Martin Kitchener, PhD, MBA¹, Micky Willmott, MA¹, and Charlene Harrington, PhD². (1) Department of Social & Behavioral Sciences, University of California San Francisco, 3333 California St, Suite 455, San Francisco, CA 94143-0612, 415-502-7364, martink@itsa.ucsf.edu, (2) Disability Statistics Center, Institute for Health & Aging, University of California, San Francisco, 3333 California Street, Room 340, San Francisco, CA 94118

This paper provides a critical analysis of inertia and change in the US field of disability that concentrates on the institutional (nursing home and ICF/MR) bias in Medicaid services provision that persists despite the Americans with Disabilities Act, the Olmstead Supreme Court decision and recent federal policy innovations such as that associated with the New Freedom Initiative (NFI). This analysis first locates the Olmstead decision and recent policy developments within the long-running struggle of the disability movement to secure extended access to Medicaid home and community-based services in general, and personal assistance services in particular. The empirical analysis draws from a unique dataset that combines three sources of information collected by the authors: (1) an annual national survey of expenditures, participants and cost control policies on Medicaid HCBS programs for the disabled (1999-02), (2) a study of the formal plans that states produce to demonstrate compliance with Olmstead, and (3) an analysis of legal cases arising from ADA and Olmstead. In combination, data from these sources indicate that, beyond much rhetoric of change following Olmstead (e.g., in states’ formal plans), the extension of Medicaid HCBS for the disabled has been limited; in part, by state fiscal crises. However, the role of state-level political will and policy is underscored by evidence of trends including: huge inter-state variations in Medicaid HCBS provision for the disabled, rising Medicaid nursing home expenditures, and an observation that improved Medicaid HCBS for the disabled has occurred in some states (only) after litigation.

Learning Objectives: Learning Objectives. From this session participants will

(
• develop a conceptual and empirical understating of disability advocates’ struggle to extend access to Medicaid HCBS following Olmstead, and (
• better understand the path dependent development of contemporary policy contradictions and concerns in the US field of disability.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.