The 2013

Fiscal Cliff
A System’s Thinking Approach to I/D Policy
Development

The problems that can result as a result of the implementation of the Budget Control Act of 2011 are
arguably unrivaled in domestic policy. Budget cuts impact policy agendas which in turn impact benefit
programs and services; these in turn impact customer service metrics and our client’s quality of life.

Quality of life is not free and neither is the absence of it. The only sound policy is one that takes
responsibility for the consequences of its policies. Quality and costs are complementary metrics. Costs
are reduced through the development and implementation of sound policies that proactively respond to
the needs of the community.

Drafted by Travis Barker, MPA GCPM

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 Table of Contents

The Purpose of Policy

The Challenge

Policy & Budget Priorities

Eligibility

Community & Support Services

Conclusions

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The problems that can result as a result of the implementation of the Budget Control Act of 2011 are
arguably unrivaled in domestic policy. Budget cuts impact policy agendas which in turn impact benefit
programs and services; these in turn impact customer service metrics and our client’s quality of life.

Quality of life is not free and neither is the absence of it. The only sound policy is one that takes
responsibility for the consequences of its policies. Quality and costs are complementary metrics. Costs
are reduced through the development and implementation of sound policies that proactively respond to
the needs of the community.

The Purpose of Policy

The purpose of policy is to identify goals, services, and goals to be prioritized.

The Purpose of the Budget

The purpose of the budget is to fund the

specific policy areas priorities. The budget is
identified for each individual policy area and
must be implemented as prescribed by the
policy area that governs the use of the
budget. Any use of the budget that falls
outside the scope of the previously
approved budget and associated policy
requires executive level approval.

The January 1st, 2013 Fiscal Cliff

The fiscal cliff is a term currently used to describe the financial gap between the government’s
current revenue and current expenditures. The Budget Control Act of 2011 requires a balanced
budget. As a result, the Federal, State, and Local Governments are required to balance the
budget by increasing revenue, identifying cost cuts, or both.

January 1st marks the end of the Bush Era

Federal Budget
Tax Cuts, Social Security Tax Cuts,
Reversion of the Minimum Tax Thresholds
to 2000 levels, Expiration of Federal
Unemployment Benefits Extension, and the
Budget & Policy
introduction of increased taxes to fund the Priorities
State Budget

new Affordable Healthcare Act. Washington

State approved their balanced budget. The
Federal Government is currently in gridlock

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over discussions to develop their balanced
budget.

The fiscal cliff of January 1, 2013 represents the point at which taxes are marked to increase
across the board unless the Federal Government can agree upon a balanced budget.

The Federal Government’s goal is thus to match revenue with expenditures as well as identify
policy priorities that minimize the negative impact of their budget on the nation.

Interdependence of Policy Priorities

The different policy priorities are Medical

interdependent upon one another. This
means that the revocation of one policy
priority area impacts the rest of the system.
For example, medical benefits & services
impacts the quality of life of a DD client Services Housing
living in their own home in the community,
and similarly services are dependent on
housing stability and are tailored to the
home setting (institutional versus
community, etc).

Without appropriate medical the ability to support a client in their own home in the community is
decreased. Similarly, the type of housing model available to the client determines the quality of
services provided. In turn, the type of services provided reinforces the type of housing the client
requires.

The Challenge
The challenge of the Federal & State governments is thus to identify policy & budget priorities
that take into consideration the larger picture of service and benefit needs of the DD community.
Failure to consider the larger picture is otherwise comparable to having a home but no staff to
provide support services.

Policy & Budget Priorities

Community
Support
The policy & budget priorities impact Services
eligibility and what community based support
services and models are available.

Eligibility
Policy &
Eligibility criterion to receive funding impacts Eligibility Budget
Priorities
what community based support services and
models are available.

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Community Support Services

Community support services and models available in the community impact the quality of
outcomes achieve as a result of the policy priorities and budget allocations.

Staff can help by researching the policy & budget areas that are being discussed at the local
and federal levels, participate in that dialogue, advocate for the DD clients you serve, and by
voting.

Policy & Budget Priorities

Balancing the Government’s Budget

 Mandatory Services & Entitlements

The Constitution of the United States identifies certain rights that are inalienable from the
person. Subsequent to the drafting of the Federal Constitution was the State Constitutions
within which inalienable rights were confirmed and expanded. Funding of services supporting
these inalienable rights is required by both the Federal and State Governments. The means by
which these rights are enforced and the level of funding allocated to these policy areas is open
to negotiation as long as these inalienable rights are protected.

 Discretionary Services
The values inherent in the Federal and
State political systems expand the
Mandatory
support beyond the inalienable rights in Services

the pursuit of goals and ideals unique to

the place and time of the era.
Legislation is enacted in these Evidence Based
Practices
Discretionary
Services
discretionary areas to enforce these
rights and obligations with the rule of
law. Funding is allocated to these policy
priorities with specific objectives in
mind. Timeframes are established Administration Shared
Efficacy Authority
during which these policy priorities are
to be enacted and rescinded.

Federal & State Interdependence

 Shared Responsibility in the Administration of Benefit & Service Programs

The Federal Government’s policy agenda is realized through regional and State efforts through
collaborative sharing of funding responsibility for shared policy commitments.
- Where the State is lacking is commitment, or funding, the Federal Government is able to
entice cooperation through funding arrangements in discretionary policy areas.

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 - Where the State is similarly lacking in commitment, or funding, in mandatory (non-
discretionary) policy areas the Federal Government has used a combination of funded
and unfunded mandates.
- The administration of benefit and service programs is configured according to the
requirements established in the guiding legislation.

 Cutbacks in One Area Impact the Delivery & Efficacy of Administration in Other Areas
Funding shortfalls impact both Federal and State policy priorities. The Budget & Control Act of
2011 requires the alignment of revenue and expenditures in government spending.
- Although the mandatory (non-discretionary) policy priorities remain due to
Constitutional requirements at the Federal and State levels the ability to achieve quality
outcomes is delimited as a result of the budgetary shortfall.
- The challenges faced by Federal and State authorities are to continue representing the
interest of their constituencies, frequently defined as maintaining existing service
standards, despite cuts in spending.

 Research and Evidence Based Practices

Realization of the national and local policy agendas represents a moving target. Research
supports the developing of tools to realize these negotiated values.
- When funding shortfalls occur the support of discretionary policy areas, including
research to identify and evaluate evolving evidence based practices, is negatively
affected.

State Funding:

 History of Federal Support of State Programs, Particularly During Economic Downturn

State and local governments depend on the Federal government to achieve mandatory and
negotiated discretionary policy priorities.
- In an economic downturn State and local governments are further depending on Federal
support to maintain current benefits and services. .

 Reduction of Federal Support Reduces State Ability to Serve Maintain Policy Priorities
Discretionary and non-discretionary policy areas
become increasingly unsustainable during State
funding shortfalls. Policy priorities are Funding
reevaluated while lobbying efforts to maintain
services to current levels provide increased
pressures to legislators, politicians, and
Policy Federal
organizations. Priorities Funding
- “Balanced” proposals to address the
reduction in resources emphasize the

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 maintenance of the constituency’s
unique agenda.
- Trade-offs are required and yet no one is willing to make these trade-offs.

 Reduction of Federal Funding Likely to Exacerbate Further State & Local Cuts in Services
A domino effect occurs in the identification of policy priorities as budgets are reevaluated,
reallocated, and the entire policy field is realigned.
- Maintenance of individual policy areas, mandatory or discretionary, creates a relative
imbalance that plays out through the allocation of adjustments to other policy areas.

Eligibility
Eligibility:

 Social Security Eligibility

Social Security eligibility criterion is
modified as the baby boomer Social
generation ages, less children are born
Security
to bear the financial burden of the
social security payouts, and the
financial viability of the program
becomes suspect.
Medicare Medicaid
 Medicaid Eligibility
Medical eligibility criterion is modified
as the economic crisis increases the
unemployment rate, families seeking
Medicaid benefits increases, healthcare costs skyrocket, and the revenue sources used to fund
the Medicaid program show decreased performance.

 Medicare Eligibility
Medicare eligibility criterion is modified as the number of people retiring increases, as
unemployment increases early retirement, as income decreases and the income based criterion
for Medicare is met, and as the revenue sources used to fund the Medicare program show
decreased performance.

Benefits:

 Food Stamps
Food stamps represent a discretionary policy item. The funding for this area is frequently
competed for and identified for allocation to other policy priorities facing funding shortfalls.

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 - The criterion of eligibility for this benefit is revaluated as a result. Studies have
replicated the general findings that food stamps and general assistance benefits
mitigate incentives to work and thus reinforce their continued use, diminish success as a
temporary fix for the policy areas identified, and create dependence.

- Food stamp benefits allow the beneficiary to spend their limited income amongst other
critical areas.
- Without food stamp benefits the non-beneficiary is required to use their limited income
on food which is likely to lack sufficient nutrition, contribute to increased medical issues,
and increased medical costs.

 Startup Assistance
Startup assistance represents a discretionary policy item. Startup assistance for people with
disabilities is limited to their first move into a community based setting. The availability of this
resource is often indeterminate and requires a case by case application and evaluation process.
- Without the startup assistance the non-beneficiary is required to use their own limited
funds for housing setup, their ability to move into the community is greatly decreased
due to greater costs, and housing quality is diminished if the move is still supported to
proceed.

 Prescriptions
The prescription benefit of the Medicaid and Medicare plans has been critically scrutinized as a
result of the challenges to balance the budget.
- Escalating healthcare costs, costs of medications, high utilization of non-generic
medications, and the often prescribed new medications and their associated costs make
prescription benefits one of the most expensive policy areas in government.
- In an effort to limit the costs of the prescription benefit individual eligibility criterion
has, medications covered, and individual programs that have this benefit.
- Without the prescriptions benefit the non-beneficiary may face increased medical issues
due to inability to secure critically needed medications, increased use of emergency
medical services due to postponed treatment, increased medical costs, depleted
savings, and hospitalization due to out of control medical conditions and/or
destabilization.

Medical:

 Caps on Healthcare Funding

Healthcare funding is one of the most costly policy agenda items at both the Federal and State
levels.
- The suggested caps on
healthcare fund determine the

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 Healthcare Caps

policy agendas that are to be

pursued, the services that are Reimbursement Healthcare
Rates Benefits
to be provided, the benefits
that are available, the criterion
of eligibility for each, and the
results that can be targeted. Emergency
Utilization Rates
Services

 Caps on Healthcare Benefits

Healthcare benefit allowances and approved procedures and treatments have been revised
during this economic recession affecting millions of people.
- Medical, dental, optical, and behavioral treatment options, to name just a few, have
been reevaluated and differentially approved depending on the benefit plan and
beneficiary characteristics.
- Caps on healthcare benefits determine the type of procedures that are allowed,
medications that will be paid for, treatment that will be covered, criterion of eligibility
to receive critical treatments that are included in the plan, as well as present with limits
to preventative care options. Healthcare benefits represent one of the key policy
agenda items that have a direct and measurable impact on quality of life.
- Although the DD community had been proposed to lose their dental, optical, and
prescription benefit coverage this has not happened yet. Other groups were not so
fortunate.

 Inadequate Benefits Increase Utilization of Costly Emergency Services

The Budget & Control Act of 2011 requires a balanced budget. How this is done is open to
debate, and is being debated.
- Saving costs by excluding a medical procedure or treatment procedure/service often
results in decreased health and postponed costs, ultimately escalating in the form of
emergency services.
- No policy agenda item is realized through this effort, except financial. Housing,
healthcare, benefits, nutrition, services, and treatment have a direct impact on quality
of life; when a DD client is missing one of these factors than the other factors are
affected.

 Reimbursement Rates
Accessible healthcare is dependent on the practitioners, physicians, and specialists that are
willing to accept the reduced rate for service that is set for reimbursement by Medicare and
Medicaid.
- When these practitioners, physicians, and specialists are no longer able to afford to
work with the public benefit plans the community suffers.
- Medical services become a commodity as the community is forced to search for new
providers.
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 - Accessibility to services is delayed and pressure is increased on the remaining system to
do more with less.
- Customer care is postponed and neglected. Costs per unit of service again increase as
service needs become increasingly complex and critical.
- Although this mechanism for saving costs has been exercised in the past reimbursement
rates are eventually restored in order to insure the policy priority of adequate medical
care is supported.
- The rollercoaster ride ends where it started; the whole point of the exercise is thus
called into dispute.

Affordable Healthcare Act

 Expansion of Healthcare Services Available

The Affordable Healthcare Act represents one of the most significant pieces of legislation since
the introduction of Social Security.
- The nation’s quality of healthcare and quality of life will improve. This affects DD clients
as well as their families, neighbors, friends, relatives, and coworkers.
- The expansion of healthcare
services available impacts the
lifespan, quality of life as the Healthcare
Expansion
population ages, generates
more demand for the
insurance industry, generates National Pre-existing
Measures Conditions
more demand for the medical
technology that serves the
industry, and supports the
development of a more health Dec. Emerg Inc. Employer
conscious nation. costs Costs

- A healthier nation is also a

more productive nation.

 Pre-existing Conditions
Pre-existing medical conditions represent a policy priority for the Affordable Healthcare Act.
- Insurance carriers identify pre-existing conditions as a policy area to avoid.
- Costs associated with pre-existing conditions are often causing the community to seek
healthcare insurance in an effort to seek critical medical treatment as well as mitigate
the costs of that treatment.
- Costs associated with the same pre-existing conditions are often causing insurance
carriers to decline a procedure.

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 - These represent two very different policy priorities. Leveraging the buying power of the
entire nation is anticipated to decrease costs while increasing potential profits to
insurance carriers and medical providers.
- The continuing treatment of pre-existing conditions is necessary to take care of the
individual’s health.
- The continuing support of healthcare coverage that does not reject procedures for pre-
existing conditions is necessary to take care of the nation’s health.
- Refusing treatment based on a pre-existing condition is tantamount to refusing housing
to a DD client who is now living on the streets.
- The rationale justifying refusal on either point fails to recognize the vision that binds
communities together and spurs technological and service based innovations to improve
everyone’s lives.

 Increases Employer Costs

The Affordable Healthcare Act, upon initial implementation, is forecasted to greatly increased
employer costs.
- Until different mechanisms for carrying the burden of the healthcare bill are realized
these costs are likely to result in decreased staffing, collateral benefit plans, capital
investments, infrastructure & facility improvements, to name a few.
- Product and service innovation and emphasis on value will be less likely to occur
without additional, itemized, and unbundled costs been transferred to the customer.
- Similar to the priorities of the Budget Control Act of 2011, business costs have to be
made up with revenue somewhere.
- This policy priority saves and costs the same beneficiary while contributing to improved
health.

 Decreases Emergency Care Costs

The Affordable Healthcare Act pursues different policy priorities than the Budget Control Act of
2011. Whether or not their implementation can be complementary is debatable.
- The costs that are saved by the Affordable Healthcare Act in preventative care, and the
avoidance of unnecessary and less efficient emergency care in the future, is to be
realized.
- It can be readily argued that the quality of life gains associated with the Affordable Care
Act more than compensates for the costs of the act’s implementation minus the saved
revenue from avoiding emergency treatments.

 Impacts National Medical Service Measures

The objective of each policy priority is to achieve the outcomes identified within that policy.
Funding is allocated to achieve the agenda specified in the policy.
- The success of the policy is dependent on the measures and metrics utilized to evaluate
policy outcomes.
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 - Although the legitimacy of the metrics utilized are left for another discussion and not
included in this analysis the outcomes are easily reduced to general themes: health,
safety, and general welfare.
- These outcomes are interdependent and no sound policy can be developed without
consideration of overlapping dependencies with other policies.

Community & Support Services

Caregivers & Family Supports

 Respite Care
Many DD clients live with their family for an extended period of time prior to their introduction
to alternative housing models in the social service industry.
- Respite care services represent one of
the discretionary policy areas that
continue to be jeopardized during
Caregiver
budget cuts. Supports
- This represents a problem since
accessibility to the funding to utilize Staffing Services

the alternative housing models in the

social service industry is scarce.
- Extensive waiting lists are common.
- The fact that respite care options are Housing Vocational

limited, and the extension of these

programs is often unfunded, increases Education
the family’s need for alternative
housing models.
- Since funding is limited for both the health of the family is undermined as they wait for
alternative services and support to finally become available.

 Program Funding Levels Impact on Family Economic Status

Socio-economic indicators include wealth, savings, health, education, employment, and the list
goes on.
- Families with a member that is disabled frequently forego these opportunities in
exchange for having the resources and time, albeit limited, to take care of their disabled
family member.
- These same socio-economic indicators represent opportunities and resources that are
then not accessible.
- Healthcare costs, support services, and housing costs are incurred by the family as long
as funding limits and eligibility restrictions can impact the family for a generation.

 Financial Impact on Ability to Retire

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 The family’s ability to retire is dependent on having unused income for investments and savings
wherein the payout is postponed until retirement age.
- With families with a member who is disabled and is not yet eligible for funding benefits
and services any unused income, if any, is used to take care of the family member.
- In many instances second and third mortgages must be taken on the home in order to
pay for the additional bills of taking care of a disabled family member.
- The technical services available to help families to better support and understand the
needs of their disabled member lack public funding sources until the disabled member is
eligible for the funding for these services and benefits.
- One of the more common gaps in funding exists between that of eighteen years of age
and twenty four years of age (or more).
- Despite many disabled children having the services and benefits available to them while
attending school these same benefits and services are not established for graduation
from school.
- The natural graduation from school to the community is left unfunded, un-served, and
unsupported through the public sector.
- As a result, disabled family members often utilize the extended high school
programming available to disabled students from the ages of eighteen years of age to
the age of twenty one as a form of supervision

 Social Security Retirement Age & Benefit Level: Impact on Family Economic Status
Social Security benefit levels and the criterion for eligibility for benefits impact’s the entire
family system. Strained systems impact every member of that system.
- Whether direct or indirect the impact of limited benefits and exclusionary criterion for
eligibility determines the scope and breadth of resources and opportunities that will be
available to each beneficiary.
- The family becomes strained as members of each family system are required to provide
services and financial support to other members of the system.
- Whereas one member may be able to accommodate their particular limitations faced
the consequence of these limitations on the system are easily magnified as a member
with a disability is left with less support and assistance.
- Diverted resources similarly divert attention. Diverted attention thus impacts the quality
of support available to disabled family members.

Services:

 Slots Available within a time of Expanded Service Needs & Institutional Closures
Services are available based on eligibility criterion and the availability of funding.
- Slots, associated with funding availability, represent a scarce commodity.

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 - New slots are infrequently made
available despite DD individuals needing
these services and resources as they
Service Slots
age out of the public education system.
- Access to services affects household
Funding for
stability, income potential, and health. Waiting List
Expansions

Limited access to services also affects

individual stability, treatment efficacy,
and their ability to successfully
integrate into the community.
Reimbursement Mandatory
- Delays are individually associated with Rates Funding

increased treatment resistance, poorer

health, and increased behavioral Discretionary
Funding

problems.

 Funding Limitations on Expansions

Treatment and service delivery models are constructed based on then current evidenced based
practices of the era. What this means is that models become outdated as customer needs and
service technologies change.
- The transition from one service model to another, and from one technology to another,
costs money.
- Delays are associated with decreased efficiencies and efficacies when compared to
more advanced standards.
- Despite this often recognized fact public and private models are resistant to upgrading
until regulatory requirements, either legal or financial, require it.
- For example, transitioning DD clients from institutions into the community was not
initiated until there were these legal and financial considerations.
- The mental health community has experienced similar trends initiating upgrading.

 Mandatory Services Threatened as a Result of Federal & State Cutbacks

Each era contains cultural characteristics that shape public policy agendas.
- These evolving agendas in many circumstances exceed the legislatively required
mandate for services and benefits.
- Service and benefit levels that are individually tailored to local communities are
supported by flexible funding mechanisms although these often required combined
local, state, and federal contributions.
- As funding cuts are increasingly necessitated by the recession the federal and state
contributions to localized efforts becomes similarly restrictive.
- Definition, identification, and evaluation of outcomes is benchmarked at lower and
lower thresholds across the spectrum of policies impacting at the local levels until

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 nothing is left except the original and dated mandated that fails to account for modern
values, norms, and technologies.
- Old methods, technologies, and objectives become normalized until the next biennial
session where it is hoped that more revenue becomes available.

 Discretionary Services Threatened as a Result of Federal & State Cutbacks

Whereas mandatory service levels remain the discretionary services that represent the era’s
modern day perspective, commitments, and priorities lose focus.
- The resulting gap between identified need and the services/benefits that are available
pangs both the individual and society.
- Social advancements are threatened as regressive priorities, technologies, and values
are reinforced.
- Although the democratic machine is enhanced through these recessionary and
regressive mechanisms the effort produces duplication of efforts, values, and
movements that already occurred in times past.
- Instead of moving forward the entire system is instead often focused on maintaining
what it has, mitigating further loss, and limiting their focus on the here and now instead
of the future.

 Reimbursement Rates
Reimbursement rates represent the set amount negotiated by the government for payment.
- These payment levels are often lower than rates adjusted by the market and represent
deterrents to providers to accept these rates.
- As costs increase these rates are not sustainable.
- As these rates decrease the provider’s ability to similarly continue to provide said
services is not sustainable.
- Negotiation between the government and providers is often played out in the market
instead of proactive discussions intended to reach a sustainable solution.
- Providers discontinue their contract with the government to provide services to the
beneficiaries of the government as costs become unsustainable when compared to
reimbursements.
- The government’s cut in reimbursement rates, or failure to increase said rates with the
cost of inflation, decreases the type, frequency, and quality of services now available to
the beneficiary.
- The government eventually recognizes this and reconsiders its reimbursement rates.
Providers thus agree to provide services again. The cycle continues.

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  Backlog of Applicants

Funding is provided with the conditional agreement that to receive funding for services/benefits
it will be applied to meet certain objectives. This is both true in government and at the
individual beneficiary levels.
- The cost of each objective, at the individual levels, establishes limits for how many
members will be able to use the benefit and how often the individual benefit is
permitted.
- Conditions that allow an exception withstanding, funding is supposed to be allocated
based on criterion, need, and eligibility.
- The efficient and effective implementation of the policy agenda, and its supporting
funds, requires that both the agenda and the funds available are a match.
- When they are not a match needs are left unmet and the agenda is debatably
unsuccessful due to underfunding.
- The Budget & Control act is evidence of both insufficient funding for the original agenda
as well as scope creep in the agenda subsequent to its implementation.
- It is not that the new terms of the modified objectives are unsubstantiated; it is that the
original agenda was more likely than not regressive or insufficiently informed. Neither is
excusable.
Vocational:

 Community Integration Influencing Output & Productivity

The right to work represents one of the major advances in society’s conception of disability and
the public’s responsibility for individuals with disabilities.
- The values of integration and the right
to work are intrinsically connected to
supporting individuals with disabilities Community
Integration
ability to actively participate in the
community.
- The system of services, policies, and
benefits are integrated within a
Employment Services Institutionalization
framework that identifies, evaluate, and
monitors the allocation of funding in
the pursuit of these modern day values.
- From hiding to institutions, and from
stigma to community inclusion, the Funding Levels

public’s attitudes towards disability are

reflected in its policy and funding
priorities.
- Policy and funding priorities emphasizing community integration in turn impacts the
public’s attitude toward disability, cultural diversity, and economic disadvantage.

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 - Community integration, as a policy and funding priority, impacts more than just
opportunity; vocational, housing, educational, economic, and spiritual domains are also
impacted as well.
- The professional, certification, legislative, regulatory, and economic systems in place to
support the pursuit of these policy and funding priorities influences national output,
quality of life, cultural competitiveness, and global authority as a driver of progress.

 Regression to Institutionalization & Marginalization as Funding & Services Decrease

As policy and funding priorities shift away from higher order values towards an emphasis on
basic necessities the short term is emphasized over the long term of the individual, community,
and the nation.
- The reduction in funding presents as a disincentive to support community building and
instead refracts such efforts thereby mitigating nation building.
- As individuals become increasingly dependent on their immediate family the community
loses the incentive to be invested in their welfare.
- The policy analysis that existed during an era of higher order value priorities becomes
hardened and instead focused on fiscal solvency as well as measures of productivity and
sustainability instead of opportunity and enrichment.
- Proactive measures are replaced with reactive measures that fail to recognize the
interdependence between mechanisms, strategies, and outcomes.
- Concerns related to health, housing, employment, education, crime, and safety are only
responded to when they become threatened; the perception of threat is limited to a
reaction after things have deteriorated instead of prior to their deterioration.
- As the frequency of the reactive approach increases the public’s willingness to utilize
restrictive and thus reactive mechanisms, increases as well. Incarceration,
institutionalization, and marginalization are a result of such practices.

 Impact of Employment on Benefits Levels: The Significant Gainful Activity Threshold

Arguably one of the most critical service areas in the support of community integration is
vocational development. Without vocational opportunities the individual’s ability to actively
participate in their community is lessened.
- Vocational development requires education.
- Similarly, access to an appropriate education requires professionals that are trained and
certified according to the specific strategies and topics appropriate to their field.
- Training and technology development requires the support of government, institutions
of education, and big business.
- The ability to access an education requires infrastructure, building, roads, and
transportation.
- For many individuals with a disability vocational development also requires regulatory
support in the employment sector.

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 - For employers to be able to effectively utilize the unique skills of individuals with a
disability they often require professional and financial supports to maintain productivity
and financial specifications.
- The opportunity for individuals with a disability to benefit from gainful employment is
dependent on their ability to balance employment opportunities with the income
threshold after which benefits levels decline. The benefit program’s income threshold,
established according to financial and eligibility criterion of corresponding policy and
funding priorities, similarly represents a barrier to progress as the individual seeks to
balance opportunity with necessity.

Education:

 Socio-economic Status
Education represents one of the critical mortars required in the foundation supporting skill,
cultural, economic, vocational, and social development.
- Without access to education other
opportunities are similarly less
available.
- Education is thus associated with SES
quality of life.
- Education is thus associated with crime
rates.
- Education is thus also associated with
debt rates, poverty, and utilization of
Integration Classroom
public benefit programs.
Efforts Size
- Education impacts gross domestic
product and the competitive advantage
of corporate strategies and processes.

 Classroom Size
Classroom size represents one of the key areas emphasized as a result of dropped performance
measures and the implementation of the No Child Left Behind Act.
- Classroom size impacts the instructor’s ability to adapt and tailor the learning materials
and teaching approach to the needs of the individual. The larger the classroom the less
individually tailored the approach.
- The instructor to student ratio also impacts school incurred costs for salaries,
infrastructure, training and development, administrative oversight and planning,
property taxes, performance scores and testing, school rankings, stakeholder
engagement, district benchmarks, local governance, as well as present and future
demographic characteristics of the present and graduating classes.

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  Integration Efforts
Integration represents one of the key routes identified when pursuing normalization and
inclusion efforts that minimize if not completely eradicate barriers.
- Efforts to integrate individuals with disabilities, etc., require appropriate training,
resources, strategies, infrastructure, zoning, and support funding to insure accurate
implementation is even possible.
- Integration also requires congruence amongst legislative, political, legal, and
institutional stakeholders, processes, and agreements to support the effort’s
implementation and enforcement.

Housing:

 Institutions Closing
The closing of institutions represents a critical sign of progress in the modern day treatment of
persons with disabilities. Although closure is justified and initiated due to many non-ideological
factors its impact as an incentive of progress in the domain of public policy is un-debatable.
- The closure of institutions provides the impetus necessary for policy and funding
development to support community based integration measures.
- The closure of institutions also
Institutions
spurs the development, Closing

analysis, and utilization of more Community

Portability
Waiver
humane treatment and service
models.
- Despite its ideological
advantages, the closure of Transition
CP Program
Prog
institutions is often unmet with
sufficient funding and
programming to support Section 8 Legal
Housing System
effective transitioning into the
community.
- Poor planning and support of policy and funding priorities that proactively respond to
the collateral impacts of institutions closing lends to negative impacts on hospitals,
service agencies, caseloads, and communities as the individual is left without housing,
treatment, medications, supports, nutrition, and/or stability.

 Community Based Waiver

The CBW represents a benefit program that covers treatment and medical costs for individuals
with disabilities. Eligibility for this program represents a significant asset since this program, in
particular, has continued to have strong support at the policy, funding, and legislative levels.
- The lengthy wait list for this program, and the limited funding and slots available within
this program, are in conflict with the actual needs of the community and the rates by

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 which individuals with disabilities graduate from high school and thus require benefits
and services sourced from different programs (see waiting list discussed earlier).
- The differential benefits available within the individual public benefit programs
increasing the administrative difficulty to administer, supervise, and thus benefit from
these programs.
- Due to the difficulties associated with the above administration issues many providers
refuse to provide their particular medical services.

 Community Protection Program

The community protection program represents a unique policy area in that it focuses on people
with developmental disability who have displayed dangerous behaviors that are currently
present and represent an ongoing risk to the community.
- This program represents an alternative to incarceration. Without this program
incarceration becomes the only alternative for offenders.
- Although incarceration lacks both the safety and treatment to adequately address the
unique needs of the DD community the community protection program continues to
face strict, and often restricting, eligibility and funding criterion.

 The Department of Corrections & the Courts

The D.O.C. and the Courts represents the judicial system’s approach to illegal and/or dangerous
conduct. The approach taken towards each individual infraction represents historical precedent,
legislative action, and judicial interpretation of said actions, precedents, and infractions.
- The legislative and judicial systems influence and are influenced by society. The
attitudes towards the individual’s conduct are represented in the corresponding policies
and practices of these complex institutional systems.
- The funding and policy priorities of each institution differ depending on the nature of
the offense, legal precedent indicating response trends for the offense within each
jurisdiction, and the funding priorities for each jurisdiction and institution.
- The punitive model is associated with less treatment, increased recidivism, and
increased trauma for people with disabilities.
- The treatment paradigm when implemented in the D.O.C. is associated with higher
costs and decreased efficacy when compared to other community based models.
- Trauma within the I/D population requires intensified treatment and housing services in
order to support in the community when compared to the general community without
an identified disability.
- Despite decreased benefit when implemented within the D.O.C., the treatment
paradigm represents a more humane and efficacious model than the strategies inherent
in the punitive model when calculating for qualitative recidivism rates that incorporate
values that extend beyond basic quantitative metrics.

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  Section 8 Housing
Housing assistance represents a means to provide significant financial assistance in a key area
for people with disabilities and meeting the low income criterion for eligibility.
- Housing assistance criterion for eligibility is met based on income and is often available
in addition to other public benefit and financial programs.
- Ineligibility for housing assistance, due to a lack of funding or other reasons, often
leaves individuals with limited source income with which to pay their bills, seek
adequate nutrition, pay for transportation, housing, education & training, as well as
medical services (when not covered by another benefit program).
- Meeting the eligibility for section 8 housing, when adequate funding exists, enables the
individual to pay for other critically necessary items thereby improving their health and
quality of life.
- When funding for section 8 is unavailable other services, such as treatment, vocational,
and community integration efforts lose their efficacy. Diminishing returns result due to
poor housing services and benefits despite the funding priorities for other areas. All
support domains are interdependent.

 Transitional Benefits & Services

The transition from home to school, from school to community, and from community to
employment/higher education requires financial, social, and institutional supports.
- When transitional benefits and services are not available the family, community, and
legal system is required to pick up the slack. Costs are thus allocated to collateral
programs with different funding and policy priorities.
- The absence of transitional benefits and services is frequently associated with the
absence of specialized knowledge and expertise necessary to deal with the unique
barriers and challenges faced by individuals with a disability.
- Skills deteriorate during transitional periods as novel situations require the identification
and implementation of unique skills.
- Individuals with cognitive and other skill deficits faced increased learning challenges
during transitional periods. The absence of specialized supports and services further
exacerbates this challenge.

 Portability: Medical, Benefit, & Services

Portability, in the context of this I/D policy discussion, represents the individual’s ability to bring
the Community Based Waiver with them to another funding jurisdiction without a lapse in
benefits and services. Funding for the waiver is ported with the individual to their new address
that resides in the new jurisdiction.
- Portability is also an option available to the section 8 program. In order to port the
section 8 voucher OR the Community Based Waiver (CBW) the criterion for a legitimate
reason to port the voucher must exist.

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 - Although denied requests to port the waiver(s) are infrequent their occurrence can limit
the individual’s ability to move closer to family, opportunities, and consolidated support
network.
- Budget cuts, such are considered necessary in the current economic recession,
jeopardize all funding jurisdictions thereby heightening their need to retain the
equivalent funding available for each CBW. The flexibility inherently needed to support
the CBW’s portability is strained as a result.
- When a CBW is ported the slot in the existing jurisdiction is not necessarily replaced.
The then service provider is left with the previous infrastructure still intact but without
the same demand for services. Transitional assistance is again required to support the
sustainability of the service delivery system. Pressure to fill the open service slot
increases albeit with an existing CBW from elsewhere through the referral process.

Staffing

 Wage Budget Allocations

Budgets are allocated according to priority and interdependence. Value chain analysis is just one
way of identifying structural, process, and technical interdependencies. Continuity of service
requires a sustainable infrastructure and this infrastructure requires that all of its parts are
working together.
- Failing to support one link in the network can leave the rest of the network weakened.
- The challenge is to identify the interdependencies inherent in these policies and budget
priorities and insure they are supported adequately.
- The benefits of receiving quality services are dependent on budgets and their
adjustment with inflation and other cost of living benchmarks in order to insure that
costs do not outstrip the capacity of the infrastructure.
- Wages impact recruitment and
retention of employees as well as the
quality of the skills recruited and
retained.
- Wages are established based on
contract rates which are funding Retention Training
through both public and private
sources.
- Reimbursement rates impact business Service
Wages
revenue streams. When costs exceed Quality
revenues the business becomes
insolvent.
- Since the business is interdependent
with its capacity to provide services to

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 specification any impact on its capacity
similarly impacts its services.
- Wages support the skills needed to meet service specifications. Without sufficient
budgets to recruit and retain talent the creativity needed to respond flexibly and
adaptively to infrastructure and other capacity challenges is decreased.
- Budgets for staffing are allocated into hours which in turn determine the frequency and
quality of the services that are provided.
- When hours are preset wage calculations must be adjusted accordingly. Recruitment
and retention then suffer as a result as wages decrease.
- Constrained capacity limits the company to pursuing lines of service that cannot
compete with other businesses.

 Training Budget Allocations

Training supports the employees to use the specific technical skills needed to flexibly and
adaptively respond to the challenges of their work.
- Training quality, frequency, and relevance impacts the effectiveness and efficiency
of staffing efforts.
- The company’s ability to differentiate itself from its competitors is determined by
the quality of its services.
- The quality of services is dependent on the quality of the staffing that provides
them.
- The retention of quality staffing is dependent on performance meeting
specifications.
- The ability to meet the specifications of performance requirements is dependent on
training.
- The retention of skills acquired in training is dependent on the retention of staffing,
without which produces a revolving door where skills are lost to competitors.
- Staffing turnover is common in the social service industry. One reason is the lack of
viable wages to support a family. Another is the challenges faced in an entry level
field where entry levels skills are frequently inadequate for a complex and changing
environment of challenges.
- Consistent staffing is required to maintain consistent service quality.
- Inconsistent staffing often leads to inconsistent service quality as new staff are hired
and trained to meet service specifications that exceed their performance at the
onset of employment. This is why it is so important to minimize staff turnover as
much as possible.

Conclusions
Policy priorities are interdependent or exclusionary, but not both. What this means is that some policies
require the support of other policy areas. When policy priorities that require interdependence are

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instead pursued with exclusionary, and thus non systems-thinking mechanisms, the combined benefit is
lost. Interdependencies amongst policies exist whether or not they are recognized.

When these are not recognized, or when these interdependencies are not incorporated into subsequent
policy planning and drafting sessions, all stakeholders suffer the consequences. This is proven by the
need for the Budget Control Act of 2011.

The problems that can result as a result of the implementation of the Budget Control Act of 2011 are
arguably unrivaled in domestic policy. Budget cuts impact policy agendas which in turn impact benefit
programs and services; these in turn impact customer service metrics and our client’s quality of life.

Quality of life is not free and neither is the absence of it. The only sound policy is one that takes
responsibility for the consequences of its policies. Quality and costs are complementary metrics. Costs
are reduced through the development and implementation of sound policies that proactively respond to
the needs of the community.

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