Day 39 – Medicaid at 50: Olmstead Decision

On this day in 1999 a lawsuit was brought to the Supreme Court that radically changed the way long-term care services were offered in states. The case, brought by two women in Georgia centered around the desire of both of these women to live in the community rather than an institutional setting. Lois Curtis and Elaine Wilson lived in state run nursing care facilities to treat mental illness. Using the Americans with Disabilities Act (ADA) as a backbone, the plaintiffs believed that the state’s requirement that they lived in an institutional setting violated their rights to live in an integrated care setting.

In a 6 to 3 decision, the Supreme Court found that institutionalization was the same as isolationism and that violated the rights of people with disabilities to live in the home or community settings. Their argument was that living in institutions prevent people from engaging in commerce and other activities that prevent them from living a normal life.

After this decision, states are required to provide Medicaid enrollees with the option to utilize services in the home or community setting so long as the enrollee’s providers determine the placement in that setting is appropriate, the person wants to live in the home or community, and the placement in the home or community setting can be accommodated. This last provision takes into account state resources and the needs of other enrollees in the program. Essentially, the court allowed some flexibility on how the home and community benefits could be provided and noted that they would not be unlimited in the home and community setting. But what is important in this decision is that it marked an end to state sanctioned mandatory institutionalization of people living with disabilities and physical or mental illness. The Supreme Court decision put the power to make the care decision in the hands of the consumers of care.

Happy 16th birthday Olmstead decision!

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