Disability Pride Month: The Olmstead Decision Turns 25
July is Disability Pride Month. But just weeks ago, on June 22nd, the disability rights community had another reason to celebrate. It was the 25th anniversary of the Supreme Court’s decision in Olmstead v. L.C., 527 U.S. 581, 119 S.Ct. 2176, 144 L.E.2d 540 (1999). In Olmstead, two women with intellectual disabilities and diagnosed mental disorders, Lois Curtis and Elaine Wilson, were patients at the Georgia Regional Hospital in Atlanta, a state institution funded by Medicaid. They sued under Title II of the Americans with Disabilities Act to be moved to a less-restrictive, community-based setting.
Justice Ginsburg’s majority opinion held that Title II requires state governments to place people with disabilities in community-based settings when treatment professionals have found those settings to be appropriate for the individual, the individual does not oppose transfer to a less restrictive setting, and the placement can be reasonably accommodated. Reasonable accommodation does not require states to “fundamentally alter” their programs or greatly increase funding to them.
The Disability Integration Project at the Atlanta Legal Aid Society, the organization which brought the case on behalf of Lois Curtis and Elaine Wilson, has a wonderful Olmstead Rights website including an I am Olmstead series of video interviews of people who were deinstitutionalized because of the rights guaranteed by the Olmstead decision. The Bazelon Center for Mental Health Law features Curtis’s story in a short video and she was also featured in our 2022 Black History Month: Celebrating Black Disability Rights Activists blog post. The Department of Justice, Civil Rights Division, features videos of many other people who were freed to live in their communities because of the decision.
Understanding Olmstead requires a basic understanding of the Medicaid waiver system. Until 1981, Medicaid primarily funded institutional care in nursing homes and state institutions for people with intellectual disabilities or mental illness. The Home and Community-Based Services (HCBS) Waiver system, enacted in the Omnibus Budget Reconciliation Act of 1981, allowed people to receive medical care outside of these institutions, often living in small group homes or family settings. Court decisions in the late 1970s and early 1980s were beginning to order deinstitutionalization of state facilities because of poor quality of care and lack of freedom for patients who could thrive in a less restrictive environment but who were institutionalized in order to receive needed care. Because Medicaid is funded by both state and federal appropriations and administered by state governments, states have waiting lists for HCBS services. Olmstead gives institutionalized people on the waiting list preference over non-institutionalized people when they can be successfully reintegrated into their communities.
Deinstitutionalization has garnered some of the blame for our nation’s poor treatment of people with mental illness. Olmstead is a civil rights decision freeing people from unnecessary confinement simply because states preferred institutions over community-based treatment. It applies to all people with disabilities, not just those with mental disabilities, and has limits based upon state government’s ability to plan and pay for community-based treatment.
In Townsend v. Quasim, 328 F.3d 511 (9th Cir. 2003), the Ninth Circuit applied Olmstead to Washington’s HCBS plan as explained in Home and Community-Based Services, Olmstead, and Positive Rights: A Preliminary Discussion, 39 Wake Forest L. Rev. 269, 284–285 (2004):
The Ninth Circuit Court of Appeals, in Townsend v. Quasim, ruled that a state’s denying HCBS waiver services to one group of Medicaid beneficiaries, while granting services to another constitutes a violation of the ADA, subject to a defense that extension of the eligibility would constitute a fundamental alteration. The court held that a person who could not live without assistance but whose income was too high for him to be deemed “categorically needy,” could not be offered services only in a nursing home, which was all that the state allowed for individuals deemed “medically needy.” The court had no difficulty applying Olmstead to the case, holding that the state had to provide the services in the adult group home where the plaintiff lived, rather than offering them only in a nursing facility.
The Ninth Circuit held that DSHS was violating Title II of the ADA by failing to provide long term care in an integrated community setting rather than a nursing home.
Olmstead does not require DSHS to increase the number of slots on the HCBS waiting lists (see Arc of Washington State Inc. v. Braddock, 427 F.3d 615 (9th Cir. 2005)). But Olmstead has been successfully used to keep DSHS from reducing the types of in-home personal care services offered under Washington’s Medicaid plan (see M.R. v. Dreyfus, 697 F.3d 706 (9th Cir. 2011)). Current DSHS Medicaid community-based programs exist for people with intellectual disabilities, behavioral health needs, and elders and others with long-term disabilities. Olmstead class action litigation is technical and complicated, yet critical for ensuring the rights of people with disabilities. Disability Rights Washington has an informative summary of the Olmstead caselaw in Washington.
Learn more about the impact of the Olmstead decision, barriers that still exist to community living for individuals with disabilities, and current efforts to embed Olmstead in federal policy in the U.S Administration for Community Living’s Celebrating the 25th Anniversary of Olmstead v. L.C. video here. (RM)
