Monday, June 16, 2014

Olmstead 15th Anniversary [Part One] - How Much Progress Has Your State Made? Information Bulletin # 390 (6/2014) On June 22, 1999, the Supreme Court held in Olmstead held that “unnecessary isolation is properly regarded as discrimination based on disability.” In this decision, the Court upheld the ADA’s regulation that “[a] public entity shall administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities.” Happy Anniversary! What a 15 year ride it has been. We’re going to look State-by-State at how much progress has been made and where advocates might focus in the future. As you know from numerous previous Information Bulletins, the total Medicaid Long Term Services and Supports (LTSS) includes expenditures both in the institution and in the community. Since the largest institution for people with disabilities is the nursing home, we’ll focus in this Information Bulletin there. Fiscal Year 2000 started on July 1, 1999. In FY 2000, the national average for community-based Medicaid funded programs and services was 18.7% of the total LTSS. Therefore, the remaining 81.3% went to keep older and younger people with disabilities “unnecessarily institutionalized” in nursing homes. These FY 2000 expenditures are the Olmstead/ADA base for comparison. In FY 2000 dollars, only $9 billion Medicaid funding was spent to keep people in the community, while $49 billion was spent to institutionalize them in nursing homes! Quite a spread. By FY 2012 (the latest year for which we have reliable national data), the national average for community-based Medicaid funded programs increased to 38.8% of the total LTSS and the institutional expenditures decreased to 61.2%. In FY 2012, $22 billion in Medicaid funding was spent in the community (up from the $9 billion in FY 2000) but $74 billion was spent to keep people in “unnecessary isolation” (up from $49 billion in FY 2000). Let’s now compare States by focusing on the 38.8% increase in the national average of Medicaid funding for community-based programs in FY 2012. This comparison looks only at the percentage increase in funding going to community-based programs from 2000 to 2012. We believe that a State’s commitment to end discrimination against people with disabilities and to enforce the Olmstead decision and the ADA is reflected in its increase in community expenditures. Here’s a State-by-State comparison of community-based expenditures as a percentage of their entire LTSS from FY 2000 to FY 2012. Remember - to compute the percentage of Medicaid institutional expenditures, just subtract the %s displayed from 100. % of Total LTSS Medicaid Expenditures In The Community for People with Disabilities 2000 2012 Alabama 11.0% 5.2% Alaska 28.8% 62.4% Arizona 14.1% 42.0% Arkansas 30.0% 31.7% California 22.6% 57.1% Colorado 26.9% 45.5% Connecticut 16.9% 25.8% Delaware 13.1% 21.3% Florida 10.1% 23.0% Georgia 14.2% 29.0% Hawaii 14.2% n/a Idaho 26.0% 43.5% Illinois 8.5% 31.9% Indiana 7.9% 18.7% Iowa 11.1% 26.6% Kansas 26.6% 31.5% Kentucky 22.6% 14.4% Louisiana 5.7% 30.0% Maine 17.1% 32.3% Maryland 12.4% 23.4% Massachusetts 17.3% 44.7% Michigan 11.3% 23.6% Minnesota 21.8% 65.4% Mississippi 6.7% 22.2% Missouri 20.9% 37.4% Montana 24.9% 36.2% Nebraska 16.9% 23.6% Nevada 17.1% 33.5% New Hampshire 9.9% 18.8% New Jersey 10.0% 15.7% New Mexico 11.4% n/a New York 29.9% 45.9% North Carolina 34.6% 39.8% North Dakota 3.4% 14.0% Ohio 11.7% 32.4% Oklahoma 16.3% 30.8% Oregon 48.0% 60.7% Pennsylvania 3.2% 24.7% Rhode Island 7.5% 18.8% South Carolina 22.5% 26.2% South Dakota 6.2% 16.3% Tennessee 0.5% 31.3% Texas 28.5% 50.1% Utah 8.3% 21.9% Vermont 23.1% 44.7% Virginia 17.0% 43.9% Washington 39.4% 61.7% Dist. of Colum 11.4% 54.1% West Virginia 30.2% 31.3% Wisconsin 19.6% 47.9% Wyoming 9.0% 20.0% U.S. 18.7% 38.8% Disability advocates of aged and younger people, at this time of celebration, many of you should recognize that these increases are extremely important and represent your real efforts. These changes do not come about by magic but by hard grass roots organizing and efforts. These changes directly impact hundreds of thousands of people with disabilities. Some states have significantly turned the balance and to them we offer real congratulations; some have made some progress but still have a ways to go. Steve Gold, The Disability Odyssey continues Special thanks to Truven Health Analytics for data. Back issues of other Information Bulletins posted after 10/2013 can be found only at Information Bulletins before 10/2013 are available online at with a searchable Archive at this site divided into different subjects. To contact Steve Gold directly, write to or call 215-627-7100. Ext 227.

No comments:

Post a Comment