DENVER -- As infrastructure legislation makes its way through Congress, advocates for people with disabilities are urging lawmakers to boost investments for in-home care programs that would allow more people to avoid placement in nursing homes.

Christiano Sosa, executive director for Arc of Colorado, said the Better Care Better Jobs Act would dramatically improve quality of life for people with disabilities.

Sosa pointed out the proposal would raise wages for caregivers, and provide benefits including paid family leave, which will help make direct care work a viable career path and reduce turnover.

"One of the things that we hear loud and clear from individuals with disabilities and families is that it's almost a full-time job just training the new person," Sosa observed.

Caregiver reimbursements have not kept up with inflation or even local minimum wages, and Sosa sees the proposed $400 billion investment in Medicaid Home and Community-Based Services as an important step to reverse decades of underfunding.

Congress has remained divided along party lines over so-called human infrastructure investments. Republicans say the price tag is too high, and worry it would lead to bigger government.

Lack of funding has led to long waiting lists for rationed in-home care services, which leaves many no choice but to turn to nursing homes.

Henry Claypool, policy director for the Community Living Policy Center at Brandeis University, said blocking the proposal would be penny-wise but pound-foolish. States are required to accept nursing-home residents regardless of their ability to pay, which costs taxpayers exponentially more than community-based care.

Claypool believes the proposal is ultimately about giving people more options.

"If you're in an institution like a nursing home, you're not able to get up and go when you want, you're totally dependent on when the staff can get to you," Claypool explained. "Most Americans really want to stay in their homes, and this is an important investment to make that happen."

Sosa noted if Congress does not invest in community-care options, the burden will continue to fall on unpaid family caregivers, which historically have been women and people of color. Sosa added the legislation should also boost recovery from the pandemic's economic fallout by providing good jobs for direct-care workers, and allowing family caregivers to rejoin the workforce.

October is National Disability Employment Awareness Month, and 14 states, including Iowa, have received large federal grants to try to link workers with better paying jobs offering career advancement.

Iowa's share of grant money is $13.8 million.

Dan Tallon, administrator of Iowa's Vocational Rehabilitation Services, said subminimum wage jobs often serve as default for those with disabilities who face barriers in getting care they need to become integrated with the community. He hopes the grant leads to opportunities to better fit their needs.

"We're not gonna set the expectation that every single person has to be working 40 hours a week at a high wage," Tallon stressed. "We want to know what do they want to pursue, and really make sure that they're involved in that decision on a personal level"

There is a long-standing federal law which allows employers to obtain certificates through the Department of Labor to pay workers with disabilities less than the federal minimum wage. But a number of states are trying to phase out such policies.

Meanwhile, the Iowa Developmental Disabilities Council said it is excited about the grant, noting it will expand real employment opportunities, which is one step closer to better community inclusion.

Through the efforts, Tallon pointed out they will bring together stakeholders to establish unified solutions, including boosting services at the high school level to ensure students with disabilities have a more defined career path as they transition to adulthood.

"Individuals that interact with students in special education are always impressed by their abilities to be highly successful," Tallon observed. "As long as we can take away that discrimination take away the other barriers that they have to employment and really allow them to express and explore their talents, we can be really successful."

State and federal officials said the funding rollout is designed to provide more comparable pay for green jobs, essential worker industries, transportation work, and the arts.

Come next year, people with developmental disabilities in New Mexico may not be able to find the help they need - because of a severe labor shortage in the field.

Agencies are struggling to find workers to staff group homes, help with daily living, help clients find jobs, and more.

Jim Copeland, executive director of the Association of Developmental Disability Community Providers in New Mexico, said the state needs to increase the amount it reimburses providers - so the agencies can pay workers more per hour - and thus attract and retain more employees.

"The citizens of New Mexico have made a commitment to families and individuals with intellectual and developmental disabilities," said Copeland, "to provide the necessary supports to allow them to live their best lives. And I think we have to live up to that commitment, whatever the cost."

And the pressure on the industry is about to get worse. The feds raised reimbursement rates during COVID through the American Rescue Plan, but rates are expected to fall once the public health emergency ends.

At the same time, the state of New Mexico has vowed to provide services for all 4,200 people on the developmental disability waiver waitlist by next spring - so they are bracing for a flood of new clients.

Copeland said developmental disability services have been underfunded for decades. Providers are asking the state for almost $18 million in the next budget - a 17% increase.

Otherwise, he said, more providers will reduce services or close.

"Families will be impacted," said Copeland. "If they have a child that needs residential support, they may or may not be able to find that group home in their local community. They may be able to find one several hours away."

The state Department of Health is currently preparing its budget request, which will be considered by the governor and the Legislature next spring.

With absentee voting under way, election season has arrived in Missouri, but voters with disabilities still face challenges.

While poll workers can assist voters with disabilities if they request help, advocates believe accessibility methods and technology should make voting more independent.

The state has a number of methods in place to help voters with disabilities access the polls.

Kara Clark Summers, president of the Missouri Association of County Clerks and Election Authorities, said poll workers are trained to offer assistance to anyone who requests it.

"We want to make sure that all people feel comfortable and be able to vote a ballot independently, or that we can assist them in whatever manner that they need assisting," Clark Summers explained.

The Missouri deadline to register to vote in the November election is Oct. 12.

Disability advocates argued the new ID restrictions around voting requiring individuals to have an unexpired ID can present both financial and logistical challenges, including having an address which affects the unhoused.

Nicole Noblet, a Missouri disability advocate who speaks through an Augmentative and Alternative Communication device, said while a mail-in ballot is an option, it is not a good one for her.

"I would have to have my mom mark my ballot, because I don't have the motor skills in my hands to be able to fill in the small circles," Noblet explained. "I like being able to have my vote be private, and being able to cast my ballot independently is important to me."

Noblet added in her experience during municipal elections, accessible voting equipment has not been available at all polling locations, and she must travel to one of two locations to use the technology. She hopes eventually Missouri will allow the use of accessible voting by mail.

"One day, maybe Missouri will allow the use of accessible vote-by-mail systems that is utilized by the US military serving overseas, several cities in California, and McLean County, Illinois," Noblet pointed out.

Accessible voting by mail consists of a ballot emailed to the voter.