Missouri's Olmstead Implementation

The Decision

On June 22, 1999, the Supreme Court decided the case of Olmstead versus L.C. (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 (Title II) of the American with Disabilities Act. The decision clarified that states are required to provide services and treatment in the least restrictive setting appropriate to their needs for people with disabilities when the 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 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 the state has a comprehensive, effectively working plan for placing qualified people with disabilities in the least restrictive setting appropriate to their needs; and
• Maintains a waiting list that moves at a reasonable pace which is not controlled by state endeavors to keep its institutions fully populated.

Olmstead Stakeholders Group

On February 4, 2000, a group of individuals and organizations impacted by the Supreme Court Decision held the first meeting of the Olmstead Stakeholders Group.  This group continues to hold monthly meetings and is considered the driving force in Missouri's implementation of the Olmstead decision.

Executive Branch

Governor Carnahan signed an Executive Order 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 Missouri's "comprehensive, effectively, working plan," as recommended by the U.S. Supreme Court.  The Commission issued its Final Report on December 31, 2000.  Many of its recommendations are based on the work and recommendations of the Olmstead Stakeholders Group.

On April 10, 2001 Governor Holden issued an Executive Order establishing the Personal Independence Commission to implement the recommendations of the original commission and advance Missouri's compliance with the Supreme Court decision.

Missouri Legislature

In the 2000 and 2001 sessions, the Legislature enacted appropriations language which allows money to follow the individual.  An individual eligible for or receiving nursing home care must be given the opportunity to have those Medicaid dollars follow him or her to the community and further be allowed to choose the personal care option that best meets the individual's needs.

During the 2001 session, the legislature passed SB 236 which included several recommendations from the original commission.  The bill established Missouri's Medicaid Buy-In Program.  It created a grant fund to assist individuals transitioning from nursing homes with costs associated with setting up a home of their own.  It mandates training for representatives of the disability community to provide information on community-based options for individuals in institutions.

State Departments

The Division of Medical Services of the Missouri Department of Social Services was awarded a $50,000 Real Choice Systems Change planning grant and a three-year Systems Change Grant for Community Living of $2 million by the Centers for Medicare and Medicaid Services.  The purpose of these grants is to enhance the life of consumers with disabilities and long term illnesses to live in the most integrated community setting and exercise meaningful choices about their life.

The Governor's Council on Disability is committed to advancing Missouri's compliance with the Supreme Court decision in Olmstead vs. L.C.  The Council provides staff and resources to support this vital effort.  The mission of the Council is to provide leadership and support so people with disabilities achieve inclusion and independence.