REVERSING FIFTY YEARS OF ADVANCES FOR PEOPLE WITH DISABILITIES

The basic tenet of disability advocates is that a “social model” of disability should replace the exclusively medical one. According to the medical model, disabilities are physical impairments that must be treated and cured. The social framework focuses on the various social factors (such as stigma, discrimination, treatment by family and friends, poverty, and the lack of both legal rights and appropriate services) that affect the experience of living with a disability.

The social model undergirds the decades-long fight for the passage of laws providing equal access and protections for people with disabilities. Congress passed the 1990 Americans with Disabilities Act, prohibiting discrimination against people with disabilities in jobs, schools, transportation, and many other places, only after people with disabilities shed their assistive devices and crawled on their hands up the Capitol Building stairs. Two years later Judith Heumann, a pioneering disability activist, led a 26-day sit-in at the Department of Health, Education, and Welfare (DHEW, now DHHS, the Department of Health and Human Services) in San Francisco, demanding that the government issue regulations implementing Section 504 of the 1973 Rehabilitation Act, which prohibits discrimination against people with disabilities in federally funded programs. And parents and advocates campaigned for years to allow children with various disabilities to sit beside other students in “mainstream” classes.

Two actions by the Trump administration in June 2026 threaten those advances. The first is the transfer of special education programs from the Department of Education to DHHS, led by Robert F. Kennedy, Jr. Those programs provide more than $15 billion through the 1975 Individuals with Disabilities Education Act to guarantee that children with disabilities have the right to a “free and appropriate education.” Michael Yudin, who served as assistant secretary of the Office of Special Education and Rehabilitation under President Obama, protests that special education “is not a health issue, this is not a medical issue, this is about educating kids with disabilities. We’re talking about making sure kids get a free, appropriate education in the least restrictive environment. What about health does that?”

The concerns cross party lines. Stephanie Smith Lee led the Office of Special Education Programs during the George W. Bush administration. “Children with disabilities are not a diagnosis,” she said. “These are students first and they need to be educated and they need to be educated alongside their general education peers—and the federal offices that oversee the education need to be in the same department.”

Disability activists also point to RFK, Jr.’s offensive comments about children with autism as a reason to keep special education outside his purview. In April 2025 he stated they “are kids who will never pay taxes, they’ll never hold a job, they’ll never play baseball, they’ll never write a poem, they’ll never go out on a date.” Although he later said that he was referring only to children with the most profound conditions, the damage was done. He also fueled fears of autism by citing greatly inflated figures on the recent rise of diagnoses, ignoring the broadening definition of the condition, the most obvious reason for the increase.

The second action was the release of a memo by the Department of Justice’s Office of Legal Counsel challenging the reigning interpretation of the 1999 Supreme Court decision in Olmstead v. L.C. That decision held that people with disabilities have a right to services in the community and cannot be forced to enter institutions. The Court explained that its ruling in the case “reflects two evident judgments.” The first is that “institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable of or unworthy of participating in community life.” The second is that “confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment.”

The decision helped to drive a dramatic change in Medicaid funding from institutions to home- and community-based services (HCBS). (Medicaid, a means-tested program for low-income people, is the major source of government funding for long term care.) Medicaid initially was based on an institutional model, appropriating only a negligible amount to HCBS. Even before the ruling, the government slowly began to correct that imbalance, most notably through a provision allowing states to apply for waivers to include more homecare under Medicaid. Olmstead accelerated the trend. The proportion of Medicaid funds directed to non-institutional services grew from 27 percent in 2000 to 45 percent in 2018. Today, nearly 75 percent of Medicaid recipients of long-term care use only home- and community-based services.

Robin Bolduc explains the benefits of providing care at home. She is a 69-year-old woman caring for her 72-year-old husband Bruce Goguen, who is quadriplegic and uses a ventilator to breathe. Both Robin and Bruce are eligible for Medicare, but that program covers only their doctors’ appointments and Bruce’s many medical procedures. Medicaid pays for his attendant care and all his medical equipment, including a wheelchair, ventilator, oxygen, and shower chair. “Medicaid allows him to live in our home rather than a nursing home or in a hospital,” Robin said. “He can be an important person in the lives of me, his children and his grandchildren. We have friends. We interact with neighbors. We have our dogs. We have a good life despite our challenges.”

But now the Department of Justice has declared that neither Section 504 of the 1973 Rehabilitation Act nor the 1990 Americans with Disabilities Act requires states to provide HCBS to people with disabilities who need support. Although the Office of Legal Counsel cannot change the law, the Executive Branch must follow its judgment. As a result, many people with disabilities who need care their families cannot provide will have to enter institutions. Others will receive no care at all. Nursing homes funded by Medicaid have lengthy waiting lists. And the supply of all nursing homes is contracting even as the population rapidly ages.

It easy to understand why the memo has appeared. The 2025 “One Big, Beautiful Bill Act” reduced Medicaid funding by $1.8 billion over ten years. Although HCBS are cheaper than institutional care, their rapid expansion means that they are the obvious ones to cut. Moreover, conservative policy makers have long disliked HCBS because they lack natural gatekeepers. Although few people willingly enroll in institutions, the fear is that the availability of HCBS encourages individuals to “come out of the woodwork” to demand care they might not otherwise want or need.

The memo also reflects Trump’s long history of demeaning people with disabilities. According to his nephew Fred Trump, he suggested that “maybe” people with disabilities “should just die.” In his first term, Trump mocked a journalist with disabilities and insisted on excluding wounded veterans from military parades because “Nobody wants to see that.” In September 2023, he questioned the choice of Luis Avila to sing “God Bless America” at General Mark Milley’s retirement party. Avila lost a leg, experienced brain damage, and had two heart attacks and two strokes during five combat tours. Trump asked Milley “Why do you bring people like that here? No one wants to see that, the wounded.” Unlike home- and community-based services, institutions keep people with disabilities out of sight.

During the 2024 campaign Trump often referred to both Biden and Harris as “mentally disabled” while touting his own genetic superiority. He also promised, “For those [unhoused people] who are severely mentally ill and deeply disturbed, we will bring them back to mental institutions, where they belong.” Trump’s July 25, 2025 Executive Order, “Ending Crime and Disorder on American Streets,” directed federal agencies to facilitate the commitment of unhoused people with mental health problems and substance use disorders to long-term institutions for “humane treatment.” (He never mentioned where he would find such facilities or the money to pay for them.)

Disability is not the story of someone else,” writes Kim E. Nielsen, a prominent historian of disability. “It is our story, the story of someone we love, the story of who we are or may become, and it is undoubtedly the story of our nation.” According to the US Census Bureau, 13 percent of Americans live with a disability, and the prevalence increases sharply with age. The number of people with a disability increases from 0.8 percent for those under five, 6.2 percent for those 5 to 7, 8.3 percent for individuals 18-34, 12.6 percent for people 35 to 64, 24.3 percent for those 65 to 74, and 45.9 percent for individuals 75 and over. We all have a stake in ensuring that the government treats everyone living with a disability with dignity and respect and endows them with equal rights.

Sources:

Cory Turner, “Trump Actions Signal Move toward Institutionalizing Disabled People, Advocates Warn,” Associated Press, July 1, 2026.

“DOJ Memo Stokes Fear among Disability Advocates of a Return to Institutionalization,” NPR, June 20, 2026.

Kim E. Nielsen, A Disability History of the United States (Beacon, 2022).

US Census Bureau, “Disability Status by Age Group,” April 14, 2024, https://www.census.gov/library/visualizations/2024/comm/disability-status-age-group.html

“Information and Technical Assistance on the Americans with Disabilities Act,” archives, US Department of Justice, Civil Rights Division, https://archive.ada.gov/olmstead

Michael C. Bender and Sheryl Gay Stolberg, “Disability Groups Fear RFK Jr.’s New Special Education Role,” New York Times, June 20, 2026.

Bobbi Dempsey, “’I Don’t Know How We Would Survive,’” New York Times, September 12, 2025.

Alice Burns, Abby Wolk, and Molly O’Malley Watts, “A Look at Waiting Lists for Medicaid Home-and Community-Based Services, from 2016 to 2025,” KFF Health News, November 20, 2025.

Mark A. Unruh, Vincent Mor, and Hye-Young Jung, “Colliding Forces—the Aging of the Baby Boom Generation and Contracting Nursing-Home Supply,” New England Journal of Medicine, 395, no. 2 (July 4, 2026).