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Olmstead v L.C. Decision Summary

Olmstead v L.C. Decision Summary

On June 22, 1999, the Supreme Court ruled that unjustified isolation of people with disabilities is discrimination and is prohibited under the Americans with Disabilities Act. Georgia had appealed the case to the Supreme Court after the lower courts ruled in favor of two women with disabilities who sued the state under the "most integrated setting mandate" of the ADA. Title II of the ADA states that public services and programs must be provided in the most integrated setting appropriate. The Georgia state mental health agency had determined that home and community-based services were appropriate, but the two women had to remain in institutions because they were on a waiting list for community services.

The Justices ruled that states must provide community options if three conditions are met:

  1. home and community-based services are appropriate
  2. the placement is not opposed by the individual, and
  3. the community placement can be reasonably accommodated taking into account the needs of all people with disabilities served by the state.

The decision also said that states may have a defense against future lawsuits if they have comprehensive, effectively working plans to move people with disabilities into the community at a reasonable rate.

Who and What does the Decision Apply To?

The Americans with Disabilities Act protects all people with disabilities against discrimination. The "most integrated setting" provision of the ADA, used by the Court in their decision, applies to all state funded services. Therefore, a plan to provide community options must address:

  • Community services for people in nursing facilities, institutional care facilities for the developmentally disabled, group homes, state psychiatric facilities or people at risk of such institutional placement.
  • Options to the state schools for the disabled, i.e. Missouri Schools for the Deaf and Blind
  • Supported employment and other employment opportunities that are integrated in the community
  • Other services such as housing and transportation

How Does the State Implement Olmstead?

In response to the Supreme Court ruling, the state must have a comprehensive plan to provide state services in the "most integrated setting" or the state will have no defense against a lawsuit. Upon the decision by the Supreme Court, then United States Secretary of Health and Human Services (HHS) Donna Shalala made Olmstead implementation a priority for the HHS Office of Civil Rights (OCR). Now, Secretary Tommy Thompson is working with other US Departments on federal Olmstead initiatives and providing technical assisting to states.

Missouri's History

The disability community in Missouri should celebrate the hard work in the last eleven years to increase access to home and community-based services, including self-directed personal attendant services. There are a number of victories that has brought Missouri to this point. A few of those are:

  • In 2000, Governor Mel Carnahan established an Olmstead Commission and signed into law Missouri’s “Olmstead language” in HB1111 stating that people with disabilities who are Medicaid eligible and nursing home eligible can choose to receive their services in the community using the best option that meets their need, including the Consumer-Directed Services.
  • The Department of Mental Health has focused on transition planning from habilitation  centers to the community and implemented a policy of no new admissions to the large state-run institutions except as temporary emergency services.
  • The Department of Health and Senior Services has greatly expanded the Money Follows the Person (MFP) project which transitions people out of institutions and nursing homes.

Current Status of Olmstead Implementation in Missouri

2010 Medicaid data show Missouri is one of 12 states that have made the most progress on re-balancing our Medicaid long-term services and support.  These 12 states have seen a 15% point drop in the amount of Medicaid long long-term care dollars spent on institutions and nursing homes between 1999 and 2010.

Making significant progress is admirable, but we believe Missouri can be one of the best states on Olmstead implementation as defined by the percentage of Medicaid long-term care dollars spent on institutions.  Re-balancing our long-term care system to spend more than 50% of Medicaid long-term care dollars on home and community-based services will not only help Missouri comply with the ADA but will also save the state money. In addition to initiatives such as Money Follows the Person, the following policy recommendations can help Missouri be one of the best states.

  • Develop a transition plan for residents of the state-run habilitation centers that includes analysis of what community supports each individual would need, the level of community capacity and timelines for down-sizing or closing the institutions.
  • Divert unnecessary nursing home placements by requiring a pre-admission screening and options counseling.  Many people end up in a nursing home because they do not know what community supports are available.  Sometimes it’s as simple as needing a home modification so that they can safely use their bathroom.
  • Transition people who do not need to be in nursing homes.  In 2008, 22% of nursing home residents met the definition of low-care and 42% had low cognitive impairment (Shaping Long Term Care in America Project at Brown University funded in part by the National Institute on Aging [1P01AG027296]).
  • Allow a self-directed option for all home and community-based services and offer options for people who want to have choice and control over who comes into their home but may need some support with employer functions such as timesheets.  People with disabilities want the maximum amount of choice and control.  Self-directed options increase access, especially in rural areas where agencies may not be available.

You can join the Paraquad Community Advocacy Network to receive alerts about legislation and advocacy activities related to Olmstead implementation.

Olmstead Resources

United States Department of Justice Olmstead Page:

HCBS Clearinghouse:


United States Department of Health and Human Services, Office on Disability Community Living Initiative:

Missouri Department of Social Services Money Follows the Person Initiative: