Creating 

 Livable 

 Communities 

 National Council on Disability 

 October 31, 2006 

National Council on Disability

1331 F Street, NW, Suite 850 

Washington, DC 20004 

Creating Livable Communities 

This report is also available in alternative formats and on the award-winning National Council on 

Disability (NCD) Web site (www.ncd.gov). 

Publication date: October 31, 2006 

202-272-2004 Voice 

202-272-2074 TTY 

202-272-2022 Fax 

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

this and all NCD documents are not subject to the A-19 executive branch review process. 

NATIONAL COUNCIL ON DISABILITY 

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

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

1331 F Street, NW  Suite 850  Washington, DC 20004 

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

1 

Letter of Transmittal 

October 31, 2006 

The President 

The White House 

Washington, D.C. 20500 

Dear Mr. President: 

On behalf of the National Council on Disability (NCD), I am very pleased to submit a report entitled, 

Creating Livable Communities. 

This report is the sequel to an earlier report entitled, Livable Communities for Adults with Disabilities, 

which NCD submitted to you in December 2004. 

Communities in the United States are faced with increasingly difficult choices and decisions about how to 

grow, plan for change, and improve the quality of life for all citizens including children, youth, and adults 

with disabilities. As we mentioned in our previous report, we believe that for the promise of full 

integration into the community to become a reality, people with disabilities need: safe and affordable 

housing, access to transportation, access to the political process, and the right to enjoy whatever services, 

programs, and activities are offered to all members of the community by both public and private entities. 

Nearly every initiative included in the report has depended, to one degree or another, on strategic 

partnerships that have worked together to achieve the following goals: (1) leverage resources, (2) reduce 

fragmentation in the service delivery system, (3) address consumers’ needs in a coordinated and 

comprehensive manner, (4) provide choice, and (5) implement policies and programs that help people 

remain independent and involved in community life. To maximize the potential for success, communities 

should use one or more of the following strategies and policy levers as well as develop all-important 

partnerships. These strategies and policy levers can and should be used at every level of government 

including federal, state, county, and local to affect change. 

Our recommendations are in line with the focus of your New Freedom Initiative’s emphasis on 

community integration, participation, and enhancement of the independence of people with disabilities at 

home, at work, and throughout the course of their daily lives. NCD stands ready to work with you and 

stakeholders inside and outside the government to see that the agenda set out in the attached report is 

implemented. 

Sincerely, 

John R. Vaughn 

Chairperson 
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National Council on Disability Members and Staff 

Members 

John R. Vaughn, Chairperson 

Patricia Pound, First Vice Chairperson 

Glenn Anderson, Ph.D., Second Vice Chairperson 

Milton Aponte, J.D. 

Victoria Ray Carlson 

Chad Colley 

Robert R. Davila, Ph.D. 

Barbara Gillcrist 

Graham Hill 

Young Woo Kang, Ph.D. 

Kathleen Martinez 

Lisa Mattheiss 

Anne M. Rader 

Marco Rodriguez 

Linda Wetters 

Staff

Jeffrey T. Rosen, General Counsel and Director of Policy 

Julie Carroll, Senior Attorney Advisor 

Joan M. Durocher, Senior Attorney Advisor 

Martin Gould, Ed.D., Director of Research and Technology 

Geraldine Drake Hawkins, Ph.D., Senior Program Analyst 

Allan W. Holland, Chief Financial Officer 

Pamela O’Leary, Sign Language Interpreter 

Mark S. Quigley, Director of Communications 

Mark E. Seifarth, Congressional Liaison 

Brenda Bratton, Executive Assistant 

Stacey S. Brown, Staff Assistant 

Carla Nelson, Secretary 
4

Acknowledgments 

The National Council on Disability deeply appreciates the incisive policy research undertaken 

by Mia R. Oberlink of the Center for Home Care Policy and Research in the writing of this 

report. 
5

Table of Contents 

Page 

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

Definition of a Livable Community...................................................................................10 

Six Strategies to Improve Community Livability..............................................................11 

Recommendations for Action ............................................................................................16 

Chapter I Introduction................................................................................................................19

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

Strategies to Promote Cooperation and Collaboration and Recommendations for 

Action.................................................................................................................................24 

Chapter II Strategy One: Agreement on Changes in the Collection and Management of, 

and Access to, Multiple Agency Information about Programs and Benefits in Order to 

be Consumer Responsive.............................................................................................................27

Aging and Disability Resource Centers...................................................................................29 

Background........................................................................................................................30 

Examples of ADRCs in Action..........................................................................................34 

Looking Forward ...............................................................................................................36 

Additional Resources for More Information......................................................................36 

Consolidating Access to Information and Services: Learning from the States ......................37 

Background: The 2-1-1 Information and Referral System ................................................37 

2-1-1 in the States..............................................................................................................39 

Funding and Cost-Savings.................................................................................................40 

Resources...........................................................................................................................41 

Chapter III Strategy Two: Utilization of Favorable Tax Treatment (e.g. tax credits) to 

Stimulate Change in Individual and Corporate Behavior that Encourages Investment in 

Livable Community Objectives ..................................................................................................43

Low Income Housing Tax Credits...........................................................................................45 

Program Background .........................................................................................................46 

Program Description ..........................................................................................................47 

Resources Used..................................................................................................................51 

State Examples...................................................................................................................52 

Additional Opportunities: The Homeownership Tax Credit .............................................54 

Resources...........................................................................................................................55 

Other Resources.................................................................................................................58 
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Expanding the Supply of Affordable, Accessible Housing: Learning from Kentucky ..........59 

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

Developing Universal Design Principles...........................................................................62 

Tying Universal Design Policy to Funding Resources......................................................63 

Success Stories...................................................................................................................64 

Chapter IV Strategy Three: Agreement on Common Performance Measures Across 

Multiple Federally Funded Programs........................................................................................67

The Program Assessment Rating Tool (PART).......................................................................69 

Program Background .........................................................................................................70 

Program Description ..........................................................................................................70 

Lessons Learned.................................................................................................................74 

Example .............................................................................................................................74

PART and People with Disabilities...................................................................................76 

Conclusion .........................................................................................................................76 

Resources...........................................................................................................................77 

Measuring Results: Learning from the Administration on Aging—State Collaboration 

to Develop Model Performance Outcome Measurement Systems....................................77 

Background: The AoA Performance Outcomes Measure Project (POMP).......................78 

Key Features of the Project................................................................................................79 

The National POMP...........................................................................................................80 

Chapter V Strategy Four: Utilization of Private Sector Match to Competitively Secure 

Public Funding and Stimulate Public-Private Sector Partnerships........................................85

Individual Development Accounts ..........................................................................................87 

Background........................................................................................................................88 

Historical Progression of IDAs, Barriers, and Solutions...................................................88 

How IDAs Work................................................................................................................91 

Lessons Learned.................................................................................................................92 

Resources Used to Fund IDAs...........................................................................................95 

Implementing IDAs in the States: Learning From Iowa..........................................................95 

Iowa....................................................................................................................................96 

The Future of IDAs..........................................................................................................100 

Additional Resources for More Information....................................................................100 

Chapter VI Strategy Five: Agreement on Changes in Infrastructure to Consolidate 

Administration of Multiple Programs and Improve Ease of Access.....................................103

Workforce Investment Act (WIA).........................................................................................105 

Program Background .......................................................................................................107 

Program Description ........................................................................................................108 

Lessons Learned...............................................................................................................110 
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Conclusion .......................................................................................................................111 

Resources.........................................................................................................................112 

United We Ride: Learning From and Helping the States to Create Coordinated 

Transportation Systems..........................................................................................................113 

Program Description ........................................................................................................113 

Arizona Rides...................................................................................................................115 

Other State Transportation Coordination Efforts.............................................................116 

North Carolina .................................................................................................................116 

Maryland..........................................................................................................................117 

Central New York, NY ....................................................................................................118 

Chapter VII Strategy Six: Utilization of Waiver Authority to Promote State Options to 

Advance Consumer Choice and Community Participation...................................................121

Medicaid and Social Security Waiver Authority...................................................................123 

Medicaid Program Background .......................................................................................123 

Program Description ........................................................................................................125 

Independence Plus Waivers.............................................................................................127 

Conclusion .......................................................................................................................128 

Resources.........................................................................................................................129 

Learning from the States........................................................................................................130 

Implementing the 1915(c) Waiver Through Maryland’s New Directions Program........130 

The Florida Freedom Initiative: Self-Directed Services with a Work Incentive Plan.....133 

California’s Independence Plus Section 1115 Demonstration.........................................135 

Conclusion .......................................................................................................................138 

Additional Resources.......................................................................................................139 

Chapter VIII Recommendations for Action............................................................................141

Recommendations............................................................................................................144 

References...................................................................................................................................151

Appendix A.................................................................................................................................159 
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Executive Summary 

Creating Livable Communities is an outgrowth of the National Council on Disability’s (NCD) 

interest and recent work in the topic of livable communities for people with disabilities. The 

main impetus for this interest is threefold: 1) the prospect of a growing population of people with 

disabilities as the baby boom generation ages, 2) the desire that people with disabilities—indeed,

all people—have to live in their own homes and communities and maintain their selfdetermination, dignity, and independence for as long as possible, and 3) the pressures that these 

factors will exert on local communities that strive to become livable for people of all ages and 

abilities. Two research reports recently published by NCD thoroughly examine these challenges, 

as well as promising practices in addressing them: Livable Communities for Adults with 

Disabilities (2004) and The State of 21st Century Long-Term Services and Supports: Financing 

and Systems Reform for Americans with Disabilities (2005). The findings in these reports 

motivated NCD to delve deeper into the topic of livable communities, identify barriers to 

developing them, and shed light on potential methods for overcoming these barriers. 

Disability prevalence is rising in the under-age-65 population and, although it has decreased 

slightly for people aged 65 and older, it will begin to rise sharply as the current senior population 

of 34 million doubles over the next 20 years.1 In light of these demographic developments, 

communities will face significant challenges as they strive to address consumers’ needs in a 

coordinated and comprehensive manner, reduce fragmentation in the service delivery system, 

provide consumer choice, and implement policies and programs that help adults with disabilities 

remain independent and involved in community life. 

As the findings from the two reports mentioned above suggest, collaboration and coordination 

among federal agencies, as well as between these agencies and the states, can support 

communities as they build and sustain key elements of livability. 

Creating Livable Communities presents six strategies or policy levers, gleaned from the two 

previous research reports, that can be implemented on the federal and local levels to promote 

collaboration and coordination and support livable community objectives. Each of these 

strategies is illustrated by actual promising practices at both the federal and state levels that can 
10

be adapted and replicated elsewhere. It should be noted that these general policy levers and 

specific illustrative examples were selected from a vast array of actions that can be taken to 

address the various elements of community livability. 

Definition of a Livable Community 

The definition of “livable community” used here is derived from the National Council on 

Disability’s earlier report entitled Livable Communities for Adults with Disabilities: 

A livable community: 

• Provides affordable, appropriate, accessible housing 

• Ensures accessible, affordable, reliable, safe transportation 

• Adjusts the physical environment for inclusiveness and accessibility 

• Provides work, volunteer, and education opportunities 

• Ensures access to key health and support services 

• Encourages participation in civic, cultural, social, and recreational activities 

Within each of these six areas, a livable community strives to maximize people’s independence, 

assure safety and security, promote inclusiveness, and provide choice. 

While no one community in the United States has addressed all six of these livability goals to 

equal degrees, many states, counties, and local communities have made extraordinary 

improvements in their livability for people with disabilities in one or even several of these areas. 

Their experiences and achievements can serve as inspiration and provide replicable “best 

practices,” which other communities can emulate as they strive to become more livable.2
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Six Strategies to Improve Community Livability 

Strategy One: Agreement on changes in the collection and management of, 

and access to, multiple agency information about programs and benefits in 

order to be consumer responsive 

As the examples in this section illustrate, this strategy can help ensure that older people and 

people with disabilities have access to key health and supportive services that enable them to 

continue living in the community as independently as possible. 

Examples 

• Aging and Disability Resource Centers (ADRC) are community-based centers that 

centralize information about long-term support options in the community. ADRC 

programs provide information and assistance to both public and private pay individuals 

and serve as the entry point to publicly administered long-term supports, including those 

funded under Medicaid, the Older Americans Act, and state programs. 

• 2-1-1 is a phone number designated by the Federal Communications Commission to be 

used exclusively for community information and referral purposes. There are 157 active 

2-1-1 systems in 32 states that provide consumers with centralized information and 

referral to basic human needs resources; physical and mental health resources; 

employment support; support for older people and people with disabilities; as well as 

support for children, among other services. 

Strategy Two: Utilization of favorable tax treatment (e.g. tax credits) to 

stimulate change in individual and corporate behavior that encourages 

investment in livable community objectives 

The availability of appropriate and affordable housing choices is one of the most important 

measures of community livability. As the examples below illustrate, Strategy Two can be used to 

expand such housing opportunities for people with low incomes and/or people with disabilities 

and ensure that the housing is affordable and accessible.
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Examples 

• The Low Income Housing Tax Credit provides states with a financial “carrot” to 

encourage development of housing without having to allocate direct federal expenditures. 

It is a significant source of financing for developers seeking to construct and rehabilitate 

housing for people with disabilities. 

• The Kentucky Housing Corporation (KHC) is Kentucky’s state housing finance agency 

that administers and monitors a number of federal and state affordable housing programs 

and sets state policy on housing. One of its objectives is to build partnerships with state 

and local housing agencies to ensure that new housing is fully accessible and incorporates 

universal design principles. The KHC has developed universal design requirements that 

are mandatory for any projects that receive a certain amount of debt or subsidy financing 

from the Corporation. It also provides technical assistance to developers to ensure they 

are meeting all building requirements, including the universal design guidelines, and 

inspects and certifies buildings once they are built. 

Strategy Three: Agreement on common performance measures across 

multiple federally funded programs 

There is an enormous variety of programs that are designed to help older people and people with 

disabilities live independently in the community. But how effective are these programs? Do they 

respond to people’s actual needs and support their aspirations? Strategy Three is one way to 

begin addressing these questions. The initiatives illustrating this approach include developed 

tools that facilitate measurement of performance and outcomes. These tools can be applied to a 

variety of programs that serve people with disabilities and older people. 

Examples 

• The Program Assessment Rating Tool (PART) was developed by the Office of 

Management and Budget to assess and improve program performance so that Federal 

Government programs can achieve better results. PART reviews help identify the various 

strengths and weaknesses of federal programs to inform funding and management 

decisions aimed at making the programs more effective. 
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• The Administration on Aging (AoA), an agency within the U.S. Department of Health 

and Human Services, is collaborating with more than 20 states to develop standardized 

performance outcome measures and data collection instruments to evaluate programs 

funded by the AoA, such as congregate nutrition programs, information and assistance, 

and transportation services. In addition, the Federal Interagency Forum on Aging Related 

Statistics is a group of 11 collaborating agencies that has established a set of key 

indicators that describe the status of the U.S. population aged 65 and older. 

Strategy Four: Utilization of private sector match to competitively secure 

public funding and stimulate public-private sector partnerships 

Livable communities ensure that all residents, regardless of ability, are able to participate in the 

community’s economic, civic, and social life. The examples included under Strategy Four 

illustrate how public-private sector partnerships can promote asset development and financial 

independence among people with low incomes and people with disabilities. When people with 

low incomes and people with disabilities are able to accumulate income to continue their 

education, buy homes, and/or start businesses, they not only enrich their own lives, they help 

support the economy of the communities in which they live. 

Examples 

• Individual Development Accounts (IDAs) are “asset development tools,” one of many 

economic development programs created by Congress to provide savings incentives 

among selected populations. It is a successful policy mechanism that has helped 

thousands of people who are low-income wage earners build their personal assets, live 

independently, and contribute to their communities’ economy in the same ways that 

millions of other citizens do. 

• Iowa is one of the many states that has passed IDA legislation in ways that minimize 

restrictions and facilitate program delivery. Iowa was one of the first states to pass IDA 

policy as part of its sweeping welfare reform bill. The five-year program, called Iowans 

Save!, has created thousands of IDAs for individuals with low incomes, including people 

with disabilities. 
14

Strategy Five: Agreement on changes in infrastructure to consolidate 

administration of multiple programs and improve ease of access 

Livable communities provide residents with access to employment opportunities and 

transportation options. But access to employment and transportation—which are inextricably 

linked—is among the most vexing barriers that people with disabilities face, partly because of 

lack of coordination among the various agencies and programs involved. The examples in 

Strategy Five illustrate how consolidation and coordination can improve access to these key 

livable community objectives. 

Examples 

• The Workforce Investment Act (WIA) was passed by Congress in 1998 to better serve 

job seekers with and without disabilities as well as employers through a new framework 

that brings together multiple federal employment and training programs into a unified 

system of support. The single system is anchored by comprehensive One-Stop centers in 

each workforce investment area in all fifty states. While WIA allows states and local 

governments the authority to design how best to implement the One-Stop system, the 

guiding principles of the Act require a focus on streamlined and integrated service with 

an emphasis on improved coordination and collaboration across agency lines. 

• United We Ride (UWR) is a relatively new program that provides information, technical 

assistance, and grants to states to develop and implement comprehensive action plans for 

coordinating human service transportation to make it more cost-effective, accountable, 

and responsive to consumers who are “transportation disadvantaged.” UWR promotes 

education and outreach to transportation providers and consumers; consolidation of 

programs; reduction of restrictive and duplicative laws, regulations, and programs; and 

coordinated planning. 
15

Strategy Six: Utilization of waiver authority to promote state options to 

advance consumer choice and community participation 

The primary objective of the livable community concept is to provide people with disabilities 

choice and support to live independently in the community. The examples in Strategy Six 

illustrate long-term services and supports policies that support this objective. Many people 

believe that long-term services and supports alternatives like state Medicaid waiver programs 

should be the rule rather than the exception.

Examples 

• Medicaid and Social Security offer two important sources of funding for support of 

individuals with disabilities. Over the past 25 years, significant expansion of Medicaid 

has occurred through the creation of waiver authority, which allows states to apply to the 

Centers for Medicare and Medicaid Services for approval of different amendments to 

their state plans that may impact who is eligible for services, what services may be 

covered, and the limits of coverage. Similarly, the Social Security Administration (SSA) 

has waiver authority it can grant to states on a case-by-case basis to modify existing 

policies and procedures and encourage testing alternative policies and procedures that 

promote independence and self-sufficiency for individuals with disabilities and their 

families. These current waiver programs constitute the principal way that states can offer 

services and supports that are consumer-centered and promote independence and 

community participation among people with disabilities. 

• Maryland’s New Directions Program, the Florida Freedom Initiative, and California 

Independence Plus are examples of state waiver programs that are rebalancing 

Medicaid’s original institutional bias and, instead, are providing self-directed home and 

community based services with expanded control by and flexibility for people with 

disabilities and low-income older people, enabling them to remain in their own homes 

and communities for as long as possible. The Florida Freedom Initiative also includes an 

SSA waiver to increase asset limits. The results are producing enhanced consumer 

choices and satisfaction. 
16

Recommendations for Action 

The selected strategies and examples in this report offer possibilities to change the way 

government organizes and manages resources, interacts with the business community and 

community developers, and responds to the expectations of evolving consumer interests, needs, 

and preferences for more choice and control in the delivery of support services. The 

recommendations for action included in the report offer multiple, complementary options for the 

legislative and executive branches of the Federal Government as well as states to proactively 

adopt strategies and policy levers that invest in livable community outcomes. With the aging of 

America and the challenges of disability in over 20 percent of families nationwide today, and 

possibly a greater percentage tomorrow, it is vital to focus on knowledge utilization and transfer 

from best practice examples. 

Recommendation 1: Issue a new Executive Order to charge the Office on Disability of the 

Department of Health and Human Services to chair a time-limited workgroup (six months, for 

example) on livable communities that would adopt and promote the strategies in this report. The 

workgroup would include representatives of the Departments of Housing and Urban 

Development (HUD), Transportation, Education, Labor, and Treasury, the Social Security 

Administration, the Centers for Medicare and Medicaid Services, the Administration on Aging, 

the Administration on Developmental Disabilities, and the Office of Community Services within 

the Department of Health and Human Services. 

Recommendation 2: Modify federal requirements for allocation of low-income housing tax 

credits so that, in making awards to developers, all states require a) the adoption of universal 

design standards, and b) documentation of approaches to allow a minimum of ten percent of 

units in multifamily affordable housing developments to be affordable to individuals with 

disabilities on fixed incomes (i.e. SSI/SSDI recipients). 

Recommendation 3: Modify current performance measures being used to assess individual 

program strengths and weaknesses to focus on cross department and agency collaboration to 

enhance livable community outcomes. 
17

Recommendation 4: Utilize grant funds from the Centers for Medicare and Medicaid Services, 

Social Security Administration, and Departments of Labor, Commerce, Health and Human 

Services, Transportation, and Housing to offer a consolidated Livable Communities Program 

Initiative that streamlines 1) a single application for funds, 2) utilization of waiver authority, 3) 

consolidation of program management and service delivery, and 4) use of tax credits to 

reengineer the delivery of long-term supports, transportation, housing, employment, education, 

and cultural, social, and recreational opportunities at a community level. 

Recommendation 5: Expand tax incentives to promote matched savings plans for low-income 

wage earners across the life span. 

Recommendation 6: Utilize and leverage community service opportunities and volunteers to 

support livable community objectives. 

Recommendation 7: Focus on the Gulf Coast recovery and rebuilding to promote livable 

community outcomes. 

Recommendation 8: Establish a National Resource Center on Livable Communities to educate 

policymakers, government administrators, community developers, people with disabilities, and 

the public about best practices in policy development and program implementation. 

The recent Hurricane Katrina and Rita disasters demonstrated that lack of cooperation and 

coordination at all levels of government can have disastrous effects on people of all walks of life, 

particularly those who are among the most vulnerable. These events and their aftermath bring a 

new sense of urgency to the need to promote cooperation and coordination among agencies as 

well as adoption of livable community principles for the benefit of all Americans. 

 
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19

Creating Livable Communities 

Chapter I 

Introduction 
20
21

Background 

In the past two years, the National Council on Disability (NCD) has published two 

groundbreaking research reports that have elucidated the elements that make communities 

livable for people with disabilities, barriers to developing livable communities, and strategies to 

overcome these barriers. 

Published in December 2004, the first report, Livable Communities for Adults with Disabilities,

identifies: 

1. The key elements of communities that promote the health, well being, and independence 

of adults with disabilities, or at risk of developing disabilities, across the age spectrum. 

These elements include: 

• Providing affordable, appropriate, accessible housing 

• Ensuring accessible, affordable, reliable, safe transportation 

• Adjusting the physical environment for inclusiveness and accessibility 

• Providing work, volunteer, and education opportunities 

• Ensuring access to key health and support services 

• Encouraging participation in civic, cultural, social, and recreational activities 

2. Communities that have incorporated one or more of these elements into their physical, 

social, and service systems and the strategies and interventions they have employed to do 

so, 

3. The major challenges and barriers that communities face in moving toward greater 

livability for persons with disabilities, as well as factors that facilitate positive change, 

and 
22

4. Promising policy levers and policy changes that, if adopted, would facilitate 

communities’ capacity to enhance their livability for their residents. 

Published in December 2005, the second report, The State of 21st Century Long-Term Services 

and Supports: Financing and Systems Reform for Americans with Disabilities, is an in-depth 

examination of the current status of long-term services and supports (LTSS) for people with 

disabilities and contains recommendations for reducing the fragmented nature of service and 

support delivery systems. The report points out that: 

1. There is a lack of a coherent public policy regarding national long-term services and 

supports for people with disabilities 

2. Service and support delivery systems are fragmented, with uneven access and service 

provisions 

3. There are more than 20 federal agencies and almost 200 programs that provide a wide 

range of assistance and services to people with disabilities, yet no single federal program, 

agency, or congressional committee has responsibility for the management, funding, and 

oversight of LTSS 

4. The current LTSS system is funded primarily by state and federal programs, but there is 

no portability provision across states and usually no single entry point at the community 

level for individuals with disabilities and seniors to learn about and access service and 

support options 

5. The costs of LTSS, which make up 22 percent or more of state budgets, are becoming 

unsustainable, and there is need for systems reform 

While these two reports focus on different, though closely related, topics—the first on livable 

communities, the second on community-based long-term services and supports for people with 

disabilities—they come to many of the same conclusions about what people with disabilities 
23

want and need in order to live as independently as possible, for as long as possible, in the 

community. For example, both reports note that: 

1. People with disabilities, like all people, want to live in supportive communities that 

facilitate their independence, help them maintain self-determination, and integrate them 

fully into community life 

2. People with disabilities desire and deserve choices, whether they are seeking health and 

support services, transportation or housing options, work and education opportunities, or 

civic, social, or recreational activities 

3. In the health and supportive services arena, people’s desire for independence and control 

is more likely to be satisfied when health care systems a) are consumer directed, b) 

provide care coordination, c) allow “money to follow the person” to eliminate barriers to 

care and provide consumers with choice over the location and type of services provided, 

d) provide high-quality, seamless, consumer-centered, and continuous care across settings 

and providers, and e) provide support services that are linked to housing to increase the 

availability and efficiency of service provision 

4. People with disabilities and their caregivers need and want access to timely, 

understandable, and culturally appropriate information that helps them navigate through 

the maze of health care, supportive services, housing, transportation, and other systems 

and make informed choices 

Both reports also point out that there are considerable barriers to fulfilling these desires and 

needs. They note, for example, that: 

• Coherent, comprehensive federal policies are lacking, leading to fragmentation in service 

and support delivery systems and frustration for people with disabilities and their 

caregivers 
24

• Scant resources or funding “silos” that restrict how funds can be used contribute to the 

fragmentation of these systems 

• Multiple, disparate resources frequently overlap and other times leave big gaps in service 

• Accountability and quality control are hampered by lack of uniform performance 

measures across systems and programs 

• Access to information is made unnecessarily difficult because it is neither centralized nor 

shared among agencies 

• Collaboration among agencies is more the exception than the rule 

As a result of this work, NCD was motivated to examine these barriers further and identify 

strategies, policy levers, and promising practices that will inspire and demonstrate the value of 

multiple agency collaboration at both the federal and state levels in order to achieve livable 

community objectives. This is in keeping with NCD’s overall purpose to promote policies, 

programs, practices, and procedures that guarantee equal opportunity for all individuals with 

disabilities and to empower individuals with disabilities to achieve economic productivity, 

independent living, inclusion, and integration into all aspects of society. 

Strategies to Promote Cooperation and Collaboration and 

Recommendations for Action 

The two NCD reports mentioned above identified a set of six strategies or policy levers that can 

be applied at the federal and state levels to facilitate much-needed cooperation and collaboration 

among agencies. Creating Livable Communities presents these six strategies, each illustrated 

with in-depth reviews of selected federal and state programs that have been or are being 

successfully implemented for the benefit of people with disabilities. Each of these examples 

addresses one or more livable community objectives, including access to information, affordable 

and accessible housing, work, education, transportation, and appropriate health and long-term 
25

services and supports. These strategies and “promising practice” examples are ones that can be 

adapted or replicated in other contexts. 

In addition to these six strategies and “on the ground” examples of federal and state programs 

that are actually addressing and/or overcoming barriers to building livable communities, we 

present eight recommendations to stimulate action in the legislative and executive branches of 

the Federal Government to further the livable community agenda and improve quality of life for 

people with disabilities and their families. 

In 2005, in the aftermath of Hurricanes Katrina and Rita, the nation witnessed the sad 

consequences of the lack of cooperation and coordination among federal, state, and local 

agencies that were responsible for evacuating people who lived in the path of the storm and 

resettling them. Not surprisingly, the most vulnerable residents of the affected areas—people 

with disabilities and older people, particularly those in hospitals and nursing homes—were 

among those who suffered the most during and after the storm. These unfortunate events reminds 

the nation that we need to redouble our efforts to remove the barriers that prevent agencies at all 

levels from working together to safeguard our citizens and communities as well as support 

independent living among people with disabilities and promote their inclusion in all aspects of 

society. 
26
27

Chapter II 

Strategy One: Agreement on Changes in the Collection and 

Management of, and Access to, Multiple Agency 

Information about Programs and Benefits in Order to be 

Consumer Responsive 
28
29

As the examples in this section illustrate, this strategy can help ensure that older people and 

people with disabilities have access to key health and supportive services that enable them to 

continue living in the community as independently as possible. 

Aging and Disability Resource Centers 

Long-term service and support systems in many states are fragmented and disjointed, with many 

public and private programs and services delivered by a variety of agencies and organizations. 

The navigation of the long-term services and support system can be confusing and frustrating for 

older people and people with disabilities of all ages and their family members. The Aging and 

Disability Resource Center grant program (ADRC) was established to pilot new approaches to 

interagency coordination that improve access and the availability of information to meet the 

needs of the target populations. 

The ADRC program is part of the President’s New Freedom Initiative, which aims at 

overcoming barriers to community living for people of all ages with disabilities. The ADRC 

program is the collaborative effort of the U.S. Department of Health and Human Services’ 

Administration on Aging (AoA) and the Centers for Medicare and Medicaid Services (CMS). 

The ADRC program takes an important step towards meeting AoA’s vision for long-term 

services and supports: 

• Affordable choices and options that promote independence and dignity for individuals 

• Consumer control and meaningful involvement in the design and delivery of the 

programs and services that affect their lives 

• Information that empowers people to make informed decisions 

• Easy access to a range of health, long-term services, and environmental supports 

• Support for family caregivers 
30

• Assurances that people are receiving the highest quality care available 

Ready access to consolidated information and referral services helps make communities more 

livable for residents of all ages and abilities. 

Background 

ADRC programs provide information and assistance to both public and private pay individuals 

and serve as the entry point to publicly administered long-term supports including those funded 

under Medicaid, the Older Americans Act, and state revenue programs. 

History 

Research into the delivery of long-term support services revealed many troubling facts. Longterm support services are sustained by numerous funding streams, administered by multiple 

agencies, and have complex, fragmented, and often duplicative intake, assessment, and eligibility 

functions. People who qualify for publicly-funded supports are often frustrated by the 

complexity of the system and its disconnected points of entry and different rules of eligibility. 

Individuals are often channeled towards skilled nursing facilities without being made aware of 

other available supports that may assist them in remaining in the community. 

ADRCs were established to help consumers overcome these problems by providing “one-stop 

shopping” for information, counseling, and access on all long-term support programs and 

services. Resource Centers will also improve the states’ ability to manage public resources and 

monitor program quality through centralized data collection and evaluation. 

Target Population for Assistance 

States must target ADRC services to the elderly population and at least one additional population 

(i.e., individuals with physical disabilities, serious mental illness, and/or mental 

retardation/developmental disabilities). 
31

ADRC programs serve individuals who need long-term support, their family caregivers, and 

those planning for future long-term support needs, regardless of income. The Centers also serve 

as a resource for health and long-term services and supports professionals and others who 

provide services to the elderly and to people with disabilities. 

Location of ADRCs 

ADRCs are presently in operation in these 43 states and in Guam, the District of Columbia, and 

the Northern Mariana Islands: 

2003 ADRC Grantees 2004 ADRC Grantees 

Louisiana 

Maine 

Maryland 

Massachusetts 

Minnesota 

Montana 

New Hampshire 

New Jersey 

Pennsylvania 

Rhode Island 

South Carolina 

West Virginia 

Alaska 

Arkansas 

California 

Commonwealth of the Northern Mariana Islands 

Florida 

Georgia 

Illinois 

Indiana 

Iowa 

New Mexico 

North Carolina 

Wisconsin 

2005 ADRC Grantees 

Alabama 

Arizona 

Colorado 

District of Columbia 

Guam 

Hawaii 

Idaho 

Kansas 

Kentucky 

Michigan 

Mississippi 

Nevada 

Ohio 

Tennessee 

Texas 

Vermont 

Virginia 

Washington 

Wyoming 
32

Stakeholder Involvement 

Stakeholders are involved in the planning, implementation, and evaluation of ADRCs. Most 

ADRCs follow AoA and CMS’s recommendation to include stakeholders from the following list: 

Area Agencies on Aging State Health Insurance Assistance 

Programs (SHIPs) 

State Assistive Technology Act 

Projects (AT Act Projects) 

Consumer advocacy groups and 

organizations 

Long-term services and supports 

Ombudsman Programs 

Housing authorities 

Benefit Planning Assistance and 

Outreach (BPAO) programs funded 

by the Social Security 

Administration 

Developmental Disabilities Councils Volunteer groups 

One-Stop Centers and other efforts 

funded by the Department of Labor 

State Mental Health Planning 

Councils 

Employers 

Alzheimer’s Association chapters Independent Living Centers Faith-based service providers 

State Vocational Rehabilitation 

entities 

Community service providers Private philanthropic organizations 

Other community-based 

organizations 

In addition, states operating ADRCs establish or designate an Advisory Board to assist in the 

development and implementation of their program and advise the lead state agency on: (a) the 

design and operation of Resource Centers; (b) stakeholder input; (c) the state’s progress toward 

achieving the goal and vision for ADRCs; and (d) other program and policy development issues 

related to the state’s Resource Center program. 

Services Offered 

As an information clearinghouse, the ADRCs offer advice and assistance to individuals with 

disabilities across the age spectrum as well as to physicians, hospital discharge planners, and 

other professionals who work with older people or people with disabilities. Services offered 

through the single entry point can be grouped into six areas: 

1. Information and Assistance. Provide information to the general public about services, 

resources, and programs in areas such as: disability and long-term related services and 

living arrangements, health and behavioral health, adult protective services, employment 

and training for people with disabilities, home maintenance, nutrition, and family care. 
33

2. Long-Term Services and Supports Counseling. Offer objective information, 

consultation, and advice about the options available to meet an individual’s long-term 

services and supports needs. 

3. Benefits Counseling. Provide accurate and current information on private and 

government benefits and programs. 

4. Emergency Response. Ensure that people are connected with someone who will respond 

to urgent situations that might put someone at risk, such as a sudden loss of a caregiver. 

5. Prevention and Early Intervention. Promote effective prevention efforts to keep people 

healthy and independent and offer both information and intervention activities that focus 

on reducing the risk of disabilities. 

6. Access to Family Care Benefit. Administer the long-term services and supports 

Functional Screen to assess the individual’s level of need for services and eligibility for 

the Family Care benefit. 

Resources 

Former Secretary of Health and Human Services, Tommy Thompson, announced the funding of 

12 state grants to develop ADRCs in September of 2003. Twelve additional ADRC grants were 

announced in April of 2004. Eighteen states and Guam were funded in 2005. 

Each project is funded for a period of up to three years. The maximum total Federal award for 

the entire three year period is $800,000 per project. Grantees are required to make a nonfinancial or cash recipient contribution (match) of five percent of the total grant award. 

States may use funds awarded through the ADRC grants program to better coordinate and/or 

redesign their existing systems of information, assistance, and access. ADRC functions are 

performed in a single location in some communities. Other communities decentralize ADRC 

functions. In the latter case, ADRCs may have multiple sites and organizations involved in 
34

performing the information and access functions. Some communities have different access points 

for different populations. 

Examples of ADRCs in Action 

Alaska 

ADRC Name ADRC Website Lead Agency Project Period 

Alaska Aging & Disability 

Resource Center Pending Alaska Housing & Finance Corporation 2004 Grantee 

Alaska will establish five regional ADRCs operated by the State Centers for Independent Living 

(SILC) to provide citizen-centered “one-stop shopping” entry to long-term support services for 

seniors and people with disabilities statewide. The ADRCs will offer information and referral 

services, eligibility screening, assistance in gaining access to long-term support services for 

private pay consumers, comprehensive assessment for those seeking publicly funded services, 

programmatic eligibility determination for long-term support services, and access to the Division 

of Public Assistance for Medicaid financial eligibility determination. The SILC will work with 

the Division of Senior and Disability Services and the Senior Housing Office to develop a 

management information system that tracks consumer intake, needs assessment, care plans, 

utilization, and costs. Formative and summative evaluations will be conducted by the Center for 

Human Development. 

Florida 

ADRC Name ADRC Website Lead Agency Project Period 

Florida Aging and 

Disability Resource Center Pending Florida Department of Elder Affairs (DOEA) 2004 Grantee 

Florida will develop and implement ADRCs operated by area agencies on aging in at least two 

Planning and Service Areas (PSAs) for both publicly and privately funded services for the 

elderly and individuals with mental illness. Florida will co-locate Information and Referral, 

screening and assessment, access to crisis intervention, medical and financial eligibility 

determination, and long-term services and supports counseling. It will establish a single 

administrative structure accessible through multiple locations (senior centers, Area 
35

Administration on Aging, housing authorities, mental health centers, etc.) in each of the ADRC 

communities. Access to ADRC services will also be available by phone and the Internet. The 

ADRC program will benefit from a current state project designed to merge existing program 

information and management databases. Since the announcement of the 2004 ADRC grant, the 

Florida Legislature passed statutory changes to implement Aging Resource Centers (ARCs) 

statewide for the aging population only. Only adults 60 and older will be targeted for service in 

the ADRC’s first year. Adults 60 and older and adults 18 and older with severe mental illness are 

targeted for service in the ADRC’s second and third years. 

Wisconsin 

ADRC Name ADRC Website Lead Agency Project Period 

Lessons Learned: 

Redefining the Expansion 

of Wisconsin Resource 

Centers 

Pending 

Wisconsin Department of 

Health and Family 

Services (DHFS) 

2004 Grantee 

The Wisconsin DHFS will expand geographic coverage of their full-service Aging and Disability 

Resource Centers, develop capacity for all target groups to be served, and develop an 

infrastructure to support ultimate expansion to all parts of the state. Five local agencies will be 

selected through an RFP process to develop new full-service ADRCs. DHFS will develop statelevel infrastructure to support current and future development of a statewide system of fullservice ADRCs that serve elders and at least one other target population of individuals with 

disabilities and have a strong collaboration with local programs. The state infrastructure will 

include: 

• Two toolkits, one to promote public awareness and one for long-term services and 

supports options counseling; 

• Identification of information management system solutions to meet state and local needs 

for consistent data collection and reporting; 

• Ability to provide technical assistance in adding new target populations, including people 

with mental illness; and 
36

• Technical assistance in identifying and accessing funding sources and in accessing 

services already available. 

Looking Forward 

AoA and CMS will evaluate whether the ADRCs increase informed decisionmaking and 

consumer satisfaction with access to needed long-term supports and services in the most 

integrated setting. Over a three-year period, each of the pilot states is expected to have at least 

one operating center that demonstrates improvements in the state’s ability to manage public 

resources, monitor program quality and costs, and improve assessment of need and effective 

coordination of services to limit unnecessary use of high cost options, including nursing 

facilities. 

Additional Resources for More Information 

Aging and Disability Resource Centers, Background Information on ADRCs, available at:

http://www.aoa.gov/prof/aging_dis/background.asp. 

Centers for Medicare and Medicaid Services New Freedom Initiative website, available at:

http://www.cms.hhs.gov/newfreedom. 

ADRC Technical Assistance Exchange website, available at: http://www.adrc-tae.org. 

Questions and Answers about the Aging and Disability Resource Center Grants Program, 

created by the Administration on Aging and Centers for Medicare & Medicaid Services, 

available at: http://www.aoa.gov/prof/aging_dis/AoACMSQA%20071403.pdf. 

Fact Sheet on the Aging and Disability Resource Centers, created by the U.S. Department of 

Health and Human Services, Administration on Aging, available at: 

http://www.aoa.gov/press/fact/pdf/fs_aging_disability.pdf. 
37

Consolidating Access to Information and Services: Learning from 

the States 

The AdvantAge Initiative 2003 National Survey of Adults Aged 65 and Older3 asked 

respondents across the country many questions about their physical and mental health, their 

knowledge about and use of services in their communities, their physical and social activities, 

and aspects of their communities that make them “livable” for older people, as well as areas that 

need improvement. One of the questions they were asked was, “What is the best resource, such 

as a person or an organization, in your city, town, or county to get information on various 

services,” and in response, fully 20 percent, or one in five, older people said “I don’t know.” This 

20 percent represents 6.7 million Americans aged 65 and older who don’t know where to turn 

when they need information and services. 

There are almost 900,000 non-profit organizations in the U.S. plus scores of government 

agencies that provide services. People looking for assistance have trouble navigating this 

complicated web of health and human service programs; often people don’t even know where to 

begin. To help remedy this situation, in recent years states across the U.S. have been making 

progress toward consolidating disparate information and referral services using an easy-toremember three-digit dialing telephone code reserved by the Federal Communications 

Commission (FCC) for this purpose. 

Background: The 2-1-1 Information and Referral System 

Community Information and Referral, often referred to simply as I&R, has been a staple of the 

health and human services industry for the past 50 years. Comprehensive and specialized I&R 

agencies provide linkages between individuals and the often daunting maze of services available 

in their communities. I&R services help people living in the community negotiate this maze by 

maintaining comprehensive databases of resources and making them available by telephone, the 

internet, and through paper directories or handbooks. I&R specialists are trained professionals 

who work with callers to find the help they need. They assess callers’ needs and help them 

determine their options and best courses of action. I&R specialists also are trained to intervene in 
38

crisis situations, determine whether a caller is eligible for programs, and advocate on behalf of 

the caller. 

In the past, most I&R telephone help lines have been 10-digit local telephone numbers or tollfree numbers serving a circumscribed area. But on July 21, 2000, the Federal Communications 

Commission assigned the dialing code 2-1-1 to be used exclusively for community information 

and referral purposes, and in many communities this central phone number has replaced 

individual agency help lines as the source of choice for residents seeking information and 

referral. 

While the specific services offered through 2-1-1, as well as the degree of accessibility of 2-1-1’s 

telephone and website services for people with disabilities, vary from community to community, 

in general 2-1-1 offers information about and referral to the following types of services: 

• Basic human needs resources: food banks, clothing, shelters, rent assistance, utility 

assistance 

• Physical and mental health resources: medical information lines, crisis intervention 

services, support groups, counseling, drug and alcohol intervention, rehabilitation, health 

insurance programs, Medicaid and Medicare, maternal health, children’s health insurance 

• Employment support: unemployment benefits, financial assistance, job training, 

transportation assistance, education programs 

• Support for older Americans and persons with disabilities: home health care, adult day 

care, congregate meals, Meals on Wheels, respite care, transportation, and homemaker 

services 

• Support for children, youth, and families: quality childcare, Success by Six, after school 

programs, Head Start, family resource centers, summer camps and recreation programs, 

mentoring, tutoring, protective services 
39

• Volunteer opportunities and donations4

2-1-1 in the States 

The 2-1-1 help line was first launched by the United Way of Metropolitan Atlanta in 1997—

several years before the FCC made the number universal. United Way chapters around the 

country have a long tradition of funding I&R services in their respective communities and since 

1997 have continued to be involved in starting up and supporting 2-1-1 services in states around 

the country. 

There are now 157 active 2-1-1 systems covering all or part of 32 states, Washington, D.C., and 

Puerto Rico and serving 40 percent of the U.S. population. In some parts of the country 2-1-1 is a 

well-known and well-used resource. Puerto Rico and 13 states have implemented 2-1-1 

statewide,5

 so that residents across each of these states have access to 2-1-1 information systems. 

In many other parts of the country, however, 2-1-1 is just in the planning stages. Many, but not 

all, of the existing 2-1-1 lines in the states that have them are available 24 hours per day, 7 days 

per week. Some locales have made their databases available on the internet so that people may 

access information at times of the day when 2-1-1 is not available. 

Connecticut was the first state in the country to implement 2-1-1 statewide. The number—called 

2-1-1 Infoline—went into effect in March 1999, replacing a toll-free number. Infoline can be 

accessed from anywhere in Connecticut. Help is available 24 hours a day, every day of the year. 

Infoline has multilingual caseworkers and is accessible by TTY to people who are deaf or hard of 

hearing. Infoline has developed the most comprehensive database of human service resources in 

the state of Connecticut. The database is continually updated and is also available on CD-ROM 

and the Internet.6

 Caller demographics and problems collected by 2-1-1 provide valuable 

information to state agencies, which use the information to understand the overall problems 

facing Connecticut residents and assess needs in the state. Since Connecticut switched to 2-1-1 

from a 10-digit, toll-free number, the volume of calls increased from 200,000 in 1999 to over 

320,000 in 2003. Top service requests were for utilities/heat, housing, mental health services, 

financial assistance, and health care.7

 Not all the statewide 2-1-1 information lines are as well 

developed as Connecticut’s, largely due to lack of sufficient funding and legislative support. 
40

Aloha United Way was launched in Hawaii in July 2002, making Hawaii the second state in the 

nation with statewide 2-1-1 service. People can call 2-1-1 from all islands 24 hours a day, 7 days 

a week for information on more than 4,000 government and non-profit programs and services. 

New Jersey’s statewide 2-1-1 service came on line in February, 2005 and is available to all New 

Jersey residents, including cell phone users.8

 The Idaho 211 project is using AmeriCorps and 

AmeriCorps VISTA Volunteers to identify community resources through community asset 

mapping activities, and this information will be integrated into Idaho CareLine’s (Idaho’s official 

2-1-1 call center) databases. Vermont’s collaborative partners in their statewide 2-1-1 line 

include the Vermont Agency of Human Services, area agencies on aging, Vermont Department 

of Libraries, Vermont E-911, Vermont Emergency Management, Vermont Network Against 

Domestic and Sexual Violence, and information and referral/assistance providers statewide. In 

Texas, the State Legislature is encouraging all state agencies to coordinate their I&R services 

with Texas’s statewide 2-1-1. For information about the status of other state 2-1-1 efforts, see 

www.211.org. 

Funding and Cost-Savings 

The 2-1-1 call centers are generally supported through a combination of funding sources, 

including local United Way chapters, community foundations, and federal and local 

governments. However, this patchwork of funding is often insufficient to start up or maintain 

full-service 2-1-1 call centers. 

Senators Elizabeth Dole (R-NC), Hillary Rodham Clinton (D-NY), and Richard Burr (R-NC) 

and Representatives Michael Bilirakis (R-FL9) and Anna Eshoo (D-CA14) have introduced the 

Calling for 2-1-1 Act that would authorize $150 million for two years, and $100 million for the 

next three years, in federal funds to assist states with implementing and sustaining 2-1-1 

statewide. This federal investment would need to be leveraged in states with a minimum of 50 

percent of program funding from state and local government and private sources such as 

corporate, foundation, and United Way dollars. The rationale behind this cost-sharing is that 

2-1-1 is most effective when built on solid public/private partnerships and with a diverse and 

sustainable funding base. The Act closed the 108th Congress with 182 bi-partisan congressional 

sponsors. 
41

A national cost benefit analysis conducted by the University of Texas estimates a net value to 

society of a national 2-1-1 system approaching $130 million in the first year alone and a 

conservative estimate of $1.1 billion over ten years. Savings include time saved, tax assistance 

and recovery, volunteer recruitment, around the clock service, a reduction in the number of 

1-800 numbers, and a reduction in non-emergency calls to 9-1-1.9

 

Resources 

As the first state to implement 2-1-1, Connecticut helps other regions develop their own 2-1-1 

call centers (see www.infoline.org for more information) 

www.211.org and www.airs.org are comprehensive websites that provide a variety of 

information about 2-1-1 and tools for starting up and maintaining 2-1-1 lines 
42
43

Chapter III 

Strategy Two: 

Utilization of Favorable Tax Treatment (e.g. tax credits) 

to Stimulate Change in Individual and 

Corporate Behavior that Encourages Investment in 

Livable Community Objectives 
44
45

The availability of appropriate and affordable housing choices is one of the most important 

measures of community livability. As the examples below illustrate, Strategy Two can be used to 

expand such housing opportunities for people with low incomes and/or people with disabilities 

and ensure that the housing is affordable and accessible. 

Low Income Housing Tax Credits 

Housing is a cornerstone of livable communities and the demand for affordable, accessible 

housing for people with disabilities has not gone unaddressed by the Federal Government. As 

part of the Tax Reform Act of 1986, the Federal Government created the Low Income Housing 

Tax Credit (LIHTC) to encourage the production and redevelopment of livable, affordable rental 

housing across the nation. 

The Low Income Housing Tax Credit is a way for states to encourage private investment in 

sustainable, livable communities for people with disabilities without having to allocate direct 

federal expenditures. The LIHTC is a significant source of financing for developers seeking to 

construct and rehabilitate housing opportunities for people with disabilities. 

Virtually all people with disabilities receiving Supplemental Security Income (SSI) are 

theoretically eligible for the affordable housing units in LIHTC properties because they have 

incomes far below 50 percent or 60 percent of area median income. On average, the national 

income of a person receiving SSI is equal to 18 percent of area median income.10 However, the 

problem for many people with disabilities is that, given their income, the tax credit rents for the 

affordable units in LIHTC properties are too high. In certain localities with relatively low tax 

credit rents, if two people with disabilities are willing to share a unit, or if both members of a 

two-person household receive SSI, the tax credit rent may be affordable. But in many localities, 

the tax credit rent charged in a LIHTC property may be higher than a person’s entire SSI 

monthly income.11 

Why should the disability community care about this complicated program if it doesn’t provide 

units that are affordable to people with disabilities receiving SSI? There are at least three 

reasons: 

12
46

1. The owners of LIHTC-financed properties are required to accept Section 8 vouchers. 

2. States are increasingly using LIHTC in combination with an array of other affordable 

housing resources in order to achieve what is called “deeper income targeting,” which 

means that they are trying to serve people with much lower incomes than 50 percent or 

60 percent of area median income. 

3. The LIHTC program is being used more and more to create permanent supportive 

housing for people with disabilities, including chronically homeless people with 

disabilities. 

Program Background 

Under the LIHTC program, states are authorized to issue federal tax credits for the acquisition, 

rehabilitation, or new construction of affordable rental housing. The credits can be used by 

property owners to offset taxes on other income, and are generally sold to outside investors to 

raise initial development funds for a project. 

To qualify for credits, a project must have a specific proportion of its units set aside for lower 

income households. Rents and utilities in these units, which are classified as general household 

expenses, are limited to 30 percent of the qualifying income. The amount of the credit that can be 

provided for a project is a function of development cost (excluding land), the proportion of units 

set aside, and the credit rate (which varies based on development method and whether other 

federal subsidies are used). Credits provide equity into a project, and they are provided for a 

period of 10 years. 

As of 2004, the LIHTC program generated $6 billion in housing investments and created more 

than 115,000 affordable rental housing units nationwide each year for low-income families, 

seniors, the homeless, and people with disabilities. The program’s structure allows developers to 

raise equity through partnerships with tax credit investors, leverage private and public funds, and 

secure additional funding to cover construction and permanent costs. These costs include loans 

and grants to create, for example, child care facilities and accessible community rooms. 
47

The Federal Government allocates to each state a certain number of budgeted LIHTCs that are 

issued by each state’s housing agency to developers of qualified low-income housing. The 

credits are allocated based upon the cost of property, less land and non-eligible expenses. The 

property generates tax credits once construction is completed and the property is occupied by the 

required number of qualified tenants. So long as the property remains in use to rent to qualified 

tenants for the requisite period of time, that property will generate a steady flow of tax credits for 

ten consecutive years. 

Program Description 

The Internal Revenue Service (IRS) oversees LIHTC compliance to ensure that states and 

investors do not use more tax credits than authorized. The U.S. Department of Housing and 

Urban Development (HUD), though not formally responsible for program oversight, monitors 

and analyzes the tax credits because of the program’s important role in providing for the housing 

needs of low-income people. 

Program Overview 

Each state receives an allocation of LIHTCs on a per capita basis. In 2004, the limit was $1.80 

multiplied by the state’s population, with a minimum of $2,075,000 per state. The credits are 

competitively awarded under Section 42 of the Internal Revenue Code and the state’s Qualified 

Allocation Plan. 

Developers who receive tax credits may syndicate (sell) the credits to raise equity (cash) for 

development. In exchange for receiving long-term income in the form of an allotment of 

LIHTCs, the developer agrees to comply with pre-determined rent restrictions. Each dollar of 

LIHTC allocated entitles the syndicator to one dollar of credit against their corporate income tax 

every year for ten years. 

State housing agencies put each development through three separate, rigorous financial 

evaluations to make sure the development receives only enough credits to make it viable as longterm, low-income housing. Only investors in properties that pass all three reviews, complete their 

developments, and actually rent them to low-income families can claim the credits. 
48

At a minimum, either 20 percent or more of the units in a given development must be occupied 

by individuals whose incomes are below 50 percent of the area median income, or at least 40 

percent of the units must be occupied by individuals below 60 percent of the area median 

income. LIHTC financed units must remain affordable to low-income people for at least 30 

years, and many are permanently dedicated to low-income use. 

On average, LIHTCs generate over 40 percent of development costs. Remaining financing 

typically comes from market-rate first mortgages and low or no-interest second mortgages, often 

from HOME or other public sources. 

Calculating the Credit 

The credit is based upon prevailing Treasury interest rates. The “9% Projects” credit is calculated 

so that the present value of the annual credits over the 10-year period equals 70 percent of the 

building costs. The “4% Projects” credit is available for new construction and substantial 

rehabilitation projects. 4% Projects are often awarded to projects that utilize mortgage revenue 

bond financing, also known as non-competitive credits. A developer cannot use both 4% and 9% 

credits. A project must use one or the other, or the LIHTC can be combined with Historical 

Rehabilitation Credits and New Markets Tax Credits. 

Applying the Credit 

The LIHTCs that may be claimed are calculated by multiplying the applicable credit percentage 

by the building’s “qualified basis.” The first step in making this calculation is determining a 

building’s “eligible basis,” i.e. the cost for the entire building, including non-low-income units if 

the quality of those units is comparable to that of the low-income units. The eligible basis is 

determined at the end of the first year of the credit period (subject to reduction for federal 

subsidies). Only building costs are included, not land costs. 

For acquisitions, only depreciable property is included in the basis. Projects involving substantial 

rehabilitation may include only expenditures within a 24-month period that can be capitalized. 

“Substantial rehabilitation” means that rehabilitation expenses either must equal at least 10 

percent of the building’s adjusted basis at the beginning of the 24-month period or cost at least 
49

$3,000 per unit, whichever is greater. For new construction, only costs that can be capitalized are 

included. Also, the eligible basis may be increased to 130 percent for new construction in areas 

of difficult development or high-cost adjustment. 

The building’s qualified basis is then calculated as the portion of the eligible basis that is used 

for low-income tenants, based on the percentage of total units or floor space, whichever is less. 

The initial qualified basis is determined on the last day of the first year the building is placed in 

service or, at the owner’s election, on the last day of the following year. The owner must 

maintain the initial qualified basis throughout the 15-year compliance period. 

Syndicating the Credit 

Developers and sponsors of projects that win the 9% Project credits through the competitive 

process will sell or syndicate the credits to individuals and companies who invest cash into the 

project in exchange for the tax credits. The credits can be sold and structured as an equity fund, 

generally financing multiple projects. Alternatively, the credits can be sold directly to individual 

investors or corporations, generally on a project-specific basis. The money raised by the sale of 

the tax credits is project equity, thereby reducing the financing needs and costs of the project, 

with the resulting cost savings going to the residents. 

Developers sell to investors the right to take these credits over ten years. The price paid for the 

credits reflects the value of the real estate, quality of development, and net present value of the 

10 years worth of credits. Tax credits are sold on the basis of their present value, so are 

discounted to 75–80 cents on the dollar. For example, $1 million in tax credits would generate 

about $750,000 to $850,000 in equity for the project developer. Maryland’s $10.5 million 

allocation of LIHTC, for example, raises $80 to $90 million in private money for affordable 

housing annually. 

Generally, the sale of the credits is accomplished through a third party syndicator who sells the 

credits to companies or individuals in need of tax relief (i.e. the investors). The investors then 

form a limited partnership with ownership interest in the project, while the sponsor (developer) is 

the general partner with responsibility for project management, construction, and compliance to 
50

tax credit restrictions. As an alternative, an investor may purchase credits in a pool or fund, and 

the revenues generated will provide equity for a number of different projects. Syndicators 

establish discrete funds as investment opportunities, with responsibilities for selling the credits, 

evaluating eligible projects and making awards, and assisting through the construction and 

compliance stages of the project. Each investor enjoys a pro-rata share of the credits consistent 

with its percentage of ownership in the pool. 

The Role of States in Shaping Rental Housing Policy for Persons with 

Disabilities 

Each state receives an annual “budget” of tax credit authority that can be used to reduce the 

federal tax liability of investors in affordable rental developments. The state passes on this tax 

credit authority to individual developments, based on a Qualified Allocation Plan (QAP). The 

QAP establishes criteria for the annual selection of developments around the state that will be 

built or preserved using LIHTC. 

Through the QAP and review of individual proposals for housing developments, state policymakers shape the way in which affordable rental housing is distributed geographically and to 

different types of families and individuals, including persons with disabilities. The QAP is 

developed through a consultative process that also gives advocates at the state level an 

opportunity to affect housing policy. 

QAPs vary widely from state to state over time. Many states hold competitions based on setasides of the tax credit to specific metropolitan and non-metropolitan areas within the state, 

while most others establish preferences for specific types of geographic areas. Sometimes suballocation follows population types and needs, while sometimes areas are believed to have 

greater relative need for affordable housing and, as a result, are favored. The state QAP has a 

base-line point value that developers must meet in order to be considered. States award 

additional points to applications based on state priorities. 

The success of a developer’s proposal to use LIHTCs allocated through a QAP can be greatly 

affected by a small number of points at the margin when all applications are similar for low-
51

income rental developments. States tend to allot between 1.5 and 3 percent of the available 

points in a QAP to proposed developments that specifically provide affordable, accessible 

housing to people with disabilities. Thus, developers who develop this kind of housing will 

receive an additional allotment of credits. State LIHTC allocations tend to emphasize developing 

geographic areas that have both needy households and shortages of rental housing. 

Resources Used 

The LIHTC program has recently been amended to give States the equivalent of nearly $5 billion 

in annual budget authority to issue tax credits. As a housing-related tax expenditure, the LIHTC 

does not require direct appropriations. The estimated cost to the federal treasury in FY 2003 was 

$6.2 billion. 

In 2000, Congress increased the LIHTC annual cap by 40 percent to restore purchasing power 

lost to inflation since Congress imposed the cap in 1986 and indexed the cap to inflation 

beginning in 2003. The 2004 limit is $1.80 multiplied by state population, with a minimum of 

$2,075,000 per state. 

When the LIHTC program was made permanent in 1993, corporations began acquiring the 

credits directly and through syndication funds. Corporations now constitute virtually the entire 

market of LIHTC investors and include banks and insurance companies as well as Fannie Mae 

and Freddie Mac. 

In 2004, States allocated over $504 million in tax credits and allocated over $533 million in 

2005. The allocation of credits ranged from just under $2 million worth of credits in Delaware to 

$50 million in credits in California. 

It is clear that through the QAP or through the selection of individual LIHTC developments, state 

policymakers are making critical choices about rental housing policy that affects the well-being 

of individual households and the economic health of the state’s metropolitan areas. These 

choices will help create public-private investments and partnerships and accelerate the 

development of sustainable, livable communities for people with disabilities and their families. 
52

State housing planners are in a particularly good position to design housing options for people 

with disabilities, since other support systems for the same populations are funded and regulated 

at the state level. Through both QAPs and the selection of individual LIHTC developments, state 

housing program administrators can encourage the development of housing that fills gaps in the 

current system of housing alternatives, including alternatives to rental housing funded by the 

federal Section 811 program. 

States that ensure point allotments through subcategorizing “Housing for People with 

Disabilities” in their QAP “Special Needs Housing” category are in the best position to ensure 

that LIHTCs will be used by developers to construct affordable, accessible, and integrated 

housing for people with disabilities. 

State Examples 

Iowa 

The State of Iowa is an example of how a state can use the tax credits program to achieve a 

policy of expanding affordable, accessible housing opportunities for people with disabilities. 

The Iowa Finance Authority (IFA, www.ifahome.com) oversees Iowa’s distribution of LIHTCs. 

IFA established that 30 percent of all the LIHTCs issued by IFA are used as equity investments 

in affordable, accessible, and integrated housing developments. 

To qualify for this set-aside: (1) 25 to 49 percent of the units in the proposed project must be set 

aside for people with disabilities within an integrated setting or a setting that promotes 

homeownership, or (2) 50 to 100 percent of the units must be set-aside for people with 

disabilities within a single-purpose setting. Any unused tax credits remaining from the set-aside 

are returned to the general pool and allocated in the current year. To receive an allocation of the 

credits, a developer must submit a supportive services plan in addition to the application. 

IFA allocates tax credits from this 30 percent set-aside based upon the QAP. Service-enriched 

housing projects are scored with all the projects except that the 30 percent set-aside is available 

in its entirety until the set-aside is fully allocated. If the set-aside is exhausted, projects proposed 
53

for the service-enriched housing set-aside are permitted to compete in the set-asides for which 

the project is eligible. 

In addition to the set-aside for projects that create accessible, affordable, and integrated housing, 

IFA has taken another substantial step to aid in the construction or rehabilitation of housing for 

people with disabilities. Under IFA’s current project scoring criteria, projects designed to serve a 

special needs population receive 30 points out of a possible 325 points, or 9.2 percent of the 

available points, as opposed to the usual 5 to 10 points, or between 1.5 and 3 percent of available 

points, in the majority of states. 

In 2005, Iowa financed 19 projects for a total of $40,159,320 in credits. Two hundred and eleven 

of the 533 units constructed with LIHTCs in Iowa are for people with disabilities. Seven of the 

19 funded projects are for service-enriched housing, which will provide new and preserve 

existing housing opportunities for people with disabilities. 

Maryland 

The State of Maryland is another example of how states are allotting their LIHTCs. The 

Maryland Department of Housing and Community Development 

(www2.dhcd.state.md.us/Website/home/index.aspx) oversees Maryland’s distribution of tax 

credits. 

Unlike Iowa, Maryland does not have a set-aside for projects that construct or rehabilitate 

affordable, accessible housing for people with disabilities. Maryland’s legislature recognizes that 

people with disabilities are historically “isolate[d], and. . . such forms of discrimination against 

individuals with disabilities [will] continue to be a serious and pervasive social problem.” Like 

many other states that recognize this need, Maryland has not yet fully leveraged their LIHTCs as 

a means to accelerate the development of housing for people with disabilities. 

Current statistics indicate that nearly 157,000 residents of Maryland will have a need for some 

form of affordable, low-income housing over the next ten years. Statistics further indicate that, 
54

over the next ten years, approximately 29,000 residents with disabilities in Maryland will need 

some form of affordable, accessible housing. 

Maryland’s QAP makes “Housing for Disabled or Other Special Needs Linked to Supportive 

Services” a single category. Maryland awards a maximum of 10 points, 1.5 percent of the total 

available points, for “Housing for Disabled or Other Special Needs.” 

In 2004, Maryland allotted nearly $10 million in tax credits. Sixty-seven of the units that 

received LIHTCs are accessible for people with disabilities. Thirty-seven of those 67 units are 

only available to elderly Marylanders. In 2003, Maryland awarded LIHTCs to 26 projects with 

207 units considered accessible for people with disabilities. Seventy-four of those accessible 

units are only available to elderly Marylanders. Maryland is moving forward to explore new 

ways to use LIHTCs to accelerate the development of appropriate housing for these populations. 

Additional Opportunities: The Homeownership Tax Credit 

Proposed in mid-March of 2005, the Homeownership Tax Credit (HOTC) would increase 

housing opportunities for working families by helping to bridge the gap between what it costs to 

build homes in lower-income neighborhoods and the price that buyers in those neighborhoods 

can afford to pay. 13 The HOTC is another lever through which public-private investments can be 

created that accelerate the development of sustainable livable communities. 

The HOTC is generally targeted to census tracts with median incomes of 80 percent or less of the 

area or state median income. Areas eligible under federal rural housing programs and Native 

American areas are eligible as well. States are able to use a portion of their credit authority in 

other economically distressed areas. Eligible buyers generally are those whose incomes do not 

exceed 80 percent of area median income. In certain distressed neighborhoods, eligible buyers 

can earn up to 100 percent of the greater of area median income. 

The program is structured in such a way that states will receive annual allocations of credit 

authority starting at $1.75 per capita and rising with inflation. States will award credits to 

developers under a competitive process in accordance with annual plans for meeting state home 
55

ownership needs. Developers that receive credit allocations will be allowed to sell them to 

investors and use the proceeds to bridge the gap between the development costs and the sales 

price of homes they develop. The credit will cover up to 50 percent of acquisition and 

development costs for either new construction or substantial rehabilitation. 

The HOTC will help produce roughly 250,000 new homes, almost all for low-income people, 

over a five year period, at a federal cost of just over $2.5 billion. This activity will help generate 

more than half a million jobs, $20 billion in wages, and $10 billion in federal, state, and local 

revenue. The development and economic activity that the HOTC will generate will also help 

close minority and low-income homeownership gaps and stabilize struggling neighborhoods. 

Resources 

United States Department of Housing and Urban Development 

Office of Policy Development and Research. http://www.huduser.org. 

Low income Housing Tax Credits Data Sets. Available at: 

http://www.huduser.org/datasets/lihtc.html. 

United States Department of Housing and Urban Development, Office of Policy 

Development and Research, Updating the Low income Housing Tax Credit Database: 

Projects Placed in Service Through 2001. available at: 

http://www.huduser.org/Datasets/lihtc/report9501.pdf. 

Fair Housing and Equal Opportunity Office. http://www.hud.gov/offices/fheo/index.cfm. 

Memorandum of Understanding Among the Department of the Treasury, The Department of 

Housing and Urban Development, and The Department of Justice. Available at: 

http://www.hud.gov/offices/fheo/lihtcmou.cfm. 

Office of Community Planning and Development. http://www.hud.gov/offices/cpd/index.cfm. 
56

HOME and Low Income Housing Tax Credits, available at: 

http://www.hud.gov/offices/cpd/affordablehousing/training/lihtc/index.cfm 

LIHTC Basics, available at: 

http://www.hud.gov/offices/cpd/affordablehousing/training/lihtc/basics/index.cfm. 

How do Housing Tax Credits Work?, available at: 

http://www.hud.gov/offices/cpd/affordablehousing/training/lihtc/basics/work.cfm. 

Allocating Housing Tax Credits, available at: 

http://www.hud.gov/offices/cpd/affordablehousing/training/lihtc/basics/allocating.cfm. 

Eligibility, available at: 

http://www.hud.gov/offices/cpd/affordablehousing/training/lihtc/basics/eligibility.cfm

Syndication, available at: 

http://www.hud.gov/offices/cpd/affordablehousing/training/lihtc/basics/syndication.cfm. 
57

State Housing Agencies 

Alabama http://www.ahfa.com/ Alaska http://www.ahfc.state.ak.us/ 

Arizona http://www.housingaz.com/ Arkansas http://www.arkansas.gov/adfa/ 

California http://www.hcd.ca.gov/ Colorado http://www.dola.state.co.us/doh/Index.htm 

Connecticut http://www.chfa.org/MainPages/default.asp Delaware http://www2.state.de.us/dsha/ 

District of 

Columbia 

http://dhcd.dc.gov Florida http://www.floridahousing.org/ 

Georgia http://www.dca.state.ga.us/ Hawaii http://www.hawaii.gov/portal/ 

Idaho http://www.ihfa.org/ Illinois http://www.ihda.org/ 

Indiana http://www.state.in.us/ihfa/ Iowa http://www.ifahome.com/ 

Kansas http://www.kshousingcorp.org/ Kentucky http://www.kyhousing.org/ 

Louisiana http://www.lhfa.state.la.us/ Maine http://www.mainehousing.org/ 

Maryland http://www.dhcd.state.md.us/ Massachusetts http://www.mass.gov/dhcd/ 

Michigan http://www.michigan.gov/mshda Minnesota http://www.mhfa.state.mn.us/ 

Mississippi http://www.mshomecorp.com/firstpage.htm Missouri http://www.mhdc.com/ 

Montana http://housing.state.mt.us/ Nebraska http://www.nifa.org/ 

Nevada http://nvhousing.state.nv.us/ New Hampshire http://www.nhhfa.org/ 

New Jersey http://www.state.nj.us/dca/hmfa/ New Mexico http://www.nmmfa.org/ 

New York http://www.dhcr.state.ny.us/ocd/progs/lihc/ 

ocdli0.htm and 

http://www.nyhomes.org/default.htm 

North Carolina http://www.nchfa.com/ 

North Dakota http://www.ndhfa.state.nd.us/ Ohio http://www.odod.state.oh.us/ohfa/ 

Oklahoma http://www.ohfa.org// Oregon http://www.ohcs.oregon.gov/ 

Pennsylvania http://www.phfa.org/ Rhode Island http://www.rihousing.com/ 

South 

Carolina 

http://www.sha.state.sc.us/ South Dakota http://www.sdhda.org/ 

Tennessee http://www.state.tn.us/thda/ Texas http://www.tdhca.state.tx.us/ 

Utah http://www.utahhousingcorp.org/ Vermont http://www.vhfa.org/ 

Virginia http://www.vhda.com/vhda_com/front_page/

default.asp 

Washington http://www.wshfc.org/ 

West Virginia http://www.wvhdf.com/ Wisconsin http://www.wheda.com/ 

Wyoming http://www.wyomingcda.com/ 
58

Other Resources 

Websites 

1. The Affordable Housing Resource Center, http://www.novoco.com/resource.shtml. 

Articles 

1. National Council on Disability, Reconstructing Fair Housing, available at: 

http://www.ncd.gov/newsroom/publications/2001/pdf/fairhousing.pdf#search= 

‘reconstructing%20fair%20housing’ (last viewed February 21, 2005). 

2. Denise DiPasquale and Matthew E. Kahn, Measuring Neighborhood Investments: An 

Examination of Community Choice, 27 Real Estate Economics 389 (1999), available at: 

http://www.cityresearch.com/pubs/Measuring%20Neighborhood%20Investments1.pdf

(last viewed January 13, 2005). 

3. Denise DiPasquale, et. al, Comparing the Costs of Federal Housing Assistance 

Programs, FRBNY Economic Policy Review 147 (June 2003), available 

at:http://www.cityresearch.com/pubs/NY%20Fed%20Cost%20Paper.pdf (last viewed 

January 13, 2005). 

4. Jean Cummings and Denise DiPasquale, Building Affordable Rental Housing, February 

1998, available at: http://www.cityresearch.com/lihtc/cr_lihtc.pdf (last viewed January 

13, 2005). 

5. Jean Cummings and Denise DiPasquale, The Low income Housing Tax Credit: An 

Analysis of the First Ten Years, 10 Housing Policy Debate 251, available at: 

http://www.cityresearch.com/pubs/cummings.pdf (last viewed January 13, 2005). 

6. Alan Mallach, Toward a Policy Framework for the Allocation of Low income Housing 

Tax Credits, available at: http://www.njisj.org/reports/framework_report.html. (last 

viewed February 21, 2005). 
59

Expanding the Supply of Affordable, Accessible Housing: Learning 

from Kentucky 

As the description of low income housing tax credits demonstrates, “financial carrots” are 

effective in stimulating the development of affordable housing. Incentives can also be used to 

encourage the adoption of universal design principles in the building of affordable housing. In 

Kentucky, builders and developers whose rental housing and/or single family home construction 

or rehabilitation projects are partially (50%) or wholly financed by the Kentucky Housing 

Corporation (KHC), must follow KHC’s Universal Design Policy. This policy, in effect since 

1993, is designed to “ensure that much of the housing produced with KHC financing meets the 

needs of the greatest number of people for the longest period of time.” 

Background 

The Kentucky Housing Corporation (KHC) is Kentucky’s state housing finance agency. It was 

created in 1972 by the state’s General Assembly and is a self-supporting public corporation of 

the Commonwealth of Kentucky, administratively attached to the Finance and Administration 

Cabinet.14 A portion of KHC funds is derived from the interest earned through the sale of taxexempt mortgage revenue bonds, which has enabled thousands of low and moderate-income 

Kentucky families to find and live in affordable homes. KHC also receives fees for administering 

federal housing programs that make affordable housing available to low-income families. 

KHC administers and monitors a number of federal and state affordable housing programs, 

such as: 

• The HOME Program, a federal program that provides funding for various types of 

affordable housing production and rehabilitation (KHC also assists with the state 

matching funds requirement in the HOME Program) 

• The Affordable Housing Trust Fund, a state program that supports the acquisition, 

rehabilitation, and new construction of very low-income housing units and provides 

matching funds for federal housing programs requiring a state or local match 
60

• The Small Multifamily Affordable Loan Program (SMAL), a state program designed to 

increase the supply of affordable rental housing for lower-income individuals, 

particularly in rural areas of the state 

• The Housing Development Fund, a state program that provides flexible, low-interest rate 

construction loans for new construction, rehabilitation, site or land development, 

acquisition, or construction of prototype affordable housing 

• A number of other financing mechanisms that are designed to increase affordable and 

accessible housing stock in the state, including a new program called the Permanent 

Supportive Housing Initiative that provides non-profit and for-profit housing developers a 

zero percent revolving loan fund to cover predevelopment costs as well as grants to fund 

supportive services.15 

In 1996, the Kentucky General Assembly established a state policy on housing. The 

Commonwealth of Kentucky Housing Policy Act sets a number of objectives, including the 

following: 

• Identify the basic housing needs of all Kentuckians, including the elderly, persons of low 

and very low-income, the disabled, the homeless, and single-parent households 

• Coordinate housing activities and services among state departments and agencies to 

ensure program flexibility and comprehensive housing production 

• Remove administrative and regulatory guidelines to ensure compatibility in the 

development of affordable housing for all Kentuckians 

• Encourage and strengthen collaborative planning and partnerships among social service 

providers, all levels of government, and the public and private sectors, including forprofit and non-profit organizations, in the production of affordable housing16
61

In 2001, Kentucky became one of the first states to receive a Real Choice Systems Change Grant 

for Community Living from the Centers for Medicare and Medicaid Services (CMS), the federal 

agency that administers the Medicare and Medicaid programs. The purpose of the grant program 

is to build infrastructure that will result in effective and enduring improvements in community 

long-term service and support systems. These systemic changes are designed to enable children 

and adults of any age who have a disability or long-term illness to: 

• Live in the most integrated community setting appropriate to their individual support 

requirements and preferences 

• Exercise meaningful choices about their living environment, the providers of services 

they receive, the types of supports they use and the manner by which services are 

provided 

• Obtain quality services in a manner as consistent as possible with their community living 

preferences and priorities.17

Two of the long-term services and supports system problems Kentucky identified in its Real 

Choice grant application were related to housing: 

• Lack of funding for transition programs and limited housing options to allow individuals 

to live in community-integrated settings 

• Lack of communication among local public housing agencies, service providers, and 

advocates about the housing needs of people with disabilities 

To remedy this situation, Kentucky proposed to increase the stock of new, affordable, and 

accessible housing options, facilitate transitions to community living for people with disabilities 

and, “through partnerships with state and local housing agencies, ensure that new housing is fully 

accessible and incorporates universal design principles.”18
62

Developing Universal Design Principles 

With support from the CMS Real Choice grant and input from the public through public hearings 

and partners across the state, the Department of Design and Construction Review of the 

Kentucky Housing Corporation developed a Universal Design Handbook19 for use by builders 

and developers in the construction and reconstruction of affordable housing. The Universal 

Design Policy went into effect on January 1, 2003. 

While housing that incorporates universal design can clearly benefit people with disabilities, the 

Department of Design and Construction Review’s definition of universal design does not target 

any group in particular. In fact, their definition is all-inclusive and stresses the wide-ranging and 

lifelong benefits of housing built according to universal design principles: 

“Universal design is a building concept that incorporates products, general design layouts, and 

characteristics into residences in order to: 

• Make the residence usable by the greatest number of people 

• Respond to the changing needs of the resident 

• Improve marketability of the residence” 

The Universal Design Handbook prescribes the following design guidelines:20

1. Finished hallways should be 42” wide 

2. All doorways, including closet doors and entry doors, should be 32” wide at minimum. 

Specifications for entry platforms are also included 

3. Ground level and elevator accessible units must have a minimum of one full universally 

designed bathroom 

4. Single lever or ADA-approved faucets must be installed at all sinks, showers, and tubs 
63

5. Electrical outlets have to be installed at a minimum height of 15” and light switches, fan 

switches and thermostats at a maximum height of 48” 

6. All units must have at least one universally designed bedroom on the ground level or 

elevator accessible floor 

Specifications for exterior accessibility, including parking areas and walkways, are also included 

and, as an acknowledgment of the fact that more and more members of the population own and 

regularly use personal computers, cabling for high-speed internet access is also required. 

Tying Universal Design Policy to Funding Resources 

There are several ways that universal design guidelines are promoted at the federal, state, and 

local levels. Federal regulations, for example, set accessibility standards for large, new or 

rehabilitated multifamily housing built with the help of federal funds, but not for smaller 

projects. Some states, such as Georgia, and cities, such as Irvine, CA, have developed their own 

accessibility guidelines that builders and developers may voluntarily adopt, although these 

guidelines apply mostly to privately funded projects. In Kentucky, the Kentucky Housing 

Corporation has tied its universal design policy to its housing finance programs. Thus KHC 

universal design requirements are mandatory for any projects that receive debt or subsidy 

financing from KHC equal to 50 percent or more of the total cost of new construction (or 

reconstruction) of single-family or multi-family housing. The Department of Design and 

Construction Review offers a full array of technical assistance and likes to begin working with 

developers right from the inception of the project to ensure that they are meeting all building 

requirements, including the universal design guidelines. Once the project is built, the 

Department’s inspectors inspect the buildings and certify them. 

Many developers and builders around the country have been reluctant to incorporate universal 

design features into their projects because they believe the cost is prohibitive. Consumers buying 

new homes are also reluctant to request the features because they fear these features will add 

substantially to the cost of the housing.21 But several studies have shown that the added cost of 

universal design features is very modest. In Kentucky, KHC’s Department of Design and 
64

Construction Review has polled developers of multifamily and single-family dwellings and has 

found that, as a result of its Universal Design Policy, additional building costs for a two-bedroom 

unit are between $900 and $1,500. “Retrofitting,” or renovating, homes after they are built to 

accommodate the occupants’ changing physical needs is considerably more expensive. 

According to the Department of Design and Construction Review, since the Universal Design 

Policy went into effect in 2003, at least 500 units have been built that meet universal design 

requirements. 

Success Stories 

Housing corporations around the U.S. have given thousands of Americans access to affordable 

housing. In the past 31 years, Kentucky Housing Corporation has helped countless families find 

affordable rental housing, and its homeownership programs have assisted over 55,000 families in 

becoming homeowners, making Kentucky’s home ownership rate (74 percent) considerably 

higher than the overall national rate of 67.8 percent, according to 2001 U.S. Census data. 

Whether they own or rent, not only do more people have access to affordable housing, with 

KHC’s Universal Design Policy in full effect, they will have housing that will meet their needs 

for a long time to come. Here are a couple of examples of recent projects built according to the 

Universal Design Policy guidelines. 

• Hilton and Lively Partnership is a builder of affordable housing in central and western 

Kentucky, and many of their clients are single parents, seniors, and people with 

disabilities. Hilton and Lively receives some financing through KHC, so it has to comply 

with KHC’s Universal Design Policy. The firm works with manufactured housing, which 

does not normally incorporate universal design principles, such as wider hallways, 

generous space in bathrooms, and so on. But it has found a housing manufacturer willing 

to revise their construction plans to meet the universal design requirements and the firm 

is standing behind the quality of the homes they build by providing warranties, 

construction reinforcements, a traditional-looking roof pitch, a permanent foundation, and 

higher insulation standards compared to other similar homes. 
65

Hilton and Lively’s most recently funded project, the Hilton and Lively Homeownership 

Program, is building affordable (manufactured) housing with the basic features of 

universal design in Grayson County’s Big Clifty. The project received KHC financing 

through the HOME Investment Partnership Program and the Housing Development Fund. 

• Another project built with funds from the HOME Investment Partnerships Program is the 

South Main Street Apartments in Edmonton, Kentucky, which will serve older people 

with incomes at or below 50 percent of the average median income for the area, which is 

currently $32,500 a year. Funds from the state’s Small MultiFamily Affordable Loan 

Program (SMAL) were also used to build the one-story, 11-unit complex. 
66
67

Chapter IV 

Strategy Three: Agreement on Common Performance 

Measures Across Multiple Federally Funded Programs 
68
69

There is an enormous variety of programs that are designed to help older people and people with 

disabilities live independently in the community. But how effective are these programs? Do they 

respond to people’s actual needs and support their aspirations? Strategy Three is one way to 

begin addressing these questions. The initiatives illustrating this approach have developed tools 

that facilitate measurement of performance and outcomes. These tools can be applied to a variety 

of programs that serve people with disabilities and older people. 

The Program Assessment Rating Tool (PART) 

The Office of Management and Budget (OMB) developed the Program Assessment Rating Tool 

(PART) to assess and improve program performance so that the Federal Government can achieve 

better results with its programs. A PART review helps identify a program’s strengths and 

weaknesses to inform funding and management decisions aimed at making the program more 

effective. PART therefore looks at factors that affect and reflect program performance, including 

program purpose and design; performance measurement, evaluations, and strategic planning; 

program management; and program results. PART allows programs to show improvement over 

time. It also allows comparisons between similar programs because it includes a consistent series 

of analytical questions. 

PART’s current approach to individual program evaluation is just a starting point, however. To 

effectively measure programs that serve people with disabilities, the system must also evaluate 

the real impact that these programs have on the people they serve as well as the extent of 

collaboration among federal agencies to advance the overall goals of social and economic 

independence and community inclusion for people with disabilities. To achieve these valued 

outcomes, federal agencies will need to improve coordination across program lines to: 

• Provide affordable, appropriate, accessible housing; 

• Ensure accessible, affordable, reliable, safe transportation; 

• Adjust the physical environment for inclusiveness and accessibility; 
70

• Provide work, volunteer, and education opportunities; 

• Ensure access to key health and support services; and 

• Encourage participation in civic, cultural, and recreational activities. 22

When agencies and programs coordinate and work together, it is more likely that these desired 

results will be achieved. 

Program Background 

In July 2002, Mitch Daniels, Director of the Office of Management and Budget, announced the 

PART program as a tool for formally evaluating the effectiveness of federal programs. Mr. 

Daniels said that this “program assessment effort presents an opportunity to inform and improve 

agency GPRA [Government Performance and Results Act of 1993] plans and reports, and 

establish a meaningful systematic link between GPRA and the budget process.”23

OMB’s guidance describes PART as part of a “systematic method of assessing the performance 

of program activities across the Federal Government.” 

Program Description 

Overview of the Program Structure 

PART is a rating tool designed to hold agencies accountable for accomplishing results. PART is 

a diagnostic tool and the main objective of the PART review is to improve program performance. 

PART assessments help link performance to budget decisions and provide a basis for making 

recommendations to improve results. Programs are rated from effective to ineffective, and the 

ratings and specific findings produced are used to make decisions regarding budgets and policy. 

PART places the burden of proving effectiveness with the federal managers responsible for 

operating the program under review. The PART program provides meaningful evidence to 
71

Congress and other decision-makers to help inform funding decisions and identify flaws in 

underlying statutes that undermine effectiveness. 

History 

Previous administrations grappled with how to hold federal programs and federal managers 

accountable. 

• President Johnson launched his Planning, Programming, and Budgeting System in 1966 

to “substantially improve our ability to decide among competing proposals for funds and 

to evaluate actual performance.” The system was the first serious effort to link budgets to 

getting results and a form of it remains in use at the Pentagon today.24 

• President Nixon followed with an effort called Management By Objective. This 

attempted to identify the goals of federal programs to make it easier to determine what 

results were expected of each program and where programs were redundant or 

ineffective. President Nixon stated, “By abandoning programs that have failed, we do not 

close our eyes to the problems that exist; we shift resources to more productive use.”25

• President Carter attempted to introduce a concept known as zero-based budgeting in 1977 

to force each government program to prove its value each year. “[I]t’s not enough to have 

created a lot of government programs. Now we must make the good programs more 

effective and improve or weed out those which are wasteful or unnecessary,” President 

Carter stated in his 1979 State of the Union Address.26

• President Clinton’s Administration also offered a broad agenda to “reinvent” government 

to make it cost less and do more.27 

Thus far the most significant advance in bringing accountability to government programs is the 

Government Performance and Results Act of 1993. This law requires federal agencies to identify 

both long-term and annual goals, collect performance data, and justify budget requests based on 

this data. For example, in the 2003 budget, the Bush Administration rated approximately 130 
72

federal programs on their effectiveness. This first-ever attempt to directly rate program 

effectiveness was only a start. Since the criteria used to rate programs were not uniform and 

ratings were based on limited information, its influence on budget decisions was limited. 

How it Works 

PART is composed of a series of questions designed to provide a consistent approach to rating 

programs across the Federal Government, relying on objective data to assess programs across a 

range of issues related to performance. PART also examines factors that the program or agency 

may not directly control but may be able to influence. For example, if statutory provisions 

impede effectiveness, legislative changes may be proposed. The formalization of performance 

assessments through this process is intended to develop defensible and consistent program 

ratings. 

PART is a questionnaire, and evaluation proceeds through four critical areas of assessment–

purpose and design, strategic planning, management, and results and accountability. 

The questions that comprise PART are generally written in a “Yes/No” response format. They 

require the user to explain the answer briefly and to include relevant supporting evidence. 

Responses must be evidence-based and not rely on impressions or generalities. A “yes” answer 

must be definite and reflect a high standard of performance. Where hard evidence is unavailable, 

assessments rely more on professional judgment. No one question determines a program’s 

assessment; and in some instances, “not applicable” may be an appropriate answer. 

The first set of questions gauges whether the program’s design and purpose are clear and 

defensible. The second section involves strategic planning and weighs whether the agency sets 

valid annual and long-term goals for programs. The third section rates agency management of 

programs, including financial oversight and program improvement efforts. The fourth set of 

questions focuses on results that programs can report with accuracy and consistency. 
73

PART’s approximately 30 questions (the number varies depending on the type of program being 

evaluated) ask for information that responsible federal managers should be able to provide. For 

instance: 

• Is the program designed to have a significant impact in addressing the intended interest, 

problem, or need? 

• Are federal managers and program partners (grantees, sub-grantees, contractors, etc.) 

held accountable for cost, schedule, and performance results? 

• Has the program taken meaningful steps to address its management deficiencies? 

• Does the program have a limited number of specific, ambitious long-term performance 

goals that focus on outcomes and meaningfully reflect the purpose of the program? 

• Does the program (including program partners) achieve its annual performance goals? 

The answers to questions in each of the four sections result in a numeric score for each section 

ranging from 0 to 100 (100 being the best). These scores are then combined to achieve an overall 

qualitative rating that ranges from “effective,” to “moderately effective,” to “adequate,” to 

“ineffective.” Programs that do not have acceptable performance measures or have not yet 

collected performance data generally receive a rating of “results not demonstrated.” 

While single, weighted scores can be calculated, the value of reporting, say, an overall 46 out of 

100 can be misleading. Reporting a single numerical rating could suggest false precision, or draw 

attention away from the very areas most in need of improvement. In fact, PART is best seen as a 

complement to traditional management techniques, and can be used to stimulate a constructive 

dialogue between program managers, budget analysts, and policy officials. PART serves its 

purpose if it produces an honest starting point for spending decisions, but it is meant to enrich 

budget analysis, not replace it. The relationship between an overall PART rating and the budget 

is not a rigid calculation. Lower ratings do not automatically translate into less funding for a 

program, just as higher ratings do not automatically translate into higher funding for a program. 
74

How PART Results are Used 

PART provides Congress and other stakeholders with important insights into the operation of 

various programs. It also informs OMB and agency budget decisions, however it is not the only 

information used in making budgetary decisions. PART is published as part of the President’s 

budget.28 

Lessons Learned 

Over half of the programs analyzed in the first performance assessment received a rating of 

“results not demonstrated” because of the lack of performance measures and/or performance 

data. The vast majority of programs have measures that emphasize outputs (such as the number 

of brochures printed) rather than outcomes or results. 

Overall, grant programs received lower than average ratings, suggesting a need for greater 

emphasis on grantee accountability in achieving overall program goals. Programs found to have 

inadequate measures had to focus on developing adequate measures and collecting the necessary 

data before the evaluations were done for 2005. OMB states: “Programs that have not yet been 

evaluated can anticipate such scrutiny and assess the measures they currently have, and improve 

them where necessary.” 

Example 

The initial PART found that the vast majority of programs are using measures that emphasize 

outputs rather than outcomes or results. The Department of Health and Human Services’ Ryan 

White program ensures care and treatment for people with HIV through assistance to localities 

disproportionately affected by HIV. The program funding goes directly to the states and other 

public/private/non-profit entities. Through PART it was discovered that the program only 

measured the number of people it served; in the future it will also measure health outcomes, such 

as the number of deaths from HIV/AIDS.29 
75

2004 Summary Example: The Ryan White Program30
76

PART and People with Disabilities 

In 2004, the President’s Committee for People with Intellectual Disabilities (PCPID) released A 

Charge We Have to Keep: A Road Map to Personal and Economic Freedom for Persons with 

Intellectual Disabilities in the 21st Century. In the Road Map, PCPID identified a weakness in 

PART, namely that there are no measures that evaluate collaboration among related programs 

across federal agencies. There is also no assessment of agency activity to partner with the private 

sector and leverage resources to reduce dependence on government. PCPID explains that such 

measures would: “reveal the degree of an existing or total absence of a fluid continuity among 

agencies and programs. Continuity is very important for people with intellectual disabilities, for 

their disability or condition continues throughout their lifespan–from early family life, to 

education, to employment, to community living, and, finally, to retirement and end of life.”31

A single agency or program may appear successful in accordance with PART, but that particular 

agency or program may fail for people with disabilities because it does not, for example, provide 

the kind of continuity described above. The PCPID recommendation urges that OMB “consider 

the life span of people with intellectual disabilities when assessing agencies and programs.”32 

Conclusion 

With proper performance measures in place, federal programs that have an impact on the lives of 

people with disabilities can be redirected from outcomes that perpetuate poverty, dependence, 

and absence of personal freedom to valued results that lead to greater self-sufficiency, 

employment, and personal freedom. 

The PART program can be used to create “a new culture of measurement and accountability that 

raises expectations for policymakers, service providers, parents, and individuals with disabilities. 

In order for PART to be most effective and, simultaneously, benefit people with disabilities in 

the areas of housing, transportation, physical environment, work opportunities, health and social 

services, and engagement in community life, the current approach for evaluating programs 

through PART must be enhanced to measure the programs’ real impact on people’s lives and the 

extent to which agencies collaborate with one another to achieve the desired outcomes. 
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Resources 

Office of Management and Budget’s PART homepage available at 

http://www.whitehouse.gov/omb/part/index.html

Office of Management and Budget, Executive Office of the President, Budget of the United 

States Government: Creating a Better Government: Improving Government Performance; Fiscal 

Year 2002, at 11-14 (2001), available at: 

http://www.whitehouse.gov/omb/budget/fy2002/budget.pdf. 

PART Training slides. Available at: 

http://www.whitehouse.gov/omb/part/fy2005/2005_training_slides.pdf. 

Introduction to PART, Rating the Performance of Federal Programs, available at: 

http://www.gpoaccess.gov/usbudget/fy04/pdf/budget/performance.pdf. 

PART Frequently Asked Questions, available at: 

http://www.whitehouse.gov/omb/part/2004_faq.html. 

President’s Committee for People with Intellectual Disabilities. A Charge We Have to Keep: A 

Road Map to Personal and Economic Freedom for Persons with Intellectual Disabilities in the 

21st Century. (2004). 

Measuring Results: Learning from the Administration on Aging—State 

Collaboration to Develop Model Performance Outcome Measurement 

Systems 

The Administration on Aging (AoA) was created with the passage of the Older Americans Act, 

signed into law by President Lyndon B. Johnson on July 14, 1965 and reauthorized on November 

13, 2000. With a yearly budget of approximately $1.3 billion, AoA is part of a federal, state, 

tribal, and local partnership network that serves about 7 million older persons and their 

caregivers. AoA consists of 56 State Units on Aging, 655 Area Agencies on Aging, 233 Tribal 
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and Native organizations, two organizations that provide services to Native Hawaiians, 29,000 

service providers, and thousands of volunteers. AoA provides federal administration of 

community services programs that are mandated under the Older Americans Act, such as 

nutrition, transportation, and health promotion services, elder abuse prevention, and family 

caregiver support. AoA also awards funds to support research, demonstration, and training 

programs. 

AoA is sponsoring an initiative to develop and field test a core set of performance measures for 

state and community programs on aging operating under Title III of the Older Americans Act. 

Called the Performance Outcomes Measure Project (POMP), this initiative helps states and Area 

Agencies on Aging (AoA) address their own planning and performance reporting needs, while 

assisting AoA to meet the accountability provisions of the Government Performance and Results 

Act (GPRA) and the Office of Management and Budget’s program assessment requirements 

using the Program Assessment Rating Tool (PART). 

Background: The AoA Performance Outcomes Measure Project (POMP) 

POMP was initiated in response to the growing importance of collecting timely, accurate, and 

comparable data as a result of GPRA and the advent of PART, as well as related state and local 

initiatives that link continued funding to demonstrated program benefits and outcomes. While 

output information describes programs, clients, and services, the Government Performance and 

Results Act actually requires information about program outcomes, that is, information about 

how services received have helped the people who receive them and how funding for service 

systems is used to improve and modernize those systems. 

In order to measure service outcomes on the local level, AoA developed POMP in partnership 

with the National Association of State Units on Aging and the National Association of Area 

Agencies on Aging. The main objective of the project is to develop and field-test performance 

outcome measures suitable for ongoing use by local agencies and AoA in determining the 

effectiveness of aging networks and the services they provide. 
79

These measures emphasize individual outcomes related to the health and psycho-social state of 

the people who are served, including their nutritional risk, physical functioning, emotional wellbeing, social functioning, and satisfaction with the services they receive. Other measures look at 

the benefits of services that support caregivers and the degree to which people are satisfied with 

the home care services they receive. Measures are also being developed to capture the 

performance of the aging network in reducing barriers to services and building the capacity of 

the aging services system. 

Key Features of the Project 

Since the inception of the project, area agencies in more than twenty states have received funding 

from the AoA to collaborate on the POMP project. AoA has contracted with researchers to help 

develop data collection instruments in each of the measurement areas that draw on the best 

research available. The participating agencies are full partners in the development of these 

instruments and are participating in the field-testing of the performance outcome measures. A 

national research corporation under contract with AoA provides technical assistance to project 

sites in data collection methodology, tools for uniform data storage and transfer, and data 

analysis services for project sites and AoA. 

The POMP data collection instruments are essentially survey questionnaires that are 

administered by the participating agencies in their locales using sampling methodology, rather 

than collecting information from each person who participates in their programs. With the 

participation of the AoA grantees, performance measurement surveys have been developed for 

the following service areas: 

• Caregivers 

• Congregate Nutrition Program 

• Homemaker Service 

• Home Delivered Nutrition Program 
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• Information and Assistance Assessment 

• Transportation Service 

• Case Management 

• Senior Centers 

In addition, survey instruments were designed to document client characteristics, such as 

physical functioning, social functioning, emotional well-being, and demographic information. 

Using these standardized survey instruments, the individual grantees are responsible for 

conducting the surveys with their own service recipients (usually through telephone interviews), 

sharing the data with AoA, and participating in the refinement of existing measures and the 

development of any new ones. Through their participation in the program, grantees learn 

sampling techniques and methodologies for data collection and analysis, which are generally not 

widespread within the aging network. 

The National POMP 

Because the initial focus of POMP was to develop outcome measures and test them for local

program assessment, the findings from data collected by the individual grantees cannot be 

generalized. This initial period of the program allowed for the development and testing of data 

collection instruments, sampling procedures and methods, and information collection processes 

and procedures, and provided the local grantees with valuable information about the outcomes of 

service provision in their communities. 

AoA is now using the tools developed in the initial, local stage of the program to measure 

outcomes nationally. To date, AoA has conducted two national surveys employing the 

performance outcome measures developed so far in the program in order to evaluate, from a 

consumer perspective, whether its programs are meeting the needs of the older people they serve. 
81

For example, looking at one of its key service areas—nutrition—the national surveys help AoA 

determine: 

• The extent to which aging networks target services to elderly individuals at high 

nutritional risk 

• The extent to which nutritional risk is improved as a result of AoA meals programs 

• Overall consumer satisfaction with meals programs provided through the network 

Similar types of information are solicited through the surveys for the other areas of interest, such 

as transportation services, information and assistance services, home care services, and caregiver 

support services. 

Through POMP, AoA is developing a performance outcomes measurement system that: 

• Truly focuses on outcomes rather than the usual outputs 

• Involves (and even depends on) local service providers as key partners in outcomes 

evaluation 

• Standardizes measures so that they can be used across local sites as well as nationally to 

assess the impact of AoA programs on the lives of people they serve 

• Through initial surveys, establishes benchmarks against which future assessments can be 

compared to track progress over time 

• Establishes performance targets for future annual performance plans 

More information, as well as the survey instruments, can be found at www.gpra.net. 
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Federal Interagency Forum on Aging-Related Statistics: A Collaborative 

Effort to Measure the Well-Being of People Aged 65+ 

The Administration on Aging is one of several federal agencies that have been collaborating 

since 1986 to establish and report on a set of key indicators that describe the overall status of the 

U.S. population age 65 and over. 

The other collaborating agencies include the: 

• U.S. Census Bureau 

• Agency for Healthcare Research and Quality 

• Centers for Disease Control and Prevention 

• Centers for Medicare and Medicaid Services 

• National Institutes of Health 

• Office of the Assistant Secretary for Planning and Evaluation 

• Bureau of Labor Statistics 

• Department of Veterans Affairs 

• Environmental Protection Agency 

• Office of Management and Budget 

• Social Security Administration 

The Forum has so far published two reports (one in 2000, the other in 2004) entitled, Older 

Americans: Key Indicators of Well-Being, that bring together federal statistics from over a dozen 
83

national data sources to monitor several important areas in the lives of older Americans—

population, economics, health status, health risks and behaviors, and health care. The reports 

provide a broad summary of indicators of well-being for the U.S. population aged 65 and over 

and monitor changes in these indicators over time. By examining a broad range of indicators, 

researchers, policymakers, service providers, and the Federal Government can better understand 

the areas of well-being that are improving for older Americans and the areas of well-being that 

require more attention and effort. 

These reports are available at: http://www.agingstats.gov
84
85

Chapter V 

Strategy Four: Utilization of Private Sector Match to 

Competitively Secure Public Funding and Stimulate PublicPrivate Sector Partnerships 
86
87

Livable communities ensure that all residents, regardless of ability, are able to participate in the 

community’s economic, civic, and social life. The examples included under Strategy Four 

illustrate how public-private sector partnerships can promote asset development and financial 

independence among people with low incomes and people with disabilities. When people with 

low incomes and people with disabilities are able to accumulate income to continue their 

education, buy homes, and/or start businesses, they not only enrich their own lives, they help 

support the economy of the communities in which they live. 

Individual Development Accounts 

Among adults with disabilities, 34% live in households with a total income of $15,000 or less 

(compared to only 12% of those without disabilities), and approximately 70% of people with 

disabilities are unemployed.33 In a recent Harris Survey poll, 39% of people with disabilities 

indicated that the lack of financial resources is the most serious problem they face.34 With such a 

high unemployment rate, and so little income, people with disabilities, like other low-income 

families, are the least likely to save money.35

Individual Development Accounts (IDAs) are “asset development tools,” one of many economic 

development programs created by Congress over the last few years to provide savings incentives. 

IDAs are matched savings accounts that help people with low incomes accrue funds for the 

purpose of purchasing a first home, paying for post-secondary education, or starting a small 

business. Generally, IDAs are implemented by community-based organizations in partnership 

with a financial institution that holds the deposit and enable people to be more self-sufficient. 

Personal savings can be matched by federal and state governments and/or private sector 

organizations, generally at rates of 1:1, 2:1, or other more generous matches. In addition, an 

account holder usually receives financial counseling when he or she opens an IDA. 

Legislation, passed at the federal and state levels, governs how IDAs operate. Since 1991, at 

least 500 community-based IDA programs have been developed in 49 of 50 states. An estimated 

20,000 IDAs have been established in the U.S.36
88

The IDA program is a successful policy mechanism that has helped thousands of low-income 

families build their personal assets and invest in their communities and themselves. By 

facilitating asset building for the purchase of homes, small business development, and higher 

education, IDA programs have helped people with disabilities and other low-income families 

live more independently and contribute to their communities’ economy in the same ways that 

millions of other citizens do. 

Background 

Asset accumulation programs first emerged as part of U.S. domestic policy in the 1970s with the 

creation of savings vehicles such as IRAs, Roth IRAs, and 401(k)s. These programs, targeted to 

middle and upper income workers, provide savings incentives through tax relief.37 

In the late 1980s, Michael Sherraden offered a new theory of welfare based on assets, and an 

asset–building tool he dubbed IDAs. Sherraden proposed IDAs as private, long-term accounts 

established at birth, by public funds, and available to every person in the country. IDAs are like 

401(k)s, except that 1) IDAs use matching deposits instead of tax breaks as the incentive to save, 

and 2) people saving in an IDA do so with the help of a non-profit organization that usually 

requires economic literacy training.38

It was not until the welfare reform efforts by the Clinton Administration and Congress in the 

mid-1990s that enthusiasm for IDAs was generated. IDA savings products are now created under 

various Federal programs aimed to broaden their applicability. The U.S. Treasury Department’s 

Bank Enterprise Awards program and various initiatives under the Community Reinvestment 

Act are two examples. There are also IDA-like vehicles, such as Family Self-Sufficiency 

Accounts, administered by public housing authorities around the country and sponsored by the 

U.S. Department of Housing and Urban Development (HUD). In addition, 44 states have some 

type of IDA policy or initiative targeting a wide variety of low-income households.39 

Historical Progression of IDAs, Barriers, and Solutions 

Initially, several barriers hindered IDA participation by low-income people with disabilities. 

Before 1996, people receiving Supplemental Security Income (SSI) could not participate in 
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IDAs. The Social Security Act states that individuals are not eligible for SSI disability benefits if 

they have more than $2,000 in countable assets, and couples are ineligible if they have more than 

$3,000 in assets. Assets accrued in IDAs would make people ineligible for SSI disability 

benefits, thus eliminating any incentive to open an IDA. This barrier was overcome when 

Congress passed the Personal Responsibility and Work Reconciliation Act of 1996 (PWORA). 

PWORA authorized states to create community-based IDA programs with Temporary Assistance 

for Needy Families (TANF) block grant funds. This legislation allowed money saved in IDAs to 

be disregarded when determining eligibility for means-tested government assistance programs 

such as SSI.40 

A second perceived barrier to IDA participation by some policy analysts and advocates is the 

earned income requirement. The Assets for Independence Act (AFIA), Section 408—Eligibility 

for Participation, currently requires that an individual have earned income in order to participate 

in IDA programs. The majority of people who receive SSI and/or Social Security Disability 

Insurance (SSDI) want to work, yet not all are able to work full- or part-time. Leydorf & Kaplan 

(2001) proposed allowing people receiving SSI and/or SSDI to set aside a portion of their 

benefits and/or other non-earned income (e.g., gifts) in an IDA to help them enter or return to 

work and achieve economic productivity. 

The three main types of IDAs are TANF IDAs, Assets for Independence Act (AFIA) IDAs, and 

“non-TANF, non-AFIA” IDAs. Both TANF IDAs and AFIA IDAs are federally funded and are 

excluded from federal benefit program asset limits. Non-TANF, non-AFIA IDAs are those that 

rely on state, local, or private funds, and may be counted as assets in determining eligibility for 

government benefit programs (IDA State Policy Briefs, Vol. 1, No. 2). 

In an effort to test the efficacy of IDA programs, the Corporation for Enterprise Development 

(CFED) launched the Downpayment on the American Dream Policy Demonstration (ADD) in 

September 1997.41,42 This five-year demonstration sought to assess the number of participants, 

longevity of participation, patterns of savings, and amounts saved, as well as the uses of IDAs, 

whether for homeownership, education, employment, or other uses. ADD brought together 13 

community-based organizations43 from around the country to design, implement, and administer 
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IDA initiatives in their communities. At completion, 2,364 IDAs were established in low-income 

and asset-poor communities. Findings from ADD showed that the average monthly net deposits 

per participant were $19.07. The average participant saved 50 percent of the monthly savings 

target and made deposits in 6 of 12 months. Participants accumulated an average of $700 per 

year including matches. Notably, deposits increased as the monthly target increased.44 In 

addition, ADD succeeded in expanding the field of community-based IDA programs around the 

country by serving as the successful model for federally funded IDAs under the Assets for 

Independence Act (AFIA).45 

A key factor in making IDAs successful is economic education. Financial literacy helped IDA 

participants reach their goals and become better integrated into the mainstream economic system. 

IDA involvement has also been shown to influence participants’ “confidence about the future, 

willingness to defer gratification, avoidance of risky behavior, and investment in community.”46 

IDAs benefit communities as funds are reinvested right back into the community. The ADD 

graduates reinvested their savings in the community as follows: 28% used their savings to 

purchase a home, 23% to start or expand a small business, 21% for higher education, and the 

remainder for home repair, job training, or retirement.47 By December 2001, the 2,364 ADD 

participants had accrued $36,481,498 in savings, including matching funds with monthly 

deposits ranging from $30–$75. Startup costs averaged $70 per participant per month; after 

startup, expenses averaged $45 per participant per month. These costs are well worthwhile–the 

Corporation for Enterprise Development (CFED) “estimates that each federal dollar invested in 

IDAs would yield a return of approximately five dollars to the national economy in the form of 

new businesses, additional earnings, new and rehabilitated homes, reduced welfare expenditures, 

and human capital associated with greater educational attainment.”48

Thus, IDAs yield many benefits, including economic household stability, higher educational 

attainment, increased health and satisfaction, increased civic involvement, and decreased risk of 

intergenerational poverty transmission.49
How IDAs Work 

Table 3 identifies the key players and activities that comprise a typical IDA program. Each IDA 

program has a sponsoring organization with dedicated staff who, usually through multiple 

partnerships with financial institutions and training providers, coordinate and carry out IDA 

program activities that include raising matching and administrative funds, developing marketing 

and outreach materials, recruiting accountholders and opening accounts, providing training and 

counseling, administering matching funds, and collecting and managing account transaction data. 

It is important to note that the division of labor among key players varies widely. This is in part 

because IDA programs are uniquely designed in accordance with the structure and available 

resources of the sponsoring organization, as well as the specific needs of the target population. 50 

Table 3. Key Roles, Players, and Activities 

Key Role Possible Players Possible Activities 

Sponsoring organization Community-based non-profit, 

faith-based organization, credit 

union, community development 

financial institution, United Way 

agency, tribal organization. 

Program design, program 

administration, outreach and 

recruitment, enrollment, data 

collection, account 

monitoring, counseling. 

Funding provider Private foundations, financial 

institutions, chambers of 

commerce, federal agencies, 

local and state governments. 

Provision of planning, 

administration, matching 

funds. 

Financial institution Banks, credit unions and 

community development 

financial institutions. 

Maintain accounts, provide 

related financial services and 

products. 

Training provider IDA program sponsor, 

cooperative extension programs, 

financial institution staff, 

financial education specialists, 

credit counselors, homebuying 

counselors, financial aid 

counselors, small business 

development trainers. 

Administer financial literacy 

education classes, provide 

asset-specific training. 

Accountholder Welfare recipients, low-wage 

workers, rural poor, Native 

Americans, persons with 

disabilities, senior citizens, 

immigrants or refugees, youth. 

Open accounts, attend 

education and training classes, 

deposit funds, withdraw 

funds, purchase assets. 

From: Boshara, R. (December 2001) Building Assets: A Report on the Asset-Development and IDA 

Field. Washington, DC: CFED. 

91
92

Once recruited, account holders participate in what is usually a four-stage process. While the 

order of these stages may vary from one program to another, the sequence outlined is most 

common: 

1. Introduction and orientation. In a one-on-one or small group session conducted by the 

sponsoring organization, prospective accountholders typically learn about asset-building 

theory, how savings accumulate through compounding interest and how assets appreciate 

over time, how the IDA program is structured and administered, who is eligible to 

participate, and what asset purchases are permissible.51 

2. Opening accounts. After attending the orientation, participants open a savings account 

with the partnering financial institution.52 

3. Financial education and asset training. Usually early in the IDA program, 

accountholders are required to attend financial education classes that cover diverse topics 

such as household budgeting, personal financial management, establishing and repairing 

credit, goal setting, and principles of investing. Some programs also provide specialized 

training classes for one or more permissible asset purchases. Others provide counseling 

and related services.53 

4. Withdrawal and asset purchase. As accountholders reach their incremental or ultimate 

savings goals and identify their desired assets, they make approved withdrawals and 

purchase assets. Once assets are purchased, accountholders will either continue to save in 

their IDA or will transition to a standard savings account or other mainstream financial 

product.54 

Lessons Learned 

The following lessons have been gleaned from ADD and other IDA programs: 

1. Accumulation period. The accumulation period refers to the number of months after 

opening an account that participants may make deposits that are eligible for matching 
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funds. While IDAs were not originally envisioned as time-limited instruments, limited 

resources and the need to demonstrate results have made accumulation periods necessary. 

However, organizations must be sure that the accumulation period provides enough time 

for individuals to develop regular savings behaviors and accumulate the funds necessary 

to achieve their individual asset goals.55

2. Monthly savings target. Instituting a minimum monthly savings target aids 

accountholders in establishing regular savings behavior. Most programs serving adults 

have minimum monthly deposits between $20 and $50 per month.56 

3. Match cap. The IDA match cap or ceiling is the maximum amount an individual’s 

account will be matched. IDA programs have found annual or lifetime (i.e., total amount 

based on duration of the program) match caps most effective. Those who wish to 

encourage greater savings through lump-sum deposits (such as income tax returns) and 

reinforce savings behavior tend to set an annual maximum IDA match cap that is more 

than the minimum monthly deposit for 12 months. For instance, if the minimum monthly 

deposit is $25, an accountholder making regular deposits would save $300. If the 

matching rate were 1:1, the total IDA would be $600 at the end of 1 year. However, if the 

annual IDA match cap is $600, there is an incentive for extra saving beyond the monthly 

minimum or a planned deposit of anticipated lump sums.57 

4. Matching rate. There is still a great deal to learn about the relationship between 

matching rates and participant behavior. Surveys of and interviews with accountholders 

indicate that the matching rate initially attracts individuals to an IDA program. Higher 

matching rates seem to reduce the risk of participants making unauthorized, unmatched 

withdrawals and encourage accountholders to keep higher balances; they do not, 

however, seem to lead to larger deposits.58 

5. Wait period. Many programs institute a wait period of some number of weeks after 

enrollment before a matched withdrawal is allowed. This wait period serves to ensure that 

accountholders are not saving before they are ready to save and also promotes the 

accumulation of funds and development of good savings habits before withdrawal.59 
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6. Financial literacy education. Almost all IDA programs require accountholders to 

complete a certain number of hours of general financial education; some programs 

require that classes be initiated before accounts are opened and others require that classes 

be completed before matched withdrawals are made. The Center for Social Development 

reports that the number of required hours of general financial education ranges from 6 to 

45 among ADD programs, with a mean of 13 hours. Additional data on ADD account 

holders indicate that savings outcomes improved as the number of hours of financial 

education completed increased from zero to 12; outcomes leveled off or diminished once 

the number of hours exceeded 12. More extensive research is needed, however, to better 

understand the relationship between financial education and savings outcomes in IDA 

programs.60 

Individual account ownership is recommended to maximize individual responsibility and choice. 

Separate, parallel accounts are recommended to simplify accounting and prevent unauthorized 

withdrawal of matching funds. Monthly account statements allow accountholders to self-monitor 

savings behavior in accordance with a monthly budget and also serve as an incentive for greater 

savings by reporting the steady accumulation of matching dollars. Instituting penalties for 

unmatched withdrawals is viewed by most practitioners as an effective way to encourage saving 

and discourage withdrawals, although opinions vary as to what type of penalty is most effective. 

There is also disagreement in the field about what constitutes appropriate permissible uses for 

matched withdrawals. While home purchase, micro-enterprise, post-secondary education, and 

job training are seen as appropriate by most (if not all) practitioners, some programs allow one or 

two uses and rule out others based on their particular resources and expertise. Additionally, some 

programs allow withdrawals for other purposes–such as home repair or remodeling, purchase of 

an automobile or computer, retirement, or tuition for summer camp–that they deem appropriate 

for their specific target population. As a general rule, when determining permissible uses, it is 

recommended that practitioners not lose sight of the underlying policy goal of IDAs: to 

incentivize the accumulation of enduring and appreciating assets.61 
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Resources Used to Fund IDAs 

The costs of IDA programs are of growing interest to a wide range of IDA stakeholders. New or 

potential practitioners want to know what it will take to plan and implement their own IDA 

programs; policymakers want to know how much funding should be allocated to ensure the 

success of proposed IDA initiatives; private foundations want to know how their contributions 

are being used by host organizations; evaluators and policy entrepreneurs want to quantify actual 

program costs to identify ways to increase efficiency and reduce delivery costs so that IDAs can 

be implemented on a larger scale. While information on IDA program costs is far from complete 

or conclusive, evaluation data from ADD programs, which represent the longest-running IDA 

programs, provide insight into what sorts of time and resources are presently required to 

effectively deliver IDAs. 

A thorough cost study of the largest ADD program found the total program costs during the first 

two years of operation to be $129 per participant-month, or $3.56 for each dollar of participant 

net deposits.62 

Implementing IDAs in the States: Learning From Iowa 

Federal IDA-related legislation has influenced state IDA-related legislation, and vice versa. 

Many states have amended IDA legislation in ways that minimize restrictions and facilitate 

program delivery across diverse areas, supporting diverse populations. While some states 

continue to pursue restriction-heavy legislation, the more prominent trend is toward flexible IDA 

policies that minimize restrictions and facilitate program delivery. 

At the present time, there are 24 state-supported IDA programs operating and five programs in 

the planning stages. These 29 programs are funded by various funding streams, most commonly 

TANF funds, state general revenue funds, state tax credits, AFIA grant funds, and private funds. 

State IDA policy has strongly influenced federal IDA policy as well as growth of the IDA 

field.63 Significant state contributions to IDA policy include: 

1. Exempting the earnings on IDA savings from taxation. 
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2. Exempting IDA deposits as assets when determining qualifications in state-administered 

means-tested programs. 

3. Allowing IDA uses beyond home ownership, small business capitalization, or college 

education, such as home repair, car purchase, retirement savings, health care, job training, 

and job-related expenses (e.g., childcare, work equipment). 

4. Establishing IDAs for children, typically for educational expenses. 

5. Removing restrictions from early IDA program designs; creating programs that are 

appealing to special populations, among whom certain restrictions are considered 

inappropriate. 

6. Including Native Americans in program planning and implementation, with special 

considerations for cultural differences and governance structures of sovereign nations. 

7. Identifying and establishing a wide variety of funding streams at the federal, state, and 

local levels. 

8. Establishing the use of tax credits as a funding source for IDAs. 

The public and private sectors should look to state IDA policies for creative and innovative ideas 

to design broader and more inclusive IDA policies. 

Iowa64

In 1993, Iowa became the first state to pass IDA policy as part of its sweeping welfare reform 

bill, the State Human Investment Policy (SHIP). SHIP included a provision to establish a fiveyear IDA demonstration program that would create thousands of IDAs for individuals with low 

incomes. The first accounts were opened in 1996, and Iowa’s legislation became a model for 

other states desiring to enact IDA policy. 
Since 1999, the Institute for Social and Economic Development (ISED) Ventures has 

administered Iowa’s IDA program entitled Iowans Save! Program participants deposit money in 

special savings accounts that are then matched 1:1 with federal and local funds. Federal match 

funds are provided by the Assets for Independence Act (AFIA) through the Office of Community 

Services in the U.S. Department of Health and Human Services (DHHS). Local matching funds 

are provided by ISED Ventures program partners, the United Way of Central Iowa, and the Iowa 

Finance Authority. 

The Iowans Save! program requires participants to use the funds for first-time home ownership, 

higher education, or starting/expanding a small business. Eligibility is based on family size and 

earned income. Participants are required to show proof of earned income that cannot exceed the 

following guidelines (Table 1): 

Table 1. Income Guidelines 

Family Size Maximum Earned Income

1 $18,620 

2 $24,980 

3 $31,340 

4 $37,700 

5 $44,060 

6 $50,420 

7 $56,780 

8 $63,140 

Table 2 shows how the maximum match amount and the uses of the funds vary by location. 

Table 2. Maximum Matches 

Des Moines Elsewhere in Iowa 

Minimum deposit $25 per month $25 per month 

Match rate 1:1 1:1 

Funding sources DHHS 

United Way of Central Iowa 

DHHS 

Iowa Finance Authority 

Maximum matching contribution • $2,000 per individual 

• $4,000 per household 

• $1,000 per individual 

• $1,000 per household 

Permissible uses • First time home ownership 

• College/vocational training 

• Start/expand a small business 

• First time home ownership 

97
98

Iowans Save! also has a refugee program that matches every dollar saved with two dollars for a 

maximum matching contribution of $2,000 per individual and $4,000 per family. The refugee 

program is more liberal in allowable uses of IDA accounts and allows accountholders to use 

accumulated funds to buy a car or a computer and make home renovations in addition to the 

standard uses allowed in the other Iowans Save! program. 

The process for enrollment in the program begins with submittal of an application. Qualified 

applicants attend an orientation program in one of three sites (Des Moines, Waterloo, or Cedar 

Rapids), and then are ready to sign a savings agreement and open a savings account. 

Depending on the participant’s location, matching funds are kept in separate Iowans Save! bank 

accounts at Bankers Trust in Des Moines or US Bank in Waterloo and Cedar Rapids. Participants 

receive monthly bank statements that show individual savings, and quarterly bank statements 

that show the combination of individual savings and matched funds earnings. Participants who 

neglect to deposit funds for three consecutive months risk being dropped from the program and 

losing the match dollars. With the permission of an Iowans Save! program manager, emergency 

withdrawals of individual savings (not match funds) are allowed after 6 months of enrollment. 

Such withdrawals must be repaid within one year. 

The program provides all participants with financial education and purpose-specific training to 

facilitate sound decision making. “Dollars and Sense Money Management” is a series of free 

workshops that help participants manage their money and develop personal savings and budget 

plans. Participants get a confidential credit report and assistance in repairing credit problems (if 

applicable). “Homeownership Counseling” is a step-by-step program that takes first time home 

buyers through the entire process of purchasing a home. “Small Business Assistance” assists 

clients in researching relevant markets, developing business plans, and obtaining low-interest 

loans. “Higher Education or Vocational Training” helps clients develop educational savings 

plans. 

According to Iowans Save! legislation, for people to be considered eligible for the program, their 

income must be below 200% of the federal poverty guidelines, or earned income tax credit, or 

TANF. 
99

While relatively few people with disabilities have taken advantage of the Iowans Save program, 

the following true story shows how well the program can work for them: 

The success of the Iowans Save! program can best be illustrated with D.L.’s65 experience. 

D.L. is paralyzed from the waist down, uses a wheelchair to get around, and rents a 2-story 

house where she lives with her young son. D.L. heard about the Iowans Save! program from 

a friend and initially planned to purchase a ranch style home, with all rooms at ground level. 

D.L. was employed full time at John Deere Community Credit Union with an annual income 

below $28,000. In February 2000, she qualified for the IDA program according to Earned 

Income Tax Credit (EITC) guidelines. Leveraging EITC helps to “jump start” savings for 

people who find it difficult to save the $25 monthly minimum while making ends meet.66

D.L. completed the required “Dollars and Sense Money Management” class in March 2000 

and the “Homeownership Counseling” class in April 2000. By October 2003, D.L. saved 

nearly $4,000 and an additional $4,000 in matching funds, but could not find a suitable home 

within her price range of $80,000. 

D.L. was disappointed and considered dropping out of the program altogether (and losing the 

$4,000 in matching funds). Program staff, however, encouraged D.L. to consider using her 

funds in other approved ways and, following their advice, D.L. decided to revise her savings 

goal to open a business with her brother–a jazz club in Valley Junction, West Des Moines, 

Iowa. In February 2004, D.L. began the legal processes, including obtaining a liquor license, 

to open the club, and in June 2004 D.L. completed the Iowans Save! program, withdrew her 

money, and used the funds to open the club, which is still in operation. 

While D.L. did not fulfill her original intent to buy a home and continues to rely on family 

and friends to help her access the second floor, she is now the co-owner of a business that 

could help raise her income to the point where she will be able to buy an affordable and 

accessible home. 

Debra Carr, Director of Asset Development and Des Moines Office Development Manager, 

who provided this story, attributes D.L.’s success to her tenacity and ability to follow 

through. 

The AFIA grant expired in August 2004. From 1999 to 2004, ISED Ventures’ citizen IDA 

program and refugee IDA program helped 1,463 participants save for their futures. The overall 

impact has been reinvestment of $11,401,063 in the community in the form of purchased homes, 

education, business start-up, car purchases, computer purchases, and home renovations. 
100

The Future of IDAs 

There are several challenges that need to be addressed before IDAs can be implemented on a 

larger scale: 

• Make savings requirements more flexible. Current IDA policy is designed for the 

short-term. Policy and program success is often defined by asset purchases made within a 

few years of establishing the account.67 However, not everyone can effectively save 

according to a prescribed timetable. Policies need to be implemented that allow people 

with disabilities and other low-income families to save irregularly or deposit less than the 

minimum monthly amount provided they are saving for homeownership. 

• Support non-profit fundraising efforts and program delivery on the state level.

States regard IDA programs as public-private partnerships and often expect non-profit 

partners to raise private or federal funds before state funds are appropriated. However, 

states rarely assist in fundraising efforts. They provide matching dollars but often do not 

provide support for such things as program start-up or operating expenses. As a result, 

this may limit the expansion of IDAs in the states.68 

• Connect IDA programs to other state or federal asset-building programs. For IDA 

programs to grow, connections between these programs and other state or federal assetbuilding programs for low-income families must be explored. Such programs could 

include the Workforce Investment Act, Housing and Urban Development (HUD) Home 

Funds, and Federal Home Loan Bank (FHLB) Affordable Housing Programs. Forging 

such connections will require imagination and action on the part of policymakers and 

advocates, as well as agreement that the goal of giving all people the opportunity to build 

assets is good for the people and good for the country as a whole.69 

Additional Resources for More Information 

The Center for Social Development at Washington University in St. Louis. 

http://gwbweb.wustl.edu/csd/ 
101

Corporation for Enterprise Development. http://www.cfed.org/

IDA Network. http://www.idanetwork.org/

Administration for Children and Families at the U.S. Department of Health and Human Services. 

http://www.acf.dhhs.gov/assetbuilding/ 

Sherraden, M. (1991). Assets and the Poor: A New American Welfare Policy. New York: M.E. 

Sharpe, Inc. 

Boshara, R. (2001). The rationale for assets, asset-building policies, and IDAs for the poor. In R. 

Boshara (Ed.), Building Assets: A Report on the Asset-Development and IDA Field (pp. 2.005-

2.024). Washington, D.C.: Corporation for Enterprise Development. 
102
103

Chapter VI 

Strategy Five: Agreement on Changes in Infrastructure to 

Consolidate Administration of Multiple Programs and 

Improve Ease of Access 
104
105

Livable communities provide residents with access to employment opportunities and 

transportation options. But access to employment and transportation—which are inextricably 

linked—is among the most vexing barriers that people with disabilities face, partly because of 

lack of coordination among the various agencies and programs involved. The examples in 

Strategy Five illustrate how consolidation and coordination can improve access to these key 

livable community objectives. 

Workforce Investment Act (WIA) 

Congress passed the Workforce Investment Act (WIA) in 1998 to better serve job seekers and 

employers through a new framework that brings together multiple federal employment and 

training programs into a unified system of support.70 The single system is anchored by 

comprehensive One-Stop centers in each workforce investment area in all fifty states. 

Four separate federal agencies—the Departments of Labor, Health and Human Services, 

Education, and Housing and Urban Development fund 17 categories of programs that provide 

services through the One-Stop system.71 The Workforce Investment Act offers one of the most 

significant attempts to date to reexamine the way services are delivered to individuals in need of 

public assistance that recognizes the importance of consolidating categorical programs and 

streamlining service delivery to more efficiently and effectively meet the needs of target 

populations. Although WIA allows state and local governments the authority to design how best 

to implement the One-Stop system, the guiding principles of the Act require a focus on 

streamlined and integrated service with an emphasis on improved coordination and collaboration 

across agency lines.72

More than 80 percent of the state One-Stop Center plans include persons with disabilities and/or 

representatives of public and private agencies, such as vocational rehabilitation programs, that 

serve persons with disabilities in the state plan development process.73

Grant funds were used to purchase and install assistive and adaptive technologies in Resource 

Rooms to remove barriers to the use of information technology and to create greater program 

accessibility. The purchase of equipment was typically accompanied by training and technical 
106

assistance with frontline workforce development staff in the One-Stops to improve their 

understanding of using assistive technology to eliminate barriers to program accessibility.74

The majority of projects developed and implemented One-Stop Accessibility Plans that have 

removed many information technology, physical, and other program barriers. In addition, the 

majority of projects worked to develop accessibility guidelines for One-Stop Center Staff, and 

they continue to make accessibility guidelines a focus of activity in the State Workforce 

Investment Board and Local Workforce Investment Board working groups on disability issues in 

which they participate. Moreover, several projects developed and used accessibility checklists 

and survey tools to evaluate current physical and program access of One-Stops and provide 

assistance to reduce and eliminate barriers.75

Partnerships were established to help coordinate services for customers with disabilities in the 

One-Stop system. A focus of activities was to improve collaboration and resource support 

between mandated partners and non-mandated partners, including the Social Security 

Administration’s benefits counseling program, Vocational Rehabilitation (VR), Special 

Education, and Mental Health services.76 

Multiple strategies were implemented to coordinate with employers regarding opportunities for 

job seekers with disabilities. Several projects offered seminars and training for employers or 

developed employer toolkits to educate the business community on the advantages of hiring 

individuals with disabilities and providing accommodations to employees.77

A majority of projects provided education and training on identifying and assisting customers 

with disabilities to various staff members in One-Stop Centers, including frontline staff, 

Resource Room staff, and employment counselors. In addition, several projects provided training 

to employers, as well as to mandated and non-mandated partners.78 

Multiple strategies were designed and implemented in an effort to market to and reach jobseekers 

with disabilities, employers, the business community, One-Stop Centers, local boards, the 

disability community, and youth with disabilities. A majority of projects used marketing and 

outreach materials, including printed materials (e.g., flyers, brochures, posters, and newspaper 
107

and newsletter articles), joint activities with disability agencies, communication with schools, 

and websites. 

Despite past negative impacts on individuals with disabilities under the Job Training Partnership 

Act, the Workforce Investment Act offers meaningful opportunities for employment and asset 

development. 

Program Background 

When the Workforce Investment Act was enacted in 1998, it was a response to continued 

concerns of multiple stakeholders about the need to change the way employment and training 

services were delivered. It replaced the Job Training Partnership Act (JTPA) with three new 

programs—Adult, Dislocated Worker, and Youth. With an intent to make accessing employment 

and training services easier for job seekers, WIA consolidated 17 categories of programs, 

totaling over 15 billion dollars from four separate federal agencies into a unified One-Stop 

service delivery system.79 The following table identifies the consolidated employment and 

training programs. 

Table 4. WIA Mandatory Programs and Their Related Federal Agencies 

Federal Agency Mandatory Program 

Department of Labor WIA Adult 

WIA Dislocated Worker 

WIA Youth 

Employment Service (Wagner-Peyser) 

Trade adjustment assistance programs 

Veterans’ employment and training programs 

Unemployment Insurance 

Job Corps 

Welfare-to-Work grant-funded programs 

Senior community service employment program 

Employment and training for migrant and seasonal farm workers 

Employment and training for Native Americans 

Department of Education Vocational Rehabilitation Program 

Adult Education and Literacy 

Vocational Education (Perkins Act) 

Department of Health and Human Services Community Services Block Grant 

Department of Housing and Urban 

Development 

HUD-administered employment and training 
108

In order for a state to receive WIA funds, it must submit a state plan that describes its approach 

to the delivery of services through an integrated, seamless service delivery system anchored by 

comprehensive One-Stop Career Centers.80 States are provided the option of submitting a 

Unified Plan to meet Title I State Plan Requirements.81 A state may submit a Unified Plan that 

includes Vocational Rehabilitation programs authorized under the Rehabilitation Act (Title IV of 

WIA), Adult Education and Family Literacy programs, and Title I of WIA incorporating core, 

intensive, and training services. 

The guidance to states from the Employment and Training Administration of the U.S. 

Department of Labor defines national strategic directions including but not limited to: Integrated, 

seamless service delivery through comprehensive One-Stop Career Centers; maximum flexibility 

in tailoring service delivery and making strategic investment in workforce development activities 

to meet the need of state and local economies and labor markets; customers making informed 

choices based on quality training providers and increased fiscal and performance 

accountability.82

The intent of this unified planning is to encourage states to design and implement an integrated 

service delivery system that reduces overlap or duplication among programs and established 

policies and procedures and ensures collaboration among partner agencies. States are required to 

describe in their Unified Plan innovative service delivery strategies the state has or is planning to 

undertake to maximize resources, increase service levels, improve service quality, and achieve 

better integration.83 A state is required to describe its strategies to ensure that the full range of 

employment and training programs and services delivered through the One-Stop system are 

accessible and meet the needs of people with disabilities. With respect to the Vocational 

Rehabilitation program, a state must describe in a Unified Plan application what policies and 

procedures will be put in place to improve coordination and non-duplication of services with 

other public and private non-profit agencies or organizations. 

Program Description 

Under Title I of the Workforce Investment Act (WIA), each state’s governor is required to 

establish a State Workforce Investment Board, designate local workforce investment areas, and 
109

oversee the creation of local Workforce Investment Boards and the network of One-Stop Centers 

statewide.84 The One-Stop system is the basic delivery mechanism for adult and dislocated 

worker services. Services are organized into three levels: core, intensive, and training services. In 

addition, supportive services may be provided to individuals who are participating in core, 

intensive, or training services so that the services are effective and meaningful.85

Core services must be made available on a universal basis to individuals 18 years old or older. 

WIA regulations identify 11 categories of core services including initial assessment, job search, 

placement and career counseling information and referral to supportive services, and follow-up 

on services.86 Job seekers in need of additional assistance may be eligible for intensive services. 

Intensive service may include development of an individual employment plan, individual and 

group counseling, case management, and short-term pre-vocational services.87 As a result of 

more comprehensive and specialized assessment of skill levels and service needs, a job seeker 

may be identified as a candidate for training services that include occupational skills training, 

skills upgrading and retraining, adult literacy, and customized training with a commitment to hire 

the individual on completion of the training.88 In the event that WIA funds allocated to a local 

workforce investment area are limited, priority must be given to recipients of public assistance 

and other low-income individuals for intensive training services. 

The One-Stops are the anchor of the workforce delivery system. Each workforce investment area 

designated by a state’s governor must include at least one comprehensive physical center in each 

local area that must provide access to other programs and activities carried out by One-Stop 

partners.89 Each of the mandated partners must enter into a memorandum of understanding 

(MOU) with the local Workforce Investment Board (WIB) to describe roles and responsibilities, 

the service to be provided, and methods of referral and coordination. A single umbrella MOU 

may be developed between the Local Board and all partners, or the partners may decide to enter 

into separate agreements between the Board and one or more partners.90

All states and local workforce investment areas must report regularly to the U.S. Department of 

Labor based on four core indicators of performance. For the adult program, these indicators are 

a) entry into unsubsidized employment, b) retention in unsubsidized employment six months 
110

after entry into employment, c) earning level six months after entry into employment, and d) 

attainment of recognized credentials related to achievement of educational skills by participants 

who entered unsubsidized employment.91

Lessons Learned 

It has been six years since states began implementation of Title I of WIA (July 2000). Two GAO 

Reports in June 2003 and December 2004 examined One-Stop strategies to strengthen service 

and partnerships and access and participation for persons with disabilities.92 In the first study, 

GAO visited 14 One-Stop Centers nationwide to learn more about current activities to 

consolidate programs, strengthen program partnerships, and streamline service delivery for job 

seekers. All of the centers visited used at least one of three different strategies to build a more 

streamlined system that improves access to services, provides more knowledgeable staff about 

the full range of service options available through partner agencies, and consolidates case 

management and intake procedures. Co-location of staff, cross-training of staff, and coordinated 

planning meetings to identify and access resources to overcome barriers to employment for 

individual job seekers were all strategies identified by GAO as improvements to service delivery. 

GAO did identify that current tracking of individual outcome data did not provide information 

about the impact of various One-Stop integrated service delivery approaches. 

The second GAO study focused exclusively on access to One-Stops for persons with disabilities. 

The focus of inquiry extended beyond access questions to examine the various relationships 

between the One-Stops and other disability-related agencies providing services to persons with 

disabilities. GAO visited 10 local areas and One-Stops nationwide. The Department of Labor has 

awarded over 100 grants and 80 million dollars in the last four years for disability-related 

activities to enhance access and meaningful participation of persons with disabilities in the 

workforce development system. In addition to these capacity building grants, all One-Stops must 

comply with Section 188 of WIA to: 

• Take steps to ensure that communications with individuals with disabilities are as 

effective as communications with others, including providing appropriate auxiliary aids 

and services where necessary; 
111

• Provide reasonable accommodation to qualified individuals with disabilities who are 

applicants, registrants, or eligible applicants/registrants for, or participants in, employers 

of, or applicants for, employment with their programs and activities, unless providing the 

accommodation would cause undue hardship; 

• Make reasonable modification in policies, practices, or procedures, unless making the 

modifications would fundamentally alter the nature of the service, program, or activity; 

• Provide the most integrated setting appropriate to the needs of qualified individuals with 

disabilities; and 

• Take appropriate steps, such as advertising and marketing, to ensure that they are 

providing universal access to their WIA financially assisted programs and activities. 

The GAO report concluded that the local areas and One-Stops visited had made varying degrees 

of progress in improving physical and communication access. However, a number of the OneStops were still automatically referring all persons with disabilities to VR, and there were limited 

relationships developed with other disability service providers and funders. GAO’s concluding 

recommendations urge the Department of Labor to develop a long-term plan to improve access 

to a seamless, comprehensive service delivery system that leverages and coordinates resources 

more effectively. 

Conclusion 

The Workforce Investment Act provides a framework to consolidate federally funded programs 

with similar goals and objectives. The potential for a streamlined service delivery system with 

improved access for jobseekers with and without disabilities remains viable as states and local 

workforce investment areas continue to improve partner agency relationships, improve 

awareness and understanding of specific agency resources, and establish policies, procedures, 

and structures to be responsive to customer needs and expectations. 
112

A seamless system of universal access, common application for services, cross-agency staff 

training, planning, and collaborative case management and resource sharing are all important 

ingredients in making a community more livable for people with disabilities. 

Resources 

Workforce Investment Act: One-Stop Centers Implemented Strategies to Strengthen Services 

and Partnerships, but More Research and Information Sharing is Needed. GAO-03-725 

http://www.gao.gov/new.items/d03725.pdf 

Workforce Investment Act: States and Local Areas Have Developed Strategies to Assess 

Performance, but Labor Could Do More to Help. GAO-04-657 

http://www.gao.gov/new.items/d04657.pdf 

Workforce Investment Act: Labor Has Taken Several Actions to Facilitate Access to One-Stops 

for Persons with Disabilities, but These Efforts May Not Be Sufficient. GAO-05-54, 

http://www.gao.gov/new.items/d0554.pdf

“A Description of the Workforce Investment Act Legal Framework from a Disability Policy 

Perspective” - Bobby Silverstein 

http://disability.law.uiowa.edu/lhpdc/rrtc/documents/silverstein/WIA_full.doc 

“A Preliminary Analysis of the Relationship between the Workforce Investment Act and the 

Federal Disability Policy Framework” - Bobby Silverstein 

http://disability.law.uiowa.edu/lhpdc/rrtc/documents/silverstein/WIA_PRE_full.doc 

WIA Information and Tools 

http://www.doleta.gov/usworkforce/wia/ 
113

United We Ride: Learning From and Helping the States to Create 

Coordinated Transportation Systems 

Program Description 

The need for consolidation and coordination is keenly felt by the states in the area of 

transportation. In 2003, the Government Accountability Office (GAO) issued a report on 

“transportation disadvantaged populations” that identified 62 different federal programs across 8 

federal agencies that provide funding that may be used for community transportation services for 

people with disabilities, persons with lower incomes, and older adults. The report also noted that 

there are multiple public and private agencies that provide human service transportation93 in any 

one community, and services vary greatly in terms of eligibility requirements, hours or scope of 

operation, specific destinations, and quality. Given the multiplicity of programs and the 

significant dollar amounts spent, more effective coordination is needed to ensure better service to 

more people, particularly when federal, state, and local budgets for human service activities are 

under extreme pressure. 

In 2004, President Bush signed Executive Order 13330 to establish the Interagency 

Transportation Coordinating Council on Access and Mobility (CCAM) to improve coordination 

among these various transportation programs. The Council is composed of 11 federal 

departments (i.e., Departments of Transportation, Health and Human Services, Labor, Education, 

Housing and Urban Development, Agriculture, Justice, and the Interior; as well as the Veterans’ 

Administration, the Social Security Administration, and the National Council on Disability). 

In 2005, the CCAM submitted a report to the President outlining several recommendations that 

the Council believes will strengthen existing transportation services and make them more costeffective, accountable, and responsive to consumers. These recommendations and the related 

action plan to implement the executive order focus on: 

• Education and outreach to transportation providers in order to encourage and facilitate 

coordination, and to consumers to help them access the most appropriate transportation 
114

service for their needs; the development of a central website for information management 

and materials for human service transportation coordination 

• Consolidation of programs to simplify access to transportation services and enhance 

customer service; tools to help people navigate and use all the service options available, 

such as transit passes, vouchers, and travel training; and computerized, consolidated 

reservation, scheduling, dispatch, payment, billing, and reporting systems 

• Reduction of restrictive and duplicative laws, regulations, and programs related to human 

service transportation at the federal level, including duplication and conflict among 

statutes and regulations across the 62 federal programs; consideration and 

implementation of waiver demonstration programs 

• Coordinated planning, including a “Framework for Action” developed for and 

implemented in states; documentation of the current status of human services 

transportation coordination; and joint planning demonstration projects at the state and 

community levels 

• Cost allocation methodology and guidance to be developed and implemented 

• Documentation of successful strategies in coordinating human service transportation at 

the federal, state, tribal, and local levels 

The United We Ride program is cataloging “useful practices” and providing technical assistance 

and training to the states as well as opportunities for states to submit proposals for grants to 

develop and implement comprehensive state action plans for coordinating human service 

transportation. Grants under this initiative range from $35,000 to $75,000. In 2004, 45 states 

received United We Ride State Coordination grants and a new round of grants was awarded in 

2005 to states that propose to address one of the following priorities: 1) development and 

implementation of transit pass policy and programs with Medicaid and other agencies; 2) 

development of strategies for meeting the transportation needs of older adults, people with 

disabilities, and individuals with lower incomes during natural or man-made disasters; and 3) 
115

development of a cross-agency coordinated tracking and accountability systems; including real 

time eligibility, billing, and reporting. 

Arizona Rides 

Arizona is one of United We Ride’s first grantees. Soon after President Bush’s Executive Order 

was issued in 2004, the governor of Arizona, Janet Napolitano, called for a working group to 

begin building a human services transportation strategy for the state. In 2004, the working group 

submitted a grant proposal to assist with this planning, and the United We Ride grant was 

awarded in 2005. In 2005, lending further commitment to improved transportation coordination 

in Arizona, the Governor signed an executive order formalizing an “Arizona Rides” initiative 

and instituting the Arizona Rides Council, with membership including the Arizona Department 

of Health Services, Arizona Department of Economic Security, Arizona Health Care Cost 

Containment System, Arizona Department of Corrections, Arizona Council of Governments, 

Governor’s Office of Highway Safety, Governor’s Office of Intergovernmental Affairs, and 

others. 

The express purpose of the Arizona Rides initiative is to provide assistance to Arizona local 

governments and human service agencies in coordinating human services transportation. In her 

executive order, the Governor asserted that Arizona has a strong commitment to providing public 

transportation to persons with disabilities, older adults, and low-income families and individuals. 

She charged the Arizona Rides Council to develop a statewide coordination action plan and 

conduct related activities to 1) establish relationships between state, federal, and local entities to 

achieve a coordinated approach to human services transportation in the state; 2) build knowledge 

of successful approaches to coordinated human services transportation that can be used to 

promote such coordination in Arizona communities; and 3) increase communication and 

collaboration between state agencies in order to efficiently disseminate federal transportation and 

human services funds. 

Arizona Rides retained a consulting firm to conduct a statewide assessment of the current human 

services transportation system. This Statewide Assessment of Human Service Transportation 

Project is developing an inventory of providers, consumers, funding sources, service 
116

characteristics, and transportation opportunities and barriers. In addition, the study will identify 

areas where federal transportation reimbursement and grants can be obtained. This project is 

working in conjunction with a pilot coordination project among transportation providers in the 

Pinal County area in Central Arizona, an historically rural area that is experiencing rapid urban 

growth. The goal of this pilot project is to develop coordination tools that other regions in the 

state could use in their own communities. 

Arizona Rides is still in the “discovery phase,” trying to understand what the current 

transportation situation is before developing its implementation plan. For more information on 

this program and to follow its progress, see http://www.azdot.gov/PTD/UnitedWeRide.asp

Other State Transportation Coordination Efforts 

The United We Ride initiative is relatively new, but various states have been working on 

transportation coordination for many years. To recognize these efforts, United We Ride instituted 

the Leadership Awards Program and presented awards to 10 communities that have developed 

exemplary models of transportation coordination. 

Winners of the awards include the following: 

North Carolina 

In North Carolina, a 1978 Executive Order mandated coordination of transportation resources 

and established a state-interagency North Carolina Human Service Transportation Council 

(HSTC) that provides policy recommendations to the Department of Health and Human Services 

(DHHS), Department of Transportation (DOT), and other state agencies in addressing needs, 

barriers, and opportunities for the provision of human service transportation. There is longestablished communication and collaboration on human service transportation issues between the 

North Carolina DOT and the North Carolina DHHS. As a result, a full-time departmental level 

Transportation Program Administrator position was established within DHHS that is fully 

funded by DOT. 
117

North Carolina was the first state in the nation to require a Transportation Memorandum of 

Understanding at the local level that assures coordination between the transportation system and 

humans service agencies. In order to be eligible for Community Transportation Program funds, 

DOT requires each local transportation system to have a transportation advisory or governing 

board, which includes representation from the local Department of Social Services, the Aging 

Program, the Public Health Department, Mental Health and Community Rehabilitative Facilities, 

and the local Center for Independent Living on the transportation advisory board/governing 

board to ensure that public transportation services continue to meet the needs of individuals with 

disabilities. 

As a result of these collaborative efforts, all 100 North Carolina counties have human service 

transportation systems to serve the transportation disadvantaged. Additionally, the state has 

established a web-based “Cross County Transit Project” that allows users to coordinate nonemergency medical transportation trips across county jurisdiction lines to regional health care 

facilities. The state is currently working on establishing recommendations for uniform 

transportation reporting requirements for human service transportation service programs. 

Maryland 

Maryland’s 1997 Executive Order established the Maryland Coordinating Committee for Human 

Services Transportation and launched the state’s effort in addressing transportation coordination 

with human services agencies. The committee, chaired by the Maryland Transit Administration 

(MTA), represents a cross-section of human service and employment agencies. A five-year 

human services transportation plan was approved by the state agencies represented on the 

Committee to provide a foundation for improved coordination of services and funds to help the 

state meet current and growing mobility needs. To give guidance and recommendations to 

Maryland’s human service transportation providers, the MTA developed a comprehensive 

Maryland Transportation Coordination Manual. 

The Maryland Job Access and Reverse Commute Program, which relies heavily on partnerships, 

has become a national model of coordination, providing over three million rides since its 

inception. 
118

ACCESS Transportation Systems, sponsored by Port Authority of Allegheny County, is one of 

the largest coordinated paratransit programs (transportation services required by the Americans 

with Disabilities Act for people unable to use fixed-route transportation like buses and taxis) in 

the nation, providing about 1.9 million rides annually primarily to individuals with disabilities, 

those with low incomes, and older adults. About 35% of ACCESS’s trips are sponsored by more 

than 125 participating agencies that purchase transportation services. A founding principle of the 

ACCESS program in 1979 was coordination, which was seen as a way to avoid costly 

duplication of service, thereby making the maximum dollars available for the highest quality, 

least restricted service possible. 

Thanks to coordination of combined resources with its partners, ACCESS is a strong and 

extensive system, serving all of Allegheny County seven days per week, 365 days per year, 

6 a.m. to midnight. There are 430 vehicles in use on an average weekday, with assistance 

provided through the door, including assistance up or down up to four steps. The system design 

is a reflection of the community’s commitment to a transportation system that provides full 

mobility for its users. 

Central New York, NY 

The Central New York Regional Transportation Authority (CNYRTA) is a public authority and a 

public benefit corporation of New York State, created in 1970. Its purpose is to continue, further 

develop, and improve transportation and related services in the Central New York Transportation 

District. Of the seven New York counties eligible to join the transportation district, three 

counties have been part of the authority district since at least 1973 and a fourth commenced 

service on April 1, 2005. CNYRTA provides approximately 12 million passenger trips annually, 

covering more than 5.2 million miles of service with a combined fleet of 208 small and large 

buses. 

Examples of CNYRTA’s efforts to implement new, innovative strategies to improve the 

coordination of public and human services transportation include coordinating ride services with 

the paratransit division and several local not-for-profit agencies in 1978; enhancing 

transportation services for foster families/grandchildren; access to nutrition, shopping centers, 
119

and medical care for seniors; and improved access to employment opportunities for visually 

impaired individuals. In 1985, CNYRTA expanded to include the Metropolitan Commission on 

Aging, increasing the availability of coordinated services to the area’s senior population. 

Medicaid transportation was added in 1996, providing enhanced transportation alternatives for 

Medicaid patients traveling to and from their doctor/hospital appointments. Projects in 1999 

addressed the growing needs of low-income individuals/families by leveraging Temporary 

Assistance for Needy Families (TANF) Job Access and Reverse Commute (JARC) funding. 

CNYRTA was one of the first transportation providers in the state to form partnerships with 

local employers, colleges, universities, and other community sectors when it implemented its 

Mobility Management Center (MMC) in 1999 and today is a one-stop transportation center. 

Other unique aspects of this system are that it provides individualized trip planning, directing 

individuals to lower cost fixed-route services; computer assistance scheduling/dispatching 

software; automated passenger counters; and automated vehicle location to aid development and 

implementation of coordinated transportation services. 

For more information about United We Ride, these and other winners of the Leadership Awards 

Program, and “useful practices” implemented by states and counties, see 

http://www.unitedweride.gov. 
120
121

Chapter VII 

Strategy Six: Utilization of Waiver Authority to Promote 

State Options to Advance Consumer Choice and Community 

Participation 
122
123

The primary objective of the livable community concept is to provide people with disabilities 

choice and support to live independently in the community. The examples in Strategy Six 

illustrate long-term services and supports policies that support this objective. Many people 

believe that long-term services and supports alternatives like state Medicaid waiver programs 

should be the rule rather than the exception.

Medicaid and Social Security Waiver Authority 

Medicaid and Social Security offer two important sources of funding for support of individuals 

with disabilities. Medicaid offers states the opportunity to receive federal financial assistance to 

share in the cost of a wide range of community services. Individual states have some flexibility 

in the determination of eligibility and the scope of services covered. When first enacted as Title 

XIX of the Social Security Act in 1965, Medicaid was intended to provide a limited federal 

entitlement to purchase acute health care for low-income individuals and families.94 Over the 

past 25 years, significant expansion of Medicaid has occurred through the creation of waiver 

authority. Waiver authority allows states to apply to the federal Centers for Medicare and 

Medicaid Services (CMS) for approval of different amendments to their state plans that may 

impact who is eligible for services, what services may be covered, and the limits of coverage. 

Similarly, the Social Security Administration (SSA) has waiver authority it can grant to states on 

a case-by-case basis to modify existing policies and procedures and encourage testing alternative 

policies and procedures that promote independence and self-sufficiency for individuals with 

disabilities and their families. 

Medicaid Program Background 

Medicaid is an entitlement program designed to help states meet the costs of medically necessary 

health care for low-income and medically needy populations. When first enacted, Medicaid 

mandated coverage of primary and acute health care services and included limited long-term 

services and supports coverage in skilled nursing facilities for individuals aged 21 years and 

older. States are required to cover certain populations and provide fourteen basic mandatory 

services to all eligible, needy groups.95 The federal Medicaid requirements prohibit states from 
124

placing limits on mandated services solely because of diagnosis, type of illness, or condition. 

States must specify the amount, duration, and scope for each service they provide, which must be 

sufficient to reasonably achieve its purposes.96 

Beyond the federally required mandatory services, a state may elect to include other optional 

benefits in its program. A state has more flexibility in defining the specific services it offers 

within an optional service category. Table 5 lists Mandatory Medicaid benefits and Optional 

Medicaid Services. 

Table 5. Mandatory Medicaid Benefits and Optional Medicaid Services 

Mandatory Medicaid Benefits 

• Inpatient hospital services 

• Outpatient hospital services 

• Prenatal care 

• Physician services 

• Nursing facility services for persons age 21 or 

older 

• Home health services 

• Federally qualified health-center (FQHC) 

services, and FQHC ambulatory services 

otherwise covered by Medicaid in other settings 

• Rural health clinic services 

• Laboratory and x-ray services 

• Nurse-midwife services 

• Vaccines for children 

• Family planning services and supplies 

• Pediatric and family nurse practitioner services 

• Early and periodic screening, diagnostic, and 

treatment (EPSDT) services for children under 

age 21 

Optional Services 

• Diagnostic services 

• Clinic services 

• Intermediate care facilities for the mentally 

retarded (ICFs/MR) 

• Nursing facility services for children under age 21 

• Rehabilitative services 

• Physical and occupational therapy 

• Speech pathology and audiology services 

• Dental services and dentures 

• Inpatient mental health services for individuals 

age 65 and older 

• Hospice care 

• Case management 

• Other medical or remedial care furnished by 

licensed practitioners under state law 

• Durable medical equipment 

• Transportation services 

• Optometrist services and eyeglasses 

• Home and community-based services as an 

alternative to institutionalization 

• Prescribed drug and prosthetic devices 

• Chiropractic services 

• Private duty nursing services 

• Screening and preventative service 

• TB-related services for TB infected individuals 

• Inpatient psychiatric facility for people under 

age 22 

• Program of All-inclusive Care for the Elderly 

(PACE) 

• Personal care/assistance 

• Respiratory care for ventilator-dependent 

individuals 

• Prosthetic devices 
125

In response to the increasingly higher costs of nursing facility care and the institutional bias 

which was part of the initial authority in 1970, home health services became a mandatory 

benefit.97 In 1981, Congress authorized the Home and Community Based Services (HCBS) 

waiver authority.98 The 1915(c) waiver, named after the section of the Social Security Act that 

authorized it, allows states to provide services not usually covered by the Medicaid program to 

keep a person from being institutionalized. Home- and community-based services (other than 

room and board) for specific eligible populations are now part of waiver programs in all 50 

states. 

In addition to the HCBS waiver authority, there is also a Section 1115 waiver authority. Section 

1115 of the Social Security Act provides CMS broad authority to support experimental, pilot, or 

demonstration projects to test new ideas related to the financing and delivery of medical and 

supportive services. The proposed experiment or demonstration must be a program model that 

had not been tested previously and could not be conducted within the boundaries of a more 

limited waiver authority, such as the HCBS waiver. A Section 1115 waiver must be budget 

neutral over the life of a project, typically five years. In other words, the model cannot be 

expected to cost the Federal Government more than it would cost without the waiver. There are a 

number of states with current 1115 demonstration projects that are testing managed-care 

approaches covering acute and long-term services. Other states are using 1115 authority to test 

self-directed support plans, individual budgets, and the hiring of family members to provide 

services.99

Program Description 

States may offer a variety of services to participants under an HCBS waiver program and are not 

limited to the number of services that can be provided. For an individual to be eligible under a 

specific HCBS waiver, the individual must meet targeting and service criteria. Targeting criteria 

may involve age, diagnosis, or condition. Most states have multiple waivers targeted to different 

groups, such as persons with traumatic brain injury, persons with AIDS, and persons with 

intellectual and developmental disabilities. 
126

Individuals who meet the targeting criteria must then meet the service criteria, which usually 

requires the individual to meet the eligibility requirements to enter either a hospital or nursing 

facility or Intermediate Care Facility for persons with intellectual, and the defined home- and 

community-based services to be provided have to correspond to the level of care provided in 

institutional settings. States must demonstrate that waiver services are only being provided to 

individuals who are eligible for institutional placement. Equivalent criteria for waiver services 

and for institutional placement stem from the waiver program’s primary purpose, which is to 

offer alternatives to institutional placement.100 

States have the flexibility to design an HCBS waiver to meet the specific needs of defined 

groups. HCBS can be divided into five overarching categories: personal care and assistance; 

specialty services, including access to assistive technology; adaptive services, including home 

and vehicle modifications; family and caregiver supports, including respite care; and social 

supports and case management or service coordination.101

States may use an HCBS waiver to provide a combination of both traditional medical services 

(i.e. dental services, speech and occupational therapy) as well as non-medical services (respite 

care, environmental modifications, and service coordination). There is no limit on the number of 

services that can be offered under a single waiver program as long as the waiver retains costneutrality and the services are necessary to avoid institutionalization. Two important 

requirements of mandatory and optional services coverage under a state’s Medicaid plan are not 

required under an HCBS waiver. Under a “comparability requirement,” a state cannot offer a 

mandatory or optional service only to persons who have a particular condition or offer it in 

different forms to different groups.102 Under the “statewideness requirement,” a state cannot 

offer a mandatory or optional service to a particular geographic region.103 With federal approval, 

however, a state can design an HCBS waiver that waives both the comparability and 

statewideness requirements so that services are targeted to a specific number of individuals in a 

defined group and in only one area or region of the state. A state may choose to cover a specific 

service such as personal assistance services at a basic level in its state plan, and then build on this 

level of coverage through waiver programs to provide additional support to specific target 

populations. 
127

Independence Plus Waivers 

On May 9, 2002, Secretary Tommy Thompson, who was Secretary of the Department of Health 

and Human Services (DHHS) at the time, unveiled the Independence Plus initiative in response 

to Executive Order 13217, in which DHHS promised to provide states with simplified model 

waiver and demonstration application templates that would promote person-centered planning 

and self-directed service options.104

Independence Plus is based on the experiences and lessons learned from states that pioneered 

consumer self-direction. Specifically, two national pilot projects demonstrated the success of 

these approaches in the 1990s: (a) the Self-Determination project in 19 states that focused 

primarily on the Home- and Community-Based Services §1915(c) waivers, and (b) the “Cash 

and Counseling” project in 3 states that focused on the §1115 demonstrations. These programs 

allowed service recipients or their families the option to direct the design and delivery of services 

and supports they received, with the goals of avoiding unnecessary institutionalization, 

experiencing higher levels of satisfaction, and maximizing the efficient use of community 

services and supports.105

The §1915(c) and §1115 Demonstration Applications have different approaches and distinctly 

different authorizing provisions of the Social Security Act. The following table compares the two 

application approaches106: 
128

Table 6. Section 1115 Demonstration Authority vs. Section 1915(c) HCBS Waiver 

Authority 

Issue Section 1115 Demonstration 

Authority 

Section 1915(c) HCBS Waiver 

Authority 

Cash allowance Participants may manage the cash 

allowance directly 

Participant does not manage cash 

allowance directly 

Hiring legally responsible 

individuals 

States may hire legally responsible 

individuals 

States may hire legally responsible 

individuals 

Provider agreements Provider agreements may be waived Provider agreements must be 

executed 

Direct payments to providers Direct payments by the Medicaid 

agency to providers may be waived 

Direct payments by the Medicaid 

agency to providers may be waived 

Payment for services made prior to 

delivery of services 

Services may be reimbursed prior to 

delivery 

Services must be delivered prior to 

payment 

Level of care Level of care may vary Individuals meet institutional level 

of care 

Services which may be self-directed 

(presents participants with the option 

to control and direct Medicaid funds 

identified in an Individual Budget). 

State plan of HCBS services HCBS services only 

Combining populations States may combine any population Combining populations is limited 

by: age/disability, intellectual 

disability/developmental disability, 

mental illness, or any subgroup 

thereof 

CMS is consolidating the existing Independence Plus template into a new web-based Section 

1915(c) application with instructions. The consolidation enables the expansion of a variety of 

self-directed options in existing waivers; consistent participant protections across all waiver 

programs; minimal administrative burden to states; an easier waiver amendment process; and 

improved communication of expectations for quality.107

There are 11 approved Independence Plus waivers in 10 states, and several states are working 

with CMS to submit proposals.108

Conclusion 

States currently operate over 250 distinct waiver programs.109 In waiver programs states have the 

ability to design programs that meet the unique needs of individuals with disabilities. The waiver 

program is the fastest growing segment of Medicaid, with expenditures and number of persons 

covered increasing annually by more than 10 percent.110
129

These waiver programs constitute the principal way that states can offer services and supports 

that are consumer-centered and promote independence and community participation among 

people with disabilities. There continues to be strong opposition to the inherent institutional bias 

of Medicaid, as well as support for converting the waiver authority into the main program 

framework rather than the exception to current Medicaid policy. At the time of writing this 

report, in the Deficit Reduction Act of 2005 new options were included for states to establish 

Home- and Community-Based Services as a state plan option without tying back eligibility to an 

institutional level of care. CMS in 2006 will be issuing program guidance to provide a more 

detailed explanation for states on design and implementation.111

Resources 

Schneider, A., Elisa, R., Garfield, R., et al. (2002). The Medicaid Resource Book. Menlo Park, 

CA: The Kaiser Commission on Medicaid and the Uninsured. Available at: 

http://www.kff.org/medicaid/2236-index.cfm. 

Understanding Medicaid Home and Community Based Services: A Primer (2000). Washington 

DC: Office of the Assistant Secretary for Planning and Evaluation. 

Centers for Medicare and Medicaid Services 

http://cms.hhs.gov/medicaid

State Medicaid Agency Websites 

http://www.cms.gov/medicaid/allStateContacts.asp

Using Medicaid to Support Working Age Adults with Serious Mental Illnesses in the Community: 

A Handbook (2005). Washington DC: Office of the Assistant Secretary for Planning and 

Evaluation. 

Home and Community-Based Services: Medicaid Research and Demonstration Waivers 

http://www.pascenter.org/demo_waivers
130

Centers for Medicare and Medicaid Services Waiver Application and Technical Guide 

http://www.cms.hhs.gov/medicaid/waivers/quality.asp

Livable Communities for Adults with Disabilities, (2004). Washington, DC: National Council on 

Disability. Available at: 

http://www.ncd.gov/newsroom/publications/2004/LivableCommunities.htm

Learning from the States 

Implementing the 1915(c) Waiver Through Maryland’s New Directions 

Program 

Maryland and Florida are profiled here because of their innovative use of Medicaid waiver 

authority. Maryland is an example of a state that is using the Independence Plus initiative of the 

1915(c) HCBS waiver program to promote livable community principles, enabling individuals 

with disabilities to remain in their own homes and communities. 

Maryland’s New Directions Waiver is a pilot program approved by the Federal Government to 

allow people receiving services from the Maryland Developmental Disabilities Administration 

(DDA) to self-direct their services. New Directions is available to people in all parts of the state 

who are living in their own homes with their families.112 The program began on July 1, 2005, 

and during its first year will allow up to 100 people to direct their own services. 113 Individuals 

who are interested in taking more of a management role in organizing the services they receive 

are good candidates for this program. 

Everyone in New Directions receives an individual budget. With assistance from a Fiscal 

Management Service (FMS) and a person called a Support Broker, the individual manages 

his/her budget, hires and supervises his/her own staff, and makes decisions about how the 

services are provided. The FMS pays bills, takes care of tax paperwork, and provides monthly 

budget statements. The Support Broker is someone the care recipient trusts to help him/her 

navigate the system, manage service providers, and act as an advocate on the care recipient’s 

behalf. 
131

Each person enrolled in New Directions develops a plan, with input from family, friends, and 

others invited to participate, that spells out how the person wants to live his/her life. The plan is 

the foundation for developing an individual budget, which identifies available funds for 

approved services.114

The New Directions Waiver is designed to increase flexibility and choice for people receiving 

community supports.115 Self-Directed Services that are available under New Directions include: 

• Assistive technology and adaptive equipment (e.g. communication devices) 

• Accessibility adaptations (e.g. grab bars, doors widened, etc.) 

• Respite 

• Supports brokerage 

• Support services 

• Supported employment 

• Transportation 

The following traditional services may be part of the plan, too:116

• Behavioral supports 

• Resource coordination 

• Traditional day services 

• Transition services 
132

The Support Broker must: 

• Have a criminal background check 

• Be trained on person-specific information 

• Be familiar with self-directed services and the DDA service system 

The Support Broker helps to: 

• Develop the plan 

• Develop and manage the budget 

• Develop an emergency back-up plan 

• Manage the services 

• Recruit, hire, and supervise the staff 

Resource Coordinators are involved with care recipients from the moment planning begins and 

adjust their level of involvement in response to the amount of help that the care recipients want 

or need. The Resource Coordinator assists the person in prioritizing what services they need, and 

will help in the budget development process. The budget is based upon the individual plan. 

The Resource Coordinator monitors the individual plan to make sure that services provided are 

helping to achieve the outcomes identified in the plan. The Resource Coordinator may also check 

in periodically to make sure that the care recipient is happy with his/her services, including 

his/her Support Broker. If necessary, the Resource Coordinator reports areas of concern to the 

Maryland DDA. If all of a care recipient’s budget is not spent, the Maryland DDA retains one 

half of the savings and allows the care recipient to purchase an item in the plan that may not have 

been originally included in the budget with the remainder of the savings. 
133

The Florida Freedom Initiative: Self-Directed Services with a Work 

Incentive Plan 

The Florida Freedom Initiative (FFI) is an attempt to build on the success of the ongoing “Cash 

and Counseling” demonstration, called Consumer Directed Care Plus. Florida has been 

conducting this program with partners that include the Centers for Medicare and Medicaid 

Services (CMS); the Office of the Assistant Secretary for Planning and Evaluation at the 

Department of Health and Human Services (DHHS); the National Program Office at the 

University of Maryland Center on Aging; the Robert Wood Johnson Foundation; the National 

Council on Aging; and Mathematica Policy Research (as the evaluator). 

FFI is an initiative that can be replicated in other states as a way of ensuring that people with 

disabilities have affordable, accessible services and housing. It is a demonstration being 

conducted by the Florida Agency for People with Disabilities (formerly the Florida Department 

of Children and Families) with a grant from CMS. Those who will participate in the 

demonstration are Medicaid beneficiaries, most of whom have developmental disabilities and use 

long-term care supports, including the services of a personal attendant. The FFI will test ways to 

better enable these individuals to live and work in their communities. 

Instead of agency-furnished services, FFI participants receive a cash allowance that is set aside 

in a restricted account. Within certain parameters, participants are able to direct disbursements 

from the account to purchase supports and services of their choosing to meet their long-term care 

needs. 

The FFI will also promote generation of personal income through work, especially through the 

development of very small businesses called micro-enterprises. Participants and their support 

network will receive training in micro-enterprise development. 

In conjunction with the FFI, the Social Security Administration (SSA) is conducting a 

demonstration called Work Incentives for Participants in the Florida Freedom Initiative. The 

SSA demonstration will provide the following waivers of SSI program rules for FFI participants: 
134

• As in the cash and counseling demonstration, funds received as a cash allowance but not 

spent will not count as resources during the demonstration, and interest earned by such 

funds will not count as income 

• SSI rules regarding federally supported individual development accounts (IDAs) will 

apply to non-federally supported IDAs, subject to approval of the IDA program’s rules by 

SSA’s Office of Disability and Income Security Programs 

• The earned-income exclusion will be $280 plus half the remainder of funds received as 

cash-allowance, but not spent, instead of $65 plus half the remainder of cash-allowance 

not spent. The general exclusion of $20 will continue to apply 

An individual may specify post-secondary education as the goal of a plan for achieving selfsupport, or PASS, as long as the plan includes a step for the specification of a work goal at least 

one year prior to completion of course requirements. A PASS approved with a goal of postsecondary education need not be completed before the Florida Freedom Initiative ends. 

SSI beneficiaries participating in the Florida Freedom Initiative will be exempt from continuing 

disability reviews (CDRs) during the demonstration. 

The FFI plans to enroll about 1,100 SSI beneficiaries statewide. Start-up activities began in 

February 2004. Recently, the Agency for Persons with Disabilities (APD) announced that 

approximately 6,600 additional persons with developmental disabilities would be served in the 

2005–2006 fiscal year (FY). Letters are already going to individuals on the waitlist to begin the 

enrollment process.117 To date, over 3,000 new people have been enrolled for services and 

supports. Florida’s Governor, Jeb Bush, signed the FY2005–2006 State budget that provides the 

APD with over $1.2 billion to provide services for Floridians with developmental disabilities.118 

The APD has been able to provide critical services and supports for persons with developmental 

disabilities to reach their full potential in the home and community. The budget has been 

increased by 144 percent and in FY2004–2005 served over 33,000 Floridians with 
135

developmental disabilities. APD will reach approximately 40,000 persons with developmental 

disabilities this year, an increase of 18 percent.119

California’s Independence Plus Section 1115 Demonstration 

California’s Independence Plus Program is called California In-Home Supportive Services 

(IHSS) Plus Demonstration. California submitted an initial proposal for the program on May 4, 

2004, and the proposal was approved by CMS on July 30, 2004. The demonstration program was 

implemented on August 1, 2004, and is scheduled to expire on July 31, 2009.120

The purpose of the program is to provide aged, blind, and disabled adults and children with selfdirected personal care assistance and service delivery options. These services and options were 

previously available under the “Residual Program” (RP) of the IHSS program that has been 

operating since 1973. The RP was set to be eliminated from the State’s budget effective July 1, 

2004, however California sought to preserve these self-directed services and options through the 

Section 1115 authority of the SSA. These services and options have enabled participants to 

remain in their family residences or in their own homes and helped to avert the need for higher 

cost institutional care, acute hospital services, and emergency room visits.121

The target population includes approximately 66,000 Medi-Cal eligible elders and persons of all 

ages with disabilities who are or will be determined to be in need of personal care or other 

supports that would allow them to remain in their homes and who select a spouse or parent to 

provide these services to them. Demonstration enrollees include the approximately 26,000 

persons who were enrolled in the IHSS RP. The IHSS Plus benefits include: 

• Self-directed, hands-on personal care services, which consist of the ability to hire, fire, 

and supervise personal caregivers, including spouses or parents; direction and 

management of caregivers’ hours of service; and the choice to receive, in advance of 

services being rendered, the cash allotment to pay caregivers directly and hire substitute 

caregivers in urgent situations (“advance pay” option). 
136

• Domestic and related services provided by a spouse or parent, i.e. house cleaning to 

reduce threats to participant health and safety; shopping for food and other necessities; 

miscellaneous chores; meal planning; preparation and clean-up; and routine laundry. 

• Restaurant Meal Allowances (RMA), an option for participants whose disabilities prevent 

them from using their own cooking facilities and who are deemed to need RMA in lieu of 

meal planning, preparation, clean-up, and food shopping services that they would 

otherwise receive. 

• Protective supervision by a spouse or parent, which consists of monitoring non selfdirecting persons, confused persons, or persons with mental illness by observing, 

reminding, cueing and/or redirecting participant behavior in order to safeguard the 

participant against injury, hazard, or accident. 

• Up to 195 hours of assistance per month, or if service recipients have significant 

impairments, up to 283 hours per month.122 

There are three types of service delivery modes: 

• Individual Provider Mode: The participant directly hires, fires, and supervises an 

individual provider 

• Contract Mode: The County or Public Authority enters into a contract with a third party, 

e.g., a home health agency, that provides a pool of workers 

• Homemaker Mode: The County trains and employs individuals that provide personal care 

assistance.123 The program will be operated at the county level. 

Counties are responsible for: 

• Processing applications for services 
137

• Completing assessments of recipient needs for service 

• Authorizing service hours based on the assessments 

• Providing social worker assistance 

• Receiving timesheets from providers and entering data into the payroll system 

• Responding to consumer issues and complaints124

The California Department of Social Services is the “payroll agent” and as such will approve 

provider rates and calculate taxes, unemployment insurance, and workers’ compensation 

benefits. Participants remain the “common law employer” of their service providers, but 

California law requires each of the state’s 58 counties to act as the “employer of record” for 

collective bargaining purposes, or to establish a Public Authority, a Non-Profit Consortium, or a 

Joint Powers Agency to fulfill these duties. Most of the state’s 58 counties have established a 

Public Authority. 

The counties or these entities have the following responsibilities: 

• Coordinate access to a provider chosen by the participant 

• Maintain a provider registry to help find caregivers 

• Conduct background checks 

• Provide access to training for providers and participants 

• Perform any other functions related to delivery of IHSS or RP services 

• Ensure that all state and federal regulations are met125
138

No cost sharing is proposed. Participants could pay a share of cost for IHSS program services 

based on individuals’ net non-exempt income in excess of the applicable SSI/SSP benefit level. 

There is no enrollment limit or cap on the number of people that can be enrolled. 

The Department of Social Services Adult Programs Branch’s Evaluation and Integrity Unit has 

ongoing quality assurance responsibilities, including conducting onsite reviews, investigating 

unusual events, and tracking consumer satisfaction and improvements by county. Public 

Authorities and the counties handle unusual events and emergencies that impact participants. 

County case managers are responsible for responding to participant issues or complaints. The 

State’s Protection & Advocacy program; the State and Local Long-Term Care Ombudsman 

Programs; the Department of Mental Health; the Department of Developmental Services; the 

Office of Civil Rights in the Departments of Social Services and Health Services; the Area 

Offices for Aging; the Adult Protective Services system; and the Regional Centers are available 

to participants for advocacy support. The State plans to put in place additional quality assurance 

strategies during the demonstration.126 

Conclusion 

Waiver authority of the Social Security Administration and CMS offer states an immediate 

opportunity to be creative and innovative in their design of policies and procedures to promote 

individual self-sufficiency and community access and participation. The relationship between 

livable community principles and the goals of the HCBS wavier program are complementary. 

Individuals with disabilities across the age span are seeking ways to remain at home and in their 

community with public assistance to respond to their long-term support and service needs. 

Federal-state collaboration that takes maximum advantage of federal wavier authority offers a 

viable strategy to redesign the service delivery system to be responsive to changing consumer 

preferences and expectations to remain in and participate in community life. 
139

Additional Resources 

Florida Assisted Living 

http://www.floridaaffordableassistedliving.org

Florida Freedom Initiative Federal Register Notice: 

http://www.ssa.gov/regulations/articles/FL%20Freedom%20Initiative.htm

Memoranda: HCBS Quality Communication #10, 1915 (c) Waiver Application; Instructions and 

Technical Guide; Resource documents; CMS Review Instrument: November 15, 2005. 

Baltimore, Maryland: Centers for Medicare and Medicaid Services, Center for Medicaid and 

State Operations. 

New Directions Waiver Fact Sheet. Maryland Developmental Disabilities Administration. 

http://www.tash.org/mdnewdirections/factsheets/index.htm

Maryland Developmental Disabilities Administration 

http://www.ddamaryland.org/

Maryland Medicaid Website: Waiver Programs 

http://www.dhmh.state.md.us/mma/waiverprograms/

State Medicaid Agency Websites 

http://www.cms.gov/medicaid/allStateContacts.asp
140
141

Chapter VIII 

Recommendations for Action 
142
143

A livable community recognizes and responds to the universality of needs of its residents 

regardless of age, economic status, race, gender, or abilities. In improving its livability for one 

particular group of constituents, the community considers opportunities to respond to all

community members’ needs from a perspective of accessibility, equality, and inclusion. 

This report identifies and highlights multiple strategies that may be applied to the design and 

support of livable community principles. The identified strategies have been initiated by federal 

and state government agencies as well as the private sector. These entities have recognized the 

power of collaboration and use of distinct tools to guide and stimulate systemic changes to make 

communities more livable for all. The highlighted strategies touch all facets of what livable 

communities do, that is provide residents with: 

• Affordable, appropriate and accessible housing 

• Affordable, accessible, reliable, and safe transportation 

• Work and education opportunities 

• Health and support services 

• Civic, cultural, social, and recreational participation opportunities 

The examples presented offer an optimistic view of the possibilities to change the way 

government organizes and manages resources, interacts with the business community and 

community developers, and responds to the expectations of evolving consumer interests, needs, 

and preferences for more choice and control in the delivery of support services. 

Reviewing the six strategies presented in this report to promote more livable communities, NCD 

recognizes in the diverse approaches several common elements of design that support livable 

community objectives, such as the need to: 
144

• Improve ease of access to and information about benefits, programs, and services for 

community members 

• Stimulate private sector interest, involvement, and investment of resources through the 

use of tax incentives 

• Consolidate program administration where appropriate and pool funds of multiple 

programs to improve consumers’ ease of access to these programs 

• Allow waivers of traditional rules of program eligibility, service architecture, and 

management of funds to improve coordination of public and private resources and 

consumer satisfaction 

• Reach agreement on common performance measures across program authorities that 

recognize the value and benefits of the livable communities framework 

The Council recognizes that to accelerate awareness and adoption of the highlighted strategies, 

there is no single recommendation that can produce the desired results at a community level. 

However, the following proposed recommendations offer multiple, complementary options for 

the legislative and executive branches of the Federal Government to direct needed attention to 

and proactively adopt strategies and policy levers that invest in livable community outcomes. 

With the aging of America and the challenges of disability in over 20 percent of families 

nationwide today, and possibly a greater percentage tomorrow, knowledge utilization and 

transfer from these best practices examples is essential. 

Recommendations 

1. Issue a new Executive Order to charge the Office on Disability of the Department of 

Health and Human Services to chair a time-limited workgroup (six months, for 

example) on livable communities that includes representation by the Departments of 

Housing and Urban Development (HUD), Transportation, Education, Labor, 

Treasury, the Social Security Administration, the Centers for Medicare and 
145

Medicaid Services, the Administration on Aging, the Administration on 

Developmental Disabilities, and the Office of Community Services within the 

Department of Health and Human Services. 

Implementation Lead: Office on Disability, HHS 

The workgroup will identify policy barriers and facilitators for livable communities with 

particular emphasis on how to adopt and promote the use of the highlighted strategies in 

this report. Each agency will identify options for reduction of fragmentation in the service 

delivery system; improved coordination of access to services and benefits; expanded 

consumer choices and direction of services and supports; and development of strategic 

public and private partnerships that invest in livable community objectives, including 

universal design of housing, access to health care, transportation, education and 

employment, and cultural, social, and recreational opportunities. The final report to the 

President will include recommendations for policy and practice changes within each 

agency as well as in coordination with other agencies. 

2. Modify federal requirements for allocation of low-income housing tax credits so 

that, in making awards to developers, all states require a) the adoption of universal 

design standards, and b) documentation of approaches to allow a minimum of ten 

percent of units in multifamily affordable housing developments to be affordable to 

individuals with disabilities on fixed incomes (SSI/SSDI recipients). 

Implementation lead: Department of the Treasury, HUD 

The utilization of low income housing tax credits is one of the most significant financial 

resources still available to create affordable, safe, housing. The success of universal 

design standards adopted by the state of Kentucky, and required in all projects that are 

awarded tax credits to expand the availability of accessible living units, merits adoption 

at the federal level. The additional documentation regarding efforts to make a percentage 

of units affordable to individuals with disabilities at 30 percent and below average 

median income would stimulate private investment in livable community objectives. 
146

3. Modify current performance measures being used to assess individual program 

strengths and weaknesses to focus on cross-department and agency collaboration to 

enhance livable community outcomes. 

Implementation Lead: Office of Management and Budget (OMB) 

The Program Assessment Rating Tool (PART) now being used by OMB has adopted 

common performance measures to evaluate programs and agencies across the Federal 

Government. However, there is no measure or analysis of cross-department and agency 

collaboration. There is also no adoption of the livable communities framework as the 

metric for measurement is on individual outcomes. Government agency and program 

performance should also focus on systems and system relationships. Three simple 

questions should be answered: 

a. Is the program promoting livable community principles? (Provide documentation) 

b. Through interagency and public-private strategic partnerships, is there improved ease 

of access to and information about coordinated programs, benefits, services, and 

supports that results in more livable communities? (provide documentation) 

c. Are policies and procedures available, including waiver authority, to help 

communities more easily blend resources from multiple authorities to enhance livable 

community results with expanded consumer choice? (provide documentation) 

An Annual Report to Congress should be prepared on individual agency performance. 

4. Utilize grant funds from the Centers for Medicare and Medicaid Services, Social 

Security Administration, and Departments of Labor, Commerce, Health and 

Human Services, Transportation, and Housing to offer a consolidated Livable 

Communities Program Initiative that streamlines 1) a single application for funds, 

2) utilization of waiver authority, 3) consolidation of program management and 

service delivery, and 4) use of tax credits to reengineer the delivery of long-term 
147

supports, transportation, housing, employment, education, and cultural, social, and 

recreational opportunities at a community level. 

Implementation Lead: Office on Disability, HHS 

Collaborating Agencies: Domestic Policy Council; Administration on Aging; 

Department of Health and Human Services (HHS); Social Security Administration; 

Centers for Medicare and Medicaid Services 

The unified grant initiative could support the more rapid evolution and demonstration of 

livable communities and move outside traditional silo funding of narrow areas of need to 

allow and stimulate more creative problem-solving. 

5. Expand tax incentives to promote matched savings plans for low-income wage 

earners across the life span.

Implementation lead: Department of the Treasury; Senate Finance Committee; House 

Ways and Means Committee 

Individual Development Accounts (IDAs) are promoting savings and asset development 

as a path to reduced dependency on government and improved self-sufficiency for lowincome wage earners nationwide. To expand access to IDAs, an expanded tax incentive 

for financial institutions to match individual savings has been proposed and has received 

strong bipartisan support. 

State and federally supported IDAs should be exempt from asset tests that determine 

continued eligibility for Social Security and Medicaid. The two authorizing Committees 

in the Senate and House should hold hearings on expansion of the IDA program to 

promote a better economic future for individuals with disabilities. The public-private 

sector partnership opportunity deserves the prompt attention of Congress as part of the 

livable communities framework. 
148

6. Utilize and leverage community service opportunities to create livable communities.

Implementation lead: Corporation for National Service (CNS) 

The strength of a community can be defined by its inclusiveness and its accessibility. 

Americorps and VISTA members have engaged individuals of all ages in community 

service to improve safety and expand the quality of educational, employment, and 

recreational opportunities. A Livable Community Initiative could target Americorps and 

VISTA volunteers to specific communities that can demonstrate a commitment to 

universal design elements to respond to the needs of all its residents. The focus of 

community service activities could include, but not be limited to, a range of challenges: 

affordable and accessible housing; social, cultural, and civic participation; access to 

lifelong learning; and improved transportation and health care systems. Awards of 

community service resources would be made on a competitive basis. 

7. Focus on the Gulf Coast recovery and rebuilding to promote livable community 

outcomes.

Implementation lead: White House; Domestic Policy Council; Congress 

The reconstruction efforts in Louisiana, Mississippi, and Texas are in their early stages. 

There are many individuals with disabilities and seniors who have been displaced by the 

hurricanes. Multiple systems must be rebuilt, including, as priorities, housing, health 

care, and transportation. The area offers a unique opportunity to design with universal 

livability standards that promote the values of accessibility, equality, and inclusion. With 

the power of tax incentives and other federal resources, there is the opportunity to 

improve the quality of life for all individuals in the impacted region. By adopting 

universal design standards, individuals with disabilities should be a part of the 

decisionmaking process. 

8. Establish a National Resource Center on Livable Communities to educate 

policymakers, government administrators, community developers, people with 
149

disabilities, and the public about best practices in policy development and program 

implementation.

Implementation lead: National Institute on Disability and Rehabilitation Research 

This report will help increase awareness of the growing number of examples of federal, 

state, and local action to respond to changing consumer expectations across the spectrum 

of age and disability. However, there is the need to establish a central source of 

information that continues to gather and update examples of communities that have 

adopted and continue to improve the livability framework. There is the need for further 

research on the outcomes of new service architecture and the impact of increasing choice 

for consumers. The proposed Center should also be proactive in bringing diverse 

stakeholders together to enhance knowledge utilization.
150
References 

1

 National Council on Disability. (2005). The State of 21st Century Long-Term Services and 

Supports: Financing and Systems Reform for Americans with Disabilities, p.15. Washington, 

DC. Available at: 

http://www.ncd.gov/newsroom/publications/2005/publications.htm 

2

 National Council on Disability. (2004). Livable Communities for Adults with Disabilities. 

Washington, DC. Available at: 

http://www.ncd.gov/newsroom/publications/2004/LivableCommunities.htm#executivesummary 

3

 Center for Home Care Policy and Research, Visiting Nurse Service of N.Y. (2004) The 

AdvantAge Initiative National Survey of Adults Aged 65 and Older. Available at: 

www.advantageinitiative.org 

4

 www.211.org 

5

 Vermont, Massachusetts, New Jersey, West Virginia, Louisiana, Texas, Iowa, Wisconsin, 

Minnesota, North Dakota, Vermont, Idaho, and Hawaii. 

6

 www.infoline.org 

7

 www.211.org 

8

 Many 211 lines do not accept calls from cell phones 

9

 Ibid. 

10 Opening Doors: Using the Low income Tax Credit Program to Create Affordable Housing for 

People with Disabilities. Emily Cooper and Ann O’Hara. 2005. Available at: 

http://www.c-c-d.org/od-April05.htm 

11 Ibid.

12 Ibid. 

13 S. 859. Oct. 26, 2005 Sens. John Ensign, R-Nev., John Kerry, D-Mass., Rick Santorum, R-Pa., 

and Debbie Stabenow, D-Mich., today sent a ‘Dear Colleague’ letter to Senate Finance 

Committee Chairman Charles Grassley, R-Iowa, and Ranking Member Max Baucus, D-Mont., in 

support of including a modified version of the Community Development Homeownership Tax 

Credit Act, as proposed in S. 859, in the tax package being developed to help rebuild the Gulf 

Coast. April, 20, 2005 Referred to Senate committee. Status: Read twice and referred to the 

Committee on Finance. 

14 http://www.kyhousing.org/about/mission.cfm 

151
152

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15 www.kyhousing.org/about/HPAC.cfm

16 Ibid. 

17 “Invitation to Apply for....”, p.3. 

18 Kentucky 2001 Real Choice Systems Change Grant. 

19 Kentucky Housing Corporation, Department of Design & Construction Review (July 2003) 

Universal Design Handbook. 

20 More details on these specifications are included in the Universal Design Handbooks. Certain 

exemptions are allowed. 

21 Livable Communities for Adults with Disabilities, Available at 

http://www.ncd.gov/newsroom/publications/2004/LivableCommunities.htm 

22 These are the six areas that define livable communities for people with disabilities. National 

Council on Disability. Livable Communities for Adults with Disabilities. (December 2, 2004). p8. 

Available at: 

http://www.ncd.gov/newsroom/publications/2004/LivableCommunities.htm 

23 Government Performance Management. “OMB’s Program Assessment Rating Tool (PART).” 

Available at: http://www.john-mercer.com/omb_part.htm 

24 Office of Management and Budget. “FY 2004 Budget Chapter Introducing the PART: Rating 

the Performance of Federal Programs.” (2004). Available at: 

http://www.gpoaccess.gov/usbudget/fy04/pdf/budget/performance.pdf/ 

25 Ibid.

26 Ibid. 

27 Ibid.

28 Office of Management and Budget. “Program Rating Assessment Tool: Training Slides.” 

(2004). Available at: 

http://www.whitehouse.gov/omb/part/fy2005/2005_training_slides.pdf

29 See note 19. 

30 Available at: 

http://www.whitehouse.gov/omb/budget/fy2004/pma/ryanwhite.pdf#search=‘Ryan%20White% 

20Program’ 
153

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31 President’s Committee for People with Intellectual Disabilities. A Charge We Have to Keep: A 

Road Map to Personal and Economic Freedom for Persons with Intellectual Disabilities in the 

21st Century. (2004). p19. Available at: 

http://www.acf.hhs.gov/programs/pcpid/2004_rpt_pres/2004_report.html 

32 Ibid. 

33 Leydorf, D. & Kaplan, D. (May 2001) Use of Individual Development Accounts by people 

with disabilities: Barriers and solutions. Oakland, CA: World Institute on Disability. 

34 National Organization on Disability/Louis Harris and Associates, Inc. (2000) Employment 

rates of people with disabilities. National Organization on Disability/Louis Harris and 

Associates: 2000 Survey of Americans with Disabilities. 

35 Leydorf & Kaplan, 2001. 

36 Edwards, K. & Mason, L.M. (May 2003) Policy Report: State Policy Trends for Individual 

Development Accounts in the United States: 1993-2003. St. Louis, MO: Washington University 

George Warren Brown School of Social Work. 

37 Leydorf & Kaplan, 2001. 

38 Ibid. 

39 Ibid. 

40 Ibid. 

41 Center for Social Development, Washington University George Warren Brown School of 

Social Work. Available at: 

http://www.gwbweb.wustl.edu/csd/asset/add.htm 

42 The Downpayments on the American Dream Policy Demonstration (ADD) was supported by 

11 foundations including: the Ford Foundation, Charles Stewart Mott Foundation, Joyce 

Foundation, Citigroup Foundation, F.B. Heron Foundation, John D. and Catherine T. MacArthur 

Foundation, Fannie Mae Foundation, Levi Strauss Foundation, Ewing Marion Kauffman 

Foundation, Rockefeller Foundation, and the Moriah Fund. 

43 ADD Partner Sites included (1) Advocap, Inc. in Oshkosh, WI; (2) Alternatives Federal Credit 

Union in Ithaca, NY; (3) Bay Area IDA Collaborative in Oakland, CA; (4) Capital Area Asset 

Building Corporation (CAAB) in Washington, D.C.; (5) Community Action Project of Tulsa 

County (CAPTC) in Tulsa OK; (6) Foundations Communities in Austin, TX; (7) Central 

Vermont Community Action Council (CVCAC) in Barre, VT; (8) Heart of America Family 

Focus Center in Kansas City, MO; (9) Mercy Corps in Portland, OR; (10) Owsley County Action 

Team in Booneville, KY; (11) Near Eastside IDA Program in Indianapolis, IN; (12) Shorebank 

Corporation in Chicago, IL; and (13) Women’s Self-Employment Project in Chicago, IL. 
154

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44 Individual Development Accounts. Retrieved August 5, 2005 from: Center for Social 

Development, Washington University George Warren Brown School of Social Work. 

Available at: 

http://www.gwbweb.wustl.edu/csd/asset/idas.htm

45 P.L. 105-285. 

46 Ibid. 

47 Ibid. 

48 Ibid. 

49 Ibid. 

50 Boshara, R. (December, 2001) Building Assets: A Report on the Asset-Development and IDA 

Field. Washington, D.C.: Center for Enterprise Development. 

51 Ibid. 

52 Ibid. 

53 Ibid. 

54 Ibid. 

55 Ibid. 

56 Ibid. 

57 Ibid. 

58 Ibid. 

59 Ibid. 

60 Ibid. 

61 Ibid. 

62 Schreiner, M. (2000). A Framework for financial benefit-cost analysis of Individual 

Development Accounts at the experimental site of the Downpayment on the American Dream 

Policy Demonstration. St. Louis, MO: Washington University in St. Louis, Center for Social 

Development. As quoted in, Boshara, R., ed. (2001). Building Assets: A Report on the AssetDevelopment and IDA Field. Washington, D.C.: CFED. 
155

______________________________________________________________________________ 

63 Edwards & Mason, 2003. 

64 The section on Iowa is based on information from the Iowans Save! website. Available at: 

http://www.ised.org/EconomicDevelopment/iowanssave.asp and 

http://www.ised.org/EconomicDevelopment/ida5year.asp. 

65 Full names are omitted to protect personal privacy. 

66 The average return on EITC investment is $1,500 but some people have received as much as 

$4,000. 

67 Edwards & Mason, 2003. 

68 Ibid. 

69 Ibid. 

70 Public Law 105-220. 

71 GAO, Workforce Investment Act: States and Local Areas have Developed Strategies to Asses 

Performance, but Labor Could Do More To Help (Washington, DC – June 1, 2004). 

72 64 FR 9403-9404 (February 25, 1999). 

73 University of Iowa, Law, Health Policy & Disability Center, Review of State Plans for the 

Workforce Investment Act From a Disability Policy Framework: Executive Summary, Michael 

Morris and Bobby Silverstein, p. vii. Available at: 

http://disability.law.uiowa.edu/lhpdc/rrtc/documents/morris/WIA_Executive_Summary.doc 

74 WIG Process Evaluation And Navigator Supplemental Survey Analysis, Round Three 

Grantees, Year 1. Document produced by the Law, Health Policy & Disability Center (LHPDC), 

University of Iowa College of Law. Document produced for the Division of Disability and 

Workforce Programs, Employment and Training Administration. 

75 Ibid. 

76 Ibid.

77 Ibid.

78 Ibid. 

79 GAO, Workforce Investment Act: One-Stop Centers Implemented Strategies to Strengthen 

Services and Partnerships, but More Research and Information Sharing Is Needed 

(Washington, DC – June 18, 2003). 
156

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80 64 FR 9406 (February 25, 1999). 

81 Section 501 of WIA (29 U.S.C. 2832). 

82 20 CFR 661.400(b) (February 25, 1999). 

83 65 FR 2477 (January 14, 2000). 

84 Section 117 of WIA (29 U.S.C. 2832). 

85 20 CFR 662.100(a). 

86 20 CFR 662.240. 

87 134 (d)(3)(c) of WIA and 20 CFR 663.200. 

88 134 (d)(4)(d) of WIA and 20 CFR 663.300. 

89 134 (c)(2) of WIA and 20 CFR 662.100(d). 

90 20 CFR 662.310(a). 

91 20CFR 666.100. 

92 GAO, Workforce Investment Act: Labor Has Taken Several Actions to Facilitate Access to 

One-Stops For Persons With Disabilities, But These Efforts May Not Be Sufficient (Washington, 

DC – December 14, 2004). 

93 Human service transportation includes a broad range of transportation service options designed 

to meet the needs of “transportation disadvantaged” populations, including older adults, disabled 

persons, and/or those with lower incomes. 

94 42 U.S.C. § 1396. 

95 Schneider, A., Elisa, R., Garfield, R., et al. (2002) The Medicaid Resource Book. Menlo Park, 

CA: The Kaiser Commission on Medicaid and the Uninsured. Available at: 

http://www.kff.org/medicaid. 

96 Understanding Medicaid Home and Community Based Services: A Primer (2000) Washington 

DC: Office of the Assistant Secretary for Planning and Evaluation. 

97 Pub. L. No. 90-248, 81 Stat. 821 (1968). 

98 Omnibus Budget Reconciliation Act of 1981 (Pub. L. No. 97-35). 
157

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99 Home and Community Based Services: Medicaid Research and Demonstration Waivers, Chart 

of State Participation (November 2004). Available at: 

http://www.pascenter.org/demo_waivers. 

100 Section 4442.5(B)(5) of the State Medicaid Manual. 

101 42 CFR 440. 

102 Section 1902(a)(1) of the Social Security Act., 42 U.S.C. § 1396(a)(1).

103 Section 1902(a)(10)(B) of the Social Security Act., 42 U.S.C. § 1396(a)(10)(B). 

104 http://new.cms.hhs.gov/IndependencePlus/ 

105 Ibid. 

106 http://new.cms.hhs.gov/IndependencePlus/Downloads/IPFAQs.pdf 

107 Ibid. 

108 New Hampshire [§1915(c) new waiver, approved 12/16/02, effective 1/1/03]; South Carolina

[§1915(c) new waiver, approved 3/11/03, effective 5/1/03]; Louisiana [§1915(c) new waiver, 

approved 4/24/03, effective 4/24/03]; North Carolina [§1915(c) new waiver, approved 12/23/03, 

effective 1/1/04] [§1915(b)/(c) new waiver, approved 10/6/04, effective 4/1/05]; Florida [§1115 

amendment to Cash and Counseling, approved 5/30/03, effective 5/30/03]; Maryland [§1915(c) 

new waiver, approved 10/21/04, effective 7/1/05]; California[§ 1115 new demonstration, 

approved 7/30/04, effective 8/1/05]; Delaware [(§1915(b)/(c) new waiver, approved 11/12/04, 

effective 12/1/04]; New Jersey [§1115 amendment to Cash and Counseling, approved 12/15/04, 

effective date pending receipt of Operational Protocol]; Connecticut [§1915(c) new waiver, 

approved 1/14/05, effective 2/1/05]. 

109 http://www.cms.hhs.gov/medicaid/1915c/ 

110 U.S. General Accounting Office, Long Term Care, Federal Oversight of Growing Medicaid 

Home and Community Based Waivers Should Be Strengthened, Washington, June 2003. 

111 Effective January 1, 2007, States may cover HCBS services under the State plan for 

individuals with incomes below 150% of the federal poverty level ($1,225 a month for a one 

person household). Individuals are not required to meet the institutional level of need criteria as 

they must for 1915 (c) waivers. 

112 New Directions Waiver Fact Sheet. Maryland Developmental Disabilities Administration. 

Available at: 

http://www.tash.org/mdnewdirections/factsheets/index.htm
158

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113 Maryland has experienced a low participation rate as of this writing, but hopes that through 

improved marketing the program will have significant benefits for individuals with disabilities. 

114 Ibid. 

115 Maryland Developmental Disabilities Administration. Available at: 

http://www.ddamaryland.org/

116 These may be part of an overall budget, but are not available for self direction. 

117 State of Florida, Agency for Persons with Disabilities (APD). Available at: 

http://apd.myflorida.com/2005-sc-handout-programs.htm#ffi

118 Ibid.

119 Ibid. 

120 California Independence Plus Section 1115 Demonstration Fact Sheet, December 1, 2004. 

http://www.cms.hhs.gov/medicaid/1115/ihssfs.pdf+California+In+Home+Supportive+Services+

Plus+Demonstration+1115+&hl=en&start=1 

121 Ibid.

122 Ibid. 

123 Ibid. 

124 Ibid.

125 Ibid. 

126 Ibid. 
159

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Appendix A: Mission of the National Council on Disability 

Overview and purpose 

The National Council on Disability (NCD) is an independent federal agency with 15 

members appointed by the President of the United States and confirmed by the U.S. Senate. The 

purpose of NCD is to promote policies, programs, practices, and procedures that guarantee equal 

opportunity for all individuals with disabilities regardless of the nature or significance of the 

disability and to empower individuals with disabilities to achieve economic self-sufficiency, 

independent living, and inclusion and integration into all aspects of society. 

Specific duties 

The current statutory mandate of NCD includes the following: 

• Reviewing and evaluating, on a continuing basis, policies, programs, practices, and 

procedures concerning individuals with disabilities conducted or assisted by federal 

departments and agencies, including programs established or assisted under the 

Rehabilitation Act of 1973, as amended, or under the Developmental Disabilities Assistance 

and Bill of Rights Act, as well as all statutes and regulations pertaining to federal programs 

that assist such individuals with disabilities, to assess the effectiveness of such policies, 

programs, practices, procedures, statutes, and regulations in meeting the needs of individuals 

with disabilities. 

• Reviewing and evaluating, on a continuing basis, new and emerging disability policy issues 

affecting individuals with disabilities in the Federal Government, at the state and local 

government levels, and in the private sector, including the need for and coordination of adult 

services, access to personal assistance services, school reform efforts and the impact of such 

efforts on individuals with disabilities, access to health care, and policies that act as 

disincentives for individuals to seek and retain employment. 

• Making recommendations to the President, Congress, the Secretary of Education, the director 

of the National Institute on Disability and Rehabilitation Research, and other officials of 

federal agencies about ways to better promote equal opportunity, economic self-sufficiency, 

independent living, and inclusion and integration into all aspects of society for Americans 

with disabilities. 

• Providing Congress, on a continuing basis, with advice, recommendations, legislative 

proposals, and any additional information that NCD or Congress deems appropriate. 

• Gathering information about the implementation, effectiveness, and impact of the Americans 

with Disabilities Act of 1990 (ADA) (42 U.S.C. § 12101 et seq.). 

• Advising the President, Congress, the commissioner of the Rehabilitation Services 

Administration, the assistant secretary for Special Education and Rehabilitative Services 

within the Department of Education, and the director of the National Institute on Disability 
160

______________________________________________________________________________ 

and Rehabilitation Research on the development of the programs to be carried out under the 

Rehabilitation Act of 1973, as amended. 

• Providing advice to the commissioner of the Rehabilitation Services Administration with 

respect to the policies and conduct of the administration. 

• Making recommendations to the director of the National Institute on Disability and 

Rehabilitation Research on ways to improve research, service, administration, and the 

collection, dissemination, and implementation of research findings affecting people with 

disabilities. 

• Providing advice regarding priorities for the activities of the Interagency Disability 

Coordinating Council and reviewing the recommendations of this council for legislative 

and administrative changes to ensure that such recommendations are consistent with 

NCD’s purpose of promoting the full integration, independence, and productivity of 

individuals with disabilities. 

• Preparing and submitting to the President and Congress an annual report titled National 

Disability Policy: A Progress Report. 

International 

In 1995, NCD was designated by the Department of State to be the U.S. government’s 

official contact point for disability issues. Specifically, NCD interacts with the special rapporteur 

of the United Nations Commission for Social Development on disability matters. 

Consumers served and current activities 

Although many government agencies deal with issues and programs affecting people 

with disabilities, NCD is the only federal agency charged with addressing, analyzing, and 

making recommendations on issues of public policy that affect people with disabilities regardless 

of age, disability type, perceived employment potential, economic need, specific functional 

ability, veteran status, or other individual circumstance. NCD recognizes its unique opportunity 

to facilitate independent living, community integration, and employment opportunities for people 

with disabilities by ensuring an informed and coordinated approach to addressing the concerns of 

people with disabilities and eliminating barriers to their active participation in community and 

family life. 

NCD plays a major role in developing disability policy in America. In fact, NCD 

originally proposed what eventually became ADA. NCD’s present list of key issues includes 

improving personal assistance services, promoting health care reform, including students with 

disabilities in high-quality programs in typical neighborhood schools, promoting equal 

employment and community housing opportunities, monitoring the implementation of ADA, 

improving assistive technology, and ensuring that people with disabilities who are members of 

diverse cultures fully participate in society. 
161

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Statutory history 

NCD was established in 1978 as an advisory board within the Department of Education 

(P.L. 95-602). The Rehabilitation Act Amendments of 1984 (P.L. 98-221) transformed NCD into 

an independent agency.