Bad, Bad Medicine—When a State’s Healthcare Infrastructure Violates the Integration Mandate of the Americans with Disabilities Act

The federal circuit courts are divided on the question of whether policies that place individuals with disabilities at risk of institutionalization constitute discrimination under the integration mandate of Title II of the ADA.By analyzing the arguments presented by circuit court decisions, this note develops a new approach to determining the bounds of the integration mandate.It identifies potential issues that may arise if the Department of Justice petitions the Supreme Court to review the Fifth Circuit's decision in United States v. Mississippi and suggests that the Supreme Court resolve the circuit split by holding that (1) actions of public entities that impede the ability of individuals with disabilities to participate in their communities constitute discrimination under Title II, regardless of whether the individual is institutionalized at the time of the claimed discrimination, and (2) the failure to provide community-based services that are reasonably accessible to individuals with disabilities constitutes a violation of the integration mandate.It further discusses evolving legal doctrine regarding agency deference that may leave the protection of individuals with disabilities "at risk of institutionalization" in the hands of the legislature.