By: Annika Agrawal.
In January 2026, a group of nine U.S. states—Texas, Alaska, Florida, Indiana, Kansas, Louisiana, Missouri, Montana, and South Dakota—filed a renewed legal challenge against federal disability civil-rights protections under Section 504 of the Rehabilitation Act of 1973. At stake is a central principle of disability rights: the right for people with disabilities to receive accommodation services and participate fully in their communities rather than being segregated in institutions.
What is Section 504?
Section 504 is a federal civil-rights law that prohibits discrimination against people with disabilities in any program or activity that receives federal financial assistance (such as hospitals, clinics, schools, and many social service programs). It is a cornerstone of disability law—predating the Americans with Disabilities Act (ADA)—and has been fundamental in expanding access to education, healthcare, employment, housing, and transportation for people with disabilities. One of its central principles is the “integration mandate,” meaning that, whenever possible, care and services should be delivered in the most integrated setting appropriate. Federal agencies have long interpreted this to mean that disabled individuals should not be unnecessarily segregated in institutional environments when community-based care is feasible. In healthcare contexts, for example, this statutory mandate supports requirements for accessible facilities, effective communication, nondiscriminatory eligibility criteria, and reasonable modifications of policies and practices. This principle was upheld by the U.S. Supreme Court in Olmstead v. L.C. (1999), a landmark decision affirming that unjustified institutionalization of people with disabilities is a form of discrimination.
What are the States Challenging?
In 2024, the U.S. Department of Health and Human Services (HHS) published multiple regulatory updates to Section 504, including provisions clarifying integration requirements, enforcement mechanisms, and accessibility standards in healthcare. This update further clarified that gender dysphoria can qualify as a disability under Section 504 in some circumstances, meaning that federally funded entities could not deny protections to transgender individuals within healthcare and human service systems. The lawsuit—led by Texas—asserts that these updates go beyond the scope of federal regulatory authority and place undue burden on state and local governments to provide services in integrated settings. The plaintiff states also contend that the recent rulings expand Section 504 beyond Congressional authorization, including the updated guidance that actions that place people with disabilities at “serious risk” of unnecessary institutionalization are discriminatory. Examples of actions considered discriminatory under the current regulations include cutting or denying home- and community-based services that someone relies on to live outside an institution, or structuring eligibility rules so that institutional care is covered, but community care is not. If the courts accept this argument, federal agencies could lose significant capacity to enforce community-integration protections across healthcare and social service systems.
Key Takeaways & Next Steps
Section 504’s integration mandate has helped push health systems and states toward models that support independence, dignity, and equitable access to care. This lawsuit has the potential to influence the legal foundation for requiring accessible medical training and diagnostic tools, whether disabled patients can receive care at home or in supportive community settings, and whether discrimination in clinical decisions—such as assumptions about quality of life — can be enforced in a court of law. Section 504’s integration mandate has helped push health systems and states toward models that support independence, dignity, and equitable access to care. If courts weaken the enforcement of this mandate, people with disabilities may find themselves with fewer legal tools to fight for care in the setting they choose.
If you’re interested in staying engaged, the Disability Rights Engagement and Defense Fund (DREDF) and National Down Syndrome Society (NDSS) often provide updates and opportunities for action, especially for students and healthcare professionals who want to support strong enforcement of Section 504 protections. For those who reside in one of the plaintiff states, visit their webpages at https://dredf.org/protect-504/ or https://ndss.quorum.us/campaign/154662/ to learn how to contact your state representatives!
