Olmstead v. L.C. was a 1999 Supreme Court case concerning disability discrimination in a state Medicaid program. The Supreme Court held that the Americans with Disabilities Act (ADA) prohibits states from unnecessarily institutionalizing disabled people as a condition of receipt of publicly assisted medical care. The original opinion requires states to provide community-based treatment for persons with mental disabilities when the state’s treatment professionals determine that such placement is appropriate, the affected individuals do not oppose such treatment, and the state can reasonably accommodate the placement. Professor Becka Rich’s rewritten opinion rejects the defendants’ arguments that the costs of community care limit their obligations under the ADA. Rich indicates that the courts will hold states to task for taking full advantage of the flexibility and funding provided by Medicaid to support compliance with the ADA’s integration mandate. Professor Doron Dorfman’s commentary highlights how the plaintiffs’ claims to community-based care generate tension between financial constraints and the needs of people with disabilities and other chronic health conditions.