Expanding Access to Health Care Services and Work-Based Experiences for Youth with Chronic Health Conditions and Disabilities
The following is cross-posted from a letter from Jennifer Sheehy, Acting Assistant Secretary, Office of Disability Employment Policy, U.S. Department of Labor, and Michael C. Lu M.D., M.S., M.P.H., Associate Administrator, Maternal and Child Health, Health Resources and Services Administration, U.S. Department of Health and Human Services, regarding Expanding Access to Health Care Services and Work-Based Experiences for Youth with Chronic Health Conditions and Disabilities. Download the original letter here (PDF, 4 pages).
July 26, 2015, marks the 25th anniversary of the Americans with Disabilities Act (ADA). The ADA promotes full inclusion of individuals with disabilities to participate in all aspects of society, including work, education, and transportation. While much progress has been made, much remains to be accomplished. That is why the Department of Labor’s Office of Disability Employment Policy (ODEP) and the Maternal and Child Health Bureau (MCHB) in the Department of Health and Human Service’s Health Resources and Services Administration are joining together to emphasize the importance of health care transition to have success in other transition domains, and to highlight opportunities to integrate health care transition and career planning available to youth with chronic health conditions, and other disabilities afforded through the Affordable Care Act (ACA) and the Workforce Innovation and Opportunity Act (WIOA).
Interdependence Between Health and Wellness and Employment
All youth need to be connected to programs, services, activities, and supports that prepare them for meaningful post-secondary school options, enhance their ability to manage their physical, mental, and emotional well-being, and develop life-readiness skills to make informed choices. This is especially true for youth with disabilities, including those with chronic health conditions.
The World Health Organization defines health as "complete physical, mental and social well-being and not merely the absence of disease or infirmity." Because the ability to manage one’s health is critical to going to school, learning, and transitioning into employment, ODEP commissioned a study on health care transition. Despite the growing recognition of the importance of health in the overall transition from school to work and independent living, the study revealed a number of challenges exist for youth with disabilities and their families. Included among these are low expectations, lack of time inadequate payment and training for health care providers, systems with distinct and disparate outcomes and goals, and lack of coordinated transition planning. The Healthy Transitions: A Pathway to Employment for Youth with Chronic Health Conditions and Other Disabilities Policy Brief is available at: http://www.dol.gov/odep/pdf/2013ODEPHealthyReport.pdf (PDF, 13 pages).
This must change. Unmet health care needs can jeopardize education, employment, and other aspects of the lives of youth with disabilities in ways that their peers without disabilities may not experience. Having access to economic and social opportunities — such as employment — is one of the key social determinants of health. In addition to financial benefits, including access to employer-based health insurance, work contributes to overall health by helping youth feel better about themselves and their prospects and assist them in maintaining physical and mental fitness. In addition, youth who learn to manage their healthcare are simultaneously developing important transitional skills such as problem solving, self-advocacy, informed decision-making, and communication that can enhance their job readiness and career development and exploration.
Therefore as we celebrate the 25th anniversary of the ADA, we urge professionals within each transition domain, including education, health, community living, employment, housing, and transportation, to strive to work together more collaboratively to explore how transition in the different realms can be better linked to maximize youth success.
Affordable Care Act and Workforce Innovation and Opportunity Act Transform Health Care Transition Planning and Career Transition Planning
A number of provisions in the Affordable Care Act (ACA) are already transforming access to health insurance coverage for youth and young adults with disabilities by ensuring that they have quality, affordable health insurance choices, regardless of how their lives change, particularly as young adults frequently change or hold part-time or temporary jobs. Through the elimination of pre-existing condition exclusions, expansions of dependent coverage to age 26, Medicaid eligibility expansions, and subsidized private plans, new coverage opportunities are available. Young adults, either by themselves or with their parents, can confidently purchase insurance coverage that includes essential health benefits, including mental health and substance use disorders services, prescription drugs, rehabilitative services and devices, preventive and wellness services, and chronic disease management. Moreover, if needed, they can receive subsidies for this coverage. With expanded income eligibility requirements for Medicaid and increased employer-sponsored options, more young adults with disabilities are able to start or continue working while maintaining their insurance coverage. Furthermore, Medicaid agencies have a new patient-centered medical homes (PCMH) option for individuals with chronic conditions designed to strengthen the physician-patient relationship. Once the individual decides who is on the physician-led care team, the team is responsible for coordinating all of the individual’s health care needs, and arranges for care with other qualified physicians and support services to make sure team members work together to meet the individual’s needs in an integrated fashion while lowering health care costs.
The Workforce Innovation and Opportunity Act (WIOA), which supersedes the Workforce Investment Act of 1998, presents an extraordinary opportunity to revitalize the workforce system. It provides state and local areas the flexibility to collaborate across systems, including workforce, education, post-secondary education, public welfare, and economic development in an effort to better address the employment and skills needs of current employees, jobseekers, and employers. To support youth and young adults, including those with disabilities in achieving their career goals, WIOA authorizes the provision of career planning for individuals. Career planning is a client-centered approach designed to develop comprehensive programs and to coordinate supportive services, including child care, transportation, and mental health services, during program participation and after job placement. In addition, WIOA also mandates that 20 percent of youth formula funding be spent on work-based experiences, which have been shown to be the strongest predictor of adult employment success among youth with disabilities.
- The Training and Employment Guidance Letter (TEGL) No. 19-14 on the Vision for the Workforce System and the Initial Implementation of the Workforce Innovation and Opportunity Act is available at: http://wdr.doleta.gov/directives/attach/TEGL/TEGL_19-14_Acc.pdf (PDF, 7 pages).
- The TEGL No. 23-14 on Workforce Innovation and Opportunity Act on Youth Program Transition is available at: http://wdr.doleta.gov/directives/attach/TEGL/TEGL_23-14_Acc.pdf (PDF, 17 pages).
Alliance on Health Care Transition Planning and Career Transition Planning
ODEP, the Youth Transitions Collaborative (the Collaborative), and MCHB’s Center for Health Care Transition Improvement (Got Transition) established a collaborative relationship in April 2014 to strengthen linkages between health care transition planning and career transition planning for youth and young adults, including young veterans, with chronic health conditions and disabilities. To accomplish its goal, the Alliance is leveraging members’ networks to disseminate its career planning and health care transition resources.
- The Six Core Elements of Health Care Transition, which define the basic components of health care transition support for youth and young adults, is available at: https://gottransition.org/six-core-elements/implementation.cfm.
- The Transition QuickGuide: Take Charge of Planning and Managing Your Own Health and Career Goals, which includes information and resources about health insurance coverage, self-care, health care transition, decision-making, and career planning and management, is available at: http://www.dol.gov/odep/pdf/HealthCareCareerTransitionQuickGuide.pdf (PDF, 6 pages).
- Information about the Alliance is available at: http://www.dol.gov/odep/alliances/hscf2.htm.
To learn more about health care transition planning and career transition planning see the following:
- Got Transition http://www.gottransition.org/
- National Collaborative on Workforce and Disability for Youth http://www.ncwd-youth.info/
- The 2020 Federal Youth Transition Plan: A Federal Interagency Strategy http://youth.gov/feature-article/federal-partners-transition
- Healthy People.Gov http://www.healthypeople.gov/