Obligations On States
While a state is not obliged to assume an "undue burden" in its pursuit of
integrated services for people with serious mental illnesses, nothing in L.C. requires
community placements to be "cost-neutral." Indeed, the entire tenor of the
decision is to the contrary. The court recognizes that needless institutionalization
is a wrong that the ADA was designed to redress. It is clear that an accommodation
under the ADA can be reasonable even if it imposes costs.
The court did not identify when it would be "too costly" for a state to provide
services in the community. (The issue was not before the court.) Instead, the
court identified relevant factors, the most significant being the resources
available to the state to fund community services. While the existing community
services system constitutes one available resource, the court made clear that
other resources must also be counted. The L.C. decision anticipates
the reallocation of resources to fund community placements.
In evaluating what resources are available to finance community placements,
states need to look both at services that are currently funded and at how community
services might be funded if the state took action to maximize its budget. These "available
resources" can include resources that the state could obtain by aggressively
seeking additional funds—from the legislature, by restructuring its Medicaid
program or through similar strategies.
Accordingly, in order to comply with the ADA's integration mandate, states
must:
- have effective plans for identifying institutional residents who could
be in more integrated community settings;
- develop and implement these plans to ensure that all such residents are
placed in the community at a "reasonable pace";
- identify how funds necessary to implement these plans could be obtained,
including potential new resources for community services; and
- take steps to obtain new resources—for example, by accessing available
federal funds and requesting resources from the state legislature, so that
individuals may be moved off waiting lists at a reasonable pace.
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