DHHS Secretary Donna Shalala on the Supreme Court’s Decision Regarding the ADA’s “Most Integrated Setting” Requirement: Olmstead v. L.C.
On June 22, 1999, the Supreme Court issued its ruling in Olmstead v. L.C.. The Court held that unjustified institutionalization of people with disabilities is prohibited discrimination under the Americans with Disabilities Act (ADA). The Olmstead case was brought by two Georgia women whose disabilities include mental retardation and mental illness. At the time the suit was filed, both plaintiffs were receiving mental health services in state-run institutions, although their treatment professionals had concluded they could be appropriately served in a community-based setting. They alleged that the failure to receive services in a community-based setting violated Title II of the ADA and its implementing regulation.
Title II and its implementing regulation require public entities to administer their programs “in the most integrated setting appropriate to the needs of qualified individuals with disabilities,” that is, a setting which “enables individuals with disabilities to interact with non-disabled persons to the fullest extent possible.” The settings that may be appropriate for an individual range from institutional settings to non-institutional residential settings such as assisted living, or home and community-based settings. Title II does not require measures that would “fundamentally alter” the nature of a public entity’s programs. “Fundamental alteration” is the concept under the ADA which governs the extent to which a public entity must modify its program to meet its obligations under the Act. Costs may bear on that determination.
In its ruling, the Court said that institutionalizing a person with a disability who can benefit from living in the community and wishes to do so constitutes discrimination because it severely diminishes the individual’s ability to interact with family and friends, work and make a life for him or herself. The decision also makes clear, however, that the right of people with disabilities to receive services in the “most integrated setting” is not absolute. In Olmstead, the Supreme Court indicated that, in evaluating a state’s “fundamental alteration” defense, courts are to consider not only the cost of providing community-based care to individuals, but also the range of services the state provides to others with disabilities and the state’s obligation to mete out those services in an equitable manner.
On July 28, 1999, Secretary Shalala addressed the impact of the Supreme Court’s decision in Olmstead v. L.C. when she spoke to the National Conference of State Legislatures. The Secretary’s remarks are attached. As the remarks indicate, in Olmstead v. L.C., the Supreme Court established a roadmap for complying with the “most integrated setting” requirement of the ADA. The Court suggested that states may demonstrate compliance with the ADA by showing that they have comprehensive and effective plans for placing qualified individuals with disabilities in less restrictive settings and waiting lists that move at a reasonable pace not controlled by the state’s endeavors to keep its institutions fully populated.
Over the past few years, the Department of Health and Human Services has focused on expanding and promoting home and community-based services as well as providing technical assistance to the states, using the flexibility of the Medicaid program. HHS is redoubling its efforts in light of the Olmstead case. To that end, HHS stands ready to meet with all of the stakeholders to discuss ways to work together to achieve what Secretary Shalala characterized as the mission established by Olmstead: “To build better systems of supports enabling people with disabilities to live life to the fullest.”
Date of Revision: Wednesday, September 15, 1999