Authors’ note: The disability community is rapidly evolving to use identity-first language in place of person-first language. This is because it views disability as being a core component of identity, much like race and gender. Some members of the community, such as people with intellectual and developmental disabilities, prefer person-first language. In this report, the terms are used interchangeably.
In May 2024, the U.S. Department of Health and Human Services (HHS) released a rule updating Section 504 of the Rehabilitation Act. The rule, titled “Nondiscrimination on the Basis of Disability in Programs or Activities Receiving Federal Financial Assistance,”1 reinforces protections to ensure disabled people have equitable access to federally funded resources and services.2
This toolkit:
- Explains why the updated Section 504 rule matters for disabled people’s access to health care
- Summarizes upcoming compliance deadlines under the rule
- Provides guidance for advocates to contact state attorneys general and state officials
- Includes a sample outreach email that advocates can customize and send
HHS’ updated Section 504 rule
The 2024 rule strengthens protections against discrimination and establishes enforceable standards related to:3
- Accessible medical diagnostic equipment (MDE)
- Websites, mobile applications, and kiosks
- Maintenance of accessible features
- Prohibitions on discriminatory medical decision-making
- Prohibitions on discriminatory barriers within the child welfare system
With 2026 compliance deadlines fast approaching,4 it is critical that state and local governments understand the regulations and the specific requirements and standards they must meet.
Who must comply with the rule
The rule applies broadly to health programs and services receiving federal funding or financial assistance, including but not limited to:5
- Local and state government departments or agencies
- Hospitals and health systems
- Nursing homes
- Senior care homes
- Family health centers and clinics
- Medicaid providers and managed care plans
- Child care; preschool; and elementary and secondary, post-secondary, and adult education programs or activities
- Child welfare systems
Because these entities serve millions of people nationwide,6 meaningful implementation of the rule has the potential to reduce disability discrimination in any program or activity that receives funding from HHS.7
Why state leadership and compliance are essential right now
Due to the Trump administration’s massive cuts to HHS’ workforce in 2025, it is unlikely that state health and human services agencies will be supported by sufficient federal guidance or enforcement.8 State and local government officials, including state attorneys general, state and local health departments, social services departments, and Medicaid offices, are uniquely positioned to help ensure compliance.
Importantly:
- Covered entities remain legally obligated to comply
- Individuals may still bring private enforcement suits for noncompliance
- Failure to implement these standards increases litigation risk for providers and states alike9
State-level leadership can help ensure:
- Consistent interpretation of the rule
- Proactive compliance support
- Technical assistance for covered entities
- Reduced legal risk for covered entities
Key requirements of the rule
Accessible web, mobile, and kiosk content (45 C.F.R. §§ 84.90 et seq. (subpart I))10
The rule clarifies that covered entities must ensure that:
- Websites, mobile apps, and online services—including online scheduling platforms and prescription refill forms—are accessible to disabled users, meeting the Web Content Accessibility Guidelines (WCAG) 2.1 level AA standard.11
- Accessibility obligations extend to content that is provided through contractors or other licensing arrangements.
- Self-service kiosks in medical settings are usable by people with disabilities. Kiosks are not required to follow WCAG 2.1 AA due to their limited programmingcapabilities, but they are required to be accessible under a generalized nondiscrimination provision.
The rule reiterates that entities have a preexisting requirement to make their websites and mobile applications accessible under the Americans with Disabilities Act (ADA) and Section 1557 of the Affordable Care Act, but new standards have been implemented in order to ensure that there is clarity on how to do so. The rule provides exceptions for archived web content, preexisting conventional electronic documents, content posted by a third party, password protected individualized documents, and preexisting social media posts, meaning that they do not need to comply with WCAG 2.1 AA but will need to be made accessible to an individual if requested.
Noncompliance with WCAG 2.1 AA that is found to have a minimal impact on access is not considered to be in violation of the regulation. For example, the current standard requires a minimum text color contrast ratio of 4.5-to-1.12 If a website has a text color contrast ratio of 4.45-to-1, it is not seen as being in violation because the access level remains the same.13 This provision allows for some wiggle room within the regulation without removing access for people with disabilities.
Accessible medical diagnostic equipment (45 C.F.R. §§ 84.90 et seq. (subpart J))
Lack of accessible medical diagnostic equipment remains a persistent barrier to equitable care access for people with mobility disabilities.14 MDE includes, for example, “examination tables, examination chairs (including chairs used for eye examinations or procedures, and dental examinations or procedures), weight scales, mammography equipment, x-ray machines, and other radiological equipment commonly used for diagnostic purposes by health professionals.”15
The rule gives the Architectural and Transportation Barriers Compliance Board’s (Access Board) Standards for Accessible MDE the force of law and requires providers to:16
- Acquire accessible exam tables, weight scales, and diagnostic equipment
- Ensure medical appointments are accessible in their entirety
- Ensure staff can successfully operate accessible MDE, assist with safe transfers and positioning of disabled people, and carry out the program access obligation regarding existing MDE
Providers may not deny disabled people services because they lack accessible equipment and could be held liable for 504 violations, if the disabled person files an administrative complaint to the HHS Office for Civil Rights, or sued in federal court.17 They should provide the patient with a referral to another provider and make every effort to come into compliance with the rules. Accessible MDE must be readily available to and usable by people with disabilities.18 It also must comply with the Standards for Accessible MDE developed by the Access Board.19 Some examples of accessible MDE include examination chairs designed to recline and be used as examination tables, weight scales that allow wheelchair users to stay in their chairs while being weighed, and imaging equipment designed for wheelchair use.20
Disability nondiscrimination within the child welfare system (45 C.F.R. §§ 84.60 et seq.)
Disabled parents are overrepresented in Child Protective Services investigations.21 They are also more likely to have their parental rights terminated.22 Disabled foster children are more likely to experience placement instability and more likely to live in an institution or community-based group home.23 Disability discrimination has influenced state policies around the rights of disabled parents24 and disabled foster children.25 For example, more than half of U.S. states allow for specific disabilities to be included as a reason for termination of parental rights.26
The rule requires state child welfare systems to:27
- Prohibit decisions and service provision based on speculation, stereotypes, or generalizations around disability about the parent, foster parent, caregiver, prospective parent, or child
- Prohibit requiring a disabled child to be placed outside the home in order to receive necessary services
- Provide reasonable accommodations to parents, foster parents, caregivers, prospective parents, and children so they can access child welfare services
- Require disabled children to be placed in the most integrated setting
Any child welfare system receiving federal funds must not deny disabled people their parental rights on the basis of disability alone, including a single general IQ. Parenting evaluations, visitations, and services must be fully accessible for both disabled parents and disabled children. Children cannot be placed outside their home or made to remain in the child welfare system solely in order to receive services.28 If the child is placed outside their home, they must be placed in the most integrated setting.29
Key compliance dates
Key compliance dates include the following: 30
- Web and mobile apps
- May 11, 2026: Web and mobile application content that is maintained by public entities with 15 or more employees must be compliant with the standards set forth in WCAG 2.1 AA.
- May 10, 2027: Web and mobile application content that is maintained by public entities with fewer than 15 employees must be compliant with the standards set forth in WCAG 2.1 AA.
- Accessible medical equipment
- July 8, 2024: All MDE that recipients purchase, lease (including lease renewals), or otherwise acquire must comply with the Standards for Accessible MDE unless and until the recipients satisfy the rule’s scoping requirements (obtain the calculated amount of equipment required to meet standards).31
- May 9, 2025: Construction should follow the Uniform Federal Accessibility Standards (UFAS) if it was built or renovated on or after January 18, 1991, and before July 8, 2024.32 If new construction or alterations started after July 8, 2024, but before May 9, 2025, the construction must follow either UFAS or the 2010 ADA standards.33 Construction built or renovated on or after May 9, 2025, must follow the 2010 ADA standards.34
- July 8, 2026: Recipients that use exam tables and weight scales must have at least one accessible exam table and one accessible weight scale by July 8, 2026.
- Nondiscrimination in child welfare systems
- July 8, 2024: Reasonable accommodations must be provided for disabled people who access or interact with child welfare systems. Disabled children must be placed in the most integrated setting. Decisions based on speculation, stereotypes, or generalizations about a disabled parent or child are prohibited.
How advocates can take action
Advocates and organizations can play a critical role by contacting:
- State attorneys general
- Medicaid agency leadership
- Officials from state departments of social services or state departments of health and human services
Outreach should:
- Highlight upcoming compliance deadlines
- Emphasize the continued legal force of the rule
- Request state-level guidance and technical assistance to covered entities to ensure they are following the rule
- Be personal and specific
Use the following template as a guide and make it your own.
Sample email/letter to send to state officials
Subject: Upcoming Section 504 Compliance Deadlines for Health Programs
I am writing to urge your office to take proactive steps to support implementation of the Department of Health and Human Services’ updated Rehabilitation Act Section 504 regulation, “Nondiscrimination on the Basis of Disability in Programs or Activities Receiving Federal Financial Assistance.”
This rule remains fully in effect and establishes time-sensitive compliance obligations for health programs across the state, including requirements related to accessible medical diagnostic equipment and web and mobile content. Several key compliance deadlines have already passed, with additional deadlines approaching in 2026.
Given limited federal outreach and technical assistance, state leadership is essential to ensure that covered entities understand their legal obligations and have the resources necessary to comply. Proactive state guidance can reduce litigation risk, promote consistent implementation, and, most importantly, ensure that disabled people can access health care with dignity and independence.
I urge your office to provide clear guidance, technical assistance, and oversight related to these requirements so that health programs across the state can meet their obligations under federal civil rights law.
Thank you for your attention to this critical issue.
Sincerely,
[Your Name]
[Job title if applicable]
[Organization if applicable]
Acknowledgments
The authors would like to thank William Roberts, Peter Gordon, and Cameron Lynch for their valuable contributions to this toolkit; Rosa Barrientos-Ferrer and Ben Greenho for fact-checking; and the Center for American Progress’ Editorial and Legal teams for their guidance.