DISABLED: Clinton Calls for Care Outside Institutions

      In a move that could "lead to tangible changes in the lives of people with disabilities," the Clinton administration has ordered state governments to evaluate hundreds of thousands of institutionalized patients to determine if they could receive care at home or in their communities, the New York Times reports. The White House is expanding a Supreme Court decision last June that said "states are required to provide community-based treatment for persons with mental disabilities when the state's treatment professionals determine that such placement is appropriate." But in a letter to states, federal officials contend that the ruling applies to individuals "with all types of disabilities in all institutions and all state programs." While many disability advocates welcome the move, state officials argue that compliance could cost "tens of millions of dollars in individual states and could easily cost more than $2 billion a year nationwide." But others, like Ira Burnim of the Bazelon Center for Mental Health Law, counter the claim, saying the states should not be permitted to "claim poverty" as an excuse for not offering community services. Rather, Burnim argues, states should seek more funds through Medicaid, state legislatures and other sources. In 1998, nationwide spending of Medicaid on long term care totaled $59 billion, with 75% used for institutional care and only 25% allocated to community care. HHS Secretary Donna Shalala said in a letter to state governors, "No person should have to live in a nursing home or other institution if he or she can live in his or her community," adding that "unnecessary institutionalization of individuals with disabilities is discrimination under the Americans With Disabilities Act" (Pear, 2/13).