By Raymond E. Glazier, Ph.D., Director of the Abt Associates Center for the Advancement of Rehabilitation and Disability Services and Member of the MA Work Without Limits Initiative in Disability.gov
Persons like me with serious physical, intellectual or psychiatric disabilities often can’t function productively in the workplace without some form of assistance. This is not to say that we can’t perform, quite capably, the essential functions of many jobs. Instead these, oftentimes, very simple accommodations (such as personal assistance services) help us go about our daily routines more efficiently.
What Are Employment-Supportive Personal Assistance Services (E-PAS)?
Personal assistance services (PAS) are defined as assistance with everyday tasks that a person would typically perform for him/herself, were it not for the disability (ODEP, 2006). These services can include in-home assistance with bathing, grooming and dressing to get ready for the workday. In the employment context, PAS does
not include routinely performing the employee’s essential job functions.
Employment-Supportive Personal Assistance Services, or E-PAS, supports people with disabilities engaging in competitive employment. E-PAS can involve personal care services performed at a workplace – for example, help eating a meal, preparing for the workday and/or getting to and from the workplace. It may also encompass job coaching, which is not always thought of as PAS.
For a worker with quadriplegia, the assistance needs might include personal care tasks like feeding or toileting at the worksite, as well as help with traveling to and from the job and task-related assistance with copying documents and perhaps, filing and retrieving papers.
For an employee with cognitive limitations, needs might include assistance with organizing work tasks, becoming acclimated to a work schedule and learning one’s way around the workplace.
For a worker with serious mental health issues, there could be a need for cueing services like medication reminders, guidance in relating appropriately to co-workers or help with interacting with supervisors.
Medicaid as a PAS/E-PAS Funding Source
Most persons with significant disabilities are in no position to pay privately for PAS, and neither Medicare nor private health insurance will cover it – even for vital personal care needs like in-home assistance with transfers, bathing, toileting and dressing, not to mention cueing services for persons with mental health issues or workplace PAS services. The only funding sources for personal care PAS are
Medicaid (which goes by different names in different states) and the
Veterans Administration for those with military service-connected disabilities.
Medicaid is a joint federal-state health care program that funds services for eligible low-income/low resource individuals and families. While there is a federally mandated set of basic core services, eligibility rules and additional optional services vary from state to state. Coverage for personal care services is a state plan option that is offered by two thirds of states and does not always extend to cueing services (even though the Centers for Medicare and Medicaid Services has reimbursed them for many years.)
Several states have explicit Medicaid E-PAS programs designed to facilitate competitive employment for persons with disabilities. California, Connecticut, Kansas, New Jersey, Nebraska and Wisconsin come to mind; Utah also has a remarkable E-PAS program targeting consumers with mental health issues.
Ordinarily, working individuals have incomes that put them over the usual income threshold for Medicaid eligibility. However, most states have a Medicaid Buy-In program that allows working persons with disabilities to become eligible for the broad array of Medicaid services by paying a monthly premium. Again, there is much variability state to state as to the minimum required work effort, services covered, premium rate structures, etc.
Other Types of E-PAS and Who Pays for What
Certain E-PAS items, like job coaching, are the province of the state operated, state/federally funded Vocational Rehabilitation (VR) programs, which also have income and asset limits for eligibility. The
state VR programs have finite funding that limits the number of consumers they can serve in a given fiscal year. Therefore, the federal
Rehabilitation Services Administration (RSA) requires that they serve persons with ‘most significant disabilities’ first.
While Medicaid may cover travel to and from the workplace, as well as on-site personal care services like feeding and toileting needed during the workday, employers are required by
Title I of the Americans with Disabilities Act (ADA) of 1990, as amended, to fund personal care services during work-related company travel. And importantly, ADA ‘reasonable accommodations’ required of employers also extend to task-related PAS with non-essential job functions like copying, mailing, filing, etc.
The following table summarizes the three main areas of E-PAS and who funds them. Obviously there are gray areas, and the distinctions between each category and responsible party are not always clear-cut.
| Three Categories of Workplace PAS/Three Funding Sources |
Medicaid-funded Personal Care PAS:
Help getting to/from worksite, personal care (mobility, feeding, toileting) at the worksite, cueing services for those with serious mental health issues. | Employer Reasonable Accommodation PAS (per ADA):
Task assistance, e.g., ASL inter-preter, filing help, scribe; personal care only for job-related travel. | Vocational Rehabilitation PAS:
Job Coach (helps organize tasks and processes; advocates for worker)/Supportive Employment. |
How to Identify E-PAS Resources Available to You
Your VR counselor or Club House are likely sources for assistance in determining your needed employment supports and how to obtain what E-PAS you require in order to achieve competitive employment.
You can also visit the websites of the
Center for Personal Assistance Services, the
Job Accommodation Network or
Disability.gov to learn more about personal assistance services and other types of workplace accommodations.
Raymond E. Glazier, Ph.D., Director of the Abt Associates Center for the Advancement of Rehabilitation and Disability Services in Cambridge, MA receives in-home PAS through the MA Medicaid Buy-In; his employer provides additional service hours at the same wages for two of his home PAS workers to provide task-related E-PAS at the office.
