From employment optional to “Employment First”: Explaining two cases of state-level disability policy change
| DOI | 10.1177/0952076720942822 |
| Author | Leanne S Giordono |
| Date | 01 July 2022 |
| Published date | 01 July 2022 |
| Subject Matter | Articles |
2022, Vol. 37(3) 283 –316
Article
From employment
optional to
“Employment First”:
Explaining two cases of
state-level disability
policy change
Leanne S Giordono
Oregon State University, Corvallis, OR, USA
Abstract
Over the last three decades, the United States has increasingly devolved social policy
decisions from the federal to the state level. These changes have resulted in substantial
variation in policy decisions and related outcomes. Just as the changes allow states to
act as policy laboratories, they also offer a window into the process by which organized
interests take advantage of such opportunities to influence state-level policy. This study
uses the Advocacy Coalition Framework to illuminate the black box of policy change
with a comparative study of two states, Washington and Pennsylvania, which adopted
“Employment First” policy aimed at prioritizing employment services for individuals
with disability. The study reveals that policy change in both states was associated with
organized stakeholder mobilization, strategic framing and narrative, and bureaucratic
activism, all in an environment of heightened stakeholder attention to the issue. That
said, the two states followed distinct paths, with early policy change in Washington
stemming from service provider mobilization, suggesting the importance of policy feed-
back mechanisms.
Keywords
Advocacy Coalition Framework, bureaucracy, disability policy, federalism, policy
process
Corresponding author:
Leanne S Giordono, School of Social and Behavioral Health Science, Oregon State University, Corvallis, OR,
USA.
Email: giordonl@oregonstate.edu
Public Policy and Administration
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DOI: 10.1177/0952076720942822
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284 Public Policy and Administration 37(3)
Introduction
Over the last three decades, the United States has increasingly devolved social
policy decisions from the federal to the state level. This shift has resulted in
increased use of federal waiver programs and block grants, and substantial vari-
ation in policy adoption decisions and related outcomes (Bruch et al., 2018; Bunch
et al., 2018; Dilger and Boyd, 2014; Guzman et al., 2013; Thompson and Burke,
2007). Just as these changes allow states to act as policy laboratories, they also
offer a window into the process by which organized interests take advantage of
such opportunities to influence state-level policy. Several policy process frame-
works (e.g. Advocacy Coalition Framework (ACF); Innovation and Diffusion
models; Policy Feedback Theory (PFT)) and theories of bureaucracy (e.g. iron
triangles, regulatory capture, bureaucratic activism, deliberate discretion, and con-
tracting) attend to the influence of interest groups in state-level policy change.
Some of these traditions are more focused on exposing the black box of interac-
tions and conditions that lead to policy change than others. The ACF, in partic-
ular, has substantial potential to illuminate the black box of policy change by
taking a causal-mechanistic look (van der Heijden et al., 2019) at the secondary
components of policy change (Pierce et al., 2017). In response, this study applies
the ACF in a comparative study of one policy domain, drawing on other theoret-
ical insights to further illuminate pathways to policy change. Specifically, this study
examines the factors leading to the adoption of state-level “Employment First”
policy changes in Medicaid-funded Day Habilitation and Employment (DH&E)
services and supports for individuals with Intellectual and Developmental
Disabilities (I/DD).
Medicaid-funded DH&E services and supports have grown exponentially since
the introduction of Medicaid Home- and Community-based Services (HCBS)
waivers in the early 1980s. Medicaid HCBS waivers were introduced to encourage
and support deinstitutionalization of the I/DD population (Agranoff, 2013;
Gettings, 2011). DH&E services and supports are intended to enable adults with
I/DD to successfully live outside of institutions by supporting participation in a
variety of community programs and settings. Such programs include day habili-
tation facilities, facility-based employment (i.e. sheltered workshops), sub-
minimum wage jobs, and competitive, integrated employment (CIE). Since 2000,
over 30 states have adopted policy prioritizing CIE
1
outcomes among the popu-
lation of working-age adults with I/DD served by DH&E systems. These policy
changes, which are often labeled as “Employment First” policy (Nord et al., 2013;
Racino, 2015), vary considerably in terms of timing, content and venue, and are
closely associated with interest group activity (Giordono, 2019; Racino, 2015).
These observations give rise to the primary research questions: (1) What does
state-level CIE-focused policy change look like? (2) Why and how did CIE-
oriented policy change occur?
Among various policy process frameworks, the ACF is particularly compatible
with these research questions. The ACF is predicated on the idea that organized
2Public Policy and Administration 0(0)
Giordono 285
Introduction
Over the last three decades, the United States has increasingly devolved social
policy decisions from the federal to the state level. This shift has resulted in
increased use of federal waiver programs and block grants, and substantial vari-
ation in policy adoption decisions and related outcomes (Bruch et al., 2018; Bunch
et al., 2018; Dilger and Boyd, 2014; Guzman et al., 2013; Thompson and Burke,
2007). Just as these changes allow states to act as policy laboratories, they also
offer a window into the process by which organized interests take advantage of
such opportunities to influence state-level policy. Several policy process frame-
works (e.g. Advocacy Coalition Framework (ACF); Innovation and Diffusion
models; Policy Feedback Theory (PFT)) and theories of bureaucracy (e.g. iron
triangles, regulatory capture, bureaucratic activism, deliberate discretion, and con-
tracting) attend to the influence of interest groups in state-level policy change.
Some of these traditions are more focused on exposing the black box of interac-
tions and conditions that lead to policy change than others. The ACF, in partic-
ular, has substantial potential to illuminate the black box of policy change by
taking a causal-mechanistic look (van der Heijden et al., 2019) at the secondary
components of policy change (Pierce et al., 2017). In response, this study applies
the ACF in a comparative study of one policy domain, drawing on other theoret-
ical insights to further illuminate pathways to policy change. Specifically, this study
examines the factors leading to the adoption of state-level “Employment First”
policy changes in Medicaid-funded Day Habilitation and Employment (DH&E)
services and supports for individuals with Intellectual and Developmental
Disabilities (I/DD).
Medicaid-funded DH&E services and supports have grown exponentially since
the introduction of Medicaid Home- and Community-based Services (HCBS)
waivers in the early 1980s. Medicaid HCBS waivers were introduced to encourage
and support deinstitutionalization of the I/DD population (Agranoff, 2013;
Gettings, 2011). DH&E services and supports are intended to enable adults with
I/DD to successfully live outside of institutions by supporting participation in a
variety of community programs and settings. Such programs include day habili-
tation facilities, facility-based employment (i.e. sheltered workshops), sub-
minimum wage jobs, and competitive, integrated employment (CIE). Since 2000,
over 30 states have adopted policy prioritizing CIE
1
outcomes among the popu-
lation of working-age adults with I/DD served by DH&E systems. These policy
changes, which are often labeled as “Employment First” policy (Nord et al., 2013;
Racino, 2015), vary considerably in terms of timing, content and venue, and are
closely associated with interest group activity (Giordono, 2019; Racino, 2015).
These observations give rise to the primary research questions: (1) What does
state-level CIE-focused policy change look like? (2) Why and how did CIE-
oriented policy change occur?
Among various policy process frameworks, the ACF is particularly compatible
with these research questions. The ACF is predicated on the idea that organized
2Public Policy and Administration 0(0)
interests (in the form of advocacy coalitions) compete to achieve policy change
(Jenkins-Smith et al., 2017; Sabatier and Jenkins-Smith, 1993). Exploration of the
ACF’s secondary components (Pierce et al., 2017) and related causal mechanisms
(van der Heijden et al., 2019) remains important lines of ACF-based inquiry
(Jenkins-Smith et al., 2017). Moreover, Giordono (2019) finds evidence of at
least two competing advocacy coalitions, “Employment First” and “Choice,” in
the DH&E Services subsystem, using the ACF.
Other frameworks also offer well-established windows into policy change, such
as Innovation and Diffusion models (Berry and Berry, 1990, 2017; Rogers, 1995;
Shipan and Volden, 2008, 2012) and Policy Feedback Theory (B
eland and Schlager,
2019; Mettler and SoRelle, 2014; Pierson, 1993; Skocpol, 1995). Relatedly, the few
disability-focused policy process studies suggest the importance of political resour-
ces and strategies (e.g. Itkonen, 2007, 2009; Jeon and Haider-Markel, 2001; Nagel,
2006; Pettinicchio, 2013; Shapiro, 1994). Theories of bureaucracy, including theo-
ries of bureaucratic activism (Eaton and Weir, 2015; Pacewicz, 2018), deliberate
discretion (Huber and Shipan, 2002), interest group influence (Adams, 1981;
Krause, 1999; Stigler, 1971), and competing theories of contracting (e.g., Bertelli
and Smith, 2010; Davis et al., 1997; Jensen and Meckling, 1976; Van Slyke, 2007;
Walsh and Seward, 1990), also offer insight into influential actors and policy change
mechanisms, from an administrative perspective. Finally, disability researchers
have extensively studied systems-level conditions that yield changes to individual
employment outcomes in this specific policy domain (Butterworth et al., 2017; Hall
et al., 2007). This study argues that accommodating relevant insights from those
literatures under the umbrella of the ACF provides a more comprehensive strategy
for addressing the research questions of interest.
Using a comparative research design, this study examines policy changes
observed in two states, Washington and Pennsylvania, to address the research
questions of interest. The application ultimately draws heavily on the ACF,
leveraging relevant expectations and evidence from these other theoretical tradi-
tions. Study results reveal a long-term policy change process considerably more
complex than the binary, lightbulb-style policy adoption process often depicted by
traditional frameworks. Instead, CIE-focused policy change in both states involved
multiple attempts to change administrative rules and legislative statutes (some
successful, some not). The findings also indicate that in both states, common
conditions for policy change include organized mobilization of stakeholders, stra-
tegic framing and narrative, all of which occurred in an environment of heightened
attention to the issue. In both cases, high levels of bureaucratic activism and dis-
cretion made a distinct difference to the timing and sequence of social policy
decisions. The timing differences (early vs. late policy adoption), however, high-
light the important role of service provider coalition membership and defection.
Relatedly, the study findings suggest that feedback mechanisms influenced the
timing of the policy adoption process, namely via antecedent CIE-related service
conditions and service provider support for (or rejection of) CIE-oriented policy.
Giordono 3
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