Missouri drops out of lawsuit challenging federal disability rights protections

Missouri withdrew this week from a multi-state lawsuit seeking to strike down a part of federal law requiring states to provide services to allow people with disabilities to live in their communities instead of institutions.

The lawsuit began in September 2024 with 17 Republican-led states challenging a Biden administration rule that indicated gender dysphoria “may be a disability” under Section 504 of the 1973 Rehabilitation Act. 

Eight states withdrew from the lawsuit after the Trump administration proposed a rule that would exclude gender dysphoria from the definition of a disability. Several more states dropped out over the following months, leaving four before Missouri’s exit.

A spokesperson from the Missouri Attorney General’s Office told The Independent in an email that Missouri joined the lawsuit “to protect our state from overreach from bureaucrats in Washington.”

“We are thankful that the Biden Administration’s absurd addition of gender dysphoria to the list of disabilities covered under Section 504, our original reason for joining the litigation, has since been corrected,” the spokesperson said.

Attorney General Catherine Hanaway “remains dedicated to protecting services for Missourians who need them most,” the spokesperson said.

After a months-long push to raise awareness about the lawsuit, advocates for Missourians with disabilities greeted the state’s exit with relief.

Sangyeal Lee, a member of the Missouri Developmental Disabilities Council from Springfield, told The Independent he was “so happy” when he found out about the state’s withdrawal. 

“When I heard, I said, ‘Yahoo!’” Lee said. “…You know, ‘Finally, somebody’s thinking.’ That was my exact reaction.”

Hannah Satterwhite, assistant director of advocacy and education for St. Louis Arc, thanked the attorney general’s office for “withdrawing from this lawsuit and protecting the rights of people with disabilities to remain living, working and interacting with their communities.”

Christina Ingoglia, policy advocacy director for the council, told The Independent she and other disability advocates began meeting with staff from Hanaway’s office about the lawsuit in February.

Those efforts coincided with a groundswell of opposition against $80.7 million in proposed cuts to state and federal spending on Medicaid programs that help Missourians with developmental disabilities live safely in their homes and participate in their communities. 

Lawmakers reversed cuts that would have slashed pay rates for care staff hired through self-directed supports or working in structured group programs called day habilitation. But the budget signed by Gov. Mike Kehoe June 30 eliminated two smaller programs, including a “community specialist” service designed to help participants become more independent outside their homes.

Ingoglia said this year’s budget process shows that “it’s very real that these cuts could happen as funding decreases and as the state budget gets tighter.”

Federal policy shifts

Ongoing changes in federal policy could further complicate Missouri’s budget picture, experts and advocates said.

The Biden-era rule challenged in the lawsuit was intended to update the regulations of the U.S. Department of Health and Human Services to reflect decades of statute and case law on disability rights, said Alison Barkoff, who led the Administration for Community Living in the department from 2021 to 2024 and helped write the rule.

While states in the lawsuit initially challenged the entire rule, which included updates on website accessibility and check-in kiosks, an amended complaint filed in January focused on the “integration mandate” in federal law. 

The integration mandate requires states to provide services to people with disabilities in their homes and communities whenever possible. It was first articulated in Section 504 and elaborated in Title II of the 1990 Americans with Disabilities Act. And it was reinforced in the 1999 Olmstead decision of the U.S. Supreme Court and subsequent court rulings and guidance from federal agencies.

Barkoff, now a professor of health law and policy at George Washington University, told The Independent that the rule challenged in the lawsuit elaborated on the department’s 1977 regulations in two major ways. It expanded the description of the “most integrated setting” and clarified that states can be sued if their actions put people with disabilities at “serious risk” of institutionalization. 

“So for example, cutting services in a way that might place people at serious risk of going into an institution,” Barkoff said.

But the U.S. Department of Justice has in recent weeks signaled its intent to revisit decades of federal consensus on disability rights.

A June 18 Justice Department memorandum stated that neither Section 504 nor the Americans with Disabilities Act requires states to provide services to people with disabilities in the most integrated setting possible. And the Justice Department on Monday issued a “clarification” that it will no longer use a 2011 policy document interpreting the integration mandate.

The document, among other things, says budget shortages don’t necessarily excuse states from providing community-based services.

“Even in times of budgetary constraints, public entities can often reasonably modify their program by re-allocating funding from expensive segregated settings to cost-effective integrated settings,” the document says.

Barkoff said these recent moves are significant because the Justice Department is “the primary enforcer of these disability rights laws.” 

The Justice Department can’t change the law, Barkoff said, but states can use the recent memorandum in courts.

“This is just their reinterpretation of the law,” Barkoff said. “(But) it is clear that they are trying to get courts to adopt this position.”

Faced with proposed budget cuts this year, advocates argued that funding self-directed supports and day habilitation saves the state money. 

The Missouri Department of Mental Health indicated in its 2026 program book that while the average cost of self-directed supports per person was $48,534 in fiscal year 2025, the average cost of residential services that year was $227,317 per person. 

Ingoglia said the recent Justice Department communications are worrisome as Missouri faces continued budget pressure.

“It feels like this in partnership with the lawsuit is attempting to undermine home and community based services and their funding,” Ingoglia said.

Nightmares

Lee, the advocate with the Missouri Developmental Disabilities Council, said that although his 14-year-old daughter Isabella, who has Down syndrome, hasn’t yet needed to use the services protected by Section 504, he “wanted to make sure that Missourians, especially people who have disabilities, have the services they deserve.”

“If we have 20 years of (disability work) and wipe it out, we have to do everything again and better,” Lee said. “So that would be like going back to the time with no cars, no phones.”

Advocacy, he said, can be discouraging, and he’s had nightmares about the lawsuit.

“I was really afraid, actually,” he said.

Lee, who leads the council’s Olmstead standing committee, said he’s hopeful that the three states remaining in the lawsuit — Texas, Florida and Alaska — will decide to withdraw. 

Advocates and people with disabilities, he said, are asking states to follow federal law.

“We’re not talking about, ‘Give me a favor,’” Lee said. “Let’s do it by the law. We have ADA, and Section 504 is the law that we’re following.”