It has been 20 years since the U.S. Supreme Court ruled in Olmstead v. L.C. that unjustified institutionalization of individuals with disabilities by a public entity is a form of discrimination under the Americans with Disabilities Act of 1990 (ADA, P.L. 101-336). As a result, states are generally required to provide community-based care to such individuals.
This ruling encouraged state Medicaid programs to rebalance delivery of long-term services and supports from institutional care to home- and community-based services (HCBS). In the past twenty years, Medicaid spending has shifted toward HCBS, supported by multiple efforts underway at the federal and state levels to serve more beneficiaries in their communities.
This brief provides the historical context for understanding Olmstead v. L.C. and its implications for Medicaid. It then provides an overview of federal and state rebalancing initiatives, and describes ongoing enforcement of Olmstead v. L.C.