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The Olmstead Supreme Court decision re-affirmed that states must provide services in the "most integrated setting."
Earlier cases laid the groundwork for arguing that states cannot require people to be in nursing homes or other institutions in order to receive assistance with personal needs:
In Helen L. v. DiDario (46 F.3d 325 (3rd cir.), cert. denied, 516 U.S. 813 (1995)), a Medicaid nursing home resident alleged that the Pennsylvania Department of Public Welfare violated the ADA by requiring her to receive services in a nursing home rather than in her own home through a state-funded personal care program for which she qualified. The court held that the state's failure to provide services in the "most integrated setting" appropriate to the individual's needs violated the ADA. Additionally, the court found that the provision of personal care to the plaintiff would not fundamentally alter any state program because the services were already within the scope of an existing program.
In Easely v. Snider (36 F.3d 297 (3rd cir.), rehearing and rehearing en banc denied, 36 F.3d 297, 306 (3rd cir. 1994)), individuals with disabilities in Pennsylvania filed a lawsuit, through their representatives, challenging a requirement that they be mentally alert in order to participate in the state's personal care program.
The court determined that given the essential goal of the program to foster independence for individuals limited by only physical disabilities, including individuals incapable of controlling their own legal and financial affairs in the program would constitute a fundamental alteration of the program. Therefore, the mental alertness requirement was found to be valid and not to violate the ADA.