Olmstead v. L.C.: Judicial and Legislative Developments in the Law of Deinstitutionalization

Emily C. Barbour
Legislative Attorney

The Supreme Court ruled in Olmstead v. L.C., 527 U.S. 581 (1999), that, under Title II of the Americans with Disabilities Act (ADA) and its implementing regulations, states must transfer individuals with mental disabilities into non-institutional settings when: a state treatment professional has determined such an environment is appropriate; the community placement is not opposed by the individual with a disability; and the placement can be reasonably accommodated. In subsequent litigation, appellate courts have (1) rejected interpretations of Olmstead that would make it more difficult to establish a prima facie violation and (2) distinguished “reasonable accommodations,” which Olmstead requires states to make to their programs and services, from “fundamental alterations,” which it does not.

In addition to these judicial developments, the 2010 health care reform package, the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148) as amended by the Health Care and Education Reconciliation Act (HCERA, P.L. 111-152) (collectively, the Affordable Care Act, or ACA), has the potential to influence states’ Olmstead initiatives. The health care reform law revises the federal Medicaid statute to give states greater incentives to provide home and community-based care services to people with disabilities, offer states greater flexibility in the kinds of packages of home and community-based services they can offer, and, perhaps, enable states to provide more Medicaid beneficiaries with long-term care services in their communities. Because judicial developments under Olmstead often occur in the context of federal Medicaid law, particularly Medicaid waiver programs, the health care reform law’s changes to the Medicaid program may affect the outcome of future cases on deinstitutionalization.

This report will discuss the Supreme Court’s decision, selected subsequent appellate court decisions, the implications of health care reform for future developments, and methods of Olmstead enforcement.


Date of Report: November 22, 2011
Number of Pages: 14
Order Number: R40106
Price: $29.95

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