Missouri's Olmstead Implementation

Introduction

On June 22, 1999, the Supreme Court decided the case of Olmstead versus Zimring (119 S.Ct. 2176, 144 L.ED 2d 540).  In this case, two women with mental illness brought suit against the state, challenging their confinement in a segregated environment.  This case fell under the public services portion of the American with Disabilities Act wherein states are required to provide community-based treatment for persons with mental disabilities when state's treatment professionals determine that such placement is appropriate, affected persons do not oppose such treatment, and placement can be reasonably accommodated, taking into account the resources available to the state and the needs of others with mental disabilities. (American with Disabilities Act of 1990, Section 202, 42 U.S.C.A. Section 12132).

The Supreme Court suggested that states take the following action:

• Demonstrate that it had a comprehensive, effectively working plan for placing qualified persons with mental disabilities in less restrictive settings; and
• A waiting list that moved at a reasonable pace not controlled by state's endeavors to keep its institutions fully populated

To address the implications of the Olmstead decision, an Executive Order was signed on April 18, 2000 to establish the Home- and Community-Based Services and Consumer-Directed Care Commission.   The objective of the Commission was to develop a "comprehensive, effectively, working plan," as recommended by the U.S. Supreme Court Olmstead decision.

The Commission was composed of fifteen members:

• Four (4) members who were Directors of the Departments of Social Services, Mental Health, Health, and the Commissioner of the Department of Elementary and Secondary Education or their designee.
• Four (4) members from the Governor's Council on Disability
• Three (3) members who were individuals with disabilities who are consumers of services or family members.
• Four (4) members selected from the Missouri General Assembly.  Two (2) appointed by the President Pro Tem of the Senate and two (2) appointed by the Speaker of the House of Representatives.

The Commission was charged with engaging in the following activities:

• Identify the current number of and current level of funding for home- and community-based services and consumer-directed care programs for individuals with disabilities in the State of Missouri
• Develop a tool or mechanism for assessing the effectiveness of these services and programs in addressing the needs of individuals with disabilities
• Identify the number of individuals with disabilities in the State of Missouri that are institutionalized
• Identify the number of waiting lists for home- and community-based services or consumer-directed care programs and evaluate the pace at which individuals move from these lists;
• Examine whether existing programs and services provide individuals with disabilities who may be eligible for community-based treatment with information regarding this option.
• Recommend any modifications or changes that may be needed to improve existing home- and community-based services and consumer-directed care programs
• Recommend any potential means of expanding home- and community-based services or consumer-directed care programs; and
• Develop a process for transitioning individuals with disabilities who are institutionalized and who are eligible for community-based treatment into community-based treatment settings.

To obtain the view of the general public, local public hearings were held in six locations throughout the state of Missouri.  Table 1 lists the hearing locations and dates.

Table 1:  Hearing Locations and Dates

This document represents the Working Plan for the State of Missouri, Home and Community Based Services and Consumer Directed Care Commission.  The plan follows the eight activities that are part of the Executive Order.  Thus, each section represents one of the activities, with the exception that Activities 6 and 7 are combined into one section.

Index | Acknowledgements | Introduction | Activity 1 | Activity 2 | Activity 3 | Activity 4 | Activity 5 | Activity 6 | Activity 7 | Activity 8

Olmstead