In Olmstead v. L.C. In addition to these judicial developments, the recent health care reform package, the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148 ) as amended by the Health Care and Education Reconciliation Act (HCERA, P.L. 111-152 ) (collectively the Affordable Care Act, or ACA), has the potential to influence states' Olmstead initiatives. Specifically, the Affordable Care Act revised the federal Medicaid statute to give states greater incentives to provide home and community-based care services to people with disabilities, offer states greater flexibility in the kinds of packages of home and community-based services they can offer, and, perhaps, enable states to provide more Medicaid beneficiaries with long-term care services in their communities. Because judicial developments under Olmstead often take federal Medicaid law into account, PPACA amendments to that law may affect the outcome of future cases on deinstitutionalization. , the Supreme Court held that "unjustified isolation ... is properly regarded as discrimination based on disability" under Title II of the ADA and its implementing regulations. Specifically, the Court held that the ADA defines discrimination to include the unjustified segregation of individuals with disabilities and thereby requires states to provide community-based treatment for persons with mental disabilities when three conditions are satisfied: (1) the state's treatment professionals determine that such placement is appropriate, (2) the affected persons do not oppose it, and (3) the placement can be reasonably accommodated given the state's resources and the needs of others with mental disabilities. A Prima Facie Case of Discrimination by Segregation

The appellate courts have generally rejected interpretations of Olmstead that would make it more difficult for plaintiffs to establish a prima facie case that the state has failed to fulfill the ADA's integration requirement.
The Supreme Court ruled in Olmstead v. L.C., 527 U.S. 581 (1999), that, under Title II of the Americans with Disabilities Act (ADA) and its implementing regulations, states must transfer individuals with mental disabilities into non-institutional settings when: a state treatment professional has determined such an environment is appropriate; the community placement is not opposed by the individual with a disability; and the placement can be reasonably accommodated. In subsequent litigation, appellate courts have (1) rejected interpretations of Olmstead that would make it more difficult to establish a prima facie violation and (2) distinguished "reasonable accommodations," which Olmstead requires states to make to their programs and services, from "fundamental alterations," which it does not.
In addition to these judicial developments, the 2010 health care reform package, the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148) as amended by the Health Care and Education Reconciliation Act (HCERA, P.L. 111-152) (collectively, the Affordable Care Act, or ACA), has the potential to influence states' Olmstead initiatives. The health care reform law revises the federal Medicaid statute to give states greater incentives to provide home and community-based care services to people with disabilities, offer states greater flexibility in the kinds of packages of home and community-based services they can offer, and, perhaps, enable states to provide more Medicaid beneficiaries with long-term care services in their communities. Because judicial developments under Olmstead often occur in the context of federal Medicaid law, particularly Medicaid waiver programs, the health care reform law's changes to the Medicaid program may affect the outcome of future cases on deinstitutionalization.
This report will discuss the Supreme Court's decision, selected subsequent appellate court decisions, the implications of health care reform for future developments, and methods of Olmstead enforcement.