How must states change their Medicaid programs to comply with Olmstead?
Because Medicaid is such an important funding source for community-based services for individuals with disabilities, and states receive federal reimbursement for a substantial share of the cost of Medicaid services, expansion of community-based Medicaid programs is often a key element in Olmstead cases. The Medicaid program affords states substantial flexibility in determining the amount, duration and scope of services covered under their Medicaid plans, but the ADA’s integration mandate requires states to expand services in ways that the Medicaid statute itself does not require. Indeed, the plaintiffs in Olmstead sought community-based waiver services, to which they were not entitled under Medicaid as long as the state was providing the number of waiver slots it had agreed to provide. Nothing in Olmstead suggests that the ADA’s integration mandate must be read to exempt states from doing anything that the Medicaid statute does not already require them to do. Yet states have argued tha
