Olmstead’s Role in Community Integration for People with Disabilities Under Medicaid: 15 Years After the Supreme Court’s Olmstead Decision

June 2014 marks the 15th anniversary of the United States Supreme Court’s landmark civil rights decision in Olmstead v. L.C., finding that the unjustified institutionalization of people with disabilities is illegal discrimination. While many cases are resolved without involving the courts, during the last 15 years, the lower courts have had the opportunity to apply Olmstead in a number of contexts, resulting in decisions furthering community integration for people with disabilities. This issue brief examines the legacy of Olmstead, with an emphasis on legal case developments and policy trends emerging in the last five years and the related contributions of the Medicaid program. Medicaid is important because of its unique role in financing the home and community-based services (HCBS) that enable individuals in institutions to return to the community and those at risk of institutionalization to remain in the community with support.

Themes emerging from recent Olmstead cases highlight Medicaid’s role in

  • providing community-based services instead of institutionalization;
  • providing services in the most integrated setting to enable people with disabilities to interact with non-disabled peers to the fullest extent possible;
  • providing community-based services to prevent institutionalization for people at risk;
  • replacing sheltered workshops with supported employment; and
  • eliminating disability-based discrimination within the Medicaid program.

States continue to make significant progress in reducing the amount spent on institutional services relative to HCBS, with Medicaid continuing to offer the means to facilitate solutions that implement the Americans with Disabilities Act’s (ADA) integration mandate.  This brief is not a review of state progress, but rather an examination of the role of the Court’s Olmstead decision and its subsequent legal enforcement in providing a vehicle for people with disabilities to gain access to services to enable them to live in the community. The on-going work of states, together with the U.S. Department of Justice, the Centers for Medicare and Medicaid Services, people with disabilities, and others, along with the important support offered by the Medicaid program can continue to strengthen the ADA’s promise of community integration for people with disabilities.


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