National Council on Disability

1331 F Street, NW, Suite 850

Washington, DC 20004

National Disability Policy: A Progress Report

National Council on Disability, [July 26, 2015] 

Celebrating 25 years of the Americans with Disabilities Act 

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

Disability (NCD) website (www.ncd.gov) or contact NCD to request an alternative format 

using the following information: 

ncd@ncd.gov Email 

202-272-2004 Voice

202-272-2074 TTY

202-272-2022 Fax

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

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

Branch review process.
National Council on Disability

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

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

Letter of Transmittal

July 26, 2015

President Barack Obama

The White House

1600 Pennsylvania Avenue, NW

Washington, DC 20500

Dear Mr. President:

The National Council on Disability (NCD) is pleased to present the 2015 National 

Disability Policy: A Progress Report. This statutorily mandated report is submitted as 

our nation celebrates the 25th anniversary of the Americans with Disabilities Act (ADA). 

In recognition of this landmark legislation, NCD has dedicated the 2015 report to 

exploring how the ADA and other federal legislation has been put into practice by five 

state and local agencies to improve outcomes for people with disabilities. It focuses on 

five critical policy areas including employment, education, health care, transportation, 

and housing. This approach provides us with the opportunity to demonstrate the impact 

of federal legislation. Equally as important, it reflects the significant role of disability 

advocates along with state and local government officials who translate the spirit and 

letter of the ADA and other federal legislation into practice. 

Our nation has made significant progress in promoting and protecting the civil rights of 

people with disabilities, but NCD acknowledges that much work remains. Youth and 

young adults who were born in a post-ADA era have still not experienced all of the 

protections that the ADA introduced 25 years ago. Looking forward, NCD’s vision for the 

future closes the report. This commentary outlines the progress that we collectively 

need to make between now and the time we celebrate the 50-year anniversary of the 

ADA in 2040. 

NCD applauds the efforts of policymakers who introduce and preserve federal 

legislation that protects the civil rights of people with disabilities. NCD also appreciates 

the activities of state and local government officials and disability advocates who 

advance federal legislation and shape inclusive policies and practices. As NCD 

celebrates the 25th anniversary of the ADA, we respectfully ask Congress and the 

White House to carefully consider the practices and concerns reflected in this report. In 

doing so, we urge support of NCD’s recommendations as a demonstration of strong 

commitment to an equitable society for all. Acting on these recommendations will lead
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to a more accessible and inclusive environment both in the short term, and by 2040, 

when we celebrate the 50th anniversary of the ADA.

Respectfully,

Jeff Rosen 

Chairperson

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

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

Members

Jeff Rosen, Chairperson

Katherine D. Seelman, Co-Vice Chair

Royal P. Walker, Jr., Co-Vice Chair

Gary Blumenthal

Bob Brown

Chester A. Finn

Captain Jonathan F. Kuniholm, USMC (Retired)

Janice Lehrer-Stein

Kamilah Oni Martin-Proctor

Ari Ne'eman

Benro T. Ogunyipe 

Neil Romano

Lynnae Ruttledge

Clyde E. Terry

Alice Wong

Staff

Rebecca Cokley, Executive Director 

Phoebe Ball, Legislative Affairs Specialist

Stacey S. Brown, Staff Assistant

Lawrence Carter-Long, Public Affairs Specialist

Joan M. Durocher, General Counsel & Director of Policy

James Flakes, Administrative Support Assistant

Lisa Grubb, Management Analyst

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

Amy Nicholas, Attorney Advisor

Robyn Powell, Attorney Advisor

Anne Sommers, Director of Legislative Affairs & Outreach
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ACKNOWLEDGMENTS

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

(AIR), particularly Cynthia Overton and her team—Robert Bartolotta, Akash Desai, Mel

Kutner, Dahlia Shaewitz, Burhan Ogut, and Emma Hinkens—for the research

conducted in developing this report. NCD also thanks the state and local agencies that

coordinated information used to demonstrate how legislation is operationalized:

 Nebraska Vocational Rehabilitation

 Minnesota Department of Education

 Massachusetts Department of Public Health, Office of Health Equity; Massachusetts 

Executive Office of Health and Human Services, Office of Medicaid; and the 

Disability Policy Consortium

 New York City Mayor’s Office for People with Disabilities

 Texas Governor’s Committee on People with Disabilities
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CONTENTS

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

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

Introduction ................................................................................................................... 19

Employment .................................................................................................................. 23

Introduction............................................................................................................. 23

Employment Initiatives............................................................................................ 26

Broader Implications ............................................................................................... 33

NCD Employment Recommendations .................................................................... 35

Education ...................................................................................................................... 39

Introduction............................................................................................................. 39

Education Initiatives................................................................................................ 41

Broader Implications ............................................................................................... 50

NCD Education Recommendations ........................................................................ 51

Health Care................................................................................................................... 55

Introduction............................................................................................................. 55

Health Care Initiatives............................................................................................. 56

Broader Implications ............................................................................................... 65

NCD Health Care Recommendations ..................................................................... 66

Transportation ............................................................................................................... 69

Introduction............................................................................................................. 69

Transportation Initiatives......................................................................................... 70

Broader Implications ............................................................................................... 79

NCD Transportation Recommendations ................................................................. 80

Housing......................................................................................................................... 83

Introduction............................................................................................................. 83

Housing Initiatives................................................................................................... 84

Broader Implications ............................................................................................... 90

NCD Housing Recommendations ........................................................................... 92

Vision for the Future...................................................................................................... 95

Introduction............................................................................................................. 95

NCD’s National Vision for the 50th Anniversary of the ADA ................................... 96

NCD’s Global Vision for the 50th Anniversary of the ADA.................................... 113
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References.................................................................................................................. 115

Appendix A: Select NCD Resources ........................................................................... 123

Appendix B: State Resources ..................................................................................... 137

Appendix C: NCD Recommendations ......................................................................... 141

NCD Employment Recommendations .................................................................. 141

NCD Education Recommendations ...................................................................... 143

NCD Health Care Recommendations ................................................................... 146

NCD Transportation Recommendations ............................................................... 148

NCD Housing Recommendations ......................................................................... 150
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EXECUTIVE SUMMARY

NCD’s 2015 Annual Progress Report commemorates the 25th anniversary of the

Americans with Disabilities Act (ADA) by demonstrating how federal legislation has

influenced state and local practices and has led to innovative initiatives designed to

improve outcomes for people with disabilities. The report explores this in five NCD

policy areas: employment, education, health care, transportation, and housing. These

policy areas influence one’s opportunities to access resources needed to thrive in

society and lead a meaningful life. NCD explored these policy areas by engaging with

five state and local agencies to learn about their experiences creating and implementing

innovative initiatives to operationalize federal legislation.

The report begins with an exploration of opportunities to promote increased

employment outcomes for people with disabilities through three Nebraska Vocational

Rehabilitation agency practices that focus on consumer engagement, employer

engagement, and assistive technology. The report then examines two education

initiatives in Minnesota that align with the spirit of the ADA to ensure that people with

disabilities are able to access the same education opportunities as people without

disabilities. These initiatives include the Minnesota Olmstead plan and statewide 504

training for Minnesota public school educators. Next, the report turns to how health

care initiatives help protect people with disabilities against discrimination and promote

accessible and high-quality health care for this population. These initiatives include the

Massachusetts Facility Assessment Tool and the One Care Dual Eligibles

Demonstration. The report then highlights initiatives that promote accessible public

transportation through New York City’s subway system, taxis, and paratransit system.

Finally, the report explores initiatives that demonstrate how housing policies have been

influenced by the ADA and subsequent civil rights laws and legal rulings. Examples

from Texas include the Amy Young Barrier Removal Program and Project ACCESS.

NCD provides policy recommendations for Congress, the White House, and federal

agencies as well as state and local governments in each of the topic areas. NCD’s

policy recommendations from each chapter are listed by topic area in the appendices.
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The Council recognizes that the initiatives featured in this report do not represent or do

justice to the full range of issues that impact the quality of life and inclusive practices for

people with disabilities. Rather, they serve to highlight the impact of the ADA and

related legislation on state and local policies.

The 2015 Annual Progress Report concludes with NCD’s vision for 2040 when the ADA

will turn 50, with additional recommendations to realize this vision. NCD envisions a

society in which all people with disabilities are fully engaged and have opportunities to

choose their careers; excel in education; receive the highest quality health care; access

any transportation option; and live in safe, affordable, and accessible housing.

Internationally, NCD also envisions that the United States will have a stronger presence

in the international arena through support of the Convention on the Rights of People

with Disabilities (CRPD) and increased representation of U.S. officials with disabilities

abroad.

As we reflect on the progress made since the implementation of the ADA 25 years ago,

we cannot overlook the work that remains for people with disabilities to achieve full

access and inclusion. A summary of NCD’s vision for 2040, along with

recommendations to realize this follows:

 Work incentive programs for Supplemental Security Income/Social Security 

Disability Insurance (SSI/SSDI) beneficiaries, such as the Ticket-to-Work 

program, will receive the support necessary to enhance their effectiveness.

Congress should provide additional guidance to state agencies and mandate closer 

collaborative, rather than competitive, relationships between state vocational 

rehabilitation agencies and employment networks to identify and develop models 

that more effectively contribute to employment for people with disabilities. 

 The promise of the Workforce Innovation and Opportunity Act will be fulfilled, 

leading to greater collaboration among local, state, and federal employment 

services and enhanced opportunities for integrated, competitive employment 

for people with disabilities. State agencies should collaborate with their planning 

and action committees to draw on the strengths of multiple programs and minimize 
11

the overlap of services. Federal agencies such as the U.S. Department of Education, 

U.S. Department of Health and Human Services (HHS), and U.S. Department of 

Labor (DOL) should support technical assistance centers to support state and local 

providers as they develop their understanding of the new federal requirements. 

These agencies should also support technical assistance opportunities that 

empower people with disabilities to participate in postsecondary education and 

prepare for integrated employment. 

 Discrimination against people with disabilities during hiring, job assignment, 

promotion, and retention will end. These decisions will be based solely on the 

qualifications and performance of the individual. Congress should provide 

additional funds to the Rehabilitation Services Administration-funded vocational 

rehabilitation agencies to address the supports needed for competitive, integrated 

employment and the education of employers to create inclusive work environments.

 The sub-minimum wage provisions of the Fair Labor Standards Act will be 

eliminated, guaranteeing competitive wages for all people with disabilities. 

Congress should amend the Fair Labor Standards Act to eliminate the allowance of

sub-minimum wages for people with disabilities once sub-minimum wage 

employment is phased-out. 

 Workplace accessibility, a reasonable accommodation, will be extended to 

people with disabilities who work remotely. Congress should amend the tax code 

to allow for an expansion of presently available tax credits for access modifications 

in home offices.

 Employers will become partners in disability employment, working in 

collaboration with the individual, support providers, disability advocacy 

groups, and state agencies to develop competitive employment opportunities 

for all people with disabilities. DOL should require representation of people with 

disabilities on local workforce investment boards required under the WIOA and 

encourage efforts to promote people with disabilities to positions of influence and 

leadership in both the public and private sectors. Simultaneously, federal contractors 
12

must recognize that the 7 percent inclusion target applies across job categories for 

firms with more than 100 people. 

 Students with disabilities will have equal opportunity and access to a 

meaningful education. Local education agencies (LEAs) and state education 

agencies (SEAs) should implement evidence-based practices such as universal 

design for learning principles and also promote positive behavior interventions and 

supports. Congress should work closely with NCD to reauthorize the Individuals with 

Disabilities Education Act (IDEA) in a manner that facilitates the meaningful inclusion 

of all students with disabilities. Additionally, Congress should authorize the United 

States Access Board to establish guidelines for accessible instructional materials 

that will be used by government, in the private sector, and in postsecondary 

academic settings.

 The school-to-prison pipeline for students with disabilities and from diverse 

backgrounds will be dismantled. SEAs and LEAs should offer social skills 

instruction and individualized wraparound supports to connect students with 

disabilities to community services. These agencies should also adopt positive 

behavioral systems and end zero tolerance disciplinary practices. Federal, state, and 

local education agencies should allocate funding to support school-based mental 

health service providers. The U.S. Department of Education should support research 

that determines factors that contribute to the disproportionality of students with 

disabilities in the juvenile justice system, as well as evidence-based practices to 

address these factors. 

 Students with disabilities will be fully included in appropriate accountability 

and achievement metrics. LEAs and SEAs should ensure that students who need 

assistive technology to access standard assessments are provided with this support, 

as well as all other accommodations identified in their individualized education 

program (IEP). These agencies should also ensure that principles of universal 

design for learning extend to assessment. The U.S. Department of Education should 

collect data on the academic progress of students with disabilities that are 
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disaggregated by subgroups of IDEA eligibility or disability categories and include 

this data within the annual state report cards, LEA report cards, and U.S. 

Department of Education report card to Congress. Data should be disaggregated by 

race, ethnicity, and other identifying factors within the IDEA eligibility subgroups.

 Technology will be readily available to support students to participate and 

succeed academically. SEAs should collaborate with institutions of higher 

education to identify basic learning standards involving technology and students with 

disabilities for pre-service teachers. The U.S. Department of Education should 

collaborate with states to identify funding options that would allow students 

transitioning out of the purview of their LEA to maintain devices provided by an IEP 

or 504 plan, or secure a comparable device within a timely manner. Further, local, 

state, and federal education and health agencies should collaborate with private and 

public health insurance providers to establish clear plans and policies to ensure that 

students with disabilities have access to the necessary assistive technology.

 Self-determination will drive the transition of students with disabilities into 

integrated postsecondary education and competitive employment settings 

that match individuals’ interests, skills, and abilities. The U.S. Department of 

Education, in collaboration with HHS and the Social Security Administration, should 

fund resources and support opportunities that help students with disabilities and their 

families to understand and navigate home and community-based services and 

manage long-term services and supports.

 Students with disabilities in postsecondary education settings will be

provided with the financial, technological, and academic supports to be 

successful. Colleges and universities should operate fully-functioning offices 

dedicated to serving students with disabilities. The U.S. Department of Education 

should require consistent, disaggregated, data collection on the enrollment of 

students with disabilities in institutions of higher education and their completion rates 

to better understand the extent to which students with disabilities enter into and 

graduate from institutions of higher learning. 
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 People with disabilities will realize health equity goals currently promised 

under the ADA. HHS and state health officials should work directly with health care 

providers to establish and maintain accessible health care facilities. Further, HHS 

should invest in research to better understand the continuing health disparities that 

exist among people with disabilities. 

 The holistic needs of people with disabilities will be an integral part of the 

health care delivery system. HHS should promote the development of health care 

delivery systems that are highly coordinated with social service and supports, and 

are able to improve the health outcomes and overall satisfaction of people with 

disabilities through continued funding of new demonstrations. Health care delivery 

systems should invest in the delivery of high-quality health care and support services 

that prevent expensive health care use in the future. HHS should develop measures 

that fully capture the lived experience of people with disabilities.

 People with disabilities will benefit from stronger consumer protections with 

health insurance and throughout the health care delivery process. HHS and 

state regulators should encourage public deliberation and stakeholder engagement 

in the design and operations of health care policy and programs. This could include 

promoting and implementing stronger ombudsman programs, consumer majority 

advisory councils, and public forums that address consumer protection issues. 

 Mass rapid transit systems will be a viable transportation option for people 

with disabilities. State agencies that provide oversight of mass rapid transit should 

engage people with disabilities early on to provide insight on unexpected barriers to 

access and opportunities to overcome those barriers. They should also reach out to 

professional peers in established cities to gain insight on access barriers that have 

surfaced and recommendations to avoid these barriers. When retrofitting existing 

transit stations to be accessible and when designing new transit systems, relevant 

state agencies should factor in alternative options to accommodating passengers 

with disabilities. 
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 Transportation network companies (TNCs) will be subjected to the same 

accessibility standards for their network of vehicles as are companies 

regulated by state or local government agencies. TNCs, the U.S. Department of 

Transportation and U.S. Department of Justice, in collaboration with NCD, should 

explore options to provide oversight of TNCs and create an operating plan to 

promote accessible vehicles in TNC networks. TNCs should also adopt universal 

design principles throughout all aspects of their service.

 Governing bodies that regulate taxi services will operate fleets that consist of 

at least 50 percent accessible taxis, 100 percent accessible mobile technology, 

and staff who are responsive to the needs of passengers with disabilities. 

State agencies should collaborate with governing bodies that regulate taxi services

to develop a strategic plan to increase the number of accessible taxis with features 

such as wheelchair access and auditory systems. 

 People with disabilities who reside in rural and suburban communities will 

have accessible and reliable transportation options. Local planners, public 

officials, staff in rural jurisdictions, and anyone affected by rural or transportation 

issues should learn about the successful strategies that have been used to provide 

rural transportation, including voucher programs, volunteers, flex services, taxis, 

mobility management, and neighborhood co-operatives.

 Autonomous vehicles will be a viable transportation option for people with 

disabilities. The U.S. Department of Transportation should collaborate with private 

sector research firms to design and invest in autonomous vehicle research to help 

refine the technology that powers this initiative and explore the implications for 

people with disabilities.

 The airline industry will operate in a manner that is responsive to the needs of 

people with disabilities. The U.S. Department of Transportation in collaboration 

with NCD, should establish a Passengers with Disabilities Bill of Rights document 

that is based on the Air Carrier Access Act but written in plain language. NCD also 

recommends that Congress authorize the U.S. Department of Transportation to hold 
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the airline industry accountable for abiding by the Air Carrier Access Act and other 

relevant federal legislation. 

 The availability of accessible public housing units will reflect the percentage 

of the population of people with disabilities. Congress should raise the current 

federal requirements for new accessible housing to reflect the percentage of the 

American population identified as having disabilities by the American Community 

Survey.

 All new homes and apartments will meet universal design accessibility 

standards. State housing commissions should mandate that universal design 

accessibility principles be incorporated into the permitting requirements for all new 

homes and apartments.

 People with disabilities will have greater access to community housing. The 

U.S. Department of Housing and Urban Development (HUD) should increase the 

number of housing choice vouchers to an amount that reflects the number of 

individuals who meet HUD Area Median Income requirements. Furthermore, HUD 

should issue a regulatory statement requiring that vouchers currently held by people 

with disabilities be set aside specifically for people with disabilities. This will reduce 

the loss of these vouchers from the disability community as they are turned in for 

reissue.

 Congress will make a permanent commitment to the Money Follows the 

Person initiative and provide expanded home and community-based services

for people with disabilities. The Centers for Medicare and Medicaid Services 

should make a permanent commitment to the Money Follows the Person initiative by 

ending its demonstration project status and making it a permanent, funded service 

available to people with disabilities nationwide.

 The United States will ratify the Convention on the Rights of People with 

Disabilities (CRPD). The White House should continue to promote the CRPD 

through its outreach efforts, explicitly identify and address common misconceptions 
17

about the CRPD, and highlight the benefits of ratifying the treaty. In addition, 

government agencies should post information on their websites about the 

implications of ratifying the CRPD for their stakeholders with disabilities. 

 Representation from the United States will be inclusive of people with 

disabilities in international activities. Congress should include specific language 

in the Rehabilitation Act that extends protections of the legislation to international 

operations of the U.S. government. The President should appoint an ambassador 

who has a disability, with the goal of 25 years from now, having at least one diplomat 

in each mission with a disability. The State Department should offer fellowship 

programs for American students with disabilities enrolled in universities that have not 

been traditional past producers of Foreign Service officers.
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INTRODUCTION

In this monumental year for our nation, we celebrate the 25th anniversary of the

Americans with Disabilities Act (ADA). This historic civil rights legislation prohibits

discrimination on the basis of disability in employment, state and local government,

public accommodations, commercial facilities, transportation, and telecommunications.

The National Council on Disability (NCD) is proud to have played a significant role in

conceptualizing, developing, and advancing the initial legislation shortly after the agency

was instituted in 1984.

The ADA and other relevant federal legislation set the standards for the protection of

civil rights for people with disabilities. As importantly, state and local policy, programs,

and practices, often with influence from disability advocates, bring such legislation to

life. NCD’s 2015 Annual Progress Report explores how federal legislation has

successfully influenced and led to innovative initiatives designed to improve outcomes

for people with disabilities in five NCD policy areas: employment, education, health

care, transportation, and housing. These policy areas influence one’s opportunities to

access resources needed to thrive in society and lead a meaningful life. Appendix A

contains a list of select NCD resources that addresses these five policy areas.

NCD explored these policy areas by engaging with five state and local agencies to learn

about their experiences to create and implement innovative initiatives that put federal

legislation into practice. These agencies shared challenges and successes in their

experiences as they took aggressive steps to enhance access and inclusion for people

with disabilities. One chapter is dedicated to each of the five policy areas. Each chapter

opens with an introduction. Next, the chapter identifies and describes initiatives and

offers an implementation subsection that provides insight on the motivations and

process behind each initiative. Each chapter then contains broader implications of the

policy topics described. Finally, each chapter closes with two sets of recommendations.

The first set guides federal policymakers as they support states and local agencies. The

second set of recommendations offers items for state and local agencies to consider as

they create and execute policy and programs that promote opportunities for people with
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disabilities related to each policy area. Recommendations are offered to help federal,

state, and local policymakers further advance provisions found in the ADA and other

legislation that promotes access and inclusion for people with disabilities. Appendix B 

offers a list of links to state resources discussed in each chapter. Appendix C lists

NCD’s policy recommendations from each policy area chapter of this report. 

The Council recognizes that the initiatives featured in this report do not represent or do

justice to the full range of issues that impact the quality of life and inclusive practices

across the country for people with disabilities. However, these examples highlight the

impact of the ADA and related legislation on state and local policies in several key areas

that promote self-directed and independent living. Principles behind each initiative have

broad applications to other state and local agencies, and anecdotal accounts from each

participating agency demonstrate how legislation can lead to positive change. In the

future, the Council would like to see a 50-state metric study exploring policy areas of

great interest to people with disabilities such as those included in this report. 

Federal Legislation That Influences Full Access and Inclusion 

 21st Century Communications and Video Accessibility Act

 Air Carrier Access Act

 Americans with Disabilities Act

 Architectural Barriers Act

 Civil Rights of Institutionalized Persons Act

 Communications and Video Accessibility Act

 Fair Housing Act

 Individuals with Disabilities Education Act

 National Voter Registration Act

 Rehabilitation Act of 1973

 Technology Related Assistance for Individuals with Disabilities Act

 Telecommunications Act 

 Voting Accessibility for the Elderly and Handicapped Act 

 Workforce Innovation and Opportunity Act
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Although our nation has made significant progress in protecting the civil rights of people

with disabilities, much work remains for people with disabilities to enjoy the benefit of full

access and inclusion throughout society. The Council sets forth a bold vision for 2040

when the ADA will turn 50. By then, all people with disabilities will be fully engaged in

society and have opportunities to choose their careers; excel in education; receive the

highest quality health care; access any transportation option; and live in safe,

affordable, and accessible housing. Internationally, NCD envisions that the United

States will have a stronger presence in the international arena through support of the

Convention on the Rights of People with Disabilities (CRPD) and increased

representation of U.S. officials with disabilities. 

Convention on the Rights of People with Disabilities (CRPD)

In addition to helping shape inclusive practices in the United States, the ADA 

contributed to the development of the CRPD. The United Nations General Assembly 

adopted the CRPD in 2006. This non-legally binding treaty provides guidance for 

nations to promote, protect, and ensure the rights of people with disabilities in order 

to realize a fully inclusive global society. The CRPD aligns with NCD’s long-standing 

commitment to human and civil rights, and the Council has been a vocal proponent 

for the United States to adopt the treaty. As of May 2015, 154 countries have ratified 

the CRPD. NCD supports our nation’s ratification of the CRPD.
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EMPLOYMENT

Introduction

NCD is strongly committed to the increased employment of people with disabilities.

Competitive, integrated, and meaningful work leads to greater economic self-sufficiency

and independence. It also contributes to personal growth and self-fulfillment as workers

develop professional skills and contribute to society. Unfortunately, a significant

employment gap exists between people with and without disabilities. In May 2015, only

19.8 percent of people with disabilities were participating in the labor force compared

with 68.8 percent of people without disabilities. For those people with disabilities who

did enter the workforce, though, the unemployment rate was at 10.1 percent, twice as

high as the national average for people without disabilities at 5.1 percent. (U.S.

Department of Labor Bureau of Labor Statistics 2015). And even when employed,

wages are on average lower for people with disabilities when compared with that of

workers without disabilities. As people with disabilities achieve greater postsecondary

education, this gap expands. While people with disabilities make about $6,500 less than

people without disabilities when both groups have a high school diploma, the gap

expands to almost $21,000 for those people with and without disabilities who achieve a

master’s degree or higher (Yin, Shaewitz, Megra 2014). As a result, people with

disabilities are unable to reap the same economic and personal benefits from

employment as their peers without disabilities.

Various factors—including low expectations, lack of training, inadequate transportation,

and discrimination—can create barriers to employment among people with disabilities.

Thus, the issue is complex and cannot be remedied by one solution. The ADA

addresses many barriers outside of the workplace that can interfere with employment

and directly prohibits discrimination during the application process and while on the job

in work settings with 15 or more employees. Both the ADA and the Rehabilitation Act of

1973 require the use of “reasonable accommodations” to allow a person with a disability

to perform employment tasks for which he or she is qualified. Failures in either of these

areas—to act without bias in employment decisions or to provide reasonable
24

accommodations to employees with disabilities—can lead to legal action by the U.S.

Equal Employment Opportunity Commission (EEOC). Examples of reasonable

accommodations include modified schedules, restructured jobs, accessible 

workstations, interpreter services, and modified equipment and policies (Americans with

Disabilities Act 1990). 

Highlights of ADA Employment Provisions

Employers with 15 or more employees must provide reasonable accommodations 

that do not impose undue hardship in the areas of:

 The job application process

 The work environment or circumstances in which a job is typically performed

 Policies that set out the benefits and privileges of employment

In addition to the ADA, the federal government has instituted other initiatives to

encourage the hiring of qualified persons with disabilities. For example: 

 Through a combination of federal and state funds, state vocational rehabilitation 

(VR) services provide significant support—such as career assessment, counseling, 

education and training, job placement, and follow-up support—to youth and adults 

with significant disabilities in search of employment. 

 The Department of Labor’s (DOL) Employment and Training Administration has 

established a national network of American Job Centers (AJCs), formerly known as 

One-Stop Career Centers, whose goal is to serve as a resource for all job seekers, 

including those with disabilities. These centers bring together numerous state 

services and act as a job announcement and recruitment agency for area 

employers, as well as provide career counseling and networking services for job 

seekers. 

 The Workforce Innovation and Opportunity Act (WIOA), the successor to the 

Workforce Investment Act (WIA), authorizes funding to state agencies to support job 
25

seekers. Title IV of the Amendments to the Rehabilitation Act of 1973 specifically 

targets funds to support job seekers with disabilities. These services are provided 

within states by VR agencies, AJCs, or contracted providers. Because of WIOA, 

state VR agencies will be required to designate 15 percent of their WIOA youth 

funds to pre-employment and employment experiences for youth with disabilities. 

AJCs use their WIOA funding to provide supported internships, work experiences, 

and on-the-job training subsidies with employers in the community to promote 

competitive and integrated employment. These opportunities assist job seekers with 

disabilities in developing their job skills and building a work history.

 The Disabled Access Credit provides a non-refundable credit for small businesses

that incur expenditures for the purpose of providing access to persons with 

disabilities—as job seekers, employees, or patrons. This benefit cannot reduce a 

company’s tax liability beyond zero, leading to a federal refund, nor can the credit be 

applied over a series of years for a single expenditure.

 The Architectural Barrier Removal Tax Deduction encourages businesses of any 

size to remove architectural and transportation barriers to the mobility of persons 

with disabilities and the aging. 

 New regulations within Section 503 of the Rehabilitation Act of 1973 that strengthen 

the affirmative action requirements for federal government contractors became 

effective March 24, 2014. The new regulations establish a nationwide 7 percent

utilization goal for qualified people with disabilities. Contractors must apply the goal 

to each of their job groups or to their entire workforce if the contractor has 100 or 

fewer employees. Although the number of federal contractors is difficult to quantify, 

the U.S. government awarded $230,578,567,445 in federal contracts in Fiscal Year 

2015 across more than 1.3 million transactions (USA Spending.gov, n.d.). This level 

of expenditure underscores the importance of the 7 percent utilization goal, which 

has the potential to greatly expand the hiring and placement of people with 

disabilities in competitive employment settings. In addition, Section 503 regulations 
26

encourage affirmative action hiring and retention of people with disabilities, which 

further supports future employment gains. 

Employment Initiatives

The Nebraska Vocational Rehabilitation (Nebraska VR) agency has adopted a “Meet

You Where You Are” approach to promoting increased employment outcomes for

people with disabilities. This approach led to an employment rate of 43.6 percent for

people with disabilities in the state in 2012, a significant improvement over the national

average of 33.5 percent in that same year (Erickson, Lee, and von Schrader 2014). This

chapter highlights three Nebraska VR agency initiatives that contribute to positive

employment outcomes for people with disabilities and involve consumer engagement,

employer engagement, and assistive technology. Each initiative begins with a

description of the action taken by Nebraska VR followed by a description of the

implementation process and effectiveness data when available.

Initiative 1: Consumer Engagement

Nebraska VR services are designed to meet individual employment needs and facilitate

a client-centered partnership with the consumers they serve. To accomplish this, staff

engage with consumers through motivational interviewing techniques and maintain

engagement through a targeted social media strategy. They also promote ownership of

the VR experience through the use of the MyVR application, an online communication

and data management tool developed by Nebraska VR. Nebraska VR personnel started

using motivational interviewing techniques after receiving training in 2012 from their

regional Rehabilitation Services Administration-funded training center. Motivational

interviewing is a counseling technique that identifies and strengthens an individual’s

commitment to change. VR is a client-centered process, and the motivation a person

with a disability possesses is critical to achieving a positive employment outcome.

Nebraska VR staff report that motivational interviewing has helped the agency improve

its rehabilitation rate from 61.58 percent in 2012 to 66.32 percent in 2014 by identifying

people with disabilities who are most ready for services and supporting them through

the creation and completion of an Individualized Plan for Employment. These
27

percentages represent 208 more people with disabilities who were successfully

employed through VR services in 2014 than in 2012. As a point of comparison, the

federal standard for the rehabilitation rate for general and combined VR agencies is

55.8 percent—Nebraska VR continues to strive for better outcomes. The state’s VR

staff have found motivational interviewing to be an especially valuable tool in

discussions about self-employment options and they credit this technique for improving

the quality of referrals to its self-employment partnership, Nebraska Self-Employment

Services.

Frequent, consistent engagement between clients and Nebraska VR counselors is

crucial for assisting consumers with disabilities in reaching their goals. Nebraska VR

staff described losing contact with consumers early in the rehabilitation process as a

challenge and they found that this was partly due to the difficulty in tracking down or

finding consumers for follow-up. Clients moved frequently or had services disconnected

because of financial challenges. The VR agency staff decided to address this by

developing a new social media strategy. Through this social media approach, VR

counselors connect with clients through social media accounts, such as Twitter,

Facebook, and LinkedIn, which helped them to maintain contact and meet the

requirement of engaging with consumers at least once every 30 days. Social media

tools are also used to disseminate information about the agency, its work, and its

offerings to the community.

Another strategy to better engage consumers has been the development of a secure

social media application called MyVR. Through grant funds provided by the Research

and Technical Assistance Center on VR Program Management, MyVR is a tool that

gives VR consumers access to certain components of their own case file, allowing them

to communicate with their counselor, update their status, read task notes, and access

pre-populated job applications and résumés. The tool was piloted in two local service

areas, Norfolk and Grand Island, and after revision, was deployed statewide in spring

2015.
28

Each of these consumer engagement strategies have been supported by the agency’s

growing use of technology. In addition, the agency has provided Nebraska VR staff with

iPads, iPhones, and other wireless systems in support of greater engagement.

Implementation

Nebraska VR personnel developed a social media strategy to identify and implement

alternative ways to engage with service consumers. They did this after learning through

surveys and counselor-consumer conversations that mobile phone texting, Facebook,

and Twitter messaging were more effective at reaching consumers than traditional calls,

emails, and letters. Development of the Nebraska VR social media strategy required

personal advocacy by the agency director, the support of the commissioner of

education, authorization of the agency director of the Office of Administrative Services’

Division of Communication, and a commitment to responsible usage by the agency’s

staff. The commissioner of education allowed Nebraska VR to pilot the use of social

media, with the understanding that significant monitoring and accountability of staff

usage would be required. The requirements for social media use were communicated to

VR staff by all levels of management with the expectation that staff would model

appropriate online behavior in their interactions with consumers, employers, and the

community at large during all online activities. Nebraska’s VR agency and the Office of

Administrative Services’ Division of Communication monitor social media use to ensure

that privacy and professional standards are maintained.

Initiative 2: Employer Engagement

Nebraska VR uses several strategies to apply its Meet You Where You Are philosophy

to employer engagement. The agency’s goal is to serve as a resource to employers by

filling vacancies, while simultaneously placing people with disabilities in competitive

employment career paths with opportunities for advancement. Nebraska VR staff offer

consultation on compliance with the ADA and the new Section 503 of the Rehabilitation

Act regulations to business leaders. Also, the Nebraska VR Omaha office began

conducting quarterly panel discussions with the local business community in 2009,

though they are now occurring only annually. Omaha staff joined the state Office of
29

Federal Contract Compliance Programs (OFCCP) to establish panel discussions on

affirmative action hiring practices for people with disabilities at these business meetings.

During these meetings, the OFCCP staff led the discussions about Section 503, and VR

staff present how the agency can support local businesses and job seekers with

disabilities. Nebraska VR and OFCCP staff identified the need for Section 503 seminars

after discovering that approximately 10,000 businesses in Nebraska hold federal

contracts and were subject to the new 7 percent utilization goals. Nebraska VR and its

partner organizations proactively reached out to human resource professional

organizations in the state and offered to coordinate panels for employers to learn more

about the requirements and resources in the state to aid in compliance. During these

events, participants discussed techniques to recruit qualified people with disabilities and

strategies to support them after being hired. These strategies included assistive

technology (e.g., ergonomic supports), job site accommodations, home office

accessibility, and ongoing consultation through Nebraska VR. The lead staff member of

this initiative indicated that these meetings have raised awareness of Nebraska VR and

established the agency as a resource for the business community.

Nebraska VR also created a new business account manager position in its offices. The

business account managers, unlike traditional VR counselors, have a business

background and the positions are funded through a blending of federal and state

resources. As of May 2015, three business account managers were hired to build

relationships with employers in Grand Island/Kearney, Norfolk/Columbus, and Omaha

to meet employer business service requirements included in WIOA. This new approach

replaces previous efforts at employer engagement through a state-level program

manager. Business account managers are charged with representing businesses for

Nebraska VR, identifying customized training needs, and using targeted placement

techniques to place qualified persons with disabilities into vacancies. Early activities

included the development of new marketing strategies for the VR agency and a

business plan for the business account manager team.

In addition to these efforts, Nebraska has also created several certificate programs for

students and adults with disabilities that reflect the training and skills needed by local
30

business partners. Offerings are based on a career pathways model and include

welding, community health worker, and auto technician certificates. The business

community is heavily involved in the design of the curriculum. To facilitate the design of

these curricula, 5 to 10 essential skills are required for entry-level candidates. Training

partners, which may include community colleges, review these lists to develop an

approach that meets the hard and soft skills requirements of employers.

Nebraska is one of many states that has developed partnerships to support its youth

transition Project SEARCH program, which include businesses, area school systems,

the Nebraska Commission for the Blind and Visually Impaired, the Nebraska Assistive

Technology Partnership (ATP), and the Nebraska Division of Developmental

Disabilities. The foundation of the Project SEARCH experience is a one-year, school-towork immersion in a large business. For five days a week, participants report to the host

business, learn employability skills in the classroom, and apply job skills while

participating in a variety of work experiences. They also receive a combination of

classroom instruction, career exploration, and hands-on training through work-site

rotations. Project SEARCH is business led and occurs completely in the workplace. This

contributes to a holistic training experience for the participants with disabilities that

match the needs and expectations of employers. Nebraska VR has 15 Project SEARCH

sites statewide with 206 graduates and enrolled 106 individuals in the 2014–2015

school year. Participants from the 2013–2014 cohort had a 77.1 percent employment

success rate compared to the average state rehabilitation rate of 66.3 percent for the

same period working a minimum of 16 hours per week in integrated, non-seasonal

employment. Statistics from Ohio, where Project SEARCH was first established, show a

58 percent employment success rate (O’Day 2009).

Nebraska VR views collaboration with employers as necessary to educate them on the

capabilities of employees with disabilities, the protections provided to employees

through various legal frameworks, and techniques and strategies to obtain maximum

productivity, demonstrating that people with disabilities are truly qualified workers.

Nebraska VR’s business account managers liaise with the business community, gain a

clearer understanding of the needs of employers, and introduce those employers to
31

qualified and trained candidates with disabilities. Project SEARCH also serves this

purpose. The seminars and demonstrations focus on Section 503 of the Rehabilitation

Act, the ADA, and the use of assistive technology to help educate employers on their

responsibilities under the law. Furthermore, these efforts provide employers with the

knowledge and resources necessary to fully partner with Nebraska VR and the state’s

disability community. 

Implementation

Nebraska’s employer engagement approach proactively connects candidates with

disabilities to businesses before discrimination occurs and identifies practical strategies

for businesses to treat people with disabilities fairly. This approach is based on the

Learning Collaborative for Vermont’s Progressive Employment Model, which was

developed through activities at the Vocational Rehabilitation Research and Training

Center (VR-RRTC) on Demand-Side Strategies (Vocational Rehabilitation Research

and Training Center on Demand-Side Strategies 2015). The goal of this model is for a 

VR agency to serve as a trusted advisor and partner with the business community. This

approach aligns with the pro-business politics of the Nebraska VR, while simultaneously

aligning with the needs of people with disabilities in the state. 

Learning Collaborative for Vermont’s 

Progressive Employment (Key Principles)

 Is a dual customer approach serving employers and job seekers

 Is low risk for both the employer and the participant

 Provides flexibility and creativity based on each person’s or employer’s 

situation

 Is an engagement strategy and eliminates the need to be job ready

The business account managers have established themselves as a responsive partner

within the business community, and their approaches align with the Sector Partnership

measures within WIOA that will be required as of July 2015. 
32

There are two important distinctions about Nebraska VR’s approach to protect and

promote the civil rights of people with disabilities. First, the Nebraska VR agency is a

non-code agency and does not report directly to the governor. Instead, Nebraska VR

reports to the commissioner of the Nebraska Department of Education who then reports

to a board. Therefore, the agency director and senior staff are professional positions,

not political. This provides greater leadership stability and the ability to develop longer

term strategies that are proactive rather than reactive. Developing relationships with the

business community takes time, consistent contact, and predictability. Having

professional, rather than political, leadership in Nebraska VR has facilitated the

development of collaborative relationships with the business community.

Second, the use of social media by state officials, as an official practice, is not common.

Obtaining approval for this strategy required support from multiple state agencies, along

with considerable security measures and training requirements for VR staff. The long

tenure of the Nebraska’s VR director and long-standing relationships between the

director and other state leaders facilitated the approval for this strategy.

Initiative 3: Nebraska Assistive Technology Partnership

Nebraska VR’s partnership with the state’s Assistive Technology Partnership (ATP) is

an example of a joint effort to support both people with disabilities and the businesses

that wish to employ them. ATP is a Nebraska state agency that provides individualized

assessments of accessibility and assistive technology usage in both home and work

environments. Nebraska VR has partnered with ATP for 25 years—using the ATP

network of specialists in occupational or physical therapy, speech language pathology,

information technology, and architecture—to identify appropriate solutions from a variety

of vendors to meet the needs of consumers and businesses. Procedurally, after

Nebraska VR determines eligibility for services, the VR counselor and consumer

discuss whether assistive technology is needed to succeed in the workplace. A referral

to ATP is then made, and the focus shifts toward formally assessing the barriers to

employment and making assistive technology recommendations. These can include a

variety of devices and accommodations. For example, reaching devices, wheelchairs,

recording devices for classroom note taking, modified equipment for the work to be
33

performed, and bathroom or vehicle modifications that may be required for self-care,

living independently, and success on the job. Although funding for assistive technology

is the responsibility of Nebraska VR, ATP routinely searches for additional funding for

equipment (grants, Medicaid reimbursement, and so on) to help extend the available

budget and provide service to more individuals.

In addition, The Lincoln ATP office is developing a model of service to employers known

as Retain Your Skilled Employee, modeled after a similar initiative in Alabama. One of the

focus areas for this initiative is to educate employers on how technology can help

employees enter, continue, or return to work after an illness or injury. The Lincoln ATP

office possesses approximately 1,100 pieces of assistive technology that are available for

loan or demonstration to people with disabilities and employers. Nebraska VR aids in

identifying employers interested in these services and supports for their present or future

employees. Since 2011, demonstrations to employers have increased by 200 percent

(Assistive Technology Partnership 2014).

Implementation

Established in 1989, ATP is funded through the Technology-Related Assistance Act of

1988, which was amended in 2004. The office works to improve the provision of

assistive technology through comprehensive, statewide programs that are consumer

responsive. For the past 25 years, ATP has focused on state leadership activities that

provide assistive technology. Nebraska VR has served as a partner to ATP for many

years and is a funder of their assistive technology recommendations and shares their

resources with consumers and employers to expand its reach.

Broader Implications

Nebraska VR takes an unusually active pro-business approach in its interactions with

the business community. It markets assistive technology supports, legal education, and

supported training models for youth. While there are many benefits to this approach, it is

important to note that the ADA emphasizes protection of consumers over partnership

with employers. Therefore, it is imperative for VR agencies to collaborate closely with
34

employers and seek to serve them as a resource for employees, though not to the

detriment of protecting workers with disabilities.

Nebraska is also one of several states not currently recognized as an Employment First

state (i.e., a state possessing codified policy requirements necessitating the use of

competitive, integrated employment as the first employment option presented to people

with disabilities receiving supported employment services). Formal action to end the use

of sheltered workshops and sub-minimum wages for people with disabilities is not

occurring under state direction. In spite of this, actions are occurring that reflect federal

leadership in this area. The State Association of Providers, in recognition of the

Employment First principles in the WIOA, has begun to support competitive employment

rather than sheltered workshops or enclave models for people with disabilities. This shift

is expected to continue, as WIOA is effective July 2015.

Unlike many other state VR agencies, Nebraska provides more direct services than

contractor services. Agency officials view this structure as advantageous because it

allows more flexibility in responding to ideas generated by their staff and requests from

the disability community. Providing direct services increases the need for communication

between the agency and the disability community. Monitoring VR staff in those

communications, as with the state’s social media efforts, is especially important when

communicating with youth populations, one of the target groups for this strategy and a

focus of WIOA.

Nebraska VR uses its Meet You Where You Are philosophy to engage constructively

with two customer groups: people with disabilities who want employment and employers

who can provide it. Direct engagement through social media to stay connected with

clients, minimal use of contracted direct service providers, and employment of business

account managers to build relationships with employers allow for rapid communication

between Nebraska VR and its constituent communities. These strategies help the VR

staff to rapidly accommodate the changing needs of people with disabilities and the

employer community in their state.
35

The practices identified in this chapter demonstrate how VR services operationalize

legislation while responding to the needs and interests of consumers and employers in

order to improve employment outcomes for people with disabilities. Proactive outreach

and collaboration with state agencies, the employer community, and VR clients

contributes significantly to the success of increased employment outcomes in Nebraska.

These practices are initiated through personal contact and formalized through

memoranda of understanding, contractual agreements, and programmatic procedures.

States could model Nebraska’s Meet You Where You Are approach to build similarly

collaborative practices between their VR agencies and service consumer and employer

constituencies.

NCD Employment Recommendations

Employment supports offered in Nebraska can inform both federal and state

policymakers as they design initiatives to promote positive employment outcomes for

people with disabilities. The following recommendations are crafted to help guide

federal policymakers as they support state and local agencies in these efforts:

 The U.S. Department of Education should fund systematic evaluations of vocational 

rehabilitation technical assistance centers to determine their efficacy and identify 

best practices. For example, the U.S. Department of Education issued notice of a 

proposed priority on May 15, 2015, for funding the Vocational Rehabilitation 

Technical Assistance Center—Youth with Disabilities. An accompanying priority 

should be an evaluation of this technical assistance center to determine its 

effectiveness. 

 The U.S. Department of Labor and the Equal Employment Opportunity Commission

(EEOC) should provide additional guidance to employers about their obligations 

under the ADA, Rehabilitation Act of 1973, and other applicable civil rights legislation 

that affects people with disabilities in the workplace. This guidance should include 

(a) proactive actions that employers can take to determine whether their practices 

are meeting requirements, (b) resources that employers can use for self-correction, 
36

and (c) industry-specific resources that address the needs of both blue-collar and 

white-collar employers. 

 The U.S. Department of Labor should provide formal guidance, technical assistance, 

compliance monitoring, and evaluation of employer efforts to comply with Section 

503 of the Rehabilitation Act. These efforts should be based on findings from the 

EEOC and address common patterns of employer discrimination identified by the 

U.S. Department of Justice. 

 The U.S. Departments of Labor and Education should issue joint statements that 

reinforce VR’s role as a collaborating partner in planning at the state level for the

WIOA, which is due to go into effect in July 2015. They should also issue a follow-up 

statement that reinforces the role that VR can have in sector partnerships with 

employers. According to WIOA, states must conduct collaborative planning among 

their federally funded state agencies, including VR. 

 Congress should authorize federal tax credits for people with disabilities to partially 

offset the individual costs of VR services. Many VR services, including assistive 

technology, are subject to ability to pay and financial participation policies.

 Congress should enact legislation that makes the Work Opportunity Tax Credit 

program permanent, signifying its commitment to incentivizing private sector 

employers to hire people with disabilities and with other barriers to employment. The 

Work Opportunity Tax Credit for employers is currently on hiatus because it was not 

reauthorized for 2015. This tax credit is designed to encourage the hiring of 

individuals with barriers to employment, including people with disabilities, and 

offered a tax rebate of $1,200 to $9,600, depending on the target group in which an 

individual with a disability qualifies.

The following recommendations are for states and local agencies to consider as they

design, develop, and execute policy and as they institute practices and initiatives to

promote employment opportunities for people with disabilities:
37

 Expand models, such as Project SEARCH, that can give youth with disabilities more 

opportunities to obtain employment experiences and on-the-job training. Youth with 

disabilities who are transitioning from high school to the workplace can benefit 

greatly from supported work experiences and job exploration guidance. WIOA setaside funds for youth with disabilities transitioning from high school may assist in 

these efforts.

 Identify opportunities to provide Section 503 of the Rehabilitation Act training and 

technical assistance, particularly in the area of assistive technology, to public and 

private employers within the community. 

 Develop strategies to maintain communication with hard-to-reach and highly mobile 

populations of people with disabilities in the community.

 Collaborate with business leaders in order to inform the development of job training 

programs for people with disabilities. 

 Identify and pursue federally funded resources. The federal government sponsors 

initiatives that support state and local efforts to promote employment opportunities 

for people with disabilities. Examples include the following:

o Job Accommodation Network (JAN): https://askjan.org/

o LEAD Center: http://www.leadcenter.org/

o Partnership on Employment & Accessible Technology (PEAT):

http://www.peatworks.org/

o National Collaborative on Workforce and Disability for Youth (NCWD/Youth):

http://www.ncwd-youth.info/
38
39

EDUCATION

Introduction

Education is the cornerstone of society, providing youth with the knowledge and skills

necessary to have successful and meaningful lives. Education attainment is correlated

with employment rates, earning potential, and life span. The regulations of the

Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation

Act of 1973 (Section 504) mandate that students with disabilities receive a free and

appropriate public education (FAPE). IDEA provides for early intervention services for

young children with disabilities and the provision of education and behavioral services

and supports to ensure that students with disabilities, aged 3 to 21, are educated in the

least restrictive environment possible.

Despite legal protections and evidence that students with disabilities can succeed

academically, students with disabilities face chronic negative misperceptions about their

abilities, disproportionate disciplinary practices, and a great disparity in education

outcomes as compared with those of students without disabilities. The U.S. Department

of Education Office of Civil Rights reported that in 2011–2012, students with disabilities

(those served by IDEA) represented 12 percent of the overall student population, with

58 percent of those placed in seclusion or involuntary confinement, and 75 percent of

those physically restrained at school to immobilize them or reduce their ability to move

freely. Furthermore, 25 percent of students with disabilities were arrested and referred

to law enforcement (U.S. Department of Education Office for Civil Rights 2014). Zero

tolerance policies have significantly increased student suspensions and expulsions

even for offenses that pose little or no safety threat. Students with disabilities and

students of color are disproportionally suspended; transferred to alternative schools;

expelled; or sent to court for committing nonviolent, minor infractions (Majd 2011). At

least one in three juveniles in the juvenile justice system in the United States has a

disability, and students with emotional disabilities are three times more likely to be

arrested before leaving high school than are members of the general population (Quinn

et al. 2005). Recently, some states have passed laws to improve and address
40

disparities in juvenile justice systems, although few are focused on students with

disabilities (Balck 2012). 

Research shows that including students with disabilities in education settings consisting 

of students without disabilities improves achievement for all students, and it is estimated

that 85 percent to 90 percent of students with individualized education programs (IEPs) 

can meet regular diploma requirements with the right supports (Thurlow and

Quenemoen 2012). However, in the 2012–2013 school year, the national average

graduation rate for students without disabilities was 81.4 percent, while for students with

disabilities it was 61.9 percent, nearly 20 percentage points lower (Balfanz et al. 2013).

Students who graduate sometimes face challenges in accessing the SAT and ACT

standardized exams that act as the gatekeepers to competitive postsecondary

education (National Council on Disability 2015b). In higher education, students with

disabilities, and most notably students with print disabilities, often experience a variety

of challenges that result from inaccessible learning materials or their delivery systems 

(U.S. Department of Education 2011). 

Highlights of Application of ADA in Education Institutions

 A school may not discriminate on the basis of disability in any of its programs 

or services.

 Institutions must provide auxiliary aids and services that support effective 

communication (e.g., qualified interpreters, Braille materials, large print 

materials, captioned videotext, materials on computer, and adapted computer 

terminals).

 Schools must establish a process for making their tests accessible to people 

with disabilities.

K–12 students with disabilities have an IEP and receive academic and behavioral

accommodations, supports, and services as a part of IDEA. Services students receive

as a part of their IEPs are executed, monitored, and reported on at the federal level by

local education agencies (LEAs) and state education agencies (SEAs) to the Office of

Special Education Programs. Unlike ADA and Section 504, IDEA is connected to a 
41

funding stream that provides state and local education agencies with monies to cover

the excess cost of educating students with disabilities; however, the ADA and Section

504 enshrine education as a civil right.

Education Initiatives

This chapter highlights two initiatives that are aligned with the spirit of the ADA to ensure

that students with disabilities are able to access the same education opportunities as

students without disabilities. These initiatives are the Minnesota Olmstead plan and

statewide Section 504 training for Minnesota public school educators.

It is not always clear how the ADA connects directly to academic achievement for

students with disabilities. The ADA does not regulate the instructional services that

students receive in the K-12 classrooms or in higher education settings. Rather, it

promotes an environment of opportunity and access by prohibiting discrimination

against students with disabilities. Section 504 of the Rehabilitation Act complements the

ADA by requiring access to education settings through the use of individualized Section

504 plans. Most data collected on students with disabilities is specific to those who have

an IEP and are served under IDEA. The first time that national data was collected on

students with Section 504 plans was the 2009–2010 school year, and this information

was simply descriptive. As a result, the data used to demonstrate how ADA has

impacted access to education opportunities and improved post-secondary outcomes

through Minnesota’s initiatives is anecdotal.
42

History of Olmstead v. L.C.

In 1999, the state of Georgia was sued for violating the ADA by unnecessarily 

institutionalizing people with intellectual disabilities. In the United States Supreme 

Court case, Olmstead v. L.C., the court ruled that unjustified segregation of persons 

with disabilities constitutes discrimination in violation of Title II of the ADA. 

The court commented in its decision that as part of the settlement of this decision and

future ones like it, a state could produce a formal plan for increasing community

integration of persons with disabilities and specifically encouraged states to plan

reforms across contexts affected by the ADA, including health, transportation,

housing, education, and other social supports. This decision reinforced the civil rights

component of Title II of the ADA for persons with disabilities. 

As a result of litigation, more than 40 states have developed Olmstead plans

(Alameida et al. 2008).

Initiative 1: Minnesota Olmstead Plan 

In 2009, Minnesota was sued on the allegation that a facility in the state subjected people

with developmental disabilities to improper and inhumane use of seclusion and

mechanical restraints (Jensen v. Minnesota Department of Human Services 2015). The

court found that the state was in violation of the ADA, and as part of the settlement,

Governor Mark Dayton established an Olmstead sub-cabinet to draft and implement a 

comprehensive plan for the state to follow to improve community integration and inclusion

of persons with disabilities.

The sub-cabinet includes representatives from eight state agencies, including the

Minnesota Department of Education (MDE). The overall goal of the plan is to make

Minnesota a place where people with disabilities are living, learning, working, and

enjoying life in the most integrated settings. To achieve the most integrated environments

in each of these settings, the plan outlines goals and actions related to the following

broad topic areas: employment, housing, transportation, supports and services, lifelong

learning and education, health care and healthy living, and community engagement.
43

Like most state Olmstead plans, Minnesota’s draft plan contains provisions to support

the transition of youth with disabilities to employment or postsecondary education

settings as a component of the plan’s workforce preparedness section. For example, as

part of the employment actions, in June 2015, the state of Minnesota determined that all

transition-age students (those aged 14 to 21 years old) on Supplemental Security

Income (SSI)/Social Security Disability Insurance (SSDI) will receive benefit summary

and Disability 1010 (DB101) estimator sessions that can be used to inform their

employment planning choices and help them understand how integrated competitive

employment and benefits will work together.

Minnesota’s draft Olmstead plan is unique in that it contains objectives and actions

specific to the school and classroom experiences of K–12 students. The plan’s Lifelong

Learning and Education goal is that “People with disabilities will experience an inclusive

education system at all levels and lifelong learning opportunities that enable the full

development of individual talents, interests, creativity, and mental and physical abilities”

(Minnesota Department of Human Services 2013, p. 11). The action steps of the

overarching Lifelong Learning and Education goal reflect a commitment to the ADA

spirit of safeguarding the civil rights and supporting the full integration of persons with

disabilities into community living. 

Lifelong Learning and Education Objectives of Minnesota’s Olmstead Plan

 Reduces the use of restrictive procedures and eliminates the use of prone 

restraints in schools

 Improves school wide systems of positive behavior interventions and supports

 Provides students with interagency supports and services to access integrated 

employment options before exiting high school

 Increases the number of students with disabilities enrolling in postsecondary 

education and training programs

 Ensures that students with disabilities who are placed out of state or in juvenile 

corrections can return to their resident district or most integrated setting 
44

The first two objectives of the Lifelong Learning and Education goal of Minnesota’s draft

Olmstead plan relate to how educators respond to and support student behavior.

Positive behavior interventions and supports (PBIS) is an evidence-based framework to

reduce disciplinary actions and improve outcomes for all students, including those with

disabilities. Evaluation and research have shown that school wide PBIS and its

components reduce the number of office discipline referrals, help prevent student

dropout rates, and improve social and academic outcomes for children with emotional or

behavioral disabilities (Horner et al. 2004; Filter et al. 2007; Duda et al. 2004). Since

2005, MDE has collaborated with staff from the National Technical Assistance Center

on School-Wide PBIS and the state leadership team has created a blueprint to support

schools and programs that demonstrate readiness to implement PBIS in schools. In

2013, MDE secured a grant to provide educators and other staff with PBIS training.

Consequently, cohorts of schools received two years of training aligned to a specific

scope and sequence to support sustained PBIS implementation.

In 2008, the Juvenile Justice Coalition of Minnesota published a blueprint for reform that

noted that there were limited and inaccurate statewide and county data on youth

involved in the juvenile justice system. This is a common problem across the country as

well (Juvenile Justice Information Exchange n.d.). People of color are disproportionally

represented within juvenile justice and adult correctional systems, but few data is

available to provide information on these instances and their outcomes. One of the

action steps of the Lifelong Learning and Education objectives calls on MDE to review

data on students with IEPs in juvenile correctional settings and transition them to more

integrated settings. In 2009, Minnesota collaborated with the Institute on Community

Integration to create a Reintegration Framework Systems Planning Toolkit to support

the successful reintegration of youth with disabilities from separate sites, including

juvenile correctional facilities. The toolkit consists of the following indicators: interagency

collaboration (10 indicators), team planning (5 indicators), education (10 indicators), and

supporting life skills (6 indicators), and continuity during and after transition (8

indicators) (University of Minnesota, n.d.).
45

The remaining objectives in the Lifelong Learning and Education of the Olmstead plan

relate to the transition of students to postsecondary education or integrated

employment. Prior to the decision that spurred the creation of Minnesota’s Olmstead

plan, the state established local Community Transition Interagency Committees that are

pivotal in connecting youth to integrated postsecondary settings and meeting the

transition goals outlined in the Olmstead plan. Recently, Minnesota began collaborating

with the Project SEARCH High School Transition Program, a one-year internship

program for students with disabilities who are in their last year of school. In the program,

students work with a team that includes their family, supervisors within the host

business, a Project SEARCH instructor, vocational rehabilitation services, and county

providers to create an employment goal. The program supports the student during the

transition from school to employment. To date, Minnesota has established five Project

SEARCH sites and will be scaling up more as part of the Olmstead plan.

The Supports and Services section of the Olmstead plan also addresses the education

of persons with disabilities. This section addresses the need to understand service gaps

and encourage innovations, such as the use of assistive technology, to support the

most integrated settings for people with disabilities. The plan also creates a milestone

for the commissioner of the Department of Human Services to designate a person to

develop a plan for agency collaboration regarding assistive technology. It also allows for

a plan for coordinated refurbishment and reuse of assistive technology that will include

forecasts, goals, and timelines for expanding the use of technology that increases

access to integrated settings (Minnesota Department of Human Services 2013). This

recommendation was made to support transition to community-based living, but could

be equally applicable to education. Elementary and secondary students use assistive

technology devices purchased by their school district when part of their Section 504

plans. The devices are typically considered property of the school. Unless other

arrangements are made, students do not retain this assistive technology when

transitioning to postsecondary settings.
46

Implementation

The sub-cabinet has been challenged with securing final approval of the plan from the

federal court monitor since the 2009 legal decision that created Minnesota’s Olmstead

plan was issued. Most recently, a draft of the plan submitted on March 20, 2015, was

rejected for failing to contain “concrete, reliable, and realistic commitments,

accompanied by specific and reasonable timetables, for which the public agencies are

held accountable” (Jensen v. Minnesota Department of Human Services 2015). Despite

these setbacks, Minnesota has continued working toward the goal of full community

integration and inclusion of persons with disabilities, and progress has been made on

the Lifelong Learning and Education goals.

In 2012, the Minnesota legislature, in collaboration with the MDE, updated state laws to

clarify that use of prone restraints against children of all ages will be prohibited effective

August 1, 2015, in Minnesota schools (Statute 125A.0942 subd. 3 (8)) (Office of the

Revisor of Statutes, State of Minnesota 2014). During the 2013–2014 school year, there

were 837 prone restraint incidents used on a total of 159 students in Minnesota. In

accordance with the Olmstead plan, Minnesota has reduced the number of students

who experienced restrictive procedures by 3 percent, from 2,707 to 2,630, for the 2014–

2015 school year. In addition, in the last year, the number of schools participating in the

PBIS implementation has increased from 423 to 478—an increase of 13 percent. As

part of the Olmstead plan, a minimum of 40 schools will be added each year.

The Minnesota Olmstead plan calls for increasing the number of students with

disabilities enrolling in postsecondary education and training programs. Baseline data

from the Minnesota Post School Outcome Survey shows that, on average, 254 students

achieve this outcome each year. MDE has committed to leveraging the Community

Transition Interagency Committees, Project SEARCH, and transition planning to

increase this number by 50 individuals each year through 2019, an increase of about 20

percent in the first year (Minnesota Department of Human Services 2013).

To meet the Lifelong Learning and Education goal of increasing the number of students

enrolling in postsecondary education and training, MDE is scaling up the number of schools
47

that use evidence-based practices, including customized employment to support students

with disabilities so they can transition into integrated, competitive employment.

The Reintegration Framework Systems Planning Toolkit was created to decrease

dropout, suspension, and expulsion rates and increase graduation rates for students

with disabilities. The toolkit to support the successful reintegration of youth with

disabilities from separate sites, including correctional facilities, has been made available

on the MDE website. The website contains suggestions and resources for group

facilitation, a self-assessment tool that uses research-based indicators, a priority-setting

tool, and an action planning tool to support and guide interagency teams to make

improvements in their organizations and communities. As part of the Olmstead plan,

data will be collected to identify students who have a disability and who are in state

correctional facilities and to document who returns to their resident districts and into the

most integrated settings, as appropriate.

Sub-cabinet members and responsible MDE staff were strategic in identifying objectives

and actions that addressed the needs of people with disabilities. They connected the

feedback of stakeholders to existing MDE initiatives and federal reporting requirements.

For example, public stakeholders identified the restraint and seclusion of students with

disabilities as an area of concern. At the same time, the Minnesota legislature had

banned the use of prone restraints in schools, and MDE was scaling up PBIS across the

state. The sub-cabinet and MDE staff drafted the Olmstead plan objectives that focused

on these issues. This has enabled the MDE to leverage funding already set aside for

PBIS and use data already collected to implement and measure the Lifelong Learning

and Education objectives of the Olmstead plan.

Most of the actions and goals of the Lifelong Learning Education section of Minnesota’s

Olmstead plan call for additional scaling up and implementation of established

evidence-based practices. This will help safeguard and improve the civil rights and

opportunities of students with disabilities in the public education system. Traditionally,

the conception of students with disabilities in education is synonymous with the funding

streams and regulations of IDEA. The inclusion of MDE and goals for K–12 students in
48

the development and implementation of Minnesota’s Olmstead plan provides an

example of how ADA and its promise of civil rights can be addressed in education.

Initiative 2: Technical Assistance on Section 504 Plans

Title II of the ADA and Section 504 of the Rehabilitation Act of 1973 protect the civil

rights of students with disabilities. They do this by mandating that public schools, 

including charter schools and institutions of higher education, provide reasonable

accommodations so that students with disabilities receive an appropriate education that

promotes academic success and access to the learning environment. These provisions

differ from the IEP and related services provided to students identified as having a 

disability under IDEA. Students can have a Section 504 plan in addition to or

independent from an IEP. However, few education professionals have an understanding

of the differences between the two.

Recently, the Americans with Disabilities Act Amendments Act (ADAAA) of 2008

broadened the definition of disability to reject several Supreme Court decisions that

were seen as interpreting the ADA too narrowly (U.S. Department of Education 2013). 

Specifically, the definition was updated to expand the definition of major life activities

which affected the number of students who were eligible for Section 504 plans,

especially those who were not receiving services under IDEA. 

Differences Between the IDEA and Rehabilitation Act 

IDEA Rehabilitation Act

Students must be evaluated and found to 

have characteristics of at least 1 of 13 

specified disability categories. 

Students must demonstrate a physical or 

mental impairment that substantially limits 

one or more major life activities. There is 

no pre-defined exhaustive list of what this 

may refer to, and activities include chronic 

and short-term disabilities, or illnesses. 

An IEP contains specific, measurable 

learning goals for students and outlines 

the type of supplemental instruction, 

services (e.g., occupational therapist, 

speech language provider), or support 

they need to meet those goals.

A Section 504 plan describes the 

physical, technological, and logistical 

accommodations and modifications that 

allow a student to access the educational 

environment and materials. 

Source. Disability Rights Education and Defense Fund, n.d. 
49

In accordance with federal regulations, MDE conducts civil rights compliance reviews of

school districts, including interviews with Section 504 coordinators and a review of

Section 504 practices and procedures. Throughout these reviews, MDE identified a

number of common Section 504 errors on forms. MDE also found that there were

misconceptions regarding the Section 504 legal requirements and definitions of

disability in communication with educators and parents. In 2010, MDE staff developed a

Section 504 manual and made sample forms available on the MDE website. However, it

became clear that technical assistance was needed to build staff capacity and provide

information to families and advocates of students with disabilities. This initiative would

also help protect the civil rights of students with disabilities.

In 2013, MDE’s Division of Compliance and Assistance developed a full-day Section

504 training. This training was designed to provide information on Section 504 eligibility,

evaluation, placement, Section 504 plans, and procedural safeguards. It was developed

primarily for Section 504 coordinators and addressed school district obligations and

responsibilities, frequently asked questions, important case law, Section 504 resources,

and the intersection between the ADAAA and Section 504.

Participants were asked to complete an evaluation form at the end of each Section 504

training. They shared what was most useful, areas in which they required additional

training, and the changes that they would apply in their districts as a result of the

training. Evaluation results were overwhelmingly positive, with 97 percent of

respondents indicating that they agreed or strongly agreed that they would be able to

apply the knowledge they learned. Eighty-two percent of participants were able to

identify a specific practice, tool, or piece of information that they planned to apply within

their district.

As of June 2015, approximately 900 individuals attended 1 of the 18 live, full-day

Section 504 trainings, which were held at 11 different sites statewide. Follow-up

conversations with educators by MDE staff provided anecdotal evidence that many of

the practices highlighted in the training have been implemented following the training.

MDE staff report that more schools are conducting high-quality evaluations, using a
50

robust Section 504 team procedure, and providing better services to more students

under Section 504. Furthermore, anecdotal evidence from staff who conduct the civil

rights compliance reviews indicates that fewer eligible students are going unserved or

under-served and that students appear to be receiving better education services and

obtaining better outcomes. MDE staff also reported that technical assistance phone and

email lines have facilitated communication and relationship building between MDE staff

and district Section 504 coordinators. These technical assistance channels have also

built capacity for staff to conduct complex evaluations and serve all students.

Implementation

The beginning stages of implementing this initiative were challenging for MDE.

Preparing for, developing, and conducting the Section 504 training required a significant

amount of staff time and resources. MDE viewed the Section 504 training initiative as a

priority and provided the resources needed for implementation. MDE staff dedicated

between three and four months reviewing Section 504 regulations, guidance from the

Office of Civil Rights, case law, and other materials. In addition, MDE held trainings at

sites across different regions of the state, which required funds for MDE staff time to

identify and secure host sites, as well as requiring staff travel time and expenses.

One challenge for implementing Section 504 training involved differences in information

provided through the MDE initiative and that provided by private attorneys external to

the initiative. In Minnesota, a few private attorneys provide legal representation for most

school districts and have also provided Section 504 compliance training for many years.

After MDE developed the Section 504 training, educators raised concerns about

conflicting information they learned on Section 504. MDE staff members raised these

inconsistencies with the attorneys. Discussions reveled that differences mainly related

to best practices for Section 504 processes and procedures rather than differing

interpretations of the law.

Broader Implications

Minnesota’s initiatives demonstrate how comprehensive state activities under ADA,

Section 504 of the Rehabilitation Act, and IDEA overlap to promote academic
51

achievement and protect civil rights for students with disabilities. The ADA protects the

civil rights of students with disabilities by mandating that they are provided with

accommodations and modifications necessary to access educational settings.

Minnesota has a history of legislation to improve education outcomes for students with

disabilities. In 1984, Minnesota was one of the first state legislatures in the nation that

formally developed a state-wide system of services to ensure that youth with disabilities

had the opportunity to transition to training, education, and postsecondary education

communities (see Minn. Stat. 125A.08 and Minn. Rule 3525.2900). However, as in the

rest of the nation, disproportionate punitive disciplinary practices and education

practices that are inconsistent with the ADA can threaten the civil rights of students with

disabilities.

Minnesota’s Olmstead plan addresses the civil rights of students with disabilities by

outlining and acting on goals for training to significantly and consistently reduce

seclusion and restraint practices for students and scale up PBIS training. It also requires

data collection on students with disabilities in the juvenile justice system and has begun

to focus on successfully integrating these students into education settings. Students

who are black or Hispanic also have higher rates of restrictive disciplinary practices

(U.S. Department of Education 2014) and instances of juvenile incarceration (Juvenile

Justice Information Exchange n.d.), so the plan will address the civil rights of these

students as well.

Issues with access to assistive technology and the accessibility of education technology

are particularly topical given the increasing prevalence of technology in classrooms and

the changing world in which youth with disabilities are learning and will be employed.

The Section 504 training in Minnesota will ensure that educators and administrators can

meet their responsibilities for providing students with disabilities their right to

accommodations, including assistive technology.

NCD Education Recommendations 

Minnesota’s Olmstead plan and Section 504 plan technical assistance offerings

demonstrate how states can establish policies and adjust practices to create an
52

environment with resources that align with the ADA. The following NCD

recommendations offer insight on opportunities for federal policymakers to support

states in their efforts to promote accessible and inclusive learning environments. The

recommendations also address the issues that states and local agencies should

consider as they develop policies and institute innovative practices to enhance learning

opportunities for students with disabilities.

Opportunities for federal policymakers to support accessible local and state education

initiatives include the following:

 Congress should reauthorize the Elementary and Secondary Education Act (ESEA) 

to include unambiguous nondiscrimination requirements for charter schools and 

private schools that educate students through Title I portability provisions along with 

clear standards for charter school authorizers.

 Congress should reauthorize the ESEA to require that state education agencies 

(SEAs) and local education agencies (LEAs) intervene when schools or districts 

report significant achievement gaps in disaggregated data between the achievement 

of students with disabilities and students without disabilities.

 Congress should work closely with NCD to reauthorize IDEA in a manner that 

facilitates the inclusion of all students with disabilities. Reauthorization should 

include updates to Indicator 5 to ensure that SEAs and LEAs are not 

disproportionally placing students of color with disabilities outside of the least 

restrictive environment, authorization of SEAs to use IDEA professional 

development funds to provide training in methods of PBIS, guidance on standards 

for Functional Behavioral Assessments (FBAs) and Behavioral Improvement Plans

(BIPs), and guidance on school districts’ obligation to provide free and appropriate 

education to students with disabilities exhibiting problematic behaviors. 

 The U.S. Department of Education Office of Civil Rights should support the 

preparation of students to better negotiate their accommodations by assisting 
53

students with coordinating and managing a variety of services from multiple sources 

and facilitating the use of technology in education or employment.

 Congress should authorize the United States Access Board to establish guidelines 

for accessible instructional materials that will be used by government, in the private 

sector, and in postsecondary academic settings.

 Congress should reauthorize the Higher Education Act to extend provisions for 

capacity building for postsecondary educators to support students with disabilities. It 

should also provide funding for model demonstration projects on implementing and 

improving campus wide accessible instructional materials and universally designed 

materials in science, technology, engineering, and mathematics (STEM).

 The U.S. Department of Education should conduct an analysis of current data on 

Section 504 plans to review current practices and determine their effectiveness in

protecting the civil rights of all students with disabilities across their education 

experiences. 

Considerations for state and local agencies include the following:

 Offer Section 504 coordinators and other relevant staff members training on Section 

504 requirements so they have a common understanding of eligibility, evaluation, 

placement, plans, and procedural safeguards.

 Include academic growth measurement in state accountability systems.

Accountability and standards should be based on both proficiency and growth and 

must fully include all students.

 Provide reasonable adaptations and accommodations for children with disabilities 

during assessments so that the academic achievement of such children can be 

measured relative to the same academic standards applied to the general population.

 Collect data disaggregated by race and disability status at key points at which youth 

interact with the juvenile justice system to determine and address disparities and 

barriers to equitable treatment.
54

 Explore federal guidance on the interpretation and application of regulations. The 

federal government provides information on public obligations under the ADA and 

Olmstead, as well as updates on different Olmstead actions in the states. The U.S. 

Department of Education Office of Civil Rights posts guidance on the application of 

Section 504 and the ADA for students with disabilities. The U.S. Department of 

Education also funds national technical assistance centers on accessible 

instructional material and behavioral supports for students with disabilities.

Examples of federally funded resources include:

o Olmstead: Community Integration for Everyone: http://www.ada.gov/olmstead/

o Frequently Asked Questions About Section 504 and the Education of Children

with Disabilities: http://www2.ed.gov/about/offices/list/ocr/504faq.html

o Bookshare: An Accessible Online Library for People with Print Disabilities (free

access to students with print disabilities): https://www.bookshare.org/cms

o National Center on Accessible Educational Materials: http://aem.cast.org

o National Collaborative on Workforce and Disability: Making the Right Turn: A

Guide About Improving Transition Outcomes for Youth Involved in the Juvenile

Corrections System: http://www.ncwd-youth.info/juvenile-justice-guide

o National Center on Secondary Education and Transition: http://www.ncset.org/

o PACER Center (Parent Advocacy Coalition for Educational Rights):

http://www.pacer.org/

o Technical Assistance Center on Positive Behavioral Interventions and Supports:

http://www.pbis.org/
55

HEALTH CARE

Introduction

The implementation of the Patient Protection and Affordable Care Act (PPACA) and

other market and policy shifts are quickly changing the financing and delivery of health

care. Health care providers and insurers are conducting many experiments, or

demonstrations, across the country to create new innovations for the reorganization and

delivery of health care and related services. Health insurance payers, including

Medicare and Medicaid, are beginning to incentivize health care providers to deliver

high-quality health and preventive care at a lower cost by moving from fee-for-service

payments to performance-based and capitated (i.e., fixed fee per enrollee) payments.

These shifts, which aim to create a more integrated health care system, have the

potential to improve preventive care, care coordination, and to promote patient-centered

care. However, they also have the potential to incentivize the stinting of health care

services to save health insurers on costs. Managed care plans have a long history

within the U.S. health care system and illustrate how the delivery of high-quality health

care can sometimes conflict with aggressive cost controls.

The ADA protects people with disabilities from discrimination by health insurers on

administrative coverage decisions, such as when a health insurer denies a covered

benefit solely on the basis of a person’s disability status. However, it does little to

protect the person from excessively restrictive benefit designs. The PPACA includes

some new consumer protections and mandated health benefits but does not fully

address some significant gaps in coverage (Rosenbaum 2007).

Although the ADA is intended to protect people with disabilities from discrimination in

the provision of health care, it remains one of the few civil rights laws that lacks real

enforcement. Enforcement of ADA accessibility regulations is most often tied to litigation

and is therefore reactionary rather than proactive. Accessibility to health care facilities

remains a surprisingly significant problem for people with disabilities because of a lack

of accountability and understanding of the ADA compliance requirements on the part of
56

health care providers and payers. Unfortunately, the PPACA does not directly address

these lingering compliance issues (Rosenbaum 2007).

Highlights of ADA Related to Health Care

 Offers protection for people with disabilities against discriminatory choices 

made by health plans in administrative coverage decisions

 Offers few protections for people with disabilities against discriminatory choices 

made by health plans in benefit design decisions

 Prevents discrimination against people with disabilities in the provision of health 

care, including failure to offer health care services in an accessible manner 

Health Care Initiatives 

This chapter highlights two innovative initiatives that demonstrate how health care

policies and programs help protect people with disabilities against discrimination as

dictated by the ADA. These practices also operationalize the PPACA to ensure that

people with disabilities receive accessible and high-quality health care, and these

practices begin to offer consumer protections where the ADA often falls short. The

initiatives highlighted in this chapter include the Massachusetts Facility Assessment 

Tool (MFAT) and the One Care Dual Eligibles Demonstration. 

Initiative 1: Massachusetts Facility Assessment Tool

The Massachusetts Facility Assessment Tool (MFAT) was developed by the

Massachusetts Department of Public Health (MDPH) and was initiated in response to its

Disability Access Project (DAP) (Massachusetts Department of Public Health, Health

and Disability Program 2009). The MFAT serves as a survey instrument to identify and

rectify common architectural barriers for people with disabilities. The MFAT compiles

standards from the ADA and other Massachusetts state accessibility requirements to

assist those responsible for facilities accessibility to better understand and comply with

architectural requirements. The MFAT does not encompass the entirety of all ADA and

Massachusetts facilities accessibility requirements but focuses on select priorities to

keep the length of the assessment manageable. 
57

The MFAT is designed for ease of use by both professional and nonprofessional

audiences and is publicly available free of charge. The tool clarifies which architectural

features to assess and how to assess them. It provides instructions and relevant

standards necessary to assess facility accessibility with easy-to-understand illustrations

and measurement guidelines and also provides specific instructions for documenting

survey findings. 

Highlights of the Massachusetts Facility Assessment Tool

 The MFAT serves as a survey instrument to identify and rectify common 

architectural barriers for people with disabilities.

 The MFAT compiles standards from the ADA and other Massachusetts state 

accessibility requirements to assist those responsible for facilities accessibility 

to better understand and comply with architectural requirements. 

 The MFAT provides instructions with easy-to-understand illustrations and 

measurement guidelines and also provides specific instructions for 

documenting survey findings.

 The MFAT is publicly available and can be adapted to align with the 

accessibility requirements of other states. 

In order to increase the usage and impact of the MFAT, the MDPH Purchase of Service

(POS) Office has worked with the Health and Disability Program (HDP) to ensure that

all health care vendors contracting with the MDPH have met certain requirements with

regard to ADA, Section 504, and other nondiscriminatory practices based on disability.

MDPH requires all vendors providing direct services to MDPH to provide a signed

attestation that they are ADA compliant and nondiscriminatory based on disability; this

requirement has been embedded in the Purchase of Service application along with one

of the other Office of Health Equity program tools, the CLAS Self-Assessment Form.

HDP collaborates with the POS unit to provide training and technical assistance on

accessibility.

Since its implementation, the MFAT has been used successfully to promote the

accessibility of health care facilities. MDPH reports that site visits using the MFAT, as
58

well as additional technical trainings on safety and accessibility, have made a positive

impact on the accessibility of mammography centers in Massachusetts. These centers

now self-report on MFAT survey findings on a public website, the Massachusetts

Mammography Project. Because of MDPH’s successes, other states—including

Montana and Oregon—have adopted and modified the MFAT to align with their

respective state requirements and improve the accessibility of mammography screening

facilities for people with disabilities (Massachusetts Department of Public Health, Health

and Disability Program 2009).

Implementation

The inception of the MFAT began in the 1990s when a disability advocacy group sued

the state for lack of access to substance abuse treatment facilities. Stakeholders were

also concerned that people with disabilities were not able to access other programs and

medical services, including mammography facilities. In response, the MDPH looked to

publicly available health data to understand whether a problem with accessibility

existed. Specifically, MDPH examined data from the Behavioral Risk Factor

Surveillance System (BRFFS) and found that the difference between the use of routine

care by women with disabilities and those without disabilities was not significant.

However, MDPH found a significant difference in the rates of mammography screening

between women with disabilities and those without disabilities (Massachusetts

Department of Public Health, Health and Disability Program 2009).

To address the newfound disparity, the MDPH Health and Disability Program

collaborated with the Women’s Health Network (WHN) on developing the

Mammography Facility Assessment Tool, which predates the MFAT. After the original

tool was implemented across the state as part of the DAP, MDPH determined that this

tool could have application for a wider audience. It was revised to become the

Massachusetts Facility Assessment Tool (also known as MFAT), which gave it

application to additional types of medical facilities.

MDPH reported that factors essential to the successful implementation of the MFAT

included the availability of funds from the Centers for Disease Control and Prevention
59

(CDC) for the Women’s Health Program and the Health and Disability Program, as well

as strong cross-collaboration across MDPH programs, advocacy groups, researchers,

and other stakeholders. Barriers to MFAT implementation included initial resistance

from hospitals and health care providers who were concerned about site visits for

measurements and the possibility of expenses for new accommodations for women with

disabilities to undergo mammography screenings. MDPH emphasized the need to

communicate clearly with providers about the importance of this work for compliance

with ADA requirements and to ensure equitable access to needed health care for

people with disabilities. MDPH also reported ongoing challenges with training staff

involved in inspections of mammography sites as well as medical staff involved in

assisting women with disabilities with their mammography appointments, but MDPH

emphasized the importance of these functions.

Initiative 2: One Care Dual Eligibles Demonstration

Massachusetts was one of 15 states to receive a Center for Medicare and Medicaid

Innovation planning grant from the Centers for Medicare and Medicaid Services (CMS)

to develop a capitated financial alignment demonstration to integrate care for dual

eligible individuals—consumers who qualify for both Medicare and Medicaid (Kaiser

Family Foundation 2015a). The dual eligibles population includes beneficiaries with

highly complex and often costly health care needs (Kaiser Family Foundation, n.d.).

Through these demonstrations and in partnership with CMS, state grantees are looking

to improve care quality and outcomes for dual eligible enrollees and reduce

inconsistency between Medicare and Medicaid policies and regulations (Kaiser Family

Foundation 2015a).

The Massachusetts capitated financial alignment demonstration, known as One Care

MassHealth + Medicare, or simply One Care, was designed to integrate medical care

with behavioral health care, long-term services and supports (LTSS), and additional

community support services for dually eligible individuals ages 21 to 64 through

contracts with health plans (MassHealth/Executive Office of Health and Human

Services, n.d.a). MassHealth began planning and developing the demonstration with a

very broad and collaborative stakeholder process that included disability advocates,
60

consumers, providers, health plans, policy experts, and other interested parties.

Discussion topics included integration of the recovery model and independent living

philosophy through the creation of a Long-Term Supports (LTS) Coordinator role,

participation in the One Care plan procurement process, and the creation of an

Implementation Council.

Highlights of Innovation in the One Care Demonstration 

 The use of an interdisciplinary care team, including the enrollee, primary and 

behavioral health care providers, a care coordinator, and a Long-Term 

Supports (LTS) Coordinator

 A unique approach of fully involving people with disabilities and advocates in 

the operations of One Care through the establishment of an Implementation 

Council—a body made up mostly of consumers that is highly active in providing 

One Care with recommendations and advice

An emphasis on the independent living and long-term services and supports (LTSS)

preferences and goals of enrollees is central to the One Care demonstration. The

addition of a unique care team role, the LTS Coordinator, was created to bring the

independent living and recovery perspective to the care team as a means of supporting

the implementation of LTSS in a person-centered manner. The LTS Coordinator is

available to meet one-on-one with One Care enrollees to assess needs, preferences,

and goals as desired by the enrollee. If preferred by the enrollee, these meetings can

occur at the enrollee’s home. The LTS Coordinator then works with the enrollee and

their entire care team including their primary care physician, personal care assistants 

(PCAs), or other parties identified by the One Care enrollee, to develop a plan for LTSS

that aligns with the enrollee’s preferences and goals.

The One Care program is also innovative for its high level of stakeholder engagement

with people with disabilities, and its approach is a much needed positive step in

developing an effective model of consumer engagement. The Massachusetts Executive

Office of Health and Human Services (EOHHS) established an Implementation Council

for One Care that is a body made up mostly of consumers that provides input and
61

recommendations on various aspects of the One Care program to the EOHHS, the

secretariat level of oversight for MassHealth and other health agencies. The

Implementation Council also solicits input from stakeholders on plan benefit delivery,

plan quality, issues raised through the grievances and appeals process and

ombudsman reports, and access to services (medical, behavioral health, and LTSS).

Further, the Implementation Council has a role in the development of public education

and outreach campaigns. In addition to the Implementation Council, MassHealth

regularly engages with stakeholders and Endeavors to make its activities highly

transparent through public meetings and posting meeting minutes and materials online. 

In addition to the high level of stakeholder engagement, One Care has also taken steps

to include strong consumer protections.

Consumer Protections Integrated into the One Care Demonstration

 Upon joining a One Care plan, enrollees’ prior providers, services, and 

authorizations are protected by a continuity of care period (approximately 90 

days) while a comprehensive assessment process and individualized care plan 

are completed with the member

 Access to a Long-Term Supports (LTS) Coordinator who is part of a 

community-based organization that is independent from each participating 

managed care plan and helps secure the best care plan possible for enrollees

 Establishment of an Implementation Council—a body made up mostly of 

consumers established by the Commonwealth that meets monthly to provide 

input on One Care

 Regular stakeholder engagement with high transparency

 Provision of cultural competency trainings to providers and One Care plans on 

disability and related matters

 Establishment of an independent ombudsman program

 The right of a consumer to opt out if the consumer believes One Care does not 

suit his or her needs
62

Because the demonstration uses a capitated model, there are ample opportunities to

examine population health, consumer experience, and cost data that would not be

available under more typical fee-for-service payment structures. It will take some time

for the impact of the demonstration to be documented, reviewed, and analyzed.

Demonstration findings have potential importance for informing new models of care

across the nation.

Implementation

The One Care program was launched in October 2013 and welcomed 4,715 new

enrollees in the first three months through self-selected enrollment

(MassHealth/Executive Office of Health and Human Services 2015a). In addition to

continuously available self-enrollment, starting in January 2014, MassHealth also began

to enroll some members through a voluntary auto-assignment process that included an

opt-out option (Kaiser Family Foundation 2015b).

One Care plans are contractually required to report on a wide range of quality metrics,

some of which will result in a withholding of payments if not met. Plans that don’t meet

certain quality metrics must earn back payment based on their performance. Other

monitoring requirements include submission of encounter data; member, provider, and

plan participation in surveys; and other quality improvement data. Quantifiable data

regarding the implementation of One Care include reports that detail both new and

ongoing monthly enrollment by plan, rating category, and enrollment penetration rates

by county, as well as opt-out rates. Other quantifiable data includes new quarterly

reports on member health assessment completion, LTS Coordinator referrals, and

program-level spending information. These reports are publically available on the One

Care and Massachusetts Duals Demonstration websites (MassHealth/Executive Office

of Health and Human Services n.d.b, n.d.c). In addition, MassHealth collects health and

experience quality metrics such as the Hospital Consumer Assessment of Healthcare

Providers and Systems (HCAHPS) and the Mental Health Recovery Measure (MHRM)

survey during the demonstration period.
63

In recognition of the need for early data on member experience with One Care to better

inform and guide the development of the program, MassHealth created the Early

Indicators Project (EIP) in collaboration with the Implementation Council. The EIP uses

multiple methods to gather qualitative and quantitative data from various sources.

These methods include focus groups, surveys, MassHealth enrollment data, the

MassHealth Customer Service Center (CSC), the One Care Ombudsman, the Serving

the Health Insurance Needs of Everyone (SHINE) program, the Commonwealth’s Brain

Injury and Statewide Specialized Community Services Program (Formerly Statewide

Head Injury Program [SHIP]), and the One Care plans themselves. The EIP has

released two reports on early member experiences, the most recent of which became

available in May 2015 (MassHealth/Executive Office of Health and Human Services,

n.d.b).

MassHealth also created an encounter data workgroup, which includes members from

the Implementation Council, in order to develop policy and evaluation questions for

analysis. In addition, CMS contracted with independent evaluators to document and

measure the impact of all of the duals demonstrations, and it is expected that the report

on the first demonstration year will come out some time during 2016. This report is

expected to include benchmarks and analysis based on quality metrics for the first year

of the demonstration.

Through discussions with the chair of the Implementation Council, a mix of successes

and continued barriers were identified. As of May 2015, approximately 17,600

consumers were enrolled in the One Care program (MassHealth/Executive Office of

Health and Human Services 2015a). The number of enrollees increased significantly

within the first two years of the demonstration and has remained fairly constant since

mid-2014. Currently, the opt-out rate of those eligible for One Care is approximately 28

percent, a decrease from the first few months of the demonstration as reported by

MassHealth.

Although six health plans initially planned to participate in One Care, three plans

withdrew because of concerns over financing and infrastructure (Kaiser Family
64

Foundation 2015b). Three One Care plans are currently operating in Massachusetts

with coverage available in 9 of Massachusetts’ 14 counties. However, one of these

plans recently announced its withdrawal effective October 2015 (Dickson 2015).

Consumer satisfaction with health care and provider interactions is generally quite high,

and 83 percent of enrollees plan to stay in One Care according to the most recent EIP

report (MassHealth/Executive Office of Health and Human Services 2015b). The EIP

report also found that there appeared to be some confusion among enrollees about the

role of the LTS Coordinator. Although the role of the LTS Coordinator seems

straightforward, the Implementation Council chair reports that there are challenges with

implementation complexity and capacity. MassHealth and its stakeholders are invested

in working through these growing pains with the LTS Coordinator role because of the

reliance of the One Care population on LTSS and nonmedical services, which can

greatly affect their quality of health.

The Implementation Council chair also raised concerns about disparities in access to care

for people with behavioral health needs as well as concerns about auto-enrollment and

the lack of objective, nonclinical measures of LTSS quality for consumers to use to

compare plan options. The chair has also raised concerns with the speed of scale and

continuing to ensure that the unmet medical and LTSS needs of the One Care population

can be addressed, and is currently pressing for a more sustainable financing structure

and risk adjustment methodology. The chair also reports that MassHealth continues to

conduct extensive outreach and education efforts, and the Implementation Council

remains highly engaged with community stakeholders. MassHealth is committed to

continuing its work with CMS, the health plans, members, the Implementation Council,

and other stakeholders to ensure the effective implementation and success of One Care.

It is too early to understand the impact of the One Care demonstration on cost and

health outcomes to date, but the continued success of the program will be measured on

both. As new models of care delivery continue to be tested across the country, lessons

from One Care’s emphasis on a holistic approach to independent living, long-term
65

services and supports, and stakeholder engagement will be important to the health care

and policy communities.

Broader Implications

Massachusetts has made targeted efforts to advance equity in health care access for

people with disabilities and is testing innovations for health care coordination and

delivery. Massachusetts’s efforts are important to the field, and federal and state

policymakers have opportunities to replicate and build from these efforts to advance

health equity and consumer protections for people with disabilities.

Many health care providers are unaware of ADA and state regulations regarding

accessibility, and they require assistance to meet accessibility goals. Furthermore, there

is little accountability for health care providers to meet these goals. The development of

the MFAT represents a smart and practical way to help organizations meet accessibility

goals, and importantly, the MFAT is a framework that other states can replicate. Federal

and state policymakers can enforce ADA accessibility regulations by establishing

systems of accountability. With adequate funding and resources, regulators can also

offer technical assistance to health care providers to proactively improve accessibility

for people with disabilities.

While health care organizations across the country continue to test and refine new

models of health care delivery, attention must be paid to the holistic needs of people

with disabilities, emphasizing supports for independent living and preferences and goals

for long-term supports and services. The Massachusetts One Care demonstration’s

model for care delivery and coordination is unique in its use of an LTS Coordinator as

well as its use of stakeholder engagement in informing health plan operations and

shaping heath plan benefit design. Although the program has had successes,

particularly with regard to patient satisfaction, significant challenges remain. For health

plans across the country, there is a serious gap in consumer protections due to illdefined federal and state-required health plan benefits, particularly in managed care

settings. Health care delivery models will continue to vary across both health systems

and states, but it is important for policymakers and regulators to prioritize the values that
66

imbue the One Care demonstration and consider how stronger consumer protections for

people with disabilities can be established.

NCD Health Care Recommendations 

There are numerous lessons from the Massachusetts experience that can inform

federal and state policymaking. For example, opportunities for federal policymakers to

support better and more equitable health care for people with disabilities include the

following:

 CMS should take a more population-based approach to rate setting and risk 

adjustment in new capitated plans, particularly for dual eligible MCOs. The needs of 

potential enrollees 65 years or older and those younger than 65 are quite different, 

and risk adjustment and capitation levels should reflect these differences in order for 

plans to succeed and beneficiaries to receive the services they need to live quality 

lives.

 CMS should reevaluate the emphasis on scale in the movement of high-risk, 

vulnerable populations with thin margins of physical and behavioral health because 

of the high potential for disrupting previously developed fragile systems of care.

Providers may be at risk of not reaching the do-no-harm threshold in delivering 

services to potential enrollees. Instead, CMS and the state should take a more 

evidence-based approach that includes putting a strong evaluative process in place 

before the full rollout of any demonstration.

 The U.S. Department of Health and Human Services (HHS) should strengthen 

consumer protections and oversight of managed care. This should begin with 

mandatory coverage of health benefits that support the holistic needs of people with 

disabilities such as home care, assistive technology, mental health services and 

supports, and wraparound services. HHS should also implement a medical loss ratio

standard for Medicaid MCOs like that required for Health Insurance Marketplace 

plans. Finally, HHS should consider implementing capacity standards for managed 
67

care—for example, a 1:40 ratio for care coordinators to beneficiaries with intellectual 

or developmental disabilities. 

 HHS should prevent the development of institutional service carve-outs from 

managed care, such as for skilled nursing. The carve-outs make it impossible for 

states to lower costs by substituting effective but less expensive community services 

for institutional care.

 HHS should enhance public health surveillance data to better understand disparities 

in health and health care access for people with disabilities by continuing to invest in 

publicly funded research. Special consideration should be given to diverse 

populations and those with behavioral health needs. 

 HHS should develop measures that fully capture the experience of people with 

disabilities and better reflect the realities of people with long-term disabilities and 

chronic conditions who use LTSS. This should include measures that are not overly 

clinical in nature as well as effective resource use measures that recognize the longterm value of delivering up-front investments in care.

Considerations for state and local agencies include the following:

 Increase public deliberation and stakeholder engagement by integrating people with 

disabilities into health care policy and program operations. This can include 

obtaining stakeholder input for health plan benefit design; health plan quality review; 

review of appeals, grievances, and ombudsman reports; outreach and

communications; and general counsel and oversight of managed care. 

 Design and implement an MFAT-type tool and establish systems of accountability to 

improve health care facilities’ compliance with ADA and state accessibility 

requirements.

 Support demonstrations of new models of care coordination to improve health 

outcomes and consumer satisfaction with health care and independent living and 

long term services and supports while reducing total costs of long-term care. 
68

 Strengthen consumer protections and oversight of managed care and mandate 

coverage of health benefits that support the holistic needs of people with disabilities. 

Strengthening ombudsman programs is also an important consideration for 

regulatory agencies.

 Explore federally funded resources. The federal government sponsors initiatives that 

support state and local efforts to provide accessible and high-quality health care. 

Examples include the following:

o State Innovation Models Initiative: General Information:

http://innovation.cms.gov/initiatives/state-innovations/

o Disability-Competent Care Self-Assessment Tool: http://www.cms.gov/MedicareMedicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-MedicaidCoordination-Office/Downloads/DCCAssessmentTool.pdf

O National Center for Assisted Living (NCAL):

http://www.ahcancal.org/ncal/Pages/index.aspx
69

TRANSPORTATION 

Introduction 

Transportation is an essential factor for participating in basic life activities, such as

employment, community engagement, service work, and recreation. The ADA contains

provisions to promote accessible transportation options for people with disabilities in

order to ensure their civil right of equitable treatment. However, people with disabilities

report greater barriers to transportation than do those without. A 2010 survey found that

34 percent of people with disabilities reported inadequate transportation compared with

16 percent of people without a disability (Kessler Foundation and National Organization

on Disability 2010a). The same study reports that the transportation gap for people with

disabilities has continued to widen since 1998 when authors started measuring

transportation disparities. 

Highlights of ADA Transportation Provisions

 Promotes equal access to public transportation services for people with 

disabilities

 Mandates that newly purchased vehicles that serve the public comply with 

accessibility standards

 Requires paratransit services for inaccessible fixed-route systems and for 

anyone who cannot use accessible transit because of disability 

More large-scale quantitative studies are needed to identify the most common

accessibility barriers related to transportation among people with disabilities. NCD offers

insight on the issue in its 2015 transportation report (National Council on Disability

2015c), which explores the state of surface transportation throughout the nation, along

with changes during the previous 10 years. The report illustrates the need for additional

progress on the basis of a review of the literature; the current state of the industry; state

and local implementation of federal legislation; and information gleaned from outreach

to stakeholders, including people with disabilities and other experts. 
70

Transportation Initiatives 

State and local governments are obligated to comply with ADA mandates but have

flexibility in their approaches to operationalize provisions of the legislation. This chapter

highlights three initiatives that demonstrate how transportation programs have evolved

to align with the letter and spirit of the ADA in response to the needs of people with

disabilities. These examples focus on initiatives in New York City (NYC): accessible

subway stations, accessible taxis, and the Access-A-Ride paratransit program.

Initiative 1: Accessible Subway Stations 

The subway system in NYC is one of the oldest, largest, and busiest rapid transit

systems in the world. The original NYC subway line opened in 1904, predating the ADA

by more than 85 years. Accessibility was not a priority when the system was introduced,

which has led to barriers in use among riders with disabilities. In 1979, disability

advocates filed a lawsuit against the Metropolitan Transit Authority (MTA) under New

York state law. One of the outcomes from the settlement agreement was retrofitting 100

key subway stations by 2020. Provisions of the settlement agreement and a similar

settlement in Pennsylvania became the model for the ADA’s key station requirements.

Key subway stations are known as

(1) Stations where passenger boardings exceed average station

passenger boardings on the rail system by at least 15 percent, unless

such a station is close to another accessible station; (2) transfer stations

on a rail line or between rail lines; (3) major interchange points with other

transportation modes, including stations connecting with major parking

facilities, bus terminals, intercity or commuter rail stations, passenger

vessel terminals, or airports; (4) end stations, unless an end station is

close to another accessible station; and (5) stations serving major activity

centers, such as employment or government centers, institutions of higher

education, hospitals or other major health care facilities, or other facilities

that are major trip generators for individuals with disabilities (Americans
71

with Disabilities Act 1990) (U.S. Department of Transportation, Federal

Transit Authority 2007). 

Metropolitan Transportation Authority (MTA)

MTA New York City Transit is a public-benefit corporation chartered by the New York 

state legislature in 1968. MTA is governed by a 17-member board. Members are 

nominated by the governor, with four recommended by New York City's mayor and 

one each by the county executives of Nassau, Suffolk, Westchester, Dutchess, 

Orange, Rockland, and Putnam counties. All board members are confirmed by the 

New York state senate (Metropolitan Transportation Authority, n.d.). 

MTA has launched initiatives that respond to the settlement agreement and comply with

the Rehabilitation Act and the ADA. As a result, 108 stations, representing 84 key 

stations and 24 non-key stations (five of which are accessible in only one direction), are

accessible with elevators, and almost every station contains accessibility features such

as tactile strips along platform edges, assistive listening devices at ticket booths, and

accessible ticket vending machines. In addition to the embedded accessibility features,

MTA offers provisions to address temporary environmental barriers. For example,

through its website, MTA updates customers about interrupted service and elevator

outages. It also offers a subscription-based email and text message alert system (ealert) that sends this information and travel alternatives to customers’ mobile devices.

MTA also maintains a telephone line so users can call for information about elevator or

escalator outages and to report outages. Gaps between subway cars and platform

edges are a structural barrier that has proven challenging to adjust. This is due to an

initial design that did not account for wheelchair access. MTA addressed gaps at

accessible stations with platform edge extensions that are placed at the center of the

platform near the conductor’s position. In all stations, MTA makes announcements

advising passengers to be aware of such gaps when exiting and entering subway cars. 
72

Features of New York City’s Accessible Subway Stations

Features of accessible NYC subway stations include elevators and ramps, handrails 

on ramps and stairs, large-print and tactile-Braille signs, audio and visual information 

systems, accessible station booth windows, accessible MetroCard vending 

machines, accessible service entry gates at subway stations, platform-edge warning 

strips, telephones at an accessible height with volume control and text telephones 

(TTYs), and accessible restrooms at commuter rail stations with restrooms

(Metropolitan Transportation Authority, n.d.). 

In addition to addressing environmental barriers in the subway system to promote

access, MTA takes into account accessibility features when new initiatives are

introduced. For example, the Public Address Customer Information Screen system, 

which is commonly referred to as a “countdown clock” and is available at 288 stations,

offers train arrival messages by using both audio and video formats to appeal to

different senses. This technology alerts passengers about the upcoming arrival of new

trains and their destinations and offers other audio and visual messages to keep

customers fully informed about service delays and emergency situations. 

MTA offers travel training to Access-A-Ride registrants that provides short-term,

comprehensive, and intensive individualized instruction for paratransit customers with

physical or cognitive impairments. The instruction addresses how to safely and

independently navigate through a repetitive route in public transit environments by using

buses or subways instead of paratransit vehicles. Travel training facilitates the use of

mass transit, thereby reducing reliance on the paratransit service. 

The addition of the Second Avenue Subway is the first major expansion of NYC’s

subway system in more than 50 years. This line, which will be completed in four phases,

will stretch 8.5 miles and consist of 16 new stations. All stations will be built in

accordance with ADA guidelines and include accessibility features described in this

section. The initial phase of the Second Avenue Subway line will involve four new

stations and is expected to be complete by December 2016. The entire project is

scheduled to be completed by 2029. MTA also has construction plans for the 7 Line
73

Subway Extension that will include an accessible subway station on the west side of

Manhattan scheduled to open in 2015.

Implementation

The ADA and New York State and NYC building codes have guided progress to date.

Accessible station activities are included in MTA capital planning and coordinated with

the city and state. The NYC Mayor’s Office of People with Disabilities and people with

disabilities provide input to the NYC mayor’s office to ensure that laws and policies are

followed. MTA board members and employees are also instrumental in this initiative

through logistical and financial planning and demonstrating support publicly.

Progress to enhance accessibility throughout NYC’s subway stations has not come

without challenges. MTA experienced significant expense to enhance accessibility at

the 108 stations that were retrofitted with access features. This has required federal

monies to be coordinated and committed to ensure that completion is on schedule. MTA

has plans to spend $100 million in additional funds through 2019 to build in features

throughout the stations. Obtaining and retaining the funds has been challenging, in part

because funding issues surface with each state budgeting process. Therefore, existing

funding allocations for the Second Avenue Subway are subject to change as the state

budgeting process evolves. Scope serves as an additional challenge to retrofitting

subway stations. The system consists of 468 stations in operation, meaning that less

than one in every four stations is retrofitted to meet accessibility standards. The scope

of retrofitting stations is limited to key stations as identified in a settlement agreement,

with an additional 24 stations that have been enhanced with accessibility features.

However, all newly constructed stations will meet ADA regulations and be fully

accessible to people with disabilities.

Initiative 2: Access-A-Ride Paratransit Program 

MTA New York City Transit (NYCT) administers the Access-A-Ride program, the city’s

paratransit service. Access-A-Ride was launched as a result of the same 1979 lawsuit

and settlement agreement that shaped accessible subway stations. The program was
74

revamped after a 1999 lawsuit filed against NYCT under the ADA, which uncovered that

NYCT did not operate in a manner that aligned with ADA mandates.

Access-A-Ride currently operates 2,200 vehicles and provides 25,000 trips per day. It is

available for people with disabilities who are certified through the paratransit service and

unable to use accessible mass transit for some or all of their travel. Access-A-Ride is

offered 24 hours per day, 7 days per week and covers destinations served by public

buses and subways. Access-A-Ride customers pay the same full fare charged for public

transit ($2.75 at the time of this report). Service options include a shared-ride service,

which drives multiple riders during a trip; door-to-door service, which drives one

passenger or party at a time; and feeder service, during which trips are made partly by

paratransit and partly by a fixed-route bus or subway. To provide Access-A-Ride

services, NYCT contracts with private companies that operate vehicles that meet the

specific needs of customers.

Access-A-Ride has grown to provide innovative methods of service delivery to its

customers. For example, NYCT introduced interactive voice response (IVR) in 2009, an

automated customer agent that provides information automatically, such as a reminder

to each customer the night before about his or her booked trips, an alert stating when a

vehicle will arrive (e.g., in approximately 15 minutes), an alert that a person’s eligibility

will expire soon and needs to be renewed, and a reminder to subscription service users

to call to reserve subscription trips on holidays. Customers subscribe to the IVR by

calling Access-A-Ride and asking staff to send information via telephone, text message,

or email.

Access-A-Ride customers can complete trip-related transactions using Manage My

Trips. Customers access this Web-based tool from their personal computers or Web

browsers on their smartphones. They can schedule, confirm, and cancel a trip; request

subscription service; learn the status of a subscription service request; and put their

subscription service account on hold or cancel it. Access-A-Ride customers may also

elect to contact Access-A-Ride directly to schedule travel and request updates. AccessA-Ride offers an automated telephone survey for customers to provide feedback about
75

their experiences using the service. NYCT keeps customers informed of Access-A-Ride

services through On the Move, a periodic newsletter that communicates information

about Access-A-Ride services and other issues related to accessible mass transit.

Implementation

Access-A-Ride has evolved in NYC over the past several decades. Although it

originated in 1984 as part of a settlement agreement, the MTA struggled to operate the

service in a manner consistent with minimum service criteria during the early years of

operation (Fleischer and Zames 2001). Consequently, in 1999, three paratransit users

and five disability organizations filed a lawsuit against MTA and NYCT under the ADA.

The plaintiffs reported that Access-A-Ride often did not pick up customers or subjected

them to long waits and lengthy trips. The settlement agreement led to a committee

appointed by the governor and NYC mayor to develop a more efficient paratransit

system. NYCT has since adopted technologies that were not anticipated at the time the

ADA was enacted to offer IVR, such as Manage My Trip, and other supports to further

improve Access-A-Ride. The NYC Mayor’s Office of People with Disabilities reports that

Access-A-Ride now operates at a 93 percent on-time pickup rate, an improvement from

90 percent in 1999. Furthermore, Access-A-Ride has attained and maintained a zero

percent denial of service rate since March 2003 through the present, which is down

from between 7 percent and 10 percent in 1999.

Improvements in the Access-A-Ride program have led to enhanced communications

between passengers and providers and increased flexibility for passenger scheduling

(e.g., more options to coordinate times properly), which reduces stress among

customers between rides and helps to increase customer satisfaction. These efforts

have decreased the amount of fuel used throughout the system, reducing operating

costs and pollution.

Initiative 3: Accessible Taxis

Taxis in NYC transport an estimated 1 million passengers each day. This includes

yellow medallion taxis and street hail livery vehicles (Boro Taxis), which are painted

green. In the past, access barriers made it challenging or impossible for many people
76

with disabilities in NYC to use taxis. Many taxis could not accommodate passengers

seated in wheelchairs, and some drivers refused to pick up people with wheelchairs or

service animals. Such incidents sparked a class action lawsuit filed by disability

advocates under the ADA. The lawsuit netted a settlement agreement resulting in a

number of initiatives to enhance access. These initiatives include increasing the number

of wheelchair-accessible taxis, providing training for drivers of wheelchair-accessible

taxis, introducing new dispatch options for passengers with disabilities, offering audioscreen technology in vehicles, and producing public service announcements.

In 2014, the NYC Taxi and Limousine Commission (TLC) began executing a long-term

plan to increase the number of wheelchair-accessible taxis throughout the city. There

are two designs of these vehicles in NYC. One involves wheelchair access through a

rear entry and accommodates one passenger who remains seated in a wheelchair or

scooter and an additional passenger next to the driver. The other design involves sideentry wheelchair access and can accommodate one person who remains seated in a

wheelchair or scooter and four additional passengers who do not use a wheelchair or

scooter. As of March 2015, the number of accessible yellow medallion taxis on the road

increased from 231 from before the implementation of the Disabled Accessibility Plan to

573. In addition, 1,003 wheelchair-accessible green taxis were introduced following the

implementation of the Disabled Accessibility Plan. The Disabled Accessibility Plan calls

for a total of 16,900 accessible taxis by 2024. TLC requires all drivers who operate

wheelchair-accessible taxis to successfully complete wheelchair passenger assistance

training to learn how to dispatch equipment.

To connect passengers to wheelchair-accessible taxis, TLC manages the Accessible

Dispatch Program. This initiative allows customers to request a taxi for pickup anywhere

in Manhattan for travel to anywhere in the five boroughs and Westchester and Nassau

counties and to three regional airports. Customers pay standard metered taxi fare, and

there are no additional costs to other passengers. TLC maintains a list of Boro Taxi car

services with wheelchair-accessible vehicles on its website for trips originating in the

Bronx, Brooklyn, northern Manhattan, Queens, and Staten Island. The agency is

scheduled to expand the Accessible Dispatch Program in 2015 to feature citywide
77

pickup by either a yellow medallion taxi or Boro Taxi, depending on availability. The

expansion is expected to include innovative smartphone app technology to request taxis

and a marketing campaign to promote the program to potential users.

NYC has also introduced technology in taxis that offer access to riders with sensory

impairments. For example, audible touch screen systems are available in select taxis,

and they enhance independence for passengers with visual impairments. They include

audio output that announces fare changes periodically throughout the duration of a trip,

verifies taxi fares, gives information on tipping, and provides guidance on paying with a

credit card. This technology also features images of trip information on the taxi screen

alongside text information, which can support individuals who struggle to process text.

Some taxis include induction loops that provide access for passengers with hearing

impairments. This technology magnetically transmits sound to hearing aids and

cochlear implants by using telecoils. Taxis equipped with induction loops have exterior

decals indicating this feature in the vehicle. In addition to this innovative technology,

taxis also contain contact information for the TLC in Braille and large print.

TLC, in collaboration with the NYC Mayor’s Office of Media and Entertainment, has

developed a public service announcement to keep customers with disabilities informed

of their right to ride in a taxi. The announcement explains that a taxi driver is not allowed

to refuse service on the basis of disability, along with destination, age, race, gender, or

ethnicity. It is scheduled to be released in 2015 and will be featured in taxis throughout

NYC.

Implementation

State and city policies have helped shape practices that promote accessible taxis

throughout NYC. For example, the New York state HAIL Act requires the NYC City

Council and New York State Department of Transportation to develop and submit the

Disabled Accessibility Plan. TLC consulted with disability advocates and the NYC

Mayor’s Office of People with Disabilities to create the plan, which outlines a framework

for growing the fleet of accessible taxis to 50 percent and ensuring that they are

reachable by people with disabilities (New York City Taxi and Limousine Commission
78

2014). The Disabled Accessibility Plan was approved by the New York State

Department of Transportation in August 2014. 

Highlights of the Disabled Accessibility Plan

 Designates a certain number of licenses to operate wheelchair-accessible 

vehicles

 Outlines an approach for 50 percent of vehicles in the yellow medallion taxi 

feet to be accessible by 2020 to people who use wheelchairs

 Addresses TLC’s position on expanding the accessible share of the Boro Taxi 

fleet beyond 20 percent accessible taxis to 45 percent by 2024 and eventually 

to 50 percent

 Describes TLC’s plans to expand the Accessible Dispatch Program to operate 

throughout NYC by using accessible yellow medallion taxis and Boro Taxis

NYC’s accessible taxi initiatives benefit riders with disabilities because they offer greater

flexibility to travel independently and on one’s own schedule. These initiatives also lead

to greater opportunities for the NYC paratransit service to use taxis as a mode of

transportation for Access-A-Ride customers. Traditional paratransit trips cost $66.00 per

request, compared with $15.33 per yellow medallion taxi ride and $13.22 per Boro Taxi

ride. However, the initial investment in accessible vehicles served as a significant

barrier to executing this initiative. It costs approximately $15,000 to convert one vehicle

to full accessibility. The TLC authorized a $0.30 per ride surcharge to offset costs

associated with increasing the number of wheelchair-accessible taxis and for operating

these vehicles. 

Compliance among the taxi industry is another obstacle to fully implementing the

Disabled Accessibility Plan. Through an undercover operation, TLC monitors the taxi

industry for compliance with TLC accessibility requirements to provide equivalent

services to passengers using wheelchairs. Examples of infractions include not offering

wheelchair-accessible vehicles, not providing wheelchair-accessible vehicles within a 

reasonable time frame, and charging more money for these vehicles. Companies that

are subjected to TLC rules and do not comply are summoned accordingly. 
79

Broader Implications

Federal legislation, such as the ADA and Rehabilitation Act, serve as the basis for New

York state and NYC to institute inclusive transportation policies that govern how MTA,

TLC, and NYCT operate. These examples also highlight the importance of advocacy to

help operationalize legislation when necessary. Disability advocates identified obstacles

throughout subways, taxis, and paratransit, and they drew on federal legislation to

facilitate change. In addition, state and local officials play important roles when

developing innovative solutions for overcoming accessibility barriers. These officials

identified accessibility barriers and offered solutions when crafting guidelines for accessible

subway stops (as reflected though capital planning), determining regulations for wheelchairaccessible taxis (as reflected in the Disabled Accessibility Plan), and operating the

paratransit service. This is especially challenging when they are faced with financial

constraints and competing political interests. However, NYC transportation initiatives

demonstrate that productive collaboration among advocates and city and state officials can

lead to common ground, accessible options, and compliance with federal legislation.

Technology has also been a critical facilitator of accessible transportation initiatives.

NYC accessible subway stations, taxis, and the Access-A-Ride program make use of

technology in ways that were not conceived of when the ADA was crafted 25 years ago.

Advances in technology can contribute to more efficient systems, enhance customer

service, and save local and state government money on operating expenses.

Features described in NYC’s accessible transportation initiatives demonstrate how cities

can transform traditional transportation services into inclusive practices that benefit

everyone in society. These initiatives also support civil rights for people with disabilities,

because they provide access to employment locations; housing communities; shopping

options; and diverse cultural, community, and recreational activities. Although

accessible transportation programs were instituted to provide equitable options for

people with disabilities, benefits associated with them reach beyond people with

disabilities. For example, access features in subway stations benefit passengers with

strollers, packages, and luggage and those who have sustained temporary injuries or

experience fatigue. Multiple means of providing information helps all passengers who
80

are unfamiliar with the subway to navigate their way around. Wheelchair-accessible

taxis provide more options for people without disabilities to ride with colleagues, friends,

and family members who use wheelchairs. Costs associated with these accessible

options remain an ongoing concern among many people with disabilities and should

always be considered when introducing new opportunities to travel.

NCD Transportation Recommendations 

Examples involving accessible subway stations, paratransit, and accessible taxis help to

illustrate the process of how legislation can be operationalized into programs that

promote accessible transportation. Opportunities for federal policymakers to support

accessible transportation initiatives at the state and local levels include the following:

 The U.S. Department of Transportation should invest in research to understand 

current facilitators of and barriers to accessible transportation as experienced by 

people with disabilities in urban, suburban, and rural settings. This could include 

developing survey items addressing experiences of customers with disabilities for 

transit systems that solicit feedback to use in their efforts to understand accessibility 

trends. Findings would help to inform new or reauthorize existing legislation and 

inform state and local policies. 

 Congress should, as it has for Amtrak, set aside funds specifically for achieving 

station accessibility on subways where it does not yet exist, including platform 

connectivity, detectable warning installation, elevators, ramps, and full-length 

platform-level boarding. There should be clear objectives, deadlines, and outcomes 

analysis to achieve full and timely accessibility. 

 Congress should explore and support regulations and universal design and 

standards for accessibility features in taxis and other transit provided through 

transportation network services. Examples include wheelchair-accessible vehicles 

and audible touch screen systems.

Considerations for state and local agencies that are designing and executing accessible

transportation initiatives are as follows:
81

 Factor in accessibility during planning phases for new transportation initiatives. This

can reduce or eliminate expenses associated with ADA lawsuits and retrofitting

equipment and infrastructure to comply with ADA guidelines.

 Offer multiple ways to communicate transit information to customers. Customers 

cannot take advantage of accessibility features if they are not aware of them. Update 

transit websites with all access features; explore opportunities to push information to 

consumers about unexpected environmental obstacles, such as elevator outages; 

and use a combination of audio and tactile signage along with audio announcements 

to convey information in stations. 

 Identify and implement ongoing feedback from people with disabilities related to

transportation policies, equipment, programs, and other factors impacting

transportation and people with disabilities. This should be done through multiple

channels, such as collecting input online, developing advisory committees for

different transportation modes, and using periodic questionnaires.

 Collaborate with governing bodies that regulate taxi services to develop a strategic 

plan to increase the number of accessible taxis. Consider incentives for compliance, 

such as additional medallions or offering priority to operate at airports. The plan 

should also include expectations for driver training that support appropriate customer 

service when engaging with passengers with disabilities, as well as an approach to 

efficiently dispatching accessible taxis. 

 Explore federally funded resources. The federal government sponsors programs and 

centers that support accessible transportation for state and local agencies. 

Examples include the following:

o Easter Seals Project Action: http://www.projectaction.org/

o Transportation for Elderly Persons and Persons with Disabilities (5310):

http://www.fta.dot.gov/grants/13093_3556.html

o National Rural Transit Assistance Program: http://nationalrtap.org/
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83

HOUSING

Introduction

Affordable, accessible, and appropriate housing is essential for all people with

disabilities to experience independent community living. Approximately one fifth of

families that receive public housing have a family member with a disability living with

them (National Low Income Housing Coalition 2012). The ADA has significantly

influenced policies that affect people with disabilities and their right to live in safe,

accessible, and inclusive housing. This law requires that public accommodations, which

include publicly subsidized housing, comply with requirements that prohibit exclusion,

segregation, and unequal treatment. In addition, it requires public accommodations to

remove barriers in existing buildings when renovation is considered not overly

burdensome, as determined by the resources possessed by the owners of the property

(Americans with Disabilities Act 1990). 

ADA Public Accommodations Requirements

 Must comply with basic nondiscrimination requirements that prohibit exclusion, 

segregation, and unequal treatment

 Must follow architectural standards for new and altered buildings; reasonable 

modifications to policies, practices, and procedures; effective communication 

with people with hearing, vision, or speech disabilities; and other access 

requirements 

 Must remove barriers in existing buildings where it is easy to do so without 

much difficulty or expense, given the public accommodation's resources

In spite of these requirements, barriers continue to exist. All housing built with federal

funds, as well as housing programs receiving federal funds, are subject to the

requirements of Section 504 of the Rehabilitation Act of 1973. These regulations require

5 percent, with a minimum of one dwelling unit per complex, to be accessible to people

with mobility disabilities, and at least 2 percent, but not less than one dwelling unit, to be

accessible for people with visual and hearing disabilities. However, these percentage
84

requirements do not match the percentage of households reported to have a family

member with a disability. Data from the U.S. Department of Housing and Urban

Development’s (HUD’s) Resident Characteristics Report state that 36 percent of public

housing units have a resident with a disability living in the unit (U.S. Department of

Housing and Urban Development 2015).

The ADA standard has influenced subsequent legal rulings and legislation that impact

housing accessibility for people with disabilities. Significant examples include the

Supreme Court’s decision in Olmstead v. L.C. (1999), one of the leading influences on

the deinstitutionalization movement, as well as the New Freedom Initiative of 2001 and

Developmental Disabilities Assistance and Bill of Rights Act of 2000. Each of these

reinforces the notion that community living should be the rule rather than the exception

for people with disabilities.

Housing Initiatives

This chapter highlights two initiatives that demonstrate how housing policies have been

influenced by the ADA and subsequent civil rights laws and legal rulings. Both

initiatives, the Amy Young Barrier Removal Program and Project Access, are found in

Texas and focus, respectively, on the enhancement of accessibility and

deinstitutionalization for people with disabilities.

Initiative 1: Amy Young Barrier Removal Program

The Amy Young Barrier Removal Program is a Texas Department of Housing and

Community Affairs (TDHCA) program within the Housing Trust Fund (HTF). The

program supports people with disabilities in need of housing modifications. Launched in

2010, the Amy Young Barrier Removal Program is named in honor of the late Amy

Young, an advocate for Texans with disabilities. Ms. Young, a public policy analyst with

the Texas Council for Developmental Disabilities, gave shape to the program and also

urged TDHCA to fund it locally through its HTF. Ms. Young passed away one year

before TDHCA announced the new statewide housing program created in part from her

advocacy and policy recommendations to improve the lives of Texans with disabilities.
85

The ADA has limited applicability to private homes and only addresses portions that

may be public accommodations within a private home—for example, a ground floor

doctor’s office or an area designated as an in-home day care (ADA National Network,

n.d.). The Amy Young Barrier Removal Program’s objectives align with provisions that

seek to promote accessibility to public spaces and the removal of barriers that hinder

functioning within those spaces. Three ADA sections (§36.207 places of public

accommodation located in private residences, §36.211 maintenance of accessible

features, and §36.304 removal of barriers) each mandate that public spaces be

accessible to people with disabilities and that modifications be made to promote their

accessibility (Americans with Disabilities Act 1990). The Amy Young Barrier Removal

Program, though not a legally enforceable mandate like the ADA, extends this focus on

accessibility into private homes.

The Amy Young Barrier Removal Program provides onetime grants up to $20,000 to

people with disabilities who need home modifications to increase accessibility and

eliminate hazardous conditions. Program beneficiaries must include a person with

disability (any age), must have a household income that does not exceed 80 percent of

the area median family income, and may be tenants or home owners. Of the $20,000

total grant, at least 75 percent of it must be applied toward barrier removal activities,

with no more than 25 percent applied to correction of other unsafe and hazardous

housing conditions. Common home modifications in the program include adding

handrails and ramps; widening doors; adjusting countertops and cabinets to appropriate

heights; installing buzzing or flashing devices; installing accessible showers, toilets, and

sinks; and customizing other modifications for program participants (Texas Department

of Housing and Community Affairs, n.d.a). These modifications help participants to

remain in their communities, which in turn keeps their existing social networks intact and

decreases their dependence on institutional assistance.

The Amy Young Barrier Removal Program, one of several HTF initiatives, is funded

under the guidance of the Texas State Legislature through the appropriations process

every biennium. The program is implemented by Texas nonprofit organizations and

local governments that process intake applications, verify eligibility, and work with
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program beneficiaries to design modifications and oversee construction. As a result, the

HTF can respond to the unique housing needs of low-income Texans—especially

people with disabilities. At the beginning of the 2014 and 2015 biennium, the Texas

state legislature allocated $3,578,250 for the Amy Young Barrier Removal Program.

Additional funds became available over the course of the biennium as a result of loan

repayments from previously funded HTF projects. This allowed TDHCA to significantly

increase the funds available to the Amy Young Barrier Removal Program during the

second half of the biennium. These funds were released during multiple phases. By the

end of state fiscal year 2015, the HTF will have funded approximately 245 persons with

disabilities to modify and improve their homes (Texas Department of Housing and

Community Affairs, n.d.a).

To promote equitable distribution of funds to urban and rural areas of the state in the

Amy Young Barrier Removal Program, the HTF applies an allocation formula in which

both rural and urban areas of the state have a predetermined amount of funding

reserved only for their region for the first phase of funding availability. For 2014 and

2015, HTF staff observed that approximately 17 percent of the total number of

participating households in the Amy Young Barrier Removal Program lived in rural

Texas. This percentage is comparable to the population of Texas as a whole––

approximately 14 percent of Texans live in a rural area (Texas Comptroller 2008).

For policy guidance and critique on the design of the Amy Young Barrier Removal

Program, TDHCA seeks public participation from TDHCA’s Disability Advisory

Workgroup (DAW) and publicly announced roundtable discussions. Participants in the

DAW include disability advocates, service providers, state health and human services

agency staff, affordable housing advocates, and TDHCA administrators. TDHCA

regularly consults with community advocates, program administrators, and potential

applicants for funding in order to research and develop effective policies, programs, and

rules. To augment its formal public comment process, TDHCA also maintains the DAW

for ongoing guidance on how its programs can most effectively serve people with

disabilities.
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Implementation

Before 2010, TDHCA had only one home modification program that focused on serving

people with disabilities, and it was administered through the federal HOME Investment

Partnerships Program. This was viewed as less flexible by government officials and not

able to yield the same kinds of results that the Amy Young Barrier Removal Program

has since been able to produce. Since 2010, the Amy Young Barrier Removal Program

has helped more than 650 Texans with disabilities increase their independence through

creative design and barrier removal. In addition, because of the funding opportunity and

TDHCA’s technical assistance, the number of administrators capable of implementing

quality home accessibility modifications has steadily increased since the program’s

inception.

The Amy Young Barrier Removal Program began in 2010 with eight administrators, and

as of 2015 it has 40. This expansion has helped to market and provide assistance to

more people with disabilities and housing modification needs, particularly in rural Texas.

Despite this rapid growth, less than 25 percent of the counties in Texas have access to

an administrator of the Amy Young Barrier Removal Program. TDHCA continues to

work on increasing the cadre of experienced nonprofit organizations and local

governments that will implement the program to the satisfaction of its beneficiaries.

A continued high level of need and limited community capacity are ongoing challenges

for the Amy Young Barrier Removal Program. Though a base of funding is established

by the Texas Legislature through its appropriations process, additional funds may

become available due to loan repayments, interest earnings, and de-obligation of

resources to HTF-funded initiatives. In the 2012–2013 biennium, unexpended funds

from the previous biennium were carried over, though the increase in community

administrators may quicken the drawdown of funds in the future as more people

become aware of the program.

Initiative 2: Project Access

The Project Access Program is a collaborative effort among TDHCA, the Texas

Department of Aging and Disability Services (DADS), and the Texas Department of
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State Health Services. The Project Access program uses Section 8 Housing Choice

Vouchers administered by TDHCA to assist low-income people with disabilities in

transitioning from institutions to the community by providing access to affordable

housing. These institutions include nursing facilities, Intermediate Care Facilities for

Individuals with Intellectual and Developmental Disabilities (ICF/IID), and state

psychiatric facilities.

Unlike many other states, DADS contracts with relocation specialists to provide

outreach to individuals in nursing facilities who have expressed a desire to move into

the community. DADS policy permits the relocation specialists access to the facilities to

educate interested individuals on services and opportunities allowed through the Money

Follows the Person (MFP) policy. With the resident’s approval, the relocation specialist

meets with family members or other representatives and accesses written records.

Transition specialists, filling a role similar to the relocation specialists, facilitate the

transition of people with disabilities from Texas’ State Supported Living Centers to

community settings. The transition specialists work with local authorities and qualified

developmental disabilities professionals regarding needed supports and services—

identifying barriers to alternate community settings, initiating strategies to overcome

those barriers, serving as a resource for the person's support team, and developing

effective information exchange strategies to support the individual's transition to the

community.

As of February 2015, Project Access and the continued coordination between state

agencies resulted in 1,025 people with disabilities successfully moved into the

community and out of an institution. This number continues to rise. The MFP policy has

helped to facilitate Project Access by allowing individuals to bypass the Medicaid waiver

program interest lists and expedite the transition process. As with the Amy Young

Barrier Removal Program, TDHCA sees more demand for placement into accessible

housing in urban areas.

THDCA’s DAW was instrumental in determining how the Project Access pilot program

would work and continues to advise staff in the design of program changes as needed
89

to address unexpected issues. Participants of the DAW include disability advocates,

service providers, state health and human services agency staff, affordable housing

advocates, staff from Centers for Independent Living, and TDHCA administrators.

Implementation

Project Access began as a pilot initiative from HUD. HUD continues to allow the

program as a set-aside in Section 8’s Annual Public Housing Agency plan. The TDHCA

governing board voted to continue the program after the pilot ended and continue the

partnership with the DADS, the Texas Health and Human Services Commission

(HHSC), and the Texas Department of State Health Services (DSHS). The TDHCA

governing board continues to sustain the program by directing staff to use TDHCA

Section 8 resources for up to 140 vouchers for people with disabilities, though

advocates continue to request additional vouchers for the program. TDHCA partners

with the DADS MFP Demonstration (MFPD) Program through the Centers for Medicare

and Medicaid Services. MFPD funding partially funds a TDHCA program performance

specialist, as well as the Section 8 manager, who transition individuals who are on the

Project Access waiting list, but have not been issued a voucher, into the community by

using the HOME tenant-based rental assistance (TBRA) program. As a result of this

effort, 31 individuals who were on the Project Access wait list have utilized TBRA to

move back into the community while waiting for a voucher. The MFPD-funded positions

have played a critical role in supporting the transition of people with disabilities, and

Texas has committed to continuing these roles after MFPD funds have been expended.

Funding for community-based services and affordable, integrated, accessible housing

continues to be a barrier. Texas continues to apply for funding as opportunities arise,

such as the Section 811 Project Rental Assistance program. In 2012, Texas was 1 of 13

states to receive funding and was awarded $12 million from HUD. Texas applied for

2013 Section 811 Project Rental Assistance funding and received an additional $12

million for the program (TAC Resource Center on Supportive Housing 2012).
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Broader Implications

Texas’ policy orders and programmatic actions are a result of the housing requirements

of the ADA, subsequent federal requirements, and the Olmstead decision. The

Promoting Independence Statewide initiative began in 1999 when Governor George W.

Bush affirmed the value of community-based alternatives for persons with disabilities in

Executive Order GWB 99-2 (Legislative Reference Library of Texas, n.d.). This initiative

supports a desire among people with disabilities to live in the most appropriate care

setting available (Texas Health and Human Services Commission 2012). In response to

Governor Bush’s order, the Texas HHSC created the Promoting Independence Advisory

Committee (PIAC). The committee advises staff of the Texas HHSC on the

development of the Texas Promoting Independence Plan and the stakeholder report.

Members represent disability advocates, service providers, and state agencies

(including TDHCA). Subsequently, Governor Rick Perry signed Executive Order RP-13

in April 2002. This order requires the Texas HHSC to review and amend state policies

that impede moving children and adults from institutions when the individual desired the

move. This plan is updated biennially and describes the state’s efforts to meet these

requirements, as well as how these efforts will continue. Furthermore, it focuses

attention on the civil rights of people with disabilities among state lawmakers and

promotes dialogue between policy makers and stakeholders in the disability community.
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Promoting Independence Plan Housing Recommendations to Support 

Increasing Affordable, Accessible, and Integrated Housing

 Increase the number of Project Access vouchers for individuals regardless of 

disability or age. 

 The Texas Department of Housing and Community Affairs should continue to 

increase the amount of set-asides for people with disabilities at the SSI level of 

income in all of its programs. 

 If directed by the legislature, funding should be increased for the Housing 

Trust Fund. 

 HHSC should request that the Texas Department of Agriculture use a portion of 

its Community Development Block Grant funding allocations to address the 

housing needs of people with disabilities who receive SSI in rural communities.

 DADS should explore allowing consumer-directed services for adaptive aids 

and home modifications in all waivers, specialized therapies in Community 

Living Assistance and Support Services, and nursing and professional 

therapies in home and community-based services and deaf-blind multiple 

disabilities.

Within the framework of Texas’ Promoting Independence Plan, the Project Access 

program responds to the Olmstead decision and preserves and protects the civil rights

of people with disabilities. The initiative offers people with disabilities the opportunity to

live in communities where they have social bonds with friends and family members

rather than having to move elsewhere to find accessible housing or remain in an

institutional setting. 

Although all levels of government should focus on the civil rights of people with

disabilities to drive housing policy decisions, fiscal limitations exist that hinder the rapid

closure of institutions and the creation of fully accessible housing. In spite of the efforts

of Texas, which have helped more than 40,000 citizens of various ages move from

institutions to the community since 2001, the number of institutional facilities remains, 

though their populations are slowly decreasing. These remaining facilities are often

significant employers in their communities, and local leaders have a vested interest in

protecting the jobs of community residents. 
92

With an aging U.S. population, many of whom will develop disabilities as they enter their

senior years, alternatives to institutions will be needed to manage costs. Financial

evidence shows that providing services in a home, rather than in an institutional facility,

are less costly. The average cost of a semi-private room in a nursing home was $6,235

per month in 2010, and this rate rises when additional supports are required

(Longtermcare.gov, n.d.). The Kaiser Family Foundation reported that the average

monthly cost for in-home supports provided through MFP was $3,934 per month in 2013

(O’Malley et al. 2014). Federal and state policies can address this issue by investing in

new housing that is accessible or retrofitting current housing stock to meet the changing

needs of residents. Adaptations and modifications to an individual’s home may include

things such as chair lifts to reach upstairs bedrooms; modifications to bathrooms that

facilitate self-care; and visual alarms and notifications for phones, doorbells, or smoke

detectors to alert an individual to needed information. These types of investments can

pay for themselves over time as people with disabilities are able to remain in their

homes and live independently for many more years.

NCD Housing Recommendations

The practices identified in this chapter demonstrate how Texas housing authorities

operationalize legislation and increase opportunities for people with disabilities to

remove barriers and access inclusive housing within communities of their choice.

The following recommendations are crafted to help guide federal policymakers as they

support states throughout processes related to accessible housing initiatives at the state

and local levels:

 Congress should establish a permanent funding stream for the MFP Demonstration 

program to increase opportunities for people with disabilities to live inclusively in 

their communities among their friends and families. 

 HUD should raise the current federal requirements for new accessible housing 

constructed with federal funds from a minimum of 5 percent (at least one) accessible 

new units for persons with physical disabilities and 2 percent (at least one) 
93

accessible new units for persons with sensory disabilities to match the percentage of

the American population with disabilities as identified by the American Community 

Survey (ACS). 

 Congress should allocate additional funding to HUD to begin retrofitting older public 

housing units so that they meet federal accessibility requirements.

 HUD should make grant money available to states to subsidize the permanent 

renovation of privately held housing stock in order to enhance its accessibility, 

allowing more people with disabilities to live safely in the community.

 Congress should increase the number of federal housing vouchers available to lowincome individuals and families. Furthermore, a percentage set-aside should be 

instituted to require that the number of available vouchers specifically for people with 

disabilities reflects the percentage of people with disabilities in the population. 

The following recommendations are for states and local agencies to consider as they

design, develop, and execute policy and institute practices and initiatives to promote

accessible housing opportunities for people with disabilities:

 State and local building commissions should modify their housing codes to institute 

universal accessibility design requirements in all newly constructed homes and 

apartments.

 State governments should offer tax credits to architectural and construction firms to 

encourage pro bono accessibility design and home modification for low-income 

people with disabilities who are living in the community.

 State legislatures should set up housing trusts that allow for funds to be used for 

home modification grants under state, rather than federal, oversight. This would allow 

for more targeted and rapid dispersal of resources. Funds for these initiatives could be 

generated through fees or surcharges on new construction permits or materials.

 Rural and suburban communities should increase the number of accessible housing 

units available, with special emphasis placed on developing units near public 
94

transportation and community service hubs. Ease of access to transportation, 

shopping, and recreation will increase community inclusion. Particular emphasis 

should be placed on housing for aging people with disabilities, especially those 

leaving institutional settings, because of functional limitations they might have that 

prevent them from driving independently.

 States should identify and pursue federally funded resources. The federal 

government sponsors initiatives that support state and local efforts to promote 

accessible housing opportunities for people with disabilities. Examples include:

o ADA National Network: https://adata.org/

o Aging and Disability Resource Center (ADRC) Technical Assistance Exchange:

http://www.adrc-tae.acl.gov/

o U.S. Department of Housing and Urban Development, Community Development 

Block Grant Program (CDBG):

http://portal.hud.gov/hudportal/HUD?src=/program_offices/comm_planning/comm

unitydevelopment/programs

o U.S. Department of Veterans Affairs, Specially Adapted Housing (SAH) and

Special Housing Adaptation (SHA) grant programs:

http://www.benefits.va.gov/homeloans/adaptedhousing.asp
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VISION FOR THE FUTURE

Introduction

The 2015 edition of National Disability Policy: A Progress Report includes just a few of

the many initiatives that state and local agencies have implemented to operationalize

the ADA and other legislation relevant to people with disabilities. These examples

demonstrate not only the role of federal legislation in improving outcomes for people

with disabilities but also the importance of advocates working with policymakers to

translate legislation into practice. Although our country has made great progress in

shaping practices that align with the ADA and other related legislation, much work

remains to be done in order for us to realize a fully inclusive society. Although youth and

young adults with disabilities were born into a post-ADA environment, far too many have

not experienced the civil rights for equitable access that federal legislation was enacted

to protect.

As we commemorate the 25-year anniversary of the ADA, advocates serve as a driving

force behind the enforcement of legislation that protects the civil rights of people with

disabilities. NCD’s hope for the 50-year anniversary of the ADA is that the role of the

disability advocate will shift to that of advisor to policymakers, technologists, industry,

educators, and others who themselves are intrinsically motivated to incorporate

provisions found in disability legislation throughout their professional practices. This

section outlines NCD’s vision for a society that has benefited from such practices. It

reflects a national perspective by highlighting policy areas addressed in this report.

NCD’s vision also extends to a global society, which aligns with the contributions that

the ADA made to the development of the Convention on the Rights of People with

Disabilities (CRPD).
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NCD’s National Vision for the 50th Anniversary of the ADA

Employment

“Full employment of youth and adults with disabilities is the surest path to America's 

economic vitality and global competitiveness.”

—Lynnae Ruttledge, NCD Council Member 

NCD envisions a future in which all people with disabilities are afforded the same

opportunities for inclusive, competitive employment as are those without disabilities.

This will require changes in discriminatory thinking, particularly in the views on the

ability of people with disabilities to perform in the workplace. At present, the percentage

of people with disabilities who are employed is still astonishingly low. In May 2015, only

19.8 percent of people with disabilities were participating in the labor force compared

with 68.8 percent of people without disabilities. For those people with disabilities who

did enter the workforce, though, the unemployment rate was at 10.1 percent, twice as

high as the national average for people without disabilities at 5.1 percent. (U.S.

Department of Labor Bureau of Labor Statistics 2015). These numbers point to a stark

employment picture for people with disabilities. For us as a nation, this is unacceptable.

The following examples describe NCD’s vision for the future in the area of employment

for people with disabilities, as well as the Council’s views on actions that should be

taken to address this challenge. 

Work incentive programs for Supplemental Security Income/Social Security

Disability Insurance (SSI/SSDI) beneficiaries, such as the Ticket-to-Work program,

will receive the support necessary to enhance their effectiveness. Ticket-to-Work is

a Social Security Administration-sponsored initiative that allows an SSI/SSDI beneficiary

to receive extended coaching and support through an employment network to enter or

re-enter the workforce. During this period, a person with a disability is able to maintain

his or her SSI/SSDI benefits, though income benefits are gradually reduced as working

income rises. Ticket-to-Work has been characterized by a low participation rate since its

inception in 1999, and evaluations have shown limited effectiveness. Congress should

act to provide additional guidance to state agencies and mandate closer collaborative,
97

rather than competitive, relationships between state vocational rehabilitation agencies

and employment networks in order to identify and develop models that more effectively

contribute to employment for people with disabilities.

The promise of the Workforce Innovation and Opportunity Act will be fulfilled,

leading to greater collaboration among local, state, and federal employment

services and enhanced opportunities for integrated, competitive employment for

people with disabilities. The Workforce Innovation and Opportunity Act (WIOA)

reauthorizes the Workforce Investment Act (WIA) of 1998 through 2020 and

reauthorizes and updates the Rehabilitation Act of 1973 (U.S. Department of Labor,

Employment and Training Administration 2014). Key provisions that directly impact with

people with disabilities include mandated cooperative agreements between state

vocational rehabilitation agencies, state agencies that provide services to people with

developmental disabilities, and Medicaid home and community-based services

providers. State agencies should collaborate with their planning and action committees

to draw on the strengths of multiple programs and minimize the overlap of services. This

could provide more comprehensive employment support to people with disabilities

through more efficient use of resources. Further, federal agencies such as the U.S.

Department of Education (Rehabilitation Services Administration), U.S. Department of

Health and Human Services (National Institute on Disability, Independent Living, and

Rehabilitation Research), and U.S. Department of Labor (Office of Disability

Employment Policy) should exercise their authority to fund technical assistance centers

to support state and local providers as they develop their understanding of the new

federal requirements and begin instituting new employment policies and practices for

people with disabilities. These agencies should also support technical assistance

opportunities that empower people with disabilities, including intellectual disabilities, to

participate in postsecondary education and prepare for, and retain, competitive,

integrated employment.

Discrimination against people with disabilities during hiring, job assignment,

promotion, and retention will end. These decisions will be based solely on the

qualifications and performance of the individual. The ADA and the Equal
98

Employment Opportunity Commission have enacted protections that prohibit

discrimination against people with disabilities in terms of hiring, job assignment,

promotion, and retention processes. Yet, the labor participation rate for people with

disabilities remains stagnant. One factor is a limited understanding among employers

concerning the capabilities of people with disabilities, particularly those with significant

disabilities. Exposure to people with disabilities builds understanding of their capacities

to perform in the workplace. Supportive employment is a practice that provides résumébuilding opportunities to people with disabilities while simultaneously providing contextbased education to employers concerning the capabilities of people with disabilities.

This type of workplace exposure benefits both people with disabilities and employers,

and can help to dispel negative perceptions of people with disabilities. Congress should

provide additional funds to the Rehabilitation Services Administration-funded vocational

rehabilitation agencies to address the supports needed for competitive, integrated

employment and the education of employers to create inclusive work environments.

The sub-minimum wage provisions of the Fair Labor Standards Act will be

eliminated, guaranteeing competitive wages for all people with disabilities.

Sheltered workshops are working environments characterized by variable wages, which

are generally based on a piece rate that can be as low as pennies per hour. This wage

rate is allowed under the Fair Labor Standards Act and reflects an outdated

understanding of the productive capabilities of people with disabilities. At present, a

large percentage of people with disabilities live below the poverty line, regardless of

their labor participation status. Competitive employment at regular wages would help to

reduce the number of people with disabilities living in poverty and provide enhanced

opportunities for self-sufficiency and personal advancement.

Although states have the ability to eliminate sub-minimum wage employment, which

New Hampshire has already done, others will need to take a phased approach, led by

the federal government, to end this practice. As described in NCD’s Subminimum Wage

and Supported Employment report (National Council on Disability 2012), the U.S.

Department of Labor should cease issuing new authorizing certificates to ensure the

phased elimination of the 14(c) sub-minimum wage program, and the present holders of
99

14(c) authorizing certificates should participate in a phased conversion to supported

employment models. People with disabilities participating in sub-minimum wage

employment will be transitioned to supported, integrated employment, with all

transitioned within six years. Clauses within WIOA encourage this phase-out and direct

funds to initiatives that support competitive, integrated employment for people with

disabilities. Following completion of this phase-out, Congress should amend the Fair

Labor Standards Act to eliminate the allowance of sub-minimum wages for people with

disabilities.

Workplace accessibility, a reasonable accommodation, will be extended to people

with disabilities who work remotely. The ADA requires that reasonable

accommodations be provided to workers with disabilities to facilitate their ability to

perform their work tasks. Employers should view working remotely—a workplace

flexibility provision that is increasingly being embraced by employers and supported by

technology advancement (Global Workplace Analytics, n.d.)—as a reasonable

accommodation for people with disabilities. Among workers with disabilities, 5.3

percent, compared with 4.3 percent of workers without disabilities, worked from home in

2013 (U.S. Census Bureau 2014). Modification of an individual’s home work space for

accessibility may be less burdensome than modifying a large work site. Tax credit

programs to reduce the cost of access modifications in home offices can help extend

accessible employment opportunities to remote workspaces. To assist in this, Congress

should amend the tax code to allow for an expansion of presently available tax credits

for access modifications in home offices.

Employers will become partners in disability employment, working in

collaboration with the individual, support providers, disability advocacy groups,

and state agencies to develop competitive employment opportunities for all

people with disabilities. Many employers currently focus on the local, state, and

federal compliance requirements of the ADA and other legislation. Federal contractors

are required to meet the 7 percent inclusion targets within the updated Section 503 of

the Rehabilitation Act of 1973 regulations. Work spaces are made compliant with state

and federal standards. These actions are reactive rather than proactive and create an
100

atmosphere of compliance rather than voluntary commitment. Closer engagement

among vocational rehabilitation service agencies, the disability community, and private

employers can assist in the development of dialogue and then action. To accomplish

this, the Department of Labor should require representation of people with disabilities on

local workforce investment boards as required under the WIOA and encourage efforts to

promote people with disabilities to positions of influence and leadership in both the

public and private sectors. Simultaneously, federal contractors must recognize that the

7 percent inclusion target applies across job categories for firms with more than 100

people. This includes senior leadership positions within an organization. Private

employers should identify qualified candidates with disabilities who can inspire an

inclusionary vision for their organizations.

Education

“With accessible and available high-quality early intervention through postsecondary 

education, people with disabilities have the opportunity to move beyond 

discrimination and high risk for prison to full realization of their abilities.”

—Kate Seelman, NCD Council Member

NCD envisions a future in which students with disabilities can enroll in any school in the

country, along with students without disabilities, and be provided appropriate supports

and instruction that prepare them with the necessary academic and social skills needed

to transition to postsecondary academic opportunities or competitive employment. At

this time students with disabilities face discrimination and misperceptions that likely

have a negative impact on their academic and behavioral outcomes. For instance, a

2012 survey found that about 40 percent of parents, educators, and members of the

general public incorrectly believe that learning disabilities are correlated with IQ or are

associated with blindness and deafness (Cortiella et al. 2014). Despite the fact that

IDEA has put in place procedures to prevent schools from suspending or expelling

students without considering the effects of the child's disability, students with disabilities

are more than twice as likely to receive one or more out-of-school suspensions as are

students without disabilities. The high school graduation rate for the majority of states
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has consistently been about 85 percent, but in many states, students with disabilities

graduate at a rate 30 points behind their peers (Cortiella et al. 2014). Discriminatory

practices and disproportionate outcomes must be addressed. The following examples

describe NCD’s vision for the future in the area of education for people with disabilities.

Students with disabilities will have equal opportunity and access to a meaningful

education. Although federal legislation encourages students to be educated alongside

peers without disabilities, many students with disabilities do not experience meaningful

inclusion and integration in schools and general education classrooms. This can be

attributed to various factors, such as teaching practices that do not reach all students

along with ineffective behavior modification strategies that separate students from

instruction time. To promote meaningful education, Local Education Agencies (LEAs)

and State Education Agencies (SEAs) should implement evidence-based practices such

as universal design for learning that support all students in the classroom, including

students with disabilities. These agencies should also promote positive behavior

interventions and supports, which are designed to be proactive in preventing problem

behavior rather than reactive. Congress should work closely with NCD to reauthorize

IDEA in a manner that facilitates the meaningful inclusion of all students with disabilities.

This should include clear requirements that all schools, including charter schools, have

inclusive recruitment, acceptance, and education policies for students with disabilities.

Additionally, Congress should authorize the United States Access Board to establish

guidelines for accessible instructional materials that will be used by government, in the

private sector, and in postsecondary academic settings.

The school-to-prison pipeline for students with disabilities and from diverse

backgrounds will be dismantled. Zero tolerance policies have significantly increased

suspensions and expulsions for students with disabilities and from diverse backgrounds.

This is true even for offenses that pose little or no safety threat. Youth with disabilities

are overrepresented in the juvenile justice systems, and students with emotional

disabilities are at greater risk of being arrested before leaving high school than their

peers. To address these issues, SEAs and LEAs should offer social skills instruction

and individualized wraparound supports to connect students with disabilities to
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community services. These agencies should also adopt positive behavioral systems and

end zero tolerance disciplinary practices. Federal, state, and local education agencies

should allocate funding to support school-based mental health service providers.

Furthermore, the U.S. Department of Education should support research that

determines factors that contribute to the disproportionality of students with disabilities in

the juvenile justice system, as well as evidence-based practices to address these

factors.

Students with disabilities will be fully included in appropriate accountability and

achievement metrics. States are accountable for the academic progress of students

with disabilities. At present, federal legislation requires that 95 percent of students with

disabilities are included in state achievement assessments, and permits less than 1

percent of students to take alternative assessments to be counted as proficient in

accountability metrics. To promote full inclusion in appropriate accountability and

achievement metrics, LEAs and SEAs should ensure that universal design for learning

extends to standard assessments. These agencies should ensure that students who

need it are provided with assistive technology, including augmentative and alternative

communication technology, to access the standard assessments. Additionally, LEAs

and SEAs should ensure that students have all accommodations, as listed in their

individualized education programs (IEPs), made available during assessments. The

U.S. Department of Education should collect data on the academic progress of students

with disabilities that are disaggregated by subgroups of IDEA eligibility or disability

categories and include these data within the annual state report cards, LEA report

cards, and U.S. Department of Education report card to Congress. These data should

be disaggregated by race, ethnicity, and other identifying factors within the IDEA

eligibility subgroups.

Technology will be readily available to support students to participate and

succeed academically. Technology devices have become more widely embraced in

education settings to help maximize student learning. Technology can be especially

beneficial for students with disabilities when used to promote universal design for

learning principles. However, many students with disabilities, especially those with
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sensory impairments, face accessibility barriers with technology that interfere with use.

In some instances, classroom technology contains access features, but teachers are

not aware of how to use it as a tool to maximize learning opportunities for students with

disabilities. In some instances, students with disabilities transition to an LEA where

technology they used in their previous education environment is not available. To

support readily available technology that promotes academic inclusion and success

among students with disabilities, SEAs should collaborate with institutions of higher

education to identify basic learning standards involving technology and students with

disabilities for pre-service teachers. The U.S. Department of Education should

collaborate with states to identify funding options that would allow students transitioning

out of the purview of their LEA to maintain devices provided by an IEP or 504 plan, or

secure a comparable device within a timely manner. Further, local, state, and federal

education and health agencies should collaborate with private and public health

insurance providers to establish clear plans and policies to ensure that students with

disabilities have access to the necessary assistive technology.

Self-determination will drive the transition of students with disabilities into

integrated postsecondary education and competitive employment settings that

match individuals’ interests, skills, and abilities. Many students with disabilities

enter postsecondary education or work environments without self-advocacy skills and

an understanding of their civil rights to reasonable accommodations. As a result, some

young people do not get the accommodations that they need to succeed in school and

in the workplace. To build self-determination skills, local, state, and federal education

agencies should collaborate and partner with other agencies, institutions of higher

education, and businesses to establish a network of opportunities and services for

transitioning individuals. The U.S. Department of Education, in collaboration with the

U.S. Department of Health and Human Services and the Social Security Administration,

should fund resources and support opportunities that help students with disabilities and

their families to understand and navigate home and community-based services and

manage long-term services and supports.
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Students with disabilities in postsecondary education settings will be provided

with the financial, technological, and academic supports to be successful.

Students with disabilities face vast differences in postsecondary education settings

when compared to their K-12 experiences. They often have instructors with limited or no

knowledge of modifying instruction to meet the needs of different learning styles. There

are no IEPs identifying how technology can support learning. Also, many experience

challenges navigating rules that impact SSI eligibility when receiving grants to offset

costs associated with higher education. To address these issues, colleges and

universities should operate fully-functioning offices dedicated to serving students with

disabilities. These offices should help students identify their financial aid needs in light

of their specific circumstances and help advocate these needs to their colleges’ financial

aid offices when students apply for financial aid. These offices should also work closely

with their institution’s information technology team to procure accessible technology as

well as assistive technology that is available broadly throughout campus. In addition,

offices that support students with disabilities should help facilitate timely accessible

instructional materials and help instructors modify instruction as needed to respond to

the needs of students with disabilities. The U.S. Department of Education should require

consistent, disaggregated data collection on the enrollment of students with disabilities

in institutions of higher education and their completion rates to better understand the

extent to which students with disabilities enter into and graduate from institutions of

higher learning.

Health Care

“Medicaid managed care represents both a tremendous opportunity and a significant 

risk for people with disabilities. If the transition to managed care is handled properly, 

our community can enjoy higher quality, more sustainable support services, shifting 

away from legacy infrastructure and overly restrictive models. If this is handled 

improperly, we may take a tremendous step backward, moving people with 

disabilities further into the medical model and resulting in a loss of necessary support 

and autonomy.”

—Ari Ne’eman, NCD Council Member 
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NCD’s vision for health care for the next 25 years is for a health care system that not

only improves the health outcomes of people with disabilities but also improves and

enriches their lives. This health care system will place the preferences and goals of

people with disabilities at the center of all care decisions, especially for home-based

care and independent living. This health care system will provide for people with

disabilities through delivery of services that are equitable, respectful, and appropriate.

Progress toward these goals will be realized through innovations in the use of data, care

delivery and coordination, and strong consumer protections.

People with disabilities will realize health equity goals currently promised under

the ADA. Currently, many people with disabilities do not experience accessible health

care facilities, as required by the ADA. At best, this may be the result of a simple

misunderstanding about the accessibility needs of people with disabilities; at worst, it

could be due to negligence or discrimination. To address this, the U.S. Department of

Health and Human Services (HHS) and state health officials should work directly with

health care providers to establish and maintain accessible health care facilities. Further,

HHS should invest in research to better understand the continuing health disparities that

exist among people with disabilities. These disparities can be identified through

continued investment in research and public health surveillance of the health care

outcomes of people with disabilities. These disparities can be corrected through

adequate funding for corrective policies and programs.

The holistic needs of people with disabilities will be an integral part of the health

care delivery system. People with disabilities face unique circumstances that can have

an indirect or direct impact on their health and wellness. Although the health care

system of the past focused heavily on medical services offered in the clinic, health care

systems of the future must do more to consider the holistic needs of patients outside the

clinic. HHS should promote the development of health care delivery systems that are

highly coordinated with social service and supports, and are able to improve the health

outcomes and overall satisfaction of people with disabilities through continued funding

of new demonstrations. This will likely require continued trial and error of new care

delivery models. Not only should new care delivery models improve health and
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satisfaction outcomes, but they should also reduce the total cost of care. Health care

delivery systems can accomplish this through up-front investments in the delivery of

high-quality health care and support services that prevent expensive health care use in

the future. HHS should develop measures that fully capture the lived experience of

people with disabilities.

People with disabilities will benefit from stronger consumer protections with

health insurance and throughout the health care delivery process. The ADA offers

little protection for people with disabilities against health plans that offer overly stringent

health benefits. This allows health plans to offer minimal or no coverage for certain

health services and assistive technology, which worsens the health care and quality of

life for people with disabilities. This consumer protection issue should be corrected at

the federal level. HHS should mandate stronger consumer protections that start with

comprehensive coverage of health benefits that support the independent living and

long-term services preferences and goals of people with disabilities, including assistive

technology and wraparound services. HHS and state regulators should encourage

extensive public deliberation and stakeholder engagement in the design and operations

of health care policy and programs. This could include promoting and implementing

stronger ombudsman programs, consumer majority advisory councils, and public

forums that address consumer protection issues. Effective delivery of health care and

health plan benefit design must be informed by the lived experiences of people with

disabilities.

Transportation

“The opportunities for inclusion of people with disabilities are perhaps the greatest in 

the field of transportation. With development of cell phone apps to summon taxis, 

kneeling buses, and even the prospect of the self-driving car, the potential 

independence of being able to get to and from our homes to school, to work, and out 

into society, cannot be underestimated. If, as we hope, government and the private 

sector can continue to work together to ensure universal design in these visionary 

forms of transportation, Americans with disabilities may truly be free, in the next ADA 

generation, to move about just like everyone else, with confidence, ease, and speed.”

—Janice Lehrer-Stein, NCD Council Member 
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Freedom to travel anyplace, at any time, and by any mode summarizes NCD’s vision for

transportation options for the next 25 years. Retrofitting existing inaccessible

transportation equipment, policies, and infrastructures that facilitate various methods of

transportation can be laborious and expensive. However, this need will remain a reality

as long as existing transportation facilitators remain. Great promise exists to realize a

vision of flexible travel by incorporating access to transportation equipment, policies,

and infrastructure at the onset of new initiatives. The following examples illustrate how

NCD’s vision for transportation can be realized across the next 25 years through both

retrofitting current transportation initiatives and factoring in inclusive design from the

onset for new transportation initiatives.

Mass rapid transit systems will be a viable transportation option for people with

disabilities. Mass rapid transit offers a cost-efficient option to travel for work and leisure

to many passengers at a time. However, if accessibility is not considered when planning

and designing mass rapid transit systems, environmental barriers that are labor

intensive and costly to address can occur. Such considerations include passengers’

experiences entering a train station from the street; traveling to the platform, which is

often above or below street level; safely entering and leaving the transit car; and exiting

the station to the street. To maximize accessibility, state agencies that provide oversight

of mass rapid transit should engage people with disabilities early on to provide insight

on unexpected barriers to access and opportunities to overcome those barriers. They

should also reach out to professional peers in established cities to gain insight on

access barriers that have surfaced and recommendations to avoid these barriers. When

retrofitting existing transit stations to be accessible and when designing new transit

systems, relevant state agencies should factor in alternative options to accommodating

passengers with disabilities. For example, including more than one elevator would allow

for uninterrupted access in the event of an elevator outage.

Transportation network companies (TNCs) will be subjected to the same

accessibility standards for their network of vehicles as are companies regulated

by state or local government agencies. TNCs are companies that maintain a network

of drivers whom they connect with passengers in need of transportation. They make
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these connections by using an online platform, and drivers use their own personal

vehicles to transport passengers. TNCs are not held accountable for maintaining a

network of drivers with a minimum standard of accessible vehicles. Although TNCs and

taxis operate under a different organizational structure, passengers receive the same

output—transportation from one point to another. Unregulated TNCs compromise the

ability of taxi companies to compete with vehicles operation through TNCs and can

serve as a disincentive for taxi companies to increase the number of vehicles in their

fleet, which by law, needs to include accessible taxis. To ensure accessible

transportation options for people with disabilities using TNCs, the U.S. Department of

Transportation and U.S. Department of Justice, in collaboration with NCD, should

explore options to provide oversight of TNCs and create an operating plan to promote

accessible vehicles in TNC networks. In addition, although legislation is pending that will

define the parameters of ADA application to technology, TNCs should adopt universal

design principles throughout all aspects of their service. This will allow passengers to

benefit from auditory systems and other innovative technology.

Governing bodies that regulate taxi services will operate fleets that consist of at

least 50 percent accessible taxis, 100 percent accessible mobile technology, and

staff who are responsive to the needs of passengers with disabilities. Taxi

services have the potential to offer flexible options for passengers to travel on demand.

However, a number of factors can interfere with a passenger’s ability to successfully

engage such services. These include vehicles that cannot accommodate wheelchairs

and scooters, inaccessible mobile technology to reserve transportation, and drivers who

are unaware of passengers’ needs and rights. Accessible taxi services require

intentional planning for access and inclusion that is informed not only by legislation but

also by input from users with disabilities. To accomplish this, state agencies should

collaborate with governing bodies that regulate taxi services to develop a strategic plan

to increase the number of accessible taxis with features such as wheelchair access and

auditory systems. This might include incentives for compliance such as additional

medallions or offering priority to operate at airports. The plan should also include

expectations for driver training that supports appropriate customer service when
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engaging with passengers with disabilities, as well as an approach to efficiently dispatch

accessible taxis.

People with disabilities who reside in rural and suburban communities will have

accessible and reliable transportation options. People who reside in rural and

suburban areas face considerable barriers to transportation. This is largely because of

limited funding for individual programs and restrictions imposed on rural providers such

as limited trip purposes, limited hours of service, client-only transportation, and

duplicative services. In addition, expenses associated with rural and suburban

communities are high due to the longer distance traveled (National Council on Disability

2015c). Those with sensory, physical, and other disabilities that interfere with the ability

to operate a vehicle independently face even more challenges. Many who decide to

pursue employment, social, and recreational opportunities outside of the home have no

option but to relocate to an area that either offers accessible transportation or is a

pedestrian-friendly community. Addressing the need for accessible transportation in

rural and suburban areas requires immediate attention and collaboration between

nonprofit organizations, neighborhood groups, and government. Local planners, public

officials, staff in rural jurisdictions, and anyone affected by rural or transportation issues

should learn about the successful strategies that have been used to provide rural

transportation, including voucher programs, volunteers, flex services, taxis, mobility

management, and neighborhood co-operatives (National Council on Disability 2015c).

Autonomous vehicles will be a viable transportation option for people with

disabilities. Autonomous vehicles—vehicles that can operate via computer control

without human supervision or input—are a cutting-edge transportation opportunity that

can contribute to convenience and efficiency throughout society. However, for people

with disabilities—including sensory, intellectual, and mobility disabilities along with

issues that occur with aging—autonomous vehicles can offer tremendous opportunities

for independence and self-sufficiency. Although the technology that powers

autonomous vehicles has come to fruition and is being tested for functionality and

safety, a number of issues must be resolved including licensing, liability, and insurance

before society can benefit from this new advancement. In anticipation of this, NCD has
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drafted legislation to ensure that the ADA covers this technology. It has also outlined

recommendations for the automobile industry to ensure the use of universal design

elements that will make this technology broadly accessible. To help make autonomous

vehicles a reality, the U.S. Department of Transportation should collaborate with private

sector research firms to design and invest in autonomous vehicle research to help refine

the technology that powers this initiative and explore the implications for people with

disabilities.

The airline industry will operate in a manner that is responsive to the needs of

people with disabilities. The Air Carrier Access Act has regulated the airline industry

since 1986, and, as does the ADA, it protects the civil rights of people with disabilities.

By the time the ADA turns 50, and the Air Carrier Access Act turns 54, NCD hopes to

see the industry revolutionized to appropriately respond to the needs of passengers with

disabilities. The Air Carrier Access Act prohibits commercial airlines from discriminatory

practices against people with disabilities during air travel. The act requires airlines to

assist with boarding, deplaning, and making connections and to provide priority storage

in the baggage compartment for assistive devices such as wheelchairs. It also prohibits

airlines from requiring advance notice that a person with a disability will be traveling with

that airline. Despite regulations outlined in the Air Carrier Access Act, many airline staff

lack training to appropriately serve passengers with disabilities. Many such passengers

go unassisted during travel and experience broken wheelchairs because of poor

handling. Multiple reports illustrate families with children with autism being denied

access to air travel or being physically escorted from aircrafts as a solution for

addressing special needs associated with their disability. Although the U.S. Department

of Transportation provides avenues for and accepts complaints from passengers who

have experienced violations to the act, a lack of understanding of this process may lead

to unreported violations. To address this issue, the U.S. Department of Transportation,

in collaboration with NCD, should establish a Passengers with Disabilities Bill of Rights

document that is based on the Air Carrier Access Act but written in plain language. The

document should identify the rights of passengers with disabilities and recourse that

people can take in the event of a violation. Airlines should be required to provide this

information on tickets for those who identify as having a disability and needing
111

assistance when purchasing tickets. NCD also recommends that Congress authorize

the U.S. Department of Transportation to hold the airline industry accountable for

abiding by the Air Carrier Access Act and other relevant federal legislation. 

Housing

“Community living for persons with disabilities cannot be achieved in our nation 

without safe, accessible, and affordable housing. This means that we as a nation 

must fully embrace public policies and innovative community programs that were 

cultivated by the intent and spirit of the Americans with Disability Act. Anything less 

means we as a nation would have failed many of our fellow citizens. This cannot and 

must not happen.”

—Royal Walker, NCD Council Member 

The shortage of available, accessible housing is one of the largest challenges people

with disabilities face. According to the 2010 Census, more than 56 million people

reported that they had a disability and this number continues to grow as the US

population ages (US Census Bureau 2012). However, as states lead

deinstitutionalization programs to comply with the Olmstead decision, there will be a 

concurrent need for housing to accommodate people with disabilities in community

settings to accommodate this positive trend to greater independence, NCD envisions a 

future with universal housing accessibility. Accomplishing this goal will require a 

multiyear campaign of federal and state action. This vision is described in the following

examples.

The availability of accessible public housing units will reflect the percentage of

the population of people with disabilities. At present, housing constructed with

federal funds must allocate a minimum of 5 percent (at least one) of the new units to be

accessible to persons with physical disabilities and 2 percent (at least one) to be

accessible to persons with sensory disabilities. These percentages do not align with the

12.1 percent prevalence rate of disabilities in the population as identified by the ACS

(Erickson, Lee, and von Schrader 2014). To address this, Congress should raise the
112

current federal requirements for new accessible housing to reflect the percentage of the

American population identified as having disabilities by the ACS.

All new homes and apartments will meet universal design accessibility standards.

As people without disabilities age and acquire disabilities through illness or injury,

having an expanding network of accessible homes on the housing market will provide

more opportunities to live inclusively rather than using nursing facilities. Furthermore,

support provided by a permanent commitment to the Money Follows the Person (MFP)

initiative will further assist people with disabilities in staying in their homes and

maintaining a high quality of life. To address this, state housing commissions should

mandate that universal design accessibility principles be incorporated into the permit

requirements for all new homes and apartments.

People with disabilities will have greater access to community housing.

Retrofitting existing housing stock and creating new accessible housing will require time

and a significant commitment from federal and state governments. Vouchers can be

used to assist people with disabilities in obtaining acceptable housing within the private

housing market while an expansion of accessible public housing stock is occurring. To

address this, the U.S. Department of Housing and Urban Development (HUD) should

increase the number of housing choice vouchers to an amount that reflects the number

of people who meet HUD Area Median Income requirements. Furthermore, HUD should

issue a regulatory statement requiring that vouchers currently held by people with

disabilities be set aside specifically for people with disabilities. This will reduce the loss

of these vouchers from the disability community as they are turned in for reissue.

Congress will make a permanent commitment to the Money Follows the Person

initiative and provide expanded home and community-based services for people

with disabilities. Each of the previously described components of NCD’s vision for

universal housing accessibility focuses on the availability and development of physically

accessible options for people with disabilities. Supported community living requires

more than this. In Home and Community-Based Services: Creating Systems for

Success at Home, at Work and in the Community, NCD advocated that HHS provide
113

additional guidance to states that are implementing home and community-based

services for people with disabilities (National Council on Disability 2015a). NCD

maintains this position and reiterates its desire for HHS to act and strengthen the home

and community-based services program, providing additional support to states and

people with disabilities who wish to live in the community. The MFP demonstration has

assisted people with disabilities in entering the community from institutional settings and

keeping people in the community by providing needed supports to the individual in the

environment of their choosing. The Centers for Medicare and Medicaid Services should

make a permanent commitment to MFP by ending its demonstration project status and

making it a permanent, funded service available to people with disabilities nationwide.

NCD’s Global Vision for the 50th Anniversary of the ADA

“Ratification of the CRPD brings us one step closer to the world as we know it can 

be—making sure that people with disabilities and people without disabilities are 

treated equally.”

—Jeff Rosen, NCD Chairperson

The United States will ratify the Convention on the Rights of People with

Disabilities (CRPD). The CRPD is a non-legally binding treaty that provides clear

guidance for nations to promote, protect, and ensure the rights of people with disabilities

in order to realize a fully inclusive global society. The United Nations General Assembly

adopted the CRPD in 2006. As of May 2015, 154 countries have ratified the CRPD. The

ADA was influential in the development of the CRPD and served as a model for this

international agreement. However, the United States has yet to ratify this treaty that it

helped shape.

The CRPD represents independence and freedom for people with disabilities around

the world. It benefits Americans by contributing to increased access to the global

economy, international education, and worldwide culture and leisure, yet

misconceptions persist that have interfered with the United States ratifying the treaty.

For example, some mistakenly believe that the CRPD will inhibit home and family rights.

In reality, family rights such as homeschooling, discipline, right to life, and abortion will
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continue to be protected by state legislation. The ratification of the CRPD will require a

two-thirds majority of the U.S. Senate. To encourage this, the White House should

continue to promote the CRPD through its outreach efforts, explicitly identify and

address common misconceptions about the CRPD, and highlight the benefits of ratifying

the treaty. In addition, government agencies should post information on their websites

about the implications of ratifying the CRPD for their stakeholders with disabilities. For

example, the DOL, the U.S. Departments of Veterans Affairs, and U.S. Department of

Commerce may highlight the benefits of enhanced access when expanding business to

other nations.

Representation from the United States will be inclusive of people with disabilities

in international activities. NCD and disability advocates have made progress in

raising awareness of the need for greater inclusion of people with disabilities in every

aspect of society throughout our country. However, a need also exists to increase

representation of people with disabilities from the United States throughout international

activities. Such increased involvement will help establish our nation as a model for

inclusion to an international audience. This will also provide our country with

opportunities to capture best practices for people with disabilities in different parts of the

world through the lens of people who live with disabilities and to apply those practices

stateside when appropriate. Congress and the White House should promote this by

shaping environmental factors to the extent possible. This can be accomplished by

including specific language in the Rehabilitation Act that extends protections of the

legislation to international operations of the U.S. government. Promoting the inclusion of

people with disabilities in international activities can also be accomplished by the

President appointing an ambassador who has a disability, with the goal of 25 years from

now, having at least one diplomat in each mission with a disability. To prepare youth for

international leadership positions, the State Department should offer fellowship

programs for American students with disabilities enrolled in universities that have not

been traditional past producers of Foreign Service officers. This opportunity could be

modeled after the Pickering Fellowship program and would provide a natural pipeline for

Americans with disabilities to work in professional jobs and develop meaningful careers

in foreign affairs.
115

REFERENCES

ADA National Network. n.d. “Does the ADA cover private apartments and private 

homes?” https://adata.org/faq/does-ada-cover-private-apartments-and-privatehomes

Alameida, M., M. Kitchener, A. Wong, and C. Harrington. 2008. A Table of State 

Olmstead Plans and Related State Activity. 

http://nasuad.org/sites/nasuad/files/hcbs/files/150/7479/Olmstead_table_1.pdf. 

Assistive Technology Partnership. 2014. “Assistive Technology Partnership Success 

with Technology: 2013 Annual Report.” 

http://atp.ne.gov/docs/AnnualReportrev.9.29.14.pdf

Balck, A. 2012. Advances in Juvenile Justice Reform: 2009–2011. Washington, DC: 

The National Juvenile Justice Network. http://www.njjn.org/uploads/digitallibrary/NJJN_adv_fin_press_sept_update.pdf

Balfanz, R., J. M. Bridgeland, M. Bruce, and J. Horning Fox. 2013. Building a Grad 

Nation: Progress and Challenge in Ending the High School Dropout Epidemic: 

Annual Update, 2013. Washington, DC: Civic Enterprises, the Everyone Graduates 

Center at Johns Hopkins University School of Education, America’s Promise 

Alliance, and the Alliance for Excellent Education. 

http://www.americaspromise.org/resource/building-grad-nation-progress-challengeending-high-school-dropout-epidemic-february-2013-0

Cortiella, Candace and Horowitz, Sheldon H. 2014. “The State of Learning Disabilities: 

Facts, Trends and Emerging Issues.” New York: National Center for Learning 

Disabilities.

Dickson, V. 2015, June 18. “Health Plan Bolts Dual Eligible Demonstration in 

Massachusetts.”

http://www.modernhealthcare.com/article/20150618/NEWS/150619902

Disability Rights Education and Defense Fund. n.d. “A Comparison of ADA, IDEA, and 

Section 504.” http://dredf.org/advocacy/comparison.html

Duda, M. A., G. Dunlap, L. Fox, R. Lentini, and S. Clarke. 2004. “An experimental 

evaluation of positive behavior support in a community preschool program.” Topics 

in Early Childhood Special Education 24, no. 3: 143–155.
116

Erickson, W., Lee, C., von Schrader, S. 2014.” Disability Statistics from the 2012 

American Community Survey (ACS).” Ithaca, NY: Cornell University Employment 

and Disability Institute (EDI). http://www.disabilitystatistics.org/

Filter, K. J., M. K. McKenna, E. A. Benedict, R. H. Horner, A. W. Todd, and J. Watson. 

2007. “Check in/Check out: A Post-Hoc Evaluation of an Efficient, Secondary-Level 

Targeted Intervention for Reducing Problem Behaviors in Schools.” Education and 

Treatment of Children 30: 69–84.

Fleischer, D., and F. Zames. 2001. The Disability Rights Movement. Philadelphia, PA: 

Temple University Press.

Global Workplace Analytics. n.d. “Latest Telecommuting Statistics.” 

http://globalworkplaceanalytics.com/telecommuting-statistics

Horner, R. H., A. Todd, T. Lewis-Palmer, L. Irvin, G. Sugai, and J. Boland. 2004. “The 

school-wide evaluation tool (SET): A research instrument for assessing school-wide 

positive behavior support.” Journal of Positive Behavior Intervention 6, no. 1: 3–12.

Jensen v. Minnesota Department of Human Services. 2015. “United States District 

Court: District of Minnesota. Civil No. 09-1775 (DWF/FLN).” Washington, DC: 

Government Printing Office. http://www.gpo.gov/fdsys/pkg/USCOURTS-mnd-0_09-

cv-01775/pdf/USCOURTS-mnd-0_09-cv-01775-21.pdf

Juvenile Justice Information Exchange. n.d. “Key Issues.” http://jjie.org/hub/racialethnic-fairness/key-issues/

Kaiser Family Foundation. n.d. “Featured Dual Eligible Resources.” 

http://kff.org/tag/dual-eligible/

Kaiser Family Foundation. 2015a. “State Demonstration Proposals to Integrate Care 

and Align Financing and/or Administration for Dual Eligible Beneficiaries.”

http://kff.org/medicaid/fact-sheet/state-demonstration-proposals-to-integrate-careand-align-financing-for-dual-eligible-beneficiaries/

Kaiser Family Foundation. 2015b. “Early Insights from One Care: Massachusetts’ 

Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries.” 

http://kff.org/report-section/early-insights-from-one-care-massachusetts-issue-brief8725/
117

Kessler Foundation and National Organization on Disability. 2010a. The ADA, 20 Years 

Later. New York, NY: Harris Interactive. 

http://nod.org/assets/downloads/2010_Survey_of_Americans_with_Disabilities_GAP

S_Full_Report.pdf

Legislative Reference Library of Texas. 2002. “Texas Executive Order No. RP-13.” 

http://www.lrl.state.tx.us/scanned/govdocs/Rick%20Perry/2002/RP13.pdf

Longtermcare.gov. n.d. “Costs of Care.” http://longtermcare.gov/costs-how-to-pay/costsof-care/

Majd, K. 2011. “Students of the Mass Incarceration Nation.” Howard Law Journal, 54(2), 

343–395. http://www.njjn.org/uploads/digital-library/Students-of-mass-incarcerationnation_Majd_Howard-Law-Journal_2011.pdf

Massachusetts Department of Health and Human Services. n.d.a. “Integrating Medicare 

and Medicaid for Dual Eligible Individuals.” http://www.mass.gov/masshealth/duals

Massachusetts Department of Health and Human Services. n.d.b. “One Care Early 

Indicators Project (EIP) Reports.” 

http://www.mass.gov/eohhs/consumer/insurance/one-care/one-care-early-indicatorsproject-eip-reports.html

Massachusetts Department of Public Health, Office on Health and Disability. 2009. 

“Massachusetts Facility Assessment Tool.” Boston, MA: Commonwealth of 

Massachusetts. http://www.mass.gov/eohhs/docs/dph/com-health/healthdisability/mfat-intro.pdf

MassHealth/Executive Office of Health and Human Services. n.d.a. “Demonstration 

Proposal.” http://www.mass.gov/eohhs/provider/guidelines-resources/servicesplanning/national-health-care-reform-plan/federal-health-care-reforminitiatives/integrating-medicare-and-medicaid/draft-demonstration-proposal.html

MassHealth/Executive Office of Health and Human Services. n.d.b. “One Care Early 

Indicators Project (EIP) Reports.” 

http://www.mass.gov/eohhs/consumer/insurance/one-care/one-care-early-indicatorsproject-eip-reports.html

MassHealth/Executive Office of Health and Human Services. n.d.c. “Integrating 

Medicare and Medicaid for Dual Eligible Individuals.” 

http://www.mass.gov/masshealth/duals
118

MassHealth/Executive Office of Health and Human Services. 2015a. “MassHealth 

Demonstration to Integrate Care for Dual Eligibles May 2015 Enrollment Report.” 

http://www.mass.gov/eohhs/docs/masshealth/onecare/enrollmentreports/enrollment-report-may2015.pdf

MassHealth/Executive Office of Health and Human Services. 2015b. “Findings from the 

One Care Member Experience Survey 2014.” 

http://www.mass.gov/eohhs/docs/masshealth/onecare/eip-survey-2-report.pdf

Metropolitan Transportation Authority. n.d. Accessibility. 

http://web.mta.info/accessibility/

Minnesota Department of Education. n.d. “Statute and Rule Alignment Chart.” 

https://education.state.mn.us/mdeprod/idcplg?IdcService=GET_FILE&dDocName=0

52923&RevisionSelectionMethod=latestReleased&Rendition=primary

Minnesota Department of Human Services. 2013. Putting the Promise of Olmstead into 

Practice: Minnesota’s 2013 Olmstead Plan. St. Paul. MN: Office of Lieutenant 

Governor. 

http://www.dhs.state.mn.us/main/groups/olmstead/documents/pub/dhs16_193693.pdf

National Council on Disability. 2012. “Subminimum Wage and Supported Employment.” 

http://www.ncd.gov/publications/2012/August232012/

National Council on Disability. 2015a. “Home and Community-Based Services: Creating 

Systems for Success at Home, at Work and in the Community.” 

http://www.ncd.gov/publications/2015/02242015

National Council on Disability. 2015b. “Quarterly Meeting Notes, May 2015.” 

National Council on Disability. 2015c. “Transportation Update: Where We’ve Gone and 

What We’ve Learned.” Washington, DC: National Council on Disability. 

http://www.ncd.gov/publications/2015/05042015/

National Low Income Housing Coalition. 2012. Who Lives in Federally Assisted 

Housing? http://nlihc.org/sites/default/files/HousingSpotlight2-2.pdf

Nebraska VR. 2015. “Nebraska’s VR Information System: MyVR Resources.” 

http://vris.vr.ne.gov/groups/vris/wiki/777b5/MyVR_Resources.html
119

New York City Taxi and Limousine Commission. 2014. “Mobility for All New Yorkers: 

Disabled Accessibility Plan (“DAP”). 

http://www.nyc.gov/html/mopd/downloads/pdf/Mobility_for_All_New_Yorkers_Disabl

ed_Accessiblity_Plan_6_11_14.pdf

O’Day, B. 2009. “Project SEARCH: Opening Doors to Employment for Young People 

with Disabilities.” Princeton, NJ: Mathematica Policy Research. 

http://www.mathematicampr.com/~/media/publications/PDFs/disability/project_search_brief.pdf

Office of the Revisor of Statutes, State of Minnesota. 2014. Minn. Stat. 125A.08 and 

Minn. Rule 3525.2900. https://www.revisor.mn.gov/

O’Malley Watts, M., E. L. Reaves, and M. Musumeci. 2014, April 25. “Money Follows 

the Person: A 2013 State Survey of Transitions, Services, and Costs.” Menlo Park, 

CA: The Henry J. Kaiser Family Foundation. http://kff.org/medicaid/report/moneyfollows-the-person-a-2013-survey-of-transitions-services-and-costs/

Quinn, M. M., R. B. Rutherford, P. Leone, D. M. Osher, and J. M. Poirier. 2005. “Youth 

with disabilities in juvenile corrections: A national survey.” Exceptional Children 71, 

no. 3: 339–345. http://helpinggangyouth.homestead.com/disabilitybest_corrections_survey.pdf

Rosenbaum, S. 2007. The Americans with Disabilities Act in a Health Care Context. In 

The Future of Disability in America, ed. M. J. Field and A. M. Jette, 426–452. 

Washington, DC: National Academies Press. 

http://www.ncbi.nlm.nih.gov/books/NBK11429/

TAC Resource Center on Supportive Housing. 2012.”HUD Awards $150 Million to 25 

States for FY 2013 Section 811 PRA Funding.” 

http://811resourcecenter.tacinc.org/policy-programs/hud-section-811-programinformation

Texas Comptroller. 2008. “Annual Financial Report for the Year Ended August 31, 

2008.” November 2008. 

http://www.texastransparency.org/State_Finance/Budget_Finance/Reports/Annual_F

inancial/afr08/

Texas Department of Housing and Community Affairs. n.d.a. “Amy Young Barrier 

Removal Program.” http://www.tdhca.state.tx.us/htf/single-family/amy-young.htm

Texas Department of Housing and Community Affairs. n.d.b. “Project Access Program.” 

http://www.tdhca.state.tx.us/section-8/project-access/
120

Texas Health and Human Services Commission. 2012. “2012 Revised Texas Promoting 

Independence Plan.

http://www.dads.state.tx.us/providers/pi/piplan/2012revisedpiplan.pdf

Thurlow, M. L., and R. Quenemoen. 2012. “Opportunities for students with disabilities 

from the common core standards.” The State Education Standard 12, no. 2: 56–62. 

University of Minnesota. n.d. 2008–2009 Reintegration Framework Systems Planning 

Toolkit. Minneapolis, MN: The Evaluation Group at the Institute on Community 

Integration. https://ici.umn.edu/evaluation/docs/ReintegrationToolkit.pdf

U.S. Census Bureau. 2014. September 18. “2013 American Community Survey”

https://www.census.gov/acs/www/data/data-tables-and-tools/

U.S. Census Bureau. 2012, July 25. “Nearly 1 in 5 People Have a Disability in the U.S., 

Census Bureau Reports.” 

https://www.census.gov/newsroom/releases/archives/miscellaneous/cb12-134.html

U.S. Department of Education. 2011. Report of the Advisory Commission on Accessible 

Instructional Materials in Postsecondary Education for Students with Disabilities.

Washington, DC: Advisory Commission on Accessible Instructional Materials. 

http://www2.ed.gov/about/bdscomm/list/aim/meeting/aim-report.pdf

U.S. Department of Education. 2013, December 19. “Protecting Students with 

Disabilities.” http://www2.ed.gov/about/offices/list/ocr/504faq.html

U.S. Department of Education Office for Civil Rights. 2014, March 21. Civil Rights Data 

Collection: Data Snapshot: School Discipline. Washington, DC: U.S. Department of 

Education. https://www2.ed.gov/about/offices/list/ocr/docs/crdc-disciplinesnapshot.pdf

U.S. Department of Housing and Urban Development. 2015. “Resident Characteristics 

Report (RCR), as of May 31, 2015.” https://pic.hud.gov/pic/RCRPublic/rcrmain.asp

U.S. Department of Labor, Bureau of Labor Statistics. 2015. “Household Data Table A6: Employment status of the civilian population by sex, age, and disability status, not 

seasonally adjusted.” http://www.bls.gov/news.release/empsit.t06.htm

U.S. Department of Labor, Employment and Training Administration. 2014. “Workforce 

and Innovation Opportunity Act” http://www.doleta.gov/wioa/

U.S. Department of Labor Office of Disability Employment Policy. 2015. “Current 

Disability Employment Resources by Topic.” http://www.dol.gov/odep/
121

U.S. Department of Transportation, Federal Transit Authority. 2007. “Title 49, Volume 1, 

Code of Federal Regulations, Part 37—Transportation Services for Individuals with 

Disabilities.” http://www.fta.dot.gov/printer_friendly/12876_3906.html

USA Spending.gov. n.d. “Overview of Awards—FY 2015.” 

https://www.usaspending.gov/Pages/TextView.aspx?data=HomeAwardTypeFunding

Vocational Rehabilitation Vermont. n.d. “The Vermont Progressive Employment Model: 

A Learning Collaborative of State VR Agencies.” http://vr-rrtc.org/demandside/wpcontent/uploads/VR_VT_brochure_web_F.pdf

Vocational Rehabilitation Research and Training Center on Demand-Side Strategies.

2015. “Vermont Progressive Employment.” http://vrrrtc.org/demandside/?page_id=169

Yin, M., D. Shaewitz, and M. Megra. 2014. An Uneven Playing Field: The Lack of Equal 

Pay for People with Disabilities. Washington, DC: American Institutes for Research. 

http://www.air.org/resource/uneven-playing-field-lack-equal-pay-people-disabilities
122
123

APPENDIX A: SELECT NCD RESOURCES

Employment

 NCD Letter to Subcommittee on Workforce Protections Regarding Wellness

Legislation, 2015, http://www.ncd.gov/publications/2015/03302015/

 Home and Community-Based Services: Creating Systems for Success at Home, at 

Work and in the Community, 2015, http://www.ncd.gov/publications/2015/02242015/

 Securing the Social Contract: Reforming Social Security Disability, 2015, 

http://www.ncd.gov/publications/2015/01292015/

 Letter to House Senate Conference on Workforce Investment Act, 2014, 

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

 NCD Letter to Senate Finance Committee in Support of Amendment Language 

Regarding Supported Employment, 2013, 

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

 NCD Letter to Senate HELP Committee Opposing Sec. 511’s Inclusion in WIA 

Reauthorization, 2013, http://www.ncd.gov/publications/2013/08012013/

 A Promising Start: Preliminary Analysis of Court Decisions Under the ADA 

Amendments Act, 2013, http://www.ncd.gov/publications/2013/07232013/

 NCD Statement on the President's FY14 Budget, 2013, 

http://www.ncd.gov/publications/2013/04182013/

 National Council on Disability Report on Subminimum Wage and Supported 

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

 Letter to the President about Chained CPI, 2012, 

http://www.ncd.gov/publications/2012/Dec202012_2/

 Deinstitutionalization Toolkit, 2012, http://www.ncd.gov/publications/2012/DIToolkit/
124

 Deinstitutionalization: Unfinished Business (Companion Paper to Policy Toolkit), 

2012, http://www.ncd.gov/publications/2012/Sept192012/

 Letter to CMS on 1915c Waiver Information Bulletin, 2012, 

http://www.ncd.gov/publications/2012/CMS10122012/

 Letter to SSA Commissioner Michael Astrue on Continuation of the Work Incentives 

Planning and Assistance (WIPA) program, 2012, 

http://www.ncd.gov/publications/2012/SSA08222012/

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

Opportunities for People with Disabilities, 2011, 

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

 Rising Expectations: The Developmental Disabilities Act Revisited, 2011, 

http://www.ncd.gov/publications/2011/Feb142011

 Workforce Infrastructure in Support of People with Disabilities: Matching Human 

Resources to Service Needs, 2010, 

http://www.ncd.gov/publications/2010/Jan202010

 Federal Employment of People with Disabilities, 2009, 

http://www.ncd.gov/rawmedia_repository/ccf09bbd_62bd_4043_b674_75ad5f37d23

7?document.pdf

 The State of Housing in America in the 21st Century: A Disability Perspective, 2010, 

http://www.ncd.gov/publications/2010/Jan192010

 Topical Brief: Transitioning Youth, 2010, 

http://www.ncd.gov/publications/2010/03232010-1

 Topical Brief: Vocational Rehabilitation Funding, 2010, 

http://www.ncd.gov/publications/2010/03232010-2
125

 Topical Brief: Workforce Investment Infrastructure, 2010, 

http://www.ncd.gov/publications/2010/03232010-3

 Topical Brief: Performance Indicators, 2010, 

http://www.ncd.gov/publications/2010/03232010-4

 Topical Brief: One-Stop Career Centers, 2010, 

http://www.ncd.gov/publications/2010/03232010-5

 Federal Employment of People with Disabilities, 2009, 

http://www.ncd.gov/publications/2009/MArch312009

 Keeping Track: National Disability Status and Program Performance Indicators, 

2008, http://www.ncd.gov/publications/2008/April212008

 The Rehabilitation Act: Outcomes for Transition-Age Youth, 2008, 

http://www.ncd.gov/publications/2008/10282008

 Empowerment for Americans with Disabilities: Breaking Barriers to Careers and Full 

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

 A Perspective from Youth with Disabilities: Benefits in a World of Employment, 2007, 

http://www.ncd.gov/publications/2007/March2007

 Issues in Creating Livable Communities for People with Disabilities: Proceedings of 

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

 The Social Security Administration’s Efforts to Promote Employment for People with 

Disabilities: New Solutions for Old Problems, 2005, 

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

 NCD Recommendations: Workforce Investment Act Reauthorization, 2005, 

http://www.ncd.gov/publications/2005/03172005

 NCD and the Americans with Disabilities Act: 15 Years of Progress, 2005, 

http://www.ncd.gov/publications/2005/06262005
126

 National Council on Disability Topical Overviews—An Overview of the Experience of 

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

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

Education

 NCD Letter to Senate HELP Committee on the Every Child Achieves Act of 2015, 

2015, http://www.ncd.gov/publications/2015/04152015/

 NCD Policy Principles & Recommendations for ESEA Reauthorization for the 

Senate, 2015, http://www.ncd.gov/publications/2015/02192015/

 NCD Policy Principles & Recommendations for ESEA Reauthorization for the 

House, 2015, http://www.ncd.gov/publications/2015/02062015/

 NCD Letter Requesting Meeting with U.S. Secretary of Education Arne Duncan, 

2014, http://www.ncd.gov/publications/2014/03212014/

 A Promising Start: Preliminary Analysis of Court Decisions Under the ADA 

Amendments Act, 2013, http://www.ncd.gov/publications/2013/07232013/

 Letter to Vice President Biden Regarding Anticipated Taskforce Recommendations, 

2013, http://www.ncd.gov/publications/2013/Jan142013/

 Letter to the President after Newtown Tragedy, 2012, 

http://www.ncd.gov/publications/2012/Dec202012/

 United States Marine Corps Exceptional Family Members: How to Improve Access 

to Health Care, Special Education, and Long-Term Supports and Services for Family 

Members with Disabilities, 2011, http://www.ncd.gov/publications/2011/Nov282011

 Letter to Secretary Duncan Regarding Forthcoming NCLB Waivers, 2011, 

http://www.ncd.gov/publications/2011/September192011

 Briefing Paper, Bullying and Students with Disabilities, 2011, 

http://www.ncd.gov/publications/2011/March92011
127

 Rising Expectations: The Developmental Disabilities Act Revisited, 2011, 

http://www.ncd.gov/publications/2011/Feb142011

 The No Child Left Behind Act and the Individuals with Disabilities Education Act: A 

Progress Report, 2008, http://www.ncd.gov/publications/2008/01282008

 The Rehabilitation Act: Outcomes for Transition-Age Youth, 2008, 

http://www.ncd.gov/publications/2008/10282008

 Issues in Creating Livable Communities for People with Disabilities: Proceedings of 

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

 Creating Livable Communities, 2006, 

http://www.ncd.gov/publications/2006/Oct312006

 Individuals with Disabilities Ed Act Burden of Proof: On Parents or Schools?, 2005, 

http://www.ncd.gov/publications/2005/08092005

 NCD and the Americans with Disabilities Act: 15 Years of Progress, 2005, 

http://www.ncd.gov/publications/2005/06262005

 National Council on Disability Topical Overviews—Access to Education by People 

with Disabilities Illustrations of Implementation from the United States: Quick 

Reference Guide, 2005, http://www.ncd.gov/publications/2005/08022005-AccessEd

 National Council on Disability Topical Overviews—Lessons for All of Us: Protecting 

the Right to Education for Persons with Disabilities, 2005, 

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

 Same Struggle, Different Difference: Civil Rights Policy Forum Summary Paper, 

2005, http://www.ncd.gov/publications/2005/06092005-1

Health Care

 NCD Letter to Subcommittee on Workforce Protections Regarding Wellness 

Legislation, 2015, http://www.ncd.gov/publications/2015/03302015/
128

 Home and Community-Based Services: Creating Systems for Success at Home, at 

Work and in the Community, 2015, http://www.ncd.gov/publications/2015/02242015/

 Securing the Social Contract: Reforming Social Security Disability, 2015, 

http://www.ncd.gov/publications/2015/01292015/

 Part 1 Summary: NCD Medicaid Managed Care Forums, 2014, 

http://www.ncd.gov/publications/2014/11042014/

 NCD Letter to CMS Inviting Participation in Upcoming Medicaid Managed Care 

Forum, 2014, http://www.ncd.gov/publications/2014/09102014/

 NCD Letter to National Children’s Study about the Design of the National Children’s 

Study and Implications for the Generalizability of Results, 2014, 

http://www.ncd.gov/publications/2014/07312014/

 NCD Letter to CMS Soliciting Its Participation at Upcoming NCD Medicaid Managed 

Care Forums, 2014, http://www.ncd.gov/publications/2014/02032014/

 NCD Letter to President Obama Regarding Mental Health Funding, 2013, 

http://www.ncd.gov/publications/2013/12202013/

 NCD Letter to CMS about Amendment to Kancare Medicaid Section 1115, 2013, 

http://www.ncd.gov/publications/2013/12132013/

 NCD Letter to EEOC Urging Employer Wellness Program Guidance, 2013, 

http://www.ncd.gov/publications/2013/06052013/

 A Medicaid Block Grant Program: Implications for People with Disabilities, 2013, 

http://www.ncd.gov/publications/2013/05222013/

 The Case for Medicaid Self-Direction: A White Paper on Research, Practice, and 

Policy Opportunities, 2013, http://www.ncd.gov/publications/2013/05222013A/

 Medicaid Managed Care for People with Disabilities, 2013, 

http://www.ncd.gov/publications/2013/20130315/
129

 NCD Statement on the President’s FY14 Budget, 2013, 

http://www.ncd.gov/publications/2013/04182013/

 Letter to House Energy and Commerce Subcommittee on Oversight on Mental 

Health, Lack of Representation of People with Psychiatric Disabilities at Roundtable, 

2013, http://www.ncd.gov/publications/2013/031413/

 Letter to Vice President Biden Regarding Anticipated Taskforce Recommendations, 

2013, http://www.ncd.gov/publications/2013/Jan142013/

 Letter to the President about Chained CPI, 2012, 

http://www.ncd.gov/publications/2012/Dec202012_2/

 Letter to the President after Newtown Tragedy, 2012, 

http://www.ncd.gov/publications/2012/Dec202012/

 Deinstitutionalization Toolkit, 2012, http://www.ncd.gov/publications/2012/DIToolkit/

 Deinstitutionalization: Unfinished Business (Companion Paper to Policy Toolkit), 

2012, http://www.ncd.gov/publications/2012/Sept192012/

 Letter to CMS on 1915c Waiver Information Bulletin, 2012, 

http://www.ncd.gov/publications/2012/CMS10122012/

 Rocking the Cradle: Ensuring the Rights of Parents with Disabilities and Their 

Children, 2012, http://www.ncd.gov/publications/2012/Sep272012/

 Analysis and Recommendations for the Implementation of Managed Care in 

Medicaid and Medicare Programs for People with Disabilities, 2012, 

http://www.ncd.gov/publications/2012/CMSFebruary272012/

 Guiding Principles: Successfully Enrolling People with Disabilities in Managed Care 

Plans, 2012, http://www.ncd.gov/publications/2012/Feb272012/
130

 United States Marine Corps Exceptional Family Members: How to Improve Access 

to Health Care, Special Education, and Long-Term Supports and Services for Family 

Members with Disabilities, 2011, http://www.ncd.gov/publications/2011/Nov282011

 Letter to President Obama in Support of the CLASS Program, 2011, 

http://www.ncd.gov/publications/2011/November172011

 Rising Expectations: The Developmental Disabilities Act Revisited, 2011, 

http://www.ncd.gov/publications/2011/Feb142011

 The State of Housing in America in the 21st Century: A Disability Perspective, 2010, 

http://www.ncd.gov/publications/2010/Jan192010

 The Current State of Health Care for People with Disabilities, 2009, 

http://www.ncd.gov/publications/2009/Sept302009

 Inclusive Livable Communities for People with Psychiatric Disabilities, 2008,

http://www.ncd.gov/publications/2008/03172008

 Youth with Disabilities in the Foster Care System: Barriers to Success and Proposed 

Policy Solutions, 2008, http://www.ncd.gov/publications/2008/02262008

 Issues in Creating Livable Communities for People with Disabilities: Proceedings of 

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

 Breaking the Silence on Crime Victims with Disabilities, 2007, 

http://www.ncd.gov/publications/2007/May212007

 Introductory Brief on NCD’s Long-Term Services and Supports Report, 2006, 

http://www.ncd.gov/publications/2006/Dec112006

 Creating Livable Communities, 2006, 

http://www.ncd.gov/publications/2006/Oct312006
131

 The Needs of People with Disabilities with Psychiatric Disabilities During and After 

Hurricanes Katrina and Rita: Position Paper and Recommendations, 2006, 

http://www.ncd.gov/publications/2006/07142006

 Cover Memorandum Upon the Reissuance of the NCD Statement Opposing 

Legalization of Assisted Suicide, 2005, 

http://www.ncd.gov/publications/2005/06092005

 Same Struggle, Different Difference: Civil Rights Policy Forum Summary Paper, 

2005, http://www.ncd.gov/publications/2005/06092005-1

 The State of 21st Century Long-Term Services and Supports: Financing and 

Systems Reform for Americans with Disabilities, 2005, 

http://www.ncd.gov/publications/2005/12152005

 NCD and the Americans with Disabilities Act: 15 Years of Progress, 2005, 

http://www.ncd.gov/publications/2005/06262005

 National Council on Disability Topical Overviews—The Right to Health: Fundamental 

Concepts and The American Disability Experience, 2005, 

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

Transportation

 Transportation Update: Where We’ve Gone and What We’ve Learned, 2015, 

http://www.ncd.gov/publications/2015/05042015/

 Letter to TSA Administrator John Pistole Regarding Security Screenings, 2011, 

http://www.ncd.gov/publications/2011/April52011

 The State of Housing in America in the 21st Century: A Disability Perspective, 2010, 

http://www.ncd.gov/publications/2010/Jan192010

 Inclusive Livable Communities for People with Psychiatric Disabilities, 2008, 

http://www.ncd.gov/publications/2008/03172008
132

 Youth with Disabilities in the Foster Care System: Barriers to Success and Proposed 

Policy Solutions, 2008, http://www.ncd.gov/publications/2008/02262008

 Issues in Creating Livable Communities for People with Disabilities: Proceedings of 

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

 Creating Livable Communities, 2006, 

http://www.ncd.gov/publications/2006/Oct312006

 NCD Position Paper on Access to Airline Self-Service Kiosk Systems, 2006, 

http://www.ncd.gov/publications/2006/05172006

 Same Struggle, Different Difference: Civil Rights Policy Forum Summary Paper, 

2005, http://www.ncd.gov/publications/2005/06092005-1

 NCD and the Americans with Disabilities Act: 15 Years of Progress, 2005, 

http://www.ncd.gov/publications/2005/06262005

 Spector v. Norwegian Cruise Line Ltd.—Background, Legal Issues, and Implications 

for Persons with Disabilities, 2005, http://www.ncd.gov/publications/2005/02082005

 The Current State of Transportation for People with Disabilities in the United States, 

2005, http://www.ncd.gov/publications/2005/06132005

 National Council on Disability Topical Overviews—Access to Transportation by 

People with Disabilities Illustrations of Implementation from the United States, 2005, 

http://www.ncd.gov/publications/2005/08022005-AccessTr2

 National Council on Disability Topical Overviews—Access to Transportation by 

People with Disabilities Illustrations of Implementation from the United States: Quick 

Reference, 2005, http://www.ncd.gov/publications/2005/08022005-AccessTr

Housing

 Home and Community-Based Services: Creating Systems for Success at Home, at 

Work and in the Community, 2015, http://www.ncd.gov/newsroom/02242015
133

 NCD Urges HUD to Issue Olmstead Guidance, 2013, 

http://www.ncd.gov/publications/2013/05212013/

 Deinstitutionalization Toolkit, 2012, http://www.ncd.gov/publications/2012/DIToolkit/

 Deinstitutionalization: Unfinished Business (Companion Paper to Policy Toolkit), 

2012, http://www.ncd.gov/publications/2012/Sept192012/

 The State of Housing in America in the 21st Century: A Disability Perspective, 2010, 

http://www.ncd.gov/publications/2010/Jan192010

 Inclusive Livable Communities for People with Psychiatric Disabilities, 2008, 

http://www.ncd.gov/publications/2008/03172008

 Issues in Creating Livable Communities for People with Disabilities: Proceedings of 

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

 Creating Livable Communities, 2006, 

http://www.ncd.gov/publications/2006/Oct312006

 NCD and the Americans with Disabilities Act: 15 Years of Progress, 2005, 

http://www.ncd.gov/publications/2005/06262005

Convention on the Rights of Persons with Disabilities (CRPD)

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

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

 NCD Letter to Vice President Biden Regarding CRPD, 2014, 

http://www.ncd.gov/publications/2014/01082014/

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

Disabilities, 2013, http://www.ncd.gov/publications/2013/12122013
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 NCD Letter to Senate Foreign Relations Committee Again Reaffirms Its Strong 

Support of Ratification of the CRPD, 2013, 

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

 NCD Letter to Senate Foreign Relations Committee Reaffirms Strong Support of 

U.S. Ratification of U.N. Disability Treaty, 2013, 

http://www.ncd.gov/publications/2013/06252013/

 Toward the Full Inclusion of People with Disabilities: Examining the Accessibility of 

Overseas Facilities and Programs Funded by the United States, 2013, 

http://www.ncd.gov/publications/2013/032013/

 Federal Agency Evaluates Disability Access Abroad, 2013, 

http://www.ncd.gov/publications/2013/03212013

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

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

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

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

 National Council on Disability Recommends U.S. Ratification of UN Convention on 

the Rights of Persons with Disabilities on 20th Anniversary of International Day for 

Persons with Disabilities, 2012, 

http://www.ncd.gov/publications/2012/03December2012

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

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

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

Convention on the Rights of Persons with Disabilities, 2008, 

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

 National Council on Disability Practical Discussions on Implementation in the U.S. 

and Other Countries, 2006, http://www.ncd.gov/publications/2006/Oct242006
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 Update on the UN Convention on the Rights of People with Disabilities, 2006, 

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

 National Council on Disability Commends Adoption of United Nations Convention on 

the Rights of People with Disabilities, 2006, 

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

 UN Convention on the Rights of People with Disabilities Takes Giant Step Forward, 

2006, http://www.ncd.gov/publications/2006/09222006

 Monitoring Symposium: A Contribution to the Formulation of Proposals for 

Monitoring a United Nations Convention on the Rights of People with Disabilities 

Report, 2005, http://www.ncd.gov/publications/2005/10242005

 Update on the UN Convention on the Rights of People with Disabilities, 2005, 

http://www.ncd.gov/publications/2005/09262005
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APPENDIX B: STATE RESOURCES

Employment

The Nebraska Vocational Rehabilitation coordinated information for this report about

initiatives in Nebraska that support employment for people with disabilities. Additional

information can be found using the URLs below:

 Project SEARCH: http://vr.nebraska.gov/partners/project_search.html

 Nebraska Vocational Rehabilitation Frequently Asked Questions for Businesses: 

http://www.vr.nebraska.gov/business/faq.html

 Nebraska Vocational Rehabilitation Facebook Page: 

https://www.facebook.com/media/set/?set=a.10152895853681412.1073741896.266

794951411&type=3

 Description of Nebraska MyVR: http://www.vr.ne.gov/connect/social_media.html

 Assistive Technology Partnership: http://atp.ne.gov/

Education

The Minnesota Department of Education coordinated information for this report about

initiatives in Minnesota that support students with disabilities. Additional information can

be found using the URLs below:

 Minnesota’s Olmstead Plan: 

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSIO

N&RevisionSelectionMethod=LatestReleased&dDocName=opc_home

 Minnesota PBIS (Positive Behavioral Interventions and Supports): 

http://www.pbismn.org/index.html

 Reintegration Framework Systems Planning Toolkit: 

https://ici.umn.edu/evaluation/reintegrationtoolkit.htm
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 Minnesota Department of Education Section 504:

http://www.education.state.mn.us/MDE/StuSuc/StuRight/Sect504/

Health Care

The Massachusetts Department of Public Health, Office of Health Equity; the

Massachusetts Executive Office of Health and Human Services, Office of Medicaid; and

the Disability Policy Consortium coordinated information for this report about initiatives

in Massachusetts that promote accessible health care. Additional information can be

found using the URLs below:

 Massachusetts Facility Assessment Tool: 

http://www.mass.gov/eohhs/docs/dph/com-health/health-disability/mfat-intro.pdf

 Massachusetts Mammography Project: http://massmammography.org/

 Integrating Medicare and Medicaid for Dual Eligible Individuals—Introducing One

Care: MassHealth plus Medicare: http://www.mass.gov/eohhs/provider/guidelinesresources/services-planning/national-health-care-reform-plan/federal-health-carereform-initiatives/integrating-medicare-and-medicaid/

 Olivia’s Story, and the Role of the IL-LTSS (Independent Living Long-Term Services 

and Supports) Coordinator: http://www.vimeo.com/95207883

Transportation

The New York City Mayor’s Office for People with Disabilities coordinated information

for this report about initiatives in New York that promote accessible transportation.

Additional information can be found using the URLs below:

 NYC Accessible Subway Stations: http://web.mta.info/accessibility/

 NYC Guide to Access-A-Ride Service: http://web.mta.info/nyct/paratran/guide.htm

 NYC TLC Wheelchair-Accessible Yellow Taxi Service: 

http://www.nyc.gov/html/tlc/html/passenger/accessible.shtml 
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Housing

The Texas Governor’s Committee on People with Disability coordinated information for

this report about initiatives in Texas that support accessible housing. Additional

information can be found using the URLs below:

 Amy Young Barrier Removal Program: http://www.tdhca.state.tx.us/htf/singlefamily/amy-young.htm

 Project Access: http://www.tdhca.state.tx.us/section-8/project-access/
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APPENDIX C: NCD RECOMMENDATIONS

NCD Employment Recommendations

Federal Recommendations

 The U.S. Department of Education should fund systematic evaluations of vocational 

rehabilitation technical assistance centers to determine their efficacy and identify 

best practices. For example, the U.S. Department of Education issued notice of a 

proposed priority on May 15, 2015, for funding the Vocational Rehabilitation 

Technical Assistance Center—Youth with Disabilities. An accompanying priority 

should be an evaluation of this technical assistance center to determine its 

effectiveness. 

 The U.S. Department of Labor and the Equal Employment Opportunity Commission

(EEOC) should provide additional guidance to employers about their obligations 

under the ADA, Rehabilitation Act of 1973, and other applicable civil rights legislation 

that affects people with disabilities in the workplace. This guidance should include 

(a) proactive actions that employers can take to determine whether their practices 

are meeting requirements, (b) resources that employers can use for self-correction, 

and (c) industry-specific resources that address the needs of both blue-collar and 

white-collar employers. 

 The U.S. Department of Labor should provide formal guidance, technical assistance, 

compliance monitoring, and evaluation of employer efforts to comply with Section 

503 of the Rehabilitation Act. These efforts should be based on findings from the 

EEOC and address common patterns of employer discrimination identified by the 

U.S. Department of Justice. 

 The U.S. Departments of Labor and Education should issue joint statements that 

reinforce VR’s role as a collaborating partner in planning at the state level for the 

WIOA, which is due to go into effect in July 2015. They should also issue a follow-up 

statement that reinforces the role that VR can have in sector partnerships with 
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employers. According to WIOA, states must conduct collaborative planning among 

their federally funded state agencies, including VR. 

 Congress should authorize federal tax credits for people with disabilities to partially 

offset the individual costs of VR services. Many VR services, including assistive 

technology, are subject to ability to pay and financial participation policies.

 Congress should enact legislation that makes the Work Opportunity Tax Credit 

program permanent, signifying its commitment to incentivizing private sector 

employers to hire people with disabilities and with other barriers to employment. The 

Work Opportunity Tax Credit for employers is currently on hiatus because it was not 

reauthorized for 2015. This tax credit is designed to encourage the hiring of 

individuals with barriers to employment, including people with disabilities, and 

offered a tax rebate of $1,200 to $9,600, depending on the target group in which an 

individual with a disability qualifies.

State and Local Recommendations

 Expand models, such as Project SEARCH, that can give youth with disabilities more 

opportunities to obtain employment experiences and on-the-job training. Youth with 

disabilities who are transitioning from high school to the workplace can benefit 

greatly from supported work experiences and job exploration guidance. WIOA setaside funds for youth with disabilities transitioning from high school may assist in 

these efforts.

 Identify opportunities to provide Section 503 of the Rehabilitation Act training and

technical assistance, particularly in the area of assistive technology, to public and 

private employers within the community. 

 Develop strategies to maintain communication with hard-to-reach and highly mobile 

populations of people with disabilities in the community.

 Collaborate with business leaders in order to inform the development of job training 

programs for people with disabilities. 
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 Identify and pursue federally funded resources. The federal government sponsors 

initiatives that support state and local efforts to promote employment opportunities 

for people with disabilities. Examples include the following:

o Job Accommodation Network (JAN): https://askjan.org/

o LEAD Center: http://www.leadcenter.org/

o Partnership on Employment & Accessible Technology (PEAT):

http://www.peatworks.org/

o National Collaborative on Workforce and Disability for Youth (NCWD/Youth):

http://www.ncwd-youth.info/

NCD Education Recommendations 

Federal Recommendations

 Congress should reauthorize the Elementary and Secondary Education Act (ESEA) 

to include unambiguous nondiscrimination requirements for charter schools and 

private schools that educate students through Title I portability provisions along with 

clear standards for charter school authorizers.

 Congress should reauthorize the ESEA to require that state education agencies 

(SEAs) and local education agencies (LEAs) intervene when schools or districts 

report significant achievement gaps in disaggregated data between the achievement 

of students with disabilities and students without disabilities.

 Congress should work closely with NCD to reauthorize IDEA in a manner that 

facilitates the inclusion of all students with disabilities. Reauthorization should 

include updates to Indicator 5 to ensure that SEAs and LEAs are not 

disproportionally placing students of color with disabilities outside of the least 

restrictive environment, authorization of SEAs to use IDEA professional 

development funds to provide training in methods of PBIS, guidance on standards 

for Functional Behavioral Assessments (FBAs) and Behavioral Improvement Plans 
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(BIPs), and guidance on school districts’ obligation to provide free and appropriate 

education to students with disabilities exhibiting problematic behaviors. 

 The U.S. Department of Education Office of Civil Rights should support the 

preparation of students to better negotiate their accommodations by assisting 

students with coordinating and managing a variety of services from multiple sources 

and facilitating the use of technology in education or employment.

 Congress should authorize the United States Access Board to establish guidelines 

for accessible instructional materials that will be used by government, in the private 

sector, and in postsecondary academic settings.

 Congress should reauthorize the Higher Education Act, and in doing so, include 

provisions for capacity building for postsecondary educators to support students with 

disabilities, as well as funding for model demonstration projects on implementing 

and improving campus wide accessible instructional materials and universally 

designed materials in science, technology, engineering, and mathematics (STEM).

 The U.S. Department of Education should conduct an analysis of current data on 

Section 504 plans to review current practices and determine their effectiveness in 

protecting the civil rights of all students with disabilities across their education 

experiences. 

State and Local Recommendations

 Offer Section 504 coordinators and other relevant staff members training on Section 

504 requirements so they have a common understanding of eligibility, evaluation, 

placement, plans, and procedural safeguards.

 Include academic growth measurement in state accountability systems.

Accountability and standards should be based on both proficiency and growth and 

must fully include all students.
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 Provide reasonable adaptations and accommodations for children with disabilities 

during assessments so that the academic achievement of such children can be 

measured relative to the same academic standards applied to the general population.

 Collect data disaggregated by race and disability status at key points at which youth 

interact with the juvenile justice system to determine and address disparities and 

barriers to equitable treatment.

 Explore federal guidance on the interpretation and application of regulations. The 

federal government provides information on public obligations under the ADA and 

Olmstead, as well as updates on different Olmstead actions in the states. The U.S. 

Department of Education Office of Civil Rights posts guidance on the application of 

Section 504 and the ADA for students with disabilities. The U.S. Department of 

Education also funds national technical assistance centers on accessible 

instructional material and behavioral supports for students with disabilities.

Examples of federally funded resources include:

o Olmstead: Community Integration for Everyone: http://www.ada.gov/olmstead/

o Frequently Asked Questions About Section 504 and the Education of Children

with Disabilities: http://www2.ed.gov/about/offices/list/ocr/504faq.html

o Bookshare: An Accessible Online Library for People with Print Disabilities (free

access to students with print disabilities): https://www.bookshare.org/cms

o National Center on Accessible Educational Materials: http://aem.cast.org

o National Collaborative on Workforce and Disability: Making the Right Turn: A

Guide About Improving Transition Outcomes for Youth Involved in the Juvenile

Corrections System: http://www.ncwd-youth.info/juvenile-justice-guide

o National Center on Secondary Education and Transition: http://www.ncset.org/

o PACER Center (Parent Advocacy Coalition for Educational Rights):

http://www.pacer.org/
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o Technical Assistance Center on Positive Behavioral Interventions and Supports:

http://www.pbis.org/

NCD Health Care Recommendations 

Federal Recommendations

 CMS should take a more population-based approach to rate setting and risk 

adjustment in new capitated plans, particularly for dual eligible MCOs. The needs of 

potential enrollees 65 years or older and those younger than 65 are quite different, 

and risk adjustment and capitation levels should reflect these differences in order for 

plans to succeed and beneficiaries to receive the services they need to live quality 

lives.

 CMS should reevaluate the emphasis on scale in the movement of high-risk, 

vulnerable populations with thin margins of physical and behavioral health because 

of the high potential for disrupting previously developed fragile systems of care. 

Providers may be at risk of not reaching the do-no-harm threshold in delivering 

services to potential enrollees. Instead, CMS and the state should take a more 

evidence-based approach that includes putting a strong evaluative process in place 

before the full rollout of any demonstration.

 The U.S. Department of Health and Human Services (HHS) should strengthen 

consumer protections and oversight of managed care. This should begin with 

mandatory coverage of health benefits that support the holistic needs of people with 

disabilities such as home care, assistive technology, mental health services and 

supports, and wraparound services. HHS should also implement a medical loss ratio 

standard for Medicaid MCOs like that required for Health Insurance Marketplace 

plans. Finally, HHS should consider implementing capacity standards for managed 

care—for example, a 1:40 ratio for care coordinators to beneficiaries with intellectual 

or developmental disabilities. 

 HHS should prevent the development of institutional service carve-outs from 

managed care, such as for skilled nursing. The carve-outs make it impossible for 
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states to lower costs by substituting effective but less expensive community services 

for institutional care.

 HHS should enhance public health surveillance data to better understand disparities 

in health and health care access for people with disabilities by continuing to invest in 

publicly funded research. Special consideration should be given to diverse 

populations and those with behavioral health needs. 

 HHS should develop measures that fully capture the experience of people with 

disabilities and better reflect the realities of people with long-term disabilities and 

chronic conditions who use LTSS. This should include measures that are not overly 

clinical in nature as well as effective resource use measures that recognize the longterm value of delivering up-front investments in care.

State and Local Recommendations

 Increase public deliberation and stakeholder engagement by integrating people with 

disabilities into health care policy and program operations. This can include 

obtaining stakeholder input for health plan benefit design; health plan quality review; 

review of appeals, grievances, and ombudsman reports; outreach and 

communications; and general counsel and oversight of managed care. 

 Design and implement an MFAT-type tool and establish systems of accountability to 

improve health care facilities’ compliance with ADA and state accessibility 

requirements.

 Support demonstrations of new models of care coordination to improve health 

outcomes and consumer satisfaction with health care and independent living and 

long term services and supports while reducing total costs of long-term care. 

 Strengthen consumer protections and oversight of managed care and mandate 

coverage of health benefits that support the holistic needs of people with disabilities. 

Strengthening ombudsman programs is also an important consideration for 

regulatory agencies.
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 Explore federally funded resources. The federal government sponsors initiatives that 

support state and local efforts to provide accessible and high-quality health care. 

Examples include the following:

o State Innovation Models Initiative: General Information:

http://innovation.cms.gov/initiatives/state-innovations/

o Disability-Competent Care Self-Assessment Tool: http://www.cms.gov/MedicareMedicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-MedicaidCoordination-Office/Downloads/DCCAssessmentTool.pdf

o National Center for Assisted Living (NCAL):

http://www.ahcancal.org/ncal/Pages/index.aspx

NCD Transportation Recommendations 

Federal Recommendations

 The U.S. Department of Transportation should invest in research to understand 

current facilitators of and barriers to accessible transportation as experienced by 

people with disabilities in urban, suburban, and rural settings. This could include 

developing survey items addressing experiences of customers with disabilities for 

transit systems that solicit feedback to use in their efforts to understand accessibility 

trends. Findings would help to inform new or reauthorize existing legislation and 

inform state and local policies. 

 Congress should, as it has for Amtrak, set aside funds specifically for achieving 

station accessibility on subways where it does not yet exist, including platform 

connectivity, detectable warning installation, elevators, ramps, and full-length 

platform-level boarding. There should be clear objectives, deadlines, and outcomes 

analysis to achieve full and timely accessibility. 

 Congress should explore and support regulations and universal design and 

standards for accessibility features in taxis and other transit provided through 

transportation network services. Examples include wheelchair-accessible vehicles 

and audible touch screen systems.
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State and Local Recommendations

 Factor in accessibility during planning phases for new transportation initiatives. This

can reduce or eliminate expenses associated with ADA lawsuits and retrofitting

equipment and infrastructure to comply with ADA guidelines.

 Offer multiple ways to communicate transit information to customers. Customers 

cannot take advantage of accessibility features if they are not aware of them. Update 

transit websites with all access features; explore opportunities to push information to 

consumers about unexpected environmental obstacles, such as elevator outages; 

and use a combination of audio and tactile signage along with audio announcements 

to convey information in stations. 

 Identify and implement ongoing feedback from people with disabilities related to

transportation policies, equipment, programs, and other factors impacting

transportation and people with disabilities. This should be done through multiple

channels, such as collecting input online, developing advisory committees for

different transportation modes, and using periodic questionnaires.

 Collaborate with governing bodies that regulate taxi services to develop a strategic 

plan to increase the number of accessible taxis. Consider incentives for compliance, 

such as additional medallions or offering priority to operate at airports. The plan 

should also include expectations for driver training that support appropriate customer 

service when engaging with passengers with disabilities, as well as an approach to 

efficiently dispatching accessible taxis. 

 Explore federally funded resources. The federal government sponsors programs and 

centers that support accessible transportation for state and local agencies.

Examples include the following:

o Easter Seals Project Action: http://www.projectaction.org/
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o Transportation for Elderly Persons and Persons with Disabilities (5310):

http://www.fta.dot.gov/grants/13093_3556.html

o National Rural Transit Assistance Program: http://nationalrtap.org/

NCD Housing Recommendations

Federal Recommendations

The practices identified in this chapter demonstrate how Texas housing authorities

operationalize legislation and increase opportunities for people with disabilities to

remove barriers and access inclusive housing within communities of their choice.

The following recommendations are crafted to help guide federal policymakers as they

support states throughout processes related to accessible housing initiatives at the state

and local levels:

 Congress should establish a permanent funding stream for the MFP Demonstration 

program to increase opportunities for people with disabilities to live inclusively in 

their communities among their friends and families. 

 HUD should raise the current federal requirements for new accessible housing 

constructed with federal funds from a minimum of 5 percent (at least one) accessible 

new units for persons with physical disabilities and 2 percent (at least one) 

accessible new units for persons with sensory disabilities to match the percentage of 

the American population with disabilities as identified by the American Community 

Survey (ACS). 

 Congress should allocate additional funding to HUD to begin retrofitting older public 

housing units so that they meet federal accessibility requirements. 

 HUD should make grant money available to states to subsidize the permanent 

renovation of privately held housing stock in order to enhance its accessibility, 

allowing more people with disabilities to live safely in the community.
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 Congress should increase the number of federal housing vouchers available to lowincome individuals and families. Furthermore, a percentage set-aside should be 

instituted to require that the number of available vouchers specifically for people with 

disabilities reflects the percentage of people with disabilities in the population. 

State and Local Recommendations

 State and local building commissions should modify their housing codes to institute 

universal accessibility design requirements in all newly constructed homes and 

apartments.

 State governments should offer tax credits to architectural and construction firms to 

encourage pro bono accessibility design and home modification for low-income 

people with disabilities who are living in the community.

 State legislatures should set up housing trusts that allow for funds to be used for 

home modification grants under state, rather than federal, oversight. This would allow 

for more targeted and rapid dispersal of resources. Funds for these initiatives could be 

generated through fees or surcharges on new construction permits or materials.

 Rural and suburban communities should increase the number of accessible housing 

units available, with special emphasis placed on developing units near public 

transportation and community service hubs. Ease of access to transportation, 

shopping, and recreation will increase community inclusion. Particular emphasis 

should be placed on housing for aging people with disabilities, especially those 

leaving institutional settings, because of functional limitations they might have that 

prevent them from driving independently.

 States should identify and pursue federally funded resources. The federal 

government sponsors initiatives that support state and local efforts to promote 

accessible housing opportunities for people with disabilities. Examples include:

o ADA National Network: https://adata.org/
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o Aging and Disability Resource Center (ADRC) Technical Assistance Exchange:

http://www.adrc-tae.acl.gov/

o U.S. Department of Housing and Urban Development, Community Development 

Block Grant Program:

http://portal.hud.gov/hudportal/HUD?src=/program_offices/comm_planning/comm

unitydevelopment/programs

o U.S. Department of Veterans Affairs, Specially Adapted Housing (SAH) and

Special Housing Adaptation (SHA) grant programs:

http://www.benefits.va.gov/homeloans/adaptedhousing.asp
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