In 2020, North Dakota reached a federal settlement regarding institutionalized care for people with disabilities.

As they carve out a newer vision, state officials are getting the word out about programs giving residents with disabilities more pathways to community care. The Department of Human Services (DHS) is highlighting initiatives designed to help people with disabilities make a smoother transition from an institution to a community setting.

Jake Reuter, program administrator for the DHS, acknowledged the state has a long way to go to improve access, but he noted demand for the programs is a good sign they are reaching the people they need to reach.

"We're having many, many referrals for services to help prevent institutional care in the first place," Reuter reported.

The department hosted a webinar this week to discuss programs like "Money Follows the Person," which helps eligible Medicaid enrollees shift to community care. Since 2007, the federally funded option has assisted more than 400 North Dakotans with disabilities. The recent settlement followed allegations the state relied too much on placing people in nursing facilities.

To meet future goals, Reuter asserted such issues as a better-trained workforce and affordable housing need to be addressed. He noted having flexibility to offer care in an integrated community setting gives affected individuals more choices in day-to-day life.

"They have meals when they want, how they want them," Reuter outlined. "They get to go out into the community, they spend time with the people they want."

Department leaders added as part of their response to past issues, they have tried to improve communications with key partners, like hospitals and nursing homes.

The Legislature has set aside more funding in this area, including use of American Rescue Plan aid.

In rankings compiled by the Case for Inclusion, North Dakota landed at 46th in the nation for policies such as promoting independence for people with disabilities.

The Americans with Disabilities Act website has gotten a makeover, with updated navigation tools and easy-to-find answers to common questions on everything from service animals to accessible polling places.

The federal government said it wants to better empower people to understand their and others' rights, and equip workplaces, local governments and other institutions to comply with the law.

The new website also employs speech software to make it even more accessible.

Connor McGarvey, chief operating officer of Easterseals Northern Ohio, said the growing use of assistive technology is improving the lives of people living with disabilities, and explained devices are becoming increasingly sophisticated, including using facial recognition tools.

"The promise of technology is definitely something that has really opened up the lives of individuals with disabilities," McGarvey pointed out. "If they were to look at their caregiver, or their parents, it will tell them who they're looking at. That's huge."

The latest census data show an estimated 10% of Ohioans under the age of 65 live with some type of disability. The number of people worldwide needing assistive technology is likely to reach more than three billion by 2050, largely driven by aging populations.

Visit the new site at ada.gov or call the Justice Department's toll-free ADA information line at 1-800-514-0301.

McGarvey added numerous disability services operated by county boards in Ohio, funded by Medicaid, are possible through ADA legislation.

"If you are receiving job coaching, and community outreach and assistance finding a vocation, in the community, all of that is funded through Medicaid," McGarvey noted.

The Centers for Disease Control and Prevention reported Ohio spends $35 billion each year -- more than a third of the state health care budget -- on services for people living with disabilities.

Medicaid "Buy In" is considered a key health insurance tool for workers with disabilities. But according to a new report, the reach of these programs is languishing, potentially keeping these individuals out of the labor force. Minnesota is among the handful of states that have no income limits for a person with disabilities to maintain Medicaid coverage while working as much as they can.

But the Bipartisan Policy Center reported many states do, and they lack the information and resources to make this option widely available.

Lisa Harootunian, associate director, health program, Bipartisan Policy Center said they are out with recommendations to make eligibility easier, so these workers don't lose out on the community health services they need.

"By addressing challenges to the availability of Medicaid buy-in, people with disabilities would no longer have to choose between health coverage and employment," Harootunian said.

The report suggested providing more funding for states to do outreach work to boost awareness. Congress is urged to compel the Centers for Medicare & Medicaid Services to offer more guidance to states on how to optimize their "buy-in" programs.

Harootunian said lawmakers from both parties are behind the idea, but acknowledges other funding priorities might get in the way.

The Bureau of Labor Statistics said last year, 19% of people with disabilities were employed in the U-S. Harootunian said states should be motivated to not let them fall out of the working world or stay employed only on a limited basis.

"These programs - they help individuals contribute more to the state through taxes," she said.

She added there is a connection between expanded eligibility and lower Medicaid costs, noting Kansas' program saw per-person monthly expenditures decline by 41% between 2007 and 2011. She said the biggest decreases were in outpatient costs, noting that also translates to a better quality of life for program participants.

A new federal grant is giving schools in three Missouri counties and St. Louis City a fresh look at the challenges of students of color living with disabilities.

Missouri students of color with disabilities face harsher school disciplinary practices than their white peers, which can lead them into the juvenile justice system. Disrupting this path is the goal of the Missouri Juvenile Justice Association's SToPP Project, with a $275,000 grant from the Missouri Developmental Disabilities Council.

Miranda Fredrick, communications coordinator for the council, said its research, as well as the "lived experience" of some of its members, has demonstrated the disparity.

"When students experience harsh, disproportionate discipline happening in the school systems, it puts them on a path to interact with the criminal justice system," Fredrick explained. "That's what's known as that 'school-to-prison-pipeline,' and those suspensions can have long-term effects."

The grant will cover training in more constructive approaches to discipline, for teams of adults in Boone, Cape Girardeau and Greene counties, and St. Louis City.

An ACLU of Missouri study found Black students with disabilities are three times more likely to be suspended than their white peers.

Liz Ballard, racial ethnic disparities coordinator for the Missouri Juvenile Justice Association, said with the help of a "restorative justice" expert, they'll train teams in less punitive ways to discipline students. Ideally, each team will include a school representative, a law enforcement or school resource officer, a local juvenile office representative, and a community or family member, or a person with a developmental disability.

She added they will receive certification as trainers, so they can share what they learn.

"There's these things called healing circles, where they all sit down and work through the issue," Ballard pointed out. "There's just proven to be better outcomes and more, you know, case-by-case basis instead of cut-and-dry suspensions."

Students who are suspended or expelled, who may also be victims of poverty, abuse or neglect, are three times more likely to have an encounter with the juvenile justice system within a year. Ballard said their hope is the teams' success will change the trajectory and foster interest throughout the state.

"We will have four counties that have decreased their suspension and expulsion rate, treating kids fairly regardless of their developmental disabilities," Ballard noted. "And then, word gets out, and then it spreads, and people start reaching out to want additional training."