Assuring Access To Community Living for People With
On June 22, 1999, the U.S. Supreme Court Affirmed that
policy by Olmstead v L.C. ruling in that under the American's with Disabilities
Act (ADA) unjustifiable institutionalization of a person with a disability
who, with proper support, can live in the community is discrimination.
In its ruling, the Court said that institutionalization severely limits the
person's ability to interact with family and friends, to work and to make a life
for him or herself.
The Olmstead case was brought by two Georgia women whose disabilities include
mental retardation and mental illness. At the time the suit was filed, both
plaintiffs were receiving mental health services in state-run institutions,
despite the fact that their treatment professionals believed they could be
appropriately served in a community-based setting.
In accordance with that Court ruling, the U.S. Department of Health and Human
Services (HHS) today issued guidance to state Medicaid directors on how to make
state programs responsive to the desires of disabled persons to live in
appropriate community-based settings. The Administration's goal is to integrate
people with disabilities into the social mainstream with equal opportunities and
the chance to make choices.
The Olmstead Decision
The Court based its ruling in Olmstead on sections of the ADA and federal
regulations that require states to administer their services, programs and
activities "in the most integrated setting appropriate to the needs of qualified
individuals with disabilities."
Under the Court's ruling, certain principles have emerged:
- unjustified institutionalization of people with disabilities is
discrimination and violates the ADA;
- states are required to provide community-based services for persons with
disabilities otherwise entitled to institutional services when the state's
treatment professionals reasonably determine that community placement is
- the person does not oppose such placement; and the placement
can reasonably be accommodated, taking into account resources available to
the state and the needs of others receiving state-supported disability
- a person cannot be denied community services just to keep an institution
at its full capacity; and,
there is no requirement under the ADA that community-based services be
imposed on people with disabilities who do not desire it.
The Court also said that states are obliged to "make reasonable modifications
in policies, practices, or procedures when the modifications are necessary to
avoid discrimination on the basis of disability, unless the public entity can
demonstrate that making the modifications would fundamentally alter the nature
of the service, program or activity." Meeting the fundamental alteration test
takes into account three factors: the cost of providing services in the most
integrated setting; the resources available to the state; and how the provision
of services affects the ability of the state to meet the needs of others with