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The word from the U.S. Department of Health and Human Services
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On Jan. 14, Sec. Donna Shalala wrote to all 50 Governors reminding them that "most integrated setting" is the LAW.
The Health Care Financing Administration (HCFA) in Baltimore, Maryland distributes Medicaid money to states.
A January 14, 2000 letter to state Medicaid directors from HCFA "outlines a framework" to get states to comply with last June's Olmstead Supreme court decision.
States now must have "a comprehensive, effectively working plan" for people to get services "in less restrictive settings." If the state has a waiting list, it must move "at a reasonable pace not controlled by the State's endeavors to keep its institutions fully populated," says the letter.
Since then there have been two followup letters from HCFA to State Medicaid Directors. The 2nd letter was co-authored by HCFA and the Office for Civil Rights. The 3rd letter shows the clear intent of HCFA to work with the States to improve and expand home and community-based services, in concordance with the Olmstead decision.
HCFA's federal boss is Donna Shalala, the U.S. Secretary of Health and Human Services
From Donna Shalala's speech to The National Conference of State Legislators, July 28, 1999.In June, the Supreme Court issued an important decision in a case that's familiar to many of you: the Olmstead case. The Court ruled that when a professional determines that a disabled individual can live in the community -- and can be served there effectively -- the person must be given the choice of doing so. If I were disabled I would want this choice -- and so would you.
In our view, the Court issued a very balanced and thoughtful decision in this case. Yes, the Court said, if community-based alternatives exist, then we are discriminating if a person who can benefit from community care -- and who wants to live in the community -- is institutionalized.
At the same time, the Court said we must acknowledge that states have limited resources. The Court's decision doesn't require any state to incur excessive new costs. it does, however, require states to move at a reasonable pace to provide community-based alternatives. And the Court also said states can meet their obligations by having comprehensive plans.
We support this. The Olmstead decision defines our mission: To build better systems of supports enabling people with disabilities to live life to the fullest. That's the job we need to do -- and I think we ought to welcome it.
As we move to implement the Olmstead decision, there are three basic principles that all of us can agree on, now We can agree that no American should have to live in a nursing home or state institution if that individual can live in a community with the right mix of affordable supports. We can agree that we all have the right to interact with family and friends in our communities...to make a living...and to make a life. And we can agree that it will take time, effort, creativity and commitment from all of us to make this a reality.
Over the past years, my department has initiated a lot of activities to help transition people out of nursing homes and other institutions. We've focused on expanding and promoting home and community-based services. We've offered support and technical assistance to states. And we've used the flexibility of the Medicaid program to pursue our goals. In just the last year, we've developed legislative proposals and funded state grants to move people out of nursing homes.
The Olmstead decision proves that we've been moving in the right direction. Now it's up to all of us to work together to implement the ruling as quickly as possible. To that end, we're ready to meet with you and others to discuss ways to work together to carry out the Olmstead decision. And that includes discussing the technical assistance we can provide. . . .
. . . Keep in mind that Olmstead furthers our ultimate goal: a nation that integrates people with disabilities into the social mainstream, promotes equality of opportunity, and maximizes individual choice."
Donna Shalala, US Secretary of Health & Human Services
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