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Community Living Efforts and People with Disabilities

Author: Wendy Taormina-Weiss : Contact: Disabled World

Published: 2012-04-19 : (Rev. 2016-10-08)

Synopsis and Key Points:

People with disabilities must have the maximum number of opportunities and choices to receive long-term services and support in the community.

Main Digest

The Olmstead case found the Court holding that unjustified institutionalization of people with disabilities constitutes a form of unlawful discrimination under the Americans with Disabilities Act.

Since the time of the Court's ruling, a number of people with disabilities have been transitioned out of institutions and into community settings, although the waiting lists for community services has grown considerably. Many people with disabilities who want to live in their own communities and receive services find themselves unable to do so, leaving America in a state of ongoing violation of the rights of people with disabilities.

The Obama Administration, with the goal of ending this ongoing discrimination, provided more than $140 million through Recovery Act funding to Independent Living Centers across America. While the Administration is aware that a certain amount of progress has been made, it is also aware that there is a great deal of work left to do. People with disabilities must have the maximum number of opportunities and choices to receive long-term services and supports in their own communities if this ongoing discrimination against us is to end.

President Obama, in regards to the Community Living Initiative and in a statement acknowledging both the Olmstead ruling and our civil rights stated, "The Olmstead ruling was a critical step forward for our nation, articulating one of the most fundamental rights of Americans with disabilities: Having the choice to live independently. I am proud to launch this initiative to reaffirm my Administration's commitment to vigorous enforcement of civil rights for Americans with disabilities and to ensuring the fullest inclusion of all people in the life of our nation."

The Department of Health and Human Services (HHS), the Center for Medicare and Medicaid Services (CMS), and the Department of Housing and Urban Development (HUD), in response to the President's call for a Year of Community Living initiative in the year 2009, pursued several efforts. Through its own department and other Federal departments, HHS made efforts to ensure our right to live meaningful lives in our own communities. HHS finds itself with new authority under the Affordable Care Act (ACA), and the Department of HHS perceived the President's statement as a command to enhance opportunities for people with disabilities to live as full members of our communities. Efforts the HHS made include the following.

Housing Vouchers:

The Center for Medicare and Medicaid Services (CMS) partnered with HUD to apply $40 million in, 'Housing Choice vouchers,' for 5,300 people with disabilities over a 12 month period of time.

Stakeholder Dialogs:

The Department of Health and Human Services hosted dialogs with stakeholders from around America, to include state and local officials, as well as members of the community. The people involved offered information that is informing public policy and practice and is helping to better meet the needs of people with disabilities and seniors - especially people who experience chronic conditions.

Opportunities for Public Input:

Through the, 'Advanced Notice of Proposed Rule-making (ANPRM), which was published as a portion of the Year of Community Living, members of the public were able to comment on specific potential changes to the, '1915(c) Home and Community-based Services (HCBS) waiver program' - to include combining of target groups within these waivers and identification of key characteristics of settings where HCBS may be provided. The ANPRM also enabled people to comment on person-centered planning and how to ensure that services are provided to individuals with disabilities in ways that meet both their needs and preferences. Upon review of the more than 300 comments submitted by the public, the Department of HHS planned a, 'Notice of Proposed Rule-making (NPRM),' to address the issues the public raised, as well as to solicit more input from stakeholders.

The, 'Money Follows the Person':

The CMS is working to fulfill a promise contained within the Affordable Care Act (ACA) that will make, 'money follow the person,' to their own community. Extension of a demonstration grant program through the year 2016, as well as taking advantage of an appropriation of $2.25 billion, finds CMS with the ability to award grants to 13 additional states through 2016. What this means is the total number of grantees participating in the demonstration now equals 43. The law also allows states to transition people with disabilities out of institutions more rapidly through reduction of the eligibility requirements for a participant to be institutionalized from a period of 6 months to 90 days.

HHS and Civil Rights Enforcement:

The Health and Human Services' Office for Civil Rights (OCR) is committed to ensuring compliance with the ADA, as well as the Supreme Court's Olmstead decision. Between April of 2000 and April of 2010, the OCR investigated more than 500 Olmstead complaints, achieving corrective action in nearly 60% of the complaints filed. Along with resolving individual complaints, the OCR investigated systemic and state-wide violations of the ADA and the Olmstead decision.

Housing Resource Coordinators (HRC's):

After collaborating with state and local human services and housing agencies, CMS funded grantees to establish HRC's to sustain the relationships. HRC's worked with human service agencies to identify accessible and affordable housing needs of persons with disabilities within a particular state, as well as to facilitate the use of the information to inform future development and distribution of housing resources.

The Community Living Initiative and (HUD)

A number of, 'Money Follows the Person,' grantees have created or enhanced housing registries. HHS and HUD collaborated and offered funding opportunities to support people at risk of institutionalization to remain in their own communities and to people who were interested in returning to their communities from institutions. The initiative resulted in the award of 5,300 housing vouchers to younger people with disabilities.

The original 30 Money Follows the Person grantees have transitioned 12,000 people with disabilities from institutions into their own communities with the services and supports they need. The program reimburses states at an enhanced Federal level for services for every participant who is enrolled for a year after their transition.

Nursing Institutions and the Minimum Data Set (MDS)

Nursing facilities, also referred to as, 'long-term care facilities,' or, 'nursing institutions,' use something called a, 'minimum data set (MDS).' The MDS 3.0 has a number of new enhancements which are more, 'person-centered,' and among these new enhancements is a particular section. Section Q addresses, 'resident discharge planning,' and nursing institutions are now required to directly ask residents if they are, "interested in learning about the possibility of returning to the community."

If a person states that yes, they are interested in returning to the community, the nursing institution they are in is required to make appropriate referrals to community integration agencies. The agencies include ones such as Aging and Disability Resource Centers (ADRC's), State Medicaid Agencies, Centers for Independent Living, and Area Agencies on Aging.

The United States Government, through the Administration in Office and a number of departments, is making efforts to ensure that People with Disabilities in America have the ability to live in our own communities and our rights as citizens. Unfortunately, far more than 200 years of ingrained stigma, prejudice, and the practice of placing us into institutions instead of seeking to include us in society finds the task of ensuring our inclusion and rights to be large. It is exceptionally difficult and trying to imagine a reversal of the policies and practices that are currently being pursued, or a lack of effort on the part of any future administration to continue pursuing efforts to include our nation's largest minority population - People with Disabilities, in society.

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