A black and white picture of people with disabilities protesting to get Section 504 signed

Texas and Eight Other States Renew Attack on Section 504 and the Right of Disabled People to Live in Their Communities

/in , /by Jackie Dilworth

On January 23, 2026, Texas and eight other states—Alaska, Florida, Indiana, Kansas, Louisiana, Missouri, Montana, and South Dakota—renewed their attack on Section 504 and the integration mandate. The integration mandate is a requirement under Section 504 of the Rehabilitation Act and the Americans with Disabilities Act (ADA). It allows people with disabilities to receive services in the community rather than in institutions. It was upheld by the U.S. Supreme Court in its landmark Olmstead v. L.C. (Lois Curtis) decision in 1999. We cannot let these states take away that right.

The nine states say that a rule about the integration mandate published by the U.S. Department of Health and Human Services (HHS) is unlawful and unconstitutional and should be blocked. The HHS rule says that state and local governments and any entity that gets HHS dollars must serve people with disabilities in the most integrated setting appropriate. The rule also says that entities may violate Section 504 when they place disabled people at serious risk of unnecessary institutionalization. The U.S. Department of Justice and many federal courts have said the same thing – that an entity can violate Section 504 when it fails to serve disabled people in the most integrated setting appropriate or when it puts them at serious risk of institutionalization.

If the states are successful in their challenge, it may be harder for disabled people to enforce their right to live and participate in the community. As a result, more people with disabilities may be forced into institutions when they can and want to live in the community instead. The disability community has fought long and hard for strong disability rights laws, and we cannot allow them to be weakened.

The states’ latest attack on disability rights is a revised version of the lawsuit Texas v. Kennedy (formerly Texas v. Becerra). In the earlier version of the case, Texas and 16 other states argued that Section 504 itself is unconstitutional and challenged updated Section 504 rules published by HHS in 2024. After outrage and advocacy from the disability community, the states withdrew their claim that Section 504 is unconstitutional. The remaining states continue to challenge the updated rules.

Eight states recently dropped out of the litigation after HHS proposed a package of three regulations aimed at the transgender community, including a regulation categorically excluding gender dysphoria from the protections of Section 504. Many disability groups, including the undersigned, have opposed this change to the Section 504 regulations.

In the new complaint, the states are now asking the court to:

  • declare that the entire Section 504 rule is unlawful,
  • stop HHS from enforcing the entire rule, and
  • stop HHS from telling states they cannot take actions that place people with disabilities at “serious risk” of institutionalization.

What Can I Do to Help?

We call on everyone in the nine states bringing this new attack on our autonomy and independence—Texas, Alaska, Florida, Indiana, Kansas, Louisiana, Missouri, Montana, and South Dakota—to urge their governors and attorneys general to withdraw this lawsuit and stop attacking the right of people with disabilities to live and participate in their communities. Information about how to contact the attorneys general in these states can be found at dredf.org/protect-504.

This update was created by The Arc of the United States, Bazelon Center for Mental Health Law, Center for Public Representation, Disability Rights Education & Defense Fund, Justice in Aging, the National Health Law Program, with contributions by Alison Barkoff, Hirsh Health Law and Policy Associate Professor, George Washington University.

Two young people sit side by side at an outdoor picnic table, smiling and looking at a smartphone together. One person sits in a wheelchair, and both wear jackets in a park setting

Medicaid Work Reporting: What Does It Mean for You?

/in , /by The Arc

Congress passed a new law that made cuts to Medicaid, called Public Law 119-21. This law says that some adults with low income who get health coverage through Medicaid will need to report their work or community activities to the state in the future

Public Law 119-21 creates a Medicaid community engagement requirement (often called a Medicaid work requirement). A community engagement requirement makes reporting work, school, or volunteering a condition of staying enrolled in Medicaid for some adults. CMS gives states guidance on how to implement Medicaid community engagement requirements.

This law does not affect you if: you get Supplemental Security Income (SSI) and Medicaid and/or you receive Medicaid home and community-based services.

Nothing is changing right now. The federal law sets the requirement to start by January 1, 2027, unless a state chooses to start sooner. Changes may happen in your state in the next few years.

In this blog, we explain:

  • Who may need to report work or activities.
  • Who does not need to report.
  • What you can do now to protect your Medicaid.

Remember: Medicaid may have a different name in your state.

Who may have to report work or activities for Medicaid?

The new rules will affect adults who:

  • Are 19–64 years old
  • Get Medicaid through Medicaid expansion

Lawmakers may decide certain groups of people are exempt. Exempt adults do not need to report. You can find out more about who is exempt below.

What is Medicaid expansion?

Some states give Medicaid to adults with low income, even if they don’t have children. This is called Medicaid expansion. Check if your state has Medicaid expansion.

What counts as work or community engagement activities?

You may need to report things like:

  • Working at a job (even part-time)
  • Working for yourself
  • Volunteering or helping in the community
  • Going to school or job training

Federal law defines ‘community engagement’ as employment, a work program, community service, or education/training. Many states will use an 80-hours-per-month standard to measure community engagement.

How reporting works:

Your state Medicaid agency runs the reporting process, and your state Medicaid agency sends the notices. Each state will decide:

  • How often you must report
  • How you report (online, by phone, or in person).

Who should NOT need to report work or activities?

Lawmakers have decided that many people with disabilities and caregivers should not need to follow these rules. They are exempt or free from the rules.

People who are exempt include:

  • People who get Medicaid because of a disability, like many people on Supplemental Security Income (SSI).
  • People who have serious health needs or need a lot of help every day. These people are sometimes called “medically frail.”
  • People who get both Medicare and Medicaid.
  • Some family caregivers who provide regular, hands-on help to a person with a disability or serious health problem.

Important: Even if you should not need to report, mistakes can happen. Always read your mail from Medicaid. Get help if you get a letter about reporting work or community activities. In past work-reporting programs, people lost Medicaid coverage because paperwork didn’t go through, even when they were eligible or should have been exempt.

What you can do now:

  • Keep copies of any letters that show you get Supplemental Security Income, Social Security Disability Insurance, a Medicaid waiver, or other disability benefits.
  • Keep letters or reports from doctors that explain your disability or the help you need.
  • If you get a notice saying you must report work and you have a disability, contact your local chapter of The Arc or legal aid right away.

Family Caregiver Information

You may not have to report work if you are a family caregiver and you:

  • Give regular, hands-on care to a person with a disability or serious health need.
  • Help with things like dressing, eating, bathing, taking medicine, behavior support, getting around, or communicating.

What you can do now:

  • Write down who you care for and how you help.
    • Example: “I help my adult son with dressing, meals, and seizures every day.”
  • Keep papers that show:
    • You are a paid caregiver through Medicaid.
    • A doctor says the person needs your help.
  • If you get a letter about work reporting, ask if you qualify for a caregiver exemption.

What Everyone Can Do Now

Even before these rules start, you can:

  • Update your contact information.
    • Make sure Medicaid has your current address, phone number, and email.
  • Open and read all mail from Medicaid or your health plan.
    • Do not ignore letters, even if they are hard to understand.
    • Ask a trusted person to help you read letters.
  • Get help right away if you get a letter asking about work or activities.
    • Contact your local chapter of The Arc, your Protection & Advocacy (P&A) agency, or legal aid.
    • Say: “I have a disability / I am a caregiver. I think I may not have to follow these new rules. Can you help me?”

Where to Get Help

Quick Answers (Medicaid Work Reporting)

Q: What is Medicaid work reporting?
A: Medicaid work reporting is the process a state uses to document “community engagement” activities for some adults.

Q: Does Medicaid work reporting affect SSI Medicaid?
A: No. People who receive SSI and Medicaid are not the target group in this post’s summary.

Q: When could this start?
A: The law sets an effective date by January 1, 2027, unless a state starts sooner.

Q: Who is most likely to be asked to report?
A: Adults ages 19–64 who receive Medicaid through Medicaid expansion (and certain similar coverage pathways).

Q: What’s the biggest risk for people who should be exempt?
A: Missing paperwork or unclear notices can still trigger coverage problems.

Q: Who can help if I get a letter?
A: Your local chapter of The Arc, your state P&A agency, or legal aid.

Written by Kim Musheno, Director of Medicaid Policy at The Arc of the United States.