Advocacy

We Fight to Protect the rights of adults with intellectual or developmental disabilities (IDD) Across the U.S.

JULY 2026 - There are several critical fights occurring now that immediately affect the lives and civil rights of individuals with IDD and other disabilities across the U.S. We will use this webpage to provide a single place to find information about each issue including the source documents, an executive summary of the facts of each issue, our analysis and position statement, and recommended actions.

  • DOJ Memorandum Re-Interpreting Olmstead and Follow-up Clarification Statement

  • Texas v. Kennedy Lawsuit Targeting Olmstead and Section 504 of the Rehabilitation Act of 1973

  • US HHS / CMS Interim Final Rule re Medicaid Eligibility Work Requirements

US Department of Justice Memorandum Re-interpreting the Olmstead v. L.C. 1999 Supreme Court Decision and Community Integration Mandate

We have assembled below (and will continue to update) many of the relevant recent and historical documents and statements about the 1999 Olmstead Supreme Court decision and Integration Mandate to make it easier for anyone who wants to research these issues using original source documents and a range of opinions and position statements from leading advocacy organizations.

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July 22, 2026 - 100 Democratic members of the Senate and House sent a letter to the U.S. Department of Justice (DOJ) asking DOJ to rescind its June 18 legal opinion [PDF].

July 2026 - US Senate Resolution calling on DOJ to rescind the opinion and on Congress and the administration to reverse cuts to Medicaid and stop other actions that undermine community living

July 20, 2026 - The U.S. Department of Justice (DOJ) published in the Federal Register [PDF] a notice “Clarification on Department of Justice Guidance” in which the DOJ stated: “The Department of Justice (the Department) is issuing this document to clarify that the guidance issued by the Department on June 22, 2011, and last updated February 28, 2020, titled ‘‘Statement of the Department of Justice on Enforcement of the Integration Mandate of Title II of the Americans with Disabilities Act and Olmstead v. L.C.’’ (Olmstead Guidance), and similar guidance documents are not enforceable.”

June 18, 2026 - The DOJ Office of Legal Counsel (OLC) released on June 18, 2026 a highly-controversial memorandum responding to questions from lawyers at the White House that concludes that Congress neither through Title II of the Americans with Disabilities Act (ADA) nor Section 504 of the Rehabilitation Act of 1973 purported to impose an “integration mandate” requiring states to provide services to people with disabilities in the most integrated setting appropriate to their needs, nor did Congress authorize the U.S. Department of Health and Human Services nor the DOJ to do so.

Bloomberg Law reported on June 23, 2026 that White House advisor Stephen Miller was the driving force behind the memo which was authored by Lanora C. Pettit, Principal Deputy Assistant Attorney General, OLC.

The reaction from disability advocates and service providers came fast and furious. We will post links below with some of the statements from those organizations and individuals. Before we get to that, it’s important to revisit positions and statements made by the DOJ under previous administrations:

Statements from Disability Advocates and Service Providers/Agencies about the June 18, 2026 memorandum:

Texas v. Kennedy Litigation

What is Texas v. Kennedy and why does it matter? The following excerpt from the Disability Rights Education and Defense Fund (DREDF) website - https://dredf.org/protect-504/#anchor - is a quick summary of the case and recent developments:

Texas v. Kennedy (previously Texas v. Becerra) is a court case in Texas that was filed in Texas in September 2024. A group of 17 states sued the United States government. The 17 states were Texas, Alaska, Alabama, Arkansas, Florida, Georgia, Indiana, Iowa, Kansas, Louisiana, Missouri, Montana, Nebraska, South Carolina, South Dakota, Utah, and West Virginia.

The complaint asked the court to get rid of Section 504 and its updated rules from 2024 that protect people with disabilities from discrimination in health care and human services. The case changed over time, in part due to the 2024 election and subsequent steps by the Trump Administration, and in part due to the advocacy of the disability community.

On January 25, 2026, nine states – Alaska, Florida, Indiana, Kansas, Louisiana, Missouri, Montana, South Dakota, and Texas – filed a new complaint, Texas v. Kennedy (2026). The states renewed their attack on Section 504 and the right to live in the community. Six states have since dropped out following intense disability community advocacy.

  • The remaining three states say that a rule about the integration mandate published by the Department of Health and Human Services (HHS) is unlawful and unconstitutional.

  • The remaining three states are asking the federal court to block the rule about integration and all of the Section 504 regulations that were updated in 2024.

Indiana dropped out on May 1, 2026, South Dakota dropped out on May 12, 2026, Kansas dropped out on June 10, 2026, and Missouri dropped out on July 20, 2026. Louisiana and Montana have not officially dropped out, but they are no longer appearing on the pleadings. There are now three states – Alaska, Florida, and Texas – challenging Olmstead.

[NOTE: LTO Ventures asked Claude AI to analyze whether the DOJ memo on the Integration Mandate is having or will have an effect on Texas v. Kennedy. Read the unedited transcript of that conversation here.

US HHS / CMS Interim Final Rule re Medicaid Eligibility Work Requirements

Here's a summary of the June 2026 CMS Interim Final Rule ("Medicaid Program: Community Engagement Requirement for Certain Individuals," CMS-2454-IFC, 91 FR 33348):

Background & authority
The rule implements section 1902(xx) of the Social Security Act, added by section 71119 of the "Working Families Tax Cut" legislation (H.R. 1 / OBBBA), which required CMS to issue the rule by a statutory deadline. CMS issued the rule on June 1, 2026, implementing a new statutory requirement for certain adults in Medicaid to meet an 80-hours-per-month work requirement (sometimes called Medicaid community engagement) as a condition of eligibility. Because Congress authorized the interim-final approach, the rule takes effect July 31, 2026 without CMS needing to issue a subsequent final rule. CMS Foley Hoag

Who's covered
The work requirement applies to non-pregnant adults ages 19–64 who are not entitled to or enrolled in Medicare and are eligible for or enrolled in the Medicaid adult (expansion) group or in certain section 1115 demonstrations providing minimum essential coverage. CMS adopted OBBBA's definition of "applicable individuals" as primarily adults eligible through the expansion group, whether via the state plan or an 1115 waiver; those enrolled in limited-benefit waivers (e.g., family planning waivers) are not subject to the requirement. The rule applies broadly across expansion states plus some non-expansion states with relevant waiver programs (e.g., Georgia, Tennessee, Wisconsin). CMSMcDermott+

The 80-hour requirement
Affected individuals must demonstrate 80 hours per month of qualifying activities — employment, participation in certain work programs, or community service — or be enrolled in an educational program at least half-time. Activities may be combined to meet the 80-hour total, or the requirement can be met by earning at least 80 times the federal hourly minimum wage (about $580/month in 2026); seasonal workers use a different calculation. For seasonal workers specifically, compliance is measured via a six-month average income above that threshold. CMSMcDermott+

Exemptions
Exemptions include individuals who are pregnant, postpartum, disabled, medically frail, American Indian or Alaska Native, parents/caregivers of young children or people with disabilities, or already complying with similar SNAP or TANF work requirements. Also exempt: individuals eligible through most mandatory Medicaid pathways, recently incarcerated individuals, and certain veterans with disabilities. NatLawReview

Notably, the rule adopts a more restrictive definition of "medical frailty" than states had expected, tying the exemption to an individual's demonstrated impaired ability to meet work activities — requiring medically frail individuals to show impaired ability to conduct work activities in addition to having a qualifying condition, which several stakeholders warn will create new barriers to coverage. KFF

Verification approach
The rule directs states to rely on data matching and ex parte processes as much as possible to verify compliance or exemption status, requiring states to first check existing data sources before requiring individual reporting. SHVS

Key dates

  • Comments on the Interim Final Rule are due to CMS by July 31, 2026.

  • General compliance requirement effective January 1, 2027 (though states may implement sooner via 1115 waivers, and Nebraska became the first state to implement the requirements on May 1, 2026).

  • States that demonstrate a good-faith implementation effort may request extensions, which CMS will approve only in increments of up to six months at a time. The overall extension authority runs through December 31, 2028.

Projected impact
CMS projects the rule will reduce Medicaid enrollment by 2.3 million people in FY2027, rising to over 3 million in subsequent years. More broadly, the new work-reporting condition is expected to affect roughly 20 million people nationwide. NatLawReview

TEXAS
One of the most critical issues in Texas now is the state-set wage rate for Direct Support Professionals (DSPs) who are the paid staff that make it possible for adults with IDD to live as independently as possible in the community. The current rate set by the state is $10.60 per hour which is unworkable. A large and growing coalition of DSPs, providers, families, and self-advocates are fighting to raise the wage rate equal to what workers are paid in State Supported Living Centers (SSLCs) which is $17.71 per hour. Read more below about our efforts.

ACTIONS YOU CAN TAKE NOW

  • Get Notified! Visit this page often or get on our email list for updates. Email molson@ltoventures.org to get on our email list.

  • Questions or comments, contact Mark Olson, President & CEO of LTO Ventures; molson@ltoventures.org; (702) 353-6540

BACKGROUND: THINGS YOU NEED TO KNOW ABOUT HOW WAIVERS WORK (OR DON’T) IN TEXAS

  1. Read presentation by TX Health and Human Services Commission (HHSC) to the TX House Appropriations Committee on Feb. 18, 2025 providing an overview of Medicaid services in Texas.

  2. Adults with IDD in Texas often need residential assistance from Direct Support Professionals (DSPs) paid with Medicaid Home and Community-Based Services (HCBS) Waivers to help them to live as independently as possible in a home or community-based setting. Adults with IDD apply to use waiver funds to pay for the supports they need, and the waiver funds can only be used in Medicaid-eligible settings.

  3. In Texas, the Home and Community-based Services program can provide 24-hour residential assistance for people with IDD or related conditions to live in these Medicaid-eligible settings: a group home where no more than four people receiving services live; a host home or companion care setting, their own home or their family’s home. For many adults with IDD these are their preferred settings.

  4. Many other adults with IDD, however, would prefer a different type of setting such as a farmstead, intentional community, or campus setting where they can enjoy a supportive community comprised largely of their peers. There are more than 300 intentional or planned communities for adults with IDD around the US, and about a dozen existing or planned in Texas.

  5. The disability community is very diverse. One size does not fit all. Adults with IDD want the right to live in the setting and manner they choose from the broadest range of options available.

  6. Paid residential assistance can be very costly for most adults with IDD. Medicaid HCBS waivers are the financial safety net that pay for those supports based on the needs and desires of the adult with IDD. The rules for how waivers can be used are governed at a federal level by the Centers for Medicare and Medicaid Services (CMS).

  7. Each state then uses the CMS rules to create waivers to address the needs of the disability community in their state. In Texas those waivers are: 1) Home and Community Services (HCS); 2) Texas Home Living (TxHmL); 3) Community Living Assistance and Support Services (CLASS); and, 4) Deaf Blind with Multiple Disabilities (DBMD). Did you know that some 350,000 Texans with disabilities are on an Interest List to receive waiver funding? Did you know that an adult with IDD may have to wait 18 years or more to receive HCS waiver funding they need to live as independently as possible in the community?

 

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