Serving People with Disabilities in the Most Integrated Setting: Community Living and Olmstead

The U.S. Supreme Court’s 1999 landmark decision in Olmstead v. L.C. (Olmstead) found the unjustified segregation of people with disabilities is a form of unlawful discrimination under the Americans with Disabilities Act (ADA).  The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) plays a pivotal role in supporting the Olmstead decision and promoting community living through enforcement of the ADA and other key civil rights laws.

OCR investigates complaints alleging a violation of the right of individuals with disabilities receive services in the most integrated setting appropriate to their needs.  This principle is central to the Supreme Court's Olmstead decision. The Court held that states are required to provide community-based services for people with disabilities who would otherwise be entitled to institutional services when:

1. such placement is appropriate;
2. the affected person does not oppose such treatment; and
3. the placement can be reasonably accommodated, taking into account the resources available to the state and the needs of other individuals with disabilities.

OCR's Olmstead enforcement protects the right to the community integration for individuals with disabilities. As a result of OCR's efforts, many people have transitioned from an institution to the community, and many others have avoided unnecessary institutionalization. For example, OCR's investigation have led to

• Individuals who had been institutionalized for decades are now receiving services in their community.
• Individuals with disabilities access home and community-based services through Medicaid "Waiver" programs.
• Increased hours of personal care and assistance are being provided to individuals who require additional services to remain in the community.
• Individuals with disabilities now have greater control over their community-based care and services.
• Individuals’ needs are met by providing reasonable accommodations in their own homes and communities.

Ensuring Beneficiary Health and Safety in Group Homes Through State Implementation of Comprehensive Compliance Oversight

• Read the Report and Model Practices
• Watch Highlights of the Panel Discussion - Video
• Watch the Full Panel Discussion - Video

Read the CMCS Informational Bulletin:  Health and Welfare of Home and Community Based Services (HCBS) Waiver Recipients 

RECENT COMMUNITY INTEGRATION UPDATES

CMS Access Rule

The Centers for Medicare and Medicaid Services (CMS)  proposes a rule that would promote public transparency and oversight in how states administer Medicaid covered home and community-based services (Ensuring Access to Medicaid Services (CMS 2442-P) Notice of Proposed Rulemaking | CMS). The comment period is 60 days and the deadline for comments is July 3, 2023.

Older Americans Act (OAA) Proposed Rule

The U.S. Administration for Community Living is seeking input on proposed updates to the regulations for its Older Americans Act (OAA) programs. The proposed rule is the first substantial update to most OAA program regulations in 35 years. The proposed rule aims to align regulations to the current statute and reflect the needs of today’s older adults. Comments must be received by 11:59 p.m. (Eastern) on Tuesday, August 15, 2023.

Support for Aging Caregivers

Families and caregivers are critical to supporting people with disabilities remain in the community and in their family homes. CMS issued resources on how state Medicaid agencies can successfully  support adults with disabilities and their aging caregivers and resources for individuals and families (CMS Releases Resources on Supporting Adults with Intellectual and Developmental Disabilities and their Aging Caregivers| ACL). 

RESOURCES FROM OUR FEDERAL PARTNERS

The federal government offers resources to states, individuals with disabilities, and families to support community living. Links to these resources from our partners at the Department of Health and Human Services, the Department of Justice, and the Department of Housing and Urban Development are discussed below.

United States Department of Justice

The United States Department of Justice, Civil Rights Division, enforces the integration mandate established in the landmark Olmstead decision through Title II of the Americans with Disabilities (ADA) Act. In 2022, the Department of Justice launched a new ADA.gov website. The  Community Integration page has more information about DOJ enforcement and how to access community-based services.

Administration for Community Living

The mission of the Administration for Community Living (ACL) is for older adults and people with disabilities to participate fully in their communities, to live independently, and to live with dignity. ACL provides information on its Aging and Disability Networks that offer information on organizations in each state and territory that connect people with disabilities to federal, state and local resources.

Department of Housing and Urban Development

The Housing and Services Resource Center (HSRC)  is an ACL and Department of Housing and Urban Development joint resource for organizations that provide services to allow people to live stably in the community. The HSRC allows community organizations to build networks for housing resources, provide information and research, and to share knowledge on how to support older adults and people with disabilities, who are experiencing homelessness, by assisting with access to and maintaining affordable housing.

Substance Abuse and Mental Health Services Administration

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) leads public health efforts that advance behavioral health, improve the lives of people living with mental illness and substance use disorders, to prevent substance misuse, and to provide equitable access to treatment. SAMHSA’s Olmstead Website, Olmstead v. L.C. Resources | SAMHSA, includes guidance and resources to assist states and stakeholders fulfill the community integration mandate. One useful resource is a Community Integration Self-Assessment tool, which allows states to identify weaknesses and strengths in their current programs.