In her cover story “Before Their Time” (10/27), Annys Shin writes that “the city has not been able to offer more home-health-care services to the disabled because Medicaid officials have not applied for a waiver from the federal government that would free up Medicaid dollars to do so.”

Services to people in their homes are far less costly than in a nursing home; not to mention that they’re mandated by a recent Supreme Court decision.

A 1999 Supreme Court decision under the Americans with Disabilities Act (ADA) mandates that services—like “care” in nursing homes—be provided in what the ADA calls the “least restrictive environment”—not a nursing home, for sure. Last June, Missouri became the first state in the nation to implement the requirements of the Supreme Court’s Olmstead decision by adopting “money follows the person” language so that people on Medicaid could get personal assistance in their own homes rather than having to enter a nursing home. Individuals “eligible for or receiving nursing home care must be given the opportunity to have those Medicaid dollars follow them to the community and choose the personal care option in the community that best meets the individual’s needs,” says Missouri’s law. Many other states are working to implement the Olmstead decision.

But like so many others, the District of Columbia, it seems, is simply ignoring this Supreme Court mandate. Their failure to act is not only costly; it’s illegal.

Deputy Director

Center for an Accessible Society

San Diego, Calif.