Introduction The Ruling Obligations on the States Populations Affected Creating the Plan Paying for Community Treatment Medicaid Services for Adults Rehabilitation services Targeted case management services Assertive case management and assertive community treatment Group homes Coverage of newer medications Nursing home placements Home- and Community-Based Services Options Medicaid Services for Children Expansion of Medicaid Eligibility The medically needy option Options to cover children The Child Health Insurance Program (CHIP) Redirecting State Hospital Spending State Appropriations Federal Block Grant Housing Section 811 Supportive Housing for People with Disabilities Community Development Block Grant and HOME programs McKinney homelessness programs Supplemental Security Income Conclusion Checklist on State Actions Table 1: Comparison of State Mental Health Agency Expenditures Bazelon Center Resource Materials Notes

Under Court Order:
What the Community Integration Mandate Means for People with Mental Illnesses

• Foreward
• Quick Contents
• About the Bazelon Center and this Publication
• Purchase this Report

Foreward

In June 1999, following the United States Supreme Court's decision in the case of Olmstead v. L.C., a group of legal advocates who work on behalf of people with physical and mental disabilities met to discuss the implications of the ruling.

During those discussions, a consensus emerged that states should be given the opportunity to demonstrate their commitment to complying with the requirements of the Americans with Disabilities Act (ADA), as spelled out by the Supreme Court. The organizations represented in the meeting agreed that advocates should expect states to engage in a meaningful planning process that results in implementation of policies to eliminate unnecessary institutionalization (with the caveats regarding fundamental alteration that the court described). Any states that have blatantly failed to do so by July 26, 2000, the anniversary of the ADA's signing, might then appropriately be challenged for failure to comply with the ADA. By that date, states should have developed comprehensive and effective plans for eliminating—or at least minimizing—unnecessary institutionalization.

This publication is designed to:

• summarize for mental health advocates and state policymakers the import of the L.C. ruling with respect to mental health policy;
• describe the various mechanisms open to states to increase their resources for community based services for persons with mental illness;
• provide information and support for policies for which advocates should press within their state systems in order to improve access to community services for all individuals who are at risk of unnecessary institutionalization and for those who are currently institutionalized unnecessarily.

(October 1999)

About the Bazelon Center and this Publication

The Bazelon Center for Mental Health Law is a national legal-advocacy organization representing low-income adults and children with mental disabilities. We promote their full integration into the community by protecting their rights to choice and dignity and expanding their access to health and mental health services, housing, employment and income support. Our strategies include system-reform litigation, legislative and policy advocacy, public education and constituency-building. The Bazelon Center publishes materials interpreting major federal laws and regulations; staff attorneys provide training and technical assistance to lawyers, protection and advocacy agencies, consumer/survivor organizations and other advocates for low-income individuals and families.

The Bazelon Center's legal and policy staff was able to produce this paper thanks to the support of our general program provided by the John D. and Catherine T. MacArthur Foundation, the Public Welfare Foundation and many individuals, law firms and other organizations. We are also deeply grateful to the Nathan Cummings and Retirement Research Foundations for their special support of our work on behalf of L.C. and E.W. in the Supreme Court's review of their case.

Purchase the Report

To obtain additional copies of Under Court Order or learn about other Bazelon Center publications on issues affecting children, adults and older adults with mental disabilities, send your mail address or fax number to request a publications list or visit our website: www.bazelon.org. Printed copies of Under Court Order: What the Community Integration Mandate Means for People with Mental Illnesses are available from the Bazelon Center's for $6.00 each (plus shipping)

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© Judge David L. Bazelon Center for Mental Health Law, Washington D.C. 1999. Although the text of Under Court Order is under copyright protection, we encourage advocates to reproduce all or part of it for noncommercial educational or advocacy purposes.