Unfinished business: deinstitutionalization and Medicaid policy

Abstract

ABSTRACT Deinstitutionalization heavily implicates Medicaid policy since waivers for home and community-based services have provided the means to realize the community integration mandate of the Americans with Disabilities Act (1990) and the Supreme Court’s Olmstead (1999) decision. Despite tremendous advances toward community living, several components of Medicaid’s design and implementation continue to create barriers for people with disabilities who want to live independently in the community. This article draws on knowledge produced from the lived experience of disability to identify five issues with Medicaid policy that prevent it from living up to the promise of the ADA and the Olmstead ruling: (1) institutional bias, (2) federalist structure, (3) work disincentives, (4) red tape and administrative burden, and (5) low reimbursement rates for personal care attendants. The wider implication of the analysis is that deinstitutionalization involves more simply closing institutions. Active measures to promote community integration are also vital.