The U.S Department of Justice has settled its sweeping lawsuit against Colorado which is expected to bring relief to thousands of people in the state with disabilities who have for years said they were needlessly and illegally made to languish in nursing homes when they were eligible for community- or home-based services.

Not only has the state agreed to improve access and information about services available, the settlement is also designed to force greater state accountability – something the federal government alleged was previously missing.

In September 2023, the federal government took the rare step of suing Colorado, accusing the state of violating the Americans with Disabilities Act, the 1990 law that protects those with disabilities against discrimination.

Specifically, it cited a 1999 U.S. Supreme Court decision that mandated a state must provide home- or community-based services if they are available and can be reasonably accommodated.

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Colorado was accused of years of inefficiency and a lack of coordination in its Medicaid-funded transition programs that were supposed to help disabled people who might be temporarily living in a nursing home find the services that would allow them to go home. Instead, some waited for months if not years causing an avoidable decline in their health.

The settlement agreement between the Department of Justice and Colorado was signed last week without the state admitting any violation of federal law.

The case was the culmination of complaints by Coloradans with disabilities dating back to 2016. They said their requests to leave nursing homes were ignored and they remained in restrictive settings even though the state had home-based and community services available.

“People with disabilities should not have to give up their lives in the community and be isolated in nursing facilities to get the services they need,” said Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division in a statement announcing the settlement.

She added: “This settlement agreement sends the message that people with disabilities deserve the same kinds of lives as others, and makes clear that our family members, friends, and neighbors with disabilities add value to our lives and strengthen our communities when they can receive the services they need right inside their own home.”

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In response to the settlement, state officials said Colorado will continue to make sure those with disabilities “can receive care in the settings of their choice.”

Bonnie Silva, director of the state’s Health Care Policy and Financing office of community living, said in a statement that her office takes its mission “very personally.”

In the 32-page settlement, Colorado has agreed to a lengthy list of terms to speed the process of moving disabled people out of institutionalized care and ease their transition back to community- and home-based services.

Among the terms are:

The state will ensure counseling for institutionalized disabled people at least once every six months at every nursing facility that cares for them. That includes making a record of requests for assistance and then following up within ten business days.

In addition, Colorado will publish on its website information on how to get community- or home-based services and develop information about available services and distribute the information to those who want it.

If a resident wants to transition to community- or home-based services, he or she will be referred to transition coordination services, and the state, except in rare occasions, must make sure the coordinator accepts the assignment within five business days and that a meeting with the resident occurs within ten business days.

Any transition plan will be “person-centered” and drafted within 52 days. That plan will specify all the services needed and any obstacles to transition. “The planned transition will not be unreasonably delayed,” the settlement said.

Regular training will be provided for case managers, transition coordinators, nursing facility staff, and other providers.

Post-transition monitoring will be implemented and residents who want community- or home-based services will be prioritized.

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Melanie Reeves Miller, a longtime disability rights expert, will gather, analyze, and monitor the state’s progress. She will be able to hire staff and consultants and be given a $350,000 per year budget to do so.

The genesis of the case against Colorado followed a complaint filed in 2016 by Disability Law Colorado. A year later the Department of Justice launched an investigation.

In March 2022, the federal government wrote to Colorado Gov. Jared Polis that it had found the state was violating the Americans with Disabilities Act. The letter said unnecessary confinement in nursing homes, when other community- or home-based-options were available, was “common in Colorado.”

State officials pledged to make corrections and accelerate Colorado’s ongoing transition programs. Over the course of the next year, Colorado officials and Justice Department attorneys met to negotiate a resolution, but those talks stalled, prompting the lawsuit.

The federal government, citing the state’s own numbers, said in its lawsuit that it can cost up to three times more to pay for someone with a disability to be housed in a nursing home rather than receive community- or home-based care. The state later disputed that, saying that sometimes it is less expensive.

The Denver Gazette wrote about the issue on Nov. 22, 2023, highlighting the harrowing plight of one woman who tried for months to leave a nursing home and return to her apartment. She said she was told repeatedly she needed to wait a bit longer while state services were being coordinated.

When she finally left the nursing home, believing that her home health care was finally in place, it was not, The Gazette’s story showed. She claimed that, as a result, she was left alone in her apartment for two days with no food, no assistance, trapped in her wheelchair soaked in urine and feces until her son found her.

Emily Harvey, a lawyer with Disability Law Colorado applauded the settlement, calling it “a crucial step forward for Coloradans with disabilities.” She added it will be most cost effective.

“While full implementation will take time and other barriers to community living still exists” she said in an emailed statement to The Gazette, “we are optimistic that this agreement sets Colorado on the right path toward a more inclusive and supportive future for all residents with disabilities.”