Print the PDF

Competitive Integrated Employment For People with Disabilities:

Setting High Expectations with Employment First (E1st) 


The law requiring a minimum wage for employees has been in place since 1938. At the same time it was created, a special clause was put into place to allow a “sub-minimum wage” to be paid to people with disabilities in “sheltered workshops” which only employ people with disabilities. Since then, in many communities “sheltered workshops” have been the primary employer of people with disabilities. Now many states are changing to a new way.

What is Employment First (E1st)?

Employment First (E1st) is based on the idea that “Employment is the first priority and preferred outcome of publicly funded services for people with disabilities.” Publicly funded programs include Home and Community Based Waiver Services (HCBS) and vocational rehabilitation services. It is the expectation that services support employment for individuals with disabilities and prioritize integrated work options rather than work in a segregated setting, paying less than minimum wage.

E1st is one way Iowa can meet requirements of the Workforce Innovation and Opportunity Act (WIOA), a law supporting competitive and integrated work experiences and employment for all citizens. Iowa systems no longer ask whether a person can work, but instead ask what employment best matches a person’s strengths, skills, interests and conditions for success.

To summarize, E1st changes the employment question from “Can a person work?” to “How can a person work?” E1st emphasizes that with a good job match and the right supports everyone can work! 

What is Competitive Integrated Employment (CIE)?

Competitive Integrated Employment is work performed by a person with a disability who:

  • Is paid minimum wage or higher;
  • Receives the same benefits from the job;
  • Interacts with employees without disabilities;
  • Has the same advancement opportunities as employees without disabilities doing the same or similar work.

What are some advantages of Employment First?

  • Integrated employment provides Iowans with disabilities with increased income, opportunities to achieve economic self-sufficiency and community involvement.
  • Our economy benefits when people with disabilities are in the workforce, paying taxes and spending their earnings.
  • Iowa benefits from reduced costs to Medicaid and income support programs.
  • Businesses benefit from the contributions of employees with disabilities.


What services are available to support someone with getting a job in the community?

Some supports, services and funding options available to assist Iowans with disabilities to obtain employment include but are not limited to services like:

  • Career Exploration;
  • Customized Employment;
  • Job Coaching;
  • Job Readiness training;
  • On-the-job training;
  • Supported Employment;
  • Transportation training, and much more.

Not all possibilities are listed so talk to your team (such as case manager, Voc. Rehab Staff, etc.) to explore more options.

The following agencies can provide services that support employment to individuals with disabilities:

Iowa Vocational Rehabilitation Services (IVRS) helps people with disabilities to prepare for, find, and keep employment. IVRS also provides Pre-Employment Transition Services (Pre-ETS) in collaboration with every high school in Iowa. Request your school’s “Service Delivery Plan” or visit the IVRS website for additional details on services.

Iowa Department for the Blind (IDB) helps educate, train and empower individuals with blindness or low vision. They also provide employment services and Pre -Employment Transition Services (Pre-ETS) in the high schools. Visit the IDB website.

Iowa Medicaid—Department of Human Services (DHS) provides many supports to people with disabilities, including waivers and Habilitation services, for those who are eligible. Those services can be used for employment related assistance. Visit the DHS website

Mental Health and Disability Services (MHDS) There are regional services and funding for eligible people who may be on waiting lists or not Medicaid eligible. Find out more on the MHDS website.

Iowa Workforce Development (IWD) IowaWORKS Centers can be found around the state that offer accommodations and assistance to increase or improve a person’s capabilities and possible job skills. Find an IowaWORKS Center near you.

Iowa Department of Education (DE) strives to provide all students with educational opportunities and successful participation in Iowa’s workforce. By at age 14, a student IEP’s team should consider the need for work goals. Read more on the Department of Education’s website.

It is important to remember throughout this process that work can and will look different for each individual. Goal setting, job exploration, volunteering, internships and skills training are experiences that job seekers may have on their way to getting a job in the community. Through this process in addition to earning their own money individuals can develop strong self-determination and advocacy skills.

Here are answers to frequently asked questions about Employment First (E1st).

Q1: Why is there all this talk about employment for people with disabilities now? A1: There is more national attention and recognition of integrated community employment as a civil right. Also, The U.S. Department of Justice and The U.S. Supreme Court now require states to direct Medicaid funds to services in integrated settings.

Q2. Why should employers hire someone with a disability? A2: People with disabilities represent a significant pool of potential applicants who repeatedly get high marks from managers on job related issues. It’s good business to hire from a potentially underutilized source of outstanding workers.

Q3: What jobs can people with the most significant disabilities expect to get? A3: It is understood not everyone will have jobs right away. The important thing is having high expectations, honoring the dreams and goals of all people, including those with significant disabilities. A person’s first job is not usually their last. Customized Employment is one option being used to create jobs. Read more about Customized Employment.

Q4: If a person with a disability is not currently on a waiver and wants to work, can they still receive employment training? A4: Yes! IVRS, Iowa WORKS, and MHDS Regions serve eligible Iowans with disabilities. IDB serves people with low vision and who are blind.

Q5: If a person with a disability works, will they lose the support services and public benefits that they can receive? A5: This is a big concern for many people but simply put, many people work and continue to receive benefits. There are lots of options established within the law to help people keep their benefits, services, and insurance while working or during a transition period.

A qualified Benefits Planner can explain these to you. Find one through your service provider, Vocational Rehabilitation, or Disability Rights Iowa.

Employment First (E1st) success stories:

Listed below are links to stories and videos that demonstrate different benefits integrated employment offers individuals, their families, co-workers and employers. No matter where people are in the process of pursuing integrated community employment these stories will show real life examples of the benefits.

Job Honor Awards- Inspiring stories of meaningful employment from the Iowa Job Honor Awards.
ID Action- See videos of people with disabilities living and working in their communities.
Iowa APSE- The Association of Persons Supporting Employment First (APSE) has a collection of success stories.
Thinking Outside the Employment Box- Entrepreneurs with Disabilities Share Their Self-Employment Success Stories 

Related Resources

Please find the following resources at

  • WIOA (Workforce Innovation and Opportunities Act)
  • Transition Terms
  • Transition Roadmap

 ASK Essential Questions

  • What supports does my child need to achieve competitive integrated employment?
  • What strengths does my child have that can be built on for employment?
  • What agencies should be involved for my child to get the services and supports that are needed to work competitively?