The U.S. is undergoing a major transition in the way we provide services and supports for people with disabilities. Two decades ago, people with disabilities were separated from society and isolated in institutional settings, and Medicaid supports and services were only available through nursing homes and other specialized residential facilities. A 1999 Supreme Court decision requiring states to provide services in the most integrated setting appropriate 1 initiated a drive to “rebalance” care from institutional to non-institutional settings and “integrate” persons with disabilities in the community. Since then, Medicaid funding for services and supports for older adults and other people with disabilities has shifted from 80 percent institutional care to over half through waivers providing home and community services, and is continuing to move toward the home- and community-based settings that are preferred by individuals with disabilities and can be less expensive to provide.
Read the white paper here.