A recent court case could significantly impact the nearly 14 million people dually eligible for both Medicare and Medicaid health insurance who rely on home and community-based services to live and age in their homes instead of institutional settings. Below, Clare Huerta breaks down what happened, how this could impact care for people with disabilities and or people who are dually eligible, and what advocates can do to fight back. 

What Happened?  

In a federal lawsuit, Texas v. Kennedy, five states (Alaska, Florida, Louisiana, Montana and Texas) are challenging portions of the Department of Health and Human Services’ (HHS) 2024 rule on Section 504 of the Rehabilitation Act, a key disability rights law that prohibits discrimination on the basis of disability by recipients of federal funds like states and school districts. On Aug. 31, HHS and the Department of Justice (DOJ) agreed to settle with the states and effectively get rid of key provisions of Section 504 requiring services to be provided in the “most integrated setting” for people with disabilities. Together, DOJ, HHS and the states asked the court to vacate the community integration sections of the regulation, which would make those sections unenforceable. According to the federal government, neither Section 504 nor the Americans with Disabilities Act (ADA) require states to serve individuals with disabilities in the most integrated setting appropriate to their needs. 

Why Does This Matter?  

DOJ’s filing is part of the administration’s broader effort to reject the legal right to community integration. However, this position is contrary to the law. Historically, people with disabilities were forced to live and receive services in institutional settings like hospitals and state-run facilities. Following the adoption of Section 504 and, later, the ADA, states have been required to offer home and community-based options to ensure that people with disabilities can live and work in their communities. Integrated service requirements have been part of Section 504 regulations since 1977 and the United States Supreme Court recognized the right to integration and community-based services in Olmstead v. L.C. 

The legal right to integration is important for people like Olivia who rely on home and community-based services (HCBS) to live independently or to work in their community. Younger people with disabilities and many older adults, particularly those dually eligible for both Medicare and Medicaid insurance, use HCBS to remain in their homes and with their families as they age. 

In the past, federal enforcement of Section 504 and the ADA expanded HCBS services in states that had not offered meaningful alternatives to segregated settings like youth psychiatric hospitals, and places designed specifically to employ people with disabilities. Many states have further designed and continued Medicaid waivers and other state options to support the services necessary for community living, like personal care services, employment support and assistive technology.  

Setting Back Disability Rights and Community Integration  

The decision in Texas v. Kennedy could influence future litigation and policy debates nationwide. Without federal enforcement, states and service systems may face less federal pressure to expand or maintain community-based alternatives. People with disabilities and older adults who rely on HCBS may be unable to remain in their homes and communities if states cut the services that support community living. Institutional care may become the default option. This will be a particularly dire consequence for people of color and/or people who are dual eligible who already report existing unmet HCBS needs. 

What Can You Do? 

Without federal enforcement, advocates must lead the charge to ensure their states comply with Section 504 and the ADA. Let your state and federal lawmakers know that HCBS and community living options matter. Seventeen states initially joined the lawsuit challenging Section 504 and the right to community living but thanks to vocal state advocates, most states have dropped out the litigation. Here’s how you can help protect community integration and disability rights: 

  • If you live in a state that is part of the lawsuit, reach out to lawmakers and your attorney general’s office to educate them on how HCBS supports individuals and families to live and receive care in their community. 
  • Encourage state and federal leaders to continue investing in home and community-based services. 
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