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Olmstead’s Role in Community Integration for People with Disabilities Under Medicaid: 15 Years After the Supreme Court’s Olmstead Decision

June 2014 marks the 15th anniversary of the United States Supreme Court’s landmark civil rights decision in Olmstead v. L.C., finding that the unjustified institutionalization of people with disabilities is illegal discrimination.1  Although the Olmstead ruling is based on states’ obligations under the Americans with Disabilities Act (ADA), the Medicaid program plays a key role in making the ADA’s community integration mandate a reality. This is because Medicaid is the major source of financing for the long-term services and supports (LTSS) on which people with disabilities rely to live independently and safely in the community.

While many cases are resolved without involving the courts, during the last 15 years, the lower courts have had the opportunity to apply the Supreme Court’s Olmstead holding in a number of contexts, resulting in decisions furthering the implementation of the ADA’s community integration mandate.  While some cases are brought by individual plaintiffs, the United States Department of Justice (DOJ) also plays an active role in enforcing Olmstead.  This issue brief examines the legacy of Olmstead, with an emphasis on legal case developments and policy trends emerging in the last five years, and highlights the important contributions of the Medicaid program to furthering and facilitating community integration for people with disabilities.2  This brief is not a review of state progress, but rather an examination of the role of the Court’s Olmstead decision and its enforcement in providing a legal vehicle for individuals in institutions, and those at risk of institutionalization, to gain access to services to enable them to live in the community.

Executive Summary Issue Brief