Commemorating the 26th Olmstead Anniversary and the Importance of the Olmstead Decision to Make America Healthy Again

Sunday, June 22, 2025, marked the 26^th anniversary of the U.S. Supreme Court’s 1999 landmark decision in Olmstead v. L.C., where the Supreme Court held that “unjustified isolation” is “properly regarded as discrimination based on disability.”  Known as the Brown v. Board of Education decision for individuals with disabilities, the Supreme Court decision in Olmstead also found that the “[i]nstitutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life.” It further found that “[c]onfinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment.”

The decision interpreted regulations under Title II of the Americans with Disabilities Act (ADA), which were based on the most integrated settings regulations that implemented Section 504 of the Rehabilitation Act of 1973.  The HHS Office for Civil Rights has responsibilities for both statutes and has a long history of being a Federal government leader in implementing what has become to be known as the most integrated setting mandate.  During both the George W. Bush Administration, with OCR’s leadership under the President’s New Freedom Initiative, and President Trump’s first Administration and continuing through to his second Administration, OCR continues to take strong enforcement actions to secure the vital right of all citizens with disabilities to receive services in the community when it is appropriate and the choice of the  individual, is a reasonable modification of policies, practices, or procedures, and does not fundamentally alter the State’s service delivery system, taking into account the resources available to the State and the needs of others with disabilities receiving services from the State.

HHS spending in the years since the Olmstead decision reflects the mandates and values in the decision and the underlying regulations.  In 1999, Medicaid spent nearly three times more on long-term services and supports for individuals with disabilities provided in institutions, like nursing homes, than it did on services for those individuals in the community.  Since then, there has been a major shift in the allocation of HHS funds.  Today, the majority of that funding supports community services.  Having worked closely with OCR while at HHS under both Administrations, I was fortunate to see this shift unfolding beginning with President Bush’s New Freedom Initiative.  Many of the innovations in Medicaid and other programs stemmed from that important blueprint and continue today as cost-effective ways to support people with disabilities in the community.  Upon my return to HHS as OCR’s Director on June 6, I have been  committed to ensuring that individuals with disabilities enjoy the rights embodied in the Supreme Court’s Olmstead decision.

OCR’s work to ensure implementation of Title II of the ADA and the Olmstead decision further support Secretary Kennedy’s priority to Make America Healthy Again, address the growing surge in autism, and combat waste, fraud, and abuse.  Today, OCR announced the resolution of a complaint involving Alexis Ratcliff, a young woman who is quadriplegic as a result of an accident when she was 18 months old.  She lived at home until age 13 when she lost her family supports and the State placed her in a hospital because of a lack of community services.  The settlement announced today carries the good news that, as a result of OCR’s intervention based on a complaint filed on her behalf, Alexis is finally leaving the hospital to live in the community, where she will pursue her college studies and desires to be a disability advocate. 

This is exactly the right result – under the law and under Secretary Kennedy’s leadership – to Make America Healthy Again and to promote opportunities for individuals with chronic disabilities to lead healthy and productive lives, while also ensuring that Federal funds are not being used to unlawfully and unnecessarily segregate individuals with disabilities.  Alexis indeed embodies the American dream and the values that this Administration, and all of us, embrace – to value the inherent dignity and worth of every individual. 

There is much work to be done for others like Alexis, and OCR’s Olmstead work is key to Make America Healthy Again and combating the waste, fraud, and abuse of using Federal funds to discriminate against people with disabilities.  We all benefit when every American has the opportunity to fully participate in, and contribute to, our communities.  OCR is committed to continuing to ensure that all individuals with disabilities have the full protection of the laws that OCR enforces.