Your browser doesn't support JavaScript. Please upgrade to a modern browser or enable JavaScript in your existing browser.
Skip Navigation U.S. Department of Health and Human Services
Agency for Healthcare Research Quality
Archive print banner

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to for current information.

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

Community-based Delivery Systems


Gregory Vadner, Director, Missouri Division of Medical Services, Jefferson City, MO.

Peter A. Sybinsky, Ph.D., then Deputy Secretary for Policy and Research, Indiana Family and Social Services Administration, Indianapolis, IN.

Missouri established an Olmstead Planning Commission to lead the State's efforts to identify needs and barriers to community-based living for persons with disabilities and to develop a comprehensive plan for integrating these persons into the community. The mission of the planning commission was to:

  • Catalog existing services for persons with disabilities.
  • Determine whether and to what extent the programs complied (or did not comply) with the requirements of Olmstead and other Federal guidance.
  • Involve the public in the evaluation process.
  • Make recommendations to the Governor about program changes that were needed to comply with Olmstead.

Commission members included:

  • State officials (Department of Social Services, Medicaid, Department of Mental Health, Office on Aging, Health Department, and Department of Education).
  • Advocates.
  • Representatives from the stakeholder groups.
  • Legislators.

The Commission emphasized public participation and willingness to listen by holding statewide meetings and taking public testimony. The Commission's work culminated in a 60-page report that outlines problems, needs, and potential solutions. Housing issues emerged as the number one barrier to community-based living, including:

  • Lack of available housing.
  • Lack of affordable housing.
  • Lack of accessible housing.
  • Concerns about the neighborhood in which available housing was located.

The second most important issue of concern was lack of adequate transportation. The Commission was successful in creating new partnerships and identifying needs, but State budget constraints will make implementation of the Commission's recommendations difficult.

Like Missouri, Indiana also established a formal process to identify needs and develop a plan for providing community-based services to persons with disabilities. An environmental scan showed a bias toward institutional care, a desire to reduce institutional capacity, and passage of legislation promoting independent community living (e.g., Ticket to Work and consumer-directed care legislation).

In developing its plan, Indiana focused on five priorities:

  • Increasing consumer choice.
  • Increasing opportunities for informed consumer choice.
  • Strengthening oversight strategies (e.g., Quality Assurance).
  • Increasing capacity to develop and maintain high-quality services.
  • Workforce development.

Indiana's planning process strengthened existing partnerships, forged new ones, and led to increased communication, openness, and responsiveness among the participants. This process is still in its infancy, with a number of issues yet to be resolved, including funding and legal issues.

Additional Resources

Carnahan M. Executive order 00-09. Jefferson City (MO): Office of the Governor, State of Missouri;1999 Jun.

Comprehensive plan for community integration and support of persons with disabilities. Indianapolis (IN): Family and Social Services Administration, State of Indiana;2001 Jun.

Governor's Council on Disability. Executive summary: Improving Missouri's delivery system for persons with disabilities: Final report and recommendations. Jefferson City (MO): Missouri Department of Labor and Industrial Relations;2000 Dec.

Holden B. Executive order 01-08. Jefferson City (MO): Office of the Governor, State of Missouri;2000 Apr.

Previous Section Previous Section       Contents         Next Section Next Section

The information on this page is archived and provided for reference purposes only.

AHRQ Advancing Excellence in Health Care