The July 1999 Supreme Court decision in Olmstead v. L.C. challenges not only state governments, but federal and local governments, to increase opportunities for persons with significant disabilities to live where they choose. In response to the direction provided by the Supreme Court in the Olmstead case, all levels of government are increasing their efforts to increase access to long-term supports and services for persons with disabilities in home and community-based services (HCBS) settings.
State governments have the lead role in expanding opportunities for persons with significant disabilities to live and work in community settings, and to function as independently as possible. However, the Federal Government also plays a key role, both as a funder (primarily through the Medicaid program) and as a provider of information and technical assistance. In addition, both the states and the Federal Government share responsibility for ensuring that the supports and services which persons with disabilities receive in the community are of the highest quality possible. While persons with significant disabilities are becoming increasingly independent, and exercising greater control over their own lives, federal and states governments remain jointly accountable for ensuring the health and safety of those who are receiving publicly-financed services.
As part his New Freedom Initiative, President Bush issued an Executive Order on June 19, 2001, charging the Attorney General, the Secretaries of Health and Human Services, Education, Labor, and Housing and Urban Development, and the Commissioner of the Social Security Administration to evaluate the policies, programs, statutes, and regulations of their respective agencies to determine whether any should be revised or modified to improve the availability of community-based services for qualified individuals with disabilities. The Executive Order also specifies that this review should focus on identifying affected populations, improving the flow of information about supports in the community, and removing barriers that impede opportunities for community placement. The Order mandates that the Secretary of Health and Human Services should report to the President on the results of this evaluation within 120 days.
To fulfill the mandate of the President's Executive Order, HHS has established the New Freedom Initiative Workgroup to review interagency efforts that have been already initiated in response to the Olmstead decision, and to recommit and refocus the Administration's efforts in promoting the full participation of adults with disabilities in community life.
In addition to working with states, the Federal Government has established a number of partnerships with private organizations to promote the development of improved HCBS systems in response to Olmstead. For example, for the Office of the Assistant Secretary for Planning and Evaluation and the Centers for Medicare and Medicaid Services (CMS) have partnered with the Robert Wood Johnson Foundation in supporting the Cash and Counseling Demonstration, and CMS is partnering with the National Conference of State Legislatures in efforts to increase awareness among state legislatures about the implications of Olmstead.
This report is intended to serve as a compendium of selected projects which are currently operational at the federal level to promote the expansion of long-term supports and services in community-based settings. Some of these initiatives (e.g., the Cash and Counseling Demonstration Program) were initiated even prior to the ruling of the Supreme Court in Olmstead v. L.C. but all reflect the guiding principles enumerated above. For each project, we present information on both the funding and implementing organization, the purpose of the project, a brief description of the activity, and contact information on where people can go to obtain more detailed information about the project. While we have tried to identify the major projects currently in operation at the federal level to support states' efforts to expand long-term supports and services for persons with disabilities, the report undoubtedly fails to include all of the activities going on at the federal level in response to the Olmstead decision.