The U.S. Department of Justice sued the state of Colorado on Friday, alleging the state failed to take steps to stop segregating people with disabilities in nursing homes.
The department’s civil rights division sent a letter in March 2022 outlining alleged violations. It said Colorado had more nursing home residents with “low care needs” – who could presumably live at home with some support – than most states, and ranked poorly in transitioning people out of institutions.
Under the Americans with Disabilities Act and other federal laws, states are supposed to pay for support services through Medicaid so that low-income people with disabilities can live in the least restrictive setting that meets their needs. Those could include help managing medications, housekeeping, meal preparation and help with personal care like bathing and dressing, among other services.
Colorado has too few service providers, the lawsuit said, especially those helping people find housing that meets their needs. It alleged the state’s decision to regularly increase payments to nursing homes, but not to providers working in the community, contributed to the problem by making it financially unattractive to offer home services.
“Far too often, people with physical disabilities – including older adults – are institutionalized in nursing facilities when they could live in their own homes,” Civil Rights Division Assistant Attorney General Kristen Clarke said in a news release. “The Justice Department is steadfast in its commitment to protect the rights of people with disabilities and ensure the promise of community integration enshrined in the Americans with Disabilities Act.”
The Colorado Department of Health Care Policy and Financing, which runs the state’s Medicaid program, said it was “disappointed” by the Justice Department’s decision to file a lawsuit. It said 81% of people with disabilities in the state who are covered by Medicaid live in the community, and that 794 people transitioned from nursing homes to community settings from 2020 to 2022.
On Thursday, the state department had announced it received a $43 million federal grant offer support to people who wish to transition out of nursing homes, with a goal of having transition counselors visit three-quarters of the nursing homes in the state by the end of June.
“Despite the DOJ’s claims, for decades Colorado has maintained a deep commitment to continue building a system that ensures people with disabilities have the option to live and receive their care in the community,” the statement said.
The lawsuit also said the state indirectly pushed people toward nursing homes by:
• Not requiring home service providers to have plans if clients’ assigned workers are sick, which contributed to unreliable service
• Only paying for home modifications (for example, installing wheelchair ramps) for people currently living in the community, not those wanting to move out of nursing homes
• Not offering assistance finding housing to people who are at-risk of moving into a nursing home
• Not informing people with disabilities of services that may be available
• Delaying transitions out of nursing homes with a lengthy process to determine if residents qualify financially
The lawsuit didn’t say exactly what the Justice Department wants the state to do, though it noted Colorado could take steps to expand its home-care workforce, incentivize the creation of affordable housing that’s accessible to people with disabilities and do more to help connect eligible people to housing. It also said the state could streamline its processes to move people who’ve said they want to leave their nursing homes.
