Health equity becomes more possible when every person with a disability can access the supports and services they need to live a full life. Through legal and policy approaches, US public health institutions are helping to improve the systems and environments that affect health day to day for people across the disability community. Since the passage of the Rehabilitation Act in 1973, we’ve seen the growth and expansion of the legal protections needed to support inclusive health services, housing, and education. Advocates continue to use these frameworks to combat ongoing health disparities. In this blog, we’re discussing the legal protections that are supporting this broader push towards equitable and inclusive communities across our health systems.
Civil Rights for People with Disabilities
People with disabilities have fought for decades to extract the deep, embedded ableism that lives in our institutions and civic body across the United States. Much of this work touches on our health systems, and the social services that drive health. The Rehabilitation Act of 1973 was the first federal civil rights law to protect the rights of people with disabilities in the United States. It set core standards for federally funded programs, like hospitals and clinics, to be accessible and inclusive for people with disabilities. The provisions applied to all recipients of federal funds, not just health care facilities.
Under the Rehab Act, federal agencies are positioned to be leaders as disability inclusive workplaces. The law mandated that relevant federal departments and contractors must proactively recruit, hire and support people with disabilities and provide reasonable accommodations to support their employment. These provisions under Section 501 and 503 have helped provide protections and workforce opportunities for people with disabilities. In 2023, the federal government reported 21%, or 423,000 individuals in its workforce, as being disabled By 2024, the Department of Labor reported employment rates for disabled workers were at a record high of 38%. Recent federal layoffs and reductions in telework accommodations have disproportionately impacted people with disabilities, and other marginalized communities.
Another key piece of the Rehabilitation Act directs federal programs to be accessible to people with disabilities, impacting health programs like Medicaid and facilities like Federally Qualified Health Centers. Section 504 ensures children and adults with disabilities can participate in programs and access benefits. This also provides for reasonable accommodations like interpreters, and that accessible equipment be made available. Research has shown that despite these protections, adequate accommodations for effective communication and accessible equipment are often not provided and provider ableism is endemic. Work is needed to advance provider knowledge, infrastructure and best practices that ensure accessible, effective health care experiences for people with disabilities. Section 508 of the Rehab Act creates a framework for ensuring digital accessibility. It requires federal health agencies to ensure fully accessible websites and telehealth platforms, especially for people who use screenreaders. These rules ensure accessibility of federal information technology, for both employees and program recipients. These access guidelines have become a model of best practices in the private sector as well. These rules aim to address the inaccessibility of digital spaces, where over 94% of webpages show detectable accessibility failures to meet WCAG 2 guidance.
Section 508 uses the Web Content Accessibility Guidelines (WCAG) as a guiding framework for technical implementation. In 2017, the government updated Section 508 to require websites and documents to follow WCAG 2.0 Level AA standards, as the legal requirement for federal agencies. Proactive implementation of these requirements is needed to close the digital divide in health care access, even as people with disabilities continue to have less access to the internet overall.
The Rehab Act of 1973 set the stage for future civil rights protections, including the Americans with Disabilities Act (ADA). Under both laws, the definition of “disability” is intentionally broad, covering many physical and mental health conditions, and they even acknowledge ableism by including those “regarded to have a disability”. In 2026, we must focus on the Act’s original vision: a health system that is shaped by, accountable to, and accessible for people with disabilities.
Legislating Accessibility into Public Life
In 1990, the Americans with Disabilities Act passed, expanding the scope and purview of disability civil rights law beyond the federal government and those who receive federal funding. In 2008, the ADA was amended to expand the definition of disabilities covered by the law. Under the ADA, people with disabilities have a legal basis to combat discrimination that affects their access to public life. The ADA outlaws discriminatory barriers to employment, state and local government services, public transit, commerce, and telecommunications. Through its 35-year legacy, the ADA has provided legal recourse for citizens to sue for disability discrimination and offered a vehicle for seeking reasonable accessibility accommodations. Based on the ADA, the Supreme Court ruled in the 1999 Olmstead decision that segregated living constitutes discrimination of people with disabilities. In recent years, remote work has become an important accommodation for people with disabilities too, and protecting telehealth continues to be an essential option for accommodating health care access needs as well.
Unfortunately, the ADA and subsequent legal precedents have not fully dismantled all ableist infrastructure or practices, particularly in healthcare. Thousands of people still lack the Home and Community-Based Services needed to support community living, with pending Medicaid cuts threatening to cut these services further. Meanwhile, people with disabilities still have high rates of unemployment and lower rates of internet access than nondisabled people. Furthering accessibility still requires funding and resources to advance access to public spaces, including renovations to transit systems and digital environments. Advocates have noted that some people with disabilities may not be sufficiently protected under the ADA, in particular those with traumatic brain injuries. With the growth of AI usage in healthcare, ableist practices and norms may be formalized in algorithm-based healthcare decision-making, posing additional risks to people with disabilities. People who are multiply-marginalized are still most likely to face discrimination, despite the ADA. The many persistent forms of ableism in our society demonstrate the urgent need to enhance the protection mechanisms that the ADA lays out.
Healthcare discrimination has continued to be a focal point for efforts to combat structural, medical ableism. Moves to affirmatively advance health equity have become possible thanks to legislation like the Affordable Care Act (ACA). The regulations for essential nondiscrimination protections under Section 1557 were updated in 2024 to broaden their application. These protections apply to any health programs or activities receiving federal funding, ACA Marketplace health plans, and federal insurance programs like Medicare and Medicaid. The Section 1557 regulations complement and overlap with the Section 504 antidiscrimination protections mandated by the Rehabilitation Act, which applies to federally funded entities only. Through the ACA antidiscrimination protections and Section 504, technologies for accessing healthcare must be accessible, including telehealth and in-person kiosks. They also protect against discriminatory algorithms that might deny coverage or impact treatment decision-making. Section 504 also calls for the installation of accessible exam tables to ensure adequate services for in-person care, and the removal of care evaluations that devalue disabled lives, as with Quality Adjusted Life Years (QALYs). The 1557 regulations are critical, but still have not eradicated healthcare discrimination for people with disabilities, especially those from intersecting backgrounds. The COVID-19 pandemic highlighted the persistence of discriminatory practices in crisis care in particular.
Equity in Mental Health Care
People with psychosocial disabilities have required additional protections to ensure coverage for their health care needs. Before the Mental Health Parity Act of 1996 (MHPA), health insurance plans were not required to cover mental health care, so coverage was not always available. Treatments could become costly and hard to access. There were no coverage guarantees to support ongoing care for lifelong chronic mental health concerns. There was no assistance to ensure healthcare access, so individuals often went without care, which could include medications or therapy. The MHPA was the first law to address this issue. It laid out that insurance plans could no longer have annual or lifetime limits on mental health benefits. These benefits were required to be as comprehensive as medical or surgical service benefits. Most plans found ways to bypass the requirements of the MPHA. They raised out-of-pocket maximums or limited covered visits. In response, Congress passed the federal Mental Health Parity and Addiction Equity Act MHPAEA in 2008.
MHPAEA requires group health plans and insurance providers to also treat substance use disorder benefits the same as other benefits, preserving and expanding all the protections of the MHPA. Under this update, MH/SUD benefits would not have different lifetime treatment limits for things like days spent in the hospital receiving care during a mental health crisis.
In 2010, the Affordable Care Act (ACA) expanded and reinforced the MHPAEA. Mental health and substance use disorder (MH/SUD) benefits were part of the ten essential health benefits (EHB) required in individual and small group plans. In 2020, the MHPAEA was updated to require group health plans and insurers to also equitably cover mental health and substance use treatments. This means the rules that can restrict treatment access must not be any different for mental health benefits. These “n” (NQTLs) for MH/SUD benefits must be documented to track how care decision-making aligns with other forms of care. Needing prior approval before starting treatment is one common NQTL, as well as proving “medical necessity,” or having limits on which providers a person can see.
By May 15, 2025, the agencies responsible for enforcement of the MHPAEA announced they would not enforce the final rule updates from the previous year. They indicated forthcoming revisions to the MHPAEA’s language. As of this writing, those changes have not been released. This choice not to enforce the 2024 parity rules came after an industry lawsuit coming from large employer health plans. The 2024 parity rules aimed to ease burdensome requirements that treatment show a “material difference” in demonstrated outcomes.
All is not lost. The MHPAEA’s statutory obligations are still in effect. Mental health and substance use disorder treatments need to be as easy to access as surgical or medical benefits. Non-enforcement is not the same as rescission. There’s still time for the 2024 Final Rules to be enacted. Advocacy and the courts can help those in need of mental health and substance use disorder care in their communities.
Protection and Advocacy Programs
Legal enforcement of disability rights relies on a state-level Protection and Advocacy system (P&A). These are federally funded programs that offer legal advocacy to people with disabilities in every state. The National Disability Rights Network (NDRN) is a membership organization that supports the P&A network nationwide. In total, there are nine distinct P&A programs that serve particular disabled constituencies and service-users. These programs are a frontline defense for supporting the health and wellbeing of the community disability. They can investigate abuse, offer legal support, and assist individuals accessing benefits, including community-based living. The first P&A ever created in 1975 was focused on supporting individuals with intellectual and developmental disabilities (PADD). Another P&A was established in 1986 to support individuals with mental health challenges (PAIMI). Additional programs serve specific communities, including recipients of Social Security, people with Traumatic Brain Injury, and people served by state rehabilitation agencies.
The P&A programs play an important role in preventing disability discrimination in federal programs like Medicaid, which are also the prominent payer for long-term supports and services like HCBS. With new work requirements and cuts to the program, it is imperative that people with disabilities are protected from coverage denials. Under the ADA, states must provide reasonable modifications to the implementation of work requirements, either exempting individuals with disabilities, or assisting people trying to meet them. This also includes ensuring accessible information about any requirements, and facilitating the process for exempting people from them. Section 504 of the Rehabilitation Act, and Section 1557 of the Affordable Care Act reinforce these requirements, focusing on the Medicaid program directly. The Bazelon Center for Mental Health Law has created a guide for states to comply with these requirements. They advise for broad determination of activities to be considered for those asked to comply with these requirements, including offering supported employment services as an accommodation. Adequately funding these national P&A programs is an important bulwark to defending against disability discrimination.
Health Equity on Hold
In 2023, NIH signaled a critical advancement towards health equity by recognizing people with disabilities as a health disparity population. This opened the door for more funding and programmatic development to target the unique health needs of diverse disability communities under the National Institute on Minority Health and Health Disparities (NIMHD). In the last few months, federal efforts to acknowledge and address health equity have reached a standstill. Research grant terminations have directly impacted this work, with the second highest number of grants lost through NIMHD, second only to the National Institute of Mental Health. NIMHD was subject to the greatest loss of NIH funding cuts, when considering their past active funding levels. Over 30% of the $1.8 billion in NIH grant funding cuts impacted NIMHD. Research programs that target health disparities are an important part of the work for improving health outcomes. We need basic consensus on the language we use to address negative health outcomes, and a trusted foundation to bring this work into being. In our policy work, we are committed to protecting the essential civil rights laws that make health equity enforceable, as well as the policy work that affirmatively advances it.