The document summarizes the Department of Justice's enforcement of the Olmstead decision, which found unjustified segregation of people with disabilities to be a form of discrimination under the Americans with Disabilities Act. It discusses DOJ's objectives to promote community integration and informed choice. It provides examples of DOJ's enforcement actions in different states through investigations, litigation, and settlement agreements requiring expansion of community-based services and supports. It also discusses DOJ's efforts related to employment and day services for people with disabilities.

1. Department of JusticeDepartment of Justice
OlmsteadOlmstead Enforcement:Enforcement:
Integrated EmploymentIntegrated Employment
National Association of Councils on
Developmental Disabilities
July 7, 2014

2. Olmstead is a top priority for
DOJ’s Civil Rights Division
• “Year of Community Living”
– "The Olmstead ruling . . . articulat[ed] one of the most
fundamental rights of Americans with disabilities: Having
the choice to live independently. [T]his initiative reaffirms
my Administration’s commitment to vigorous
enforcement of civil rights for Americans with disabilities
and to ensuring the fullest inclusion of all people in the life
of our nation.” President Obama June 22, 2009
• DOJ Olmstead enforcement efforts
– Approx. 40 matters in 25 states over the past
several years

3. DOJ’s Olmstead Enforcement
Objectives
• Help people with disabilities live like people
without disabilities
• Help people with disabilities have true
integration, independence, choice and self-
determination in all aspects of life – where
people live, how they spend their days, and
real community membership

4. Objectives (cont’d)
• Ensure quality services that meet people’s
needs and help them achieve their own goals
–Accountability of services/quality
management
–Person-centered planning
–Informed choice

5. Important Lessons
• Not just about moving people out of
institutional settings; focus on creating quality
community alternatives
• Ensure that people have opportunities for
integration in all aspects of their lives – where
they live and how they spend their days
• Engagement of a range of stakeholders –
consumers, families, advocates, providers – is
essential

6. Important Lessons (cont’d)
• Access to a range of quality community
services, affordable, integrated housing, and
opportunities for integrated day activities are
critical to success of Olmstead efforts
– Cross-agency collaboration with DOJ, HUD and
HHS regarding community services and housing
– Cross-agency collaboration with DOJ, HHS, DOL,
and DoEd regarding employment and integrated
day activities

7. Range of DOJ “Tools”
• Investigations & findings letters leading to
system reform settlement agreements or
litigation
• Intervention or statements of interest in
private Olmstead litigation
• Olmstead Technical Assistance Guidance
• Cross-agency Olmstead activities – with HHS,
HUD, DOL, DoEd,
• Olmstead website (www.ada.gov/olmstead)

8. Legal Background

9. Title II of the ADATitle II of the ADA
• Prohibits discrimination by public entities in
services, programs and activities
• Integration regulation requires administration
of services, programs and activities in the
most integrated setting appropriate
• Most integrated setting is one that enables
people with disabilities to interact with
people without disabilities to the fullest
extent possible

10. Olmstead v. L.C.: Unjustified
segregation is discrimination
• Supreme Court held that Title II prohibits unjustified
segregation of people with disabilities
• Set out “two evident judgments” about institutional placement:
1. “perpetuates unwarranted assumptions that persons so
isolated are incapable or unworthy of participating in
community life”
2. “severely diminishes the everyday life activities of
individuals,” including family, work, education and social
contacts

11. Olmstead v. L.C. (cont’d)
• Held public entities are required to provide
community-based services when:
– Such services are appropriate; and
– Affected persons do not oppose community-based
treatment; and
– Community-based treatment can be reasonably
accommodated, taking into account the resources
available to the entity and the needs of others
receiving disability services

12. When is the ADA’s Integration
Mandate Implicated?
• Not limited to state-run facilities/programs
• Applies when government programs result in
unjustified segregation by:
– Operating facilities/programs that segregate
people with disabilities
– Financing the segregation of people with
disabilities in private placements
– Promoting segregation through planning, service
design, funding choices, or practices.

13. Who Does the Integration
Mandate Cover?
• ADA and Olmstead are not limited to
individuals in institutions or other segregated
settings
• They also extend to people at serious risk of
institutionalization or segregation
– Example: people with urgent needs on waitlists
for services or people subject to cuts in
community services leading to the person’s
unnecessary institutionalization.

14. Significant DOJ Olmstead
Enforcement Efforts

15. State-Operated Facilities
• US v. Virginia Settlement Agreement
– Agreement remedies finding that Virginia violated the ADA by
overly relying on its state-operated ICFs for more than 1000 people
and placing thousands more people at serious risk of
institutionalization due to a lack of community-based services
– HCBS waivers for people transitioning out of state-operated ICFs,
youth transitioning from nursing homes and large private ICFs, and
people with “urgent needs” on the waitlist (4200 waivers)
– Family support program to help people on waitlists (1000 people)
– Full range of community-based crisis services (crisis hotline, mobile
crisis teams, crisis stabilization programs)
– Expanded case management
– Develop and implement Employment First policy and expansion of
supported employment and integrated day opportunities
– Integrated housing (including subsidies for independent living)
– Expansive quality management system for community services

16. State-Operated Facilities (cont’d)
• Other Settlement Agreements:
– US v. GA – community svs. for 1,000+ people in
state DD facilities and on waitlist and 9,000+
people in or at risk of entering state psych hosp.
• DD relief includes waivers, family supports, crisis
services, and case management
– US v. DE – community svs. for 3,000+ people in
or at risk of entering state psych. hospital and
private facilities
• ACT, crisis services, supported housing, supported
employment

17. - US v. NH – people with MI in or at risk of
entering state psychiatric hospital and state-run
nursing facility for people with MI; settlement
agreement filed December 19.
State to create and expand services over the next six years: new
mobile crisis teams and crisis apartments; expand ACT services, providing
state-wide coverage for at least 1,500 people; add hundreds of new
supported housing units and work to create community alternatives for
people with complex health care needs; and expand effective supported
employment services for hundreds of people.

18. State-Operated Facilities (cont’d)
• Litigation:
– US v. NH – case began in 2012 with contested
litigation.
• Open Findings letters:
– Mississippi Findings Letter – violations re adults
& children in public and private DD and psych.
facilities and people on waitlists for community
svs.

19. State-Operated Facilities (cont’d)
• Litigation About Institutional Closures
– Families of people in state-operated institutions
slated for closure have filed lawsuits claiming the
ADA and Olmstead create a right to remain in the
institution and prevent its closure
– DOJ has filed Statements of Interests in these
cases, arguing that the ADA’s integration mandate
creates a right to integration, not segregation;
courts have agreed
– States must ensure that individuals have
alternatives that meet their needs

20. Private Facilities
• Nursing homes
– Steward v. Perry (Texas)
• Litigation regarding thousands of people with ID/DD
who are in private nursing homes, or at risk of entering
them. Litigation involves the ADA and PASRR.
• Parties reached an interim agreement in August 2013
to address obligations over the upcoming biennium
and are negotiating a comprehensive settlement.
Provisions include:
– New PASRR screens for all people in nursing facilities;
– Service Planning Teams and Service Coordinators for all adults
with ID/DD in nursing facilities or who are diverted from
nursing facilities;

21. Private Facilities (cont’d)
– Steward v. Perry (continued)
– Community supports:
» Medicaid HCBS waivers to transition people from NFs and
to divert people (635 in current legislative biennium);
» Expansion of community-based medical, nursing, and
nutritional management supports and services,
» Expansion of integrated day, employment, recreational and
other community activities.
– Diversion efforts:
» Identification of individuals with ID/DD at risk of entering
nursing facilities,
» Education about community alternatives, and
» Diversion Coordinators to identify and arrange community
services to prevent admission for such individuals.

22. Private Facilities (cont’d)
– U.S. v. Florida
• Litigation regarding hundreds of children with complex
medical needs unnecessarily in nursing homes and
thousands more at-risk of entering nursing homes
because a lack of community alternatives and cuts to
in-home supports
– Also relief in VA agreement
• Target population includes persons with ID/DD in
nursing facilities;
• Prioritizes waiver slots for people under 22 in NFs;
• Heightened review of any proposed transfers to NFs
from state-operated ICFs

23. Private Facilities (cont’d)
• Adult care homes (large board and care
homes for people with mental illness)
– US v. NC – settlement providing community svs. to
3,000+ people in or at risk of entering ACHs
• Supported housing, ACT, supported employment,
transition supports, enhance QM
– DAI v. Cuomo – settlement providing 2,000+
supported housing units to eligible residents of 23
large, privately owned institutional settings
• ACT, crisis services, transition supports

24. Private Facilities (cont’d)
• Private ICFs
– Statement of Interest in private litigation
– Also relief in VA agreement (similar as for nursing
homes) and findings in Miss.

25. At-Risk Cases
• Significant statement of interest practice
supporting private plaintiffs
– Cuts to critical services without individualized
assessments of impact or exceptions process
– Policies requiring people to first enter an
institution in order to access community services
– Providing services to persons in institutions, but
not equivalent services to individuals in the
community

26. Segregated Days
– Lane v. Kitzhaber/U.S. v. Oregon:
• Court decision on motion to dismiss found that
ADA and Olmstead applies to all government
services, programs and activities, including
employment. Rejected argument that only
applies to residential services and programs.
– Settlements in VA, DE, NC and GA– Include an
expansion of supported employment & integrated
day activities as part of system wide relief.

27. U.S. v. Rhode Island - Landmark
Settlement Agreement
• Relief for 3,250 individuals with intellectual
and developmental disabilities.
• Opportunities for real employment in the
community at competitive wages, and
integrated day activities for non-work hours.

28. U.S. v. Rhode Island – DOJ Findings
• State of Rhode Island violated the ADA and
Olmstead by failing to serve individuals with
I/DD in the most integrated day activity
service setting appropriate for their needs,
and by placing transition-age youth at serious
risk of segregation.

29. U.S. v. Rhode Island – DOJ Findings
• 80 percent of the people with I/DD receiving
state services, about 2,700 individuals, are
placed in segregated sheltered workshops or
facility-based day programs.
• Only about 12 percent, or approximately 385
individuals, participate in individualized,
integrated employment.
• Investigation found that the state has over-
relied on segregated service settings to the
exclusion of integrated alternatives.

30. U.S. v. Rhode Island – DOJ Findings
• Placement in segregated settings is frequently
permanent: nearly half (46.2 percent) of the
individuals in sheltered workshops have been
in that setting for ten years or more, and over
one-third (34.2 percent) have been there for
fifteen years or more.
• Individuals with I/DD in sheltered workshops
in Rhode Island reportedly earn an average of
only about $2.21 per hour.

31. U.S. v. Rhode Island – DOJ Findings
• According to state data, among youth with
I/DD who transitioned out of Rhode Island
secondary schools between 2010 and 2012,
only about five percent transitioned into jobs
in integrated settings, even though many
more of these youth are able to work in
integrated employment and are not opposed
to doing so.

32. U.S. v. Rhode Island Consent Decree
• Transitions 2,000 people with intellectual and
developmental disabilities now in sheltered
workshops or facility-based day programs, or
who have recently left high school, to real jobs
in the community over 10 years.
• Provides 1,250 youth with access to high-
quality transition services over 10 years.

33. U.S. v. Rhode Island Consent Decree
Integrated Employment means:
• Individualized, typical jobs in the community.
• Earning at least minimum wage.
• Working among peers without disabilities for
the maximum hours consistent with a
person’s abilities and preferences.
• Average of at least 2O hours of employment
per week across the target population.

34. U.S. v. Rhode Island – DOJ Findings
• Requires Rhode Island Department of
Education (RIDE) to adopt an employment
first policy, making work in integrated
employment settings a priority service option
for youth.
• Youth in transition will receive integrated
vocational and situational assessments, trial
work experiences, and an array of other
services to ensure that they have meaningful
opportunities to work in the community after

35. U.S. v. Rhode Island Consent Decree
• All persons receiving supported employment
placements will also be provided with
integrated non-work services.
• Integrated day services allow persons with
I/DD to engage in self-directed activities in the
community (e.g., mainstream community-
based recreational, social, educational,
cultural, and athletic activities, including
community volunteer activities and training
activities).

36. U.S. v. Rhode Island Consent Decree
Sustained Commitment to Funding
• Over ten years.
• Redirect, redistribute, and reallocate funds
currently used primarily to support segregated
services to instead fund integrated
alternatives.

37. U.S. v. Rhode Island Consent Decree
Outreach, Education and Support:
• Requires state to develop an outreach, in-reach and
education program explaining benefits of supported
employment and addressing families’ concerns about
participating in supported employment.
• To ensure informed choice, individuals with I/DD
may remain in segregated programs if they request a
variance after they have received a vocational
assessment, a trial work experience, outreach
information and benefits counseling.

38. U.S. v. Rhode Island Consent Decree
• Requires state to create an “employment
first” task force of local stakeholders,
advocacy organizations, parent and business
leadership networks, individuals with I/DD
and family representatives.

39. U.S. v. Rhode Island Consent Decree
Provider Capacity:
• Requires state to establish a sheltered workshop
conversion institute to assist qualified providers to
convert their employment programs to supported
employment services.
• Requires state to establish a sheltered workshop
conversion trust fund of $800,000 to assist with
upfront start-up costs to providers to convert their
services from primarily sheltered employment to
primarily supported employment services.

40. U.S. v. Rhode Island Consent Decree
• Requires state to contract with technical
assistance providers to provide leadership,
training and technical assistance to
employment and day services providers and
to state staff.
• Requires state to ensure reimbursement
model for day activity services allowing
reimbursement for costs such as
transportation, employer negotiation and
counseling clients by phone.

41. U.S. v. Rhode Island Consent Decree
Interagency Collaboration:
• The state will implement interagency
agreements among the Department of
Behavioral Healthcare, Developmental
Disabilities & Hospitals (BHDDH), the Office of
Rehabilitation Services (ORS) and RIDE.

42. Segregated Days (cont’d)
• U.S. v. Rhode Island/City of Providence:
– Found the state of Rhode Island and the City of
Providence violated the ADA by overly relying on
sheltered workshops to the exclusion of more
integrated alternatives.
• Vast majority of people in sheltered workshops could and
want to be served in more integrated settings, like
supported employment and integrated day settings.
• Students with ID/DD at risk of unnecessary segregation in
sheltered workshops. In-school sheltered workshop served
as pipeline to adult workshop; lack of transition services to
prepare students for more integrated options (e.g.,
internships, part-time jobs, and work-based learning)

43. Segregated Days (cont’d)
• U.S. v. Rhode Island/City of Providence:
Interim Settlement Agreement
– Provides relief to: (1) Individuals currently at
state’s largest sheltered workshop provider (TTP)
or who have received services at TTP in the last
year; (2) youth preparing to leave in-school
sheltered workshop program (Birch) or who left
Birch within the last two years; and (3) youth
participating in the Birch program.

44. Segregated Days (cont’d)
• U.S. v. Rhode Island/City of Providence:
Interim Settlement Agreement
Under the Interim Agreement, the State and City committed
to work together to:
• Provide career development plans, vocational assessments, and
benefits counseling for all individuals at TTP and all youth
leaving, or who recently left, Birch.
• Provide supported employment services and placements to all
individuals at TTP and youth leaving, or who recently left, Birch;
• Provide access to integrated transition services to Birch
students through a youth transition planning process beginning
at age 14;

45. Segregated Days
– Lane v. Kitzhaber/U.S. v. Oregon:
• DOJ issued findings letter that Oregon violates ADA by
over-reliance on employment services in segregated
settings (e.g., sheltered workshops)
– Found segregation in sheltered workshops of people who could
and want to work in integrated settings
– Focus on people unnecessarily in sheltered workshops and
people at risk (esp. transition age students)
– Seeks expansion of supported employment

46. Segregated Days (cont’d)
– Lane v. Kitzhaber/U.S. v. Oregon (cont’d):
• DOJ intervened in private litigation alleging that
Oregon administers the State’s employment,
rehabilitation, vocational, and education service system
such that people with disabilities are denied the
benefits of the State’s vocational and employment
services, programs, or activities in the most integrated
setting.
– Includes people currently in sheltered workshops as
well as “at risk” class of students with ID/DD whom
Oregon fails to provide with meaningful choices and
preparation for work in integrated settings.

47. Segregated Days (cont’d)
– Lane v. Kitzhaber/U.S. v. Oregon (cont’d):
• Factual allegations in the complaint:
– Over 52% of participants earn less than $3.00 per
hour. Some earn only a few cents per hour.
– Individuals with ID/DD remain in sheltered
workshops an average of 11-12 years. Some
remain for as long as 30 years.
– 61% received services in segregated sheltered
workshops, while only 16% received any services in
individual supported employment.

48. CROSS-AGENCY
COLLABORATION
REGARDING OLMSTEAD

49. DOJ-HHS
• HHS Technical Assistance to states
implementing DOJ Olmstead settlement
agreement
• Participated in planning HHS Olmstead
Academies
• Input on HCBS Regulations and guidance
documents regarding Medicaid funding
opportunities for critical community services

50. DOJ-HUD
• HUD TA to states implementing DOJ
settlement agreements
• HUD Olmstead Guidance (June 2013)
– HUD-funded affordable housing programs are a critical
resource for Olmstead implementation
– HUD is committed to ensuring that HUD-funded housing
gives choice, self-determination, and opportunities for
people with disabilities to live and interact with people
without disabilities
– Provides guidance on how to structure preferences related
to state Olmstead implementation

51. OTHER CROSS-AGENCY WORK
• Community Employment Working Group
– DOJ, HHS, SSA, DOL, DoEd, EEOC collaboration to improve
employment outcomes for people with disabilities
• US Interagency Council on Homelessness
– Identifying strategies to expand the impact of Olmstead
for persons experiencing homelessness
– Place-based DOJ-USICH collaborations
• Department of Labor
– ODEP initiatives to expand supported employment
– Implementation of the Companionship regulations,
including Olmstead implications

52. Guidance and Website
• Statement of the Department of Justice on
Enforcement of the Integration Mandate of
Title II of the Americans with Disabilities Act
and Olmstead v. L.C. (June 22, 2011)
• Website: www.ada.gov/olmstead
– All settlement agreements, findings letters, briefs,
guidance, testimony, speeches, etc.
• Faces of Olmstead: People impacted by DOJ’s
Olmstead enforcement work

53. Contact Information
Sheila Foran
Special Legal Counsel
Disability Rights Section
Sheila.Foran@usdoj.gov
202-305-0160