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Independent Living News & Policy from the National Council on Independent Living

NCIL Policy on Independent Living & Rehabilitation Act: Overview

A NCIL Member smiles at the camera during the 2015 Annual Conference on Independent LivingNCIL continues to work with the Independent Living Administration (ILA) to actualize the significant changes created by the Workforce Innovation and Opportunity Act (WIOA) and reauthorization of the Rehabilitation Act contained therein. The ILA, within the Administration for Community Living (ACL) in the U.S. Department of Health and Human Services, has worked very closely with NCIL as new regulations have been developed. The regulations are one piece of the various and numerous tasks required to implement the changes required by WIOA and many more are in process.

In order to effectively carry out the additional core services as authorized in this legislation and to strengthen America’s Independent Living Program, it has been determined that additional funding of $200 million will be required.

NCIL is requesting $200 million in additional funding in the 2018 budget for the Independent Living line item.

CILs are grassroots, advocacy-driven organizations run by and for people with disabilities. CILs envision a society in which people with disabilities are valued equally and participate fully. In order to accomplish this vision, CILs support consumers moving out of nursing homes and into the community, and advocate for individuals facing discrimination in employment, education, housing, transportation, and healthcare to ensure equal opportunity for people with disabilities as citizens of our democratic nation.

The additional core services authorized by WIOA in Title V are labeled Transition; as defined:

  1. Facilitate the transition of individuals with significant disabilities from nursing homes and other institutions to home and community-based residences;
  2. Provide assistance to individuals with significant disabilities who are at risk of entering institutions so that the individual may remain in the community; and
  3. Facilitate the transition of youth (including students) who are individuals with significant disabilities, who are eligible for individualized education programs under section 614(d) of the Individuals with Disabilities Education Act (20 U.S.C. 1414(d)), and who have completed their secondary education or otherwise left school, to post-secondary life, including employment.

The Independent Living Program has had tremendous influence for systems change in the delivery of cost-effective long-term care services using home and community-based services (HCBS) and transition of youth. For decades, the Independent Living Program has been woefully underfunded and has not received additional funding. Conversely, Vocational Rehabilitation agencies routinely receive increases of $365 million in COLA every year. Due to state budget constraints, state VR agencies have returned over $80 million to the Treasury because they are not able to match with state funds. Clearly, investing in Centers for Independent Living makes sense.

This $200 million funding request will restore devastating cuts to the Independent Living Program, offset inflation costs, address the increased demand for independent living services, and fund the new transition services.

According to data collected by the Rehabilitation Services Administration, during fiscal years 2012-2014, Centers for Independent Living:

  • Provided the core services of advocacy, information and referral, peer support, and independent living skills training to nearly 5 million individuals with disabilities;
  • Attracted over $2.26 billion through private, state, local, and other sources, and;
  • Moved 13,030 people out of nursing homes and institutions, saving states and the Federal government over $500 million, AND improving the individuals’ quality of life.
  • In that same period, Centers provided other services to hundreds of thousands of individuals with disabilities in their respective communities that included:
    • Personal assistance services to nearly 184,240 people with disabilities;
    • Assistance to 145,937 people in securing accessible, affordable, and integrated housing;
    • Assistance with Assistive Technology for 171,441 people with disabilities;
    • Vocational and employment services to 96,492 people with disabilities;
    • Advocacy to significantly increase access and opportunities to fully participate in community life;
    • Transportation services to over 103,175 people with disabilities, and;
    • Services to over 35,137 youth with disabilities.

Independent Living saves taxpayer dollars through home and community-based services. Home and community-based services, accessed through Medicaid or the private sector, allow people with disabilities (including the ever-growing senior population) to remain in their homes rather than living in nursing homes or other institutions. HCBS Medicaid Waivers allow recipients to spend their Medicaid funds on case management, home health aides, personal care attendants, health, and other services. According to research funded by the National Institute on Disability and Rehabilitation Research (NIDRR) and the Kaiser Commission on Medicaid and the Uninsured In 2006:

  • Medicaid HCBS expenditures for personal care services, home health, and 1915(c) waivers were $39 billion;
  • Medicaid HCBS waiver expenditures were $25 billion;
  • Medicaid institutional costs were about $60 billion;
  • National average waiver costs per participant were $43,039 compared with $125,019 in institutional costs;
  • After including average Community Living Costs of $14,308 a year, waiver recipients spent $67,672 less than a resident in a facility;
  • Including average Community Living Costs (room, food and other), waiver recipients spent $44,992 a year, compared to nursing homes costs of $63,095;
  • Community-based services are 21% – 29% less expensive than nursing homes, saving taxpayers $18,103 a year per participant.

The President, OMB, and Congress want Federal programs to measure their outcomes, not just their activities or outputs, and Centers for Independent Living agree. Our network of local CILs, funded by the Department of Health and Human Services to help persons with disabilities remain as independent as possible, agrees that programs cannot improve unless they know their current effectiveness. On their own initiative, CILs have worked with an independent evaluator for the past five years to develop ways to measure their outcomes, and they have now succeeded. This is a rare and exciting accomplishment for a Federal program.

The National Council on Independent Living has led a nationwide effort to develop outcomes, indicators, measurement tools, and ways to gather, analyze, and interpret outcome data. The Independent Living Administration and all segments of the Independent Living community of practice have been closely involved at every step. CILs have field-tested their outcomes over the past three years. The findings from 2011 are presented below.

What did we learn about Centers for Independent Living?

  • 85% of at-risk clients are kept out of institutions
  • 30% of institutionalized clients move back into the community
  • 72% of callers receive the information they requested
  • 52% of callers use a new resource they learned from the Center
  • 70% of all clients have new skills, knowledge, or resources because they contacted the Center
  • 51% are more independent as a result of using Center services
  • 58% are now able to speak up for themselves
  • Most CILs also identify barriers and problems in their communities, develop plans to address them, and successfully engage with decision-makers

NCIL respectfully requests your careful consideration to increase funds for the Independent Living line item for the 2018 budget.

Updated: March 23, 2017.