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Trial of Lawsuit Brought by Floridians Seeking Community Services

A trial was held in early 2010 in a class action lawsuit (Lee v. Dudek) brought by Medicaid beneficiaries in Florida who allege that their civil rights have been violated by unnecessary segregation in nursing homes and denial of long term care services provided in the most integrated setting. This is believed to be the first class action trial of a case extending the Olmstead principle, that the receipt of government series cannot be conditioned on residence in an institutional setting, to a traditional nursing home population of primarily aged and disabled persons.

Plaintiffs are represented by attorneys from AARP, Southern Legal Counsel, the National Health Law Project, and a private attorney, Stephen Gold. A decision is expected by early Spring, 2011.

Nursing home care is one service that states must provide through their Medicaid program, while more popular and less expensive home and community-based long term care services are an option that a state may, but is not required to, provide. If a state provides HCBS as an optional service it must comply with applicable law, such as the Americans with Disabilities Act which requires public entities to administer programs in the most integrated setting appropriate. For many nursing homes residents, the most integrated setting for services is the community rather than a nursing home. The U.S. Supreme Court, in the Olmstead decision, confirmed the most integrated setting mandate requirement of the Americans with Disabilities Act in the context of institutional versus community-based care.

This Dispute

Increasing home and community-based care as an alternative to nursing homes makes sense for state budgets. In Florida, per-person spending for nursing home facilities can be 13 times that for home and community-based care. Yet Florida's policymakers have headed down a path that makes home and community-based care for its nursing home residents very difficult to obtain. Since 1999, the state has been steering its funding toward institutions. In 2006, nearly 90 percent of Florida's Medicaid long-term care funding went to nursing facilities, while only 10 percent went to community-based services; the national average is closer to a 70-30 split.

In this case seven plaintiffs filed a class action lawsuit challenging Florida's failure to provide adequate home and community-based care options to nursing homes residents alleges that the state's failure to make home and community-based care options available violates federal disability anti-discrimination law.

Millions of people with disabilities need some assistance but prefer to live in their own homes as independently as possible and for as long as possible. Almost a decade ago, the U.S. Supreme Court unequivocally articulated important safeguards enabling people to age in place, and these safeguards need to be enforced.

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