Senior Policy Analyst
Nineteen years ago today, the Supreme Court found in Olmstead v. L.C. that states and localities must generally serve people with disabilities in the community rather than in institutions when community-based services can meet their needs. Over the last 19 years, the Olmstead decision has helped many people with disabilities live in their community rather than an institution, and Medicaid has played a key role in that. It’s the main funding source for home- and community-based services (HCBS), on which people with disabilities rely to live independently and safely in the community. Medicaid has grown better at supporting community-based services, and the President and Congress should build on that progress.
The Olmstead case was brought by Lois Curtis and Elaine Wilson, two women with cognitive and mental health disabilities who were institutionalized in Georgia. They sued the state in 1996 for violating the Americans with Disabilities Act’s community integration mandate by not providing community-based services as their doctors recommended. That mandate requires that states and local governments “administer services, programs, and activities in the most integrated setting appropriate” to the needs of people with disabilities. Failing to do so in a community-based setting, the Court found, is “unjustified isolation,” and can be a form of unlawful discrimination.
Medicaid plays a key role in supporting the community integration that Olmstead requires:
Medicaid also promotes community integration for people experiencing homelessness. Specifically, Medicaid funds housing stability services to improve physical and behavioral health outcomes for people experiencing homelessness and at risk of institutionalization, or living unnecessarily in institutional care. People who have long histories of institutionalization or homelessness often need special supports — such as help finding safe, accessible, affordable housing, or community social services — to manage their health and living on their own. States, recently including Washington and Illinois, are increasingly adding these services to their Medicaid programs.
Despite these many successes, the President and Congress can do more to ensure continued improvements in transitional care. For example, they should reauthorize the Money Follows the Person Demonstration project — which expired in September 30, 2016, and which helped over 75,000 Medicaid beneficiaries in 44 states transition back to their communities. Demonstration participants saved Medicare and Medicaid up to $978 million during their first year after transitioning to home- and community-based care.