West Virginia has increased the amount it spends to allow the disabled to live outside institutions in the years since a landmark Supreme Court ruling.
The 1999 decision said unnecessarily segregating people in mental hospitals, nursing homes and other institutions amounts to discrimination. Advocates for the mentally ill, older people and the disabled cite the ruling in arguing for home- or community-based care. The ruling has limitations. It says individuals should be "reasonably accommodated" and offers no guidance on allotting funds.
In 2002, West Virginia spent nearly 38 percent of Medicaid funds on such services. In 2012, the figure was more than 47 percent.
Nationally in 2012, states devoted an average of 49.5 percent of Medicaid long-term care funding for home settings, compared to 31.1 percent a decade earlier.