Justice Department Celebrates Anniversary of the Supreme Court’s Olmstead Decision

Today marks the 24th anniversary of the Supreme Court’s decision in Olmstead v. L.C., in which the Court ruled that the Americans with Disabilities Act (ADA) prohibits the unnecessary segregation of people with disabilities. The Justice Department has enforced the ADA’s integration mandate in states across the country, securing remedies for people with disabilities who are not receiving services in the most integrated setting, including where they live, where they work, and where they go to school. As we commemorate this anniversary of the Olmstead decision, we highlight the department’s recent Olmstead work in two key areas: securing community-based crisis services to prevent needless hospitalization and criminal justice involvement and securing community-based services that enable children with disabilities to live with their families and go to school with non-disabled peers.

Avoiding Needless Institutionalization and Criminal Justice Involvement

Too often, people with disabilities do not get the critical community-based services that they need to succeed and thrive in the community. As a result, many people with disabilities experience needless institutionalization, and many also experience preventable law enforcement encounters that may result in institutionalization, incarceration, trauma, injury or death. The department’s Olmstead enforcement has helped to expand and enhance community services, including crisis services and to break cycles of institutionalization and arrest. 

• In Georgia, the department’s Olmstead settlement agreement prompted the state to create 131 mobile crisis teams with statewide coverage, serving both people with serious mental illness and people with developmental disabilities. Recent data shows the teams are dispatched about two thousand times per month, often diverting people from contact with a hospital or the police. Our agreement also prompted the state to create over a dozen crisis walk-in centers and three dozen mental health crisis apartments that can serve more than 80 people at a time located in integrated community settings across the state and to expand community crisis stabilization to more than two dozen crisis stabilization units.
• Similarly, New Hampshire created its first mobile crisis teams in the state as a result of requirements in our Olmstead settlement agreement. The agreement required the state to create one team in each of the three largest cities in New Hampshire, but given their demonstrated value, the state later elected to expand mobile crisis team services statewide. The state reports that mobile crisis team intervention has prevented thousands of people with serious mental illness from having contact with a psychiatric or clinical hospital during a crisis, and in recent quarters, less than 10% of the calls handled by mobile crisis also involved law enforcement.
• In response to Olmstead litigation brought by the department, Mississippi has established mobile crisis teams throughout the state. The state reports that in fiscal year 2022, Mobile Crisis Response Teams received 30,571 total contacts/calls and successfully diverted over 80 percent of people from hospitalization.
• The department’s Olmstead findings in Alameda County, California underscore the critical role that community-based services play in preventing psychiatric hospitalization and avoiding needless criminal justice system involvement. The department’s ongoing Olmstead investigations in Kentucky and Oklahoma are examining whether people with mental health disabilities experience unnecessary institutionalization and preventable law enforcement encounters due to insufficient availability of community-based services.

Enabling Children to Live at Home and Go to School with Non-Disabled Peers

As children learn and grow, it is critical for them to live with families and be part of their communities. The department is enforcing Olmstead in multiple states with the goals of enabling children with disabilities to live and receive needed services at home, and to attend school alongside children without disabilities. Community-based services including intensive care coordination, crisis services, intensive in-home services, and family-based supports such as therapeutic foster care and respite can prevent placement in hospitals and residential treatment facilities. For many children with significant physical disabilities, services such as private duty nursing and care coordination are critical to enable them to live with their families.   

• In May, the Justice Department completed a two-week Olmstead bench trial in federal court in United States v. Florida. The department presented evidence that Florida unnecessarily segregates children with medical complexity in nursing facilities and places other children at serious risk of segregation. At the conclusion of the trial, the judge observed “[i]t is my tentative belief that the United States has met its burden of proving that the State of Florida is violating the civil rights of children with medical complexity who reside in nursing facilities” and “those who reside in the community that are at risk of institutionalization due to access of necessary services.” The department seeks an order requiring Florida to provide medically necessary private duty nursing, person-centered care coordination plans, transition plans to help children with medical complexity move out of nursing facilities and increased access to community-based services.
• Last fall, the department completed investigations of the children’s mental health systems in Maine, Nevada and Alaska. In Maine, the department found that hundreds of children with behavioral health disabilities were unnecessarily segregated each year in psychiatric hospitals, residential treatment facilities and a juvenile detention facility due to the unavailability of sufficient community-based services.
• In Nevada, the department found that over 1,700 children with behavioral health disabilities were admitted to a hospital for psychiatric care in fiscal year 2020, and the same year, over 480 children received services in residential treatment facilities. The state reported that children remain in residential placements for an average of nine to twelve months. But the state could expand availability of its community-based services like crisis response, intensive in home behavioral support, and care coordination to prevent unnecessary hospitalizations and residential placement.
• In Alaska, the department determined that hundreds of children with behavioral health disabilities, including Alaska Native children in significant numbers, receive treatment in institutional settings within Alaska. Hundreds more are sent to segregated facilities in states as distant as Texas and Missouri. While such children are typically eligible and appropriate for community-based services and supports that Alaska offers through its Medicaid program, they cannot access the services.
• To address the same unnecessary institutionalization of children with behavioral health disabilities in West Virginia, the department entered into a settlement to expand community-based services and reduce reliance on residential placement. Since then, the state has enrolled hundreds of children in a new Medicaid Waiver program, which includes a wide range of community-based supports including intensive care coordination, in-home therapy, in-home family support, mobile crisis response, independent living/skills building, peer parent support and respite.
• The department continues to pursue litigation alleging that thousands of Georgia public school students with behavior-related or emotional disabilities are segregated from their general education peers and served in segregated settings with unequal educational opportunities. The department contends that the vast majority of these students could be served in general education classrooms with mental health and therapeutic educational services and supports.

In October 2022, following an investigation, the department found that Alabama has relegated hundreds of students with disabilities to segregated and inferior educational programs, in violation of the ADA’s integration mandate. We concluded that children in foster care who are placed in Alabama’s psychiatric residential treatment facilities are often automatically enrolled in segregated on-site schools. These unnecessary placements, which can extend for long periods of time, sever children’s ties to their home schools, teachers, social activities, and peers. Children in these highly segregated placements also often lack access to grade-appropriate curricula, adequate instruction, facilities (e.g., libraries, science labs and gyms) and activities (e.g., sports and extracurriculars).

The department will continue to vigorously enforce Olmstead so that people with disabilities can live, work, and attend school in the most integrated setting appropriate, and have the chance to participate fully in their communities.

To learn more about the ADA, call the toll-free ADA Information Line at 1-800-514-0301 or 1-800-514-0383 (TDD), or access the department’s ADA website at ada.gov.