland’s MPH law, which requires 12.5 to 15 percent of the total number of 

units in a new development to be moderately priced. HUD should provide guidance to 

local communities to promote greater investment in housing developments incorporating 

universal design and to ensure greater availability of accessible housing units and promote 

opportunities for aging in place.

Housing, continued

Transportation

1. DOJ should issue regulations that require privately funded transit agencies to provide 

accessible transportation options for people with disabilities in all communities. This includes 

but is not limited to taxicabs and transportation arranged through smartphone applications.

2. Local municipalities should require taxicab authorities to provide mandatory training 

for taxicab operators about the proper ramp deployment and securement policies and 

procedures so that people with mobility disabilities can safely and effectively use privately 

funded transit options.

3. Local communities should provide guidance that clarifies and bolsters the ADA 

nondiscrimination standards in order to address issues faced by people with disabilities 

who require assistance to use transportation services because of their disability. This 

includes but is not limited to refusal to accommodate service animals, claims of broken 

lifts and ramps, and late pickup or no shows.

4. DOT’s Federal Transit Administration should work with local communities so that the DOT 

ADA regulations are followed to guarantee that all public transit stations and bus stops 

are accessible. This includes but is not limited to ensuring the detectability of bus stops 

through tactile signage or unique bus stop pole designs for people who are blind or have 

visual impairments and installation and maintenance of shelters and level concrete pads 

for people with mobility disabilities.

5. Congress should place greater emphasis on funding transportation programs in rural areas 

to address minimal or nonexistent public and privately funded accessible transportation 

options for people with disabilities.

6. Neighboring paratransit agencies should coordinate with each other to eliminate 

the arbitrary line between paratransit jurisdictions, which would provide people with 

disabilities with increased job opportunities in major business hubs.

72 National Council on Disability
L

ike all Americans, people with disabilities 

want equal opportunity to participate fully 

in their communities, live independently, 

and achieve economic self-sufficiency. However, 

poverty is a significant issue for people 

with disabilities. The 2017 Progress Report

demonstrates how established public programs 

seek to address the connection between poverty 

and disabilities across education, employment, 

financial assistance and incentives, health care, 

long-term services and supports, transportation, 

and housing. However, existing programs and 

policies often act as a barrier to needed public 

services in ways that perpetuate a cycle of 

poverty among people with disabilities. These 

barriers include physical access barriers, lack 

of available programs, complex relationships 

between programs and eligibility requirements, 

and inaccurate perceptions of the capabilities of 

people with disabilities. The barriers people with 

disabilities experience are often due to limited 

integration across existing programs, which may 

work at cross purposes.

It will take a commitment by policymakers 

to examine existing policies and practices to 

determine which ones work to create a better 

path to economic self-sufficiency for people with 

disabilities and which ones do not. A coordinated 

review of all federal disability programs would 

improve the efficiency of existing structures 

to better meet the needs of people with 

disabilities. Such a review would also begin to 

break down the silos that often exist between 

federal agencies and address the barriers often 

caused by the interconnected nature of existing 

programs. This is a critical step toward improving 

the economic outlook for people with disabilities 

and including them in all aspects of society.

NCD encourages readers of the 2017 Progress 

Report to consider ways that public policies 

and programs can promote the employment 

of people with disabilities and be reoriented 

to remove the barriers that prevent people 

with disabilities from achieving economic 

self-sufficiency. It is essential that efforts to 

address the perpetual cycle of poverty that 

people with disabilities experience focus on all 

areas of life. This includes ensuring that people 

with disabilities are able to access education, 

employment opportunities, and transportation; 

afford their daily living expenses; get needed 

medical care; and live in affordable, accessible 

housing. Reorienting existing support systems 

toward the goal of helping people with disabilities 

to achieve gainful employment and economic 

self-sufficiency will benefit all of society.

Conclusion

National Disability Policy: A Progress Report 73
74 National Council on Disability
Appendix A: Focus Group Summary

Focus groups were held with 12 people with disabilities on March 6 and 7, 2017. The purpose of the 

focus groups was to discuss successes and barriers to achieving financial self-sufficiency for people 

with disabilities, successes and challenges faced when accessing policies and programs designed to 

help people with disabilities achieve economic self-sufficiency, and suggestions for what incentives and 

supports would make it easier for people with disabilities to achieve economic self-sufficiency. Quotes 

and anecdotes in the 2017 Progress Report were obtained during these focus groups.

Focus Group Highlights

Recruitment and Participants

Two focus groups were held by phone with six participants in each group. Participants were recruited 

through contacts at NCD and the National Disability Institute. Participants included four men and eight 

women, including two parents of adult children with disabilities. Participants were from Delaware, 

Maryland, Massachusetts, Minnesota, Nevada, and Washington, DC. The group included people with 

physical and intellectual disabilities, as well as individuals who were blind, Deaf, and Hard of Hearing. 

Participants were asked open-ended questions and invited to share their experiences related to 

education, looking for a job, working, health care and health insurance, housing, and transportation, 

including their experiences facing stereotypes or misunderstandings about their disability in these 

arenas.

Relevant Highlights

Education. Participants reflected on their educational experiences from high school and 

postsecondary or vocational training. One parent participant noted that their children with disabilities 

were at a disadvantage in finding employment after high school because they had received alternative 

high school diplomas. The parents noted that, because employers did not believe that an alternative 

diploma was the same as a standard high school diploma, the children had a more difficult time 

finding employment. Several participants described the benefits of new technology, including greater 

availability of large print and audio books, which was making education easier than when they were 

younger.

Income and Health Care. Participants described having trouble earning enough income to cover 

all of their day-to-day living costs and the costs associated with their disabilities. Participants rely on 

SSI and/or SSDI or have relied on it at some point in time. Some participants noted that they kept their 

income low enough to maintain their SSDI/SSI benefits. Participants also noted that SSI can act as a 

National Disability Policy: A Progress Report 75
poverty reinforcer because of the connection between SSI and SSDI and access to health care services 

through Medicare and Medicaid. A number of participants noted the importance of using benefits 

counselors who can explain and guide participants through eligibility, enrollment, and income and asset 

requirements. Several participants noted the burden of SSI and SSDI overpayments and the important 

support provided by benefits counselors to navigate the overpayment process.

Affordable Transportation and Housing. There was extensive discussion about access to 

affordable transportation services and affordable, accessible housing. All participants noted difficulties 

accessing reliable transportation services in order to maintain employment. Some of the difficulties 

included the lack of coordination among transit services between counties, cost of transportation 

services on a limited income, limited availability of bus routes, and the time costs of using paratransit 

or fixed-route services (e.g., scheduling a ride, travel time, problems with on-time arrivals). In addition, 

participants who had previously lived in rural communities noted that there were several challenges 

unique to rural areas, including limited or no fixed-route bus service, no paratransit service, and 

difficulty finding accessible transportation options. Several participants noted that they often relied on 

family members or friends for transportation support because they could not afford or rely on other 

services. The ability to find affordable, accessible housing near public transit was also extensively 

discussed. Participants explained that accessible housing options were difficult to find. Accessible 

housing options that were close to fixed-route transit options often cost significantly more than 

nonaccessible housing options. As a result, participants discussed settling for affordable housing that 

was not accessible and developing accommodations as needed (e.g., using benches to transfer from 

wheelchair to shower).

Lessons from Focus Group Discussions

The focus groups produced several insights for NCD to consider regarding policies and practices 

to support the economic self-sufficiency of people with disabilities and the availability of accurate 

information and resources to help coordinate the array of services and supports they received. The 

focus groups highlighted the fact that people with disabilities often relied on word of mouth, nonprofits, 

and community connections to find the information they needed. The focus groups also highlighted the 

connection between policies that were meant to support people with disabilities but often trap them in 

poverty rather than help them escape it. In particular, people with disabilities want to be employed and 

earn higher incomes, but because they often rely on health care and long-term services and supports 

from Medicare and Medicaid, they maintain a lower income, which keeps them in poverty.

76 National Council on Disability
Appendix B: Policies, Poverty, and People 

with Disabilities

This section provides an overview of how select legislation applies to economic self-sufficiency for 

people with disabilities.

Americans with Disabilities Act (ADA)

The ADA, enacted in 1990 and amended in 2008, prohibits discrimination on the basis of disability in 

employment, state and local government programs, services and activities, public accommodations, 

and commercial facilities. The goal of the ADA is to ensure full participation in society for people with 

disabilities by facilitating equal opportunity, independent living, and economic self-sufficiency.

Title I: Employment

Title I of the ADA prohibits discrimination against people with disabilities in employment both 

before and after they are hired. Access to employment is one of the most important issues affecting 

people with disabilities. Although the ADA has led to increases in accessibility and accommodations 

in employment and public awareness about the capabilities of people with disabilities, there has 

been little change in available employment opportunities for people with disabilities. Reasonable 

accommodations are required for job applicants and employees with disabilities among employers 

with more than 15 employees. However, attitudes and stereotypes about the cost of reasonable 

accommodations and the abilities of people with disabilities persist.

Title II: State and Local Governments

Title II of the ADA requires that state and local governments give people with disabilities an equal 

opportunity to benefit from all state programs, services, and activities (e.g., public education, 

employment, transportation, health care, and social services) in compliance with regulations 

determined by DOJ. Title II also prohibits discrimination against people with disabilities for public 

transportation services. Under Title II, state and local governments must provide accessible buses, 

subways, or commuter rails and also provide paratransit services in all areas where they operate fixedroute bus or rail systems.

Olmstead v. L.C. (1999) was the landmark case which determined that “unjustified isolation” of 

a person with a disability is a form of discrimination under Title II of the ADA. Under the decision, if 

a state treatment professional determines that community placement is appropriate, then a person 

National Disability Policy: A Progress Report 77
with a disability should be placed in the community, if the person with a disability chooses. This case 

had a significant impact on the opportunities for people with disabilities to live and fully participate in 

their communities.

Title III: Public Accommodations and Commercial Facilities

Title III of the ADA requires places of public accommodation and commercial facilities to meet 

accessibility standards. All new construction as well as existing structures must conform to the 

ADA Accessibility Guidelines. Existing structures must remove architectural barriers if doing so can 

be accomplished easily and without significant expense. Places of public accommodation include 

restaurants, hotels, shopping centers, doctor’s offices, and day care centers.

Individuals with Disabilities Education Act (IDEA)

The IDEA, enacted in 1975 (at the time called the Education for All Handicapped Children Act, or 

EHA) and reauthorized in 1990 and 2004, ensures that free public education resources are allocated 

to students with disabilities to meet their unique needs. IDEA ensures that students with disabilities 

have the same opportunities as other students. It mandates that students with disabilities who 

attend public schools receive a free appropriate public education that is tailored to their individual 

needs. The Office of Special Education Programs was created to help states with the implementation 

of IDEA.

Under IDEA, students in special education programs are expected to learn in the least restrictive 

environment, which means they spend as much time in an integrated classroom with their peers 

who do not receive special education services. Separate classes and schools are recommended only 

in cases where the disability is so severe that aids and services in the general education classroom 

are not adequate. How much time students with disabilities spend in general education classes will 

vary based on what is most appropriate for each student. School IEP teams work to ensure the most 

appropriate learning environments for each student.

Workforce Innovation and Opportunity Act (WIOA)

WIOA, signed into law in 2014, is designed to “help job seekers access employment, education, 

training, and support services to succeed in the labor market and to match employers with the 

skilled workers they need to compete in the global economy.” The Act reauthorizes and amends 

the Workforce Investment Act (1998) and amends the Adult Education and Family Literacy Act, the 

Wagner-Peyser Act, and the Rehabilitation Act of 1973.

WIOA programs operate through a network of local centers in each state called American Job 

Centers (AJC), which provide youth job training, education, and employment services at a single 

location. AJCs provide skills assessments, information on employment, information on training 

opportunities, job search and placement assistance, up-to-date information on job vacancies, and 

transition services to job seekers regardless of their disability status.

78 National Council on Disability
WIOA includes a number of improvements for job seekers with disabilities including:

1. A much larger role for public vocational rehabilitation as people with disabilities make the transition 

from school to adult life;

2. Limits on the use of subminimum wage;

3. Required agreements between state VR systems and state Medicaid systems and state 

intellectual and developmental disability (IDD) agencies;

4. A definition of “customized employment” in federal statute and an updated definition of 

“supported employment” that includes customized employment;

5. A definition for “competitive integrated employment” as an optimal outcome;

6. Enhanced roles and requirements for the general workforce system and One-Stop Career Centers 

in meeting the needs of people with disabilities; and

7. Changes in performance measures, with potentially major implications for VR.

Supplemental Security Income (SSI)

SSI is a federal supplemental income program funded by general tax revenues (not Social Security 

taxes). Like SSDI, SSI provides monthly cash payments to people with disabilities where disability is 

defined as the inability to engage in SGA (specifically, the inability to earn $1,170 a month in 2017 or 

$1,950 for blind individuals) because of “one or more severe physical or mental impairments that are 

expected to last at least a year or result in death.” Eligibility is based primarily on medical evidence. 

The disability determination process can often be lengthy. During this process, applicants must provide 

medical information to prove to disability evaluators or administrative law judges that they are unable to 

work above SGA. SSA periodically reassesses eligibility as part of its CDRs.

SSI is a means-tested program. Thus, in addition to meeting the definition of disability, SSI recipients 

must have countable income below SSI income levels and have less than $2,000 in countable assets 

($3,000 per couple). The maximum benefit in 2017 is $735 ($1,103 for a couple) and this amount 

is reduced based on other income and financial resources. For any earnings over $65 per month, 

SSI benefits are reduced by one dollar for two dollars of additional earnings. In most states, SSI 

beneficiaries also can qualify for Medicaid to pay for hospital stays, doctor bills, prescription drugs, and 

other health costs. Many states also provide a supplemental payment to certain SSI beneficiaries and 

some beneficiaries may also be eligible for food assistance in every state except California. In some 

states, an application for SSI also serves as an application for food assistance.

SSI includes a number of work incentives designed to help beneficiaries go to work by minimizing 

the risk of losing their SSI or Medicaid benefits. Under some of these incentives, SSA will exclude 

some income or resources when calculating the benefit amount (such as the earned income exclusion, 

the student earned income exclusion, impairment-related work expenses, and the Plan for Achieving 

Self Support). Other incentives provide continued Medicaid coverage even when the beneficiary is not 

receiving cash benefits (such as the Medicaid Buy-In and section 1619(b) of the Social Security Act).

National Disability Policy: A Progress Report 79
Social Security Disability Insurance (SSDI)

SSDI is funded by payroll tax contributions from workers and employers. In order to qualify for benefits, 

applicants must reach insured status for Social Security by working enough during the years before 

filing to have contributed a specific amount to the Social Security system through FICA taxes. The level 

of benefits is based on earnings prior to the onset of the disability; SSDI does not consider assets 

or other household income. SSDI benefits are subject to a five-month waiting period, which means 

that SSDI applicants must wait five months after the onset of their disability to receive cash benefits. 

Most SSDI beneficiaries are eligible for Medicare after a two-year waiting period. Like SSI, disability 

is defined as the inability to engage in “substantial gainful activity” because of “one or more severe 

physical or mental impairments that are expected to last at least a year or result in death.”

Ticket to Work and Work Incentives Improvement Act

The Ticket to Work and Work Incentives Improvement Act of 1999 (P.L. 106–170) was designed to 

expand options for employment preparation and placement services to people with disabilities so that 

these individuals can reduce their dependence on cash benefit programs. The Act was also designed 

to enable beneficiaries to maintain access to health care even if they no longer qualify for SSI or SSDI 

because their incomes exceed SGA. The ultimate goal of the program is to reduce, and whenever 

possible eliminate, beneficiaries’ dependence on Social Security cash benefit programs.

The TTW is an outcome-based employment program. Eligible SSI and SSDI beneficiaries with 

disabilities and those who are blind receive a “ticket” they may use to obtain vocational rehabilitation, 

employment, or other support services from an approved EN or state VR agency of their choice. 

The TTW program is voluntary for beneficiaries and ENs. Because the TTW program is an outcomebased system, Social Security provides payments to ENs only when the ticket holder attains certain 

“milestones” and “outcomes” in moving toward self-supporting employment.

In addition to creating the TTW program, the Ticket to Work Act expanded access to health care by 

encouraging states to allow people with disabilities to purchase Medicaid coverage that is necessary 

to enable such individuals to maintain employment and to give SSDI beneficiaries the option of 

maintaining Medicare coverage while working.

The Ticket to Work Act also expanded work incentives designed to reduce the risk that an individual 

will lose benefits when they attempt to work. In these situations, if the work is unsuccessful, they are 

left without employment or benefits. These work incentives include the option to request expedited 

reinstatement of benefits without filing a new application when an individual’s Social Security or SSI 

disability/blindness benefits have ended because of work activity. They also allow for the deferral of 

medical continuing disability review for an individual who is “using a ticket.”

In order to ensure that beneficiaries have accurate information about the impact of employment on 

their benefits, the Ticket to Work Act directed SSA to establish a community-based work incentives 

planning and assistance program called the Benefit Planning, Assistance, and Outreach (BPAO) 

program. The purpose of this program is to provide SSI and SSDI beneficiaries with information so they 

can make informed choices about employment. The BPAO program awards cooperative agreements 

80 National Council on Disability
(or grants or contracts) to community-based organizations to provide all beneficiaries with access to 

benefits planning and assistance services.

Work Incentives Planning and Assistance (WIPA)

The WIPA program grew out of the BPAO program, established through the Ticket to Work and Work 

Incentives Improvement Act of 1999 to provide funding to community-based organizations to educate 

SSDI and SSI beneficiaries about the benefits and work incentives available to them. SSA funds 

83 WIPA projects that provide information and benefits planning to enable beneficiaries with disabilities 

to make informed choices about work. The primary objective of the WIPA initiative is to assist SSA 

beneficiaries with transitioning from dependence on public benefits to paid employment and greater 

economic self-sufficiency.

WIPA projects hire and train Community Work Incentives Coordinators (CWICs) to provide in-depth 

counseling to SSI and SSDI beneficiaries about benefits and the effect of work on those benefits. All 

WIPA services are free. In addition, the CWICs conduct outreach efforts to SSI and SSDI beneficiaries 

(and their families) who are potentially eligible to participate in federal or state work incentives 

programs and work in cooperation with federal, state, and private agencies and nonprofit organizations 

that serve SSI and SSDI beneficiaries with disabilities.

Medicaid Buy-In

The Ticket to Work Act also created the Medicaid Buy-In program, which offers Medicaid coverage to 

people with disabilities whose income is higher than the allowable substantial gainful activity levels. 

The purpose of the Medicaid Buy-In program is to allow people with disabilities to purchase Medicaid 

coverage while still being able to work. The eligibility requirements and benefits for this optional 

Medicaid program vary across states. Most states review employment status, disability status, income, 

and resources to determine Medicaid Buy-In eligibility. Some states require people who are eligible for 

the Medicaid Buy-In to pay a monthly premium or other cost-sharing charges, which are typically set on 

a sliding fee scale based on income. Many buy-in programs charge a state-specific premium and have 

copayments that are higher than traditional Medicaid.

Achieving a Better Life Experience Act of 2013 (ABLE Act)

The ABLE Act, which was signed into law on December 19, 2014, is designed to improve the financial 

stability of persons with disabilities by authorizing tax-advantaged savings accounts, known as ABLE 

accounts, for youth and adults with disabilities. The law recognizes that many individuals and their 

families depend on a wide variety of means-tested public benefits for income, health care, and food 

and housing assistance. Eligibility for many of these benefits requires applicants to have few assets. 

Thus, to remain eligible for these programs, an individual must remain poor.

ABLE account funds and distributions for qualified disability-related expenses are not taken into 

consideration when determining eligibility for federally funded means-tested benefits, including SSI 

and Medicaid. According to language in the ABLE Act, an ABLE account will, with private savings, 

National Disability Policy: A Progress Report 81
“secure funding for disability-related expenses on behalf of designated beneficiaries with disabilities 

that will supplement, but not supplant, benefits provided through private insurance, Medicaid, SSI, the 

beneficiary’s employment, and other sources.”

These accounts are similar in construction to college savings accounts; both are included in Section 

529 of the IRS Code. Assets in ABLE accounts can be used to cover any “qualified disability expense” 

including housing, transportation, support services, and any other expense reasonably related to a 

disability.

Under the ABLE Act, eligibility is limited to individuals with significant disabilities for whom the 

onset of disability occurred before the age of 26. Individuals who meet age criteria and are already 

receiving benefits under SSI and/or SSDI are automatically eligible to establish an ABLE account. Those 

who do not receive SSI and/or SSDI but still meet the age of onset disability requirement may establish 

eligibility by obtaining a letter from a licensed physician certifying that they meet Social Security’s 

definition of disability and criteria regarding significant functional limitations.

ABLE accounts must be opened through individual state-sponsored ABLE account programs. In 

order for a state to sponsor an ABLE program, it must enact state-level enabling legislation. Most, 

but not all, state-sponsored ABLE programs are open to people living outside those states, as long 

as they are otherwise eligible for an ABLE account. As of May 2017, 22 states have established ABLE 

programs.

Any person may contribute to an ABLE account for an eligible beneficiary including family members, 

friends, or the person with a disability. An ABLE account may not receive annual contributions 

exceeding the annual gift-tax exemption ($14,000 in 2015). A state must also ensure that aggregate 

contributions to an ABLE account do not exceed the state-based limits for 529 accounts.

Patient Protection and Affordable Care Act (ACA)

The ACA, which was signed into law in 2010, requires hospitals and primary care physicians to shift 

their focus to better health outcomes and lower costs and enhance the distribution and accessibility 

of their professional practices. Among the provisions in ACA is the creation of essential health benefits 

required as part of private insurance coverage. ACA Sections 1302(b)(4)(B) and (C) define essential 

health benefits and indicate that providers shall “not make coverage decisions . . . or design benefits in 

ways that discriminate against matching dollars with no waiting list or caps. In National Federation of 

Independent Business (NFIB) v. Sebelius, the Supreme Court decided that states were not mandated 

to expand Medicaid coverage.

82 National Council on Disability
Appendix C: Select NCD Resources

2017

■ Mental Health on College Campuses: Investments, Accommodations Needed to Address Student 

Needs, 2017, https://ncd.gov/publications/2017/mental-health-college-campuses-investmentsaccommodations-needed-address-student

■ NCD Comments to Department of Education Regarding Mandatory Civil Rights Data Collection, 

2017, https://ncd.gov/publications/2017/ncd-comments-education-mandatory-civil-rights-datacollection

■ NCD Letter to CMS Administrator Verma Regarding Medicaid HCBS Settings Rule, 2017, https://

ncd.gov/publications/2017/ncd-letter-cms-hcbs-settings-rule

■ NCD Letter to CMS Administrator Verma Requesting Meeting Regarding Medicaid Policy, 2017, 

https://ncd.gov/publications/2017/letter-cms-requesting-meeting-on-medicaid

2016

■ NCD Letter to Treasury Regarding Tax Debt of Discharged Loans of Borrowers with Disabilities, 

2016, https://ncd.gov/publications/2016/ncd-letter-treasury-tax-debt

■ The Impact of the Affordable Care Act on People with Disabilities: A 2015 Status Report, 2016, 

https://ncd.gov/publications/2016/impact-affordable-care-act-people-disabilities-2015-status-report

2015

■ NCD Letter to Small Business Administration regarding Its 8a Program, 2015, https://ncd.gov/

publications/2015/ncd-letter-small-business-administration

■ Home and Community-Based Services: Creating Systems for Success at Home, at Work and in 

the Community, 2015, https://ncd.gov/publications/2015/02242015

■ Securing the Social Contract: Reforming Social Security Disability, 2015, http://www.ncd.gov/

publications/2015/01292015/

■ Breaking the School-to-Prison Pipeline for Students with Disabilities, 2015, https://ncd.gov/

publications/2015/06182015

■ Transportation Update: Where We’ve Gone and What We’ve Learned, 2015, http://www.ncd.gov/

publications/2015/05042015/

National Disability Policy: A Progress Report 83
2013 and Earlier

■ A Medicaid Block Grant Program: Implications for People with Disabilities, 2013, https://ncd.gov/

publications/2013/05222013

■ NCD Urges HUD to Issue Olmstead Guidance, 2013, http://www.ncd.gov/publications/2013/

05212013/

■ National Council on Disability Report on Subminimum Wage and Supported Employment, 2012, 

https://ncd.gov/publications/2012/August232012

■ The State of Housing in America in the 21st Century: A Disability Perspective, 2010, http://www.

ncd.gov/publications/2010/Jan192010

■ Topical Brief: Transitioning Youth, 2010, https://ncd.gov/publications/2010/03232010-1

■ Topical Brief: Workforce Investment Infrastructure, 2010, https://ncd.gov/publications/2010/

03232010-3

■ Topical Brief: One-Stop Career Centers, 2010, https://ncd.gov/publications/2010/03232010-5

■ Workforce Infrastructure in Support of People with Disabilities: Matching Human Resources to 

Service Needs, 2010, https://ncd.gov/publications/2010/Jan202010

■ Effective Emergency Management: Making Improvements for Communities and People with 

Disabilities, 2009, https://ncd.gov/publications/2009/Aug122009

■ People with Disabilities and Emergency Management, 2008, https://ncd.gov/publications/2008/

08082008

■ Issues in Creating Livable Communities for People with Disabilities: Proceedings of the Panel, 

2007, http://www.ncd.gov/publications/2007/Oct12007

■ Creating Livable Communities, 2006, http://www.ncd.gov/publications/2006/Oct312006

■ School Vouchers and Students with Disabilities, 2003, https://ncd.gov/publications/2003/

April152003

84 National Council on Disability
Appendix D: Institutions of Higher Education with 

Transition and Postsecondary Programs for Students 

with Intellectual Disabilities

This appendix includes a list of institutions of higher education that have TPSID.*

Albany Technical College

Appalachian State University

Bergen Community College

Borough of Manhattan Community College

California State University, Fresno

College of Staten Island

Colorado State University

Columbus State University

East Georgia State College

Florida International University

Florida State College at Jacksonville

Georgia State University

Georgia State University (consortium)

Highline College

Hostos Community College

Jacksonville State University

Kingsborough Community College

Lipscomb University

Marietta College

Mercyhurst University

Millersville University

Minot State University

Ohio State University

Ohio State University (consortium)

Penn State Harrisburg

Pennsylvania Inclusive Higher Education Consortium

Portland State University

Queens College

National Disability Policy: A Progress Report 85
Rhode Island College

Spokane Community College

Syracuse University

The College of New Jersey (partner site)

University of Alabama

University of Central Florida

University of Central Florida (consortium)

University of Cincinnati

University of Georgia

University of Hawaii

University of Kansas

University of Memphis

University of Missouri Kansas City

University of Rochester (consortium)

University of South Alabama

University of South Florida

University of Toledo

University of West Georgia

Utah State University

Vanderbilt University

*Source: More information about TPSID programs can be found at http://www.thinkcollege.net/. The list of 

Institutes was retrieved from http://www.thinkcollege.net/images/stories/Cohort_2_TPSID.pdf

86 National Council on Disability
Endnotes

1 Peiyun, She, and Gina A. Livermore. 2008. “Long-Term Poverty and Disability Among Working-Age Adults.” 

Journal of Disability Policy Studies 19(4): 244–256. http://journals.sagepub.com/doi/abs/10.1177/

1044207308314954

2 Brucker, Debra L., Andrew J. Houtenville, and Eric A. Lauer. 2016. “Using Sensory, Functional, and Activity 

Limitation Data to Estimate Employment Outcomes for Working-Age Persons with Disabilities in the United 

States.” Journal of Disability Policy Studies 27(3): 131–137.

3 Peiyun and Livermore, “Long-Term Poverty and Disability.”

4 Lustig, Daniel C., and David R. Strauser. 2007. “Causal Relationships Between Poverty and Disability.” 

Rehabilitation Counseling Bulletin 50(4): 194–202. http://journals.sagepub.com/doi/abs/10.1177/

00343552070500040101.

5 U.S. Senate Committee on Health, Education, Labor, & Pensions. 2014. Fulfilling the Promise: Overcoming 

Persistent Barriers to Economic Self-Sufficiency for People with Disabilities. Washington, DC: U.S. Senate 

HELP Committee. https://www.help.senate.gov/imo/media/doc/HELP%20Committee%20Disability%20

and%20Poverty%20Report.pdf.

6 Sanford, Christopher, et al. 2011. The Post-High School Outcomes of Young Adults with Disabilities up to 6 

Years after High School: Key Findings from the National Longitudinal Transition Study-2 (NTLS2) (NCSER 2011-

3004). Menlo Park, CA: SRI International.

7 Carnevale, Anthony P., and Richard A. Fry. 2000. Crossing the Great Divide: Can We Achieve Equity When 

Generation Y Goes to College? Princeton, NJ: Educational Testing Service.

8 Sanford et al., Post-High School Outcomes.

9 Ibid.

10 Yin, Michelle, and Dahlia Shaewitz. 2015. One Size Does Not Fit All: A New Look at the Labor Force 

Participation of People with Disabilities. Washington, DC: American Institutes for Research. http://www.air.org/

sites/default/files/downloads/report/Labor-Force-Participation-People-with-Disabilities-Yin-Sept-2015.pdf.

11 Houtenville, Andrew J., and Debra L. Brucker. 2014. “Participation in Safety-Net Programs and the Utilization 

of Employment Services Among Working-Age Persons with Disabilities.” Journal of Disability Policy Studies

25(2): 91–105.

12 Houtenville and Brucker, “Participation in Safety-Net Programs”; Goodman, Nanette, and Michael Morris. 

2015. Financing Transition Services When Everyone Is the “Payer of Last Resort.” Durham, NC: Employment 

Policy and Measurement Rehabilitation Research and Training Center.

13 U.S. Census Bureau. 2014. “Measuring America: How Census Measures Poverty.” https://www.census.gov/

library/visualizations/2014/demo/poverty_measure-how.html. (Accessed March 26, 2017.)

14 Office of the Assistant Secretary for Planning and Evaluation. 2016. “Computations for the 2016 Annual 

Update of the HHS Poverty Guidelines for the 48 Contiguous States and the District of Columbia.” https://

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15 Renwick, Trudi, and Liana Fox. 2016. “The Supplemental Poverty Measure: 2015.” In Current Population 

Reports, P60-258. Washington, DC: U.S. Census Bureau, U.S. Government Publishing Office. https://www.

census.gov/content/dam/Census/library/publications/2016/demo/p60-258.pdf.

16 Rivera Drew, Julia A. 2015. “Disability, Poverty, and Material Hardship since the Passage of the ADA.” 

Disability Studies Quarterly 35(3): 4947.

National Disability Policy: A Progress Report 87
17 Rivera Drew, “Disability, Poverty, and Material Hardship.”

18 National Collaborative on Workforce and Disability for Youth. 2009. “Graduation Requirements and Diploma 

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19 National Center for Education Statistics. 2013. “Indicator 13: Children and Youth with Disabilities,” in “Chapter 

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20 National Center for Education Statistics, U.S. Department of Education. 2016. “The Condition of Education 

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21 National Collaborative on Workforce and Disability for Youth, “Graduation Requirements”; National Center for 

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22 National Center on Educational Outcomes. 2017. “Graduation Requirements for Students with Disabilities: 

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23 DO-IT (Disabilities, Opportunities, Internetworking, and Technology). 2012. “Working Together: K–12 Teachers 

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atoms/files/Working-Together-K12-Teachers-Students-Disabilities.pdf.

24 Cameto, Renee, Phyllis Levine, and Mary Wagner. 2004. Transition Planning for Students with Disabilities: 

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SRI International.

25 Hoover, Ariel. 2016. “The Role of the Community in Transition to the Adult World for Students with 

Disabilities.” American Secondary Education 44(2): 21.

26 Snyder, Thomas D., Cristobal de Brey, and Sally A. Dillow. 2016. Digest of Education Statistics 2014 (NCES 

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27 Umbricht, Mark R. 2016. “Helping Low-Income and Middle-Income Students: Pell Grants and the Higher 

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28 Radwin, David, Jennifer Wine, Peter Siegel, Michael Bryan, and Tracy Hunt-White. 2013. 2011–12 National 

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29 Federal Student Aid. n.d. “A Federal Supplemental Educational Opportunity Grant (FSEOG) Is a Grant for 

Undergraduate Students with Exceptional Financial Need.” U.S. Department of Education. https://studentaid.

ed.gov/sa/types/grants-scholarships/fseog. (Accessed May 15, 2017.)

30 Association of University Centers on Disabilities. 2015. “Transition Programs for Students with Intellectual 

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aucd.org/docs/policy/appropriations/TPSID_FY15_Brief.pdf. (Accessed March 20, 2017.)

31 National Coordinating Center. n.d. “Think College.” Institute for Community Inclusion, University of 

Massachusetts Boston. http://www.thinkcollege.net/about-us/think-college-grant-projects/nationalcoordinating-center. (Accessed April 5, 2017.); Federal Student Aid. n.d. “Students with Intellectual Disabilities 

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88 National Council on Disability
32 Association of University Centers on Disabilities, “Transition Programs for Students.”

33 Yin and Shaewitz, One Size Does Not Fit All; Erickson et al., “Disability Statistics.”

34 Hiersteiner, Dorothy, et al. 2016. Working in the Community: The Status and Outcomes of People with 

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35 U.S. Census Bureau. 2016. “2015 American Community Survey (ACS) 1-Year Public Use Microdata Samples.” 

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36 Yin and Shaewitz, One Size Does Not Fit All.

37 U.S. Government Accountability Office (GAO). 2012. Employment for People with Disabilities: Little Is Known 

About the Effectiveness of Fragmented and Overlapping Programs. Washington, DC: U.S. Government 

Accountability Office. http://www.gao.gov/assets/600/592074.pdf.

38 Mils, Lisa, and Michael Morris. 2013. “Making Collaboration Real: Building a Progressive Vision for a Policy and 

Service Delivery Framework That Promotes the Effective Leveraging of Resources to Improve Employment 

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39 Lauer, Eric A., and Andrew J. Houtenville. 2017. Annual Disability Statistics Compendium: 2016. Durham, NH: 

University of New Hampshire, Institute on Disability.

40 U.S. Department of Education. 2017. Rehabilitation Services and Disability Research: Fiscal Year 2017 Budget 

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budget17/justifications/i-rehab.pdf

41 Dutta, Alo, et al. 2008. “Vocational Rehabilitation Services and Employment Outcomes for People with 

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42 U.S. Government Accountability Office. Vocational Rehabilitation: Earnings Increased for Many SSA 

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332). Washington, DC: U.S. Government Accountability Office.

43 National Center on Leadership for the Employment and Economic Advancement of People with Disabilities. 

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files/resource/downloadable_version/wioa-rehab-act-final-rule-aug.pdf.

44 Ipsen, Catherine, and Grant Swicegood. 2017. “Rural and Urban Vocational Rehabilitation Self-Employment 

Outcomes.” Journal of Vocational Rehabilitation 46(1): 97–105.

45 Minority Business Development Agency, U.S. Department of Commerce. n.d. “What Is the 8(a) Business 

Development Program?” https://www.mbda.gov/news/blog/2012/03/what-8a-business-developmentprogram?page=2. (Accessed June 7, 2017.)

46 Pumkam, Chaiporn, et al. 2013. “Health Care Expenditures Among Working-Age Adults with Physical 

Disabilities: Variations by Disability Spans.” Disability and Health Journal 6(4): 287–296; Burns, 

Marguerite, Nilay Shah, and Maureen Smith. 2010. “Why Some Disabled Adults in Medicaid Face 

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and Julia Foutz. 2017. “Medicaid Restructuring Under the American Health Care Act and Nonelderly 

Adults with Disabilities.” The Henry J. Kaiser Family Foundation. http://kff.org/medicaid/issue-brief/

medicaid-restructuring-under-the-american-health-care-act-and-nonelderly-adults-with-disabilities/.

47 Young, Katherine, et al. 2013. Medicaid’s Role for Dual Eligible Beneficiaries. Menlo Park, CA: The 

Henry J. Kaiser Family Foundation, The Kaiser Commission on Medicaid and the Uninsured. https://

kaiserfamilyfoundation.files.wordpress.com/2013/08/7846-04-medicaids-role-for-dual-eligible-beneficiaries.pdf.

48 Musumeci, MaryBeth, and Katherine Young. 2017. “State Variation in Medicaid Per Enrollee Spending 

for Seniors and People with Disabilities.” The Henry J. Kaiser Family Foundation. http://kff.org/medicaid/

issue-brief/state-variation-in-medicaid-per-enrollee-spending-for-seniors-and-people-with-disabilities/.

National Disability Policy: A Progress Report 89
49 U.S. Social Security Administration, “Federally Administered Payments,” SSI Annual Statistical Report (U.S. 

Social Security Administration, Office of Retirement and Disability Policy, 2015). https://www.ssa.gov/policy/

docs/statcomps/ssi_asr/2015/sect02.html.

50 Young, Medicaid’s Role for Dual Eligible Beneficiaries.

51 Levy, Alice R., Brian K. Bruen, and Leighton C. Ku. 2013. “The Potential Employment Impact of Health Reform 

on Working-Age Adults with Disabilities.” Journal of Disability Policy Studies 24(2): 102–112.

52 Sowers, Mary, Henry Claypool, and MaryBeth Musumeci. 2016. Streamlining Medicaid Home and 

Community-Based Services: Key Policy Questions. Menlo Park, CA: The Henry J. Kaiser Family Foundation. 

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53 Musumeci and Foutz, “Medicaid Restructuring.”

54 National Federation of Independent Business (NFIB) v. Sebelius, 132 S. Ct. 2566 (2012).

55 Hall, Jean P., et al. 2017. “Effect of Medicaid Expansion on Workforce Participation for People with Disabilities.” 

American Journal of Public Health 107(2): 262–264.

56 Sowers et al., Streamlining Medicaid.

57 Musumeci and Young, “State Variation in Medicaid.”

58 Congressional Budget Office. 2017. “Detail of Spending and Enrollment for Medicaid for CBO’s January 

2017 Baseline.” https://www.cbo.gov/sites/default/files/recurringdata/51301-2017-01-medicaid.pdf. (Accessed 

May 30, 2017.)

59 O’Malley Watts, Molly, Elizabeth Cornachione, and MaryBeth Musumeci. 2016. “Medicaid Financial Eligibility 

for Seniors and People with Disabilities in 2015.” The Kaiser Commission on Medicaid and the Uninsured. 

http://files.kff.org/attachment/report-medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-in-2015.

60 U.S. Social Security Administration, “Federally Administered Payments.”

61 Ibid.

62 Bailey, Michelle Stegman, and Jeffrey Hemmeter. 2015. “Characteristics of Noninstitutionalized DI and SSI 

Program Participants, 2013 Update.” In Research and Statistics Note No. 2015-02. Washington, DC: U.S. Social 

Security Administration, Office of Retirement and Disability Policy. https://www.ssa.gov/policy/docs/rsnotes/

rsn2015-02.html.

63 Bailey and Hemmeter, “Characteristics of Noninstitutionalized DI.”

64 U.S. Social Security Administration, “Federally Administered Payments.”

65 Bailey and Hemmeter, “Characteristics of Noninstitutionalized DI.”

66 Martin, Patricia P. 2016. “Why Researchers Now Rely on Surveys for Race Data on OASDI and SSI Programs: 

A Comparison of Four Major Surveys.” In Research and Statistics Note No. 2016-01. Washington, DC: U.S. 

Social Security Administration, Office of Retirement and Disability Policy. https://www.ssa.gov/policy/docs/

rsnotes/rsn2016-01.html.

67 Ryan, Paul, Speaker of the House of Representatives. 2016. A Better Way: Our Vision for a Confident America, 

video. https://abetterway.speaker.gov/. (Accessed April 5, 2017.)

68 Goodman, Nanette, Michael Morris, and Debra L. Brucker. 2013. Use of the Earned Income Tax Credit Among 

People with Disabilities. Durham, NH: University of New Hampshire, Institute on Disability. http://scholars.

unh.edu/cgi/viewcontent.cgi?article=1066&context=iod

69 Ibid.

70 Public and Affordable Housing Research Corporation. 2016. Housing Is a Foundation: 2016 PAHRS Report.

Cheshire, CT: HAI Group. https://www.novoco.com/sites/default/files/atoms/files/pahrc_2016_housing_

report_080216.pdf; National Low Income Housing Coalition. 2017. A Place to Call Home: The Case for 

Increased Federal Investments in Affordable Housing. Washington, DC: Campaign for Housing and 

Community Development Funding.

71 John D. and Catherine T. MacArthur Foundation. 2016. “How Housing Matters in Chicago Conference: 

White Paper.” https://www.macfound.org/media/files/How_Housing_Matters_in_Chicago_Conference_White_

Paper1.pdf.

90 National Council on Disability
72 Technical Assistance Collaborative. 2011. “Frank Melville Supportive Housing Investment Act of 2010: 

Reforms to HUD’s Section 811 Program Enacted.” https://www.ncsha.org/system/files/resources/TAC_

Summary_1.7.11.pdf

73 Schaak, Gina, and Lisa Sloane. 2016. “Section 811 Supportive Housing for Persons with Disabilities Program.” 

2015 Advocates’ Guide. Washington, DC: National Low Income Housing Coalition. http://nlihc.org/sites/default/

files/Sec4.10_Section-811_2015.pdf.

74 Center on Budget and Policy Priorities. 2016. Chart Book: Rental Assistance Reduces Hardship, Promotes 

Children’s Long-Term Success. Washington, DC: Center on Budget and Policy Priorities. http://www.cbpp.org/

sites/default/files/atoms/files/7-5-16hous-chartbook.pdf.

75 Center on Budget and Policy Priorities, Chart Book; John D. and Catherine T. MacArthur Foundation, “How 

Housing Matters in Chicago Conference: White Paper.”

76 National Council on Disability. 2010. “The State of Housing in America in the 21st Century: A Disability 

Perspective.” https://ncd.gov/publications/2010/Jan192010/. (Accessed August 30, 2017).

77 Blumenthal, Pamela, and John McGinty. 2015. Housing Policy Levers to Promote Economic 

Mobility. Washington, DC: The Urban Institute. http://www.urban.org/research/publication/

housing-policy-levers-promote-economic-mobility.

78 American Public Transportation Association Transit Board Members & Board Support Seminar. 2014. Enabling 

and Promoting the Use of Fixed-Route Transit by People with Disabilities. Cleveland, OH: APTA. http://www.

apta.com/resources/statistics/Documents/FactBook/2016-APTA-Fact-Book.pdf.

79 American Association of People with Disabilities. “Transportation Equity,” AAPD Transportation website. http://

www.aapd.com/our-focus/transportation/. (Accessed May 30, 2017.)

80 American Association of People with Disabilities, “Transportation Equity.”

81 Transportation Research Board. 2014. “Current Use of Fixed-Route Transit Services by People with 

Disabilities.” In TCRP Research Brief, TCRP Report 163: Strategy Guide to Enable and Promote the Use 

of Fixed-Route Transit by People with Disabilities. Washington, DC: Transportation Research Board. http://

onlinepubs.trb.org/onlinepubs/tcrp/tcrp_rpt_163IBCurrentUse.pdf. (Accessed July 14, 2017.)

82 U.S. Department of Transportation, Federal Transit Administration. 2015. FTA C 4710.1 Circular: Americans with 

Disabilities Act (ADA): Guidance. Washington, DC: Federal Transit Administration. https://www.transit.dot.gov/

sites/fta.dot.gov/files/docs/Final_FTA_ADA_Circular_C_4710.1.pdf.

83 American Association of People with Disabilities, “Transportation Equity.”

84 Taxis for All Campaign v. New York City Taxi and Limousine Commission, 1:11-cv-00237-GBD (S.D.N.Y. 2014).

85 49 U.S.C. 5307.

86 49 U.S.C. 5311.

87 49 U.S.C. 5310.

88 National Center for Education Statistics, Condition of Education 2016.

89 National Collaborative on Workforce and Disability for Youth, Graduation Requirements.

90 Morgan, Paul L., et al. 2012. “Are Minority Children Disproportionately Represented in Early Intervention 

and Early Childhood Special Education?” Educational Researcher 41(9): 339–351; U.S. Department 

of Education. 2016. Racial and Ethnic Disparities in Special Education: A Multi-Year Disproportionality 

Analysis by State, Analysis Category, and Race/Ethnicity. Washington, DC: Office of Special Education 

and Rehabilitative Services, U.S. Department of Education. https://www2.ed.gov/programs/

osepidea/618-data/LEA-racial-ethnic-disparities-tables/disproportionality-analysis-by-state-analysiscategory.pdf.

91 Baker, Jane, and Deana M. Hollaway. 2009. “A Comprehensive Approach to Disruptive Behaviors in the 

Classroom and Home.” International Journal on School Disaffection 6(2): 37–40.

92 Skinner, Deborah, and Thomas S. Weisner. 2007. “Sociocultural Studies of Families of Children with Intellectual 

Disabilities.” Mental Retardation and Developmental Disabilities Research Reviews 13(4): 302–312.

93 National Council on Disability. 2015. Breaking the School-to-Prison Pipeline for Students with Disabilities.

Washington, DC: NCD. https://www.ncd.gov/publications/2015/06182015.

National Disability Policy: A Progress Report 91
94 National Collaborative on Workforce and Disability for Youth, Graduation Requirements.

95 Thurlow, Martha, Rachel Quenemoen, and Sheryl Lazarus. 2011. “Meeting the Needs of Special Education 

Students: Recommendations for the Race-to-the-Top Consortia and States.” Minneapolis, MN: University of 

Minnesota, National Center on Educational Outcomes Institute on Community Integration. https://ici.umn.

edu/index.php?products/view/385.

96 Ibid.

97 U.S. Census Bureau, 2015 American Community Survey.

98 Ibid.

99 Federal Student Aid, “Federal Supplemental Educational Opportunity Grant.”

100 National Council on Disability. 2015. “Briefing Paper: Reauthorization of the Higher Education Act 

(HEA): The Implications for Increasing the Employment of People with Disabilities.” https://ncd.gov/

publications/2015/05192015. (Accessed August 30, 2017.)

101 National Council on Disability. 2015. Briefing Paper: Reauthorization of the Higher Education Act (HEA): The 

Implications for Increasing the Employment of People with Disabilities. Washington, DC: NCD. http://www.

ncd.gov/publications/2015/05192015.

102 U.S. Department of Education, Federal Student Aid. 2014. Annual Report FY 2014. Washington, DC: U.S. 

Department of Education. https://studentaid.ed.gov/sa/sites/default/files/FY2014_FSA_Annual_Report_508.pdf.

103 Student Debt Crisis. n.d. “Department of Ed Forgives Debt For Americans with Disabilities.” http://

studentdebtcrisis.org/dept-of-ed-disability-forgiveness/. (Accessed May 15, 2017.)

104 Church, Thomas E. 2009. “Returning Veterans on Campus with War Related Injuries and the Long Road Back 

Home.” Journal of Postsecondary Education and Disability 22(1): 41–52; Rudd, David M., Jeffrey Goulding, 

and Craig J. Bryan. 2011. “Student Veterans: A National Survey Exploring Psychological Symptoms and 

Suicide Risk.” Professional Psychology: Research and Practice 42(5): 354–560. https://msrc.fsu.edu/system/

files/Rudd%20et%20al%202011%20Student%20veterans%20A%20national%20survey%20exploring%20

psychological%20symptoms%20and%20suicide%20risk_0.pdf.

105 Thomas E. Church, “Returning Veterans on Campus.”

106 Yin and Shaewitz, One Size Does Not Fit All.

107 Wittenburg, David, and Pamela Loprest. 2003–2007. Ability or Inability to Work: Challenges in Moving Towards 

a More Work-Focused Disability Definition for Social Security Administration (SSA) Disability Programs.

Briefing Paper for the Ticket to Work & Work Incentives Advisory Panel. Washington, DC: The Urban Institute. 

https://www.researchgate.net/publication/267198732_Ability_or_Inability_to_Work_Challenges_in_Moving_

Towards_a_More_Work-Focused_Disability_Definition_for_Social_Security_Administration_SSA_Disability_

Programs.

108 U.S. Social Security Administration, Office of Retirement and Disability Policy. 2015. “SSI Annual Statistical 

Report, 2015.” https://www.ssa.gov/policy/docs/statcomps/ssi_asr/2015/sect07.html.

109 Technical Assistance Collaborative. n.d. “Current Priorities” http://www.tacinc.org/policy-leadership/currentpriorities. (Accessed May 30, 2017.)

110 U.S. Census Bureau. 2016. “New Census Data Show Differences Between Urban and Rural Populations.” 

https://www.census.gov/newsroom/press-releases/2016/cb16-210.html.

111 National Council on Disability. 2015. “Transportation Update: Where We’ve Gone and What We’ve Learned.” 

Washington, DC: NCD. https://ncd.gov/rawmedia_repository/862358ac_bfec_4afc_8cac_9a02122e231d.pdf;

Association of Programs for Rural Independent Living. 2010. “Transportation Act Reauthorization Position 

Statement: Rural Transportation for People with Disabilities.” Little Rock, AR: Association of Programs for 

Rural Independent Living. https://www.april-rural.org/images/stories/200911/april_transportation_position_

statementjanuary_2010.pdf. (Accessed July 14, 2017.)

112 Ju, Song, Eric Roberts, and Dalun Zhang. 2013. “Employer Attitudes Toward Workers with Disabilities: 

A Review of Research in the Past Decade.” Journal of Vocational Rehabilitation 38(2): 113–123. http://content.

iospress.com/articles/journal-of-vocational-rehabilitation/jvr625.

92 National Council on Disability
113 Newman, Lynn. 2005. Family Involvement in the Educational Development of Youth with Disabilities: A Special 

Topic Report of Findings from the National Longitudinal Transition Study-2 (NLTS2). Menlo Park, CA: SRI 

International.

114 National Collaborative on Workforce and Disability for Youth, Graduation Requirements.

115 Rix, Jonathan, et al. 2006. A Systematic Review of Interactions in Pedagogical Approaches with Reported 

Outcomes for the Academic and Social Inclusion of Pupils with Special Educational Needs. London: EPPICentre, Social Science Research Unit, University of London. http://eprints.soton.ac.uk/55260/.

116 Newman, Family Involvement in Educational Development.

117 L. Johnson, AdriAnne. 2006. “Students with Disabilities in Postsecondary Education: Barriers to Success and 

Implications for Professionals.” VISTAS Online (American Counseling Association. https://www.counseling.org/

Resources/Library/VISTAS/vistas06_online-only/Johnson.pdf.

118 Singh, Delar K. 2003. “Students with Disabilities and Higher Education.” College Student Journal 37(3): 

367–379.

119 Ju, Song, Eric Roberts, and Dalun Zhang. 2013. “Employer Attitudes Toward Workers with Disabilities: 

A Review of Research in the Past Decade.” Journal of Vocational Rehabilitation 38(2): 113–123. http://content.

iospress.com/articles/journal-of-vocational-rehabilitation/jvr625; Houtenville, Andrew, and Valentini Kalargyrou. 

2012. “People with Disabilities: Employers’ Perspectives on Recruitment Practices, Strategies, and Challenges 

in Leisure and Hospitality.” Cornell Hospital Quarterly 53(1): 40–52. http://journals.sagepub.com/doi/

abs/10.1177/1938965511424151.

120 Advisory Committee on Increasing Competitive Integrated Employment for Individuals with Disabilities. 

2016. “Final Report to: The Honorable Thomas E. Perez, United States Secretary of Labor, the United States 

Senate Committee on Health, Education, Labor and Pensions, The United States House of Representatives 

Committee on Education and the Workforce.” https://www.dol.gov/odep/topics/pdf/ACICIEID_Final_

Report_9-8-16.pdf.

121 National Council on Disability. 2012. “National Council on Disability Report on Subminimum Wage and 

Supported Employment.” Washington, DC: NCD.

122 ACICIEID, “Final Report.”

123 National Council on Disability, “Report on Subminimum Wage.”

124 Cimera, Robert Evert. 2011. “Does Being in Sheltered Workshops Improve the Employment Outcomes of 

Supported Employees with Intellectual Disabilities?” Journal of Vocational Rehabilitation 35(1): 21–27.

125 National Council on Disability. 2012. “Report on Subminimum Wage and Supported Employment.” https://ncd.

gov/publications/2012/August232012. (Accessed August 30, 2017).

126 National Council on Disability, “Report on Subminimum Wage.”

127 U.S. Department of Justice, Office of Public Affairs. 2014. “Department of Justice Reaches Landmark 

Americans with Disabilities Act Settlement Agreement with Rhode Island.” https://www.justice.gov/opa/

pr/department-justice-reaches-landmark-americans-disabilities-act-settlement-agreement-rhode; U.S. 

Department of Justice, Office of Public Affairs. 2015. “Justice Department Reaches Landmark Settlement 

Agreement with State of Oregon Regarding Americans with Disabilities Act.” https://www.justice.gov/opa/pr/

justice-department-reaches-landmark-settlement-agreement-state-oregon-regarding-americans.

128 National Council on Disability, “Transportation Update.”

129 Equal Rights Center v. Uber Technologies, Inc., 1:17-cv-01272 (U.S. Dist. Ct. District of Columbia June 28, 

2017), https://equalrightscenter.org/wp-content/uploads/equal-rights-center-v.-uber-technologies-inc.-complaint.

pdf; Access Living of Metropolitan Chicago v. Uber Technologies, Inc., 1:16-cv-09690; Ill. Northern Dist. Ct. 

Oct. 13, 2016), https://www.law360.com/cases/57ff9a753b739629f7000002.

130 Squire, Alexis L., and Gregg A. Kelley. 2017. “Equal Rights Center Files Lawsuit Against Uber for Providing 

Services That Are Inaccessible to Wheelchair Riders.” https://equalrightscenter.org/press-releases/

equal-rights-center-files-lawsuit-uber-providing-services-inaccessible-wheelchair-riders/.

131 Blumenthal and McGinty, Housing Policy Levers.

National Disability Policy: A Progress Report 93
132 Initiative for Empowerment and Economic Independence (IEEI). 2017. “Case Statement”; Initiative for 

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National Disability Policy: A Progress Report 95
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