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Twenty-four years ago, Lois Curtis and Elaine Wilson helped change the world for people with disabilities.  Lois and Elaine, two women with psychiatric and intellectual disabilities, challenged their unjustified segregation in a Georgia psychiatric hospital in a lawsuit that reached the United States Supreme Court.  In the 1999 landmark disability rights decision, Olmstead v. L.C. , the Court ruled that unjustified segregation of people with disabilities violates the Americans with Disabilities Act and that people with disabilities have a right to receive services in the most integrated setting appropriate to their needs.

The HHS Office for Civil Rights (OCR) is committed to advancing compliance with Olmstead and the integration mandate.  Working alongside our other federal partners, OCR federal nondiscrimination laws that require entities to serve people with disabilities in the most integrated setting, including Section 504 of the Rehabilitation Act, which applies to HHS programs and entities receiving HHS funds, Section 1557 of the Affordable Care Act, which applies to health programs and activities, and Title II of the Americans with Disabilities Act, which applies to state and local governments.

To that end, we have pursued a broad range of compliance, policy, and coordination actions during the past year to protect the rights of people with disabilities under the integration mandate.  On August 4, 2022, OCR published a Notice of Proposed Rulemaking (NPRM) for Section 1557 in the Federal Register.  The NPRM requires covered entities to administer health insurance coverage and other health-related coverage in the most integrated setting appropriate to the needs of qualified individuals with disabilities.  As announced in the Federal Register, we also plan on proposing proposed regulations this year under Section 504 that update and clarify disability rights obligations, including those under Olmstead.

OCR is proud of our partnerships throughout the federal government to help ensure that people with disabilities have access to the broader community.  Together, we are committed to fulfilling the promise of Olmstead: that all people with disabilities can receive services in the most integrated setting appropriate to their needs.  To that end, we are working with our HHS partners, including the Administration for Community Living, the Centers for Medicare & Medicaid Services, and the Substance Abuse and Mental Health Services Administration, to provide technical assistance and coordination on their efforts to support community living.  Earlier this year, we also launched with the Department of Justice Civil Rights Division a Federal Interagency Coordinating Group to coordinate our Olmstead efforts in the Biden-Harris Administration priority areas.

OCR is also launching a reinvigorated Olmstead Initiative to bolster our enforcement, compliance, policy, technical assistance, and outreach efforts to support community living.

The Olmstead decision transformed federal and state policy from a segregated, institutional service model  to promote community-based supports. Yet, we acknowledge that for many, the promise of Olmstead is still unfulfilled, as some people with disabilities continue to spend their lives in institutions or at risk of being institutionalized without sufficient access to alternatives. This Initiative renews our commitment to advancing the word and spirit of community integration, the Olmstead decision, Section 504, Section 1557, and the ADA.

These efforts will include:

  • Undertaking compliance and enforcement efforts to address OCR complaints and barriers to community living;
  • Ensuring that HHS recipients of federal funds and state and local entities under Title II of the Americans with Disabilities Act understand and comply with their obligations; and
  • Engaging in technical assistance and outreach efforts to ensure that providers know their obligations and stakeholders know their rights under the law.

We welcome information from the public about individual and systemic Olmstead compliance issues that would benefit from OCR’s investigation, technical assistance, and enforcement activities.  If you believe that a person with a disability has been denied access to community-based services and supports, you may file a complaint with HHS OCR.

Melanie Fontes Rainer
Director, Office for Civil Rights
U.S. Department of Health and Human Services