Medicaid Waivers Help Parents of Children with Autism Stay in the Workforce

PENNSYLVANIA— Medicaid waivers that improve access to home and community-based services for children with autism also help their parents keep their jobs, according to research from Penn State College of Medicine and collaborators.

Previous research found that families of children with autism spectrum disorder experience more challenges obtaining child care and other services compared to families of children with other special needs. Medicaid waivers that target children with autism spectrum disorder help families obtain expensive services they may not have otherwise been able to afford.

Parents of children with autism are also encouraged to commit significant time to participating in their child’s treatment.

“When you’re spending all that time just trying to help your child, there’s less time for work,” said Douglas L. Leslie, professor of public health sciences and psychiatry, Penn State College of Medicine.

When these two factors are combined, the reality is that one parent often significantly reduces their work hours or stops working altogether, increasing financial stress on families that may already be struggling to pay for costly services.

Leslie’s team, along with collaborators at the Perelman School of Medicine, University of Pennsylvania and the RAND Corporation, set out to determine if Medicaid waivers affected parental employment in families of children with autism. The study appears today (Feb. 6) Health Affairs.

Historically, private health insurers have not covered services for children with autism, Leslie said, putting the onus on school systems. That help can come too late, because research shows that children with autism benefit from interventions that begin before school-age.

“There’s been a lot of policy work over the last decade or so to try and improve insurance coverage for kids with autism,” he said. “One of the main mechanisms they’ve tried to do this through is Medicaid waivers.”

Many states have introduced home and community-based services waivers that expand eligibility for Medicaid-reimbursed services and provide services that are not covered under the standard Medicaid benefit.

“We’ve done some research looking at the effects of these waivers on things like access to care and unmet needs, and we thought it would be useful to see whether they’ve had an impact on parent’s labor market decisions,” Leslie said.

Leslie and his collaborators used information from a nationally representative survey as well as Medicaid waiver data to determine how waivers impacted parental employment from 2005-2006 and 2009-2010.

They found that waivers were effective at allowing parents to remain in the work force. When cost limits and enrollment limits for waivers were raised—giving more families access to more services—the likelihood that a parent had to leave the workforce also decreased.

Characteristics of waivers, such as how much can be spent per child participating in the waiver and how many families can receive services under the waivers, differ from state to state. In the study, the characteristics of a state’s waiver program determined who was helped by that program.

Waiver programs that increased cost limits—making waivers more generous and putting more services into homes—helped the most in lower-income households.

Waiver programs that increased enrollment limits—allowing more families to receive benefits—made the biggest difference in higher-income households that would not otherwise have qualified for Medicaid services.

“Characteristics of the waivers matter,” Leslie said.

He noted that although waivers can help parents of children with autism stay afloat financially, keeping these parents in the workforce goes beyond monetary considerations.

“Caring for a child with autism is difficult,” Leslie said. “Having an outlet through a job can be very beneficial to the parent’s mental wellbeing. It gets them out into the community.”

Leslie hopes his findings will provide more information to policy makers who hold the purse strings for assistance programs such as home and community-based Medicaid waivers.

“The policy landscape with respect to autism services is very much in flux right now, especially with talk of healthcare reform potentially being reversed,” Leslie said. “I think we need as much information out there as we can get about the benefits of some of these programs so that policy makers can be informed about which policies work and how we can ensure that these vulnerable populations can remain protected as we continue to think about healthcare reform.”

Leslie is continuing to research how waivers affect families and children with autism. He is currently investigating whether waivers are effective at getting more children with autism into evidence-based care and if they reduce problematic outcomes, such as hospital admissions and emergency department visits.

Other researchers on this study were Khaled Iskandarani, research data analyst, Diana Velott, senior instructor and Edeanya Agbese, research project manager, Department of Public Health Sciences Penn State College of Medicine; Bradley D. Stein, RAND Corporation in Pittsburgh, Pennsylvania; Andrew W. Dick, RAND Corporation in Boston, Massachusetts; and David S. Mandell, Perelman School of Medicine, University of Pennsylvania.

How to Work with Multiple Generations and Technology in Human Services

Working with multiple generations in any field can be challenging, and human services is no exception. Most challenging can be helping all employees – from directors to caseworkers – utilize technology in human services when workers have very different comfort levels using systems like case management systems, electronic document management software in the office or even tablets in the field.

comicsRight now, four generations of workers comprise the workforce:

  • Veterans, sometimes called The Silent Generation
  • Baby Boomers
  • Generation X
  • Millennials, sometimes called Generation Y

Speaking in stereotypes, younger workers, Gen X and Millennials, are technically savvy and rely heavily on technology in their day-to-day life. This transcends to work. Younger workers, who comprise 45% of the workforce, view using mobile devices in meetings to capture notes or quickly access the Internet to find information as an advantage.

On the flip side, older generations, Baby Boomers and Veterans, may find using technology in meetings to be rude or distracting because they prefer less technology-driven interactions through in-person meetings or phone calls. They tend to be less literate in technology than their younger counterparts, but have an interest in learning more.

What does this means for social services agencies?

Agencies need to keep the generational differences in learning and communication in mind when implementing new technology. Here are key strategies to help make the transition smooth.

Build on the skills of each generation to benefit the whole team

Here’s an example. A social services agency is establishing a new electronic document management system. Workers from older generations can excel on the mechanics of a new project. Veterans can provide expertise of business processes and metrics from years of experience. Baby Boomers are well positioned to serve as the project manager or coordinator because of a strong network of contacts and good face-to-face communication skills.

In dealing with younger workers, Gen Xers and Millennials make good pilot teams to try new technologies because they are tech savvy and eager to learn. They can then serve as coaches and mentors for the older generations, who are often afraid they will break technology or use it incorrectly.

By leveraging the skill set of each generation, everyone has a distinct role and feels like they are part of the team, which greatly improves the likelihood a technology project will succeed.

Train employees on new technology based on each generation’s learning style

The younger generations tend to have shorter attention spans and often prefer verbal and hands-on training to reading documents, whereas older generations prefer to read documentation and take time to internalize new processes.

The key here is to remember no one-size training will ever fit all. Technology training needs to accommodate a variety of different learning styles.

For Millennials and Gen Xers, consider short video tutorials; specific, bulleted how-to documents; and interactive, technology-based training to allow workers to jump right in.

Veterans and Baby Boomers may benefit from longer, written explanations of the new system before formal training. They may favor more traditional training methods, such as PowerPoint presentations, than their younger counterparts. These generations may also benefit from post-training tutorials to review new skills since they may not pick up on technology quite as quickly.

Keep in mind that these strategies are based on generalizations about millions of people who happened to be born during the same timeframe. Some Millennials may be petrified of trying something new like taking a tablet on a home visit, while a Baby Boomer might think writing case notes in a yellow legal pad is as outdated as a Sock Hop.

Regardless of their generation, workers who receive information, training, and support from human services agencies through a variety of communication methods will excel when using new technology.

Paid Maternity Leave: A Policy Imperative

Living in a country so focused on the reproductive behaviors of women, from contraception to abortion, it seems preposterous that despite the myriad policy imperatives that want to control women’s fertility, there is no federal policy that supports our decision to give birth by granting us paid maternity leave.

Maternity Leave in America: Where are we at?This policy gap is even more significant given that the USA is the only industrialized nation not to mandate paid maternity leave and is one of only a handful of countries globally that does not. The countries that are members of the Organization for Economic Cooperation and Development (OECD) average 18 weeks of paid maternity leave. Maternity leave is a social, economic and health policy that has broad and significant impacts for individuals, families, organizations and nations.

(For reasons of brevity and simplicity I am deliberately focusing on maternity leave but it is important to note that many national and organizational ‘maternity’ leave polices are subsumed within parental policies that apply to both mothers and fathers).

Family and Medical Leave

In the USA, the primary policy related to maternity leave is the Family and Medical Leave Act (FMLA) which puts various kinds of family-related leaves into one unpaid 3 month pot which includes leave for caring for a parent and leave for caring for an child. However, New Jersey, Rhode Island and California provide state-funded paid family and medical leave that includes pregnancy and childbirth. These policies are paid for by employee-paid payroll taxes and distributed through disability programs – with ‘disability’ being an unfortunate, if economically useful, way of categorizing pregnancy and birth.

If they do not work for one of the top law firms of the Vault 100 or a Fortune 500 corporation that competes for top talent and grant paid maternity leave to attract and retain employees, women are generally out of luck. If you are a woman with a ‘regular’ job, what do you do when you get pregnant or have just given birth? You have to take upaid leave at a time when your expenses have increased. Thus many women return to work within weeks of birth. Though some women try to continue to breastfeed, not many workplaces allow for convenient pumping and so women find themselves having to wean their infants because of workplace conditions in addition to their ‘early’ return to the paid workforce.

Many feminist activists do not want to ‘provoke’ a paid maternity leave policy because they think it makes women stand out as needing different (special) treatment than men. The fact is we are different from men and therefore need different policies related to our health and well-being. We incubate human beings for 9 months. We also have breasts that can be the sole nutritional source for infants for more than 6 months. This highly differentiates women’s parenting roles from that of males, regardless of how egalitarian a construct we may consider parenting to be.

Gender and Class Differences

In order for women to get the policies we want, we should acknowledge the difference, own the power in that difference, and demand what we need to take care of the next generation. The absence of child benefits, dearth of subsidized high-quality childcare, costly access to healthcare, low-performing public schools and high tuition costs for tertiary education are evidence of a government that talks about supporting families while neglecting the policies that would do so.

Not many women can afford to take unpaid leave and the women who work for companies were paid leave is a perk are more likely to be able to afford to take an extended leave without being paid while doing so. By making work incompatible with motherhood, women are forced to make hard choices between taking care of their children and being in the workforce, and men are forced to make this choice. Leaving the workforce because of motherhood not only reduces present income, it also limits lifetime income on which pensions are calculated while maintaining and expanding the income gap throughout the lifespan.

Our social welfare policies push poor women to work and yet social norms push middle class and wealthy women to stay home. Taking care of one’s own child should not be an economic luxury. Our economic and social policies recognize childcare as a ‘job’ only if someone other than a parent is taking care of a child. If a woman is taking care of her own child, her contribution to the economy and society is not ‘officially’ acknowledged by society at large.

For women who qualify for subsidized childcare, it is counterproductive and expensive to pay so much more money for a non-parent to care for a child while being unwilling to support a woman to take care of her own child. With regard to paid maternity leave and subsidized childcare, it is clearly not just about money, but it is about values.

The Wage Gap

Maternity leave is a key factor in the gender gap in wages and employment and in the ‘family gap’ in income that exists between women with children and women without children. Forty to fifty percent  of the gender gap income can be explained by the family gap differential due to marital and parental status among women.

The absence of paid maternity leave in the USA has been perceived by feminists and public health professionals as anti-woman, anti-child and anti-family because it does not provide income for woman post-childbirth nor does it support the 6-month breast-feeding recommendations of the American Pediatric Association.

Health Outcomes

There is no coincidence in having no paid maternity leave and the poor health outcomes we have for infants/children in this country. This is not to say that this is the only policy to blame as health policies are also significant contributors to poor health outcomes in mothers, infants and children. Policy ‘obsession’ with humans in utero do not continue once children are born.

There is little regard for comprehensive sexual health education for children and adolescence and too much attention paid to contraceptive choice and abortion. Once the child is born, our social welfare and health policies leave all but the poorest of mothers to fend on their own. The poorest women qualify for Medicaid and WIC (Women, Infants and Children). This is reflected in lack of affordable, high-quality childcare, poor performing public schools, juvenile justice facilities that are full to overflowing, low high school graduation rates and college costs that leave young adults mired in debt.

The Price of Motherhood

The price of motherhood should not be so financially challenging. Is possible women in developing nations will simply choose to opt out of the motherhood game altogether? Though the fact that American women continue to give birth at such high rates despite a social welfare net that has very large holes is a social policy paradox that is not easily understood. The demographic and economic challenges of low birthrates are not so easily fixed by social policy. Doing research on this topic for an economics class on gender and family, it was really hard to find a rationale for the resistance to paid maternity leave in the USA so I’m not sure why we are stuck in some sort of policy dark age along with universal access to health care.

Where Do We Go From Here?

In 2010, Ernst and Young was listed among the top 10 family friendly companies by Working Mother Research Institute, provides new mothers with 12 weeks paid leave and 10 weeks unpaid leave. Bank ofAmerica, which was also on the top 10, gives a paid leave to either gender of 12 weeks and allows them to take a total of 26 weeks. These organizations are profit-making institutions that would not be handing out benefits if they did not make economic sense. Getting good benefits lead to staff loyalty that reduces the costs of staff turnover. Furthermore, the costs of educating and training women get recouped over time when women are retained in the workforce.

For women who are joining the workforce, paid maternity leave should be a consideration when deciding on potential employers because the economic, social, health, personal and family benefits that result from such policies contribute much to our overall well-being and that of our families and society at large.

As is the norm in the USA, paid maternity leave is a social and health policy that is attached to employment and an employer. This leaves women at the whim of the workforce. Paid maternity leave should be a federal concern and not dependent on the whims of workplace or state policies.

Ageism In The Workplace

If we are not welcome in the workplace and we are expected to live well into our nineties and beyond, how can we ever hope to be able to sustain ourselves financially?

Can you imagine a workforce made up of 3 generations?  I am 68, my children are in their forties, and my oldest grandchild is 17. I am one of the fortunate aging boomers who is still part of the American workforce. I have no problem envisioning a workplace where my granddaughter, my son, and I will all be participating in the growth of our nation’s economy. Yet, there is one major obstacle to achieving this goal. It is the oldest, most entrenched form of discrimination in this country. Ageism!

agediscriminationintheworkplace02Nowhere is it easier to identify ageism than in the workplace. As older workers are staying longer and younger workers enter the field, more often than not they will find themselves part of a multigenerational workforce. By the middle of the next decade, the United States will be an aging society, with more Americans over age 60 than under age 15.

What this means for an evolving job market is that there will not be enough young workers to fill entry level jobs. We will then have two choices. We can import young workers from other countries, or we can prepare ahead by accommodating older workers and encouraging them to remain or re-enter the workplace. This would be a welcoming departure from the cold shoulder that older workers receive when applying for jobs today.

Our country’s leaders are always a day late and a dollar short when it comes to planning ahead. For years and years people have been writing about the “graying of the American workforce” and the “aging tsunami”. The boomers are not coming; we have arrived!

We are healthier than previous generations, and we are living longer–in many cases, as much as 20 years longer. Yet, when we leave our career jobs, whether by choice or not by choice, we step into a void. We discover that there is no role for us in society. We become invisible. The invisible man today is not a bandaged wrapped non-body. He is an invisible somebody.

Here’s the dilemma: If we are not welcome in the workplace, and we are expected to live well into our nineties and beyond, how can we ever hope to be able to sustain ourselves financially? We have the intelligence, skills and wisdom to become one of society’s greatest assets.  Yet, without the opportunity to earn our own way, we will certainly become society’s burden. Most salient is our position as repositories of historical and cultural history and our ability to solve long term problems that younger people do not have the time for.

One excuse I hear for not keeping or hiring older workers is the fear that it will be too expensive. “They will be sick too often and, therefore, be less productive.” Not true. Older workers come with an innate work ethic. We take less sick days than our younger co-workers. We also come with our own health insurance, namely, Medicare. And, older workers are often willing to work for lower salaries as a supplement to our Social Security.

Mainly, we want to be valued and be seen as contributors to a better society, not as a drain. I wonder if those who would shut older adults out of the workforce are ageists who drank the youth-obsessed Kool-Aide that the media hands out. They probably do not even recognize their own internalized ageism. Have they thought about why they do not want a workplace filled with grey haired people? Could it possibly be the threat of having a workforce who reflect the true life process of aging that they would rather deny?

Ageism does not only affect the old. It affects our entire society. It deprives one generation the opportunity to pass on knowledge to the next, while depriving the younger generation the opportunity to learn and build on that knowledge.  It deprives an older generation the opportunity to keep growing and learning new skills for which the young are our best teachers.

The stereotypes of older people that we all own do not match up with the reality of today.  They are out of date.  It’s time for an upgrade.

 

Exit mobile version