In Olmstead v. L.C. by Zimring, the United States Supreme Court addressed the relationship between the Americans with Disabilities Act (ADA), a landmark in US civil rights law, and the Medicaid program. Olmstead holds that qualified individuals with disabilities who are protected by the ADA have the right to receive publicly funded services in community-integrated treatment settings and that medically unnecessary institutionalization violates the ADA. But the Court had to wrestle with the extent to which the ADA requires state Medicaid programs to make deep and structural reforms in how long-term care services are organized, financed, and delivered. From a strictly legal perspective, Olmstead's impact has been limited by the fact that the ADA does not require fundamental alterations in public programs. Despite this fact, Olmstead remains a watershed decision in US disability law that has helped spur transformational changes in how Medicaid addresses community-based long-term care.