Category: Policy

Mental Health Among Top Policy Priorities for the States

By Jennifer Horton and Sean Slone

The Council of State Governments works to help state officials solve problems and share information with other policymakers across the U.S. As a nonpartisan association of all state officials, elected and appointed, the work of CSG is research informed in order to help states identify solutions that help their communities. We recognize that no single solution works for everyone, but we can learn from the successes — and failures — of other states.

Through extensive survey work conducted by the CSG Center of Innovation research team, the CSG national office identified five top priority public policy issues that — in addition to work in other areas — CSG policy staff will expand on and provide resources for during 2023:

INFRASTRUCTURE AND TRANSPORTATION.
FISCAL AND ECONOMIC POLICY.
HOUSING.
MENTAL HEALTH INCLUDING SUBSTANCE USE DISORDER.
EDUCATION AND WORKFORCE.

Each issue of CSG Capitol Ideas magazine in 2023 will focus on the work states are doing in each of these policy areas. This issue kicks off with a deeper dive into mental health and the different ways states are working to address this growing issue.

STATE ACTIONS TO ADDRESS MENTAL HEALTH
Nine out of 10 adults in the U.S. believe the country is experiencing a mental health crisis. With that consideration, which resulted from a poll conducted by CNN and the Kaiser Family Foundation, and the topic of mental health gaining more attention in the conversations surrounding health care and wellness, many states are directing efforts at some of the most pressing concerns.

Recently, these have included suicide prevention (a leading cause of death in the U.S.), children’s mental health (1 in 6 children between the ages of 2 and 8 has a diagnosed mental, behavioral or developmental disorder), and expanding access to care. Mental Health America’s 2022 report provided a state-by-state look at access to mental health services, ranking states overall and in a number of categories including adult mental health, youth mental health, prevalence of mental illness and access to care.

SUICIDE PREVENTION
In 2020, there were 45,979 deaths attributed to suicide, or one death every 11 minutes. Even more people thought about or attempted suicide with more than 16 million adults seriously thinking about, planning or attempting suicide.

Suicide is now ranked as the 12th leading cause of death in the U.S. overall and is the second leading cause of death for children between the ages of 15 and 19 years old. As cases of mental health conditions rise and the search for solutions continues, specialists around the nation are calling it a national mental health crisis.

A number of states passed legislation to fund and implement the new National Suicide Prevention Lifeline, 988, in 2021. Experts hope that the inclusion of 988, dubbed by some as the mental health equivalent of 911, will successfully prevent more people from dying due to mental health concerns. Colorado (Senate Bill 21-154; 2021) and Washington (House Bill 1477; 2021) established telecommunications charges and appropriated funds to support the help line’s implementation and working groups to provide recommendations and/or oversee and administer the hotline.

Individuals who identify as LGBTQ+ experience disproportionate levels of poor mental health and suicidality. According to a survey conducted in 2021 by the Centers for Disease Control and Prevention looking at high school students, 25% of lesbian, gay or bisexual students attempted suicide during the past year compared to 5% of heterosexual students. States have passed legislation to support this population, both by protecting them from practices that have been linked to substantial harm as well as by enacting bills that increase access to LGBTQ+ affirmative care.

In 2021, North Dakota enacted new ethics standards in alignment with the American Psychiatric Association’s Guidelines for Psychological Practice with Sexual Minority Persons and the APA’s Position Statement on Conversion Therapy and LGBTQ Patients that prohibit licensed social workers from subjecting LGBTQ+ youth to conversion therapy and require practitioners to use therapies that affirm individuals’ sexual orientations and gender identities. During the 2021 and 2022 legislative sessions, Illinois (SB 4028) and Vermont (HB 210) enacted bills creating task forces that will provide recommendations for increasing access to LGBTQ+ supportive care.

CHILDHOOD MENTAL HEALTH
In recognition of the role of schools as a crucial access point to youth mental health care, states have enacted at least 100 laws since early 2020 aimed at supporting schools in the delivery of school-based mental health services. Some examples of this recent legislation include:

Connecticut: HB 6621 (Public Act No. 21-95, enacted June 2021) established requirements for the School Emotional Learning and School Climate Advisory Collaborative, which will develop a strategy to initiate collaborations with community-based mental health providers and support school staff in mental health and social-emotional learning. Connecticut SB 2 (Public Act No. 21-46, also enacted in June 2021) requires local boards of education to allow students to take up to four mental health days per school year.
Illinois: SB 818 (Public Act 102-0522, enacted August 2021) requires that health education courses for students include information on mental health.
Massachusetts: H 4002 (Chapter 24, enacted July 2021) appropriated funding for a pilot program for telebehavioral health services through schools.
North Carolina: SB 105 (SL 2021-180, enacted November 2021) allocated funding from the American Rescue Plan Act to establish a grant program for schools to hire psychologists in response to COVID-19.
Rhode Island: SB 31/HB 5353 (Chapter 131, enacted April 2021) requires that school staff and students receive education on suicide awareness and prevention.
Texas: SB 279 (enacted June 2021) requires schools to include crisis line contact information on all identification cards for students in grades six through twelve.
Virginia: SB 1288/HB 2299 (Chapter 452, enacted March 2021) requires that school counselors receive mental health training in order to obtain and renew their license.
Wisconsin: Assembly Bill 528 (enacted February 2020) established a competitive grant program to support peer-to-peer suicide preven tion programs in high schools.

Mental Health Stigma and Employability

Attitudes and stigma around mental health were one of the topics addressed in a 2021 study on mental health at work published by the organization Mind Share Partners. According to the study, the country may be witnessing a subtle shift in those attitudes in the wake of the impacts of COVID-19.

58% of respondents were willing to hire or work with someone with a mental health condition, up from 46% in 2019.

55% of respondents believe that an employee with a mental health condition could be just as productive as one without, up from 52% in 2019.

55% said they knew someone personally with a mental health condition, up from 50% in 2019.

READ MORE about states addressing stigma and employability on the State Talk blog.

ACCESS TO CARE
Many states have expanded behavioral health care in Medicaid to address mental health and substance use outcomes. Many of these initiatives extend beyond Medicaid enrollees and funding. Research indicates that Medicaid expansion, and the resulting increase in mental health coverage, is associated with a decrease in suicide mortality.

Montana’s Healing and Ending Addiction through Recovery and Treatment 1115 demonstration waiver expands access to treatment and recovery services, improves transitions of care across treatment levels, and seeks Medicaid coverage for evidence-based substance use disorder treatment models and pre-release care management for individuals involved in the justice system. In another state example, North Dakota’s Medicaid 1915(i) state plan amendment, authorized by SB 2012, allows North Dakota Medicaid to pay for 12 additional home and community based services to support individuals with behavioral health conditions. The program includes policies that address rural challenges.

MENTAL HEALTH PARITY
Disparities in mental health coverage persist despite Congress passing the Mental Health Parity and Addiction Equity Act in 2008. The bill, requiring equitable coverage of mental health and substance use disorder treatment, was further bolstered by the 2010 Affordable Care Act’s requirement that most health plans cover mental health and substance use disorder care. Some forms of insurance, such as Medicare, the Veterans Administration and short-term limited duration health plans, are able to place limitations on mental health coverage and the laws don’t require parity in reimbursement rates, making it difficult or impossible to find in-network mental health care providers.

Although states must meet the minimum standards established by the MHPAEA, some have taken steps to make their laws more rigorous, to have a broader scope, or to oversee enforcement. During the 2021 and 2022 legislative sessions, at least 14 states passed parity laws: Maryland, Wyoming, Oklahoma, Montana, Oregon, Ohio, Kentucky, Missouri, Colorado, Florida, Georgia, Illinois, Nevada and Washington.

In 2021, both Ohio SB 284 and Missouri HB 604 enacted legislation requiring their state insurance directors to issue regulations and enforce the MHPAEA. And Illinois SB 0471 expanded and clarified requirements for insurers to provide timely access to treatment.

Some state’s bills expand telehealth options while others focus on oversight and reporting requirements. In Maryland, SB 3 amended the state’s telehealth law to promote coverage for mental health and substance use disorder services. Additionally, Nevada AB 181 requires providers and insurers to report suicide attempts to the chief medical officer for parity compliance.

ADDITIONAL RESOURCES
50-State Medicaid Budget Survey for Fiscal Years 2021 and 2022, Kaiser Family Foundation (VIEW)

National Alliance on Mental Illness State Legislation Report: Trends in State Mental Health Policy (2019), National Alliance on Mental Illness (VIEW)

Mental Health America State Policy Recommendations: Youth Mental Health, Mental Health America (VIEW)

Final Facts

TRENDS IN STATE LEGISLATION

Among the bills lawmakers passed in 2022, some notable trends emerged across the states. According to FiscalNote, the biggest policy issues that state legislatures dealt with last year fall into the areas of health, labor and employment, and education. These broad trends in legislative focus coincide with a few policy choices made in several states. Looking at specific policies, The Council of State Government conducted a scan of state legislation that revealed multiple states enacted bills in 2022 on daylight savings policy, consumer privacy, reproductive health care, paid family leave and gender-affirming health care. This does not include all trends in state legislation but does highlight areas of common interest in multiple states.

Please note: CSG is a nonpartisan organization and takes no position on state legislation or laws mentioned. CSG provides unbiased research that is based on evidence-informed and objective analysis.

These graphics appeared in Capitol Ideas Magazine (2023, Issue 1). To view current and past issues, click here.

Expanding Representation

Under-represented populations and minority groups see state leaders sworn in following 2022 midterms

By Trey Delida

The 2022 midterm election was historic on many fronts. From newly elected officials to landmark rulings, states across the country experienced many milestones last year.

Midterm elections are often a temperature check for how the public feels about the presiding administration. This midterm came at a culmination of special circumstances: every seat in the U.S. House of Representatives was contested, the nation endured a divisive presidential election and the world emerged from a debilitating pandemic.

Ahead of the 2022 midterms, an estimated 60% of U.S. voters believed health care, inflation, jobs and the economy, and national security were the most important issues, according to Statista.

Statista also reported a historically high voter turnout for midterm elections. An estimated 46.9% of the eligible voter population took part, but that figure did not top 2018’s record-holding midterm turnout of 49.4%.

The 2022 midterms also proved successful for underrepresented populations. People of color, LGBTQ+, women and other minority groups won many key races, expanding representation in public office.

Newly elected Arkansas Gov. Sarah Huckabee Sanders, once a press secretary for former President Donald Trump, became the first female elected to the role in state history. Florida Rep. Maxwell Frost became the first Afro-Cuban and first born member of Generation Z elected to serve in Congress. Maryland Gov. Wes Moore made history as his state’s first Black governor. His running mate, Lt. Gov. Aruna Miller, became the first immigrant and first Asian-American elected to statewide office in Maryland.

Among the other historic outcomes of the midterm elections were victories by two political newcomers. Rhode Island Sens. Victoria Gu and Linda Ujifusa made history as the first Asian Americans elected to their state Legislature.

Gu is a first-generation American, while her parents were raised in an island community outside of Shanghai. They came to the states for education and stayed after taking jobs at the University of Rhode Island. Gu now represents her hometown, South Kingstown, as a senator.

Before her election, Gu studied at Harvard University, obtaining a degree in economics and computer science. Although she originally had no plans to run for office, Gu’s work as a citizen lobbyist expanded her involvement with campaigns and political organizations.

“I think I’m similar to a lot of younger folks who are concerned about climate change and environmental issues,” Gu said. “Outside of my day job I was citizen lobbying, working with and managing a lot of volunteers. I found that I really enjoyed working with people who were very passionate about any kind of issue.”

Anti-Asian hate crime spiked 339% nationwide from 2020 to 2021, according to NBC News. That was a pivotal point for Gu, who, like those around her, saw the need for more representation of their community.

“When I first started talking to family friends about running, they were very enthusiastic because they saw the need for more representation, especially after everything that was happening at the beginning of COVID with the resurgence of anti-Asian sentiments and bias,” Gu said. “I guess — stereotypically — we’re the scientists, engineers or office workers but not often looked to for leadership roles. When it comes to running for office, it’s often the local parties that recruit candidates, and that pipeline has historically not included many minorities.”

It wasn’t long after Gu announced her campaign that she received an outpouring of support and encouragement from her family and community. Her campaign was also an inspiration for some. After Gu’s campaign announcement, an Asian American high school student from a town just north of South Kingston reached out to volunteer.

“She reached out on her own. She said she was really inspired and wanted to work on the campaign or volunteer,” Gu said. “She started coming out about once a week for canvassing, and that was very early on during the primary when we were essentially going door to door.”

Gu’s victory also aligns with a successful election for women across the country. Data from the CSG Center of Innovation shows that women won 34.1% of all projected state-level races and 71.5% of all projected state-level races with at least one woman on the ballot. In total, 46.1% of women incumbent candidates won reelection.

The expansion of LGBTQ+ representation in public office was furthered by the victories of Oregon Gov. Tina Kotek, Massachusetts Gov. Maura

Healey and New Hampshire Rep. James Roesener. Govs. Kotek and Healey made dual history as the first openly gay women elected in their respective states, while Rep. Roesener became the first openly transgender man to be elected to a state legislature.

The U.S. needed to elect 35,854 more LGBTQ+ individuals across local, state and national offices prior to the 2022 midterms to reach equitable representation, according to the Victory Institute, a branch of the Victory Fund organization, which is dedicated to aiding LGBTQ+ candidates get elected.

Of those LGBTQ+ candidates, Michigan Rep. Jason Hoskins made history as the first LGBTQ+ person of color elected to his state Legislature — a responsibility he does not take lightly.

“I’ve gone into a lot of spaces where I’m usually the first or the only. It can be a lot because sometimes you are speaking for all the people you represent,” Hoskins said. “If I’m going into a room, I might be the only Black person; I might be the only gay person; and certainly, I’m going into the Michigan House as being the only Black gay person. So, there are going to be times when things come up and I — and only I — might be able to speak on it. That could be a great opportunity to educate and be a voice for those who are not here or don’t see themselves here.”

Hoskins never intended to run for office despite garnering a wealth of experience in local government as a member of city council in Southfield, Michigan, and even by establishing and running the University of Detroit Mercy Law chapter of the American Civil Liberties Union. Throughout his rise in the political ranks, he didn’t believe public office was for people like him. Being both Black and gay, Hoskins never believed he could win an election. That was until he started working with Michigan’s first openly gay Senator, Jeremy Moss.

“I could see what he dealt with, and how he navigated being gay and being an elected official,” Hoskins said. “Seeing how he was able to navigate that space showed me you can be an LGBTQ elected official and be effective, respected and be able to do great work for your community. I think seeing it be possible is the main thing and then getting the support to do it.”

Running for office is challenging, especially for those who do not have connections and funds like more seasoned politicians. Now that offices across the nation have elected many officials who are a recorded first for their respective roles, the focus has shifted toward maintaining diverse representation.

Organizations like the Council of American-Islamic Relations (CAIR) help elected officials maintain a sustainable model of equity that accurately represents the population served by the official. This is achieved by aiding minority candidates with funds, volunteers and other essential resources needed to run a campaign — all of which are crucial to mobilizing and empowering minority communities.

Georgia Rep. Ruwa Romman, a political newcomer, understood the importance of these organizations as their work entails much of her background. She co-founded the CAIR Georgia chapter Georgia chapter in 2020, and also helped create the Georgia Volunteer Hub to connect volunteers nationwide to available organizational opportunities.

This year, Romman made history as the first Muslim woman elected to the Georgia House and the first Palestinian to serve in any of the state’s public offices, a feat she believed could not have occurred without a community behind her.

“I didn’t magically become a successful candidate. It took having an entire community behind me and, for the record, it wasn’t just the Muslim community,” Romman said. “The majority of people that stood with me, voted for me and helped me are not Muslim. The reason I had the confidence, tools and vocabulary to explain my unique experience is because of other Muslims who have come before me and built an infrastructure to help me.”

According to CAIR, 146 Muslim-American candidates ran for local, state and federal office positions in this past election. Of those candidates, 82 were victorious, up from 71 in 2020. With the percentage of Muslim-American elected officials rising, the pressure on people like Romman can be heavy.

“I am incredibly honored and proud to be making history,” Romman said. “It’s also a huge sense of responsibility. In addition to representing my district, I’m now representing a group of people who for a long time have not had representation at the table.”

LOOKING TO THE FUTURE

Being part of a marginalized or notoriously underrepresented group, these candidates know what it’s like to walk in that identity and what changes will be beneficial, or detrimental, to their communities.

Winning an election is just the start. Those who run for public office do so for a multitude of reasons, but at the core they want to help others. Helping others for Rep. Hoskins means making Michigan a more welcoming place to all.

“I hope what comes out of this is me making policies that really impact change here in Michigan,” Hoskins said. “I do want to make it a more open and welcoming place for everyone. I also want to make sure that we’re doing everything we can in the state to make it more economically vibrant.”

As for Rep. Romman, she hopes that in using her platform to share her experiences that she can incite the change she wanted growing up.

“I can share my experience; I can talk about — for example — the impact that public education had on me. I can talk about the importance that teachers have had in my life and how they saved my life. I can talk about the fear I had growing up because I didn’t have consistent access to health insurance,” Romman said. “I think, as a state lawmaker, people now listen to that a little bit more than they did if it was just a random millennial tweeting or posting on Instagram, Facebook or Tik Tok.”

Undeniably, the 2022 midterm elections will go down in the history books. Historic firsts swept the nation, even in unsuspecting states. Post-election results reveal that this midterm was historically close, and neither party totally dominated, leaving us all to wonder what awaits in 2024.

2022 midterm election elections jasonhoskins midterm election representation ruwaromman victoriagu voting

Period Poverty: Barriers to Safe and Equitable Menstrual Hygiene

By Grace Harrison

Period poverty is a term gaining worldwide traction in discussions of public health and gender equality. It refers to the general struggle that people face when they cannot access or afford proper menstrual hygiene products or information about their menstruation. Menstrual product shortages like the tampon shortage created by the COVID-19 pandemic, as well as the financial burden of purchasing these products, can make them inaccessible to many consumers. Currently, 22 states (Map 1) tax tampons, pads and other necessary period products at rates ranging from 4-7%. The tampon tax, in addition to rising costs of inflation, contribute to period poverty.

The Impacts of Period Poverty
Period poverty impacts mental, physical and social health. The lack of menstrual products and the stigma around menstruation can cause frequent absences from school, work and other activities, causing disruptions to education and creating additional financial strain. More than four out of five teens had personally missed class or knew someone that missed class due to menstrual hygiene products being inaccessible, according to a survey commissioned in the U.S. by Thinx, a period product company, and PERIOD, a nonprofit. When people lack access to pads, tampons or other menstrual products, they may turn to unsanitary substitutes such as old clothes or toilet paper. In addition to the embarrassment and discomfort this may cause, there is potential risk of infection, further deteriorating overall wellbeing.

Period poverty is particularly pervasive for individuals in prisons, detention facilities and homeless shelters. Just 25 states (Map 2) explicitly require state prisons and detention facilities to provide free menstrual hygiene products in sufficient quantity to prisoners. Even so, these products are often of poor quality or the policies are not properly enforced, sometimes leading to the exploitation of prisoners in exchange for menstrual hygiene products.

For individuals experiencing homelessness in any capacity, hygiene – especially menstrual hygiene – becomes difficult. Access to bathrooms, clean water and privacy is limited even in homeless shelters. Hygiene product donations to shelters often do not include period products, making it hard for shelters to meet the needs of the people they serve.

Legislative Action
Thirty-two states and Washington, D.C., have statutes or legislation regarding the provision of free menstrual hygiene products in schools, prisons and/or shelters. Illinois and New York currently maintain the most complete policies, as they require free menstrual hygiene products in schools, shelters and prisons statewide.

Most states requiring menstrual hygiene products in schools utilize district funding. However, policies established in states like Alabama, Colorado and North Carolina rely on grant programs. Several states have established gender-inclusive policies or updated existing policies with gender-inclusive terminology. For example, California, Rhode Island, Washington D.C., and others include gender-neutral school bathrooms as a location requirement for menstrual hygiene supplies. Alternatively, states like Arkansas require schools to make these products accessible in a central or specified location aside from bathrooms so that any student may have access.

Despite efforts by legislators and nonprofit organizations, individuals who menstruate still face daily challenges of sanitation, privacy and access to menstrual hygiene products. More comprehensive and nationwide legislation addressing taxation and provision of products, as well as thorough menstrual health education, is needed to eliminate the frequency of period poverty in the U.S.

Arkansas Pilots State as a Model Employer Policies within Individual State Agencies

By Sean Slone, Senior Policy Analyst

State as a Model Employer (SAME) initiatives refer to policies and practices states engage in to increase the recruitment, hiring, retention, and advancement of people with disabilities within state government. SAME efforts allow states to advance their diversity, equity, and inclusion goals and serve as examples for private sector employers to follow. While 20 states and Washington D.C. have adopted SAME policies statewide, other states have focused on efforts within specific state agencies. One such state is Arkansas.

As a 2020 equal employment opportunity report to the state legislature demonstrates, Arkansas state government and multiple state agencies have supported SAME policies and concepts, although no formal statewide efforts have yet emerged. Nevertheless, the Arkansas Department of Finance and Administration (DFA) moved forward in 2022 to pursue a SAME effort on its own. According to Jonathan Taylor, Executive Director of the Governor’s Council on Developmental Disabilities, DFA has established an initial goal that 10% of its employees will be people with disabilities and is reevaluating and modifying its hiring processes to meet that goal. If successful, the department’s efforts could be something other agencies emulate, including those that have struggled to implement such policies in the past.

Strategies to Increase Employment of People with Disabilities within DFA

DFA’s Diversity and Inclusion team has agreed to four specific steps designed to make hiring processes more inclusive and help DFA reach its 10% goal.

(1) Accessible Job Descriptions

DFA is conducting a full accessibility review of job descriptions. This includes looking at language in entry-level state government job descriptions that indicate a successful candidate must have a certain number of years of job experience, which might dissuade literal thinkers – including individuals on the autism spectrum – from applying. DFA will instead adjust job descriptions to consider and give weight to academic and volunteer experience.

To be inclusive, job descriptions can also clearly indicate the essential functions, knowledge and skills, and physical requirements of a job, to help people with disabilities understand whether they are able to perform the essential functions of the job with or without accommodations. The Job Accommodation Network provides additional strategies for developing an inclusive job description.

(2) Inclusive Interview Questions and Evaluations

Arkansas officials convened a working group to talk about how traditional interview questions and evaluation criteria can put people with disabilities at a disadvantage.

For example, questions about abstract concepts can present challenges for literal thinkers, including those with autism spectrum disorder. The Job Accommodation Network instead recommends that questions focus on the applicant’s specific abilities, achievements, and qualities.

Similarly, traditional evaluation criteria may discriminate against individuals with certain disabilities. For example, traditional methods of assessing an applicant’s communication skills – such as based on smoothness of speech – may discriminate against people with speech impediments or ADHD.

While each office within DFA will continue to use its own interview questions, a guide on inclusive interviewing will be provided to department hiring managers. This can address the way interview questions are worded and how applicants are evaluated, to avoid discriminating against job applicants with disabilities.

(3) Hiring Etiquette Training for Staff

Arkansas Rehabilitation Services and Disability Rights Arkansas will conduct a disability etiquette training with the Diversity and Inclusion team at DFA, then expand to other agencies. These trainings will allow hiring managers, supervisors and others to learn about and incorporate policies and procedures to create a more inclusive application, interview and hiring process for individuals with disabilities. Arkansas will incorporate the perspectives of people with disabilities to inform the trainings.

Etiquette trainings can help remove bias in the interview process, by helping staff understand how to interpret certain behaviors. “Most interviewers have been conditioned that if you don’t make eye contact, you’re clearly not interested,” says Taylor. “People with autism often don’t make eye contact. Eye contact is an old paradigm; the new paradigm is [figuring out what] connectivity looks like.”

(4) Preferential Interviewing

DFA uses a point scale in the interview process, and currently veterans receive “bonus points.” Applicants with disclosed disabilities would also receive bonus points under the plan. Preferred interviewing for applicants who disclose a disability is already part of the application process in Arkansas, but the new point scale will allow the department to further prioritize individuals with disabilities in the hiring process.

According to Taylor, DFA’s inclusive hiring initiatives will benefit the department with reduced attrition; a dedicated staffing pipeline; and improved diversity, equity, and inclusion within the agency. In addition, the policies being piloted to hire people with disabilities can be applied to other underrepresented groups. Finally, the initiatives would standardize onboarding processes and establish best practices for all department agencies.

Considerations for States

Other states have taken similar approaches to develop inclusive and accessible hiring practices and to generally become model employers of people with disabilities.

Connecticut, Illinois, Minnesota, and New Jersey have established and pursued goals for increasing the number of people with disabilities employed in state government.

Arizona, Colorado, Kansas, Montana, Utah, and Virginia have established hiring preferences for people with disabilities.

Kentucky, Maryland,and Vermont have adopted a mandatory interview option for qualified individuals with disabilities.

Illinois, Massachusetts, Minnesota, Missouri, and Ohio have enacted legislation to provide disability training to public and private sector employers.

For more on state as a model employer policies and practices, The Council of State Governments and the State Exchange on Employment and Disability (SEED) have published a report titled “The State as a Model Employer of People with Disabilities: Policies and Practices for State Leaders,” which includes policy options and state examples from around the country. The SEED website includes a policy curriculum page on SAME.

In addition, states are invited to participate in a new community of practice (CoP) focused on State as a Model Employer initiatives. The CoP meets monthly and includes participants from vocational rehabilitation and other agencies across multiple states, including Alaska, Arkansas, Colorado, Maryland, Massachusetts, Michigan, Minnesota, and South Carolina. SAME leaders have expressed a desire to learn best practices from other states in order to better serve individuals with disabilities. The CoP facilitates this exchange, and brings in subject matter experts, to help each state become an employer of choice for individuals with disabilities. For more information about this initiative, contact [email protected].

Arkansas Looks to Broadband, New Partners to Tackle Rural-Urban Divide in Disability Service Delivery

By Sean Slone, Senior Policy Analyst

Nearly 50 million Americans live in rural areas, where the percentage of people reporting disabilities is highest (17.8%, compared to 12.1% for metropolitan counties). Yet despite the high rate of disability in rural areas, people with disabilities can face significant barriers accessing services and supports, including employment supports. Challenges include long waitlists for Vocational Rehabilitation (VR) services, limited employment options, and lack of transportation and/or broadband to access training and employment opportunities.

Arkansas is one state that has sought to address the challenges faced by people with disabilities living in rural areas and better connect them to employment services, supports, and opportunities. Strategies include expanding broadband access in rural areas, delivering VR services remotely, and leveraging statewide and community partners to better reach individuals with disabilities living in rural areas.

Employment Barriers for People with Disabilities in Rural Areas in Arkansas

A 2021 profile by the University of Arkansas Division of Agriculture identifies Arkansas as one of the most rural states in the country; forty-one percent of Arkansas’ population lives in rural areas, compared with 14% of the U.S. population. According to Jonathan Taylor, Executive Director of the Governor’s Council on Developmental Disabilities, Arkansans with disabilities living in rural areas can face significant barriers to employment in the state. Many experience a four-to-six-month wait to receive VR services, which help them prepare for and attain employment. Once an individual is able to work with a VR client manager, they then struggle finding employment opportunities.

“There are large pockets of the state where in your community, the only employers may be a gas station, a convenience store or a Dollar General,” Taylor said. “In those environments with very low staff, it can be very difficult for somebody with an intellectual or developmental disability to find an environment where they can thrive.”

In addition, there may be limited opportunities for remote work, due to the lack of broadband internet in the state. According to the Federal Communications Commission, only 60% of Arkansans in rural counties live in areas with internet that meets a benchmark download/upload speed. “There are parts of Arkansas where you literally hear that old school dial tone, because that’s all you can get—dial-up [internet]—and it’s unbelievably slow,” said Taylor.

Expanding Broadband and Remote Services and Opportunities

Former Arkansas Gov. Asa Hutchinson devoted significant resources to expanding broadband access in the state. In 2019, he issued a state broadband plan and created a state broadband office that has awarded nearly $400 million in grants to connect rural parts of the state, utilizing federal funding from the American Rescue Plan Act, the Infrastructure Investment and Jobs Act, and other sources. He also worked with the legislature to commission a study of households underserved by broadband.

In addition to connecting individuals with disabilities in rural areas to remote work opportunities, expanded broadband can help them better access VR services. Taylor said the state’s VR agency, Arkansas Rehabilitation Services (ARS), was able to pivot effectively to providing virtual client management during the pandemic. Taylor feels that more virtual interface options for people with disabilities in rural Arkansas can go a long way in solving both their transportation and service delivery challenges. ARS is expected to upgrade its website in 2023 to provide more options for virtual service delivery.

Working With Other Partners to Reach Rural Communities

In their efforts to provide employment supports and services to more people with disabilities in rural areas, state agencies in Arkansas have started to collaborate and blend and braid funding to expand their collective reach. This includes collaboration between ARS and the state’s Provider-Led Arkansas Shared Savings Entity (PASSE) program, which serves Medicaid clients with complex behavioral health, developmental, or intellectual disabilities. ARS is able to share funding with the PASSEs to reach more rural pockets of the state with Pre-Employment Transition Services (Pre-ETS), which provide students with disabilities the opportunity to prepare for and explore the world of work. The sharing arrangement allows ARS, which can offer services in only a limited number of high schools in the state, to extend its reach to serve more people.

Similarly, ARS is working with Easter Seals Arkansas to extend Pre-ETS to rural areas through its SET for Success program in several central Arkansas school districts. As part of the program, trained professionals work with students to help them navigate the post-high school transition period with workplace readiness training, work-based learning experiences, and other initiatives.

Additional Proposed Strategies

State officials see promise in two other strategies to extend service delivery to people with disabilities living in rural areas: engaging people with disabilities directly to better understand their needs and connect them to each other, and collaborating with non-traditional partners such as churches and faith communities to better reach those with disabilities.

Taylor said the Arkansas State Rehabilitation Council has started to engage people with disabilities at a high level to talk about the accessibility of ARS offices and services. However, they’re now considering a more concerted effort to build networks within and among smaller rural communities and to connect the individuals who could benefit from services to each other.

As for faith communities, Taylor believes they could be an answer to helping overcome mistrust of government services in some communities.

“There are more churches than anything else, particularly in the smaller communities,” said Taylor. “I certainly see that as key [to reaching individuals with disabilities in rural areas].”

Considerations for States

Other states have also launched initiatives to help deliver employment and related services to people with disabilities in rural areas.

Colorado Senate Bill 17-011 (2017) created a technical demonstration forum to study solutions to improve transportation access for people with disabilities, including those living in rural areas of the state, with an emphasis on providing adequate access to geographically dispersed jobs.

Hawaii Senate Bill 892 (2015)makes appropriations to expand broadband access, in part to “empower people with disabilities and remov[e] barriers that keep them from participating in everyday activities.”

In Idaho, the Division of Vocational Rehabilitation has collaborated with libraries to establish information and referral procedures for serving individuals with disabilities in rural communities, where VR lacks a physical presence.

From 2015-2017, Montana Vocational Rehabilitation and Blind Services contracted with the Rural Institute for Inclusive Communities at the University of Montana to provide Pre-ETS to students with disabilities.

In July 2020, the Tennessee Department of Human Services published a best practice guide to delivering Pre-ETS virtually. It includes practices for partnering with local education agencies, which can aid in delivering virtual services to those in rural areas.

Wyoming addresses rural transportation access needs for workers with disabilities through regional transportation voucher programs operated by Wyoming independent living centers, Wyoming Independent Living Rehabilitation and Wyoming Services for Independent Living, with funding support from state government.

Black History Month: An Interview with Justin Tapp

By: Justin Tapp, Guest Contributor and Abeer Sikder, Policy Analyst

In honor of Black History Month, The Center for Advancing Policy on Employment for Youth (CAPE-Youth) recently discussed intersectionality and disability employment with Justin Tapp, graduate student and disability leader.

Youth and young adults with disabilities (Y&YADs) are a diverse community, in terms of not only disability type, but also race and ethnicity, gender identity, sexual orientation and socioeconomic status. While Y&YADs face barriers to education, training and employment, those who have intersectional identities may face additional challenges. For example, the jobless rate for Black Americans with disabilities (15.1 percent) in 2021 was higher than the rates for other racial minority groups. Yet Black Y&YADs and other Y&YADs with overlapping identities can also leverage their unique perspectives, strengths and support systems to address these challenges and promote greater inclusion in the workforce, across multiple factors.

Justin Tapp, who was born with Klippel-Feil syndrome and scoliosis, is an individual doing just that. Justin identifies as African American, LGBTQ+ and disabled. He earned a bachelor’s degree in disability studies and political science from the University of Toledo and is currently working toward a master’s degree in science in social administration from Case Western Reserve University. Previously, Justin was a 2019 Policy Fellow at RespectAbility and worked as a Learning Disability Specialist in higher education before taking on his current role at a community health organization.

Recently, Justin discussed his experiences in disability studies, self-advocacy and networking, as well as his thoughts on effective policy for supporting the success of future generations of diverse Y&YADs.

Disability Studies

“I recommend disability studies for a lot of people who have disabilities; it gives you time to self-reflect and analyze how you exist within your environment.”

Justin explains his degree in disability studies “was a theoretical framework of understanding what disability meant” using an intersectional approach that examines disability through medical, social, historical and even cultural viewpoints, such as how it is portrayed in the media.

Justin emphasizes that disability studies programs are not just for individuals interested in working in the disability space. His classmates in these courses included majors in nursing, business, public policy, speech therapy and even music education seeking “a new set of skills and knowledge to look at disability in a certain way that is more universal.”

Synthesizing these perspectives led Justin to promote Universal Design (UD) in work settings, which means that “anyone designing a service should always consider how individuals with disabilities may utilize it.” According to Justin, UD is a way to “construct environments to fill all walks of life to get rid of the social constructs of disability and accommodate all [individuals].”

Self-Advocacy

“As a person with a visible disability…, I need to be explicit about my accommodations and what a ‘reasonable’ accommodation means.”

Justin says Y&YADs entering the workforce should not be afraid of advocating for themselves and should “understand their own worth and what they’re capable of doing, and sometimes teach others and employers what a reasonable accommodation is.”

Justin also understands the importance of advocating for mental health support, because “mental health plays a big part for anyone with an intersectionality in their identity.” He suggests that Y&YADs encourage employers to understand mental health issues to promote greater inclusion of people from all backgrounds.

Networking and Social Supports

“I am lucky in the position I have with my career. It’s because of strong family and friend support.”

Justin stresses that social support is key to success. Family and friends can provide a safety net from “fighting in the arena for your rights.”

Furthermore, he thinks that young adults – particularly recent graduates – should maintain strong networks, because “networking is key in school. The people you meet will be your foundation and should be your go-to support for advice.”

For those without direct support, Justin recommends attending focus groups and diversity initiatives focused on disability inclusion. “Get to know directors and leaders of these initiatives – both outside organizations and groups within your school setting or workplace,” he says.

Advice to Policymakers

State policymakers can help advance opportunities for Y&YADs entering the workforce by engaging youth with disabilities (including those with intersecting social identities) in the policymaking process. “When you are helping a community, you need to bring that community with you to understand what they are facing,” Justin says, adding that he learned this lesson from his social work training. He further highlights the important role of youth voices in designing programs, noting that “sometimes, it takes someone else’s opinions to look in on the situation to get done what needs to get done.”

For more information about policy options for improving employment outcomes for Y&YADs, see CAPE-Youth’s brief, “Addressing the Needs of Youth with Disabilities and Other Intersecting Identities: State Strategies for Program Implementation.”

Disclaimer from Justin Tapp: Any opinions expressed are solely my own and do not express the views or opinions of my employer.

The post Black History Month: An Interview with Justin Tapp first appeared on Cape – Youth.

State Approaches to Address Homelessness and Increase Affordable Housing

By Jennifer Horton

The U.S. has a shortage of affordable and available rental homes for extremely low-income households — those whose incomes are at or below the poverty guideline, or 30% of their area median income, whichever is higher. There are just 36 affordable and available rental homes for every 100 low-income households — a deficit of 7 million homes nationwide. For extremely low-income renter households, 71% are severely cost burdened, meaning they spend more than half of their income on housing, making it more difficult to afford healthy food and health care.

In 2022, a person working full time in the U.S. needed to earn $25.82 an hour on average to afford a modest, two-bedroom rental home — $18.57 higher than the $7.25 federal minimum wage. In some states, the two-bedroom housing wage is even higher — up to more than $40 an hour. The average worker earning minimum wage would need to work almost 96-hours-per-week to afford a two-bedroom rental at the national average fair market rent of $1,324.

With the rapid increase in home and rent prices over the last several years, millions of low-income renters struggled to afford their rent even before the pandemic. The economic impacts of COVID-19 exacerbated the problem even further as low-wage workers lost income. While temporary eviction moratoriums and Treasury Emergency Rental Assistance programs kept millions of disadvantaged renters housed during the pandemic, as these programs end, the need for affordable housing for the lowest-income renters will not.

The pandemic also had a negative impact on the nationwide poverty rate, with the number of people living in poverty increasing by 3.3 million in 2020, leaving 11.4% of the population in poverty, struggling to avoid basic necessities like housing and putting them at risk of homelessness.

As of January 2020, the most recent date for which comprehensive data is available due to disruptions in surveying during the pandemic, there were 580,466 people experiencing homelessness in the United States. While this number has been steadily increasing since 2016, some subgroups of the overall homeless population, such as homeless veterans and homeless families with children, have seen significant reductions in homelessness. This is due, in part, to increased attention and resources, showing that reductions in homelessness are possible.

Rates of homelessness vary widely across the states. New York state has the highest rate at 46.9-per-100,000, while Mississippi has the lowest at 3.7-per-100,000. In some instances, the high rates could be attributed to high housing costs, while in others it could be attributed to high rates of poverty. Such nuances facing each state suggest a need for a variety of solutions.

Legislators have taken a range of approaches to address homelessness and increase affordable housing, including transitional housing, changing zoning laws and streamlining the development review process.

Homelessness

Housing First
Housing First (HF) is an evidence-based approach to ending homelessness that provides people with immediate access to housing and support services without preconditions. Based on the belief that people need to have their basic needs met before addressing other issues like employment or substance abuse, the HF model emphasizes client self-determination within a trauma-informed, harm-reduction framework. The model has been successful when applied to a range of circumstances, including families who became homeless due to a temporary crisis and chronically homeless individuals. The U.S. Department of Veterans Affairs cites HF as a best practice and uses it in its Housing and Urban Development Veterans Affairs Supportive Housing (HUD-VASH) program which currently serves almost 90,000 veterans across the U.S.

There are two common models that utilize the HF approach depending on a person’s needs and whether they need long or short-term assistance. One model, permanent supportive housing, provides long-term rental assistance and supportive services to individuals with chronic illnesses, disabilities, mental health issues, or substance use disorders who have experienced long-term or repeated homelessness. A second model, known as rapid re-housing, provides short-term rental assistance and services to help people obtain housing quickly and increase self-sufficiency so they can remain housed.

Research indicates people assisted through the HF model access housing faster and are more likely to remain housed, with studies showing a one-year housing retention rate ranging from 75-98%. The approach tends to also be cost-efficient, generating savings through reduced usage of emergency services, hospitals, jails and emergency shelters.

Through city council resolution number 20110728-031 passed in 2010, the city of Austin, Texas, directed the city manager to develop a comprehensive strategy to construct and operate permanent supportive housing units and prioritized the city’s affordable housing resources, including local and federal funding, for permanent supportive housing (PSH). Elected officials also pledged to create 350 housing units for those most vulnerable to homelessness by 2014. The goal was surpassed, leading to the passage of resolution number 20141002-043, which established PSH as the primary intervention to end homelessness in the city and set another target of 400 additional PSH units in four years.

California SB 1380 (2016) required all housing programs in the state to adopt the HF model, which it defined with specific core components.

Transitional Housing
Some states have paired rapid re-housing with Critical Time Intervention (CTI). Referred to as Critical Time Intervention for Rapid Re-Housing (CTI-RRH), the evidence-based model provides support for vulnerable individuals during periods of transition by facilitating housing stability, community integration and continuity of care. CTI has successfully supported a return to housing for people in a variety of situations, including those with serious mental illness, veterans and others experiencing homelessness.

Several states have implemented CTI-RRH or some form of transitional housing to prevent homelessness in vulnerable populations.

California CA A 592 (2021) requires a transitional housing unit with a host family to include supervised transitional housing services provided by the licensed transitional housing placement provider and authorized a transitional housing placement provider to provide supportive services to a non-minor dependent placed in a certified family home or resource family of a foster family agency if that provider signs a memorandum of understanding with the foster family agency.

In 2010, Connecticut leveraged the American Recovery and Reinvestment Act’s Homelessness Prevention and Rapid Re-Housing Program (HPRP) to expand its rapid re-housing services, re-housing 3,100 people in more than 1,600 households in three years. The Connecticut Coalition to End Homelessness looked at the outcomes for these 3,100 people and found that 82% of singles and 95% of families had not returned to a state shelter three years after being housed. Currently, the state’s Department of Housing’s rapid re-housing programs are conducting a pilot program directed by the National Alliance to End Homelessness and the Center for the Advancement of CTI implementing CTI as a way to prepare individuals for independent living.

The state’s Department of Housing was established by Public Act 12-1 as the lead agency for all housing-related matters, including housing development, community development, housing affordability, and individual and family support programming, and provides assistance funds to a wide variety of programs utilizing rapid re-housing and other methods to address homelessness.

Hawaii S 471 (2019) appropriated funds to homeless programs, including outreach, rapid re-housing, the Housing First Program, family assessment centers, law enforcement-assisted diversion programs, and coordinated statewide homelessness initiatives, and established and appropriated funds for a long-term rental assistance pilot program for certain categories.

New Hampshire HB 400 (2017) instructed the department of health and human services to develop a 10-year plan for mental health services, the findings of which were released in 2019 and led to the launch of a statewide CTI program designed to connect people discharging from psychiatric hospitalization with services and supports. The nine-month, no-cost program provides participants with help securing housing, finding employment, and arranging additional mental health and social supports to improve quality of life and prevent homelessness and/or readmission.

The Veterans Administration (VA) has developed a CTI toolkit to assist in the implementation and evaluation of CTI across 32 sites in seven regions over four years. While homelessness has been trending upward in recent years, veteran homelessness has gone down by 47% since 2009. Three states and 83 communities have announced they’ve ended veteran homelessness, defined as having systems in place that ensure homelessness is prevented or is rare, brief and occurs only once.

Washington WA H 1860 (2022) seeks to prevent homelessness among persons discharging from inpatient behavioral health settings, in part by mandating housing-related care coordination services.

West Virginia WV H 3304 (2021) authorized the Division of Corrections and Rehabilitation to establish a Reentry and Transitional Housing Program.

Affordable Housing

Zoning Changes to Facilitate the Construction of Higher-Density Housing
Florida Statute 163.31771 (2021) allows localities with a shortage of affordable rental housing to adopt an ordinance permitting accessory dwelling units in single-family residential areas to increase the availability of affordable housing for low and moderate-income individuals.

Massachusetts State Statute 40B enables local zoning boards of appeals to approve affordable housing developments under flexible rules if at least 20-25% of the units have long-term affordability restrictions.

Oregon HB 2001 (2019) implemented state-level legalization of “missing middle” housing. It expands the areas across the state available for duplex construction.

Streamlining Development Review Process
California Assembly Bill 2162 (2018) encourages the production of supportive housing statewide by mandating streamlined and expedited approval for such projects and the elimination of minimum parking requirements for developments located within half a mile of public transit.

Other
Iowa House File 772 (2019) amended the administration of the workforce housing tax incentive program, allocating $10 million to qualified housing projects in small cities located in counties that have been declared a major disaster and where individuals are eligible for federal individual assistance.

Additional Resources

State Actions to Improve Health Care

By Jennifer Horton

Location can be crucial in determining a patient’s experience with the U.S. health care system. For example, residents of Texas are six-times more likely to be uninsured than those living in Massachusetts. In Utah, the rate of premature death from preventable causes in adults under 75 is half that of West Virginia.

The Commonwealth Fund’s Scorecard on State Health System Performance, which provided the aforementioned data, assesses state performance across several measures, including overall health outcomes, access and affordability, and prevention and treatment. The 2022 scorecard was the first to assess the impact of the COVID-19 pandemic on Americans’ health.

While all states suffered, the impact of COVID-19 depended on how stable a state’s public health foundations were before the pandemic began. States with stronger health systems, indicated by low uninsured rates, strong primary care capacity and effective care management, experienced lower rates of preventable deaths due to COVID-19 and had healthier populations. The health of a population is marked by rates of premature death, health status, health risk behaviors and other factors.

To address health care deficits — some that predated the pandemic and those that were created by it — states are taking a wide variety of policy approaches, including expanding access to care, improving maternal health outcomes, reducing the cost of prescription drugs and expanding direct care.

Access to Care

Opponents of Medicaid expansion object to the lack of a work requirement for eligible parties and worry an expansion could impact a state’s budget, among other concerns. The federal government covers 90% of the cost of Medicaid coverage for adults under the expansion, leaving states to pay the remaining 10%. The American Rescue Plan Act of 2021 offered states an additional fiscal incentive to implement the expansion by increasing the federal match to 95% for two years, an estimated net benefit of $9.6 billion to the eligible states, but no states accepted the offer. Proponents pushed back on economic concerns caused by the potential influx of federal dollars on local economies, citing analyses conducted by expansion states suggesting the expansion actually reduced total state spending.

In 2014, the Affordable Care Act gave states the option to expand Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level and provided states with an enhanced federal matching rate. As of December 2022, all but 11 states had adopted the expansion. An analysis by the Kaiser Family Foundation revealed states that adopted the expansion experienced budget savings, revenue gains and overall economic growth. Research indicated the expansion also improved access to care, affordability, utilization of services and led to coverage gains and reductions in the number of uninsured citizens, particularly among low-income and vulnerable populations.

While the debate continues, several states took action to expand Medicaid or make enrollment easier:

In January 2016, Gov. John Bel Edwards signed executive order JBE16-01, instructing the Louisiana Department of Health and Hospitals to expand Medicaid to adults who are ages 19-64, have an income less than 138% of the federal poverty rate, do not already qualify for Medicaid or Medicare, and meet the citizenship requirement. The state’s Medicaid Expansion Dashboard compiles data on the order’s impact on residents and access to health services.
Maryland Senate Bill 802 (2019) established the Easy Enrollment Program, allowing state residents to indicate their interest and facilitate enrolling in Medicaid, the Children’s Health Insurance Plan or subsidized exchange coverage by checking a box on their tax return.
Utah House Bill 3 (2022) directed $3 million to establish the One Utah Health Collaborative, an initiative designed to reduce health care costs, improve health outcomes, close gaps in health care and improve quality of life through a public-private partnership centered on patient needs.
Washington Senate Bill 5526 (2019) established “Cascade Care,” a semi-public option health care plan offering premium subsidies to allow individuals whose incomes are less than 500% of the federal poverty level to purchase individual market coverage on the state health benefit exchange.

Maternal Health

Roughly 700 women die each year from pregnancy-related causes in the U.S., resulting in the highest maternal mortality rate among all developed countries. In 2018, the latest available year of data, the national average was 17.3 pregnancy-related deaths per 100,000 live births. But the averages cover up crucial differences in sub-populations: Black people are three times more likely to die in childbirth than white people. Some states have taken steps to address racial disparities in maternal mortality rates:

California Senate Bill 464 and Maryland House Bill 837 require health care professionals involved in perinatal care to undergo an evidence-based training program.

States have approached improving the maternal mortality rate from a variety of angles, including doula care, home visiting programs and workforce training.

Research shows pregnant people who receive doula care are more likely to have healthy birth outcomes and positive birth experiences. Medicaid reimbursement for doula services can increase access to health care and strengthen birth outcomes for Black people experiencing pregnancy.

Minnesota (SPA 14-07, 2014), New Jersey (SPA 20-0011, 2021), Oregon (SPA 17-0006, 2017) and Virginia (SPA 21-0013, 2021) reimburse doulas as an optional Medicaid benefit. A chart summarizing the components of each state’s Medicaid doula benefits can be viewed here.

Home visiting programs, which helps deliver babies and connect pregnant people and new parents to social, health and educational services, are another strategy for improving health outcomes. Studies show the programs can reduce child abuse and domestic violence and improve maternal and child health outcomes while also delivering long-term cost savings. Federal funding is available to support home visiting services in the U.S., with at least 20 states using Medicaid to support their programs.

New Jersey Senate Bill 690 and Oregon Senate Bill 526 established voluntary statewide home visiting programs providing free services to support healthy child development, strengthen families and provide parenting skills.

Prescription Drug Pricing

At least twenty states have enacted co-payment caps to reduce the cost of insulin, with most caps only applying to people with private insurance. Minnesota is one of the only states with a co-payment cap for the uninsured and requires insulin manufacturers to provide universal discounts. Other states take different approaches to help make prescription drugs like insulin more affordable, as shown in Table 1 below.

TABLE 1

State Actions To Make Prescription Drugs More Affordable

State	Bill or Action	Status	Summary
Alabama	House Bill 249	2021 Enacted	Required a health benefit plan that provides coverage for prescription insulin to cap the total amount of any cost sharing or co-payment, without regard to the policy deductible, regardless of the amount or type of insulin needed.
California	State Budget	2022-2023 Enacted	Allocated $100 million to launch an effort allowing the state to contract and make its own insulin at a lower price.
Illinois	House Bill 119	2021 Enacted	Formalized the legal process for donating unused prescription drugs to certified pharmacies or health departments for reuse by eligible populations.
Kentucky	House Bill 95	2014 Enacted	Capped the cost-sharing requirements for prescription insulin.
Louisiana	Senate Bill 165	2014 Enacted	Required health benefit plans that cover prescription drugs and use a specialty drug tier to cap copayments or coinsurance.
Maryland	House Bill 761	2014 Enacted	Capped copayments and coinsurance for specialty prescription drugs.
Minnesota	House File 3100	2020 Enacted	Created the Insulin Safety Net Program, allowing eligible individuals to receive a free 30-day supply of insulin in an emergency and caps the insulin copayment for a 90-day supply at $50.
Oklahoma	House Bill 1019	2021 Enacted	Capped cost sharing for a 30-day supply of covered prescription insulin. The bill also requires insurers to provide coverage for equipment and supplies for the treatment and management of diabetes.

Direct Care Direct Care Workers, a broad umbrella term that includes personal care aides, home health aides and nursing assistants, who support older adults and people with disabilities, comprise the largest workforce in most states and provide essential support to millions of people in a variety of settings. Currently, both a worker shortage and an inability to meet the growing demand for long-term services and support hinders the field’s growth. States approach the long-term care crisis from a variety of angles:

New Jersey Senate Bill 3847 (2020) established a program allowing a family member or approved individual of an enrollee in Medicaid or NJ Family Care who is under 21 years old to be certified as a certified nursing assistant and provide services to the enrollee under the established reimbursement rates.
Washington state’s Long Term Services and Supports Trust Act (2019) established the WA Cares Fund, a long term care insurance benefit for all eligible Washington state residents to address the future long-term care crisis. The law provides individuals with access to a lifetime benefit amount up to $36,500.

Additional Resources

Disability Mentoring: Benefits for Youth with Intersecting Identities

By: Luke Byram

January is National Mentoring Month. While mentoring relationships benefit all youth, they may have a particularly positive impact on youth who face barriers to education and employment—such as youth with disabilities and especially those who may have intersecting identities.

According to the U.S. Department of Labor’s Office of Disability Employment Policy (ODEP), disability mentoring occurs when a person with a disability provides advice and support to another person, usually someone with a similar disability. Mentoring can be short-term in nature, such as a single-day job shadowing opportunity or career exploration experience, which could occur on National Job Shadow Day on February 2, 2023 or on National Mentoring Day on October 27, 2023. Mentoring could also reflect a more robust ongoing relationship between a mentor and youth with regularly scheduled meetings focused on supporting the youth in planning and achieving their goals. The relationship often focuses on a specific task, such as living independently, recovering from a traumatic event, obtaining employment or transitioning into the workforce. The mentor serves as a role model and provides information and guidance specific to the mentee’s experiences and identified needs.

Research clearly indicates the success of disability mentoring. Mentoring promotes career exploration and helps youth and young adults with disabilities make more informed choices about their academic and employment goals. The National Mentoring Resource Center reviewed 40 studies on mentoring for youth with disabilities and found that having a mentor with the same disability is associated with better employment and career development outcomes, including a stronger academic trajectory, smoother transitions, more well-developed life skills and higher quality of life.

These findings reinforce the benefits of mentoring overall. According to Mentor, mentoring programs help middle and high school students develop essential cognitive and social-emotional skills for school and workplace success. Guider reports similar long-term benefits for marginalized populations, including increased self-esteem and confidence in their ability to achieve goals.

Youth and young adults who have intersecting identities—such as youth of color with disabilities—are particularly vulnerable to discrimination and other barriers and may need tailored mentoring to fit their unique needs. Bernadette Sánchez of DePaul University states that there is a strong need for mentoring youth of color (Black youth in particular) to help them achieve positive academic, social and employment outcomes in the long term.

Hamza Jaka is a person of color and disabled attorney who has experience with these positive benefits from both sides, having been mentored and served as a mentor himself. Recently, CAPE-Youth had the opportunity to speak with him about his mentoring experiences.

Question: In what ways did you benefit by having a mentor?

Jaka: My mentors have always helped me think about my life and what I want, helped me plan out my career and my future and provided a comforting, but firm presence in my life.

Question: What tips, suggestions, recommendations or advice do you have for those considering whether to be mentored?

Jaka: Find a mentor who fits your life. Don’t just take people’s suggestions, and certainly take a mentor’s advice with a grain of salt. It is your life – you need to find someone who fits. Mentors should have hard conversations if you want to have them, but they should not make you feel awful.

Question: In what ways did you benefit by being a mentor yourself?

Jaka: I learned just how much I have grown and the importance of being a presence in someone’s life, without overstating my own experiences.

Question: What tips, suggestions, recommendations or advice do you have for mentors of other youth and young adults with disabilities?

Jaka: Be kind, don’t project [your experiences onto them] and remember your mentee is different from you and doesn’t always need to take your advice. Respect their time as well. Your mentees are awesome people and deserve that respect.

Question: What did you learn through your mentorship relationships?

Jaka: How to keep my promises and share my experiences without living vicariously through other people. Too often mentors bring their own lived experiences into a mentee’s life rather than listening to the mentee.

Question: What challenges did you experience in the mentoring relationship?

Jaka: Finding time to connect! I also would have loved to meet in-person.

Question: What can state policy leaders do to advance disability mentoring for youth and young adults with disabilities at the state level?

Jaka: Fund evidenced-based mentoring programs, make connections between disabled constituents and come to disability events. Also, make it a priority to listen to organizations run by disabled people, especially disabled people of color.

CAPE-Youth offers a number of resources to help state policymakers explore ways to implement programs and services—including mentoring initiatives—that meet the needs of youth and young adults with intersecting identities. Further information about Mentoring Month, including outreach tools and tips, is available at MENTOR.

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