Employment First is failing Level 3 adults, and nobody’s tracking the outcomes
Thirty-one states passed Employment First legislation. The national competitive integrated employment rate for people served by state disability agencies is 16%. The other 84% are a policy category nobody named.
Employment First does not require every person to be employed. It requires employment to be the presumed first option, explored and documented, before something else is chosen. If competitive work is not right for your adult child, the plan should say so explicitly and then describe what does fill the day, with authorized hours attached. A plan that lists an employment goal nobody is working on, and nothing else, leaves your adult child with an aspiration instead of a service. Ask for both in writing at the next person-centered planning meeting.
The policy spread
Thirty-one states have Employment First legislation, sixteen have executive orders, and thirty-two have state agency policy. Many have more than one.
16%
The outcome stalled
In 2024, 16% of people receiving services from their state intellectual and developmental disabilities agency were employed in an integrated community job, individual or group.
The settings shrank
Workers earning subminimum wage under Section 14(c) fell 68% between 2018 and 2024. Active certificates fell 52%.
What Michigan offers
The Habilitation Supports Waiver includes Individual Supported Employment, which targets competitive integrated employment, and Small Group Employment for two to six workers, which the state states plainly is not CIE.
54%
The disappearing cohort
Federal auditors tracking Oregon’s transition over eight years found 18% working, 28% in day or prep services without working, and 54% no longer in the state data at all.
What nobody measures
There is no national indicator for whether an adult who cannot work competitively has a structured, funded, meaningful day. So there is no number to defend in a budget.
Employment First by the numbers
31
16
32
16% in 2024
124,066
38,524
1,459 down to 700
54% by September 2023
Sam is 27, needs one-to-one support, and has had “competitive integrated employment” as the top goal on his plan for five years running. No job coach has been assigned in three of those years because the provider cannot staff one. Sam’s mother Denise asked what he does instead. The answer, written on the plan, was community integration, twelve hours a month. Sam is awake about 480 hours a month.
Make the plan describe the actual day
At the next planning meeting
- 1Ask whether employment was explored and documented.
- 2Ask what specifically was tried and what happened.
- 3If employment is not the goal, get that in writing.
- 4Then require a named alternative with hours attached.
- 5Ask which provider will deliver it, by name.
- 6Ask what happens if that provider cannot staff it.
Questions that expose an empty plan
- How many hours per week does this goal produce?
- Who is the assigned job coach, by name?
- When was the last documented employment attempt?
- What are the authorized units for non-work supports?
- Is Small Group Employment available in this region?
- Does the plan address transportation?
- What is the fallback if no provider accepts the referral?
- What does the plan say happens at age 40? At 60?
Employment First was never supposed to mean employment only. Where it has, that is an implementation failure, and implementation failures can be documented and fixed.
I support Employment First. I want to say that at the top, because what follows is going to read like an attack on it and it is not. Competitive integrated employment is the right presumption, segregated subminimum wage work was indefensible, and the people who spent thirty years dismantling it were right. What they were not right about is what happens to the adults who were never going to be placed, because nobody planned for them at all.
The policy worked exactly as designed
Employment First is now nearly universal in state policy. Thirty-one states passed legislation. Sixteen issued executive orders. Thirty-two have state agency administrative policy, and most states have more than one of those three.
The presumption is straightforward and correct. Every working-age person with a disability is presumed capable of competitive integrated employment with appropriate support, and integrated employment must be the first option explored and funded.
Segregated settings shrank accordingly. Workers earning subminimum wage under Section 14(c) certificates dropped from 124,066 in 2018 to 38,524 in 2024, a 68% decline. Active certificates fell from 1,459 to 700 over the same period.
If you measure Employment First by whether it closed sheltered workshops, it is one of the most successful disability policy campaigns in American history.
The outcome number that did not move
Now measure it the other way.
In 2024, 16% of people who received services from their state intellectual and developmental disabilities agency were employed in an integrated community job, counting both individual and group placements. Sixteen percent. That figure has been stubborn for over a decade, through the entire period when Employment First went from a handful of states to nearly all of them.
So the settings closed and the employment rate did not rise proportionately. Which raises the question the movement has never been forced to answer in public. Where did those people go?
The Government Accountability Office went looking, in a report published in April 2025 examining Colorado and Oregon. In Colorado, of 195 former subminimum wage workers tracked between 2021 and 2023, about half moved into competitive integrated or group employment, and more than a third moved into Medicaid employment preparation or day services. By early 2024, nearly 20% were no longer appearing in Medicaid data at all.
Oregon is the harder read. Of 1,875 individuals tracked between 2015 and 2023, 18% were working, 12% in competitive integrated employment and 6% in group employment. Twenty-eight percent were receiving employment preparation or day services without working. And 54% were no longer included in state data.
The wages went up, and that matters
I promised no both-sidesing, so let me be equally direct about the good news.
For the people who did move into jobs, the wage change is enormous. Colorado workers went from an average of $4.33 an hour to $12.74. Oregon workers went from $4.01 to $13.93. Those are not marginal improvements. That is a person going from a wage that was a legal fiction to a wage you can partly live on.
Average weekly hours fell in both states. So the picture is fewer hours at dramatically better pay, for the subset of people who landed. For many individuals that is a straightforwardly better life, and anyone arguing to bring back subminimum wage work should have to explain why $4.33 an hour was the right answer for them.
The argument in this post is not that Employment First hurt the people it placed. It is that the people it did not place were never given a policy of their own.
Where Level 3 adults actually fall
Michigan is unusually honest about this in its service definitions, which I will credit even while criticizing the outcome.
The Habilitation Supports Waiver includes Individual Supported Employment, which targets competitive integrated employment. It also includes Small Group Employment, covering two to six workers, which the state describes plainly as not competitive integrated employment. That is a state acknowledging in writing that the employment paradigm does not fit everyone it serves.
What the array does not include is a robust, funded, measured answer to the question of what a meaningful day looks like for an adult who is never going to be competitively employed and who needs staffed support to be anywhere at all.
Michigan removed Prevocational Services from the waiver in the renewal effective October 2024 and routed people toward 1915(i) Skill Building and Out-of-Home Non-Vocational Habilitation. Those are real services. The question is whether there is provider capacity to deliver them at scale, and in most counties the answer right now is no.
So the adult sits at home with an employment goal on a plan and twelve hours a month of community integration. The plan is Employment First compliant. The Tuesday is empty.
The measurement problem is the policy problem
Here is what I keep coming back to. We measure competitive integrated employment nationally, every year, by state, and publish it. That is why it is 16% and why we can argue about it.
There is no national indicator for whether an adult who cannot work competitively has a structured, funded day. No percentage. No annual report. No state ranking.
What gets measured gets budgeted. A state can be told it is failing on CIE and respond. No state has ever been told it is failing on meaningful day supports for adults with high support needs, because there is no number to fail against.
That is not an accident of data collection. It is the natural consequence of building a policy framework around one outcome and treating everything else as the residual. The residual is 84% of the people being served.
None of this was inevitable. Some states funded day supports and employment supports together, kept capacity while shifting the presumption, and phased down segregated settings on a timeline that matched what they were building. Others closed first and figured it out later. At every decision point, different choices were available.
Your practical next steps
At the next planning meeting. Ask directly whether competitive integrated employment was explored, what specifically was tried, and what happened. If employment is not the right goal, ask for that determination in writing, and then insist the plan name what does fill the day, with authorized hours and a named provider.
In writing, this month. Ask your supports coordinator how many hours per week of non-work day support your adult child is currently authorized for, and how many of those hours were actually delivered last month. The gap between those two numbers is your real problem, and it is documentable.
When you testify or write. Do not argue against Employment First. Argue for a second measure. Ask your state to report, annually and publicly, how many adults served by its disability agency have a funded, structured, staffed day, whether or not it involves employment. Ask for the number. Once the number exists, the budget conversation changes.
Sixteen percent are working. Nobody in Lansing or Washington can tell you what the other eighty-four percent did yesterday. Start by demanding that somebody find out.