On December 16, 2024, the Judge David L. Bazelon Center applauded the Centers for Medicare & Medicaid Services (CMS) for prioritizing community integration, quality healthcare, and oversight in considering California’s recent proposal to use federal dollars provided through Medicaid to build and operate segregated, residential settings that do not meet the state’s legal requirement to provide services to people with disabilities in the most integrated setting.
On August 30, 2024, Bazelon had filed comments with CMS expressing deep concerns about California’s proposal to use Medicaid dollars to build congregate settings, referred to as “enriched residential settings” (ERS), that would be populated exclusively or primarily by people with disabilities whose activities would be regulated and other restrictions imposed. The ADA and Olmstead v. L.C. (Lois Curtis) require that individuals with disabilities be served in the most integrated setting appropriate and not unnecessarily provided institutional care.
Bazelon's comments argued that California has not made and is not making mainstream housing, subsidized and with appropriate supports, available to those it proposes to serve in ERS. In Bazelon's experience, these individuals could be served in such settings, like “supported housing,” with better results. Evidence and research also was cited that showed that a step-down model or “linear continuum of care” - where people with mental health disabilities are moved through temporary congregate settings before they are transitioned to independent housing - is not necessary nor effective. At a minimum, CMS was urged to impose guardrails limiting the use and size of these segregated, residential settings.
There was immediate progress. This month, in responding to the state’s application for funding, CMS denied California’s request for federal funding of ERS and instructed California to first develop, seek public comment on, and submit additional details on critical related issues such as how the proposed pilot will ensure people are placed in the least restrictive setting and how it will confirm service settings are committed to being truly integrated, with independent choice. Bazelon has praised CMS for its active and crucial oversight to ensure that people with disabilities are not unjustly segregated and instead can live and receive services in their own homes and communities.
