A DOJ Opinion Raises Questions About Support at Home

A June Justice Department legal opinion says federal disability rights laws do not require states to provide services that let people remain in their homes rather than enter institutions. KFF Health News reported that the opinion reverses the interpretation previous administrations used after the 1999 Supreme Court ruling that unjustified institutionalization violated the Americans with Disabilities Act. The opinion does not change existing law. HHS spokesperson Emily Hilliard said the agency remains committed to enforcing federal civil-rights laws and to access to community services. Some states with ongoing lawsuits are already citing the opinion in hopes it will help them prevail. KFF reports that the opinion has set the stage for a legal fight among advocates, states, and the federal government. Advocacy groups told KFF that the interpretation could undermine protections for about 40 million adults and 5 million children with disabilities. They worry that the Justice Department and HHS could rescind guidance and regulations that mandate integration.

DeSimone-Shabrack told KFF that Virginia recently reduced her home care help from 30 to 18 hours a week. Virginia's Medicaid program covers the assistance that lets her work, run errands, and keep her son, Mason, at home. That legal question sits beside a separate coverage question in Arkansas. Laura Hellinga said her family's insurance would no longer cover moving a ceiling track that helps lift her daughter, Landry, after the family moved to a new house. Landry's insurance is through PASSE, Arkansas's Medicaid managed-care program for people with complex disabilities. Four participating insurance companies cover 46,564 Arkansans as of July 1, according to a department spokesperson. As of July 1, 2,268 Arkansans were on the Community and Employment Services waiver waitlist and people at the top had waited three years, a department spokesperson said. The reports concern different systems and different points of access to support at home.