Tuesday, November 9, 2004 - 8:48 AM

Abstract #83075
Dynamics of change and inertia in the US disability field: Olmstead and beyond

Martin Kitchener, PhD, MBA, Micky Willmott, MA, and Charlene Harrington, PhD.

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: 1.
develop a conceptual and empirical understating of disability advocates’
struggle to extend access to Medicaid HCBS following Olmstead, and 2.
better understand the path dependent development of contemporary policy
contradictions and concerns in the US field of disability.