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Justice Department finds Alabama illegally segregates children with physical disabilities

The DOJ found that the state must make community-based services accessible so that physically disabled children can avoid being segregated in nursing facilities.

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The U.S. Department of Justice recently concluded its investigation into Alabama’s long-term care system for children with physical disabilities and found the state unnecessarily segregates such children in violation of the Americans with Disabilities Act.

The DOJ sent a letter containing its findings to the state on Jan. 15, according to a release from the department. That letter thanked the state for cooperating and expresses hope for “an amicable resolution.”

The Justice Department opened its investigation in response to complaints alleging that the State’s long-term care system for children with physical disabilities results in the unnecessary segregation of some children in nursing facilities and hospitals and places others at serious risk of such unnecessary segregation.

“The State’s violation forces families to make life-altering choices. Some parents—because they cannot access medically necessary services for their children but are also balancing the demands of a job or raising other children—felt they had no option but to send their children away to nursing homes, where they have remained for years, and sometimes, for the rest of their childhoods,” the DOJ wrote. “Other parents reluctantly leave careers to provide full-time care for their children at home because promised State services go undelivered. In short, many children with physical disabilities in Alabama are unnecessarily institutionalized or are at serious risk of unnecessary institutionalization.”

The DOJ points to five ways in which the state fails that leads to this unnecessary segregation.

  • Limited access to community services, also known as long-term support services, “through restrictive authorization criteria and policies”
  • Failure to provide critical information and appropriate referrals that would connect children to necessary services by failing to coordinate its agencies
  • An under-developed community-based workforce to staff services for children, leaving children without community-based care
  • Failure to use its existing case management, care coordination, or transition services programs to ensure children with physical disabilities can live at home
  • Failure to support foster parents who care for or are considering caring for foster children with physical disabilities, leaving foster families without information and services necessary for successful home placement

As a result, some children who could otherwise be cared for in family homes have spent their formative years growing up in nursing homes, separated from their families and communities,” the DOJ wrote. “Others live on the brink of such institutionalization, as their families struggle physically, financially, and emotionally to keep them at home.”

The DOJ lays out a path for remedying the ADA violation by modifying its existing system.

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“The types of services needed to support children with physical disabilities in community settings already exist in Alabama and cost less than nursing facility and hospital placement,” the DOJ wrote. “And, under the Medicaid Act’s EPSDT provisions, the State already must provide these services to all Medicaid-eligible children, making modifications that would result in Alabama meeting its existing obligation inherently reasonable. Moreover, because the modifications listed below build on the State’s existing framework for providing services and enable the State to more fully utilize and expand that framework to make the services truly accessible, they are reasonable.”

Jacob Holmes is a reporter at the Alabama Political Reporter. You can reach him at jholmes@alreporter.com

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