The Olmstead Decision and Long Term Care in California

Eliot Z. Fishman, Bruce C. Vladeck, Ann-Gel S. Palermo, and Margaret H. Davis

This report examines the U.S. Supreme Court's landmark decision limiting the power of states to place people with disabilities in institutions as a condition for providing them with publicly funded health coverage and explores the likely impact on long term care in California.

December 2003

Along with all other states, California is required to comply with the U.S. Supreme Court's 1999 landmark Olmstead decision, which concluded that confining persons with disabilities in institutions without adequate medical reasons is a form of discrimination that violates the Americans with Disabilities Act. In Olmstead, the Supreme Court held that states cannot make institutionalization a condition for publicly funded health coverage unless it is clinically mandated. Instead, states must direct their health programs for persons with disabilities towards providing community-based care.

This report finds that although California's long term care system has distinct strong points, glaring problems will hinder the state's ability to comply with Olmstead unless resolved. These include the paucity of alternatives to nursing homes for people who need more than part-time unskilled personal assistance.

California's long term care programs and services for the frail elderly, physically disabled, people with mental illness, and people with developmental disabilities are examined, and comparisons are made with three states (Colorado, Washington, and Wisconsin) that have successfully reduced institutionalization, shifting resources into home and community-based services while holding down growth in overall costs. The report makes several specific recommendations for solving lingering problems and spurring the state's fulfillment of the Olmstead mandate.

The full report is available under Document Downloads below.