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Community Living Initiative

On June 22, 2009, to mark the 10th anniversary of the Supreme Court Olmstead v. L.C. Decision, President Obama announced the "Year of Community Living". In so doing, the President reinforced his vigorous commitment to the enforcement of civil rights for Americans with disabilities and to ensuring the fullest inclusion of all people in our Nation. This action underscored the importance of the Olmstead decision and affirmed the Administration's commitment to addressing isolation and the discrimination against people with disabilities that still exists today. In order to maintain the momentum created under the "Year of Community Living", Department of Health & Human Services' Secretary Kathleen Sebelius created the Community Living Initiative. Workgroups under the CLI continue to work towards promoting Federal partnerships that advance the directive of the Olmstead decision.


The Olmstead Decision issue999, requires states to administer services, programs, and activities "in the most integrated setting appropriate to the needs of qualified individuals with disabilities." This decision interpreted Title II of the Americans with Disabilities Act (ADA), which gives civil rights and protections to individuals with disabilities and guarantees equal opportunity for individuals with disabilities in public accommodations, employment, transportation, State and local government services, and telecommunications.


On May 20, 2010, CMS issued a State Medicaid Director (SMD) Letter to provide information on new tools to support community integration, as well as to remind States of existing tools that remain strong resources in States' efforts to support community living. With the issuance of this letter, CMS reaffirms its commitment to the policies identified in previous Olmstead guidance. In the May 20, 2010 letter the agency expressed an interest in working with States to continue building upon earlier innovations and a hope that the letter will help States identify new strategies to improve community living opportunities.


Homelessness Initiative - The Centers for Medicare & Medicaid Services is partnering with agencies within the Departments of Health and Human Services (HHS) and Housing and Urban Development (HUD) to improve services and supports for individuals who are homeless. Efforts include initiatives to:

  • Prevent homelessness
  • Improve access to medical, behavioral health, and supportive services, and
  • Increase access to permanent housing.


Participation in Assessment & Goal Setting: Nursing Home Minimum Data Set (MDS), Version 3.0 Section Q– MDS Version 3.0 went into effect on October 1, 2010. As a portion of the MDS instrument, Section Q will be administered to all SNF/NF residents regardless of payer source. Critical improvements to this functional assessment instrument are designed to give SNF/NF residents a voice in the survey process, increase clinical relevance and accuracy, and increase communication and collaboration between providers of services and facility staff.  This revised version of Section Q improves the ability of Skilled Nursing Facilities, Nursing Facilities (SNFs/NFs), States, and other qualified entities to identify institutionalized individuals that are interested in returning to the community.


Residents (or their designee) are now asked directly if they wish to speak to someone aboState–by-State point of contact (POC) listut the possibility of returning to the community.  When a resident express a desire to learn about Home & Community Based Service (HCBS) options nursing facility staff are now required to make referrals to a State designated local contact agency (LCA) who will, in turn, contact the resident to discuss whatever HCBS may be available to them. If the resident is determined to be Medicaid eligible, the SNF/NF and LCA will work together with the resident to plan their transition back to the community if possible.