Federal Government Reversal on Disability Integration Feels Like 'Knife in Your Chest', Leader Says

A federal judge has struck down key community-integration protections in the US Department of Health and Human Services' Section 504 regulations nationwide, in what advocates say is a major reversal of nearly 50 years of federal support for disabled people's right to live in the community rather than institutions.

The ruling came after the Justice Department, representing HHS, joined the states in asking the court to vacate the provisions, a shift from the federal government's prior position supporting community-integration requirements that had been reflected in federal regulations for nearly half a century.

The 23 September court order in Texas v. Kennedy vacated specified community-integration provisions of HHS' Section 504 regulation nationwide.

Background: Section 504 and the 2024 Rule

Section 504 of the Rehabilitation Act was first passed in 1973, with enforceable regulations added in 1977 after years of advocacy.

The Biden administration's HHS issued a revised Section 504 regulation in 2024 that elaborated on recipients' obligations, including requirements concerning the most integrated setting appropriate to a person's needs. The 2024 rule expressly said it was intended to clarify existing obligations.

The Trump administration began reversing course in June, when the Justice Department's Office of Legal Counsel issued an opinion concluding that neither Section 504 nor Title II of the ADA imposed an integration mandate on states in their treatment of people with mental disabilities.

That set the stage for the Sept. 23 court order, which vacated specified community-integration provisions of HHS' Section 504 regulation nationwide.

Integration Mandate Rollback Sparks Alarm Among Disability Advocates

Bruce Darling, president and CEO of the Center for Disability Rights, said the ruling felt 'like a knife in your chest.' 'Because what we're hearing, what people are hearing, is that the federal government has made a determination that [disabled people] don't have a right to live in freedom, that they can be locked up against their will,' Darling said.

The court's decision removes several HHS regulatory provisions that required covered recipients to administer programmes and activities in the most integrated setting appropriate. The order did not overturn the ADA or the Supreme Court's 1999 decision in Olmstead v. L.C.

Jennifer Mathis, a disability rights lawyer with the Bazelon Center for Mental Health Law, warned the lack of clarity would affect enforcement. 'My concern is that right now, where we're at is disabled people have a right to integration on paper.

It is in the law, but whether it gets practically enforced is a serious question,' Mathis said. Mathis added that she was concerned the changed federal position could make some state officials more willing to reduce community-based services as they seek to control Medicaid spending.

Florida Case Illustrates Stakes

One of the clearest examples involves children with complex medical needs in Florida. In 2013, the Justice Department sued Florida, alleging that the state's service system unnecessarily institutionalised children with complex medical needs and placed others at serious risk of institutionalisation.

A federal district court ruled in the government's favour in July 2023, finding that Florida violated Title II of the ADA and issuing an injunction. In August, the Justice Department also sought relief from the 2023 judgment, citing the department's new legal position. Mathis called the reversal 'shocking' and 'incredibly heartless.'

States and Lawmakers Pursue New Disability-Integration Protections

Disability advocates are rallying behind several actions to combat the federal shift. Alison Barkoff, a health law and policy professor at George Washington University who worked on disability rights enforcement during the Obama administration, said the community is hard at work protecting those rights.

On Sept. 30, a bipartisan group of lawmakers introduced H.Res. 1586, a House resolution reaffirming the right of people with disabilities to live in their homes and communities. The resolution follows a July 22 letter signed by 100 members of Congress urging DOJ to rescind its June 18 OLC opinion.

There is also movement at state level. Delaware has enacted a law adopting Section 504's protections and implementing regulations as they existed on Jan. 1, 2025. Barkoff said she had received calls from at least a dozen state leaders about codifying the integration mandate.

Darling helped draft the Latonya Reeves Freedom Act, legislation introduced in the House and Senate that would strengthen and codify protections for people with disabilities who need long-term services and supports.

The Senate bill is S. 4865 and the House bill is H.R. 9401. The legislation has not advanced beyond committee referral in the current Congress. Although the bill has faced a difficult road, Darling said he is hopeful.

'I think the issue has really come to a head now and folks can see that Olmstead is seriously at risk, that we need to do something,' he said. The longer-term effects on state policy and enforcement remain uncertain.