ADA and Olmstead

Man in Wheelchair

The Americans with Disabilities Act

The Americans with Disabilities Act (ADA) was signed into law on July 26, 1990, by President George H.W. Bush. The ADA is one of America's most comprehensive pieces of civil rights legislation that prohibits discrimination and guarantees that people with disabilities have the same opportunities as everyone else to participate in the mainstream of American life -- to enjoy employment opportunities, to purchase goods and services, and to participate in State and local government programs and services. Modeled after the Civil Rights Act of 1964, which prohibits discrimination on the basis of race, color, religion, sex, or national origin – and Section 504 of the Rehabilitation Act of 1973 -- the ADA is an "equal opportunity" law for people with disabilities.

To fall under the protection of the ADA, individuals must: (1) have a physical or mental impairment that substantially limits one or more major life activities; (2) have a record of such impairment; or, (3) be regarded as having such impairment. The ADA does not specifically name all of the impairments that are covered, and an estimated 54 million people in the United States have a disability that meets the standard for coverage under the ADA.

The ADA has four main titles, which prohibit discrimination on the basis of disability in employment, State and local government, public accommodations, commercial facilities, transportation, and telecommunications. It also applies to the United States Congress.

Current Law

The Americans With Disabilities Act of 1990, As Amended

The ADA’s Integration Regulation

To address the segregation of individuals with disabilities, Title II of the ADA employs broad language in outlawing discrimination by public entities, stating that:

“[N]o qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity. ” (42 U.S.C. § 12132). Upon passage of the ADA, Congress directed the Attorney General to promulgate regulations implementing this provision. Known as the ‘integration mandate,’ the Title II regulations require public entities to “administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities.” (28 CFR § 35.130(d)).

According to the Department of Justice, “the most integrated setting” is one that “enables individuals with disabilities to interact with nondisabled persons to the fullest extent possible ...” In guidance released in 2011, DOJ further explained that integrated settings are those that provide individuals with disabilities opportunities to live, work, and receive services in the greater community, like individuals without disabilities.

The ADA’s integration regulation is implicated where a public entity administers its programs in a manner that results in unjustified segregation of persons with disabilities. More specifically, a public entity may violate the ADA’s integration mandate when it: (1) directly or indirectly operates facilities and or/programs that segregate individuals with disabilities; (2) finances the segregation of individuals with disabilities in private facilities; and/or (3) through its planning, service system design, funding choices, or service implementation practices, promotes or relies upon the segregation of individuals with disabilities in private facilities or programs.

The Olmstead Decision

In Olmstead v. L.C., the Supreme Court provided an important clarification about how states should comply with Title II of the ADA, ultimately holding that the ADA prohibits states from unnecessarily institutionalizing persons with disabilities and from failing to serve them in the most integrated setting.

Under the Court's decision, states are required to provide community based services for persons with disabilities who would otherwise be entitled to institutional services when: (a) the state's treatment professionals reasonably determine that such placement is appropriate; (b) the affected persons do not oppose such treatment; and (c) the placement can be reasonably accommodated, taking into account the resources available to the State and the needs of others who are receiving State-supported disability services.

The Court cautioned however, that nothing in the ADA condones termination of institutional settings for persons unable to handle or benefit from community settings, nor is community placement the state’s responsibility if doing so would impose a fundamental alteration.

Federal Guidance on Olmstead Compliance

In the years since Olmstead, as states and other public entities have worked to comply with the Supreme Court’s ruling, several federal agencies, including HHS and DOJ, have periodically released guidance to facilitate implementation of the law. A thorough understanding of the technical assistance provided in this guidance is one important strategy that states can adopt to comply with the Olmstead decision.

  • The first piece of informal guidance was released by HHS in the form of a state Dear Medicaid Director letter on January 14, 2000. The guidance addresses opportunities to make state programs responsive to individuals with disabilities who want to live in appropriate community-based settings. This guidance is available here.
  • Subsequently, HHS released updated guidance on July 25, 2000, also in a Dear State Medicaid Director (SMD) letter, to answer frequently asked questions regarding Olmstead compliance. This letter is available here.
  • On January 10, 2001, HHS distributed additional guidance to help states in their efforts to enable individuals with disabilities to live in the most integrated setting appropriate to their needs, consistent with the ADA. The letter contains several attachments in which HHS outlines a number of tools available to improve state health and long-term service systems. This document is available here.
  •  In May 2010, in anticipation and recognition of the tenth anniversary of the Olmstead decision, HHS issued a letter outlining President Obama’s Community Living Initiative, to provide information on new tools for community integration, as well as to remind states of existing tools that remain strong resources in state efforts to support community living. The letter is available here.