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The Olmstead Decision


Picture of West pediment above main entrance to U.S. Supreme Court building, showing 'Equal Justice Under Law' inscription.

On June 22, 1999, the United States Supreme Court held in Olmstead vs. L.C. that the unnecessary segregation of individuals with disabilities in institutions may constitute discrimination based on disability. The court ruled that the Americans with Disabilities Act (ADA) may require states to provide community-based services rather than institutional placements for individuals with disabilities. The official summary of that decision can be seen at:

This decision has far-reaching consequences at both the federal and state level. See the National Disability Rights Network (NDRN) -- formerly the National Association of Protection and Advocacy Systems (NAPAS) -- website at:
This website has information about the development of state-level plans for moving unnecessarily institutionalized persons into the community with support. The same website has information on subsequent case law and on tools that advocates and states can use in developing state plans.

The decision has implications for many programs, including those involving employment, housing, medical care, and other aspects of daily living. On June 19, 2001, President George W. Bush issued an Executive Order based on the Olmstead decision that is having far reaching consequences. The Executive Order can be seen at:

On June 19, 2001, the Department of Housing and Urban Development (HUD) announced its new pilot programs for Independent Living and Home Ownership for people with disabilities. The announcement can be seen at:

The federal agency that administers the Medicaid and Medicare programs is reviewing all of its regulations, policies and previous guidance to assure that they are compatible with the requirements of the ADA and Olmstead decision, and facilitate States' efforts to comply with the law. More information about the efforts of the Centers for Medicare and Medicaid Services (CMS) can be seen at:

The Centers for Medicare and Medicaid Services (CMS) has also established a Web Site to help states share "promising practices" of innovative programs that states have adopted to strengthen their community long-term support systems. These promising practices are targeted towards diverse populations and usually supported by a combination of funding mechanisms, such as the Medicaid Home and Community Based Services (HCBS) waiver program, regular Medicaid state plan options, programs funded by other federal agencies, and state and local resources. The Web site is:

On March 25, 2002 Health and Human Services (HHS) Secretary Tommy G. Thompson presented to President Bush reports from nine federal agencies entitled "Delivering on the Promise: Compilation of Individual Federal Agency Reports of Actions to Eliminate Barriers and Promote Community Integration". The reports are published on the HHS website at:
The reports outline more than 400 specific solutions agencies can implement to support community living for the nearly 54 million Americans living with disabilities. The reports stem from the first comprehensive federal review of barriers preventing people with disabilities from living in their communities instead of in institutions which was undertaken in response to President Bush's Executive Order on Community-based Alternatives for People with Disabilities and the President's New Freedom Initiative.

HHS's Office of Civil Rights has a list of links to information about State initiatives relevant to the Olmstead decision. It can be found at:

And finally, the National Conference of State Legislatures has published a report detailing the responses of the States to the Olmstead decision. It can be found at:

Additional Information

New Freedom Initiative: State Coalitions to Promote Community-Based Care (Olmstead) logo

In order to assist States and Territories in their efforts to respond effectively to the needs of adults with serious mental illnesses and children with severe emotional disturbances, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Center for Mental Health Services (CMHS) are committed to providing leadership, guidance, resources, and technical assistance to aid in this process. To this end, SAMHSA has created an initiative to support State and local coalitions, by providing financial assistance, technical assistance and training to promote community-based care.

The New Freedom Initiative: State Coalitions to Promote Community-Based Care is charged with examining the characteristics and service needs of adults with serious mental illnesses and children with severe emotional disturbances; identifying the barriers to serving these individuals in the community; and exploring strategies to ensure their successful community living. The overarching goal of the initiative is to assist each State and Territory to develop or expand existing community integration plans for individuals with mental illnesses.

SAMHSA, aided by a working group and technical assistance team, provides resources, materials, training, and technical assistance to State and Territory coalitions. This support is intended to help these coalitions secure the investment of stakeholders, who will provide critical support and resources to assist individuals and families to obtain adequate housing, income, jobs, health and mental health treatment, and other necessary community supports. States and Territories have the opportunity to request both on and off-site technical assistance as part of their participation in this initiative.

A website,, is used to support State participants in this federal initiative, and to provide useful information to other individuals and organizations involved in efforts to promote community based care for adults with serious mental illness and children with severe emotional disturbances. The website offers free downloads of audio recordings, transcripts, PowerPoint presentations, and the bibliography from the National Teleconference: "Retraining the Workforce to Support Recovery". Additionally, you can order a free VHS tape or DVD of the film "Inside Outside: Building a Meaningful Life Outside the Hospital" about eight individuals with histories of long-term care in psychiatric hospitals, and their stories of returning to life in the community. The Olmstead Community website is online at:

See also:

A summary of the President's New Freedom Initiative may be found in the New Freedom Initiative topic.

Many additional activities from the New Freedom Initiative are discussed on the website.

More information about national and state Protection and Advocacy organizations may be found in the Protection and Advocacy Systems - Overview topic.

Read more about one type of institution that has been impacted by the Olmstead Decision in the Intermediate Care Facility for People with Mental Retardation (ICF/MR) topic.

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