CW: Institutional Bias & Ableism
Disability rights in the United States have slowly changed over time, with big steps forward often followed by inconsistent enforcement. A pivotal moment came with the passage of the Americans with Disabilities Act (ADA) in 1990. This law created broad civil rights protections, making discrimination illegal in the workplace, in transportation, and in public places, and requiring reasonable accommodations. The ADA transformed our perception of disability, shifting it from an individual issue to a shared public responsibility.
Getting it passed proved difficult; it came after years of people fighting for change, while many others opposed it. Businesses were concerned about the cost of complying with regulations and the risk of lawsuits. Meanwhile, some politicians were reluctant to have the federal government get more involved.
Then there was the HIV/AIDS discussion, which also caused some tension. With HIV increasingly seen as a disability in the eyes of the law, some lawmakers and groups were concerned the ADA would mean more protections for people with HIV, particularly in the workplace and healthcare. Much false information about how HIV spread, along with the stigma attached to it, made the situation more difficult, resulting in the ADA’s passage through Congress becoming more challenging.
Despite all of this, the law was still passed, reminding us that true equality goes beyond what is on paper. It is about actually being able to participate in everyday life.
Progress continued, with the goal of achieving greater inclusion of disabled people in their communities with the Supreme Court’s 1999 Olmstead v. L.C. decision. It said states should end unjustifiably segregating disabled people and provide services in the most integrated way possible. This really solidified the idea that if someone can live in their community with the right support, they shouldn’t be forced into an institution.
After that, federal policy pushed states to expand Medicaid’s Home- and Community-Based Services (HCBS). These are services like therapies, home care, and medical equipment that allow people to live in their own communities.
But even with HCBS, there’s still a clear gap between what the law says and what people actually experience. Since coverage isn’t mandatory under Medicaid, each state gets to decide who qualifies, how much funding is allocated, and how many people can enroll.
Unfortunately, that leads to great disparities, long waiting lists, and inconsistent access to services depending on the state you live in. So, living in your community often comes down less to federal rules and more to what a state decides to prioritize and how it manages its budget.
Under the Trump administration, conversations around disability policy have primarily focused on the bigger picture of healthcare spending instead of broadening civil rights protections. Plans involving reducing federal Medicaid funding, perhaps through block grants or spending caps, have worried disability advocates.
Advocates fear that more cuts would put a huge strain on HCBS programs. While these changes would not completely strip away legal rights, they could undermine the very support systems that ensure those rights are effective.
This could mean more people end up in nursing homes and institutions if community services can’t keep up. It’s not just one administration, though. For decades, making sure disability rights are protected has been difficult.
The ADA gives us a solid legal base. But, in practice, things often depend on people filing complaints and lawsuits, instead of a system that actively checks and enforces compliance.
And with so much of our lives moving online these days, we still see major accessibility issues within websites, apps, and digital services. It just goes to show that legal protections, by themselves, don’t automatically mean everyone is included.
HCBS, by its very design, really brings this conflict into sharp focus. These services are absolutely crucial for living independently, but because funding is tight and state policies vary so much, accessing them can be very uncertain.
When there isn’t enough community support, institutions and nursing homes – even though they’re more restrictive – often end up being the option with the most reliable funding. It creates this strange paradox where the places that are the least inclusive are those with the most funding.
Looking at the big picture, disability rights have come a long way since the passage of the ADA. We’ve seen more laws and a real push for community inclusion. But the fundamental challenge is still there: making sure our legal rights are firmly upheld through adequate funding and support systems that make community living a practical, realistic part of life for everyone.
Sources:
Goldberg, Michelle. “Want to Help Disabled People? Be More Like George H.W. Bush.”The New York Times,
The New York Times Company, 4 May 2026, https://www.nytimes.com/2026/05/04/opinion/george-hw-bush-trump-disability.html.
McCammon, Sarah. “The ADA, 32 Years Later: Activists Say More Protections Are Still Needed.” NPR,
National Public Radio, 29 July 2022, https://www.npr.org/2022/07/29/1113535976/ada-disabilities-act-activists-more-protections.
Milden, Ian. “‘Examining the Opposition to the Americans with Disabilities Act of 1990: “Nothing More than Bad Quality Hogwash.”’ Journal of Policy History, vol. 34, no. 4, Cambridge University Press, 2022, pp. 505–528, https://doi.org/10.1017/S0898030622000185.
Shapiro, Joseph. “Lois Curtis, Who Won a Landmark Civil Rights Case for People with Disabilities, Died.” NPR,
National Public Radio, 5 Nov. 2022, https://www.npr.org/2022/11/05/1134426128/lois-curtis-who-won-a-landmark-civil-rights-case-for-people-with-disabilities-di.
Valdes, Marcela. “The Madden Sisters Don’t Want to Be Institutionalized.” The New York Times Magazine,
The New York Times Company, 18 Aug. 2025, http://www.nytimes.com/2025/08/18/magazine/medicaid-cuts-home-care-disabilities.html.