Trump Administration Reverses Olmstead Interpretation on Disability Care

The Justice Department issued a memo this month stating that the federal government no longer interprets the Supreme Court's 1999 Olmstead decision as requiring states to deliver Medicaid-funded care in community settings rather than institutions. The memo follows enactment last year of legislation that reduces projected federal Medicaid spending by nearly $1 trillion over ten years.

The law does not directly alter home-care rules, which remain optional for states under existing statute. Rebecca Anger, 41, who has been paralyzed from the neck down since age 7, receives Medicaid-paid aides who assist with daily tasks including transfers, hygiene, and meals.

She and her husband live in a Chicago condominium and both work; she practices law and he receives disability support.

Maryland, scheduled payment reductions for family caregivers take effect July 1. In Colorado, state officials doubled the waiting period for a residential-care program that currently has an eight-year backlog. Ohio lawmakers have expanded fraud investigations that affect provider enrollment.

Anger said the policy shift leaves her concerned that Illinois may reduce home-care hours once federal funding reductions reach state budgets next year. She currently pays aides $19.50 per hour through Medicaid. The White House referred questions to the Justice Department, which did not respond to inquiries.

Administration statements have described the Medicaid changes as measures to reduce waste while preserving services for eligible recipients.