THE OLMSTEAD DECISION

CFILC ISSUE BRIEF

In 1999, the Supreme Court decided in Olmstead v. L.C. that states are obliged by the Americans with Disabilities Act to provide services in the most integrated setting including community-based services for persons with disabilities who would otherwise be entitled to institutional services when:

• The state’s treatment professionals have determined that community placement is appropriate;

• The individual chooses community placement; and

• The placement can be reasonably accommodated, taking in to account the resources available to the state and the needs of others with disabilities.

The court’s decision has significant implications for the federal and state governments in how they fund and administer disability and aging services. Following the court ruling, the Center for Medicare and Medicaid (CMS) took the following actions:

• Issued a series of Medicaid Director Letters discussing the implications of Olmstead; providing some additional flexibility to support institutional transition; and encouraging states to develop Olmstead plans and engage persons with disabilities in all stages of their plan’s development and implementation.

• Internally developed organizational linkage between the Medicare program (which serves older adults and some younger persons with disabilities) and the Medicaid program (which serves low income persons) and established an office to work across these major systems and foster home and community-based options.

• Funded grants to states to conduct Olmstead related activities aimed at overall systems change, including efforts through Medicaid to fund more home and community-based supports, increase the quality of those supports; and redesign those programs to include a consumer-directed philosophy.

Through these efforts, CMS has sought overall system wide state improvements that create:

• Strategies for transitioning persons residing in institutions back into the community and diverting persons with significant disabilities into home and community based supports;

Interventions that affect not just one population (ie. Seniors) but multiple disability subgroups; and,

A “Money Follows the Person” approach—a system of flexibile financing for Long Term Care services that enables available funds to move with the individual to the most appropriate and preferred setting as the individual’s needs and preference change.  Money Follows the Person models allow funding to freely move from institutions into the community and refute tying money to specific institutions—such as nursing homes.