DOJ Memo Says States Aren’t Required to Provide Community-Based Care for Mentally Disabled Patients

The Justice Department’s Office of Legal Counsel says federal disability law does not require states to treat people with severe mental illness or disabilities in the most integrated setting.

In a memorandum dated June 18, the office concluded that neither Section 504 of the Rehabilitation Act nor Title II of the Americans with Disabilities Act imposes an “integration mandate” on states in their treatment of mentally disabled individuals. The opinion also says those statutes do not authorize federal agencies to require such a mandate by regulation.

Looking at Olmstead v. L.C., a 1999 Supreme Court decision, the office said Olmstead held only that “unjustified institutional isolation” can be a form of discrimination under Title II, and did not establish a rule that states must always provide care in the most integrated setting appropriate to a person’s needs.

Over the past two decades, the Civil Rights Division has relied on Olmstead and agency regulations to negotiate consent decrees and settlement agreements that commit states to deinstitutionalization benchmarks in nearly a dozen jurisdictions, according to the memo. Those agreements have typically required states to base placement decisions on individual needs rather than the availability of community resources and to avoid admitting people with developmental disabilities to institutions except in limited circumstances.

The Office of Legal Counsel’s opinion argues that reading Section 504 and Title II to impose a broad integration mandate raises “serious questions” about Congress’ power under the Fourteenth Amendment, the Commerce Clause and the Spending Clause. It says Congress may prohibit irrational discrimination against people with disabilities, but a universal requirement to deliver services in maximally integrated settings would go further than those powers allow without a clear statement from Congress.

The memo also concludes that existing regulations issued by the Department of Health and Human Services and the Justice Department, which require covered entities to administer programs “in the most integrated setting appropriate to the needs of a qualified person with a disability,” are not supported by the text of Section 504 or Title II. Those rules, the office says, effectively create a right for individuals to demand specific community-based services that the statutes themselves do not provide.

At the same time, the opinion acknowledges that most federal appeals courts have adopted a broader reading of Olmstead and treated the plurality’s description of when community placement is required as binding. The office warns that any effort by federal agencies to revise or rescind the integration-mandate regulations could face challenges under administrative law and that states may continue to face individual Olmstead claims in court regardless of executive-branch policy changes.

The memorandum does not question the overall constitutionality of the Rehabilitation Act or the ADA. The memo doesn’t itself change the law or overrule Olmstead, instead, the opinion gives the Trump administration a way to try to roll back DOJ and HHS regulations that enforce the integration mandate, and to scale back Olmstead-based enforcement actions and consent decrees.