Much of the curse lies in the uncertainly with potential changes that come with President Trump’s administration.
“While the parties typically agree on the principle affirmed by the U.S. Supreme Court — that people with disabilities should live in the most integrated setting possible — costly housing markets and complex service delivery systems are formidable barriers to this goal. More than 15 years after the Supreme Court’s landmark Olmstead decision, states still struggle to serve people with disabilities in integrated settings.”
Both New Jersey and Delaware, whose settlement, was signed in 2011, have successfully moved thousands of seriously mentally ill people into community settings.
“What is perhaps most impressive is that a substantial part of the system reform accomplished by New Jersey and Delaware occurred during the great recession (2007 to 2009) and the following period of slow economic recovery.”
Quoting from a Bazelon press release, “Between 2005 and 2016, New Jersey invested nearly $104 million in services and rental assistance for Olmstead-related activities. The state also established a $200 million special needs housing trust fund, and created nearly 1,500 new permanent supportive housing units through capital and rental assistance. New Jersey’s state psychiatric hospital census was reduced by a third, patients’ average length of stay went down, and one state hospital was closed — changes that allowed state hospital operating funds to be reinvested in community supports. New Jersey created a Medicaid benefit to fund community support services for residents of supportive housing, and leveraged additional Medicaid money with investments in community-based services.”
But the future of community integration for the seriously mentally ill in other states, lies in the balance. One risk factor is the fact that the status of Medicaid expansion “lies in the balance” even with the repeal of the Affordable Care Act delayed.
Another factor is the uncertainty over how seriously the Department of Justice will focus on Olmstead.
Martone and Kovich conclude, “Community integration mandates in the Olmstead decision, Title II of the Americans with Disabilities Act, and Section 504 of the Rehabilitation Act are still the law, regardless of fluctuations in federal enforcement and support. Furthermore, serving individuals with disabilities in integrated, community-based settings is good, cost-effective policy. With these facts in mind, states should continue to design and implement Olmstead plans that build sustainable, system-wide improvements. The benefits — to individuals, communities, and all who recognize the value of true integration — are well worth the challenges.”