Senator Harkin stated that states have come a long way since the Supreme Court ruled in Olmstead v. L.C. in 1999 that the unnecessary segregation of people with disabilities in institutions is a violation of the Americans with Disabilities Act and told states to provide community-based long-term care services. But he said that most states still have much to do to achieve the goal of allowing most people with disabilities the opportunity to stay in their own homes and receive care.
Indiana has made great strides in rebalancing services toward integrated, community-based options for those individuals with intellectual and developmental disabilities that are already in the service delivery system. Over nearly a decade of planning and effort, hundreds of individuals have moved from large, congregate institutional settings into their own homes and communities with services funded through the Medicaid HCBS Waiver, fulfilling Olmstead's primary charge. That being said, the efforts highlighted below would likely have significant impact on the current service delivery system.
The 110-page report recommended a series of steps Congress or the states could take to improve access to home and community based care for people with disabilities. Three highlights include:
1. The Centers for Medicare and Medicaid Services (CMS ) should finalize its proposed rule defining what type of setting qualifies as home and community-based.
2. The Department of Justice (DOJ) should expand its Olmstead enforcement efforts, to include investigations of segregated employment settings for individuals with disabilities and the inappropriate placement of young people with disabilities in nursing homes, especially in states that are in the bottom quartile of spending on Home and Community-Based Services and/or for discreet subpopulations.
3. CMS, the Administration on Community Living at the Department of Health and Human Services, the Office for Civil Rights at HHS, the Department of Housing and Urban Development, the DOJ's Civil Rights Division, the National Council on Disability, and the National Institute on Disability and Rehabilitation Research should create a high-level interagency task force within six months of the issuance of this report on Olmstead implementation and should deliver a consistent message to states about their Olmstead obligations and the federally created tools that can help them comply with the decision.
"The Supreme Court's decision in Olmstead was a landmark moment for the disability community - holding that the ability to live in the community is a protected civil right under the Americans with Disabilities Act," said Harkin. "Yet my report reveals that 14 years later, many states are still not making a commitment to provide all individuals with disabilities the choice to live in their own homes and communities. This is amazing given that study after study has shown that home and community-based care is not only what people want, but is more cost-effective."