Medicaid and Pay for Workers with Developmental Disabilities

Frederica Freyberg:
For years, the debate to expand Medicaid in Wisconsin has been shut down by Republicans refusing to consider it, even as a new report from the Wisconsin Policy Forum says it could save the state $1.7 billion. One population that Medicaid serves, but often feels left out of the conversation, are people with disabilities. Many of whom are pitted between earning a fair wage and keeping their Medicaid benefits. In a collaboration with Wisconsin Public Radio’s “America Amplified” project, “Here and Now’s” Aditi Debnath is reporting on questions voters are asking this election. This is the third story in that series.

Laura Paepke:
This is part of their day. This is part of their routine. They enjoy that paycheck at the end of every two weeks.

Aditi Debnath:
Laura Paepke runs a job skills building program for people with developmental disabilities.

Laura Paepke:
We are their day service provider. So if there are days that there is not work available, we’ll do some vocational workshops.

Aditi Debnath:
Paepke’s program called TTI Industries, is one of 49 employers in the state with a special certification known as 14(c). It allows her to pay workers with disabilities based on their productivity, even if that comes out to less than the state minimum wage of $7.25 an hour. That pay arrangement, however, doesn’t sit well with advocates like Beth Swedeen, executive director of the Wisconsin Board for People with Developmental Disabilities.

Beth Swedeen:
Our position is that people with disabilities should be working at similar jobs to other people based on their interests, and that they should get compensated at market rates.

Aditi Debnath:
Paying workers with disabilities less than the minimum wage has induced controversy across the country, causing 13 states to eliminate those kinds of private employers altogether.

Kristina Mueller:
So my brother’s name is Matthew, and he is 46 years old. He’s been at TTI Industries for at least 20 years.

Aditi Debnath:
Kristina Mueller lives with her brother Matthew, who enjoys his work at TTI. She says that even if he earned minimum wage, he wouldn’t be able to get ahead.

Kristina Mueller:
If he makes above a certain amount of money, his SSI benefits automatically get reduced and he then is also subject to losing his Medicaid benefits.

Aditi Debnath:
She’s found the debate over 14(c) employment programs for disabled workers to be frustrating.

Kristina Mueller:
Since everything has started with trying to eliminate the 14(c) certification, the managed care organizations putting more restrictions.

Aditi Debnath:
Managed care organizations are the decision makers for how Medicaid dollars are spent, which includes funding for TTI Industries. In 2014, federal regulations forced Wisconsin to increase the age requirement to participate in 14(c) programs from 18 to 25. This change was aimed at getting younger adults to seek standard jobs before turning to sheltered workshop employment.

Beth Swedeen:
Like any complex social problem, there’s no silver bullet solution.

Aditi Debnath:
Swedeen says Medicaid expansion could improve these programs.

Beth Swedeen:
That money could be invested back into wages, benefits and other supports.

Aditi Debnath:
This would eliminate one of Kristina Mueller’s main reasons for favoring subminimum wage work for her brother: Fear of losing his Medicaid benefits.

Kristina Mueller:
We should be fighting for no caps on their Social Security benefits, you know. For not having caps for their Medicaid benefits so they can get these community jobs and work and not worry about losing their benefits and having, you know, those cut or reduced because now they’re making too much money.

Beth Swedeen:
That’s not true. There’s a lot of benefits counseling out there that can help people understand how much they can earn and still retain their health insurance and other public benefits.

Aditi Debnath:
Medicaid expansion would also mean added supports for personal care and employment skills for people with disabilities, and not having to choose between fair wages and disability benefits.

Mary Swifka:
Noah’s not one for learning how to, you know, manage money or learn about cell phone etiquette or anything.

Aditi Debnath:
Mary Swifka is Noah’s mother. He has Down syndrome.

Mary Swifka:
The idea is to give him the independence that he deserves.

Aditi Debnath:
Swifka is an advocate for Medicaid expansion, but she feels people with disabilities are often left out of the conversation at the state level.

Mary Swifka:
What I’ve heard from state legislative leaders, they think that all Medicaid does is provide medical insurance for people who are lower income and frail elderly, but Medicaid does so much more than that. Medicaid dollars pay for Noah to be independent in his community. They pay for job coaching. Medicaid pays for people with disabilities who have significant medical conditions to have at home care.

Aditi Debnath:
Swedeen says that regular jobs are most valuable for people with developmental disabilities, both in wages and experiences, but that she recognizes the value in sheltered workshop programs and Medicaid expansion would give people that choice.

Beth Swedeen:
There’s still a place for some people who are older maybe, or have had worked or have gotten those vocational supports for many years where we’re not advocating the erasure of providers, but we are advocating that it’s important for people, whenever possible, to get their supports in the community and at a fair market wage.

Aditi Debnath:
Paepke says a statewide elimination of programs like TTI would be difficult for her clients.

Laura Paepke:
Community employment, vocational services, we have day activities, and that’s really what the clients — should be their choice to decide not, you know, a government entity making that choice.

Aditi Debnath:
Reporting from West Bend, I’m Aditi Debnath for “Here & Now.”