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Senator Harkin Releases Report Showing ADA’s Promise of Integration is Not Being Met for Many Americans with Disabilities

July 18, 2013
Source: U.S. Senate

A Senate Health, Education, Labor, and Pensions (HELP) Committee report unveiled today by Chairman Tom Harkin (Democrat-Iowa) revealed that 14 years later, many states are failing to live up to the integration mandate of the Americans with Disabilities Act. The Supreme Court ruled in Olmstead v. L.C. in 1999 that the unnecessary segregation of individuals with disabilities in institutions is a violation of the Americans with Disabilities Act, thus directing states to enable community-based long-term care services for these Americans.

The report, titled “Separate and Unequal: States Fail to Fulfill the Community Living Promise of the Americans with Disabilities Act,” is the result of requests for information sent by Chairman Harkin to all 50 states on the progress made to transition individuals out of institutions. Harkin, who is the Senate author of the landmark Americans with Disabilities Act, has long sought to ensure that all Americans have a real choice to receive Medicaid-funded care in the community. Today’s report is a comprehensive review of the types of community-based services states provide to individuals with disabilities compared to the institution-based services they must provide.

The report reveals that almost a quarter of a million working-age Americans remain unfairly segregated in nursing homes, and the number of working-age Americans with disabilities confined to nursing homes is actually growing. While progress has been made nationally, by 2010 only 12 states spent more than 50 percent of Medicaid funds on community-based care instead of institutional care.

“The Supreme Court’s decision in Olmstead was a landmark moment for the disability community – holding that the ability to live in the community is a protected civil right under the Americans with Disabilities Act. Yet my report reveals that 14 years later, many states are still not making a commitment to provide all individuals with disabilities the choice to live in their own homes and communities. This is amazing given that study after study has shown that home and community-based care is not only what people want, but is more cost-effective,” Harkin said. “The report makes clear that we need to honor the anniversary of the ADA by redoubling our efforts to give people with disabilities who remain in institutions a chance to experience the same dignity and freedom—the same shot at the American Dream—as every other citizen.”

“Congress and our federal government can take additional steps to improve progress on Olmstead and fulfill the promise of independent living for Americans with disabilities that require long-term services and supports,” Harkin continued. “States must set clear benchmarks to make the right to live in the community a real choice for all Americans with disabilities.”

The HELP Committee report makes key policy recommendations to better ensure that the choice to live in the community becomes a reality for all Americans. These recommendations include an amendment to the ADA to clarify and strengthen the law’s integration mandate in a manner that accelerates implementation and clarifies that every individual who is eligible for long-term services and supports (LTSS) under Medicaid has a federally protected right to a real choice in how they receive services and supports. The report also recommends Congressional action to amend the Medicaid statute to end the institutional bias in the program by requiring every state that participates in the Medicaid program to pay for home and community-based services (HCBS) — just as every state is required to pay for nursing homes, for those who are eligible.

The full report, with executive summary, can be found at (PDF, 110 pages).

A copy of responses from states can be found at (PDF, 638 pages).

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