The Olmstead Decision Five Years Later: How Has It Affected Health Services and the Civil Rights of Individuals with Disabilities?

For decades, it was routine in the U.S. to house individuals with disabilities in institutions. Those with mental illnesses, for instance, were placed in “insane asylums,” as they were once called. The U.S. Supreme Court took a firm step toward ending this practice five years ago. In the Olmstead v. L.C. decision, the court found that institutional isolation of individuals with disabilities was, under certain circumstances, a violation of the Americans with Disabilities Act.

What was the significance of the Supreme Court decision for Medicaid beneficiaries? What has been the practical impact of the decision five years later? Are more individuals with disabilities being served today in Medicaid home and community-based settings, rather than in institutions, as compared to 1999? Has the mix or quality of services changed? How have recent state budget constraints affected the response to the Olmstead decision? Overall, what is the state of states’ progress in complying with Olmstead?

To help address these questions and others, the Alliance for Health Reform and the Kaiser Commission on Medicaid and the Uninsured sponsored a June 21, 2004 briefing. Panelists were: Eileen Elias, deputy director of the HHS Office on Disability; Michael Gottesman, of Georgetown University, who was the plaintiff’s attorney in the Olmstead case; Tim Westmoreland, a senior Medicaid official in 1999 and now a visiting professor of law at Georgetown; Matt Salo, director of the Health and Human Services Committee at the National Governors Association; Tom Perez, former head of the HHS Office for Civil Rights and now on the law faculty at the University of Maryland; and Bob Williams, former commissioner of the Administration on Developmental Disabilities. Ed Howard of the Alliance and Diane Rowland of the Kaiser Commission moderated the discussion.