Seniors and people with disabilities who receive Medicaid should have access to the home and community-based services that enable them to live with dignity and independence in their homes. Under Medicaid law, funding exists to give consumers the ability to receive necessary long-term services and supports without moving into a nursing home or other healthcare institution. We work at the federal and state level to help preserve home and community-based funding for settings that are truly non-institutional, and provide assistance to state advocates to ensure that low-income seniors get the care they need in the setting they prefer.

In 1999 the Supreme Court ruled in Olmstead that unnecessary institutionalization of people with disabilities is a type of discrimination prohibited by the Americans with Disabilities Act (ADA). New federal Medicaid rules have set standards to ensure that Medicaid-funded home and community-based services are provided in settings that are not institutional in nature. States have until March of 2022 to ensure that all settings receiving Medicaid home and community- based funding come into compliance with the new rules. Many details remain to be determined by individual states, subject to review and approval by the federal government. Advocacy is critical at this juncture as both the states and the federal Centers for Medicare and Medicaid Services must accept and consider recommendations from consumers and other stakeholders.

Justice in Aging is meeting regularly with federal agencies to share information about how states are implementing the rule and identify areas where tougher oversight is needed. We also provide technical assistance and resources to state stakeholders working at a local level to develop and implement these new rules.

We are currently engaged in two active lawsuits against states for failing to provide individuals with Medicaid-funded care in the least restrictive environments. in December 2018, we filed a lawsuit against the state of Florida for prioritizing the funding of nursing facility care over HCBS. In July 2017, we filed a lawsuit against California for failing to implement California’s spousal impoverishment protections.