On June 19th, just days before the 27th anniversary of the Supreme Court’s decision in Olmstead v. L.C., the Department of Justice (DOJ) issued a memo advancing an interpretation of the Olmstead decision that breaks from decades of established precedent. The memo questions whether the Olmstead decision requires states to serve people with disabilities in the most integrated setting appropriate to their needs. As the DOJ acknowledged, the new interpretation is out of step with how federal courts have understood Olmstead since 1999.
CSH is deeply concerned about this departure. Defending and advancing Olmstead is central to our work. The core principle— that people with disabilities should be able to live, work, and thrive in the community of their choice — is the foundation of supportive housing. At its heart, Olmstead recognized that no one should be cut off from their families, friends, and people they love simply to receive the care they need.
Olmstead has shaped how states support people with disabilities for nearly three decades. Courts across the country have consistently affirmed its core principle: that unnecessary isolation is a form of discrimination. That principle has guided state investment and practice. It has moved systems toward community-based housing and services that help people achieve stability, health, and independence.
This does not mean that treatment and housing are at odds. Some people, at some point in their lives, need intensive clinical care, including time-limited stays in hospitals or residential settings. A strong system includes that full continuum, but those settings work best as a bridge to stable community living, not a substitute for it. The choice is not between treatment and housing. Both are essential, and neither works in isolation.
The harder truth is that legal standards are only part of what stands between a person and a life of their choosing in the community. America faces a severe shortage of affordable housing and wide gaps in access to care. Efforts to expand access to evidence-based treatment supports, particularly community-based models, would be more effective than focusing on compelling services that simply are not available. These realities do more than any legal interpretation to determine whether someone with any disability including serious mental illness stays housed or falls into homelessness. Without a stable home, too many people either languish in institutional care or leave institutional care only to cycle back through emergency rooms, shelters, and jails.
Our FUSE work had demonstrated for more than two decades that when communities prioritize intensive services with housing, even people with the most complex needs find stability and recovery while communities enjoy reduced homelessness and costs associated with institutionalization.
North Carolina shows what is possible and what it takes to ensure that people have freedom of choice and the opportunity to thrive. Before 2012, the state relied on large, segregated adult care homes to serve people with serious mental illnesses. Those conditions resemble what this memo would now treat as legally acceptable. The DOJ found that this reliance violated the ADA and Olmstead, and that the resulting agreement required the state to build supportive housing and community-based services.
Building that capacity took the state more than a decade, several extensions, and sustained public investment, and the work continues today. The work required new levels of cross-sector collaboration between the housing and health sector state and community leaders. That investment has helped thousands of North Carolinians leave institutional settings for homes of their own.
The DOJ memo targets the very tool that drove progress. North Carolina’s problem was a shortage of housing and services. The legal expectation to integrate is what finally pushed the state to address the shortage. Removing that expectation, while the capacity gap remains, abandons people in the middle of a transition that is finally helping them.
Stepping back from community-based housing and services will push more people, and more cost, onto public systems. Institutional and crisis care is much more expensive than supportive housing, by many estimates more than three times as much per person. Without stable housing to exit to, that spending recirculates through repeated hospitalizations, law enforcement contacts, and time in jail, with little lasting stability to show for it.
The evidence of the last quarter century points in one direction. Supportive housing and community-based care improve health, strengthen communities, and reduce reliance on costly crisis systems. As policymakers and state leaders study this memo, the strongest path forward is to follow the evidence and build on community integration for people with disabilities by: expanding supportive housing, strengthening access to mental health and substance use care, and ensuring a full continuum of support that meets people where they are.
CSH remains committed to working with federal, state, and local partners so that every person has access to safe, stable housing and the support they need to thrive in the community.
