Increasing Opportunities for Integrated Employment: Lessons from Indiana

May 17, 2016
Annette Shea, Administration for Community Living Program Specialist

Home and community-based services (HCBS) provide opportunities for individuals with disabilities and older adults to receive services in their own home or community. On January 16, 2014, the Centers for Medicare & Medicaid Services published a final rule that sets forth new requirements for states using Medicaid funds to pay for HCBS, supports enhanced quality in HCBS programs, and adds protections for individuals receiving these services. In addition, the rule reflects the intent of CMS to ensure that individuals receiving services and supports through Medicaid’s HCBS programs have full access to the benefits of community living and are able to receive services in the most integrated setting. The Administration for Community Living (ACL) is highlighting an example of a promising practice for employment benefits designed to meet the needs of individuals, promote integrated employment, and comply with requirements of the HCBS settings rule and the Supreme Court’s Olmstead v. L.C. ruling. With regard to Medicaid-funded employment services it is the state’s responsibility to ensure that 1915(c) HCBS supported employment waiver services are furnished to a waiver participant to the extent that they are not available as vocational rehabilitation services funded under section 110 of the Rehabilitation Act of 1973.

LIFEDesigns serves 350 people with intellectual and developmental disabilities (I/DD), traumatic brain injuries, and other disabilities in the south central Indiana area.

The community-based organization has an annual budget of $11 million and a staff of 320, all of whom are trained to incorporate integrated employment into every aspect of their work. Four LIFEDesigns staff members serve as team leads working to promote employment for the 40 individuals who do not receive supported living or group home services from the agency. An additional 20–30 team managers work with the 310 individuals living in group homes or supported living settings. There are more than two hundred direct service staff that support people on a daily basis to access the community.

LIFEDesigns takes a holistic approach to their work providing “wrap-around” services to meet the diverse needs of their customers.

Among the services that they provide in community-based integrated settings are:

  • fitness, computer, and cooking classes

  • Volunteer placements to develop skills and experiences

  • basic and continuing education programs for adults

  • support with resume development and interviewing

LIFEDesigns’ success in transitioning individuals into more independent community living arrangements and integrated employment has lead the organization to close four group homes. They plan to close more group homes in the next few years as individuals move into apartments, sometimes back to their original communities.

Sixty percent of LIFEDesigns’ employment support funding comes from vocational rehabilitation services and forty percent comes from Medicaid HCBS waivers.

CEO Susan Rinne notes three key factors that have contributed to LIFEDesigns’ success:

  • The Employment First movement has made competitive integrated employment a priority for people with disabilities.

  • Optimizing funding mechanisms and incentives, including federal grants from the U.S. Departments of Labor and Health and Human Service over many years.

  • Perhaps the most important of all are the positive experiences of individuals moving into more independent settings.

This is ACL’s third profile of a local program promoting integrated employment for people with disabilities; learn about Community Link in Colorado and the Arc of Washington County, MD.

ACL is interested in hearing from states, providers, and advocates working on integrated employment. Share your successes, challenges, and questions by e-mailing

Last modified on 05/07/2020

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