Fulfill the Promise of Olmstead: Protect Community Living and Strengthen the Direct Care Workforce
The Americans with Disabilities Act (ADA) and the Supreme Court’s 1999 decision in Olmstead v. L.C. established that unjustified segregation of people with disabilities is illegal discrimination, and that states must provide services in community settings when appropriate. For more than 25 years, Olmstead’s integration mandate has driven the expansion of home and community-based services (HCBS), helping millions of older adults and people with disabilities live in their own homes and communities.
That foundation for HCBS is now under threat. In June, the Department of Justice’s (DOJ’s) Office of Legal Counsel issued a legal opinion asserting that federal law does not impose an integration mandate on states, and in July, DOJ announced that it would no longer rely on its longstanding Olmstead guidance. These actions do not overturn Olmstead, but they create a profound danger: shifting the burden of enforcing the right to community living onto people with disabilities themselves, while inviting states to test the limits of their obligations.
Fulfilling the integration mandate by providing access to community living has always depended on home care workers. In the decades since Olmstead, the home care workforce has become one of the largest and fastest-growing in the country because home care workers perform the majority of labor of HCBS. To meet the needs of an aging population and rising demand for community-based care, the federal government should be focused on supporting this workforce, not rolling back decades of progress. PHI’s Midterm Policy Brief Series lays out how to do that: restore Medicaid, the program that funds most HCBS and shapes direct care job quality; support the immigrant workers who are essential to home care today and to its future workforce pipeline; and defend the labor rights that provide the foundation for quality direct care jobs. Investing in this workforce is how we build an HCBS system capable of fulfilling Olmstead’s promise.
Twenty-seven years after Olmstead, we should be focused on protecting the foundations of HCBS and strengthening the workforce that makes its promise a reality. DOJ should withdraw its recent legal opinion, preserve the longstanding integration regulations, and recommit to meaningful enforcement of the ADA and Olmstead. Congress and the states should protect the Medicaid funding that HCBS depend on and advance measures like the HCBS Access Act, which would make HCBS a mandatory Medicaid benefit while improving direct care workforce compensation, recruitment, and retention. As PHI’s Kezia Scales argued in Meeting the Integration Mandate: The Implications of Olmstead for the Home Care Workforce, realizing the right to community living requires meaningful, sustained investment in the home care workforce that millions of Americans depend on to live with dignity, independence, and choice.
