# data[].attributes.body
The Olmstead decision doesn’t change Medicaid itself but pushes states to reassess long-term care policies since Medicaid funds most of it. Health care Financing Administration (HCFA) reminds states of their duty to review institutional care and encourages stronger community services. While not required, states can show ADA compliance with a solid plan and reasonable waiting list. HCFA and the Office of Civil Rights strongly encourage these plans and offer support.

# data[].attributes.attachment_link.title
How Does The ADA Relate To The Rehabilitation Act? - Your Civil Rights Guide

# data[].attributes.headline
Real-world example where the ADA fell short

# data[].attributes.subject
Real-world example where the ADA fell short

# data[].attributes.body
Example 1 of many: Toyota Motor Manufacturing v. Williams (2002)

Ella Williams, who had carpal tunnel syndrome, sued Toyota for failing to accommodate her. The Supreme Court ruled she wasn’t “disabled” under the ADA because she could still perform daily activities outside of work, even though she couldn’t do her job tasks. This narrow interpretation excluded many workers with serious conditions until the ADA Amendments Act of 2008 expanded the definition of disability.

# data[].attributes.attachment_link.title
Toyota Motor Manufacturing, Kentucky, Inc  v  Williams Case Brief Summary | Law Case Explained

# data[].attributes.body
The ADA’s definition of “disability” was interpreted narrowly by courts in the 1990s and 2000s, which excluded many people (e.g., those with epilepsy, diabetes, cancer, or mental health conditions). This had to be corrected by the ADA Amendments Act of 2008 (ADAAA)

# data[].attributes.body
Title I: Employment:

Prohibits private employers with 15 or more employees from discriminating against qualified individuals with disabilities. It requires employers to provide "reasonable accommodations" unless it would create an "undue hardship".

Title II: State and Local Government Services:

Ensures that people with disabilities have equal access to the programs, services, and activities provided by state and local government entities, including public transportation.

Title III: Public Accommodations:

Prohibits discrimination in public accommodations (like restaurants, movie theaters, and hotels) and commercial facilities. It requires businesses to remove barriers and make "reasonable modifications" to their services and facilities.

Title IV: Telecommunications:

Requires telephone and internet companies to provide nationwide relay services, allowing people with hearing and speech disabilities to communicate over the phone.

Title V: Miscellaneous Provisions:

Contains other important provisions related to the ADA, including its relationship to other laws and protections against retaliation.

# data[].attributes.headline
interesting facts on the rehabilitation act of 1973

# data[].attributes.subject
interesting facts on the rehabilitation act of 1973

# data[].attributes.body
Section 504’s Groundbreaking Role:

Section 504 of the Act prohibited discrimination against people with disabilities in any program receiving federal funding. This was the first time disability rights were framed as a civil rights issue rather than just medical or welfare support.

It also guaranteed accommodations in schools receiving federal funds, paving the way for today’s Individualized Education Plans (IEPs) and 504 plans for students.

Sparked Disability Rights Movement:

These protests helped unite diverse disability groups into a broader civil rights movement.

# data[].attributes.body
States must distribute funds by geography & need

Must be approved by the Assistant Secretary for Aging

Funds flow from SUAs → AAAs → local programs

Example:

Step 1: Federal Funds (Title III)

Step 2: State Unit on Aging (SUA)

Distributes funds using IFF

Step 3: IFF Factors

Geographic distribution of older adults

Economic need (poverty level)

Social need (disability, isolation, language/cultural barriers)

Special focus on low-income minority seniors

Step 4: Local Distribution

Allocations to Planning & Service Areas (PSAs)

Funds support:

Nutrition programs

Supportive services

Family caregiver programs

# data[].attributes.body
The Act must be reauthorized periodically to adapt to the changing demographics and needs of an aging population.

currently, it has been reauthorized to prioritize Greatest Need (Individuals at/below the poverty line or Individuals whose social factors, like disabilities, language barriers, or isolation impede their health)

# data[].attributes.body
To improve the quality of life and care for residents in federally certified nursing homes by ensuring they receive the necessary care and services to attain or maintain their highest practicable physical, mental, and psychosocial well-being.

# data[].attributes.headline
Number of State Psychiatric Hospital Beds per 100,000 Population 

# data[].attributes.subject
Number of State Psychiatric Hospital Beds per 100,000 Population 

# data[].attributes.body
Regular inspections (surveys) are conducted; penalties can include fines, denial of Medicare/Medicaid funding, or closure.

# data[].attributes.body
Certified CNA's have to complete at least 75 hours of training and demonstrate competency

# data[].attributes.body
OBRA required nursing homes to provide services that maintain residents physical, mental, and psychosocial well being. This shifted the focus toward quality of life and not just basic survival.

# data[].attributes.body
care must enable residents to maintain their highest physical, mental, and psychosocial well being

# data[].attributes.body
Requires a comprehensive assessments and car plans tailored to each resident

# data[].attributes.body
the care provided in in nursing homes began to move beyond room and board to include posthospital rehabilitation services, and as years passed quality declined. Federal and state dollars are flowing into nursing homes but care is declining leading to an investigation into nursing home standards, oversight, and enforcement. Law ensures residents can reach and maintain their highest physical, mental and psychosocial well being.

# data[].attributes.body
Residents must be free from abuse, neglect, and mistreatment; have rights to privacy, dignity, and self-determination.

# data[].attributes.body
A recent reauthorization which:

gives states more flexibility on how they allocate resources

improves the capacity of the network

includes elder abuse prevention programs

provides education and training for caregivers

increases focus on trauma-informed services for elders

# data[].attributes.body
In 1977, activists protested for the federal government to sign Section 504 of the Rehabilitation Act (which prohibits discrimination against people with disabilities in any program or activity receiving federal funding). The largest and longest protest occurred in San Francisco, where over 150 disabled activists occupied the federal building for 26 days. It ended with Section 504 being implemented.

# data[].attributes.body
About 11 million (one in five) older adults are served annually by OAA programs.

The cost of one day in a hospital is roughly the same as providing a patient with one year of meals through OAA nutrition programs.

The cost of one month in a nursing home is the same cost as providing an OAA nutrition client with mid-day meals, five days per week, for seven years.

# data[].attributes.headline
Omnibus Budget Reconciliation Act of 1981

# data[].attributes.subject
Omnibus Budget Reconciliation Act of 1981

# data[].attributes.body
Omnibus Budget Reconciliation Act of 1981 complemented the Economic Recovery Tax Act in 1981 which enacted larger tax cuts for individuals and businesses.

# data[].attributes.body
These concerns pushed Congress to call for a closer look at nursing home care. Lawmakers wanted stronger oversight, standards, and accountability for facilities

# data[].attributes.headline
Mental Illness Statistics for Adults in the U.S.

# data[].attributes.subject
Mental Illness Statistics for Adults in the U.S.

# data[].attributes.body
-1 in 5 U.S. adults experience mental illness

-1 in 25 U.S. adults experience serious mental illness

# data[].attributes.body
By the 1980s, many reports showed poor quality of care in nursing homes across the country. At the same time, large amounts of federal and state funding were being spent with little accountability.

# data[].attributes.body
This case was brought by two women in Georgia. They both suffered from mental health and development disabilities and received care in institutions. They both realized the importance of seeking services in the community. They ended up filing a lawsuit against the institution and the state of Georgia, arguing that they should have the right to receive services in the community if they meet the requirements.

# data[].attributes.headline
Omnibus Budget Reconciliation Act of 1981

# data[].attributes.subject
Omnibus Budget Reconciliation Act of 1981

# data[].attributes.body
Reduced funding for a wide range of domestic social programs like food stamps, Medicaid, Education

# data[].attributes.body
- Established in 1965, the AOA is an agency within the Department of Health and Human Services.

- It works to advance the needs of older adults and their caregivers.

funds and supports state and federal agencies that provide services such as: home and community-based care, nutrition programs, caregiver support, legal assistance, and falls prevention

# data[].attributes.body
After Medicare and Medicaid began in 1965, nursing homes expanded their services to include rehabilitation. By the 1980s, concerns about poor care and misuse of funding led to a government investigation. In 1986, the Institute of Medicine released a report urging reforms, which resulted in the Omnibus Budget Reconciliation Act (OBRA) of 1987, also called the Nursing Home Reform Act. OBRA required nursing homes to provide care that supports residents’ physical, mental, and psychosocial health, along with individualized care plans and regular assessments. It also established a patient bill of rights, including freedom from unnecessary restraints and the right to participate in councils. Finally, OBRA reformed the inspection process to focus more on resident outcomes rather than just structural compliance.

# data[].attributes.body
Our key reauthorization priorities are:

Healthy aging: Everyone deserves access to care that helps them stay healthy and independent—and avoid costly hospital or nursing home stays. Falls prevention, chronic disease self-management education (CDSME), and evidence-based healthy aging programs should be maintained.

Economic security: With poverty rising, older adults need better support, especially as many work longer while facing age-related barriers to employment. The Senior Community Service Employment Program(SCSEP), the only workforce development program for older workers, should be maintained.

Senior centers: Senior centers promote healthy living, social connection, and overall well-being for older adults. Congress and the administration must strengthen the authorization for modernizing these vital community hubs.

# data[].attributes.attachment_link.title
What Is the History of the Older Americans Act?

# data[].attributes.attachment_link.description
Learn more about the Older Americans Act and why it’s vital to preserving the right for older Americans to age with health and financial security.

# data[].attributes.body
Congress passed the Older Americans Act (OAA) in 1965 in response to concerns by policymakers about a lack of community social services for older persons.

To all individuals aged 60 and older, for those with social and economic needs.

Service Programs like:

-Nutrition

-Transportation, in-home care

Family caregiver support

health promotion

# data[].attributes.body
Each year, funding for OAA programs and services needs to be approved by Congress and signed into law by the president.

The Older Americans Act (OAA) has been updated several times through the reauthorization process, most recently in 2020. It is now up for reauthorization again. NCOA remains committed to securing annual funding for OAA programs that support the vital needs of older adults, caregivers, and the communities that serve them.

# data[].attributes.body
States that individuals with disabilities related to their mental or emotional health should not be unnecessarily institutionalized, but rather they will receive protection under the ADA that requires them to receive services in the least restrictive setting.

# data[].attributes.body
The core of this decision is the requirement that people with disabilities be provided services in the least restrictive setting that meets their needs. "They cannot be excluded from participation in, or be denied benefits of the services, programs, or activities of a public entity."

# data[].attributes.attachment_link.description
U.S. Supreme Court Olmstead v. L.C. Ruling

# data[].attributes.body
1. Reasonable modifications that allows a disabled person to participate in work

2. Employers must hire people who can form the essential functions of a job - with or without accommodations

3. Public places must make their places accessible to people with disabilities

1. Including aids that ensure communication is effective

# data[].attributes.body
Social programs and laws enacted in the 1960s by President Lyndon B. Johnson to address injustice and poverty.

established Medicaid and Medicare, for example

The OAA was enacted under this wave of progress.

# data[].attributes.body
The OAA has been legislatively reauthorized multiple times; the Supporting Older Americans Act of 2020 reauthorized OAA programs through fiscal year 2024 (ACL 2021).

# data[].attributes.body
Although perhaps historically overtasked and underfunded, the OAA sought to improve access to LTSS, provide caregiver support, establish congregate and home-delivered meal programs, support job training programs for older workers, and build an educated elder workforce. Significantly, many services provided via the OAA are not tied to income levels and include all adults aged 60 or older.

# data[].attributes.body
The United Cerebral Palsy Association in a 1996 poll of persons with disabilities, their friends, and family members, found that the ADA had made a great difference in the lives of those who have disabilities. The survey demonstrated that the ADA prompted better access to buildings, greater access to transportation, and fuller inclusion in the community.

ADA has no doubt increased employment opportunities for people with disabilities. However, Mr. Weber believes discrimination persists against people with disabilities and that it is demonstrated by both statistical and anecdotal information. He also believes that the ADA's protection for individuals with disabilities is minimally effective and that it tends to favor people at the margins of the ability spectrum those who can be made more competitive with reasonable accommodation or who are only perceived to be disabled.

# data[].attributes.attachment_link.description
The Effects of the ADA In this chapter, the Commission explores the practical effects of the ADA. By understanding and addressing the issues surrounding the actual effects of the ADA, policymakers, legislatures, and private organizations will be better able to embrace the ADA and strive to eliminate discrimination against people with disabilities.

# data[].attributes.body
Legislation passed by the US Congress in 1965 established the Administration on Aging and a network of state and local units to address the social services needs of older adults.

# data[].attributes.body
Despite being signed into law, Section 504, which prohibits discrimination against people with disabilities in programs receiving federal funding, was not immediately enforced

Businesses initially lobbied against the implementation of Section 504, arguing it was a burden, which led to disability rights activism and Sit-in protests

The definition of a "handicapped individual" has been challenged, with courts in some instances debating what constitutes a "disability" for the purposes of the Act

# data[].attributes.attachment_link.readable_text
What Sparked the 504 Protests?

The protest was sparked by the government's failure to implement Section 504 of the Rehabilitation Act of 1973. The Rehabilitation Act was the first major disability rights legislation to be passed, over 15 years prior to the Americans with Disabilities Act. Section 504 of the Rehabilitation Act prohibited discrimination against people with disabilities in programs and activities receiving federal funding. This included things like libraries, transportation services, schools, etc.

Section 504 states,

No otherwise qualified individual with a disability in the United States, as defined in section 705(20) of this title, shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance or under any program or activity conducted by any Executive agency or by the United States Postal Service.

Despite Section 504 of the Rehabilitation Act being signed into law by President Richard Nixon (albeit after being vetoed twice), Section 504 had not been fully enforced, leaving people with disabilities without the necessary accommodations and access to public services. It remained unenforced and unaddressed for 4 years. This was in large part due to businesses and organizations lobbying against implementing Section 504, arguing that it was burdensome and unfair to expect them to implement accessibility or else lose federal funding.

One of the 504 Sit-in participants Corbett Joan O'Toole shared, "At that time in history, there was simply no access-no right to an education, no public transit. You couldn't get into a library or city hall, much less a courtroom." Disabled people wanted to see the government committed to disability inclusion and access. The disabled activists warned that if Joseph A. Califano Jr., who served as the Secretary of Health, Education, and Welfare during President Jimmy Carter's administration, didn't take action by April 4th, nationwide protests would ensue.

On April 4th, 1977, after the government did not sign the regulations into law, protests took place all over the country. In San Francisco, over 500 disabled individuals and their allies attended a rally on San Francisco's Civic Center Plaza.

Image Description: Hundreds of disabled protestors and allies gather in San Francisco's Civic Center Plaza.

Image Credit: The Disability Rights Education and Defense Fund

Image description: Demonstrators with a sign reading "Sign 504 now."

Image Credit: Anthony Tusler

Why San Francisco's 504 Protest Was Different

Most of the protests happening across the country ended that day. However, the story in San Francisco was different. Following the San Francisco rally, nearly 150 people with disabilities streamed into the Health, Education, and Welfare (HEW) Federal Building. They began climbing to the fourth floor where the HEW regional offices were located. Over 120 activists occupied the building, and they refused to leave the federal building until their demands were met, even when threatened with arrest and eviction.

Image Description: Protestors enter the HEW building

Image Credit: The Disability Rights Education and Defense Fund

Government officials attempted to remove the activists from the building by cutting the phone lines and denying them food, water, medicine, and more. But the disabled protestors were more cunning than them, and they were prepared for this. Deaf and CODA (Child of Deaf Adult) protesters used sign language to communicate through the windows of the building to the outside. They worked with allied groups to get food, medicine, blankets, and more.

The disabled protesters worked closely with and received support from a wide range of organizations and individuals, including labor unions, religious groups, and civil rights activists. Groups that supported the 504 protesters included the Black Panther Party, Glide Memorial Church, Gay Men's Butterfly Brigade, Delancey Street, the United Farm Workers, the Gray Panthers, Salvation Army, and more. Because of this, the 504 Sit-in is considered an important moment for cross-movement organizing.

Image Description: Dozens of disabled demonstrators gathered inside the HEW building

Image Credit: AP Images

Image Description: Protesters sitting on the group floor of the HEW building

Image Credit: Getty Images

Brad Lomax and the Black Panthers

One of the 504 Sit-in protest leaders, Brad Lomax, a Black man with multiple sclerosis, was a member of the Black Panthers. He was integral in connecting the disabled activists with the Panthers, who provided them with hot meals and supplies needed to withstand the long Sit-in. Corbett O'Toole, one of the disabled protestors, applauded Brad's work and stated that "the most critical gift given to us by our allies was the Black Panthers' commitment to feed each protester in the building one hot meal every day... Black Panthers saved the 504 sit-in." Disabled leaders of the 504 Sit-in widely acknowledge and credit much of the occupation's success to the Black Panthers.

Image Description: Brad Lomax, center, next to the activist Judy Heumann at a rally in 1977 at Lafayette Square in Washington.

Image Credit: HolLynn D'Lil

Disability Activists Go To D.C.

After the protest had been ongoing for two weeks, a group of activists participating in the Sit-in journeyed to Washington DC to intensify their efforts against Califano. They organized candlelight vigils outside of his residence and attempted to enter his office building by forcefully pushing their wheelchairs against the doors when their request for entry was denied.

While in the capitol, Judy Heumann addressed congressional representatives and reporters:

"I can tell you that every time you raise issues of 'separate but equal,' the outrage of disabled individuals across this country is going to continue. It is going to be ignited. There will be more takeovers of buildings until finally maybe you begin to understand our position. We will no longer allow the government to oppress disabled individuals. We want the law enforced."

Image description: Several protesters, including one in a wheelchair holding a sign reading "Sign 504 Now."] Judy Heumann, holding the sign, and Kitty Cone, right, protested in front of the White House on April 26, 1977.

Image Credit: HolLynn D'Lil

Blog written by Maddie Crowley

Maddie is Disability Rights Florida's Social Media and Content Specialist who writes many of DRF's blog posts. They are a multiply disabled person who cares deeply for disabled issues and believes in the power of advocacy and awareness.

# data[].attributes.attachment_link.description
The longest sit-in in American history belongs to the disability rights movement.

# data[].attributes.headline
Americans with Disabilities Act (ADA) of 1990

# data[].attributes.subject
Americans with Disabilities Act (ADA) of 1990

# data[].attributes.body
Extended the reach of the Rehabilitation Act

Prohibited discrimination against people with disabilities in the areas of employment, transportation, public accommodations, communications, and government activities

Identified discrimination against individuals with disabilities as similar to discrimination based on race, gender, religion, and age.

Required accommodations for employees with disabilities

# data[].attributes.body
Legislation expanding vocational training and guaranteeing certain rights to people with disabilities

First US federal civil rights protection for individuals with disabilities.

Cornerstone for a series of

laws to follow

# data[].attributes.body
The Jimmo Settlement Agreement required manual revisions to restate a "maintenance coverage standard" for both skilled nursing and therapy services.

# data[].attributes.attachment_link.description
The Centers for Medicare & Medicaid Services (CMS) reminds the Medicare community of the Jimmo Settlement Agreement (January 2013), which clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met). Specifically, the Jimmo Settlement Agreement required manual revisions to restate a “maintenance coverage standard” for both skilled nursing and therapy services under these benefits:

# data[].attributes.body
Must have SS Disability Insurance or Supplement Security Income

Be ages 18-64

Have a physical or visual disability

# data[].attributes.body
The Center for Medicare Advocacy(the Center) and Vermont Legal Aid brought the class action lawsuit against the Center for Medicare and Medicaid Services.

# data[].attributes.body
In January of 2013, the healthcare and rehabilitation communities witnessed a significant milestone with the approval of the Jimmo Settlement. This landmark agreement with Medicare clarified a long-misunderstood policy regarding the coverage of skilled nursing and therapy services.

# data[].attributes.attachment_link.title
The Jimmo Settlement: A Shift in Rehab and Therapy Services - Life Skills Village

# data[].attributes.attachment_link.description
In January of 2013, the healthcare and rehabilitation communities witnessed a significant milestone with the approval of the Jimmo Settlement. This landmark agreement with Medicare clarified a long-misunderstood policy regarding the coverage of skilled nursing and therapy services. According to the settlement, Medicare’s coverage decisions in Skilled Nursing Facilities (SNF), Home Health (HH), and Outpatient…

# data[].attributes.body
Centers for Medicare and Medicaid Services

# data[].attributes.body
Jimmo vs. Sebelius 2013 requires CMS to confirm that Medicare coverage is based off the beneficiary's need for care and not the potential for improvement.

# data[].attributes.body
The program provides job training and education while allowing participants to keep their healthcare and other benefits.

The goal is to help people earn more money and become financially independent.

By 2021, 318,000 people with disabilities were using the program while working.

The Ticket to Work program was created in 1999 to help with this issue.

# data[].attributes.headline
Omnibus Budget Reconcilliation Act (OBRA) of 1981

# data[].attributes.subject
Omnibus Budget Reconcilliation Act (OBRA) of 1981

# data[].attributes.headline
Ticket to Work & Work Incentive Improvement Act of 1999

# data[].attributes.subject
Ticket to Work & Work Incentive Improvement Act of 1999

# data[].attributes.headline
Rehabilitation Act of 1973 + ADA of 1990

# data[].attributes.subject
Rehabilitation Act of 1973 + ADA of 1990

# data[].attributes.body
1. In your small groups, read and then summarize the paragraph(s) related to your MILESTONE in Chapter 2.

2. Each fact, idea, opinion, or point should be its own post. You should create 7-10 posts.

3. Once you have summarized the paragraph(s) in post form, go looking elsewhere on the internet for additional information that provides deeper context than what is found in the textbook.

4. Be creative using Padlet. Include pictures, links, etc to make your part of the timeline as fun, interactive, and informative as possible.

5. One member of the group will be asked to present your findings during the last part of class. You may choose who represents your group.

# data[].attributes.headline
Medicare covers care to maintain an individual's condition or slow decline

# data[].attributes.subject
Medicare covers care to maintain an individual's condition or slow decline

# data[].attributes.body
The settlement clarified that Medicare covers skilled nursing and therapy services when they are necessary to maintain a patient's condition, even if the patient is not expected to improve.

# data[].attributes.body
https://medicareadvocacy.org/

# data[].attributes.body
The Jimmo Settlement applies to all Medicare beneficiaries throughout the country, regardless of whether an individual is in traditional Medicare or has a Medicare Advantage plan (Center for Medicare Advocacy 2020).

# data[].attributes.body
The Americans with Disabilities Act (ADA) of 1990 extended civil rights protections to individuals with disabilities, outlawing discrimination and setting the stage for future reforms, including Olmstead.

# data[].attributes.body
In 1999, the U.S. Supreme Court ruled in Olmstead v. L.C. that unnecessary institutionalization of people with disabilities is a violation of the ADA. This case marked a turning point in disability rights.

The decision spurred expansion of Medicaid’s HCBS waivers (Section 1915 of the Social Security Act), allowing states to use Medicaid funding for services outside institutions.

By 2017, nearly 58% of Medicaid long-term care spending went to non-institutional services like home care and assisted living, reflecting Olmstead’s lasting impact.

# data[].attributes.body
Following Olmstead, innovative models such as assisted living facilities, Eden Alternative homes, and Green House Project cottages emerged to provide more homelike and less institutional care.

Despite progress, the cost of long-term services (both institutional and community-based) continued to place financial strain on families and government budgets.