Category: Policy

By Sean Slone, Senior Policy Analyst

The COVID-19 pandemic has exacted a heavy toll on the mental health of many people living in the U.S., but perhaps none more so than those who have been on the frontlines of protecting the public’s health—first responders, law enforcement officers and the nation’s health care workforce.  

A 2021 report from the Centers for Disease Control and Prevention found that the overall prevalence of mental health conditions among public health workers was higher than among the general population. The prevalence of post-traumatic stress disorder (PTSD) symptoms was 10 to 20 percent higher than previously reported for these individuals after months of traumatic and stressful pandemic work experiences. 

Researchers in the United States, Europe and South Africa 21 journal article offered a series of policy recommendations for prioritizing the mental health and well-being of health care workers worldwide. Among them:  

Enacting national and local evidence-based interventions and programs to support frontline health care workers’ health and well-being in the long-term.  Creating national knowledgebases (information, tools and resources) designed to improve the resilience and well-being needs of workers and their leaders in times of crisis, recovery and rebuilding. Ensuring adequate staffing levels in health care systems and fair pay for workers. Encouraging help-seeking and ensuring the availability of mental health resources for frontline health workers in distress. Condemning and combating the stigmatization of frontline health care workers and increasing efforts to de-stigmatize mental health across society. Ensuring a wider and more actionable dialogue about mental health in the workplace. 

A number of states have recently worked on legislation that recognizes the toll of the last two years on health care workers, frontline first responders and law enforcement officers. Workers’ compensation laws, PTSD screening and the availability of mental health resources have been particular areas of focus. 

California legislators last year debated Assembly Bill 562, which would require the establishment of a mental health resiliency program to provide mental health services to licensed health care providers who provide or have provided “consistent in-person health care services to COVID-19 patients.” Connecticut Senate Bill 1002/House Bill 6595 sought to add to the list of those eligible for compensation for PTSD health care workers engaged in activities dedicated to mitigating or responding to the COVID-19 emergency, as well as corrections officers, emergency medical services personnel and dispatchers who witness certain traumatic events during their employment.  A Nebraska bill (Legislative Bill 1133) would include health care workers within provisions of the state’s Workers’ Compensation Act concerning mental injuries and mental illness. The bill notes that “on any given day, first responders can be called on to make life and death decisions, witness a young child dying with the child’s grief-stricken family, make a decision that will affect a community member for the rest of such person’s life, or be exposed to a myriad of communicable diseases and known carcinogens.” The legislative language goes on to say “it is imperative for society to recognize occupational injuries related to post-traumatic stress and to promptly seek diagnosis and treatment without stigma. This includes recognizing that mental injury and mental illness as a result of trauma is not disordered, but is a normal and natural human response to trauma, the negative effects of which can be ameliorated through diagnosis and effective treatment.” Legislation enacted in Nevada in 2021 (Assembly Bill 315) requires the employer of a police officer, firefighter or correctional officer to make available to them during employment, information relating to the awareness, prevention, mitigation and treatment of mental health issues, including post-traumatic stress disorder, depression, anxiety and acute stress. It also requires mental health counseling for these officers within three months of their retirement.  The Nevada Psychiatric Association and others recently established a mental health hotline, called Curbside Nevada, for frontline workers in the state. Legislation introduced in New York last year (Assembly Bill 6641) would require any law enforcement officer or emergency medical services personnel to submit to pre-employment mental health screenings and undergo mental health evaluations as part of regular medical examinations in order to monitor changes in their mental health. If diagnosed with post-traumatic stress disorder while on the job, the disorder is presumed to be proximately caused by their employment. Another bill (Senate Bill 1301) passed this year directs the commissioner of mental health to create a workgroup and report regarding frontline worker trauma informed care. South Carolina legislators are considering a workers’ compensation bill (Senate Bill 94) that, for purposes of collecting workers’ compensation, exempts first responders from having to establish by a preponderance of evidence that stress, mental injury or mental illness arising out of or in the course of employment stems from conditions that are extraordinary or unusual relative to the normal conditions of employment.  Vermont lawmakers approved and the governor signed Senate Bill 42 in 2021 to create an emergency service provider wellness commission charged with considering the diversity of these providers and the unique needs of those who have experienced trauma and identifying where increased or alternative supports or strategic investments within the emergency service provider community could improve the physical and mental health outcomes and overall wellness of emergency service providers. 

To learn more about the policies and programs states can utilize to support worker mental health, read the CSG and the State Exchange on Employment & Disability (SEED) report addressing the Mental Health Needs of Workers Throughout and Beyond the Pandemic and watch our webinar on mental health for employees here. 

By Anna Lucchese, Policy Fellow and Dalton Goble, Policy Fellow

In this rapidly changing world of workforce development, businesses are seeking to diversify their staff through a variety of ways. Hiring people with disabilities is a beneficial option for organizations to achieve this goal while addressing labor needs and obtaining competitive advantages. Studies have indicated that hiring individuals with disabilities improves profitability, productivity, customer satisfaction and inclusive work culture. To encourage these positive outcomes, state governments have worked closely to construct policies that engage the private sector and provide meaningful job opportunities for individuals with disabilities.

States have sought to accomplish this through: 

Issuing tax incentives to businesses for hiring persons with disabilities and for providing employment accessibility; Providing technical assistance and engaging businesses in the policymaking process; Developing and using talent pipelines to link businesses with qualified applicants; and Including diversity and inclusion initiatives and goals in partnerships with the private sector. 

This brief focuses on state examples of tax incentives, which have served as an efficient way to encourage businesses to hire people with disabilities. “Tax incentives” refers to providing tax credits to businesses that hire workers with disabilities and/or provide additional training to workers with disabilities.  

Examples of State Tax Credits: 

Delaware provides tax credits for businesses that hire individuals with disabilities who participate in vocational rehabilitation programs. This tax credit is accessible throughout the duration of the individual’s employment with the company. Once the employee is hired, the business is eligible to receive a tax credit equivalent to 10 percent of the employee’s wages.  

Iowa provides small businesses who hire individuals with disabilities with a tax credit of 65 percent of wages for the first year of employment. To be considered a small business, there must be 20 or less full-time employees. This law defines a person with a disability as, “someone who has a physical or mental impairment which substantially limits one or more major life activities, has a history of impairment…qualifies for the targeted job tax credit as a person with a disability undergoing rehabilitation.” Within in this definition, “impairment” includes, and is not limited to, psychological conditions, anatomical loss and cosmetic disfigurement.  

Some states are taking a different approach to support businesses who employ individuals with disabilities through tax credit policies aimed at the consumer. For example, the Kansas legislature passed House Bill 2044, which provides an income tax credit for taxpayers who purchase goods and services from certified vendors employing persons with disabilities. This tax credit is equal to 15 percent of the amount purchased by the qualified vendor and cannot exceed $500,000 per tax year.  

Examples of Federal Tax Credits: 

When constructing tax credit policies, states can draw lessons from federal tax credit programs. The Work Opportunity Tax Credit (WOTC) supports individuals who have faced barriers to employment. The WOTC provides a tax credit to businesses that hire individuals formerly involved in the justice system, vocational rehabilitation referrals and Supplemental Security Income (SSI) recipients. The Disabled Access Credit is focused on businesses that gross under $1 million and have 30 or fewer employees. This tax credit is provided to alleviate expenses that occur because of improvements in accessibility for individuals with disabilities. Examples of common accessibility expenses include access to sign language interpreters and readers, adaptive equipment and audio tapes. 

Another accessibility tax credit for a business of any size is The Architectural Barrier Removal Tax Deduction and is specific to removing physical barriers in new and existing business facilities. Through this deduction, a business can receive up to $15,000 per year to pay for accessibility expenses.   

In sum, tax incentive policies and programs can promote workforce growth and diversification. These measures provide support to businesses while also encouraging the employment of persons with disabilities. Such outcomes benefit the economy by addressing labor shortages within industries and reducing business tax obligations. States have achieved these goals through crafting tax incentives for businesses to hire individuals with disabilities. States also have enacted policies providing tax incentives for consumers to buy goods and services from these businesses. Employment opportunities for individuals with disabilities can be further expanded by mirroring federal programs designed to assist businesses in diversifying their workforces.  

By Anna Lucchese, Policy Fellow

State Vocational Rehabilitation (VR) agencies assist individuals with disabilities to prepare for, secure, retain, advance in, or regain employment that is consistent with the individual’s unique strengths, abilities, interests, and informed choice. Due to limited funding, State VR agencies do not always have the capacity to serve everyone eligible for VR services. Order of Selection (OOS) was therefore included in Title I of The Rehabilitation Act of 1973 to prioritize individuals already receiving assistance from these agencies. OOS requires that during times when resources are scarce, VR agencies must create “the order to be followed in selecting eligible individuals to be provided vocational rehabilitation services.” As of April 2022, there are 41 VR agencies that use the OOS system and 37 VR agencies that do not.

The U.S. Rehabilitation Services Administration has established general policies governing OOS [34 Code of Federal Regulations 361.36]. If the State VR agency is unable to provide the full range of VR services to all eligible individuals who apply for services, it must: 

Show the order to be followed; 
Provide justification for the order; and 
Assure that individuals with the most significant disabilities will be selected first. 

In addition, State VR agencies are required to provide access to services provided through a mandatory information and referral system. [34 Code of Federal Regulations 361.36(a)(3)(iv)(B) and 361.37] This policy enables candidates for services to be proactive while they wait for VR services and potentially secure employment in the interim. A VR agency also must refer the candidate to other agencies within the state’s workforce development system (e.g., job centers) that may have the capacity to help them while they are on the waiting list. As a result, these options may help reduce the number of eligible individuals waiting to be provided support and free up resources within VR agencies.  [See, for example, the regulations implementing the Missouri Information and Referral system.] 

Consistent with these general policies, each state may establish its own policies implementing OOS. For example, in Kentucky, there are five priority categories based on an individual’s functional capacity. Functional capacity refers to a person’s ability to perform employment-related tasks, which includes mobility, communication, self-care, self-direction, interpersonal skills, work tolerance and work skills. In Washington, the OOS system categorizes candidates as either open or closed based on the severity of the individual’s disability and the number of functional limitations. Candidates within the open category can access the full range of services at the agency. Candidates in the closed category are placed on a statewide waitlist and may be served once resources become more available.  

While the purpose of OOS is to prioritize services to individuals with the most significant disabilities, some have argued this may deter these less significant cases from receiving assistance. To remedy this, some states still work to serve individuals who have been placed on the waiting list in a more limited capacity. For example, Missouri ensures all eligible individuals, regardless of their OOS status, will have access to accurate information and referral systems offered by VR agencies. This method makes it possible for candidates to be proactive while they wait for additional services and potentially secure employment before, they become eligible for more personalized resources. A VR agency also can refer the candidate to other agencies that may have more capacity to help them while they are on the waiting list. As a result, these options may help reduce the number of eligible individuals waiting to be provided support and free up resources within VR agencies.   

Another proposed solution is increasing funding for VR programs to provide additional staffing and resources. Since only a small portion of the millions of individuals with disabilities are eligible for services, advocates have suggested there needs to be more investment in these facilities so qualified candidates will receive sufficient support. States have addressed this concern in recent years by increasing funding for VR agencies. For example, Georgia has increased funding for VR agencies to help individuals with disabilities “achieve independence and meaningful employment.” An increase in access to more resources will likely lead to fewer individuals having to wait for services and instead be placed on a more efficient pathway to achieving their employment goals.  

By Sean Slone, Senior Policy Analyst

“Our civil rights laws stand no matter what, including during disasters or emergencies, and it is critical that we work together to ensure equity in all that we do for all patients,” said Health and Human Services Secretary Xavier Becerra in a statement.

This statement followed a string of complaints filed in early 2020 against a number of states alleging that their respective guidelines illegally discriminated against persons with disabilities. For example, the Alabama Disabilities Advocacy Program and others raised concerns that a state plan governing critical care allocation during the pandemic ordered hospitals to “not offer mechanical ventilator support for patients” with “severe or profound mental retardation,” “moderate to severe dementia” or “severe traumatic brain injury.” These concerns formed the basis for a formal complaint with the U.S. Department of Health and Human Services, Office for Civil Rights (HHS/OCR). Similar complaints were filed against other states.

Rather than negate these complaints, Alabama, North Carolina, Pennsylvania, Tennessee and Utah entered settlement agreements with HHS/OCR.  In addition, OCR resolved complaints with the North Texas Mass Critical Care Guidelines Task Force, the Southwest Texas Regional Advisory Council and the Indian Health Service to revise each entity’s crisis standards of care guidelines to reflect best practices for serving individuals with disabilities. OCR also resolved a complaint in Connecticut involving visitation rights for persons with disabilities in hospitals who require support personnel.

Consistent with these settlement agreements applicable to particular states, OCR recently issued guidance to healthcare providers making it clear that civil rights protections for people with disabilities continue to have the force of law even when the nation is in a public health emergency.

“During a public health emergency like the COVID-19 pandemic, biases and stereotypes may impact decision-making when hospitals and other providers are faced with scarce resources,” said OCR Director Lisa J. Pino. “OCR will continue our robust enforcement of federal civil rights laws that protect people with disabilities from discrimination, including when Crisis Standards of Care are in effect.”

Crisis Standards of Care are state rules for triaging scarce resources that hospitals are required to follow. The standards vary widely by state and some plans give hospitals substantial discretion. 

Under the OCR guidance, persons with disabilities must be provided an opportunity to participate in, or benefit from, all healthcare and health-related services afforded to others, including COVID-19 testing, medical supplies, medication, hospitalization, long-term care, intensive treatments and critical care, including oxygen therapy and ventilators.

The guidance reflects concerns that biases and stereotyping may have impacted decision-making when hospitals and other healthcare providers have allocated scarce resources during the COVID-19 pandemic. The new guidance updates a previous issuance in March 2020. Any healthcare program or activity receiving federal financial assistance from HHS is subject to federal civil rights protections. To be in compliance, such healthcare entities must consider a specific patient’s ability to benefit from the treatment sought, free from bias about disability.

The new guidance is based on protections articulated in federal regulations implementing Section 504 of the Rehabilitation Act of 1973 and Section 1557 of the Affordable Care Act and is part of continuing HHS efforts to protect at-risk populations, advance equity and address disparities in healthcare provision during the pandemic.

The guidance was issued in the form of frequently asked questions (FAQs). Numbers 5, 6 and 7 of the FAQs outline scenarios that a healthcare provider might consider in the allocation of resources:

Whether an individual with a disability or an individual who is likely to have a disability after treatment will have a lower quality of life or relative worth to society compared with an individual without a disability who also requires treatment.Whether they can provide healthcare or deny a resource to an individual with a disability who has COVID-19 if it may require more of the resource than treating individuals without disabilities for COVID-19.Whether they can consider that an individual with a disability may not live as long as an individual without a disability after treatment.

The answer in each case is “No.”

The guidance also addresses how civil rights obligations apply to visitation policies and vaccination, testing and contact tracing programs.

Disability rights advocates say COVID-19 has exacerbated existing disparities faced by people with disabilities. The guidance is something they have argued for since the earliest days of the pandemic, said Maria Town, president and chief executive officer of the American Association of People with Disabilities.

“While we wish this guidance would have been issued sooner, the FAQs released by the department will provide health care providers and patients with disabilities alike with vital information to ensure that no person with a disability is denied necessary care during a crisis, a fear that continues to be all too real as we enter the third year of the pandemic,” she said.

By: Sydney Blodgett

Observed each February, Career and Technical Education (CTE) Month® celebrates the importance of CTE and the accomplishments of related programs across the nation. The Association of Career and Technical Education (ACTE) explains that “CTE is education that directly prepares students for high-wage, high-demand careers. CTE covers many different fields, including health care, information technology, advanced manufacturing, hospitality and management, and many more. […] CTE encompasses many different types of education, from classroom learning to certification programs to work-based learning opportunities outside the classroom.”

CAPE-Youth recognizes that CTE accessibility is important for youth and young adults with disabilities (Y&YAD). While all students can benefit from participation in CTE, it is an especially effective career pathway for Y&YAD. Research demonstrates that CTE leads to improved graduation rates and employment outcomes for Y&YAD. For example, students with disabilities (SWD) who participate in 4 or more CTE classes are 20% more likely to be employed after graduation.

However, Y&YAD can face challenges accessing and succeeding in CTE programs, such as CTE facilities that are unequipped to accommodate students with physical disabilities or inadequate CTE instructor training on supporting SWD. The COVID-19 pandemic further exacerbated these challenges. CAPE-Youth recently published a policy brief entitled Promoting and Maintaining Career and Technical Education for Students with Disabilities: State Strategies Developed During the COVID-19 Pandemic. This brief describes how states were able to adapt resources to address challenges SWD had accessing CTE during the beginning of the COVID-19 pandemic. Furthermore, it shares how states have expanded CTE access for students with disabilities. The brief offers policy considerations for states, including:

1. Strengthening interagency collaboration to maximize resources, address inequities and streamline CTE service provision.

2. Using federal funding to leverage and provide technology to expand access to CTE for SWD.

3. Offering stackable credentials to facilitate employment opportunities.

4. Increasing CTE instructors’ capacity to serve SWD through professional development opportunities.

5. Improving data collection efforts to identify and address CTE access challenges for SWD.

Access a recording of CAPE-Youth’s webinar highlighting its CTE brief and featuring state leaders here: Promoting Career and Technical Education for Students with Disabilities

In addition, CAPE-Youth will present Inclusive Workforce Readiness: Apprenticeships for Youth with Disabilities at the upcoming ACTE National Work-Based Learning Conference.

Learn more about how to engage in National CTE Month at acteonline.org/why-cte/cte-awareness/cte-month/.

By Sean Slone, Senior Policy Analyst

States are moving forward in a variety of ways to ensure a future for apprenticeships that expands into new fields and offers greater inclusion for individuals with disabilities. A February 24 webinar from The Council of State Governments (CSG) will highlight the efforts of three states and the findings of a recent report from CSG and the State Exchange on Employment and Disability (SEED), “The Future of Apprenticeship: Inclusion, Expansion, and the Post-Pandemic World of Work.” 

Colorado: Lawmakers approved legislation in 2021 to create a new state apprenticeship agency to “accelerate new apprenticeship program growth and assist in promotion and development.” Two councils that will advise development of a state plan will each include at least one member focused on promoting equal opportunity in apprenticeships. Denise Miller, apprenticeship expansion manager in Colorado’s Office of the Future of Work, will talk about how the state’s approach will be different. New Jersey: It is not just about offering apprenticeship opportunities to those with disabilities. States also can make efforts to ensure apprentices with disabilities are ultimately successful by providing support services and removing barriers to success. Lawmakers in New Jersey passed legislation in 2020 establishing a five-year pilot program providing stipends to offset transportation and childcare costs for apprentices. Workers underrepresented in apprenticeship programs, including individuals with disabilities, were given priority under the measure. New Jersey Senate Majority Leader Teresa Ruiz, who has championed apprenticeship legislation, will be among the webinar presenters. Ohio: States are encouraging more inclusion of individuals with disabilities in apprenticeships by acting as model employers, signing up apprentices for public sector work experience opportunities at state agencies. Jon Hackathorn, business relations manager for employer and innovation services at Opportunities for Ohioans with Disabilities, will talk about one such program. Ohio’s Vocational Apprentice Program supports a 2019 executive order issued by Governor Mike DeWine establishing Ohio as a disability inclusion state and model employer of individuals with disabilities.

Moderating the discussion will be David Leon, director of workforce programs at the Virginia Department for Aging and Rehabilitative Services. 

The recent CSG-SEED report on “The Future of Apprenticeship” incorporates input from dozens of apprenticeship program officials and experts around the country, examples from 30 states, and a comprehensive list of suggested strategies across four categories: 

Promoting and sustaining inclusivity in apprenticeships, particularly for individuals with disabilities; Ensuring long-term sustainable growth in funding for apprenticeships; Expanding apprenticeship opportunities; and Ensuring the resilience of apprenticeship programs. 

As noted in the report, among the ways state officials can promote and sustain inclusivity are: 

Working across state agencies to ensure apprenticeship programs reflect the unique strengths and needs of individuals with disabilities; Creating pre-apprenticeship opportunities to ensure those with disabilities have the necessary skills to participate in apprenticeships; Creating tax incentives for businesses that hire apprentices with disabilities; and Requiring that apprenticeship expansion initiatives increase diversity and inclusion. 

The benefits of inclusive apprenticeships are numerous, offering the opportunity for: 

Apprentices to gain hands-on career training; Employers to train their future workforce; and  States to increase the pipeline of qualified public and private sector employees. 

For individuals with disabilities, the benefits of inclusive apprenticeships can be even more profound, allowing them to demonstrate their value to an employer and gain new skills that can set them on a promising career path.  

The free webinar, The Future of Apprenticeship: Inclusion and Expansion in a Post-Pandemic World of Work, will take place February 24 at 2:00 p.m. (ET). Register HERE to receive the Zoom link for the conversation. 

By Rachel Wright, Policy Analyst 

State governments have increasingly recognized the advantages of proactively recruiting and hiring people with disabilities. As such, many states have pursued “state as a model employer” policies and practices to increase the number of people with disabilities employed in the public sector. 

The Council of State Governments, in collaboration with the State Exchange on Employment and Disability, recently published a report titled The State as a Model Employer of People with Disabilities: Policies and Practices for State Leaders. This report offers public officials policy options as well as real-life examples of innovative policies and programs that states have successfully implemented to build a stronger, more inclusive public-sector workforce. 

For state hiring officials, model employer policies enhance diversity, equity and inclusion in the workforce. In turn, this can increase the state’s profitability and comparative advantage as an employer. For people with disabilities, employment in the public sector can improve employment outcomes and increase economic self-sufficiency. These benefits are critical when considering the long-standing labor force inequities experienced by people with disabilities as well as the talent gaps that employers are seeking to fill nationwide. 

The report provides the following policy options to state legislators as they work to be model employers of people with disabilities: 

Instituting formal mechanisms (legislation, executive orders) – States can institute formal mechanisms such as legislation and/or executive orders to increase the likelihood that employment-related issues affecting people with disabilities are addressed by government officials throughout all stages of policy development and implementation. 

Creating infrastructures (cabinet positions, task forces, working groups, advisory committees) – Creating formal infrastructures such as cabinet level positions, taskforces, working groups and advisory committees allow for disability-issues to be considered at the highest levels of state government. They can also enhance coordination and collaboration on disability-related issues across all branches of state government.  

Extending diversity and inclusion initiatives – State officials can advance public-sector employment of people with disabilities by extending diversity and inclusion initiatives, such as affirmative action plans, to include state agencies and departments.  

Developing comprehensive, government-wide strategic plans – Developing comprehensive-government wide strategic plans can guide SAME efforts and ensure that reporting mechanism are in place to enhance accountability and facilitate continued progress toward agency goals.  

Instituting fast-track and other hiring systems to facilitate employment – States can consider increasing the accessibility of application processes for public-sector employment by instituting fast-track hiring and other systems. Fast-track hiring systems seek to systematically recruit and hire individuals with disabilities through streamlined or simplified processes.  

Enacting advancement and retention practices – Policymakers can implement strategies to facilitate the enhancement and retention of people with disabilities in the public sector workforce. Strategies include establishing reasonable accommodation policies; stay-at-work, return-to-work (SAW/RTW) programs; and disability-inclusive telework policies.  

Ensuring accessibility of information and communication technology – States can act as model employers of people with disabilities by ensuring that accessibility is a primary policy consideration in the design, development and procurement of information and communication technology (ICT). To achieve this, states can institute accessibility requirements for ICT and/or adopt inclusive procurement procedures for all ICT acquired by state government.  

Ensuring availability of personal assistance services – Neither federal law nor many state anti-discrimination laws require employers to provide personal aids and devices, including personal assistance services. States can establish policies and programs that provide and finance the provision of personal assistance services for employees with disabilities.  

Developing disability awareness training for state personnel – States can reduce stigmas around disabilities and foster inclusive workplace cultures for employees with disabilities through instituting disability awareness training for all personnel.  

As states recover from the COVID-19 pandemic, policymakers can enhance diversity, equity and inclusion in the public sector workforce through adopting “state as a model employer” policies and practices. These policies prioritize accessibility and inclusion of people with disabilities throughout all stages of the employment process — recruitment, hiring, advancement and retention.  

For further information and examples of how your state can act as a model employer of people with disabilities, please read and share The State as a Model Employer of People with Disabilities: Policies and Practices for State Leaders.