- Associated Press - Thursday, June 26, 2014

COLUMBIA, S.C. (AP) - Fifteen years after a landmark Supreme Court ruling on giving people with disabilities a choice to live outside institutions, South Carolina has shown little progress.

But state officials say they’re working to change that.

The 1999 Olmstead v. L.C. decision says unnecessarily segregating people in mental hospitals, nursing homes and other institutions amounts to discrimination. Advocates for the mentally ill, elderly and disabled cite the ruling in arguing for home- or community-based care.

Since 1999, the percentage of Medicaid funds spent to help people live independently has nearly doubled. But progress varies widely, with states devoting anywhere from 27 percent to 78 percent on non-institutional spending.

South Carolina ranks behind 40 other states and the District of Columbia by spending 41 percent of Medicaid long-term care funding on home and community services in 2012. That’s up from 35 percent a decade earlier, when the state ranked 22nd, according to the Centers for Medicare and Medicaid Services.

“We do have a long way to go” in funding more cost-effective, humane care, said Sue Berkowitz of the Appleseed Legal Justice Center.

While the numbers improved little over that decade, they should show improvement since 2012, said Pete Liggett, a deputy director at the state Department of Health and Human Services. A reasonable goal is a 50/50 balance in institutional and alternative care, he added.

The 2014-15 state budget includes $45 million for home- and community-based care - $13 million of that from state coffers - which is expected to take at least 1,400 people with disabilities off waiting lists in the fiscal year that starts July 1. The state’s Medicaid agency already has eliminated the waiting list for people with head and spinal cord injuries, which had grown to 300 people, Liggett said.

The agency is also seeking additional wavier authority from the federal government in how Medicaid money can be spent outside institutions, he said.

There’s no question that such spending is cheaper for taxpayers, at typically half the cost of an institutional placement, he said.

“But the benefits are more human in allowing someone to live their life in the places they want to live,” Liggett said.

Berkowitz agreed there’s been some improvement in the last two years but said much work remains. That includes coming up with a comprehensive plan after evaluating all services and how they’re funded, she said.

Medicaid-paid services for people with disabilities are provided through the Department of Disabilities and Special Needs, which contracts with local providers. The state’s slow progress is partly because those who make money off people being in private institutions are unwilling to let go of it, Berkowitz said.

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