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Olmstead is a Supreme Court ruling that says it is unlawful for governments to keep people with disabilities in segregated settings when they can be supported in the community. This means that states must offer services in the most integrated setting, including providing community based services when possible.  Medicaid (a government insurance program for individuals whose income and resources are insufficient to pay for health care) 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.

Medicaid is important because of its unique role in financing the home and community-based services (HCBS) that enable individuals in institutions to return to the community and those at risk of institutionalization to remain in the community with support, although historically, Medicaid has had a structural bias toward institutional care because state Medicaid programs must cover nursing facility services, whereas most HCBS are provided as a state option.

Themes emerging from recent Olmstead cases highlight Medicaid’s role in

  • providing community-based services instead of institutionalization;
  • providing services in the most integrated setting to enable people with disabilities to interact with non-disabled peers to the fullest extent possible;
  • providing community-based services to prevent institutionalization for people at risk;
  • replacing sheltered workshops with supported employment; and
  • eliminating disability-based discrimination within the Medicaid program

For more information

(image description: a blue slide that says, The Integration Mandate Looking back at the Supreme Court’s Olmstead decision – and forward)


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