States are failing to meet their obligations to transition individuals with disabilities out of institutions and into community settings, a year-long investigation finds.
The U.S. Supreme Court ruled more than a decade ago in a case known as Olmstead v. L.C. that unnecessarily segregating individuals with disabilities in institutions is a violation of the Americans with Disabilities Act. Nonetheless, a report set to be released Thursday by the U.S. Senate Health, Education, Labor and Pensions Committee finds that the number of people with disabilities in nursing homes is on the rise and, as of 2010, just a dozen states devoted the majority of their Medicaid dollars to community-based care.
“The Supreme Court’s decision in Olmstead was a landmark moment for the disability community,” said Sen. Tom Harkin, D-Iowa, who chairs the committee. “Yet … 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.”
Last year, Harkin asked officials from all 50 states to provide him with information about their progress in transitioning individuals with disabilities out of institutions. The report being issued this week details what the senator found.
Across the country, hundreds of thousands of people with disabilities remain on waiting lists for Medicaid home and community-based services. Meanwhile, the percentage of Medicaid funding spent on these integrated offerings varied widely from more than 80 percent to less than 20 percent in some states in 2009, the report indicates.
Comparing the situation from one state to another is difficult, however, due to varying terminology and the lack of a uniform reporting system to assess which states are meeting obligations under Olmstead. In Hawaii and Minnesota, for example, the report found that a “home” could include living in a car or being homeless. And in Texas, two-dozen types of facilities qualify as group homes.
Many states have focused more on enrolling people already living in the community in Medicaid programs as opposed to transitioning people in institutions to more integrated settings, according to the report. In cases where individuals were moved out of institutions, however, it was unclear whether or not they ended up in the most integrated environments.
The Senate committee’s report urges the U.S. Department of Justice to expand its Olmstead enforcement efforts. In addition, recommendations call for Congress to bolster the rights of Americans with disabilities to receive services and supports in community-based settings.