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 Federal disability 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 when:

Integration in the community is appropriate;
the affected person does not oppose living in the community; and
the provision of services in the community would be a reasonable accommodation when balanced with available resources and other similarly situated individuals with disabilities.

OCR’s Olmstead enforcement initiative 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 investigations 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

OCR has joined with our partners in the U.S. Department of Health and Human Services Office of Inspector General (OIG) and Administration for Community Living (ACL) to publish a joint report, entitled “Ensuring Beneficiary Health and Safety in Group Homes Through State Implementation of Comprehensive Compliance Oversight,” focused on preserving the health, safety and well-being of individuals with disabilities who live in group homes. The joint report, issued on January 17, 2018, is a resource to help ensure that group homes are safe and healthy places for people with disabilities, as part of a spectrum of integrated options.

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

Recent Community Integration Updates

CMS Access Rule

The Centers for Medicare and Medicaid Services (CMS) recently finalized a rule Ensuring Access to Medicaid Services. The rule updates regulations to promote public transparency and oversight in how states administer Medicaid covered home and community-based services The Federal Register published the final rule (CMS-2442-F) on May 10, 2024. The new regulations will become effective on July 9, 2024.

Administration for Community Living (ACL) Older Americans Act Final Rule

HHS ACL recently finalized a rule updating regulations to implement its Older Americans Act programs. The final rule updates family caregivers, tribal elders, emergency preparedness and response, nutrition, elder abuse prevention, legal assistance, guardianship and long-term care ombudsman programs. The rule also authorizes grants to state agencies, which provide funding to area agencies on aging to coordinate programs and advocate for older adults and family caregivers. The Older Americans Act final rule published in the Federal Register on February 14, 2024. The new regulations took effect on March 15, 2024, and regulated entities have until October 1, 2025, to comply with the new regulations.

Resources From Our Federal Partners

The federal government, through the Department of Health and Human Services, the Department of Justice, and the Department of Housing and Urban Development, offers resources to states, individuals with disabilities, and families to support community living. The following are brief descriptions and links to resources.

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 and the Rehabilitation Act. In 2022, the Department of Justice launched a new ADA.gov website. The Community Integration page provides a user friendly overview of the integration mandate. Summaries of DOJ enforcement with searchable archives can be found at Enforcement | ADA.gov . Guidance and resource materials to assist with accessing community-based services are available at Guidance & Resource Materials | ADA.gov.

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 organizational resource links via and resources that connect people with disabilities to federal, state and local resources through its Aging and Disability Networks.

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 in their efforts to 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.