MHW: Olmstead Initiative to Help States Support Community Integration

Olmstead Initiative to Help States Support Community Integration

Mental Health Weekly Exclusive   June 25, 2012


A cohort of key federal agencies, including the Centers for Medicare and Medicaid (CMS) and the Department of Justice (DOJ), are collaborating on the launch of a new initiative to further the goals of the landmark Supreme Court decision in L.C. v. Olmstead that would offer selected states the opportunity to assist each other in addressing housing, employment and other community supports for consumers with mental illness.


The Supreme Court ruling on June 22, 1999, required states to eliminate unnecessary segregation of persons with disabilities and to ensure that persons with disabilities receive services in the most integrated setting appropriate to their needs. Thirteen years later, states are still struggling with Olmstead-related efforts, said program officials.


The new opportunity will consist of an Olmstead Policy Academy to help states with strategic planning and technical assistance from the aforementioned agencies along with the U.S. Department of Health and Human Services (HHS), the U.S. Department of Housing and Urban Development (HUD), the HHS Administration for Community Living and the HHS Office of the Assistant Secretary for Planning and Evaluation.


The Substance Abuse and Mental Health Services Administration (SAMHSA) is sponsoring the new initiative in partnership with the National

Association of State Mental Health Program Directors (NASMPHD). SAMHSA officials issued a letter on June 12 to state mental health commissioners and directors inviting them to submit a 1-3 page “Letter of Interest” describing how they would use the opportunity to strengthen current efforts to build Olmstead capacity. The letters, due June 27, should describe specific steps the state has taken in planning and implementation activities.


Five states will be selected to bring teams of up to seven state leaders to participate in the Policy Academy. States will be selected based on their potential to benefit from the Policy Academy and related technical assistance and their ability to implement new Olmstead related strategies on behalf of adults and children with mental disorders.


“Overall, the objectives are to help increase state readiness and strategic planning around promoting increased community integration for consumers with mental health and addiction disorders as well,” Paolo del Vecchio, acting director for SAMHSA’s Center for Mental Health Services (CMHS), told MHW. “We’re looking at those states that have demonstrated interest in supporting community integration and states that have a variety of [support] from mental health commissioners, and other entities within the state, such as the Medicaid office and state housing representatives,” said del Vecchio.


Diverse participation

SAMHSA will also be seeking diversity in participation with respect to state size, geography and urban/rural mix, added del Vecchio. All states will be considered, even those that have had previous involvement with the DOJ regarding Olmstead implementation, as well as those states that have not, he said.


While teams may vary, they could include someone from the state Medicaid office, and representatives from housing, the state legislature and the governor’s office. Each state’s team should also be composed of key policymakers, state leaders, and state or local housing directors, budget directors, providers and family representatives.


“What makes this initiative unique is that it is looking very much at a holistic approach that would include housing, employment, health care needs and really a need to address a range of issues to support people’s recovery and their integration into the community,” said del Vecchio.


A location for the Olmstead Policy Academy has yet to be determined in the Washington, D.C., area, he said. States will be notified if they’ve been selected on July 11. The Policy Academy will be held September 20- 21 in Washington, D.C. SAMHSA will fund travel expenses for the selected

states to participate in the Policy Academy, del Vecchio said.


“The Olmstead Policy Academy will offer states the opportunity to learn about resources offered by the federal government and strategies being used by other states to provide opportunities for people with mental illness to live and thrive in the community, as required by the Supreme Court’s Olmstead decision,” Alison Barkoff, special counsel for Olmstead enforcement at the DOJ, told MHW. “The department encourages all interested states to submit a letter of interest to participate in this opportunity,” she said.


Policy Academy agenda

The agenda for the Policy Academy will include seminars and plenary panels provided by federal and state resource experts. The topics to be addressed will include expanding housing options for people with disabilities, reducing institutional use, providing employment services, using

Medicaid effectively and other strategies to The agenda will also include discussions in team meetings with resource experts to answer specific

questions and issues from state participants.


Additionally, facilitated state team meetings will be held to develop strategy frameworks for Olmstead implementation. Participants will share lessons learned and best policy practices in Olmstead program development.


Community transition

Many states are interested in how to integrate people back into the community who have been institutionalized, said Estelle Richman, senior advisor to the deputy secretary at HUD, told MHW. “The key part is to find people places to live,” she said.


HUD intends to issue guidance over the next couple of weeks that will give all states options on working with people coming out of institutions, she said. The Remedial Action Option is in response to Olmstead litigation or enforcement. Although all states will have the option available to them, HUD will work with five selected states at the Policy Academy on how to implement all housing-related options, including remedial action, said Richman.


The Olmstead consent decree has been in effect since 1999, she said. “Since then there hasn’t been a lot of movement,” Richman said. “DOJ has increased its vigilance in states with little or no movement on integration. This is a way for states to get in front of that action.” CMS will be providing states with information regarding the various strategies they may deploy for using the current Medicaid authorities (state plans, 1915i, waivers, etc.)

to assist them with designing and financing their community integration strategies, said John O’Brien, senior policy advisor at CMS.


O’Brien said other states not participating in the Policy Academy will receive information on lessons learned during the Policy Academy. The documents for the states participating in the initial meeting will be available for all state Medicaid and behavioral health directors, he said. “We would continue our offer of state-specific technical assistance efforts,” said O’Brien.


‘Unprecedented’ initiative

“This initiative is unprecedented,” Robert Glover, Ph.D., executive director of the NASMHPD, told MHW. “These groups have never come together in quite this way before in working with states to help them build capacity to meet the objectives of Olmstead. This initiative is an important opportunity and the lessons learned will be helpful to the entire nation.”


States are challenged by budget cuts and how to build capacity to integrate people into the community, said Glover. “I’m worried that more and more states are unable to comply with the Olmstead agreement,” he said. “Some states are hesitant about negotiating an Olmstead agreement

because of the lack of resources and political pressures.” States need to develop community programs and housing alternatives, he said.


Many states have been pressured by efforts by the DOJ to enforce the Supreme Court’s Olmstead decision, Glover noted. “This initiative is a proactive way of getting in front of this litigation and helping to reduce litigation,” he said. “This is not a way to dodge a lawsuit. This is

about good, committed leadership.”


Glover added, “We are hopeful states will develop programs that serve people with serious mental illness and allow them to seamlessly transition into the community, and keep them out of institutions, such as state hospitals, large congregate living situations, nursing homes, jails and prisons.”


“What we’re trying to do is bridge the gap between federal, state, and local resources and their expertise,” he said.


Letters of Interest can be submitted via e-mail to Chris Marshall, acting special assistant to the SAMHSA/CMHS director, at For questions, he can be reached at 240-276-1967.