Jan. 14, Sec. Donna Shalala wrote to all 50 Governors reminding them that
"most integrated setting" is the LAW.
Health Care Financing Administration (HCFA) in Baltimore, Maryland distributes
Medicaid money to states.
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.
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.
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.
Olmstead Update No: 2
Olmstead Update No: 3
HCFA's federal boss is Donna Shalala, the U.S. Secretary
of Health and Human Services
Donna Shalala's speech to The National Conference of State Legislators,
July 28, 1999.
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.
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.
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.
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.
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.
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.
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."
Shalala, US Secretary of Health & Human Services