2026-07-31T05:00:13-0400 / https://www.cbsnews.com/news/trump-doj-disability-rights-home-care/
阿曼达·德西莫内-沙布拉克依靠家庭保健助理照顾自己患有自闭症、需要高度护理的12岁儿子。弗吉尼亚州的医疗补助计划覆盖了这项服务，让她能够同时担任教育技术专家和大学教授、处理日常事务，并让梅森留在家里生活。
但这一切可能会改变。今年6月，美国司法部发布了一份法律意见，称联邦残疾权利法并未要求各州提供服务，以帮助残疾人留在家里而非进入机构疗养。
这与1999年的情况形成鲜明反差，当时具有里程碑意义的最高法院裁决认定，根据《美国残疾人法案》，无正当理由将残疾人送入机构疗养构成歧视。历届政府都依据这项裁决维护残疾人的民权，但特朗普政府称这一长期以来的解释是错误的。
倡导组织表示，约4000万成年残疾人和500万残疾儿童的法律保护可能会遭到破坏，他们担心新的解释可能预示着强制送医机构疗养的回归。
目前，倡导者、各州与联邦政府之间的法律斗争已箭在弦上。一些正在诉讼中质疑残疾权利要求的州已经援引司法部的这份意见，希望借此赢得官司。
例如，在得克萨斯州的一起案件中，一些由共和党领导的州辩称，一项基于1973年民权法案制定的规则代价高昂，且侵犯了各州的权利，该规则曾推动残疾人融入社区和家庭生活。
像德西莫内-沙布拉克这样的人尤其担忧，他们表示，这份意见出台之前，白宫和共和党领导的一系列举措已经开始削弱来之不易的残疾人保护措施。
“我很担心。我是不是得把他送进疗养院？那对他来说会是什么样子？”德西莫内-沙布拉克说道，她的私人家庭护理服务最近被该州从每周30小时缩减到了18小时。“随着他年龄增长，没有这些支持，我还能照顾他吗？”
美国卫生与公众服务部仍在坚定地执行联邦民权法律，该部门发言人艾米丽·希利亚德在一封电子邮件中表示。
“我们确保残疾人享有尊严、获得平等机会，并能够切实获得社区服务的承诺始终未变，”她说道。
但倡导组织表示，司法部的这份意见可能会产生广泛影响。该意见并未改变现行法律，但倡导者担心，卫生与公众服务部和司法部可能会开始撤销要求残疾人融入社区的指导方针和法规。
他们担心相关机构将不再执行禁止不必要送医机构疗养的残疾法律。例如，卫生与公众服务部历来会调查医院和接受联邦资助的州存在的残疾歧视指控，通过自愿协议强制要求将残疾人融入家庭和社区。残疾权利专家表示，这些协议现在可能面临风险。
此外，一些面临财政压力的州可能会缩减帮助残疾人留在家里和社区的医疗补助服务——在去年通过《宏大美好法案》后，这种趋势已经出现，该法案预计在十年内从这项安全网计划中削减9000多亿美元的资金。
民主党人抓住这份司法部备忘录中发布的意见，将特朗普总统和共和党描绘成对残疾人权利的威胁。参议员塔米·达克沃斯（D-伊利诺伊州）和其他参议院民主党人牵头提出了一项决议，呼吁司法部撤销该意见。
“特朗普政府的备忘录是对残疾群体权利和独立的无耻攻击，”达克沃斯在一份声明中说道。
司法部未回复置评请求的电子邮件。
根据司法部的解释，赋予残疾人要求日常起居服务（如洗澡、心理健康咨询和财务预算帮助）的相关规定，以及要求各州为智障人士提供社区服务的规定都是非法的。该机构承认，这一观点“与联邦法院对该裁决的普遍理解不一致”。
备忘录中写道，各州可能有正当理由将智障人士送入机构疗养，“包括资源限制、社区设施的能力限制，以及对患者和社区的安全担忧”。
最高法院的“奥姆斯特德诉L.C.案”长期以来一直影响着联邦政策。虽然法院将如何回应司法部的意见仍有待观察，但一些寻求缩减残疾人保护措施的州认为这份意见意义重大。
以2024年得克萨斯州北区联邦法院的一起诉讼为例，由共和党领导的州辩称，卫生与公众服务部关于融入要求的规定是非法的。该诉讼最初提出了更广泛的主张，共有17个州作为原告。在残疾群体进行大量倡导活动后，目前仅剩得克萨斯州、阿拉斯加州和佛罗里达州仍在参与。
在司法部发布新的解释后，这些州提交了文件，告知法院该备忘录是一项新的相关进展。美国智障人士协会（The Arc of the United States）这一残疾倡导组织表示，类似援引该备忘录的文件已在佛罗里达州和新罕布什尔州的残疾权利案件中提交。
残疾人群体的倡导者表示，原告援引该意见的速度之快，凸显了它可能被用来为削弱保护措施辩护。
“政府试图摧毁几十年来在社区融合方面取得的进展，这令人担忧，且与联邦残疾权利法律、最高法院先例以及历届政府的关键执法工作不一致，”美国智障人士协会法律倡导高级执行官兼总法律顾问希拉·瓦克斯拉格说道。
强制送医机构疗养曾导致人权侵犯、种族隔离，以及19世纪末至20世纪初包括非自愿绝育在内的优生学运动。
对这类虐待行为的曝光、法律斗争和独立生活运动，推动了向社区融合的重大转变。明尼苏达大学住宅信息系统项目（该项目跟踪此类长期服务和支持的相关数据）的数据显示，2021年，仅有不到1%的智力或发育障碍残疾人住在公立机构，而1967年这一比例接近30%。
倡导者表示，特朗普政府已经采取措施扭转这一趋势。
特朗普先生去年签署了一项行政命令，通过扩大非自愿治疗和机构疗养来解决无家可归问题。
特殊教育项目办公室的大部分职能正从教育部转移到卫生与公众服务部，这引发了倡导者的担忧，即政府正在回归将残疾视为需要纠正的医学问题而非需要包容的差异的观点。
此外，针对低收入人群或残疾人的联邦-州联合保险计划医疗补助的联邦资金削减，也预示着资源和服务的减少。各州已相应缩减了一些可选福利，如家庭保健助理服务和支持。此外，在大多数州将于明年1月1日生效的医疗补助工作要求豁免资格申请，将给残疾人带来重大障碍。
倡导者表示，6月的司法部意见可能会加速这一转变，并导致法院裁决逐步削弱残疾权利。
“虽然它不会在一夜之间改变法律，但这非常令人不安，也非常危险，”美国公民自由联盟残疾权利项目主任佐伊·布伦南-克龙说道。“这反映了本届政府对残疾人的极度不尊重，以及完全不了解居家生活的残疾人的真实生活经历。”
数据显示，非自愿入院可能会带来好处。2024年9月发表在同行评审学术期刊《精神病学、心理学与法律》上的一篇综述指出，与自愿入院的精神病患者相比，非自愿入院的患者“症状和功能改善更为显著”。
去机构化也带来了新的挑战。由于床位短缺，越来越多的医院被迫在急诊室收治精神病患者。而将残疾人转移到家庭和社区生活本应伴随门诊护理和治疗的增加，但这一情况并未实现，导致支持服务出现缺口。
但残疾群体的倡导者表示，非自愿机构疗养剥夺了人们的自主权，且更有可能遭受忽视和虐待。
57岁的詹妮弗·库塞拉来自克利夫兰，曾在一家疗养院住了两年。她患有脊髓性肌萎缩症，这是一种会破坏运动神经元的遗传病，导致她只能移动部分左臂和头部。
她说，在疗养院期间，她感到无聊和被困，还因疥螨引起的疥疮患上了严重的瘙痒症。
但十多年来，她一直在护理人员的帮助下住在公寓里，护理人员早上会来帮她穿衣打扮，晚上再帮她上床休息。她在一家残疾权利组织工作，她的护理费用由医疗补助计划覆盖。
“我在疗养院度过的两年，是我人生中最可怕的时光，”库塞拉说道，她对司法部关于奥姆斯特德案的意见感到担忧。“我的未来就像脚下的地板在晃动。他们只要签个字，就能毁掉我为自己建立的一切。”
KFF健康新闻是一家全国性新闻机构，专注于健康问题的深度报道，是KFF的核心运营项目之一——KFF是独立的健康政策研究、民意调查和新闻资讯来源。
People with disabilities fear service cuts as Trump’s DOJ questions legal protections
2026-07-31T05:00:13-0400 / https://www.cbsnews.com/news/trump-doj-disability-rights-home-care/
Amanda DeSimone-Shabrack relies on a home healthcare aide to help her high-needs autistic 12-year-old son. Virginia’s Medicaid program covers the assistance, enabling her to work as both an education technology specialist and a professor, run errands, and keep Mason in the home.
That could change. In June, the Department of Justice issued a legal opinion saying federal disability rights laws don’t require states to provide services that allow people with disabilities to remain in their homes rather than institutions.
It’s a sharp reversal from 1999, when a landmark Supreme Court ruling held that unjustified institutionalization constituted discrimination under the Americans with Disabilities Act. Previous administrations have relied on that ruling to enforce civil rights for disabled people, but the Trump administration says that long-held interpretation is wrong.
Advocacy groups say legal protections for about 40 million adults and 5 million children who have disabilities could be undermined, and they worry that the new interpretation may herald a return to forced institutionalization.
The stage is also now set for a legal fight between advocates, states, and the federal government. Some states with ongoing lawsuits challenging disability rights requirements are already citing the DOJ opinion in hopes it will help them prevail.
In a case in Texas, for example, some Republican-led states are arguing that a rule instituting a 1973 civil rights law that led to community and home integration of people with disabilities is costly and infringes on states’ rights.
People like DeSimone-Shabrack are especially worried because, they say, the opinion follows a spate of White House and Republican-led initiatives that have already begun eroding hard-won protections for people with disabilities.
“I’m worried. Am I going to have to put him in an institution, and what’s that going to be like for him?” said DeSimone-Shabrack, whose personal home care help was recently reduced from 30 to 18 hours a week by the state. “As he gets older, am I going to be able to care for him without this support?”
The Department of Health and Human Services remains steadfast in enforcing federal civil rights laws, agency spokesperson Emily Hilliard said in an email.
“Our commitment to ensuring that individuals with disabilities are treated with dignity, afforded equal opportunity, and are able to meaningfully access community services remains unchanged,” she said.
But advocacy groups say the DOJ opinion could have sweeping repercussions. The opinion doesn’t change existing law, but advocates worry that HHS and the DOJ could begin rescinding guidance and regulations that mandate integration for people with disabilities.
They’re concerned that agencies will stop enforcing disability laws that ensure people aren’tunnecessarily institutionalized. HHS, for example, has historically investigated disability discrimination claims at hospitals and in states that get federal funding, enforcing compliance with home and community integration through voluntary agreements. Disability rights experts say those agreements could now be imperiled.
And some states facing financial pressures may roll back Medicaid services that enable people with disabilities to stay in their homes and communities — a trend that’s already happening following last year’s passage of the One Big Beautiful Bill Act, which cuts a projected $900 billion-plus from the safety net program over a decade.
Democrats are seizing on the opinion, which was released in a DOJ memo, to portray President Trump and Republicans as a threat to people with disabilities. Sen. Tammy Duckworth (D-Ill.) and other Senate Democrats led the introduction of a resolution calling on the DOJ to rescind the opinion.
“The Trump Administration’s memo is an outrageous attack on the rights and independence of the disability community,” Duckworth said in a statement.
The DOJ didn’t return emails seeking comment.
According to the DOJ’s interpretation, regulations that give disabled people the right to demand certain services for daily living — bathing, mental health counseling, and financial budgeting help, for instance — and that require states to extend community-based services to mentally disabled individuals are unlawful, a view the agency acknowledged “is out of step with the common understanding of that decision within the federal courts.”
States may have legitimate reason to treat mentally disabled people in institutions, “including resource constraints, capacity limitations in community-based facilities, and safety concerns for both the patient and the community,” the memo reads.
The Supreme Court case, Olmstead v. L.C., has long shaped federal policy. And while it remains to be seen how courts will respond to the DOJ, some states seeking to curtail disability protections see the opinion as significant.
Consider the 2024 lawsuit in federal court in the Northern District of Texas by Republican-led states arguing that an HHS rule about the integration mandate is unlawful. The lawsuit began with broader claims and 17 state plaintiffs. Following significant advocacy from the disability community, only Texas, Alaska, and Florida remain.
Following the new DOJ interpretation, the states filed documentation to inform the court about the memo as a new and relevant development. Similar documentation citing the memo has been filed in disability rights cases in Florida and New Hampshire, according to The Arc of the United States, a disability advocacy group.
Advocates for people with disabilities say the speed at which plaintiffs are citing the opinion underscores how it may be used to justify the erosion of protections.
“The administration’s attempt to dismantle decades of progress in community integration is alarming and inconsistent with federal disability rights laws and Supreme Court precedent as well as the critical enforcement work of prior administrations,” said Shira Wakschlag, senior executive officer of legal advocacy and general counsel at The Arc.
Forced institutionalization led to human rights violations, segregation, and a eugenics movement in the late 19th and early 20th centuries that included involuntary sterilization.
Exposure of the abuses, legal battles, and an independent living movement caused a major shift toward integration. Fewer than 1% of people with intellectual or developmental disabilities lived in state-run facilities in 2021, down from almost 30% in 1967, according to data from the University of Minnesota’s Residential Information Systems Project, which maintains metrics on such long-term services and supports.
The Trump administration has already taken steps to reverse that trend, advocates say.
Mr. Trump signed an executive order last year that addresses homelessness by expanding involuntary treatment and institutionalization.
Much of the special education program office is moving from the Department of Education to HHS, raising concerns among advocates that the administration is reverting to a view that disabilities are a medical issue to be fixed rather than differences that can be accommodated.
And cuts in federal funding for Medicaid, a federal-state insurance program for people with low incomes or disabilities, also portend fewer resources and services. States have responded by reducing some optional benefits such as home health aides and support. In addition, qualifying for an exemption from the program’s work requirements, which take effect Jan. 1 in most states, will pose significant hurdles for people with disabilities.
The June DOJ opinion, advocates say, could accelerate the shift and result in court rulings that chip away at disability rights.
“While it doesn’t overnight change the law, it’s very troubling and very dangerous,” said Zoe Brennan-Krohn, director of the Disability Rights Program at the American Civil Liberties Union. “It reflects a really deeply held disrespect for disabled people from this administration and a total lack of awareness of the lived experiences of people with disabilities who are living in their homes.”
Data shows there can be benefits to involuntary institutionalization. Relative to those voluntarily admitted, people with psychiatric illness who were involuntarily admitted “experienced greater improvements in symptoms and function,” according to a September 2024 review in Psychiatry, Psychology and Law, a peer-reviewed academic journal.
Deinstitutionalization has created new challenges. More hospitals have been forced to board people with psychiatric illness in emergency rooms because of a dearth of available beds. And moving people into home- and community-based living was supposed to be accompanied by an increase in outpatient care and treatment that never materialized, creating gaps in support.
But advocates for the disabled community say involuntary institutionalization strips people of their autonomy and poses a higher risk of neglect and abuse.
Jennifer Kucera, 57, of Cleveland, spent two years in a nursing home. She has spinal muscular atrophy, a genetic disease that kills motor neurons, leaving her able to move only part of her left arm and her head.
At the institution, she said, she felt bored and trapped and developed intense itching from scabies, which is caused by microscopic mites.
For more than a decade, however, she has lived in an apartment with the help of caregivers who come in the morning to get her dressed and ready and return to put her to bed. She works at a disability rights group, and her care is covered by Medicaid.
“The two years I lived in the nursing home, it was the most horrible time in my life,” said Kucera, who worries about the DOJ opinion on Olmstead. “My future is a shaking floor beneath me. With the stroke of a pen, they could get rid of everything I’ve built for myself.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.