What is the Olmstead Decision?
The Olmstead Decision was handed down in response to a case filed by Georgia Attorney General Olmstead, and relating to two Georgia women who had been institutionalized as the result of mental illness. It was handed down by the US Supreme Court in June 1999, to answer this question:

Does the Americans with Disabilities Act (ADA) require states to provide treatment in the community for people with disabilities?

How are Olmstead and the ADA related?
The ADA is the most significant civil rights legislation since the Civil Rights Act of 1964, the legislation on which it was modeled. It was signed into law in 1990 by President George H.W. Bush, and is, in his words:

…a comprehensive national mandate for the elimination of discrimination against individuals with disabilities.

In its interpretation of the ADA, the Supreme Court ruled that discrimination on the basis of disability is illegal. Discrimination can occur when:

• People with disabilities can’t get needed services unless they live in an institution
• A state’s disability services don’t offer consumers real choices

People with disabilities have the right to services provided in the most integrated setting appropriate to their needs. Community placement must be an option when:

• Treatment professionals determine community placement is appropriate

• The person wants to leave the institution, or is not opposed to leaving

• The placement can be accommodated, considering state resources and the needs of other people with disabilities.

Presidential Executive Order
President Bush, as a part of his New Freedom Initiative, issued Executive Order 1327, "Community-Based Alternatives for Individuals with Disabilities.” In it, he says:

The United States is committed to community-based alternatives for individuals with disabilities and recognizes that such services advance the best interests of the United States.

• The order directs the key federal agencies to ensure compliance with the Olmstead Decision. They are called on to evaluate and revise their policies, programs, statutes, and regulations. Agencies working to implement Olmstead include the Departments of:

  • Health and Human Service
  • Housing and Urban Development
  • Justice
  • Labor
  • Transportation
  • Veterans Affairs
  • Office of Personnel Management
  • Small Business Administration
  • Social Security Administration

• Called upon states to develop "effectively working plans” to move people from institution to community-based services, and to ensure that people on waiting lists to leave institutions for community-based services move to these services at a reasonable pace
  

• Awarded millions of dollars in grants to states to develop programs for people with disabilities and long-term illnesses. States are using these grants to:

  • Move people from nursing facilities into the community

  • Improve personal assistance services (PAS)

  • Implement improvements in community long-term support systems to enable children and adults of all ages with disabilities or long-term illness to live and participate in their communities.

What is Iowa doing to respond to the Olmstead Decision?

Department of Human Services
In early 2000, Governor Vilsack named the Department of Human Services (DHS) as Iowa’s lead agency for responding to Olmstead. He called on DHS to:

• Report on Iowa’s current service system

• Develop an “effectively working plan” for Iowa

From October 2000 through January 2001, DHS gathered input from consumers, family members, advocates, providers, and others through Olmstead Teamwork Meetings held across the state. DHS used this input as they developed Iowa’s “effectively working plan.” It was presented to Governor Vilsack, and approved by him in July 2001. The plan included a steering committee made up of people with disabilities, family members, advocates, representatives of state agencies, service providers, and other key players.

In 2001, the Iowa Department of Human Services received a federal Real Choices Systems Change grant. The steering committee now became Iowa's Olmstead Real Choices Consumer Task Force.

• Remove the institutional biases that shape Iowa’s service system

• Prevent institutionalization

• Provide real choices to Iowans with disabilities about where they will live and what services they will use

In 2005, Iowa was awarded a second Real Choices Systems Change Grant, Iowa Care: Rebalancing for Increased Community Capacity, Access, and Choice. The Iowa Medicaid Enterprise will oversee grant activities, which will focus on implementing Iowa Care Act (House File 841). This legislation sets the direction for the redesign of our long-term care system for Iowans with disabilities and older Iowans. 

Governor’s Executive Order 27
In February 2003, Governor Vilsack issued Executive Order 27, calling upon Iowa state agencies to:

• “Move purposefully to swiftly implement the Olmstead Decision"
• Coordinate a comprehensive effort by state agencies to “reshape the structure and nature of community-based services”

• Department for the Blind
• Department of Corrections
• Department of Economic Development
• Department of Education
• Department of Elder Affairs
• Department of General Services
• Department of Human Rights
• Department of Human Services
• Department of Inspections and Appeals
• Department of Management
• Department of Personnel
• Department of Public Health
• Department of Public Safety
• Department of Transportation
• Iowa Board of Regents
• Iowa Civil Rights Commission
• Iowa Commission of Veterans Affairs
• Iowa Finance Authority
• Iowa Veterans Home
• Iowa Workforce Development

The Executive Order names the Olmstead Real Choices Consumer Task Force as a resource each of these state agencies can tap as they:

• Identify and prioritize barriers to community living in Iowa

• Develop plans for effective, efficient use of their resources in support of ADA goals

Institutional biases and related barriers to implementing Olmstead are identified in:

• Delivering on the Promise, the federal report to the President

• Iowa Plan for Community Development, the DHS report to Governor

Iowa Olmstead Real Choices Task Force Priorities

• Adopt CMS (HCFA) policy changes.. Review and make maximum use of recent federal Medicaid program policy changes designed to facilitate community service development.
  

• Overcome institutional bias in Medicaid. Review and take steps to make comparable the Medicaid eligibility requirements and services for institutional settings and community settings. Services and supports paid for in facilities must be paid for in the community. Income eligibility and spousal impoverishment rules that apply for institutions should also apply for community services.
  

• Increase flexibility. Increase the flexibility of waivers by basing eligibility criteria on needs or functional ability without regard to specific diagnosis. Provide one consolidated menu of services for individuals to choose from within their personal services budget.

II. Implement a personal assistance program.
Adopt a personal care option as a benefit in Iowa’s state Medicaid plan. Develop and implement a comprehensive statewide Personal Assistance Program. Funding should be based on individual need rather than a single universal rate. Services should be available to use at home or at work.

III. Make maximal use of federal funding opportunities.
Make state policy choices necessary to fully utilize federal Medicaid funds to provide appropriate services in a full range of settings. Pursue federal grant opportunities specifically identified for community development activities.

V. Fund people.
Pursue legislative, regulatory, and policy changes necessary to allow funding to follow the person. Funds equivalent to those available to support the needs of an individual in an institution must be made available to support that person in the community.

Develop and implement a statewide system of crisis prevention and intervention services. Include respite care, community “crisis care” beds, and supplemental funding for supervision or treatment services. Crisis services should be regionally based within reasonable travel distance in all areas of the state.

VIII. Provide clear, accurate information.
Make clear and consistent information available to consumers, family members, professionals, and the general public. Develop and support an educational process for consumers, parents, and guardians in rights, responsibilities, and service options.

Olmstead-related accomplishments in Iowa, 2001-2005