Testimony of 

Henry Claypool 

Principal Deputy Administrator 

Administration for Community Living 

U.S. Department of Health and Human Services 

Before the 

Senate Committee on Health, Education, Labor and Pensions 

“Olmstead Enforcement Update: Using the ADA to Promote Community Integration”

June 21, 2012 
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Chairman Harkin, Ranking Member Enzi and members of the Committee, thank you for the 

opportunity to testify this morning on the Supreme Court’s Olmstead decision, and the 

Department of Health and Human Services’ (HHS) commitment to ensuring that individuals with 

disabilities can live and participate fully in their communities with access to the services and 

supports they need. 

Chairman Harkin, I would be remiss if I did not take this opportunity to acknowledge your 

leadership in protecting the rights of, and advocating for increased opportunities for, Americans 

with disabilities to live as valued and contributing members of their communities. Not only did 

you author the Americans with Disabilities Act (ADA) and serve as its chief sponsor in the 

Senate, but today – almost 22 years later – you continue to offer unwavering support to ensure 

that Americans with disabilities have full access to society, including the right to live 

independently in their own communities. 

I would also like to take a moment to recognize my colleague, Tom Perez. When the Olmstead

decision was handed down, he was serving as the Director of the Office on Civil Rights at HHS, 

and helped issue the Department’s first guidance to state Medicaid directors on how to make 

state programs responsive to and comply with Olmstead. Today, as Assistant Attorney General 

for Civil Rights at the Department of Justice (DOJ), he continues to place a high priority on

Olmstead enforcement, among the many other important civil rights matters at DOJ. Thank you, 

Tom. It is a pleasure to testify here with you today.
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In 1999, the Supreme Court determined in its Olmstead ruling that under the ADA, it is 

discrimination to unnecessarily institutionalize a person with a disability who chooses to live in 

the community with the proper services and supports, and does not oppose community 

placement; taking into account the resources available to the state. This Administration has 

made significant strides, as well as key investments, toward the day that all Americans with 

disabilities can live in a home of their choosing, accessing the services and supports they need 

and experiencing the dignity and respect that comes with the opportunity to fully participate in 

all aspects of our communities.

Before I share with you some of the key investments and achievements the Department of Health 

and Human Services has made in recent years to ensure that individuals with disabilities can 

achieve their right to live fulfilling, healthy lives in the community, I first want to take a moment 

and recognize where we started. 

In 1967, the number of individuals with intellectual and developmental disabilities living in 

institutions reached the peak of nearly 195,000 on an average day.1 While that number had 

dropped to about 60,0002by the mid-1990s, there were still many individuals – including Lois 

Curtis and Elaine Wilson – who were living in institutions and wanted to live freely in their 

communities. In 1995, with the State of Georgia refusing to allow the women to live and receive 

services in a more integrated, community-based setting, Lois and Elaine filed suit, under the 

name Olmstead v. LC and EW. Today, Lois rents her own home and is finally able to able to live 

meaningful life, contributing as a member of society through creating and selling art. 

 

1

Statistic comes from http://rtc.umn.edu/docs/risp2010.pdf, p. 12. 

2

Statistic comes from http://rtc.umn.edu/docs/risp2010.pdf, p. 12.
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Year of Community Living

Recognizing that there is still much work to be done, in his first months of office President 

Obama sought to focus on the goals of the Olmstead decision by announcing the “Year of 

Community Living.” Announced on the tenth anniversary of the decision, this initiative 

established critical partnerships between three Departments of the federal government and has 

sparked new activity to help individuals with disabilities transition from institutions into the 

community. Specifically, in this signature disability initiative, the President called for an 

unprecedented partnership between HHS and the Department of Housing and Urban 

Development (HUD) to address one of the most significant barriers to living in integrated 

settings: accessible and affordable housing for those living with a disability who want to live in 

the community. 

Under the leadership and direction of Secretary Sebelius and Secretary Donovan, our agencies 

meet regularly to identify and implement strategies that address the coordination of long-term 

services and supports with accessible and affordable housing, particularly for individuals at risk 

of institutionalization. In the initial year of the partnership between HHS and HUD, the 

coordination of $40 million in Section 8 Housing Choice Vouchers made it possible for 5,300 

people with disabilities, who rely on supportive services to live in the community, to access 

affordable housing across the country. This includes nearly 1,000 vouchers designated for

individuals transitioning to community-based services and supports through the federal Money 

Follows the Person program. 
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The awarding of nearly 1,000 vouchers was a deliberate effort by HHS and HUD to coordinate

rental assistance, health care and other supportive services to support to this population and help 

states comply with Olmstead. For states that are actively working to comply with Olmstead and 

rebalance their Medicaid long-term services and supports programs to increase the emphasis on 

providing services in home and community-based settings instead of institutional settings, the 

lack of affordable and accessible housing remains a significant barrier to people with disabilities 

seeking to realize their right to live in the most integrated setting. The HHS-HUD partnership 

has begun to change how the housing and health care agencies at the state and federal level view

their relationship with regard to the needs of individuals with disabilities – a population they are 

both charged with serving.

We have seen how this type of partnership and innovation affects individual lives. Three years 

ago, a mother of two named Sonia was crossing the street when a car hit her, put her in a coma 

for five months, and left her with the left side of her body paralyzed and in a nursing home 

separated from her children. Last June, she received a housing voucher and services under the 

Money Follows the Person program, allowing her to return home. Today she can support and 

play with her children, go to job training, and participate in her community.

Moreover, HHS has also worked closely with HUD to implement changes to improve integration 

of HUD’s Section 811 Program, which is designed to develop and subsidize rental housing for 

very low-income adults with disabilities. Last month, HUD announced a new $85 million 

funding opportunity under the Section 811 program for state housing agencies that meet new 

eligibility criteria, including having a partnership with a state health and human services agency 
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and Medicaid agency, to provide essential supports and services that help people live in 

integrated settings in the community. This funding opportunity works to align critical health and 

housing services, and aims to assure integration by setting the number of apartments that can be 

exclusively set aside for people with disabilities at 25 percent. This is a fundamental shift in 

housing policy at HUD and brings the Section 811 program into alignment with the principles of 

the Americans with Disabilities Act and promotes Medicaid efforts to serve people in the most 

integrated setting appropriate to their needs. 

The reinvigoration of the efforts by the Department of Justice to enforce the Olmstead decision 

was the other component of the President’s “Year of Community Living.” The testimony of 

Assistant Attorney General Perez outlines the steps taken by DOJ to ensure that states understand 

how they can comply with the ADA when they use Medicaid to provide long-term services and 

supports. HHS has worked closely with DOJ on matters related to Olmstead. Specifically, 

HHS’ Office for Civil Rights (OCR) partners with DOJ to enforce the ADA and the Olmstead 

decision. For example, in 2008, OCR entered into a voluntary resolution agreement with the 

State of Georgia to resolve Olmstead complaints regarding the state’s mental health and 

developmental disabilities systems. The state failed to comply with the agreement and DOJ 

initiated litigation. In October 2010, OCR, DOJ and the State of Georgia signed a 

comprehensive settlement agreement that will ensure that thousands of people with disabilities 

will receive community services instead of institutional care. OCR continues to resolve 

Olmstead complaints, often working with people with disabilities, families, advocates, state 

agency officials, and other HHS agencies to ensure that individuals can remain in the community 
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without risk of institutionalization and have the opportunity to transition to the community from 

an institutional setting. 

To organize and coordinate efforts at HHS related to the President’s “Year of Community 

Living,” Secretary Sebelius created the Community Living Initiative. This facilitated a crossagency workgroup that met to discuss key issues related to community living and the 

infrastructure of the home and community-based services delivery system. Along with access to 

affordable housing, the initiative addressed the needs of the workforce that provides communitybased services and supports, providing new opportunities to make community-based services 

available under the Medicaid program, and explored how gathering better data related to 

disability could enhance the quality of these home and community-based services. Historically, 

the approach to defining home and community-based services has been exclusively focused on 

defining services and settings against the framing of “not an institutional setting” instead of 

defining the positive and necessary elements that create a home in the community. The crossagency workgroup’s work on person-centered planning and self-direction was incorporated into 

the Community First-Choice and the 1915(i) State Plan Home and Community-Based Services 

rulemaking, which has helped inform the agency’s current effort to define the locations in which 

Medicaid recipients are receiving coverage for home and community-based services. 

Finally, in addition to the Community Living Initiative, Secretary Sebelius formed an HHS 

Coordinating Council, bringing together multiple HHS agencies and offices and asking them to 

coordinate their efforts to build and strengthen home and community-based services. 

Workgroups have been formed to address issues such as affordable housing, building the home 
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and community-based workforce, improving employment supports, and enhancing access to 

services. Discussions in these intra-departmental conversations inform HHS’ work internally

and its engagements with other agencies that are part of the Community Living Initiative.

Affordable Care Act 

On March 23, 2010, President Obama signed the Affordable Care Act, which set forth numerous 

protections for all Americans, including people with disabilities, filling in an important piece of 

the ADA by addressing healthcare discrimination and improving access and affordability. 

Thanks to the new healthcare law, people like Tina from Michigan have more control and access 

over their healthcare. Tina has epilepsy that requires consistent monitoring and care. After 

graduating from college at the age of 22, Tina could find a job, but she couldn’t find health 

insurance except for a very limited policy that did not meet her needs. Now, because of the 

Affordable Care Act, Tina – who is now 24 years old – can stay on her family’s health insurance 

plan until she is 26, which not only provides great coverage but also includes the doctors who 

know her, understand her epilepsy, and whom she trusts.

Moreover, starting in 2014, Tina and other people with disabilities will be protected by the law’s 

prohibition on some insurance companies’ egregious practices of denying benefits or charging 

more to any person based on their medical history. For children younger than age 19, the law 

has already gone into effect, and insurance companies can no longer discriminate and deny 

coverage based upon pre-existing conditions for children and youth.
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Not only does the Affordable Care Act expand access to health coverage, but also it expands 

affordability for many low-income individuals, including many people with disabilities. 

Specifically, starting in 2014 the new health care law includes a Medicaid program expansion 

that will reach more Americans, including some people with disabilities. This expansion will 

cover many low-income people with disabilities who do not currently meet the Social Security 

Administration’s definition of disability.

Another critical aspect of the Affordable Care Act are the provisions that address long-term 

services and supports, including rebalancing Medicaid investments from institutions to home and 

community-based services. Specifically, the law strengthens the Money Follows the Person 

(MFP) program, which provides states significant federal support to help institutionalized 

individuals get out of their institutions and return to their homes or other community settings, 

which in almost all cases substantially improves their quality of life. By extending MFP through 

2016 and investing an additional $2.25 billion in funding, the program will build on its successes 

to date, which in the past five years has helped 20,000 individuals leave institutions for the 

community. Today, 43 states and the District of Columbia are participating in MFP, and the 

renewed commitment toward MFP in the Affordable Care Act means that thousands more can

leave institutions and live where they want with the services that they need. 

The successes of this program can be understood through the story of Quentin Hammond. After 

a traumatic brain injury as an infant, Quentin lived in a nursing home for the first six years of his 

life, where he was not engaged at his fullest potential. He was misdiagnosed as being blind and 

non-responsive. However, thanks to the Money Follows the Person program and the tireless 
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advocacy of his mom, Quentin was able to leave the nursing home and move home with his mom 

and little brother, receiving the necessary services and supports so that he got the same high-level 

of care. Quentin now attends school and is learning to communicate. His quality of life has 

improved tremendously. 

This critical choice to be able to live in one’s own home, and have access to the medical services 

and supports they need, are the exact kinds of rights that the Affordable Care Act gives 

Americans, especially Americans with disabilities.

In addition to strengthening the Money Follows the Person program, the Affordable Care Act 

gives new incentives for states to offer home and community-based long-term services and 

supports as an alternative to institutions. Under the Balancing Incentive Program, $3 billion in 

enhanced federal Medicaid matching funds are available to states that that make structural 

reforms to increase nursing home diversions and access to non-institutional long-term services 

and supports. In March 2012, New Hampshire and Maryland were the first states to receive this 

new funding; and Georgia, Iowa, Mississippi, and Missouri have all since been approved to 

participate in the program as well. 

States have an additional incentive to reduce the institutional bias in Medicaid through the 

Community First-Choice program, which increases federal Medicaid support for states that 

choose to provide home and community-based attendant services to Medicaid beneficiaries 

otherwise facing institutional placement. In addition to receiving a broad range of services, 

Community First-Choice recipients must have their self-determination supported through the 
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opportunity to develop a person-centered plan that allows the individual to determine how 

services are provided. The Community First-Choice benefit will further assist Medicaid 

beneficiaries in avoiding unwanted institutional placement while at the same time providing 

states with more resources to support this work.

Finally, the Affordable Care Act makes investments to integrate care delivery under Medicaid 

and Medicare for dual eligibles. Often, people with disabilities are beneficiaries under both 

programs, creating the need for care coordination and management across these two programs. 

Done right, the integration of these two programs can improve access to essential health care 

services and promote enhanced access to long-term services and supports, which can help avoid 

unnecessary hospitalization and institutionalization for people with disabilities, and at the same 

time lowering costs to our nation’s healthcare delivery system. 

In keeping with the integration mandate of the Americans with Disabilities Act, and as required 

by the Olmstead decision, these critical provisions of the health care law provide new ways to 

serve more people in home and community-based settings. 

Administration for Community Living 

The President’s Year of Community Living, the Secretary’s Community Living Initiative, 

critical improvements thanks to the Affordable Care Act, and the pressing need to continue to 

transform our health care delivery systems, have all culminated in Secretary Sebelius’ creation of 

the Administration for Community Living. 
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Today, I serve as the Principal Deputy Administrator of the Administration for Community 

Living, as well as Senior Advisor to the Secretary for Disability Policy. Kathy Greenlee 

maintains her role as Assistant Secretary for Aging, while also serving as the Administrator of 

the new agency. 

The establishment of the Administration for Community Living creates a single agency charged 

with developing policies and improving supports for seniors and people with disabilities by 

bringing together the key organizations and offices focused upon these populations. The agency 

builds upon this Administration’s work to promote the goals of the Americans with Disabilities 

Act: to assure equality of opportunity, full participation, independent living, and economic selfsufficiency for individuals with disabilities. We are committed to improving the broad range of 

supports that individuals may need, focusing on populations that have an extraordinary reliance 

on health care and long-term services and supports. Ultimately, the integration of the health care 

system and the long-term services and supports systems is essential to the health and well-being 

of millions of Americans with disabilities and seniors that have functional support needs. 

The Department’s efforts to better align the Medicare and Medicaid programs hold great 

promise to improve the health of those eligible for both programs, such as younger adults with 

disabilities and seniors who have chronic health conditions and functional support needs. To that 

end, the Administration for Community Living will work closely with the Centers for Medicare 

& Medicaid Services to advance its alignment efforts directed to the population jointly served by 

the two agencies. The potential for better coordination of health care and crucial communitybased services and supports will be an area of emphasis for the new agency. 
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We realize that we are serving diverse populations, including frail elders, individuals with 

physical disabilities, and those with intellectual and developmental disabilities across the 

lifespan. Representing the voice of each of the populations served is core to the work of the 

entities coming together under the Administration for Community Living. This will continue 

with an increased strength through a unified mission while still acknowledging the unique needs 

and attributes of each group. However, these communities share a common vision – that all 

Americans should have the right to live in a home of their choosing, with people whom they care 

about, that is integrated into a community that values their participation and their contributions –

and the Administration for Community Living will work to support that vision. 

We also know that community living relates to more than where people live. Integration requires

the availability of appropriate supports including opportunities in health care, housing, 

employment, education, childcare, and social participation for people with disabilities and older 

Americans. The Administration for Community Living will take a holistic approach to meeting 

the community living needs of people with disabilities and older Americans.

We are excited about this realignment and the renewed focus the development of the 

Administration for Community Living has placed on community living and community 

integration at HHS and across the Administration. At the Department of Health and Human 

Services, we look forward to working internally, with other agencies across the Administration, 

with Congress, and with the public at large to advance policies that support community living 

and ensure that those who have been harmed by discrimination, like Lois Curtis, can pursue their 

passions living in the community. 
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Thank you again for inviting me to testify and at this time I would be happy to address any 

questions.