The 1999 Supreme Court’s decision in Olmstead vs. LC applied the Americans with Disability Act to people in long term care settings.  The Court said that people with disabilities were to be allowed to live in the “least restrictive environment”.   This decision set the stage for subsequent efforts at reforming the Medicaid-based long-term care system across the On June 18, 2001, President George W. Bush signed Executive Order No. 13217, Community-Based Alternatives for Individuals with Disabilities. The Order calls upon the federal government to assist states and localities to implement swiftly the decision of the United States Supreme Court in Olmstead v. L.C., stating:”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”. With this, the Federal government launched the Medicaid Systems Change grants to encourage reform at the state level.

People with disabilities issued the People’s Olmstead Plan in January 2003

This Olmstead Plan is not a bureaucratic response to the broad disability community meant to appease some, but instead, a passionate declaration from the front lines; the nursing homes; the state hospitals; the chronic care facilities, and multitude of other places that society has placed, and continues to place, its citizens' with disabilities.

The plan is a powerful remedy to the existing Massachusetts climate for people with disabilities which is to hastily place "clients " into institutional care, at a phenomenal personal and financial cost, rather than explore viable and proven community-based alternatives.  The practice of funding and developing institutionally biased programs, such as nursing homes, at the expense of, a well-developed community-based service system for people with disabilities who want to live independently in the community, is poor public policy, and probably illegal.  People’s Olmstead Plan, January 2003.

Presumptive Eligibility

The current system assumes an elderly person or a person with a disability being released from a hospital acute care ward will be eligible for MassHealth (Medicaid) upon entering a nursing home.  The extended care facility is given 90 days to qualify the individual for MassHealth and regardless of that outcome, the person’s nursing home costs will be paid.

This legislation is written to give a similar ‘presumption of eligibility for personal care services for up to 60 days. This will allow the person who needs assistance, but not medical care, to go home. 

This is so simple that it defies logic as to why it hasn’t happened sooner.  Personal care services in a home setting are geometrically less expensive than in an institutional extended care setting.  The person is happier at home and the ever-present risk of losing an apartment is gone.