Home and Community-Based Services: Creating Systems for Success at Home, at Work and in the Community

Charles R Moseley, Pamela M Walker, Ben Cichocki, Renata Ticha, Steven Taylor, Mary Sowers


A report reviewing the research on outcomes since the Supreme Court's decision in Olmstead v. L.C. (1999), and finds that strong trends indicate that smaller, more dispersed and individualized community settings further integration and positive outcomes for individuals with disabilities. Specifically, greater individual choice, satisfaction, housing stability, and higher levels of adaptive behavior and community participation are associated with living in residential settings of smaller size. This research tends to support the U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services (HHS/CMS) decision to promulgate final regulations impacting all Medicaid Home and Community Based Services authorities which establish that only settings of limited size and with certain characteristics will be entitled to receive Federal Financial Participation under the various Medicaid HCBS authorities. However, this national policy shift in favor of integrated supports and services presents a number of challenges to the state agencies and providers that have been furnishing supports prior to the implementation of these regulations. The research compiled in this report can help guide state policy makers, service providers, people with disabilities and their advocates in a collaborative effort to align support systems with the Olmstead decision and the requirements of the HCBS regulations.


February 24, 2015 
National Council on Disability


  • Community life
    • Civil rights
    • Community supports and services
  • Housing and residential services
    • Institutions and deinstitutionalization