Edward Markey

From the office of:

Edward Markey

From: The Honorable Matt Cartwright
Sent By:
Bill: H.R. 5547
Date: 10/29/2014

Help Improve Access to Home-Based Care!

Cosponsor the Community Integration Act of 2014

Supported By:  The American Bar Association, the American Network of Community Options and Resources (ANCOR), the American Occupational Therapy Association (AOTA)

Cosponsors:    Rep. Michaud*

Dear Colleague,

Passed in 1990, the Americans with Disabilities Act (ADA) guarantees the same civil rights and equal opportunity protections to individuals with disabilities as provided on the basis of race, sex, national origin, and religion.  The Supreme Court held in Olmstead v. L.C.[1] that the unnecessary segregation of individuals with disabilities in institutions violates the ADA.

Olmstead concluded that the ADA meant community-based services should be available when deemed appropriate by health care professionals, when desired by the individual, and when the request can be accommodated.  Fifteen years later, more must be done to remove institutional bias and ensure the availability of home- and community-based services as an alternative to nursing homes and other institutional settings.

Numerous studies conducted between 2008 and 2012 show that home and community-based care is less expensive and more cost-effective than institutional care.  Unfortunately, only 12 states spent more than 50% of Medicaid funds on community-based care in 2010.  The number of individuals under age 65 in nursing homes increased between 2008 and 2012.  Moreover, a July 2013 report from the Senate HELP Committee found that more than 200,000 working-age Americans remain segregated in nursing homes, costing states thousands of extra dollars per person, per year.[2]

Originally introduced by Senator Harkin, the Community Integration Act would ensure that we continue moving toward the full realization of Olmstead.  This bill would require all States, under their Medicaid plan, to provide all individuals that require an institutional level of care the choice and opportunity to receive their care in home and community-based settings.  Specifically, this bill would:

  • Eliminate the nursing home bias in Medicaid by amending the mandatory services that states must provide to include similar care or services in home and community-based settings.
  • Require states to ensure that such services are “widely available for all such individuals within the State.”
  • Set seven non-discrimination requirements for states regarding the provision of services in home and community based settings, and permit the Secretary of HHS to reduce a state’s FMAP if a state fails to comply.
  • Creates a private right of action (including attorney’s fees) for an individual if a state fails to comply with the state plan or non-discrimination plans.
  • Require annual reporting by states regarding the number of individuals with disabilities in institutional settings and the number that have been transitioned to home- and community-based settings.
  • Require states to develop a statewide plan to increase the availability of affordable and accessible private and public housing stock for individuals with disabilities within 180 days.

We must ensure that all individuals with disabilities have the opportunity to choose the care that best fits their wants and needs.  If you are interested in becoming a cosponsor of the Community Integration Act or you have any questions, please contact Sarah Nasta or Shelby Boxenbaum at or at 202-225-5546.


Matt Cartwright

Member of Congress

[1] Olmstead v. L.C.