On Tuesday, Senator Tom Harkin (D-IA) introduced the "Community Integration Act". According to Harkin's press release, the bill would "ensure that the choice and opportunity to live in home- and community-based settings are available to all Americans with disabilities". Harkin chairs the Senate Health, Education, Labor and Pensions (HELP) Committee, and was one of the chief authors of the Americans with Disabilities Act (ADA). Last year, Harkin released a report which showed that many states continue to favor institutional settings over home and community based services (HCBS). (See WICs article "HELP Committee Releases Report with Olmstead Recommendations", July 19, 2013.) According to the data in that report, only twelve states spend more Medicaid funds on HCBS than on institutional care.
The Supreme Court decision of Olmstead v. L.C. was decided 15 years ago this week. The Court held that the ADA requires that states provide services in the least restrictive, most integrated settings appropriate. “Fifteen years ago in Olmstead v. L.C., the Supreme Court held that under the ADA, individuals with disabilities have the right to choose to receive their services and support in home- and community-based settings, rather than only in a nursing home or other institutional setting. But we have yet to fully realize this promise, and many individuals with disabilities—our family members and our friends—continue to reside in institutional settings against their wishes," Harkin said. “Studies clearly show that home and community-based care is not only what most people want, but it is also more cost-effective. The choice to live in the community is one of the most important civil rights issues we face today. The Community Integration Act honors the Olmstead decision and ensures that states take the steps needed to ensure that all individuals with disabilities are given the opportunity to receive their services and supports in a community based setting, where they can work, participate in community life, and be an integral part of their communities.”
The text of the legislation has not been made available yet, but according to Harkin's summary, the Community Integration Act would:
- Eliminate the Nursing Home Bias in Medicaid by clearly allowing the provision of similar care or services in home and community based settings.
- Prohibit states from making anyone ineligible for home- and community-based services based on a particular disability.
- Require states that have found an individual to be eligible for nursing or institutional care to similarly find those same individuals to be eligible for care in home and community-based settings.
- Set clear requirements for states regarding the provision of services in home and community based settings.
- Require annual reporting by states about the number of individuals with disabilities in institutional settings and the number that have been transitioned to home and community based settings.
Harkin lead a HELP Committee roundtable on Tuesday to hear from individuals who have successfully transitioned into the community, to consider further action that can be taken to increase opportunities for full integration, and to learn more about the important role that the federal government and Congress can play in protecting the rights of Americans with disabilities and making sure that community-integrated living options are available. Video of the hearing is available here.
UPDATE: The text of the bill is now available. It is attached below.