New Legislation Would Increase Funding Toward Home & Community Based Services

Fifteen years after a landmark Supreme Court ruling and one year following a report showing that many states have not made adequate progress in ensuring the availability of home- and community-based services (HCBS), a U.S. Senator is now taking action with a new piece of legislation.

This week, Senator Tom Harkin (D-IA) introduced The Community Integration Act to ensure that the choice and opportunity to live HCBS settings are available to all Americans living with disabilities, as an alternative to nursing homes and other institutional settings. 

“Studies clearly show that home and community-based care is not only what most people want, but it is also more cost-effective,” Harkin stated. “The choice to live in the community is one of the most important civil rights issues we face today.”


Harkin’s legislation arrives almost 15 years ago to the data that the Supreme Court ruled in Olmstead v. L.C. that the unnecessary segregation of individuals with disabilities in institutions is a violation of the Americans with Disabilities Act (ADA).

Despite the ruling, a July 2013 report released by the Senate Health, Education, Labor, and Pensions (HELP) Committee—of which Harkin is Chairman—found that more than 200,000 working-age Americans remain unfairly segregated in nursing homes. 

A critical finding in the report reveled that by 2010, only 12 states had spent more than 50% of Medicaid funds on HCBS care rather than institutional care. 


“Fifteen years ago in Olmstead v. L.C., the Supreme Court held that under the ADA, individuals with disabilities have the right to choose to receive their services and support in home- and community-based settings, rather than only in a nursing home or other institutional setting,” Harkin stated. “But we have yet to fully realize this promise, and many individuals with disabilities—our family members and friends—continue to reside in institutional settings against their wishes.”

Harkin’s Community Integration Act aims to eliminate the “nursing home bias” in Medicaid by alloying the provision of similar care or services in HCBS settings, as well as prohibit states from making anyone ineligible for HCBS based on a particular disability.

The legislation would also require states that have found an individual to be eligible for nursing home care to also be eligible for care in HCBS settings; set clear requirements for states regarding the provision of services in HCBS services.

States would also be required to report the number of individuals with disabilities in institutional settings and the number that have been transitioned to HCBS settings.

“The Community Integration Act honors the Olmstead decision and ensures that states take the steps needed to ensure that all individuals with disabilities are given the opportunity to receive their services and supports in a community based setting, where they can work, participate in community life, and be an integral part of their communities,” Harkin stated. 

Written by Jason Oliva