The National Council on Disability (NCD) and the National Association of State Directors of Developmental Disabilities Services (NASDDS) released a joint report on home and community-based services (HCBS) for individuals with disabilities.
The report draws on recent guidance issued by the Centers for Medicare & Medicaid Services (CMS) on HCBS, the framework in the Americans with Disabilities Act (ADA) and the 1999 Olmstead decision on community integration. NCD notes that, despite clear legal mandates shifting services to home and community-based settings, providers and policymakers are struggling to transition individuals with disabilities from traditional congregate settings based on outdated methods of service delivery. In congregate settings, individuals with disabilities are often segregated from the general community and placed in large groups in the same housing, employment or education programs.
HCBS funding through Medicaid is intended to provide a variety of residential, day, employment and therapeutic supports, to help people with significant disabilities, reside and engage optimally in typical communities. In the report, NCD conducted an extensive literature review on data related to post-Olmstead outcomes. The report found strong evidence in favor of smaller, dispersed and individualized service models provided in typical community settings. People with disabilities experience the most individual choices, satisfaction, housing stability, adaptive behaviors and community participation when living in smaller settings. The report found that, despite financial incentives to move away from institutional settings, states continue to provide services in settings that are not meaningfully integrated in the community. NCD recommended that service delivery systems should incentivize residential, day and employment services that are individualized and reflect typical community settings and similar scenarios experienced by individuals without disabilities. NCD further recommended that all stakeholders receive updated information on ideal types of services and individualized support models to make informed decisions promoting meaningful community integration.