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Beyond Olmstead: Community-Based Services for All People with Disabilities

Policy & Planning Implications


Claudia Schlosberg, J.D., Senior Civil Rights Analyst and Policy Advisor, Office of Civil Rights, U.S. Department of Health and Human Services, Washington, DC.

Sara Rosenbaum, J.D., Director, Center for Health Services Research and Policy, George Washington University Medical Center, Washington, DC.

The Federal Office for Civil Rights (OCR) coordinates civil rights activities within the U.S. Department of Health and Human Services to ensure that civil rights laws are enforced. OCR enforces civil rights laws by:

  • Conducting outreach and providing education and technical assistance on civil rights laws and how to comply with them.
  • Investigating complaints and conducting compliance reviews.
  • Seeking voluntary compliance with civil rights laws.
  • Applying sanctions and penalties and initiating legal action when necessary.

OCR, in partnership with the Centers for Medicare & Medicaid Services (CMS), established a task force to help implement the recent Olmstead ruling, in which the Supreme Court interpreted Title 2 of the Americans with Disabilities Act (ADA) as a mandate for public entities to provide services to persons with disabilities in the most integrated setting appropriate for their circumstances. Therefore, inappropriate institutionalization is discrimination and consequently illegal under the ADA.

Under Olmstead, public entities have an affirmative duty to remedy discrimination by making reasonable modifications, but they are not required to make fundamental alterations. The obligation to make reasonable modifications can be met in the following ways:

  • Develop and implement comprehensive plans to provide services for people in less restrictive settings.
  • Ensure that waiting lists for services in community-based settings move at a reasonable pace.

The Bush Administration fully supports the principles of the Olmstead decision through the New Freedom Initiative, which seeks to remove barriers to participation in community life for Americans with disabilities and through Executive Order 13217, which commits the United States to full enforcement of Title 2 of the ADA, including developing community-based alternatives for all persons with disabilities. Federal assistance will be provided to States to develop community-based options, and Federal agencies will coordinate their efforts to support the development of community-based options for the disabled.

The Center for Health Services Research and Policy (CHSRP) at the George Washington University provides research and analytic support to the Office of Civil Rights in the area of Title 2 of the ADA and implementation of the Olmstead decision. CHSRP analyzed 334 Olmstead complaints pending with OCR. The complaints were placed into an anonymous database and studied to:

  • Determine their implications for policy and long-term planning.
  • Increase understanding of the unmet needs of persons with disabilities.
  • Identify barriers to moving to and living successfully in the community.
  • Provide insight into effective resource allocation.

Findings from the CHSRP study as of April 2001 include the following:

  • Complaints by region: Complainants tended to be from Eastern and Midwestern States.
  • Type of complainant: Most of the complaints came from individuals, although many were received from advocacy groups.
  • Age of complainant: The largest group of complainants were working adults ages 50 to 64.
  • Residential status of complainant: Most of the complaints were from people living in institutions (nursing facilities) at the time of filing.
  • Living arrangement of complainant: Approximately one-half of the complainants lived at home with one or more family members.
  • Nature of disability of complainant: The single most common type of disability among complainants was physical.
  • Complainant's service request: There were approximately 2 service requests per complaint. The most common service requests were for transportation, in-home care, housing, and equipment. The most common service request among complainants under age 21 was housing.

Policy and planning implications of the CHSRP study are that State and Federal policymakers should focus their attention on providing community-based services for adults with serious physical disabilities who have family support (e.g., live with one or more family members) and require services that are not reimbursed by Medicaid.

Additional Resources

Rosenbaum S. Memorandum to Dr. Stephen Somers, President of the Center for Health Care Strategies: Olmstead v. L.C. analysis and implications for Medicaid policy. Washington (DC): Georgetown University, Center for Health Services Research and Policy; 1999 Jul.

A blueprint for new beginnings: Assist Americans with disabilities. Washington (DC): The White House, Office of the Press Secretary; 2001 Jun. bud08.html

Executive order: Community-based alternatives for individuals with disabilities. Washington (DC): The White House, Office of the Press Secretary; 2001 Jun.

Fact sheet: President Bush highlights commitment to Americans with disabilities. Washington (DC): The White House, Office of the Press Secretary; 2001 Jun.

Zimring J. Olmstead v. L.C. Washington (DC): United States Supreme Court; 1999 Jun.

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