A significant legal battle that could redefine the rights of people with disabilities to live and receive services within their communities is moving forward, despite a growing number of states opting out of the litigation. The multi-state lawsuit, known as Texas v. Kennedy, challenges a recent federal regulation designed to bolster community-based living for individuals with disabilities. While Indiana and South Dakota have recently withdrawn their participation, Texas and six other states continue to vigorously pursue the case, raising alarms among disability advocates who fear it could dismantle decades of progress in disability rights and lead to increased institutionalization.
The Core of the Legal Dispute: The Integration Mandate
At the heart of Texas v. Kennedy is a 2024 update to regulations issued by the U.S. Department of Health and Human Services (HHS) concerning Section 504 of the Rehabilitation Act. This landmark civil rights law prohibits discrimination on the basis of disability in any program or activity receiving federal financial assistance. The states challenging the regulation argue that the updated rule, particularly its "integration mandate," exceeds the authority granted to HHS under Section 504 and the Americans with Disabilities Act (ADA).
The integration mandate, as codified in the updated HHS rule, requires state and local governments, as well as other federally funded entities, to serve individuals with disabilities in the "most integrated setting appropriate." This means prioritizing community-based services over institutional care whenever possible. Furthermore, the regulation explicitly states that it constitutes a violation of Section 504 if individuals with disabilities are placed at "serious risk of unnecessary institutionalization." Non-compliance with these regulations can result in the loss of crucial federal funding, a significant financial incentive for states to adhere to the mandates.
In their amended complaint filed with the U.S. District Court for the Northern District of Texas, the participating states articulated their position: "The Final Rule exceeds the legitimate scope of Section 504 of the Rehabilitation Act and the Americans with Disabilities Act. The Final Rule’s unlawful provisions regulating institutionalization should be set aside for exceeding the scope of HHS’s authority under Section 504 and the ADA. Neither statute empowers HHS to mandate community-based care or to regard as discriminatory care that involves the mere prospect of institutional care."
The states are now seeking a judicial decision on the case without proceeding to a full trial. Their legal arguments center on the assertion that the federal regulation infringes upon their "budgetary and policymaking discretion" and effectively imposes a requirement for states to "redesign their Medicaid programs." This argument suggests that the federal government is overstepping its bounds by dictating how states manage their healthcare systems and allocate resources for disability services.
A Timeline of the Litigation and Shifting Alliances
The legal challenge began in 2024 with a broader coalition of 17 states, initially seeking to declare Section 504 unconstitutional. The early focus of the litigation was reportedly on a mention of gender dysphoria within the preamble of the HHS rule. Following actions taken by the Trump administration to address these specific concerns, eight states withdrew from the lawsuit. This led to a strategic pivot by the remaining states, who refocused their arguments on the integration mandate and the alleged overreach of HHS authority.
Since that initial withdrawal of eight states, disability advocacy groups have intensified their efforts to persuade other state attorneys general to disengage from the lawsuit. These advocacy campaigns, involving direct outreach, public awareness initiatives, and legislative pressure, appear to be yielding results. The recent withdrawals of Indiana and South Dakota are seen as a direct consequence of these sustained advocacy efforts.
Indiana Attorney General Todd Rokita, in explaining his state’s decision to withdraw, stated, "While we remain concerned about federal overreach into traditional state matters, President Trump’s decisive action has resolved the gender dysphoria issue. With that core victory secured, we have dismissed our claims." This statement highlights the evolution of the lawsuit’s core arguments and the specific concerns that motivated some states to participate and others to withdraw.
Texas Attorney General Ken Paxton, who is leading the current iteration of the lawsuit, has not publicly responded to requests for comment regarding the ongoing litigation or the recent withdrawals. The states that remain active in Texas v. Kennedy are Alaska, Florida, Kansas, Louisiana, Missouri, and Montana.
The Stakes for People with Disabilities: A Fundamental Right at Risk
Disability rights advocates and experts emphasize the profound implications of this lawsuit for individuals with disabilities. Alison Barkoff, a professor at George Washington University and former head of HHS’s Administration on Community Living under the Biden administration, articulated the severity of the situation: "This lawsuit by Texas puts at risk one of the most fundamental and hard-won rights of people with disabilities – the right to live and participate in their own communities."
Barkoff further explained the legal nuances: "Despite the new Section 504 regulation just codifying the 25 years of interpretations of the integration mandate by the courts, the states now claim that the regulations create new obligations for states that are illegal and beyond their constitutional authority. If a court were to agree, it could greatly narrow the right to community living and restrict the ability to enforce the law."
The core argument of the plaintiffs is that the HHS regulation is an unlawful expansion of federal power. However, from the perspective of disability advocates, the regulation represents a crucial step in upholding established legal interpretations and ensuring that individuals with disabilities are not relegated to institutional settings when community-based alternatives are available and appropriate. The legal precedent for community integration has been developing for decades, stemming from landmark court cases that interpreted Section 504 and the ADA. The 2024 HHS update is seen by many as a formalization of these long-standing interpretations.
Broader Context: The Evolution of Disability Rights and Community Integration
The push for community-based living for people with disabilities gained significant momentum following the deinstitutionalization movement of the mid-20th century. Driven by a growing understanding of the human rights implications of institutionalization and advancements in medical and therapeutic approaches, the focus shifted towards enabling individuals with disabilities to live more independent and integrated lives.
Section 504 of the Rehabilitation Act, enacted in 1973, was a pivotal piece of legislation in this regard. It laid the groundwork for prohibiting discrimination and mandating reasonable accommodations in federally funded programs. The Americans with Disabilities Act of 1990 further expanded these protections, solidifying the rights of individuals with disabilities to access public spaces, employment, and services.
The concept of "least restrictive environment" or "most integrated setting" has been a guiding principle in disability law and policy for years. Court decisions, such as the Supreme Court’s ruling in Olmstead v. L.C. (1999), affirmed that the unjustified institutionalization of people with disabilities is a form of discrimination prohibited by the ADA. The Olmstead decision established that public entities are required to provide services in the most integrated setting appropriate to the needs of qualified individuals with disabilities.
The 2024 HHS regulation can be viewed as an effort to strengthen and clarify these long-standing legal obligations, particularly in light of ongoing challenges in fully realizing community integration. The lawsuit by the states represents a direct challenge to this interpretation and enforcement, arguing that the federal government is attempting to impose new, burdensome requirements that infringe upon state sovereignty and fiscal responsibility.
The Impact of Federal Funding and State Autonomy
A critical element of the HHS regulation, and a point of contention in the lawsuit, is the potential loss of federal funding for non-compliant states. Federal funding, particularly through Medicaid, plays a substantial role in financing long-term services and supports for individuals with disabilities. The prospect of losing this funding creates a powerful incentive for states to align with federal regulations.
However, states also assert their inherent right to manage their own programs and budgets. The argument that the HHS rule forces states to "redesign their Medicaid programs" suggests a concern that federal mandates could lead to unsustainable costs or require significant shifts in state spending priorities, potentially impacting other public services. This tension between federal oversight and state autonomy is a recurring theme in intergovernmental relations.
Advocacy Efforts and Public Pressure
The sustained advocacy by organizations like The Arc has been instrumental in influencing the course of this litigation. Shira Wakschlag, senior executive officer for legal advocacy and general counsel at The Arc, has been vocal in urging states to withdraw. "For over a year, people with disabilities have been watching this case and wondering what it could mean for their daily lives, including whether they can keep the supports they need to live in the community," Wakschlag stated. "We urge every remaining state to follow the lead of Indiana and South Dakota and withdraw from this lawsuit."
The intensity of the public response has been notable. Reports indicate that the office of Texas Attorney General Ken Paxton has been inundated with calls and emails from advocates and concerned citizens, to the point where their phone lines have experienced intermittent disconnections. This demonstrates a significant level of public engagement and concern surrounding the potential implications of the lawsuit.
Looking Ahead: The Future of Community Integration
As Texas v. Kennedy proceeds, the legal arguments presented to the court will be crucial. The plaintiffs are banking on the argument that the HHS rule constitutes an unconstitutional overreach of federal authority, while disability advocates and the federal government will likely argue that the rule is a necessary measure to uphold civil rights and ensure that individuals with disabilities have the opportunity to live full and integrated lives in their communities, as protected by existing federal law.
The outcome of this case could have far-reaching consequences, potentially setting a precedent for the balance of power between federal and state governments in disability rights enforcement and shaping the future of community-based services for millions of Americans with disabilities. The ongoing withdrawals suggest a growing awareness among states of the potential legal and public relations ramifications of challenging these fundamental rights, but the determination of the remaining states to pursue the litigation underscores the deep divisions on the interpretation and application of disability law.
