In the Spotlight

People With Disabilities Foundation (PWDF) Defends Mentally Disabled Client’s Right to Independence; Concurrently, Nine States Attack That Right 

The landmark U.S. Supreme Court Olmstead[1] decision solidified the right of disabled people to maintain their independence under Title II of the Americans with Disabilities Act of 1990 (ADA) by requiring states to allow them to receive health care services in the most integrated setting appropriate to their needs.

This year, PWDF cited Olmstead, among other cases, to defend a disabled client’s right to be reinstated as plaintiff in his own case in federal court against the Social Security Administration (SSA). (This case recently settled; see related e-newsletter article.)

Concurrently, the “integration mandate,” requiring delivery of services in the least-restrictive environment, has recently come under attack by Texas and eight other states.  They are asking a court to block the U.S. Department of Health & Human Services (HHS) from implementing a rule requiring them to provide community services to disabled individuals if at serious risk to becoming homeless and hospitalized.

PWDF Defends Client’s Right to Live as Independently as Possible

The Olmstead case originated in 1995 when two women, confined for years in the psychiatric unit of a Georgia state hospital, sued the state and sought placement in a community-based mental health program. The women, L.C. and E.W., claimed that Georgia was in violation of the “integration mandate” under Title II of the ADA by keeping them institutionalized and failing to provide community-based treatment. The issue before the Court was that the Eleventh Circuit had ruled that Georgia was in noncompliance with Title II of the ADA, but leaving the states without any meaningful defenses. Olmstead applies to the 50 states and governmental subdivisions such as counties.

Steven Bruce, PWDF Legal Director, relied in part on Olmstead in a January 2026 filing in Doe[2] v. Commissioner of the Social Security Administration.[3] In this case, the Plaintiff sought reasonable accommodations in the form of effective communication so he will have meaningful access to the SSA’s programs. In this brief, filed in U.S. District Court for the Northern District of California, PWDF sought removal of a guardian ad litem (GAL) assigned to substitute and make decisions for this Plaintiff, a San Francisco Bay Area man in his 30s with schizophrenia.

After undergoing several acute psychiatric episodes throughout his life, Plaintiff was arrested in December 2023 and ordered by a state judge to be sent to a state hospital for anti-psychotic medication treatment. After the Plaintiff was returned to the county, the judge ordered Mental Health Diversion under the California Penal Code, which would release him to a residential mental health program. The county continued to hold the man in jail, resulting in him being in jail or hospitalized for a total of 516 days instead of releasing him to a residential setting, as ordered by the judge. The SSA intentionally held up his new Supplemental Security Income (SSI) application for approximately five months; a new SSI application is required to be filed for anyone off SSI for one year.

The county wanted funding in order to release Mr. Doe to a residential program, which put him in a “catch-22” situation in that he could not receive disability checks to pay for the program until he was released from jail.  Mr. Bruce and co-counsel sent letters to the county objecting to its failure to provide Mr. Doe with services in the least-restrictive setting, as mandated by Olmstead.

Once Plaintiff’s condition had stabilized, Mr. Bruce and Mr. Doe’s treating psychiatrist produced evidence that he was competent to work with counsel on his disability civil rights case against the SSA.  In the January 1, 2026 motion seeking to remove the GAL and substitute him back in as Plaintiff, Mr. Bruce quoted this passage from Justice Ruth Bader Ginsberg’s opinion from Olmstead: “…Some individuals, like L.C. and E.W. in prior years, may need institutional care from time to time to stabilize acute psychiatric symptoms… There may be times [when] a patient can be treated in the community and others when an institutional placement is necessary….”

PWDF stated that the “unjustified isolation of disabled individuals” as evidenced in the Olmstead case was analogous to Plaintiff’s situation. Congress wrote into the ADA that everyone has a right to have their health care in the least-restrictive community environment, taking into account defenses of undue hardship and so long as the nature of the program is not changed.

On February 2, 2026, the federal judge granted the motion to remove the GAL and allow Mr. Doe to exercise his own judgment with counsel. The Plaintiff had been hospitalized but still had the right to live independently. Like the women in the Olmstead case, our client may need to be in a hospital at some point in time, rather than receiving outpatient treatment. But it should not affect his right to live as independently as possible, including continuing to be Plaintiff in his own case when appropriate.

Integration Mandate Comes Under Attack

As PWDF was submitting the brief to remove the GAL in our client’s case, the right to receive services in the most integrated setting came under attack from Texas and eight other states.

HHS is responsible for ensuring the “integration mandate” of Section 504 of the Rehabilitation Act of 1973 is followed. It requires federal agencies, states and other entities receiving federal financial assistance, and federal contractors to deliver services to disabled individuals in the most-integrated setting appropriate to the person’s needs. The ADA applies to the private sector as well.

On January 23, 2026, Texas, Alaska, Florida, Indiana, Kansas, Louisiana, Missouri, Montana, and South Dakota sued HHS, seeking to remove a proposed change to the integration mandate of Section 504.[4] The state Plaintiffs claim HHS’s amendment to Section 504 regulations (published but not yet implemented) exceeded its authority under both Section 504 and the ADA. They ask the Court to set aside what they characterize as the “unlawful provisions regulating institutionalization.”

It is unclear why Texas and the eight states take this position, since states usually recognize that people at risk of being institutionalized and/or homeless can offset at least some of the financial burden on counties, and therefore states, if these individuals receive Social Security disability benefits, which include health insurance (Medicaid and/or Medicare).

These states argue that the final regulation’s definition of “most integrated setting” is exceedingly broad. It includes, “…a setting that provides individuals with disabilities the opportunity to interact with nondisabled persons to the fullest extent possible… to live, work, and receive services in the greater community, like individuals without disabilities… offer access to community activities and opportunities at times, frequencies and with persons of an individual’s choosing; and afford individuals choice in their daily life activities.”[5]

The states argue, “anything short of that is considered ‘segregated’ and therefore discriminatory. And the obligation to provide a specific service in a community setting is practically limitless, no matter how specialized, and regardless of whether a specific service is designed for a non-community setting.”[6]

Olmstead, 26 years ago, spelled out the defenses for the states so that there would not be undue hardship if states could not comply with Title II of the ADA due to lack of infrastructure in place for the numbers of people waiting for community health care services. In fact, lack of meaningful defenses was the only issue before the Supreme Court in Olmstead. Thus, it is unclear why Texas et al. are taking a position that pretends Olmstead defenses do not exist.

[1] Olmstead v L.C. 527 U.S. 581 (1999).

[2] PWDF does not publish client names unnecessarily; therefore, Plaintiff is referred to in this article by pseudonym.

[3] Doe v. Frank Bisignano, Commissioner of the Social Security Administration, Case No. 3:23-cv-01037 (N.D. Cal. 2026).

[4] Texas et al v. Kennedy; 5:24-cv-00225-H, U.S. District Court, Northern Division of Texas, Lubbock Div. PWDF notes that this case is now only filed in federal District Court, which has no legally binding authority.

[5] Texas, at 8.

[6] Texas, at 8.

PWDF Profile

Who We Are

People With Disabilities Foundation is an operating 501(c)(3) nonprofit organization based in San Francisco, California, which focuses on the rights of the mentally and developmentally disabled.

Services

Advocacy: PWDF advocates for Social Security claimant’s disability benefits in eight Bay Area counties. We also provide services in disability rights, on issues regarding returning to work, and in ADA consultations, including areas of employment, health care, and education, among others. There is representation before all levels of federal court and Administrative Law Judges. No one is declined due to their inability to pay, and we offer a sliding scale for attorney’s fees.

Education/Public Awareness: To help eliminate the stigma against people with mental disabilities in society, PWDF’s educational program organizes workshops and public seminars, provides guest speakers with backgrounds in mental health, and produces educational materials such as videos.