Crime & Law
DOJ Targets Integration Mandate, Staple of Civil Rights for Americans With Disabilities
A Justice Department memo released last month is raising new questions about decades of civil rights protections for Americans with disabilities.
The memo challenges the integration mandate, a legal principle that requires states to provide services that enable people with disabilities to live in their own communities rather than in institutions.
While DOJ opinions don’t change the law, disability rights advocates worry the memo could be the first step toward the department backing away from enforcing the integration mandate.
Karen Tamley, CEO of Access Living, a nonprofit that helps Chicagoans with disabilities to live independently, said the memo, despite not carrying legal weight, is concerning.
“Just knowing that the DOJ doesn’t necessarily have our back anymore when it comes to fighting for community inclusion is a serious concern,” Tamley said.
What Is the Integration Mandate?
The integration mandate was established in the 1990 Americans With Disabilities Act after lawmakers concluded that unnecessarily segregating people with disabilities in institutions and other care facilities was unlawful discrimination.
It requires states and public health entities to ensure that services are provided in “the integrated setting appropriate to the needs of qualified individuals with disabilities”— usually in their homes and communities.
The mandate was upheld in Olmstead v. L.C., a 1999 Supreme Court case in which two Georgia women sued Georgia for failing to provide at-home health services. The court agreed that states have a legal responsibility to provide integrated care, creating a 27-year precedent.
“Justice Ginsburg issued an opinion that said ‘unjustified isolation and segregation is discrimination under the ADA,’” said Barry Taylor, a law lecturer at the University of Chicago. “She pointed to a DOJ regulation that said that people should be served in the most integrated setting.”
What Did the DOJ Memo Conclude?
The memo scrutinized three aspects of the integration mandate.
“You have asked us three questions relating to the integration mandate: (1) whether Olmstead conclusively decided that section 504 of the Rehabilitation Act and Title II of the ADA impose (or authorize the imposition of) the integration mandate; (2) assuming the question remains open, whether Congress constitutionally could impose such a mandate; and (3) whether Congress statutorily did impose such a mandate,” the memo reads.
The memo concluded that the Olmstead ruling actually did not uphold the integration mandate and that Congress never meant to create such a mandate in passing the ADA.
“We start with whether Olmstead conclusively imposes an integration mandate as a requirement of Title II. We conclude that it does not,” the memo reads. “We conclude that Congress has not imposed an integration mandate on states.”
Instead, the memo argues that Olmstead only bars states from institutionalizing patients without justification. The memo adds that “what counts as adequate justification remains an open question.”
Taylor said the DOJ’s position represents a stark abandonment of settled law.
“The memo is saying, ‘Maybe this Supreme Court didn’t get it right. Maybe all the courts across the country didn’t get it right. Maybe DOJ’s three decades of enforcing the ADA didn’t get it right. Maybe we should re-look at this thing.’ It’s really wrongheaded,” Taylor said.
How Could This Impact Americans With Disabilities?
Tamley said the memo could give states who view at-home services as costly more leeway to get around the integration mandate.
“While this is not law, we are concerned that this memo could be used as a justification to not advance home- and community-based services or use it as a defense if states are challenged around the integration mandate,” Tamley said.
States not looking to skirt providing at-home services could also be vulnerable.
Most Americans with disabilities become eligible to receive care through Medicaid Home and Community Based Services (HCBS) waivers.
In Illinois, the Department of Healthcare and Family Services provides non-medical services like bathing, dressing and housekeeping and medical services like physical therapy to Medicaid-eligible Illinoisans.
But cuts made to Medicaid in the One Big Beautiful Bill Act could cause states to be forced to re-institutionalize residents with disabilities, Tamley said.
“As we’re seeing more pressure on states particularly with H.R. 1 and the cuts to Medicaid, states are going to be forced to make some difficult decisions,” Tamley said. “Home- and community-based services are optional under Medicaid, whereas institutionalization is an entitlement. So when the state has more Medicaid financial pressure, what are we going to be losing?”
How Does Integrated Care Differ From Institutionalized Care?
Mark Ishaug is the CEO of Thresholds, a nonprofit that provides mental health services in the Chicago area. He said the difference between integrated and institutional care is night and day.
“In the last 16 years we’ve moved almost 1,800 people from institutional settings into the community where they have lived and thrived,” Ishaug said. “Many have gone back to work, reunited with family and friends. The road to mental health recovery is in the community.”
Ishaug said community-based care helps people with disabilities — especially those with invisible disabilities or mental illness — build more fulfilling lives than they could in an institutional setting.
“This is about Ariana in Kankakee who was in a nursing home,” Ishaug said. “We moved her safely into the community. She’s about to get her bachelor’s in social work. She’s going for her master’s degree. She’s got a job. She’s an artist. She lost 100 pounds and took care of herself and her life. This is transformative.”
A multi-state federal lawsuit, Texas v. Kennedy, that again challenges the integration mandate is making its way through lower courts. Taylor said it could eventually reach the Supreme Court.
