Twenty five years ago this week, the Americans with Disabilities Act (ADA) was signed into law, making clear that people with disabilities should experience equal opportunity, independent living, economic self-sufficiency, and full participation in all aspects of our society. Over the past two and a half decades, our communities have become more accessible and more inclusive – in obvious ways, like curb cuts and accessible buildings, and in sometimes less recognized ways, such as the integration of people with disabilities in our schools, workplaces, businesses and neighborhoods.
At the heart of the ADA is the promise that people with disabilities are treated as equal citizens, afforded the same opportunities and rights as all Americans. But the 1990 law left out one critical civil rights protection – full access to health care coverage.
Fortunately, with the passage of the Affordable Care Act (ACA), Americans with disabilities no longer face exclusion from health insurance on the basis of medical history or pre-existing conditions, nor do they need to worry about hitting lifetime caps on benefits. As a result, many more people with disabilities are able to access quality health insurance that meets their needs, and they will no longer lose coverage when they need it most. While we have more work to do to address disparities and equal access, the ACA and the ADA have fundamentally changed the healthcare landscape for people with disabilities and the HHS Office for Civil Rights will be issuing a proposed rule to further explain non-discrimination under the ADA.
As well as improving access and quality of clinical health care, the Affordable Care Act also expanded home and community-based services for people with disabilities and older adults. Medicaid options such as Community First Choice, Balancing Incentives and Money Follows the Person are making a difference, bringing community living options to more people. HHS recently reported that for the first time, the majority of Medicaid long-term services and supports expenditures occurred in home and community-based services—as opposed to institutional care – based on 2013 data. This represents the third straight year in a row that we have seen growth in home and community-based services and a decrease in institutional spending.
Community living is the preferred option for the vast majority of Americans, and most of us take for granted the ability to choose where we live, with whom we live, when and what we eat, how we spend our days, or how we decorate our bedrooms. Yet for many people with disabilities, in particular people with significant support needs and those with complex medical needs, those basic choices have been out of reach.
This does not have to be an inevitable consequence of living with a disability. In this day and age, we know how to support people in integrated settings, to encourage community membership and reciprocal relationships, and to further employment in our mainstream workplaces.
Receiving services should expand opportunities, not create barriers. With the implementation of our home and community-based services regulations, many more Americans will receive services that support integration into the broader community instead of isolating them, consistent with the Olmstead decision under the ADA.
The Administration for Community Living and the Office for Civil Rights work together daily, along with other partners at HHS, to ensure that the promise of the ADA becomes reality. We all benefit when every American has the opportunity to fully participate in, and contribute to, our communities. As we pause to reflect on the silver anniversary of the ADA, there is much to celebrate, and still much to be done to ensure that all Americans, regardless of disability, can achieve equal opportunity.
Sharon Lewis is the Principal Deputy Administrator at the Administration for Community Living and Jocelyn Samuels is the Director at the Office for Civil Rights