The Changing Face of MRC

The Massachusetts Rehabilitation Commission has been the mainstay for employment of people with disabilities for the past 80+ years and community living for people with disabilities for the past 40 years. Combining the two functions in one agency makes sense because you can't work if you're not in a stable living setting. 

Since 1980, MRC funded Centers for Independent Living (CIL's) have developed a network of community living services that support over 30,000 people with all disabilities to live independently in the community statewide outside of nursing homes and other institutions. Services include advocacy, peer support and counseling, benefits counseling, skills training, housing assistance, employment preparation and coordinated long-term services and supports.

MRC has done a good job providing programs and services that meet its Community Living mission, but it appears to be in turmoil with the Vocational Rehabilitation (VR), or employment, side of the agency. Last year MRC had significant audit findings with the federal Rehabilitation Services Administration (RSA) coupled with a loss of federal funding and poor internal controls that resulted in overspending $22 million in the VR program.

In an effort to stop the bleeding, MRC put spending limits in place and initiated a new “Priority of Service” system that is resulting in fewer people with disabilities being determined eligible for paid VR employment services like training in the trades, on-the-job training, books, transportation, and other pathways to competitive integrated employment. Today MRC will only allow $1000 per year per client per year to be spent in these areas and new clients are required to prove that they have the “most significant disability” in order to receive paid services. Additionally, MRC has increased the number of activities of daily living that present barriers to employment from 3 to 4 in order for applicants to meet the highest priority of eligibility; in essence, they’re screening out more people. The process VR counselors are forced to use to determine eligibility is cumbersome, confusing, subjective and makes it even harder to get services that lead to a job.

Counselors routinely require clients to get a healthcare professional to document that activities of daily living are "present" which ignores the clinical training that counselors who are required to have Master’s degrees in VR counseling already possess and adds weeks or months to the eligibility process. As a result, the number of clients moving into paid services with an Individualized Plan for Employment (IPE) has dropped off dramatically.

With these draconian measures one would think MRC is starving for cash, but not so. In an unprecedented move for MRC, in FY 19 the agency received $10.1 million in a supplemental appropriation and in the Governor’s FY 20 budget EOHHS allotted $8.5 million "for lost revenue and to address federal audit findings." In addition, it received $4.5 million in Department of Mental Health (DMH) funding to serve DMH clients with supported employment services while it seeks to abolish its existing Supported Employment Services (SES) division that provides services to people with any type of disability that need job supports. The new DMH funding will provide enough funding to hire at least 15 new VR counselors to exclusively serve their clients. What happened to the hiring freeze imposed by the Baker administration?

And, incredibly, MRC just gave Mass Hire (new name for Career Centers) $450,000 to "train their clients." Career Centers have received hundreds of thousands of dollars over the decades through the federal Disability Employment Initiative grant program and other Department of Labor funding to serve clients with disabilities more appropriately, or at all. Not much has changed in 20 years and people with significant disabilities have not reported positive experiences. In fact, just the opposite. Why would MRC be shelling out close to half a million dollars to be spent by July 1 to a system with a poor track record and an already existing federal requirement to serve people with disabilities? Why is this money going out the door while clients already in paid services have a $1000 per year cap? Where is the logic?

With unemployment of disabled people at a solid 30% in one of the most robust economy’s in the past 30 years we should be demanding more from MRC and for it to get its internal affairs in order and increase employment training, placement and support for the ever-growing number of people with all disabilities living in the community who want to work toward economic self-sufficiency.

Rather than engage the disability community in a dialogue about how to correct their problems that we ultimately bear the consequences of, they hired Deloitte at an exorbitant expense to assist in redesigning their operation. The plan has been complete for months and now MRC is looking to hire another consultant to implement it. Have we been invited to the table for our opinions and recommendations? No, we haven't!

The time to act is now. We need to hold MRC accountable for its actions and demand transparency of its "Redesign" with active outreach, involvement and advice from the disability community now rather than react later. How can we expect to break the cycle of poverty and get a job if the very agency tasked with this is becoming a barrier?

Charlie Carr was the Commissioner of MRC from 2007-2015

All I want is a job

Disabled people are the most oppressed and marginalized group of people in the world. Here in the US, the stigma of disability is pervasive; the media either portrays us as helpless cripples or superheroes for doing everyday things. We're also the poorest with the highest rate of unemployment. Well over 90% of us are on federal public benefits receiving just under $9000 a year on SSI with an unemployment rate of 30%.

Most of us live in public subsidized housing, rely on Medicaid or Medicare as our primary source of healthcare and Long Term Services and Supports (LTSS) and struggle with food insecurity. State legislatures and the Congress generally view us as "takers" with little or no value to society. This is evident by heartless cuts in Medicaid, housing, and the constant threat to cut Social Security benefits.

For the most part, unless you're wealthy, if you want to break the cycle of poverty and get a job it's generally a nonstarter. Because the laws are so archaic and geared toward providing helpless people with a subsistence existence and "taking care of us," we're trapped in a system that penalizes us for working. If you go to work you have to give up Medicaid which is the primary source of LTSS like Personal Assistance Services, drug benefits and Durable Medical Equipment (DME). Even if a company offers health insurance, it doesn't cover LTSS and appropriate DME. 

Then there was the fight for the Ticket to Work Incentive Act (TWIIA) in 1999 that would address the barriers associated with working and continuing to receive Medicaid. On some level it did and the Medicaid Buy-in (MBI) was created so that disabled people can essentially buy Medicaid by paying a premium and work at the same time. Radical in its day, the devil was in the details and how states decided to implement it. Today, most states have anemic MBI programs that don't allow for a decent salary and or realistic assets. So, disabled people who do venture into work generally earn less than $40,000 per year and can only have limited assets; slightly better but certainly not what we wanted. To rub salt in the wound, we later realized that if we had to stop working for any reason, we have to "spend down" our savings and return to poverty in order to continue receiving Medicaid. And, the last nail in the coffin, the deceptive Estate Recovery provision; whatever earnings you've accumulated and saved throughout your working years are "clawed back" by state Medicaid agencies when you die. Your estate is on the hook for whatever was paid by Medicaid from age 55 on.

 No wonder people with disabilities are unemployed. Who wants to work hard for a living and have the government take your nest egg and retirement money away if you can’t continue working and from your estate when you die?

Although this seems like an impossible situation to actually do something about, it's imperative that we come together and push elected officials to have government take its foot off our necks and let us work and have affordable healthcare and LTSS. We can't tolerate another minute of being forced into poverty due to federal legislation that doesn't reflect reality and inextricably links disability with work. The disability community desperately needs to agree on a strategy to separate work from disability legislatively. By unlinking the two, legislators and advocates can agree on legislation that promotes employment for people with disabilities and doesn't tie income and assets to eligibility for Medicaid for disabled people that work.

Just like other oppressed groups, if we lift ourselves out of poverty, we'll have endless opportunity to live a good quality life.

Onward!