Office for Civil Rights

Preventing Discrimination Against People with Disabilities in Health Care and Social Services

Serving People with Disabilities in the Most Integrated Setting: Olmstead and New Freedom Initiative

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OCR investigates complaints alleging a violation of the Americans with Disabilities Act (ADA's) "integration regulation," which requires that individuals with disabilities receive public services in the most integrated setting appropriate to their needs. This work carries out the Supreme Court's 1999 decision in Olmstead v. L.C., 527 U.S. 581 (1999) [Olmstead], finding that the unnecessary institutionalization of qualified individuals with disabilities in institutions is a form of discrimination prohibited by the ADA. The Court held that states are required to provide community-based services for people with disabilities who would otherwise be entitled to institutional services when: (a) treatment professionals reasonably determine that such placement is appropriate; (b) the affected person does not oppose such treatment; and (c) the placement can be reasonably accommodated, taking into account the resources available to the state and the needs of other individuals with disabilities. In February, 2001, the President announced the New Freedom Initiative, promoting full access to community life for persons with disabilities, and directed swift implementation of the Olmstead decision. In June 2001, the President also signed Executive Order 13217, directing federal agencies to assess all of their policies, practices and procedures to determine the existence of barriers to services people with disabilities in the most integrated setting.

OCR's response to Olmstead complaints has had a significant impact in facilitating the community integration of individuals with disabilities. OCR has received complaints filed by or on behalf of a wide range of individuals, including individuals with physical, psychiatric, developmental and cognitive impairments, and individuals of all ages, including children, young and middle-aged adults, and elderly persons. As a result of OCR's efforts, many individuals have been able to move from an institution to the community, and many individuals have avoided unnecessary institutionalization. For example:

• Community services are being provided to individuals who had been institutionalized for decades.
• Community services are being provided or restored to individuals who lost their housing and/or community-based supportive services when they entered institutions due to an acute health care problem.
• Community services are being provided to individuals with disabilities through "waiver" programs.
• Increased hours of personal care and assistance are being provided to individuals who need them to stay in the community.
• Individuals with disabilities are having greater control over their community-based care and services.
• Individuals are provided reasonable accommodations where they reside, rather than having to move to a more restrictive setting.

OCR Olmstead Success Stories

State of Georgia Olmstead Settlement Agreement (signed July 1, 2008) More than 2,500 individuals with disabilities institutionalized in Georgia's eight public psychiatric hospitals and mental retardation facilities will have the opportunity to live in their home communities with appropriate supports tailored to meet their individualized needs as a result of a statewide settlement agreement entered between the State of Georgia and OCR. The agreement resolves statewide complaints filed with OCR by four state advocacy groups alleging that, in violation of the Americans with Disabilities Act, Georgia failed to treat qualified individuals with developmental disabilities and mental health disabilities in the most integrated setting appropriate to their needs. The State of Georgia agreed to shift the emphasis of its Medicaid program away from long-term institutional care to a system that offers qualified individuals with intellectual and developmental disabilities and mental illness consumer choice in the community. Georgia will engage in a comprehensive planning process, with consumer input, to update its State Olmstead Plan in order to provide adequate community services to address the needs of all Georgians with disabilities who are currently living in institutions or at risk of institutionalization. Georgia's implementation of the agreement will rely, in part, on a $44 million dollar Money Follows the Person Rebalancing Demonstration Grant awarded to Georgia by the HHS Centers for Medicare & Medicaid Services. In addition, experts from HHS' Substance Abuse and Mental Health Services Administration will work with Georgia officials to develop the state's community mental health infrastructure to carry out the requirements of the agreement. Read the Settlement Agreement. Read the Summary of the Settlement Agreement. Read the HHS Press Release.

City and County of San Francisco re Laguna Honda Hospital and Rehabilitation Center (LHH) (Resolved on June 13, 2008) The U.S. Department of Justice (DOJ) and San Francisco entered into a settlement agreement resolving complaints related to Laguna Honda Hospital that were jointly investigated by DOJ and the HHS Office for Civil Rights. San Francisco agreed that: (1) through interdisciplinary team assessments by qualified professionals, informed decision making by the affected individuals (including those with developmental disabilities or mental illness and those at risk for homelessness), development and implementation of individual transition plans, and post-placement quality assurance and monitoring, each individual LHH resident will be served in the most integrated setting appropriate to his or her individualized needs; and (2) in accordance with LHH residents' federal constitutional and statutory rights, each LHH resident will be provided with adequate and appropriate protections, care, treatment, support and services to meet his or her individualized needs, consistent with generally accepted professional standards. Read the June 13, 2008 Settlement Agreement. Read the April 1, 2003 DOJ and HHS OCR Findings Letter.

West Virginia Department of Health and Human Services (WVDHHS): Aged and Disabled (A&D) Waiver Program (Resolved on February 25, 2008) An advocacy group filed a complaint alleging that an individual and a participant in the A&D waiver program was at risk of institutionalization because her contract service providers were failing to provide the hours of care for which she is eligible at the times and frequency outlined in her Plan of Care. OCR's Region III investigation included several conference calls with the individual and representatives from WVDHHS, OCR Headquarters, and the Centers for Medicare and Medicaid Services. To resolve the matter, WVDHHS provided technical assistance to the individual's contract service provider. The contract service provider has located additional staff and now consistently provides an average of 92% of the monthly number of hours of care for which the individual is eligible.

West Virginia Department of Health and Human Services (WVDHHS) (Resolved on February 7, 2008) OCR's Region III office investigated a complaint alleging that WVDHHS had discriminated against a nursing home resident by failing to provide her with ventilator services in her own home. The parties entered into mediation with a U.S. Department of Justice contract mediator, but a settlement did not immediately follow. The complaint was then resolved when the complainant moved back into her home and received ventilator services through the Ron Yost Personal Assistance Services (RYPAS) Act, a West Virginia statute that that provides resources to individuals with severe disabilities so that they may contract with service providers and live in their own homes and communities.

Texas Department of Aging and Disability Services (DADS) (Resolved on October 15, 2007) An advocacy group filed a complaint on behalf of an individual with disabilities who resided in a nursing home but wanted to live in the community. To resolve the matter, OCR's Region VI office initiated an informal resolution process and the individual is now enrolled with Amerigroup (a STAR+PLUS managed care organization) and living in his own apartment in the community, with the assistance of Money Follows the Person (MFP) funding from the Centers for Medicare and Medicaid Services. The individual also obtained furniture for his new apartment through DADS Transition Assistance Services and now receives weekly visits from a nurse for medication management.

Montana Department of Public Health and Human Services (DPHHS) (Resolved on October 3, 2007) Two complaints were filed with OCR's Region VIII office by disability rights advocates alleging that DPHHS discriminated against persons with developmental disabilities who participated in sheltered workshops by failing to afford them the opportunity to work in an integrated setting. To resolve the complaints, DPHHS: (1) engaged in Olmstead compliance planning; (2) used a Systems Change Grant to collect information from consumer focus groups to learn about their employment experiences and goals; (3) converted to a consumer choice service delivery model; and (4) modified the reimbursement rate for developmental disability service providers to eliminate the incentive for providers to direct consumers to sheltered workshops or day services.

Oklahoma Department of Human Services (ODHS) (Resolved on September 24, 2007) The complainant, a person with multiple physical disabilities, alleged that he did not receive services as described in his Advantage Waiver Program service plan. As a result, the complainant believed ODHS' failure to follow his service plan put him in danger of institutionalization. OCR's Region VI office initiated an informal resolution process and the complainant is now receiving personal service assistance (PSA) hours to meet his needs through ADvantage Consumer-Directed Personal Assistance Services and Supports.

OCR Report Update on Success in Facilitating the Community Integration of People with Disabilities - This document updates "Delivering on the Promise: OCR's Compliance Activities Promote Community Integration." The report summarizes the satisfactory resolution of complaints filed with OCR on or on behalf of approximately 250 individuals with disabilities. These complaints alleged that individuals were denied the opportunity to receive services in the most integrated setting appropriate to their needs. OCR produced this document in accord with HHS' response to President Bush's Executive Order 13217, Community-Based Alternatives for People with Disabilities, and HHS' commitment to broadly disseminate individual accounts of how civil rights compliance activities have facilitated community integration. See "Empowering through the New Freedom Initiative".

Additional Resources

• Centers for Medicare and Medicaid Services Olmstead/New Freedom Initiative
• OCR's Civil Rights on the Basis of Disability Page
• Links to States with Olmstead web site information
• OLMSTEAD v. L. C. (98-536) - Supreme Court Decision
• Transcript of OCR's July 16, 2001 Olmstead Housing Technical Assistance Call

Archives:

Chronology of Past HHS Actions in the Olmstead/New Freedom Initiative Arena

• July 26, 2006 - HHS Provides Funding to States for Alternatives to Nursing Home Care in Medicaid

• July 26, 2005 - Surgeon's Call to Action to Improve the Health and Wellness of Persons with Disabilities

• July 22, 2005 - Transforming Mental Health Care in America: The Federal Action Agenda

• May 31, 2005 - OCR partnered with the Office on Disability to support National Governor's Association policy academy on young adults with disabilities

• February 1, 2005 - U.S. Department of Housing and Urban Development Notice on New Freedom Initiative and the Housing Choice Voucher Program [PDF - 65.9KB]. This Notice explains President Bush's New Freedom Initiative and Executive Order 13217 and provides guidance to public housing agencies and HUD field staff on initiatives that can be implemented to assist families with a person with disabilities in their search for housing under HUD's Housing Choice Voucher program. The Notice also clarifies issues related to the issuance and preservation of certain types of "special purpose vouchers" for families where the head of household, spouse or sole member is a person with disabilities.

• July 2004 - Department of Health and Human Services Office on Disability publishes progress report on HHS New Freedom Initiative activities http://www.hhs.gov/od/

• July 22, 2004 - Executive Order: Individuals with Disabilities in Emergency Preparedness

• July 9, 2004 - HHS Approves Texas Plan To Help More Disabled Individuals At Home

• July 7, 2004 - Statement by Tommy G. Thompson Secretary of Health and Human Services Regarding the 14th Anniversary of the Americans with Disabilities Act

• June 3, 2004 - HHS Identifies States for Medicare Demonstration of New, Less Restrictive Homebound Definition

• May 28, 2004 - HHS Expands Demonstrations to Recruit and Retain Personal Assistance Workers for People with Disabilities

• March 23, 2004 - The 2004 Progress Report: The President's New Freedom Initiative for People with Disabilities http://www.whitehouse.gov/infocus/newfreedom/toc-2004.html

• February 2004 - National Conference of State Legislatures Report on the States' Response to the Olmstead Decision: A 2003 Update The fourth annual Olmstead report categorizes current Olmstead-related plans, the role of the federal systems change grants, legislative initiatives, structural changes and implementation barriers.

• January 6, 2004 - CMS has redesigned and expanded its Promising Practices web page with new case studies on systems reform efforts to facilitate community integration of people with disabilities.

• November 5, 2003 - HHS Office on Disability (OD) co-sponsored with HUD, Fannie Mae, CMS and NIH a Symposium on Home ownership for Persons with Disabilities Web cast. To access this Symposium's resource materials go to: http://www.hhs.gov/od/webcast.html. Questions about homeownership or other affordable housing issues may be directed to the OD website at: http://www.hhs.gov/od/contactus.html
  
  
• October 30, 2003 - HHS to Award Individuals During Celebration of National Disability Employment Awareness Month http://www.hhs.gov/news/press/2003pres/20031030a.html
  
  

• October 2, 2003 - HHS Awards $33 Million to States, Other Organizations to Help People with Disabilities http://www.hhs.gov/news/press/2003pres/20031002a.html

• October 2, 2003 - HHS Launches Demonstrations to Recruit and Retain Personal Assistance Workers to Help People with Disabilities http://www.hhs.gov/news/press/2003pres/20031002.html

• September 25, 2003 - Statement by Tommy G. Thompson, Secretary of Health and Human Services Regarding the 13th Anniversary of the Americans with Disabilities Act http://www.hhs.gov/news/press/2003pres/20030725b.html

• September 22, 2003 - HHS Awards $9.3 Million to Help States Develop New Aging and Disability Resource Centers http://www.hhs.gov/news/press/2003pres/20030922a.html

• September 17, 2003 - CMS Dear State Medicaid letter on promoting the principle "Money follows the Person" (PDF)

• July 22, 2003 - The President's New Freedom Commission on Mental Health Delivers Final Report to White House



• August 12, 2002 - HHS Secretary Tommy Thompson Urges States to Continue to Expand Home and Community Based Care for Disabled Residents, Supports "Funding Follows the Person" Model



• March 25, 2002 - HHS Secretary Tommy G. Thompson presented to President Bush reports from nine federal agencies entitled "Delivering on the Promise; Compilation of Individual Federal Agency Reports of Actions to Eliminate Barriers and Promote Community Integration". The reports provided more than 400 specific solutions that agencies can implement to support community living for Americans living with disabilities. The reports were undertaken in response to President Bush Executive Order on Community-based Alternatives for People with Disabilities and the President's New Freedom Initiative.



• February 1, 2001 - President Bush announces the New Freedom Initiative as part of a nationwide effort to remove barriers to community living for people with disabilities. The initiative's specific proposals include HHS to promote full access to community life through implementation of the Olmstead Supreme Court decision; integrate Americans with disabilities into the workforce through implementation of the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA); and the creation of the New Freedom Commission on Mental Health.

HHS Grants and Activities to Promote Community Integration

• October 30, 2003 HHS Announces More Than $8 Million in Medical Reserve Corps Grants
  http://www.hhs.gov/news/press/2003pres/20031030.html



• October 2, 2003 HHS Awards $33 Million to States, Other Organizations to Help People with Disabilities (October 2, 2003)
  http://www.hhs.gov/news/press/2003pres/20031002a.html



• October 2, 2003 HHS Launches Demonstrations to Recruit and Retain Personal Assistance Workers to Help People with Disabilities
  http://www.hhs.gov/news/press/2003pres/20031002.html



• September 22, 2003 HHS Awards $9.3 Million to Help States Develop New Aging and Disability Resource Centers
  http://www.hhs.gov/news/press/2003pres/20030922a.html



• April 15, 2003: HHS announces promising findings from a demonstration project jointly supported by HHS and the Robert Wood Johnson Foundation on self-directed services for persons with disabilities
  http://www.hhs.gov/news/press/2003pres/20030415.html



• March 11, 2003: HHS approves South Carolina Medicaid plan to enable people with disabilities to control their care at home
  http://www.hhs.gov/news/press/2003pres/20030311.html



• February 24, 2003: HHS awards $2.5 million to five states to enable more disabled persons to work
  http://www.hhs.gov/news/press/2003pres/20030224.html



• February 20, 2003: HHS to provide home health quality information to improve quality of care provided by home health agencies
  http://www.hhs.gov/news/press/2003pres/20030220.html



• February 12, 2003: HHS approves Florida Independence Plus waiver to allow more people with disabilities to control their care
  http://www.hhs.gov/news/press/2003pres/20030212.html

Last revised: July 3, 2008

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