Today, a majority of disabled people and older adults live at home and in their communities. Nearly 50 years of federal civil rights legislation extended the right for disabled people to live in these integrated settings. The purpose of this brief is to describe the current federal policy landscape, explain why it creates a threat of housing instability and institutionalization for older adults and people with disabilities who could otherwise stay in community settings, and propose potential paths forward for states and local governments as they prepare to respond to a growing need for care.

Research shows that home- and community-based care are cost-saving approaches. However, states and localities face steep challenges as they navigate the current policy landscape and comply with rapidly changing laws and regulations while continuing to provide high-quality, person-centered services to their residents. It will be extremely difficult for states to replace the federal investments that sustain community living for disabled and older adults. The potential for losing many of the gains of the past five decades is very real, and the next few years will be a critical period as states, local governments, and service providers adapt to the quickly evolving policy environment.