California Health and Human Services

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Link to the California Web State Portal

Olmstead Document Archive

Follow California’s Olmstead Implementation Activities
  1. The state affirms its commitment to provide services to people with disabilities in the most integrated setting, and to adopt and adhere to policies and practices that make it possible for persons with disabilities to remain in their communities and avoid unnecessary institutionalization.
  2. The California Health and Human Services Agency (HHSA) shall do all of the following:
    • Assess the state’s ability to reasonably accommodate new and improved efforts to prevent unnecessary institutionalization of individuals with disabilities and to facilitate or expand community-based services and supports.
      • Long Term Care Finance Study. Click here.
      • Home and Community Based Services Study – California Medicaid Research Institute. Click here.
      • The committee raised interest at the 8/13/09 meeting to analyze outcomes for individuals who have been impacted by budget reductions. Click here to see research being conducted at UCLA through funding by The SCAN Foundation. See funding priorety two for policy development information.
    • Continue to evaluate the May 2003, California Olmstead Plan and make revisions as necessary to insure that it will result in positive action toward the objectives of providing services to people with disabilities in the most integrated setting possible, and enabling persons with disabilities to remain in their communities and avoid unnecessary institutionalization.
      • OAC Workgroups identified priority objectives in areas of Assessment and Transitions, and Diversion. Click here.
    • Identify additional strategies to identify Californians who could be served successfully in non-institutional settings and the barriers to these individuals moving at a reasonable pace from, or avoiding admittance to, institutional long-term care facilities.
      • Medi-Cal Hospital Waiver Renewal: Click here.
      • Status of recent Medi-Cal waiver renewals. (Link to page that has updates on IHSS Plus waiver into the State Medicaid Plan service through a 1915(j) State Plan Option; Multi-Purpose Senior Service Program; Assisted Living Waiver; and the waiver creating small Intermediate Care Facilities with continuous nursing services. Click here.
      • California Community Transitions demonstration facilitates transition of long-stay institutional residents to community living. As of October 2009, 100 people have successfully transitioned from nursing facilities after having resided there for six months or longer. Click here.
      • Six Aging and Disability Resource Connection centers are developing strategies to assist people in avoiding admittance to institutional long-term care facilities. ADRCs provide web-based and in-person resources to individuals and families regarding needed services and programs. In September 2009, the State Independent Living Council received funding to expand ADRCs and to plan for statewide implementation. Click here.
    • Research funding opportunities to support expanded or new activities to support individuals with disabilities in their communities.
      • CHHS and it’s departments received funding in each of the four grant areas. See the “Navigating Long Term Care” section here.
      • In 2010, the California Department of Aging was awarded a New Freedom grant offered by CalTrans under FTA Section 5317 to improve mobility management for seniors and people with disabilities. For more information on mobility action plans, Click here.
      • Develop recommendations for changes in state policies that will remove programmatic and fiscal incentives for institutional placement and increase opportunities to utilize community-based services.
      • In the Fall of 2006 CHHS received funding under the Real Choice System Transformation initiative to pursue three objectives, one being to complete a comprehensive study with recommendations, to improve the State’s understanding of the financial and structural barriers to increasing access to home and community-based services. California Community Choices.
      • Develop recommendations for changes in federal policies that will remove programmatic and fiscal incentives for institutional placement and explore options for expanding or modifying the state Medicaid plan or Medicaid waivers.
      • The U.S. Housing and Urban Development will announce new Section 8 vouchers available specifically for individuals needing housing upon discharge from institutional settings such as nursing facilities.  The solicitation references the Money Follows the Person demonstration, indicating the federal government has heard the message from CCT and other state demonstrations that affordable and accessible housing is the major barrier to transitions for the target population.
  1. In order to inform the Administration’s understanding of the current system and future opportunities and insure the involvement of persons with disabilities and other system stakeholders, the Secretary of HHSA, at his or her discretion, is authorized to form an advisory group to provide input to the HHSA on its efforts to evaluate, revise, implement, and monitor the Olmstead Plan, on recommended actions to improve California’s long-term care system, and on opportunities to fund expanded or new activities to support individuals with disabilities in their community.  The Secretary should take into account the diversity of California’s citizenry with respect to culture, language, geography, and disability in formulating the membership of his or her advisory group.
  2. All state agencies and departments are hereby directed to cooperate with and assist the HHSA in carrying out its duties under this Executive Order.
    • Representatives of CalTrans and HCD within the Business, Transportation and Housing Agency attend Olmstead meetings. CalTrans is leading efforts to remove barriers to transportation services for older adults and people with disabilities of all ages with funding from a United We Ride grant, and with advice by a Mobility Action Plan Advisory Committee that is chaired by the Director of the Department of Aging. Click here.
    • Employment Development Department and the Governor’s Committee on Employment of People with Disabilities are working on initiatives to increase employment outcomes and increased access to employer-covered healthcare. These entities within the Labor and Workforce Development Agency have spearheaded a public marketing campaign Talent Knows No Limits. Click here.
    • Together with Department of Developmental Services, DHCS and DOR and many other state departments, EDD is elevating employment opportunities within government, promoting the State as a Model Employer.

CHHS/DHCS received a 3-year grant to enhance existing ADRC programs and the Medical Case Management program addressing hospital to home transitions for seniors and people with disabilities at risk of repeat hospitalization or long term nursing facility placement. Both programs will include patient empowerment components.

DOR is investing American Recovery and Reinvestment Act funds toward Olmstead activities. Non-profit disability organizations are recipients of grants for Olmstead-related education and awareness, technical assistance and training, and peer mentoring programs. Click here

Report: Home and Community-Based Long-Term Care: Recommendations to Improve Access for Californians

Executive Summary
PDF | Word | Rich Text Format

Final Report
PDF | Word | Rich Text Format (available upon request:

November 12, 2009 Briefing Presentation

Hard copies of the Executive Summary, Final Report and Briefing Presentation are available upon request:

The Department of Health Care Services (DHCS) will be renewing, converting, or amending several Medi-Cal HCBS waivers during State Fiscal Year 2008-09.  These processes generally take several months of planning, development and negotiation with the federal Centers for Medicare and Medicaid Services (CMS) before waiver approval.  They involve DHCS waiver, fiscal forecasting, and budget staff as well as program management from departments involved in the specific waiver.  The fiscal impact of the waiver must meet applicable federal requirements for cost neutrality, and comply with any additional fiscal or cost restrictions imposed through the State’s budget process or legislation authorizing the waiver.

Process for Getting Stakeholder Input

DHCS is working with the Olmstead Advisory Committee (OAC) and other external stakeholders to get input on HCBS waiver issues relating to what services are most critical, how to outreach to vulnerable populations, waiver caps and waiting lists, and evaluation of quality and effectiveness.  The input received will be vetted with executive management, and, as appropriate, included in the final application to CMS.

1915(j) Self-Directed Personal Assistance Services State Plan Amendment Pre-Print

IHSS Plus Waiver (IPW) Comparison Chart

Presentation: State Plan Amendment Process for Incorporating IHSS Plus Benefits into 1915(j)

Multipurpose Senior Services Program Waiver Renewal – Stakeholder Input Session

Intermediate Care Facilities for the Developmentally Disabled- Continuous Nursing Pilot Project – Stakeholder Input Session

Background: Olmstead v. L.C.

On June 22, 1999, the United States Supreme Court issued a decision in the case of Olmstead v. L.C., finding that the unjustified institutional isolation of people with disabilities is a violation of the Americans with Disabilities Act (ADA). The court found that under certain circumstances, regulations implementing Title II of the ADA require the placement of persons with disabilities in community settings rather than institutions. The decision challenged federal, state and local governments to develop cost-effective community-based services to prevent or delay institutionalization.

Additional Olmstead Advisory Committee Information:

Olmstead: Advisory Committee Members
Olmstead: A Primer
Olmstead Plan Implementation Update
Olmstead Advisory Committee Policy Statement
Olmstead Advisory Committee Policy Filter
Comments on Proposed Rule 2249-P

Nursing Facility and In-Home Operations Waiver Summaries:

October 2010
January – June 2010
September 2009
September 2008
September 2008 Chart
August 2008
August 2008

Publications on Long-Term Care:

AARP Briefing on Long-Term Care Reform – National
AARP Briefing on Long-Term Care Reform – California
AARP Briefing on Long-Term Care Reform – Microsoft Word Version

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