Recent Department of Justice releases may could change how states provide home and community-based services to support individuals with disabilities or mental health conditions.
The Department of Justice (DOJ) recently released a clarifying statement that their guidance on the Integration Mandate for Title II of the ADA, the Olmstead Guidance, and similar documents are not enforceable. This statement appeared weeks after the DOJ posted a memo about how states do not have to provide in-home or community-based care for people with disabilities. It is essential to understand the background of the Olmstead v. L.C. case, how Ohio disability and aging advocates are responding, and the implications for the state.
History of the Olmstead v. L.C. case
To understand the significance of the DOJ memo, it is important to refer to the history of the Olmstead vs. L.C. case. In 1995, the Atlanta Legal Aid Society initially filed the lawsuit and represented two women—Lois Curtis and, eventually, Elaine Wilson in 1996—both living with mental health conditions and developmental disabilities. They voluntarily admitted to the psychiatric unit of the Georgia Regional Hospital (a state-run entity) to receive treatment.
After completing medical treatment at the hospital, mental health professionals decided that Curtis and Wilson were able to move to a community-based program. Despite this determination, they remained in the psychiatric unit of the hospital for several more years, confined because the State of Georgia argued that their request for community-based care was unreasonable. Limited funding and constraints within the state’s mental health budget were cited as the reasoning.
In 1997, Judge Marvin Shoob ruled in favor of the plaintiffs, determining that the Georgia Department of Human Resources and the Georgia Regional Hospital failed to place them in community-based treatment programs, violating Title II of the Americans with Disabilities Act (ADA).
The Georgia Defendants later appealed to the Eleventh Circuit Court of Appeals and lost, but elevated the case to the United States Supreme Court. The Supreme Court agreed with the plaintiffs that under the ADA, it is against the law for a state to discriminate against an individual based on their disability. Furthermore, the Supreme Court explained that the state discriminated against Curtis and Wilson by making them live in a mental health hospital.
The court ruled that public entities must offer community-based services or people with disabilities when:
- Services are appropriate;
- The affected individuals do not oppose receiving community-based treatment; and
- Community-based services are reasonably accommodated, and the public entity has the appropriate resources to address the needs of people with disabilities.
DOJ memo and pending Texas v. Kennedy lawsuit
This past June, the DOJ issued an advisory opinion that argues that neither the American Disabilities Act (ADA) nor Section 504 of the Rehabilitation Act, a federal law that prohibits disability discrimination in federally funded programs and services, requires states to provide community-based services to people with disabilities. This position is concerning because it undermines the Olmstead v. L.C. decision.
The DOJ’s opinion could provide cause for states to cut or reduce community-based services, ultimately forcing families to place their loved one with disabilities in a nursing home or other institutions, even when they can live at home safely and successfully in their community. The timing of the DOJ’s opinion is important to acknowledge, as it was released while Texas v. Kennedy was filed and making its way through the courts.
Texas v. Kennedy (formerly known as Texas v. Becerra), was filed September 2024 by 17 states against the United States Department of Health and Human Services (HHS). Ohio was not among the states that joined the lawsuit in 2024. The amended and current lawsuit, filed in January 2026, initially involved nine states, challenging HHS’s 2024 regulations concerning the implementation of Section 504 of the Rehabilitation Act.
Since then, Indiana, South Dakota, and Kansas have withdrawn from the case, leaving six states as plaintiffs. Section 504 regulations help protect the ability of people with disabilities to receive services and support in their homes and communities rather than being forced to enter an institution to access those same services. The states are arguing that these new regulations are unlawful and are an overreach in authority by HHS.
More than 40,000 Ohioans with developmental disabilities alone are typically enrolled in waivers every month.
Implications for Ohio and perspectives from advocates
The Justice Department memorandum does not immediately change Ohio’s Medicaid program or eliminate the right of Ohioans with disabilities to receive services in community settings. It is an opinion of the department’s Office of Legal Counsel, not a Supreme Court ruling or an amendment to the Americans with Disabilities Act.
Courts may reject its reasoning, and existing Medicaid waiver requirements, state laws, court decisions, and individual legal rights remain in place. But the memorandum may still have profound consequences by weakening the federal government’s willingness to enforce the principle that people in Ohio with disabilities should receive services in setting most appropriate to their needs.
That matters in Ohio because home- and community-based services do not operate automatically. They depend on annual appropriations, adequate reimbursement rates, a sufficient direct-care workforce, available waiver slots, and a functioning network of providers.
Ohio operates multiple Medicaid waivers for older adults, people with physical disabilities, and people with developmental disabilities. More than 40,000 Ohioans with developmental disabilities alone are typically enrolled in waivers every month, while others may be placed on waiting lists when their needs cannot be met through existing services.
The central risk is not necessarily that Ohio would announce a wholesale return to institutional care. It is more likely to appear through a gradual erosion of the community system: waiver enrollment that fails to keep pace with need, reimbursement rates that do not support a stable workforce, reductions in optional services, narrower eligibility or service authorizations, and longer waits for personal care, transportation, supported employment, behavioral health treatment, or residential assistance.
For many Ohioans with disabilities, those policy changes are not abstract. They represent the possibility of losing the lives they have built in their communities. As Jennifer Kucera Director of Policy, Advocacy and Outreach for the Center for Disability Empowerment in Columbus, Ohio and Chair of the Ohio Olmstead Task Force explained:
"I have often said that I feel like I live on shifting ground because, by the sway of someone's pen they could get rid of the life that I have built for the last 57 years and force me to live in an institution. Without state or federal assistance, many of us simply could not finance the supports we need to continue living in our communities."
Federal Medicaid budget reductions then make this possibility more than theoretical. The Health Policy Institute of Ohio (HPIO) has reported that HR 1 will reduce Ohio Medicaid funding by billions of dollars, forcing state policymakers to make difficult decisions about how to absorb those losses. HPIO notes that KFF's analysis of Congressional Budget Office estimates projected approximately $33 billion in lost federal Medicaid funding to Ohio over the next decade.
That creates a troubling fiscal scenario. When revenues fall, Ohio cannot simply stop covering all Medicaid nursing-facility care, but it may have greater discretion to limit waiver enrollment, reduce optional community benefits, or allow provider capacity to deteriorate.
Until now, Olmstead enforcement has served as an important counterweight to that imbalance. If the Justice Department continues to reduce its enforcement of the integration mandate, Ohio policymakers may face less federal pressure to preserve community-based services during periods of fiscal stress.
For Ohio, the most consequential change may therefore be one of accountability. If the federal government no longer investigates whether service shortages place people at serious risk of institutionalization, state budget officials may face less legal pressure to protect community programs during fiscal retrenchment.
Gary Tonks, President and CEO of the Arc of Ohio, said of the guidance, "The DOJ memo does not change the law. But it sends a dangerous message to states at a time when they are navigating reductions in federal Medicaid funding. Current budget shortfalls place home and community-based services at risk of being cut. The need to comply with the ADA, Section 504, and Olmstead has been a critical counter to the pressure to cut community services."
Ohio's Buckeye Institute, in its recent report The Cost of Aging, notes concerns that the DOJ memorandum could encourage greater institutionalization of people with disabilities. It then concludes that "policy moves at the state and federal level that hinder rather than help in-home long-term care... would be misguided."
Ohio’s recent investments in waiver reimbursement and community services provide some protection against an abrupt reversal, but they do not eliminate the structural vulnerability.
The state’s community system already depends heavily on low-paid direct-support professionals, family caregivers, county boards, aging agencies, managed-care organizations, and nonprofit providers. Even without an explicit policy favoring institutions, sustained workforce shortages or inadequate rates can make institutional care the default option.
