Community Living for All: Celebrating the 20th Anniversary of the Olmstead Decision


>>Good afternoon. On behalf of the administration on community
living at the U.S. Department of Health and Human Services, I wanted to welcome you all
here today as we celebrate the 20th anniversary of the Olmstead decision. My name is Julie Hocker and I am the Commissioner for the Administration on Disabilities
here at ACL. It is my pleasure to kick off our celebration
today. 20 years ago, the U.S. Supreme Court ruled
in Olmstead v. L.C. that the unjustified segregation of people with disabilities is a form of unlawful
discrimination under the Americans with disabilities act. The decision fundamentally changed the way
our country approaches disability rights and opened the doors for millions of Americans
to live the lives we want. Alongside people of all ages in our communities,
with and without disabilities. Of course, it is one of the cornerstones of
the work so many of us in this room do each day. Olmstead unlocked many doors. It took hard work, collaboration, and perseverance. It to perseverance by many people in this
room and it truly knocked open those doors. Today, we are going to celebrate all we have
achieved across the last two decades since Olmstead. There is a lot to celebrate. We are also going to talk about some of the
challenges that remain and the direction forward. We will hear from federal partners at HHS
and at the Department of Justice but some of the work we are doing together. Our keynote speaker will share research that
reinforces what we all know. Community living is the best option for people
living with disabilities. Most importantly, the core principles of Olmstead
will be brought to life for us by several people with disabilities who will share their
experiences and the vision they have for the future. To get us started, I am thrilled to welcome
our first speaker, my colleague at the U.S. Department of Health and Human Services, Roger
Severino. Roger currently serves as the director of
the Office for Civil Rights at HHS. Prior to joining HHS he served as director
of the divorce center for religion and civil society — the DeVos Center for Religion and
Civil Society. Before that, he was a trial attorney in the
Department of Justice is Civil Rights Division, where he enforced the Fair Housing Act, the
religious land use and individualized persons act, title II and title VI of the Civil Rights
Act of 1964. It has been such a pleasure to work with Roger. He is a staunch advocate for disability rights
and he has been a steadfast supporter for all of the work that we do at the administration
for community living to improve the opportunities for community living for all people with disabilities. Please welcome Roger Severino.>>[ Applause ]
>>Thank you very much. Julie, you are a force of nature. I love working with you. I want to begin with a story about my childhood. When I was a kid growing up in Los Angeles,
I went to a public elementary school and did not have much interaction with people with
disabilities. The kids with disabilities were put on separate
buses, shipped off to some other facility, I don’t know where, and were not seen. There was never that connection. This was not by chance. This was a decision to create separation. It has an effect on children with disabilities
and without. I was realizing that perhaps there was something
going on here. Why was the government doing this? It created a sense of otherness. Part of it came from the misguided sense of
paternalism, that it would be better for the kids on both sides of the equation. At its root, there was something more invidious,
implicit measuring of a kid’s work and of where resources should be dedicated. Things changed when I got to high school. I had the opportunity to interact with people
who were in my neighborhood, because there was a group home for people with disabilities. Just as I walked through my neighborhood,
so with a, enjoying the day just like me. That was also not by chance. It presented an opportunity to start breaking
down barriers and even addressing preconceived notions that this kid had. That is some of the progress I have seen in
my life. It is a bit of a microcosm of what the story
has been in the United States. In the 1880s, our nation’s first investigative
journalist posed as a person with a mental disability to get into what was then called
insane asylums. What she reported shocked the nation. The conditions were filthy. People were abandoned, mentally abused, restrained,
physically abused. She called it a house of horrors. She reported to a nation who nothing about
what was going on behind closed doors. Progress was still slow. In the 1920s, we had an infamous decision
where our Supreme Court said the government can force sterilization on persons with disabilities
specifically to limit their ability to have more people with disabilities. The sense of other and less than was a part
of our culture and our lives. In the 1960s, there was a movement to create
large institutions for people with disabilities. This was dramatized with the movie and the
book one flew over the cuckoo’s nest. People were being shunted away into large
institutions. Their desire to be integrated into the community
was ignored. Some had no chance of ever getting out. Again, stigma and separation. Things started to change in the 19 sections
— 1970s. We had various acts and the government was
saying we will not fund discrimination against persons with disabilities and in education. And then we had a landmark of the Americans
with Disabilities Act in 1990. It was followed up with what we are celebrating
here today, the anniversary of the 1999 Olmstead Supreme Court decision. What the Supreme Court took away, it helped
to restore a generation and a half later. Olmstead stood for the important principle
that every individual should have the right to live in the place they want to live and
fully integrate into the communities they want to be integrated in. The default should not be isolation and restraint
because of a person’s disability, but equal treatment. It recognizes a fundamental, common humanity,
our equal human dignity. That is the principal of Olmstead, the principles
of the laws we enforce, and what we fight for every day at Office for Civil Rights and
at HHS more broadly. It is my distinct pleasure, privilege, and
honor to be part of a team that enforces section 504 of the rehabilitation act, the ADA, and
the Affordable Care Act. We make sure people with disabilities are
treated as fully equal under our laws. We have an initiative underway to make sure
that life-saving care is not denied from any person with a disability based on stereotypes. We had a case a few months ago where a person
sought to be put on a transparent — transplant waiting list for a new heart. However, that person was denied a position
on the list because the doctor noted that he was on the autism spectrum. We intervened in that case and, thankfully,
the policy was reversed by the hospital. We are dedicated to making sure that stereotypes
do not infect the practice of medicine. We want no implicit bias where judgments are
made by doctors and professionals evaluating whether one life is worth more than another
life because of the presence or absence of a disability. Those quality-of-life judgments can turn into
discrimination. We are dedicated to making sure it has no
place in our healthcare system. I am encouraged to see all of you here partnering
with ACL, D.O.J., advocates in the disability rights community. Just as I have seen progress in my own life
and we have seen progress in our government, there is much work to do. This is just the beginning. For the moment, we can look back with pride
and 20 years of progress since the Olmstead decision that recognizes the common human
dignity of all. I will introduce our next speaker.>>This is our Deputy Secretary of HHS, Eric
Hargan. Deputy Secretary Eric Hargan was sworn in
on 2017 and served as acting Secretary . He was the big cheese for several months at HHS. He served in various capacities from 2003
up to 2007. He was part of the new freedom initiative
under the Bush administration, which also impacted the question of Olmstead during the
Bush days. He is head of the regulatory policy office. He has a degree from Harvard University, a
JD from Columbia University Law School. He was senior editor of the Columbia Law Review. In between his tours, he taught at Loyola
school of Law in Chicago. Please welcome Deputy Secretary Eric Hargan.>>[ Applause ]
>>Thank you, Roger, for that introduction. Thank you, everyone who has joined us here
and by live stream today. Thank you to everyone at HHS who has made
today’s gathering possible. We are celebrating an important event today. It is an honor for me to help celebrate the
20th anniversary of the Supreme Court decision of Olmstead v. L.C.. It caused a sea change in how our country
thinks about supporting people with disabilities. Today, in part thanks to Olmstead, we recognize
that community living should be the default expectation for all people. We are working to make that vision a reality. As you know, that was not always the case. Olmstead was not the first step on the path
to where we are today. That case allowed us to take a significant
leap forward and to celebrate the pace of change. We want to acknowledge resource limitations,
but it said that states to take reasonable steps to provide community-based alternatives
to institution. It has increased the availability and quality
of services for people with disabilities. I am chief operating officer of the department
and head of the budget. I can see what a dramatic shift this is from
looking at the trajectories on HHS’s program spending. 1999, Medicaid spent nearly 3 times more on
long-term services and supports provided to institutions like nursing homes than it did
on surfaces in the community. By 2013, a majority of that funding was going
towards services and support in the community. It was a dramatic shift in a relatively short
period of time, especially for such a large institution like HHS, and that is a sea change
in how the department deals with funding services. Olmstead helped spark innovation and research. This morning, I visited a university to learn
about the rehabilitation engineering research Center. It is for improving second — accessibility
for people who are deaf or hard of hearing. This was funded by the research Institute
within the community living in ministration, which is for rehabilitation research. Through advanced research and development
work, the RERC provides people who are deaf or hard of hearing with the knowledge and
tools to take control of their communication and hearing technologies, adapt those technologies
to their environments, and achieve greater autonomy and satisfaction in their use of
technology. It can be quite dramatic. I saw a couple of interesting demonstrations
this morning about the new research that they have done, partially using HHS money. It is intriguing to see a mission of a place
like this that is focused not only on providing services now and providing teaching. In fact, a good friend of mine is an alumnus
of the University. It was very interesting time visiting there. This kind of work happens at universities
across the country and it happens in part because Olmstead created those expectations. Before Olmstead, those born with significant
disabilities sometimes had no choice but to grow up in an institution. Because of Olmstead and legislation supporting
the rights of people with disabilities, children with disabilities increasingly have the opportunity
to attend schools with and without people with disabilities. As those children become young adults, they
have many of the same decisions as people without disabilities. Where to go to college and if to go, if it
is acceptable to come home from college to make your mother do your laundry, how long
you’re supposed to talk to your parents, etc. Where to live, what kind of career to pursue,
these benefits extend throughout a person’s life. Before Olmstead, adults who need help with
many physical tasks had few options. They could continue living with their family
or they could live in an institution. Olmstead has greatly increased the availability
of these types of services in the community, thus increasing the opportunities for people
with disabilities to live independently. Around the country, states and communities
are adopting an Employment First philosophy. It starts with the belief that people of all
abilities should have the opportunity to work in integrated workplaces. Individuals, families, nonprofits, and states
are working together to provide the supports necessary to make this work and to change
the assumptions that people make about the capabilities of people with disabilities. I also saw this work go on under President
George W. Bush when we led the new freedom initiative to lay out a blueprint for more
community integration. Olmstead created the environment for that
kind of change. And I was there before, it was a new decision. I have been around a long time now. You can tell. It was a relatively new decision at that time. Putting together the new freedom initiative
and trying to articulate within the department how to bring some of those principles into
reality was a big challenge than. Olmstead has changed the world for older adults,
as well, providing help with getting dressed or doing household tasks is often crucial
to allow older adults to continue living in their own homes. What all these changes have in common is that
they put people with disabilities as well as older adults in control of their own lives
with help from their family if they needed. Despite the great progress of the last two
decades — and it has been great — we still have a lot of work to do to make Olmstead’s
vision of options a reality for all Americans. Far too many people who could be and want
to be living independently in the community face barriers that need to them living in
institutions. That is why we are committed to making home
and community-based services available, to improving access to health care, and improving
quality and coordination of the services. I think my first trip as acting Secretary
was dealing with home and community-based services with ACL. That was my first visit outside the department. This is a piece of broader work going across
HHS. We all recognize that it is foolish to pay
for patients to stay in the hospital, but not to pay for preventive care that would
keep them out of the hospital in the first place. We want to allow people to stay in their homes,
to stay in their communities, and out of institutional settings. It is the best thing for everyone. It is best for everyone in the community. The caregivers, the people themselves, the
government, the payers, everyone benefits from this. This change in mindset has been part of a
shift towards value-based healthcare, one of the secretaries top priorities, where we
look at the continuum of care. As you know, we need to think even more broadly. The continuum needs to include more than just
care. We need to think in terms of a continuum of
support in care. This means incorporating a greater amount
of coordination between the health and human services sides of HHS. As I like to say, the most important word
in our department name is and. The integration between these two sides of
the house at HHS, we are working on it. It proceeds by fits and starts. It is a part of this administration strive,
to put these things across the line. We are actively working across the department
to accomplish this. All Americans, including those who are older
or have disabilities are best off when they can live their lives integrated and included
in their communities aside people of all ages with and without disabilities. Our communities and country are stronger when
we harness everyone’s talents and contributions. We have made progress on the school in the
last 20 years in America since the Olmstead decision. It is my hope and our hope that, over the
next 20 years, we will see more progress. Thanks to all of you for the work you have
done to make that progress possible. Thank you for your ongoing commitment to this
cause. Last, thank you for having me here, recognizing
all of your work here today. Thank you.>>[ Applause ]
>>Thank you. It is always an honor to have you join our
events. Thank you so much. Next, I want to do the introduction to every
one of our keynote speaker. Dr. Amy Hewitt will share what research tells
us about the benefits of community living. She has extensive experience in the field
of intellectual and developmental disabilities. For more than 30 years, she has worked to
improve community inclusion and quality of life for children and adults with disabilities
and their families. As the director of the Institute of community
integration at the University of Minnesota, she directs federal and state research, evaluation,
and demonstration projects focused on community-based long-term services and support for children
and adults with IDD. Her projects focus on community living. Autism, outcome measurement, direct support
workforce development, person centeredness, and positive behavior support. She has authored and co-authored numerous
journal articles, curricula, technical reports, and the books. She serves on the editorial board on the Journal
inclusion. She is an associate editor on intellectual
and developmental disabilities. She is a past president of the American Association
on intellectual and developmental disabilities and currently serves as the vice president
of the Board of Directors for the Association of University centers on disabilities. Please welcome Dr. Amy Hewitt.>>[ Applause ]
>>Thank you. Good afternoon. Thanks, everyone, for inviting me here this
afternoon. A special thanks to ACL and the HHS for recognizing
the importance of the Olmstead decision and its effect on long-term services and supports
for people with disabilities in the United States. While I did not know Lois Curtis or Elaine
Wilson and I was not involved at all in the case, I do remember exactly where I was standing
when the Olmstead decision came down, because I knew how important it was and the difference
it would make in our future. The Olmstead decision, as you have heard,
was the result of a case brought forward by two women based on discrimination and under
the protections of the Americans with Disabilities Act. Because they were unjustifiably segregated
in an institution, these two women wanted the right to be freed and have the opportunity
to live in their community. I think often of them and their families. I wonder if they could ever imagine what a
significant and long-term and lasting effect that their brave and unwavering advocacy and
fight for freedom and choice would have on so many people. This decision and the legal precedent that
it’s that led to new opportunities for people with disabilities, including people with complex
needs, to live and be participating members of their communities. That is in their neighborhoods, workplaces,
and educational institutions. Over the last 20 years, the right to be participating
members of community has fundamentally changed the types of services provided to people and
the outcomes that we expect. Certainly, additional cases that have come
since the Olmstead , the enforcement of the Americans with Disabilities Act and the civil
rights division of the Department of Justice have led to several Olmstead settlements that
target a wide variety of populations and systems and communities.>>We have a lot to celebrate. I appreciate the administration on community
living for recognizing the need to pause, to reflect, and to celebrate the importance
this legal decision has had on many people’s lives. Lois Curtis and Elaine Wilson stood up for
their rights. They knew what they wanted. They knew what they did not want. They spoke up. They used their power, the courts listened,
and they made history. As a result, they raised expectations of our
systems and communities. Many more people with disabilities and their
families are speaking up and advocating for themselves. Since the time of the Olmstead decision, we
have really changed how we think about community living and what participation in the community
means to people. Even when the Olmstead decision was decided,
community living was somewhat defined as simply not living in an institution or a nursing
home. We were focused on where a person lived and
how many people they lived with. Over the past 20 years, we have been involved
— we have evolved how we think about how we think about community living and what it
means to be living in the community. Is no longer enough to be living in the community. It is a matter of being of the community. And being of the community means a lot of
things.>>In means having the right to practice the
faith of your choice. It means simple things like being able to
choose where you live and with whom you live. It means working for a real wage in a real
job. It means being able to learn new things the
rest of your life and to do the things that you really like and enjoy doing. All of these are new ways of thinking about
life in the community for people with disabilities.>>There are also a number of key aspects,
or key components of living in the community. These are things like engagement, reciprocity,
lifelong learning — I am struggling here a little bit with this computer. I apologize. It is catching me a little bit off guard. I am a Mac user. Every time I get put in front of a PC, I really
struggle. I am going to go back to my written notes
so I can feel a little bit more comfortable with the set up. Engagement, valued social roles, expectations,
connectedness, self-direction. All of these things are components of community
living and participation that we expect in our communities now.>>Olmstead really made — Olmstead and the
many state-level plans that were developed throughout the country brought about important
systems collaboration. Advocates and people with disabilities and
families, researchers, providers, and state systems are all working together to improve
community supports. That is as well as sustained, longitudinal
data that is helping us to stay on the pulse of how well we are doing with regard to meeting
the intent of Olmstead and the decision that was made. Also continued Department of Justice enforcement
has been incredibly important to realizing the intent of the Olmstead decision. One of the things that Olmstead has done is
develop new public policies that are designed to align with the intent of Olmstead by providing
direction and, in some cases, incentives to states to shift towards community living and
participation. You probably recognize some of these. Money follows the person, home and community-based
services, the Workforce Innovation and Opportunities Act. There are a number of proposed pieces of legislation,
too, that will further the intent of Olmstead and further community living, such as the
Disability Integration Act, the transportation to competitive employment act, and the Access
to Free Speech for All Act. I often say that systems change takes decades. We are at Olmstead two decades, and we have
seen a lot of change already.>>If you look at this trend line, it shows
the population of people with intellectual and developmental disabilities. If you look at the decade, you can look at
the intermediate care program that started in 1967, followed in 1981 by Medicaid home
and community-based services. And then you have the Americans with Disabilities
Act and Olmstead. You can clearly see that, since the time that
the Olmstead decision was made, we have seen significant deinstitutionalization of people
with intellectual and developmental disabilities were freed from institutional settings. Since 1960, in fact, 248 institutions have
already closed with another two projected to close in 2019. Of those 99, 40% of them closed since the
Olmstead decision was made.>>Institutional closures are not the only
data point to look at. Since Olmstead, there is a clear trend towards
the increase of people with disabilities living in their own home that they rent or they own. And smaller group homes in which fewer than
six people live. Equally obvious is the trend away from group
homes where seven or more people live.>>Important policies such as money follows
the person have resulted in 90,000 people with disabilities transitioning from congregate
living situations to community living. That is something that we should really celebrate. That is affective policy.>>While not nearly as obvious or as quick,
there have been some small trends in the increase in the number of employment for people with
intellectual and developmental disabilities to have jobs in their community. Is a small uptick, but it is progress that
we should be celebrating, especially when you look at how these programs are funded. There are clear imbalances in where investments
are made. We continue to make much more investment in
segregated kinds of programs than we do real work. We are still making some progress.>>Without question, since the Olmstead decision,
we see state systems investing more in community support. You heard that just a bit ago. And much less in community programs. We are nearing $70 billion in investment in
community services. That is substantial. When I think back to Lois and Elaine and I
think about what their lives were like in the institution they were living in and I
read about their lives after being freed from the institution and I think about what we
know for outcomes with people with disabilities, I know we have made progress.>>Let’s look at a little bit of that progress. Today, over half of people with intellectual
and developmental disabilities choose or have input into where they live. 40% have input into who they have as roommates. The overwhelming majority choose their schedule
each day. Or, they have input into a. And they decide or have input into how they
spend their money. I am pretty certain that Lois and Elaine did
not have those outcomes. Since 2013, roughly 10% if you look across
the years of people with intellectual and developmental disabilities self direct their
services, meaning they make decisions about how the money is spent and what services they
are going to purchase.>>If we look at people with physical disabilities
and people who are receiving long-term services and supports due to aging, 70% can choose
the service that they receive or modify it, 60% — 65% choose the actual type of service
that they get, 40% choose their roommate, and 95% determine when they get up. 80% choose when they eat their meals. Additionally, 90% have transportation to get
to medical appointments. 70% have transportation to get to the places
that they want to go. Again, I certainly expect that none of these
outcomes were present for Lois and Elaine when they were living in an institution.>>I think the data I showed you gives you
a tiny glimpse of the progress that we have made sense the Olmstead decision. Research consistently shows that people have
better lives when they live and work in their communities. While there is much to celebrate, we have
a lot of opportunities ahead of us. We need to continue to make progress as we
move forward in the next 20 years post Olmstead.>>Perhaps one of the greatest challenges
that we face related to community living for people with disabilities is the disparity
based on states. One of the most significant contributions
to the ability to achieve individual outcomes of community living and participation in the
United States is that we have 50 states, the District of Columbia, and 369 counties. Time and time again in the studies that we
have done at the research and training center on community living, the single biggest predictor
of outcomes for people with disabilities is the state in which they live. As you know, in the United States, it is very
uncommon for us to have a law that says here is the program and you shall implement it
in exactly the same way in every single state and community in the United States. Services very tremendously across states. That means outcomes for people with disabilities
very tremendously across states.>>Another area in which disparity exists
is in the area of racial, ethnic, and linguistic diversity, and the context of community living
and participation for our citizens in the United States. We know that there is an underutilization
of home and community-based services by some groups. We also know that there is a disproportionate
use of more congregate care options by some groups. Making sure that state systems are ensuring
that community living and participation is available to, known by, and used by people
across racial, ethnic, and linguistic diverse communities is critical to ending spend their
days — to ending disparities in the United States.>>The institution that’s deinstitutionalization
is something we should celebrate. We still have 20,000 people in institutions
or lingering in nursing homes. What about people with disabilities who are
still in nursing homes, hospital units, institutions were people have mental illnesses, and private
institutions? Yes, we have made a lot of progress in the
United States. But we have a long way to go to truly realizing
the intent of Olmstead. One of the things that I know for sure is
that institution is not about size. It is not about just the place. As much as anything, institutionalization
is about attitude. What we have done in the United States is
create a lot of little tiny, many institutions. Many of the smaller group homes that people
live in are just as controlling of environments. People have just as much difficulty in making
their own choices and choosing their own destiny in life. We have to address that attitude. Until we can change the attitudes of the people
who are running services and the people who are supporting individuals with disabilities,
we will still have institutions. They just may not be big places.>>An area that we have not explored enough
at all is the reality that overwhelmingly the majority of children with the most significant
disabilities are not experiencing inclusion in schools. Community living is about learning, too. These children are not being included. It is an area of much opportunity as we move
forward. As I said, states certainly vary in how they
deliver services. That is a major predictor of outcomes. As you look across states, there is a major
variance in the percentage of people with disabilities who have legal guardians. This number ranges from 5.5% in some states
to 89% in others. In some states, it is almost an automatic
process that, when you turn 18, you will have a legal guardian assigned to you. Yet we know people with disabilities, including
intellectual and developmental disabilities, have rights and are perfectly capable of making
most decisions in their lives. Supportive decision-making is an area in which
we have a lot of opportunity moving forward. If people are not allowed to make their own
decisions, if they don’t have rights, they are not going to fully embrace participation
in their communities.>>Perhaps the greatest challenge we face
is the workforce. There has been virtually no policy broadly
to address and very little state policy to address the workforce of Direct Support Professionals
who choose careers in supporting people with disabilities. We have built our community system on the
backs and out of the pocketbooks of these workers. And yet, we know that they are the key to
quality. This systemic flaw is that we have sustained
turnover rates that approach 50%. Vacancy rates near 20% and wages on which
no one can make a living, let alone support a family. These numbers have remained the same for the
past 25 years. To date, we have no systemic approach in finding
and implementing solutions. We know that these direct support workers
are multidisciplinary professionals were not recognized, not celebrated, and not valued
by our systems of supports or our communities for what they do. Most people in our communities don’t even
know they exist. The profession is not recognized by our Bureau
of Labor Statistics. In order to sustain the promises of Olmstead,
we have to find solutions to the workforce challenges.>>Lastly, we have to continue to improve
our ability to measure progress to a person centered lands, developing effective measures,
and holding states accountable for measures that are specific to home and community-based
service outcomes identified in the National Quality Forum framework is an important step
as we move forward to improve the quality of community living. Thank you so much for the opportunity to talk
to you today. I hope you tear up and are ready for the challenges
of the next 20 years post Olmstead.>>[ Applause ]
>>Thank you so much, Amy. Thank you for joining us all the way from
Minnesota. We are so grateful to have you here in Washington. Our next speaker is Melissa Harris. She has been with CMS since the summer of
1995 and is currently the Acting Deputy Director for the Disabled and Elderly Health Programs
Group. Prior to this role, she was a senior policy
advisor in DEHPG, developing and implementing a number of policies to advance home and community-based
services as an alternative to institutional placement. As the director of the Division of Benefits
and Coverage from 2012 up through 2015, she was responsible for overseeing implementation
of most Medicaid benefits, including benefits provided to individuals in the Medicaid expansion
population, and the expanse establishment of national benefit policy. Please help me welcome Melissa Harris.>>[ Applause ]
>>Thank you. It is really such an honor for me to be here
today. I am from the centers for Medicare and Medicaid
services. I am going to be talking to you a little bit
about the provision of Medicaid funded home and community-based services and the cues
that we took from the Olmstead decision. Olmstead really set the stage for many of
federal entities, including health and human services, to re-examine whether and how the
distribution of funds were advancing community living, optimal self-sufficiency, and social
economic advancement for people with disabilities. This paved the way for the release in 2014
of the final regulation on Medicaid funded home and community-based services and the
settings in which those services are to be provided. This regulation is designed to achieve two
games. First, it is to ensure that individuals receiving
long-term services and supports through home and community-based services have full access
to the benefits of community living and the opportunity to receive services in the most
integrated setting appropriate. You will recognize that language from Olmstead. The second is to enhance the quality of home
and community-based services provided to recipients.>>It is important for me to acknowledge that
Medicaid is an important resource for states in satisfying their responsibilities under
Olmstead. Compliance with federal Medicaid requirements
will not necessarily wholly satisfy states requirements for Olmstead. We take our cues from title 19 of the Social
Security act. Sometimes that is a great fit and sometimes
not. Accordingly, we encourage states to regularly
review their policies and operations to ensure that they are facilitating persons with disabilities
to be served in the most integrated setting appropriate to their needs, irrespective of
whether their services are being funded by Medicaid or from another public funding source. That being said, the federal regulation on
Medicaid funded home and community-based services is a really strong opportunity for states
to engage in the type of systems change to significantly increase the potential for individuals
to be supported and receive services in the most integrated setting appropriate. There is a transition period associated with
compliance with the tenets of the home and community-based settings provisions. It was initially running through March 2019. It was extended until March 2022. This was in recognition that time would be
necessary for states, providers, beneficiaries, and other stakeholders to understand the actions
that would be needed to ensure not only compliance, but the regulatory criteria, but to further
systems change that would improve the overall quality in the provision of home and community-based
services.>>The criteria for settings in which home
and community-based services are to be provided include things like optimizing individual
autonomy and making life choices, providing opportunities to seek competitive, integrated
employment, providing access to the greater community, ensuring greater control over personal
resources, and ensuring the rights of dignity, respect, and freedom from coercion and restraint. In return, settings have to ensure that people
can receive services in their broader community to the same degree as those not receiving
Medicaid funded services. There are some additional criteria for individuals
receiving services in the location in which they live. These are called provider owned and controlled
residences. Those extra criteria are the ability to access
food at any time, the ability to have visitors at any time, the ability to choose a roommate
is available, the ability to lock their doors, protection from eviction under tenancy laws
or other laws of that jurisdiction.>>In some ways, those criteria are very basic
and they afford individuals receiving Medicaid funded home and community-based services the
ability to make decisions that many of us make on a daily basis and take for granted. And yet, the implementation discussions that
CMS has had with states and providers and beneficiaries and other stakeholders speak
to the degree of changes that are necessary to adhere to these criteria, meaning that
some individuals were previously not receiving decayed funded home and community-based services
in settings that reflected these basic criterion.>>For many of us, the provision of home and
community-based services and the receipt of those services is a personal matter. We have family members, friends, loved ones
who need services and supports authorized under the umbrella of home and community-based
services. While the criteria represents a standardization
that had been missing from the construct of service provision, the regulation also contains
key flexibilities and how that criteria is to be implemented to individuals. It all boils down to the concept of person
centered planning.>>I cannot stress enough the importance of
that concept. It is the backbone of that regulation and,
more importantly, the linchpin to the provision of good services and supports. The provision of Medicaid home and community-based
services is not a required entitlement to individuals who need a certain level of care. These are optional services in the Medicaid
program. This could mean there are waiting lists and
a large demand for a relatively small pool of resources. The criteria in the regulation helps to ensure
integrity of how indicate home and community-based services is used.>>I do want to spend a moment talking about
states. You heard from Amy a minute ago that one state
is not like the other in terms of the services it offers. That is very true in the Medicaid program. States have a fair amount of discretion in
implementing Medicaid in general and implementing the home and community-based settings role. It is important for stakeholders to understand
how their state is approaching the implementation of the various components of the home and
community-based services, including a scope of providers the state wants to continue offering
home and community-based services. We are seeing major progress since our work
really got going in 2014. We are constantly talking with states and
providers and stakeholders. We see progress being made in five key areas.>>The first is that states are taking major
steps to invest in the capacity of providers to offer more integrated home and community-based
service options, as well as building a competent, qualified direct support workforce. Second, states are focusing more attention
on what they are paying for, how they are paying for, and ultimately how to best assess
the quality of the home and community-based services being provided. States are engaging with their providers to
become proactive in making organizational changes necessary to reflect the regulations
intent, to ensure that individuals have full access to benefits of community living, and
the opportunity to receive services in the most appropriate setting — I keep saying
that. Services in the most integrated saying. That is kind of important. Fourth, we have seen a major push across states
to redesign their approach to person centered planning. Through the work that CMS is embarking on
with our partners in the Administration for Community Living, we have launched the national
Center for the advancement of person centered practices and systems. That is to support states and systems across
the country in improving their person centered practices, processes, and policies. Finally, we have seen a number of states come
up with innovative methods of engaging stakeholders in their implementation work of the regulation,
with a particular emphasis on individuals with disabilities and their families. There needs to be great attention paid to
implement in creative options for ensuring that individuals with disabilities have a
say in how states are operationalizing some of these requirements and to make sure that
their concerns are the forefront of policy implementation. To wrap up, the field of home and community-based
services provision is involving in exciting ways.>>We have new provider models that are coming
onto the scene, including multi-income, multi-ability, multigenerational housing, customized employment
opportunities in the general workforce, and control over one’s resources, schedule, and
lifestyle choices. Individuals who once would have only had an
option of being institutionalized are now living meaningful lives in their communities. CMS and our HHS partners, including the Administration
for Community Living are developing promising practices for how we can further states system
change efforts, to improve the quality of home and community-based services, as well
as ensuring that people have full access to community living and the opportunity to receive
services in the most integrated setting appropriate. Thank you so much for having me today.>>[ Applause ]
>>All right. Thank you so much, Melissa. Thank you for being here. We are always grateful for our partnership
across ACL and CMS. Thank you for joining us today. You have heard from leaders across HHS’s and
from our expert. Now, we get to hear from individuals themselves
who have been impacted by the Olmstead decision. We have seen as people with disabilities that
Olmstead does not just represent a decision, but a promise. It is a commitment, not just a construct. It is a reality, not just a dream. For many of us, our lives are not just better
because of Olmstead ; we are happier and healthier because of Olmstead. We are not just in houses and apartments instead
of institutions. We are living and thriving in communities. Importantly today, we are going to hear from
a panel of individual leaders in their communities, their offices, their state capitals, and white
— right here in Washington. I am so proud to call each of them my friends. They have been such an asset to me as Commissioner. Without further ado, I will give some quick
introductions. I think we are going to hear so many wonderful
things from these individuals. To my immediate left is Kayla McKeon. She is the manager of grassroots advocacy
for the National Down Syndrome Society. She resides in Syracuse, New York. She is the 2016 recipient of the National
Down Syndrome Society self advocate of the year award. She is a member of the National Down Syndrome
Self Advocacy Advisory Board panel. She is best known for becoming the very first
registered lobbyist with down syndrome. Welcome, Kayla.>>Next is Liz Weintraub. She has a long history of self advocacy and
has held countless board, leadership, and advisory positions at the state and national
levels. She is a full-time member of the policy team
for this and well known for Tuesdays With Liz, where she is successful at making policy
accessible to all. Prior to coming to AUCD, she worked for the
Council on Quality & Leadership. She was at the center for leadership and disability
at Georgia State University. She has received numerous awards, recognitions,
and commendations. Today, one of her favorite things to do is
to mentor other people with disabilities. Finally, to my far left is Kimberly Tissot. She is the CEO of Able SC, a center for independent
living located in Columbia, South Carolina, a beautiful town. Thanks for inviting me. I loved my visit down there. Under her leadership, she pushes cutting-edge
approaches to community living and disability rights programs. I got to see this firsthand. It is great. This year, she chaired the South Carolina
Employment First initiative study community. She has given great traction across her state
with this work. She mentors other centers for independent
living across the nation and other nonprofit leaders right in her home state in South Carolina. She has been appointed by the governor to
statewide Independent living Council and currently chairs the states advisory Council on the
education for students with disabilities. She is a true leader across programs and across
her state. And without further ado, I am going to turn
this over to them with the very first question. Kayla, we will put you on the hot seat first. Can you — and then we will go right to Liz
and write to Kimberly, can you tell us a little bit more about yourself and specifically what
has community living meant to you? What does community living look like today
in your life?>>What is community living? To me, it means making my own decisions. Where do I want to live? Sorry. Now can everybody hear me? Perfect. What is community living? To me, it means making my own decisions. Where do I want to live? How much is it going to cost me? Who do I want to live with? Being an adult, house maintenance, budgeting,
shopping, living on your own is never easy. I know, because I have friends who live in
an apartment together. They support each other through ups and downs. Think about it. It is always two-sided. Community living is about making your own
choice, your own choice. Having a support system at the same time still
matters. Living in the community works for me because
I have a voice. It allows me to be independent. Being independent lets me meet my life goals. There is grocery shopping, going to the bank,
being able to walk in and deposit money or cash a check, finding recipes that allow me
to maintain a healthy lifestyle and make a meal for my family. Independence is definitely a huge key to a
successful life. Community living is so crucial in today’s
society. I want my message to be heard and not someone
else’s. This is why community living is so impactful
to us today. Thank you so much, Julie.>>Thank you, Kayla.>>[ Applause ]
>>Thank you, Julie. I am really excited and honored to be on this
panel to help celebrate the 20th anniversary of Olmstead decision. It allows us to live in the real community. The reason why I said the real community is
because, when my parents sent me to an institution, it was called the community. I have to admit that when I first saw it,
I thought it looked like a community. It had 10 or 12 little cottages where I lived
with one other person. There was a driveway to get down to this community. Also, there was a long rectangle building
in the front. I called it a fake community. I don’t know about you, but it is not the
kind of community that I live in today. Today, I have a wonderful life living in a
real community with my husband. I would like to tell you a little bit about
it. We live in a regular apartment building with
other people without disabilities. There are stores around that we can shop and
enjoy everything that the community has to offer, just like everyone else. We would not be able to live in a community
independently without some help from our agency. Someone comes and helps us manage our money
or helps me with my diabetes or helps me shop for my close. Our story isn’t unlike a lot of our friends. It is the Olmstead decision. If it was not year, we would not be able to
live in the community. Community is for all. I want to thank Lois and Elaine for their
bravery fighting for community living. Thank you.>>Thank you, Liz.>>[ Applause ]
>>Community living for me is quite simple. It is about having freedom. It is about having the supports in place so
we can live independently. I have the privilege of serving as the executive
director of an organization that is run and operated by people with disabilities. We understand — that I don’t think we get
too much credit for is we help implement Olmstead every single day of the programs that we implement. The programs that we design and living at
everything will day with our staff and board of directors is essential. We are proving every day how easy it is to
be in the community and to live when there are supports in place. In a nutshell, that is what community living
means to me.>>Thank you, Ladies.>>[ Applause ]
>>Much of what we have talked about today is how far we have come since the Olmstead
decision and how far we have come in the last 20 years. I want to take a second and look forward. I want to think about 20 years from now. We might have a little more gray hair, might
be a little, right? We will be a little bit older. But in 20 years from now, if we come back
and we filled this room with individuals again and we bring back this great panel, I am going
to start with Kimberly this time. We will go in the opposite order. How about that? Kimberly, what are we going to be celebrating? What are we going to have achieved 20 years
from now? What are you hoping that this panel is focused
on?>>I am hoping that there will be no segregated
programs. People with disabilities will be heard in
every single program. Disability rights are truly at the forefront
of what we are doing. There is a lot of programs right now that
exist that are going into that direction. There is also new segregation starting. There are new institutions, even in our school
settings, that are popping up daily. We have to bring disability rights back at
the forefront of every single thing we do. We also have to have people with disabilities
at the table making these decisions. I think that we have learned in the past 20
years that sometimes when programs are designed without the input of individuals with disabilities,
they fail. We have to do something about that and change
that today.>>[ Applause ]
>>Thank you, Kimberly. I can certainly attest to the fact that I
have seen that living and thriving in your organization down in Columbia, South Carolina. Liz, 20 years from now, what are you going
to be talking about on Tuesdays With Liz and talking to us about at this event we
>>I have to agree with Kimberly. 20 years from now, I want to see people with
disabilities, all kinds of disabilities, as leaders in all jobs and careers. I want to see more people with disabilities
in elected office. I want to see more people with disabilities
leading federal agencies like you, Julie. I want to see more people with disabilities
lead businesses.>>[ Applause ]
>>That is a great one. That is a great one. Awesome. Thank you, Liz. All right, Kayla, where are we going to be
in 20 years?>>My hope is to be on a panel 20 years from
now, but not be on a panel because we have reached equality for those of us who are differently
abled. If we have not reached equality, my hope is
that we at least are on a higher level of expectations. Thank you, Julie.>>Thank you.>>[ Applause ]
>>All right, I want to hit on a topic that I know is near and dear to everyone in this
room and on this panel. It is something I have talked to each of you
about. Kimberly, I will start with you on this one
again, because I got to come down and spend time with your team and all of your partners
across the state and with the governor to talk about this employment. Some people say it is one of the last frontiers
to push the envelope on. Kimberly, I want to ask you. I got to tour your Center for Independent
Living. I got to come to your employment conference. But as we are looking out and looking towards
the future on that last question, when it comes to employment, where is your center
going? Where do you believe that so much of our work
in the disability space is going around employment to finally move that number of individuals
who are employed in competitive and integrated settings?>>Absolutely, yeah. It is all about changing perceptions. I think there is a perception out there that
people with disabilities cannot work, they cannot work every day. They cannot work in the community. There is a protection against the disability
community. We have to change that. I think the voices again of individuals with
disabilities can bring that. We also have to make sure that people with
disabilities are working and getting the opportunity to be the model in our communities. I do think we have to close down sheltered
workshops.>>[ Applause ]
>>It is appalling that, after 20 years of Olmstead , and we are approaching 30 years
of the ADA, that sheltered workshops are still existing. That is not a choice. A lot of people with disabilities who are
placed into these environments, they have never had that choice to be in there. And so I think that we have to start with
that. We have to do some provider transfer formation,
helping a system providing services in segregated settings and assisting them with going into
the community direction.>>Great. Thank you. Liz, I will come to you off of that. I know that you have had both experiences. You have worked, not in competitive and integrated
settings, and you have had the great joy of being a part of a team today. Can you tell us what is one significant difference
for you and your life livered in a community now that you are in a fully competitive and
integrated setting?>>I am proud. I woke up this morning and I am proud to go
to my job. When I think about a job, my job at here,
I don’t think about just a job, but a career. I am in a career. I don’t work. I don’t have a job at AUCD. I have a career. Yes, for the last 20 years, 30 years, whatever,
we have been talking about jobs. Yes, let’s hope for jobs or whatever. But we don’t often talk about careers. There are people at this conference who have
careers. Why can’t I have a career?>>That is a great question. It is a perfect lead into Kayla, who is just
starting her career in so many ways. Can you tell us as you are looking ahead to
your career and you are out doing advocacy and meeting and educating so many of us, including
me, what is the number one thing that you help clear up? That you help make meaningful for the people
you get to speak to about people with disabilities having meaningful careers like Liz just talked
about?>>Thank you for the Segway. I appreciate it. I just started my career as a volunteer for
the National Down Syndrome Society, going to meetings to Capitol Hill. I lobby for independent living and supports
that are tailored to individual needs. I lobby for laws that enable the differently
abled to work and not lose our benefits. I lobby for a career with equal wages and
ending some minimum wages. My personal goals are individual living, having
access to supports that are needed to enable me to live on my own. My goals are to have that support system to
help me along. I will further educate and advocate for all
individuals who are differently abled and those with Down syndrome. Like I said earlier, all voices need to be
heard. We will not stop here and now. I will continue with the great fight. I will speak to many lawmakers, members of
Congress. I want these issues to be faced forward and
forward thinking. Like I said, keep up with me, because I am
not done yet.>>[ Applause ]
>>I mean, I don’t know about you guys, but sometimes around 2:00, 2:30 in the afternoon,
I get a little lull. I am quite awake for this panel. I want to thank you all and highlight a few
things as we reflect back. What I think is so important is, as we take
everything that we have heard from Roger and our Office for Civil Rights, our Deputy Secretary,
Amy, and Melissa have all talked about , is really the need to think comprehensively,
to think across the lifespan. To go back to the fundamental idea, as Roger
talked about earlier this afternoon, and the fundamental idea that each of us is given
dignity and talents to share. What I think is so incredible in what each
of you three young ladies bring to this is really your own path and your own experiences. Liz, you know, what I loved about you is you
highlighted what it means to make it all happen, right? What it takes to run a life that you enjoy
with a career that you are building and continue to challenge herself in at AUCD. Kayla, we see your energy. We will keep an eye on you. Don’t worry. You know I have your number.>>Oh, I know.>>Kimberly, we know it is going to take leaders
just like you in the trenches all across the nation, not just here in Washington, but in
state capitals like Columbia, South Carolina. I want to thank you all for joining us. I know Kayla has had a busy travel schedule. We flew Kimberly in last evening, as well. I want to thank you all for joining us and
sharing your experiences and your knowledge in continuing to inform this conversation. Thank you so much for being here.>>Thank you, Julie.>>[ Applause ]
>>All right. We are going to give these ladies a second
to kind of maneuver off the stage. While I get the great opportunity to bring
up our last two speakers this afternoon, I think we have two great individuals for you
to share — for them to share with you, I should say. Our very next beaker is Eric Dreiband, who
serves as the Assistant Attorney General for the civil rights division at the U.S. Department
of Justice. In earlier roles, he was a partner at a major
international law firm. He also served as the General Counsel of the
U.S. equal employment opportunity commission, where he directed the federal governments
litigation of title VII of the Civil Rights Act of 1964. He also issued the regional attorneys manual,
which established policies of EEOC’s litigation program. Prior to his EEO service, he served as deputy
administrator of the U.S. Department of Labor’s wage and hour division. He directed the federal government’s enforcement
of the Fair Labor Standards Act, the Family and Medical Leave Act, and other laws. He received his law degree with honors from
Northwestern University of law, a master of theological studies from Harvard Divinity
School, and his undergraduate degree from Princeton University. Ladies and gentlemen, please give a welcome
to Mr. Eric Dreiband.>>Thank you. Thank you for that introduction. Thank you for the opportunity to participate
in today’s celebration. As you know, today, we commemorate the 20th
anniversary of a landmark Supreme Court case called Olmstead v. L.C.. The court in that case found that the Americans
with Disabilities Act makes unlawful the unjustified institutionalization of people with disabilities. I think it is important to say at the outset
the very fundamental premise of both the Americans with Disabilities Act and the Supreme Court
decision. That is that disability rights are civil rights. It is critically important that individuals
with disabilities enjoy the privileges and freedoms available to all Americans.>>[ Applause ]
>>Congress enacted the Americans with Disabilities Act in 1990. Just before he signed the bill into law, President
George H.W. Bush explained its importance. This is what he said in part. Our success with this act proves that we are
keeping faith with the spirit of our courageous forefathers who wrote the Declaration of Independence. We hold these truths to be self-evident that
all men are created equal, that they are endowed by their Creator with certain unalienable
rights. President Bush continued. These words have been our guide for more than
two centuries as we have labored to form a more perfect union. But tragically, for too many Americans, the
blessings of liberty have been limited or even denied. The Civil Rights Act of 1964 took a bold step
towards writing that wrong, but the stark fact remains that people with disabilities
were victims of segregation and discrimination. That was intolerable. Today’s legislation brings us closer to that
date when no American will ever again be applied — deprived of their basic liberties of life
in the pursuit of happiness. This is something that we continue to strive
for at the U.S. Department of Justice and at the department of Health and Human Services
and elsewhere throughout our country. In the Olmstead case, the court determined
that the act’s prohibition against discrimination they require placement of persons with disabilities
in community settings rather than institutions. The court determined that such action is in
order when the state’s treatment professionals have determined that community placement is
appropriate, the transfer from institutional care to a less restrictive setting is not
opposed by the affected individual, and the placement can be reasonably accommodated taking
into account the resources available to the state and the needs of others with mental
disabilities. At the Department of Justice, we continue
to work to fulfill the promises of this. We incorporate issues that are critical to
the full participation of people with disabilities in all aspects of community life, such as
and including living in a community when appropriate, and the right to competitive, integrated employment. The department currently enforces 11 statewide
Olmstead settlements. Last month, we announced a competence of settlement
with the state of West Virginia. In that case, West Virginia agreed to expand
community-based services for children with serious emotional or behavioral disorders. Our investigation of West Virginia’s children
and mental health system showed that the state was sending many of its children to segregated
residential care rather than allowing these children when possible and appropriate to
remain in their communities and live with their families or foster families. During our investigation, we spoke with families
were unable to obtain community-based care for their children. For example, one 14-year-old and her mother
could not find treatment in the community. So the child spent several months in a segregated
facility in another state. She was four hours away from her family and
had to sleep on an air mattress on the floor and take cold showers every day.>>Another family had a 10-year-old who was
institutionalized four times and yet was unable to obtain services to prevent additional hospital
stays. Under our agreement, West Virginia will make
available mental health services to children in their homes and communities in the intensity
and for the duration of time that they need them. West Virginia will also expand until health
services across the state. The state is also working with the centers
for Medicaid and Medicare services to leverage available Medicaid of 40s to help pay for
necessary and appropriate home and community-based services. The settlement would give all affected children
the best chance to grow and thrive. I commend the state of West Virginia for working
with us at the Department of Justice to find a resolution. In another case just over one year ago, the
department also entered into a settlement with the state of Louisiana to settle allegations
that Louisiana unnecessarily relied on nursing facilities to treat adults with serious mental
illness who did not oppose receiving community-based support. The state is working collaboratively with
an independent expert and with the Department of Justice to implement reforms that will
better screen and divert people with mental illness from unnecessary placement, use person
centered planning to identify supports, improve transition planning from nursing facilities,
and expand needed community-based services for people transitioned or diverted from nursing
facilities.>>Expanded services include crisis services,
intensive case management services, and assertive community treatment, integrated stay services,
housing and tenancy support, and quality monitoring for all community-based services.>>We all know that work can provide so much
more than a paycheck. A sense of purpose, dignity, independence,
value, self-worth, and belonging. The Department of Justice is working to ensure
that people with disabilities have equal access to the tangible and intangible benefits of
competitive, integrated employment. The department settlement agreements with
the state of Rhode Island and the city of Providence offer individuals with disabilities
opportunities to receive services designed to prepare them for competitive employment. To date, 786 individuals have obtained employment
over the course of these agreements. In Oregon, another agreement has produced
similar results. Over 5000 persons have received new employment
services and over 600 former sheltered workshop workers have newly obtained, competitive,
integrated employment. We cannot reach an agreed resolution, of course,
and sometimes we can’t. We try, but we can’t at times. The Department of Justice does not shy away
from using its litigation authority. We have tried two Olmstead matters this past
year. This past fall, we challenged the state of
Texas is alleged institutional issues for people in nursing homes where the institutionalization
was unnecessary as we allege. In the ongoing litigation, even as we speak
today, in Mississippi, we allege that the state failed to provide needed community-based
services and it has resulted in the unnecessary segregation of adults with serious mental
issues in state hospitals. That case is on trial right now.>>As President Bush reminded us when he signed
the bill into law, the Americans with Disabilities Act seeks to extend the blessings of liberty
to all persons with disabilities in our nation. The Department of Justice will continue. Our Americans with Disabilities Act enforcement
will ensure that Americans with disabilities can lead lives free from discrimination. I think you again for allowing me to share
our work and our collaborative work and enforcement. Together, our disability rights continue to
address a vast array of barriers of individuals who face disabilities every day. We have worked hard to face a future where
people with disabilities can live and work as integrated members of their chosen communities. We have made much progress. Of course, more work remains. We continue to look for to work with all of
you in these objectives. Thank you.>>[ Applause ]
>>Thank you so much. Finally, I get the distinct honor and privilege
to introduce someone who most everyone in this room knows, Lance Robertson. Lance Robertson is the Assistant Secretary
on aging and the administrator of the Administration for Community Living here at HHS. He was appointed to serve as assistant Secretary
on August 11, 2017. His vision for ACL focuses on what we call
the five pillars. These are key areas of focus that are critically
important across both aging and disability and are areas where we make a real difference
for the people we serve. These pillars are supporting families and
caregivers, protecting rights and abuse, and preventing abuse. It connects people to resources, strengthens
the aging and disability networks, and expands employment opportunities. As we have heard today, that last one is particularly
important to people with disabilities. His leadership in the field of aging and its
ability began in Oklahoma, where he served for 10 years as the director of aging services
within the state’s Department of Human Services. Prior to that, he spent 12 years at Oklahoma
State University. I finally got that one right. All of us at ACL are so very grateful for
his leadership and his support of all of our programs that are making a difference for
people all across our nation with his abilities. Please help me welcome Lance Robertson.>>Thank you, Julie.>>[ Applause ]
>>It is very kind of you, but I know you have looked at your watches and you recognize
that we are 10 minutes over. I will wrap us up quickly. I really cannot stress how valuable I have
found this afternoon to be. I hope, likewise, you have taken good notes. I feel all the speakers were just outstanding. While they had to be brief, they hit upon
some good key points. It is great to hear from Roger and have our
Deputy Secretary year. That is a wonderful nod of support for the
work that we do had ACL to have HHS’s Deputy Secretary come over and say a few words. And certainly, as we dug in and heard from
Amy. Again, great job. I loved your overviews, the callout for NCI
and and CID and workforce. The things you covered are all really wonderful
and timely points. And of course, Alyssa, the support that you
continue to provide to us. We are honored to work with you closely. For those who may not be aware, with CMS more
broadly, we talked about how we can continue to support home and community-based services. Great panel we had, too, Julie. That was a great panel you put together. I want to thank Kayla, Liz, and Kimberly. Thank you all for coming and sharing your
personal insights and opinions. Thank you for being the champion of this conversation. Thank you very much for the commitment of
your time. Always great to have D.O.J. in the room, unless
they are coming to serve you.>>[ Laughter ]
>>We are glad for our partnership with D.O.J. I am glad he is able to come by and say a
few words. Let me ask all of you to give a round of applause
to Julie.>>[ Applause ]
>>Julie and her team put this event together. We all know it takes a lot of work. It is certainly worthy to do for such a great
celebration. We also want to thank the Kayser Family Foundation
for offering their facility. What a great facility. I think I will close by reinforcing what we
have all heard today. It is a great message around the criticality
of community support. We’re celebrating the 20th anniversary of
the Olmstead decision. As you would know within the mission of ACL
and by our name, we are about community living and how we can make sure people are offered
every support needed to live in the community in an inclusive and meaningful way that is
person centered. Those are all within the hallmark of what
we do. Woven within every comment is the day-to-day
work that we are honored to do at ACL. As I look across the room, we are so thrilled
to be working with so many partners. I know that Amy and others have called out
the importance of really what states are enabled, equipped, and powered to do when it comes
to supporting this conversation. Thanks all of you who, again, every day are
having this conversation. It is an honor to work with you. Thank you for taking part of your Tuesday
to be with us. We wish you a wonderful rest of the week. Again, thanks for your time.>>[ Applause ]
>>[ Event Concluded ]

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