The Trump administration moved to reverse federal policy on the integration of people with disabilities, rolling back rules that for decades required public programs to serve disabled Americans in mainstream settings rather than in institutions.
The reversal targets the regulatory framework built on the Supreme Court's 1999 decision in Olmstead v. L.C., which held that unjustified segregation of people with disabilities amounts to discrimination under the Americans with Disabilities Act. Federal agencies have cited that ruling for more than 25 years to require states to place people in community-based housing and employment rather than nursing homes, sheltered workshops, and other segregated facilities.
The change carries direct consequences for the roughly 14 million Americans with disabilities who rely on Medicaid-funded home and community-based services, a system that states built to comply with the integration mandate. Roughly 40 states operate such programs, which together serve more than 3 million people and cost the federal government over $100 billion annually.
Under the Olmstead framework, states that failed to offer community alternatives risked losing federal funding and faced Justice Department enforcement actions. The Justice Department has settled integration cases against states including Georgia, Rhode Island, and Texas, each of which agreed to shift thousands of people out of institutions.
Disability rights advocates have warned that loosening the integration requirement could slow or halt the closure of state-run institutions. About 30,000 people with intellectual and developmental disabilities still live in large state facilities, down from roughly 200,000 in the 1960s, according to figures tracked by the University of Minnesota's Residential Information Systems Project.
The administration's move aligns with a broader deregulatory push that has also touched education and health care rules. In March, the Department of Education cut staff at the Office for Civil Rights, the division responsible for investigating disability discrimination complaints in schools, by nearly half.
How quickly the reversal takes effect depends on whether the affected agencies issue new rules through formal notice-and-comment procedures, which can take months and invite legal challenges. Disability advocacy groups have signaled they intend to fight the change in court, arguing that the Olmstead decision is binding precedent that no administration can override by regulation.
Federal spending on home and community-based services has grown every year since 1999, reaching $126 billion in 2022, the most recent year for which Centers for Medicare and Medicaid Services data is available. That figure now exceeds spending on institutional long-term care for the first time in the program's history.
