In Olmstead v. L.C. (1999) 527 U.S. 581, the plaintiffs were two mentally retarded women being treated in Georgia state mental hospitals. Both women were medically evaluated and considered proper candidates for community placement services. Another regulation requires the states to make reasonable modifications to avoid discrimination against the disabled, but permits the states to resist modifications which would fundamentally alter their services and programs (the fundamental alteration defense). (28 C.F.R. 35.130(b)(7) (1999).) The state contended that requiring community placements for the women would be too costly and would therefore fundamentally alter Georgia's mental health programs. The Georgia federal district court granted a partial summary judgment for the plaintiffs, finding a violation of the integration mandate. The Eleventh Circuit affirmed in part, but reversed because the district court's ruling left state officials no room to put on their fundamental alteration defense. The Supreme Court affirmed that a violation of the integration mandate occurred, but held that the Eleventh Circuit's formulation of the fundamental alteration defense was still too restrictive. (Olmstead, supra, 527 U.S. at pp. 603-606.) The state contended that its decisions were based on a lack of funding and were not by reason of the plaintiffs' disabilities. It also contended the plaintiffs could not prove discrimination because they were not treated differently than were other similarly situated persons. The Supreme Court rejected the latter contention, opting for a "more comprehensive view of the concept of discrimination advanced in the ADA." (Olmstead, supra, 527 U.S. at p. 598 119 S. Ct. at p. 2186) In discussing the integration mandate of section 35.130(d), the Olmstead court said the regulation reflected the Attorney General's conclusion "that unjustified placement or retention of persons in institutions, severely limiting their exposure to the outside community, constitutes a form of discrimination based on disability prohibited by Title II." (Olmstead, supra, 527 U.S. at p. 596.) Recounting earlier congressional efforts to protect the disabled, the court said "the ADA stepped up earlier measures to secure opportunities for people with developmental disabilities to enjoy the benefits of community living," noting how one measure stated that the treatment and services offered the disabled " 'should be provided in the setting that is least restrictive of the person's personal liberty.' " (Id. at p. 599 119 S. Ct. at p. 2186.) When enacting the ADA, "Congress explicitly identified unjustified 'segregation' of persons with disabilities as a 'form of discrimination.' " (Id. at p. 600 119 S. Ct. at p. 2187, citing 42 U.S.C. 12101(a)(2), (5).) Recognizing that "unjustified institutional isolation" of the disabled is a form of discrimination reflects two evident judgments, according to Olmstead. "First, institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life. Second, confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment." (Olmstead, supra, 527 U.S. at pp. 600-601.) In Olmstead, after holding that the failure to provide community-care placements to the plaintiffs who qualified for such placements violated the integration mandate, the court said: "We emphasize that nothing in the ADA or its implementing regulations condones termination of institutional settings for persons unable to handle or benefit from community settings. Title II provides only that 'qualified individuals with a disability' may not 'be subjected to discrimination.' " (Olmstead, supra, 527 U.S. at pp. 601-602, citing 42 U.S.C. 12132.) Under the ADA, qualified individuals are disabled persons who " '. . . meet the essential eligibility requirements for the receipt of services or the participation in programs or activities provided by a public entity.' 42 U.S.C. 12131 (2). Consistent with these provisions, the State generally may rely on the reasonable assessments of its own professionals in determining whether an individual 'meets the essential eligibility requirements' for habilitation in a community-based program. Absent such qualification, it would be inappropriate to remove a patient from the more restrictive setting. See 28 CFR 35.130(d) (1998) (public entity shall administer services and programs in 'the most integrated setting appropriate to the needs of qualified individuals with disabilities' Nor is there any federal requirement that community-based treatment be imposed on patients who do not desire it. In this case, however, there is no genuine dispute concerning the plaintiffs' status . . . as individuals 'qualified' for noninstitutional care: The State's own professionals determined that community-based treatment would be appropriate for plaintiffs, and neither woman opposed such treatment." (Id. at pp. 602-603 119 S. Ct. at p. 2188.) The Supreme Court interpreted 28 Code of Federal Regulations section 35.130(b)(7) (2001), implementing the ADA, which provides (as noted): "A public entity shall make reasonable modifications in policies, practices, or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the services, program, or activity." The court held: "The State's responsibility, once it provides community-based treatment to qualified persons with disabilities, is not boundless. The reasonable-modifications regulation speaks of 'reasonable modifications' to avoid discrimination, and allows States to resist modifications that entail a 'fundamental alteration' of the States' services and programs. The Court of Appeals construed this regulation to permit a cost-based defense 'only in the most limited of circumstances,' , and remanded to the District Court to consider, among other things, 'whether the additional expenditures necessary to treat the plaintiffs in community-based care would be unreasonable given the demands of the State's mental health budget' . "The Court of Appeals' construction of the reasonable-modifications regulation is unacceptable, for it would leave the State virtually defenseless once it is shown that the plaintiff is qualified for the service or program she seeks. If the expense entailed in placing one or two people in a community-based treatment program is properly measured for reasonableness against the State's entire mental health budget, it is unlikely that a State, relying on the fundamental-alteration defense, could ever prevail. Sensibly construed, the fundamental-alteration component of the reasonable-modifications regulation would allow the State to show that, in the allocation of available resources, immediate relief for the plaintiffs would be inequitable, given the responsibility the State has undertaken for the care and treatment of a large and diverse population of persons with mental disabilities." ( Olmstead v. L.C., supra, 527 U.S. at pp. 603-604.)