Section-by-Section Review

Background and Strategy

The Latonya Reeves Freedom Act (LRFA) is the direct descendant of the Disability Integration Act (DIA), first introduced in 2015 and reintroduced across five Congresses under the DIA name before being renamed in honor of Latonya Reeves — a woman who was forced to flee a Tennessee nursing home for Colorado to access the community-based services and supports she needed to live free. The bill's legal architecture and strategic approach carry forward unchanged from DIA.

Rather than amending Medicaid directly, LRFA strengthens the Americans with Disabilities Act's integration mandate to accelerate implementation of the Supreme Court's 1999 Olmstead v. L.C. decision. This approach was deliberate, for several reasons that remain true today:

• Medicaid already has the infrastructure to deliver Long-Term Services and Supports (LTSS) — what is missing is an enforceable statutory federal right to receive them in the community rather than an institution. We've seen how a Medicaid fix leaves Disabled people locked away in states which implemented the Community First Choice Option.
• The injustice at the center of this fight is that Disabled people are forced to give up their freedom to receive the assistance they need to live. Framing the bill as a civil rights measure, not a Medicaid amendment, keeps the legislative language aligned with how the Disability Community understands and organizes around the issue.
• Medicaid is not the only payer of LTSS. Managed Care Organizations and other LTSS insurance providers are directly covered by LRFA, closing gaps that a Medicaid-only fix would leave open.
• Tying the right to community living to a specific funding stream would put that right at risk every time federal funding models change. Anchoring the right in civil rights statute rather than appropriations law protects it from being reduced or eliminated administratively or through a budget reconciliation process.
• By creating a strong, national definition for "community-based" in the context of civil rights, LRFA makes sure that people with disabilities have a right to receive services in a true community setting while not preventing individual state Medicaid programs from calling services that do not meet the LRFA threshold "community-based." This addresses concerns raised by states as well as institutional and congregate-setting providers.
• Anchoring the right in civil rights statute also protects it against future changes to the health care system itself — if the U.S. ever moved to Medicare for All or another model, the right to live in the community would carry over intact, because it would already exist as a basic civil right rather than a feature of whatever program happened to be paying for LTSS at the time.

This background and strategy section describes the legal and organizing rationale behind the bill's structure, consistent across the DIA and LRFA versions of the legislation. It is not part of the bill text itself.

Section 1 — Short Title

Establishes the name of the Act: the "Latonya Reeves Freedom Act of 2026."

Section 2 — Purposes

Section 2 sets out seven purposes that anchor the rest of the bill and will guide courts and agencies interpreting it. LRFA is meant to:

1. Clarify and strengthen the ADA's integration mandate as recognized in Olmstead v. L.C., 527 U.S. 581 (1999), in a way that accelerates and improves state compliance;
2. Affirm that every individual eligible for LTSS has a federally protected right to be integrated into their community and to receive community-based LTSS;
3. Ensure states and LTSS insurance providers deliver services so individuals with disabilities can live in the most integrated setting, including their own home;
4. Ensure individuals with disabilities have maximum control over the services and supports that allow them to live in the community;
5. Ensure LTSS are provided in a manner that allows individuals with disabilities to lead an independent life;
6. Establish a comprehensive planning requirement, with enforceable and measurable objectives, to transition individuals of all disabilities and all ages out of institutions and into the most integrated setting — if they choose that transition; and
7. Identify and address disparities in the provision of community-based LTSS — so the right to live independently in the community applies regardless of race, religion, ethnicity, or where in the country someone lives.

Purpose (7) — identifying and addressing disparities — is new relative to earlier DIA language and reflects LRFA's stronger emphasis on demographic and geographic equity in who actually receives community-based services, discussed further under Section 6.

Section 3 — Definitions and Rule

Long-Term Services and Supports (LTSS)

LTSS is defined broadly as assistance, equipment, technology, or other support provided to accomplish, acquire the means to accomplish, maintain, or enhance activities of daily living (ADLs), instrumental activities of daily living (IADLs), health-related tasks, or related functions. The definition of "assistance" explicitly includes support for people with confusion, dementia, behavioral symptoms, or cognitive, intellectual, mental, or emotional disabilities — covering goal-setting, communication, executive functioning, decision-making, reassurance, orientation, and memory support. This language ensures LRFA's protections are not limited to physical or sensory disabilities.

Individual with an LTSS Disability

Defined as an individual with a disability (per the ADA's definition) who needs assistance with ADLs, IADLs, health-related tasks, or related activities to live in the community and who is either currently institutionalized or at risk of institutionalization without community-based LTSS.

Public Entity and LTSS Insurance Provider

"Public entity" covers state and local governments and their agencies, departments, and instrumentalities that provide or fund institutional placements. "LTSS insurance provider" is defined broadly to include any public or private entity that funds LTSS and is engaged in commerce — reaching Managed Care Organizations and private insurers, not just government payers.

Community-Based (Services and Settings)

LRFA defines what "community-based" means affirmatively, and anything that doesn't meet that standard falls outside it.

For dwellings and non-residential settings alike, a community-based setting must be integrated into the greater community, chosen meaningfully by the individual from real options, and must respect the individual's privacy, dignity, and freedom from coercion or restraint. For dwellings specifically, community-based housing includes homes owned or individually leased by the person, or small group settings of no more than four unrelated individuals with LTSS disabilities, where each resident has landlord-tenant-equivalent legal protections, a lockable private entrance, choice of roommate, control over furnishing and schedule, and the ability to have visitors at any time.

This granular housing definition is what allows LRFA to reach the "four walls and a lease" problem — group homes and adult care facilities that are technically community-located but functionally institutional in how they control residents' lives.

Institution and Institutionalization

"Institution" is defined by explicit statutory cross-reference: skilled nursing facilities, nursing facilities, long-term care hospitals, ICF/IID-type facilities, psychiatric hospitals and residential psychiatric settings, and — as a catch-all — "any congregate setting that is not community-based or that has the effect of isolating individuals with disabilities from the community." This catch-all closes the loophole that a narrower, purely enumerated list would leave open because states could change the names and funding of the institutions and claim the residents are 'in the community' without changing anything about their daily lives.

Rule of Construction

Section 3(b) clarifies that nothing in the definitions should be read to prevent an individual from receiving community-based services in ordinary integrated public settings — a grocery store, restaurant, bank, park, concert venue, theater, or workplace. This closes off a bad-faith reading in which LTSS could only be delivered at home.

Section 4 — Discrimination

Section 4 is the operative civil rights provision, modeled on the general-rule-plus-specific-prohibitions structure of ADA Title III. The general rule: "No public entity or LTSS insurance provider shall deny an individual with an LTSS disability who is eligible for institutional placement, or otherwise discriminate against that individual in the provision of, community-based long-term services and supports that enable the individual to live in the community and lead an independent life."

Twelve specific prohibitions give that general rule teeth and affirmatively define discrimination in a manner consistent with the Supreme Court's Major Questions Doctrine. Discrimination under LRFA includes:

1. Eligibility criteria or other policies that prevent an individual, or class of individuals, from receiving community-based LTSS;
2. Service or cost caps, or other mechanisms, that prevent access to community-based LTSS;
3. Failing to provide a specific community-based service or type of service that is needed;
4. Policies that interfere with full participation in community life, including requirements to receive services such as day or employment services in a congregate or disability-specific setting;
5. Waiting lists or other mechanisms that delay or restrict access to community-based LTSS;
6. Failing to set adequate rates or payment structures needed to sustain a workforce capable of supporting community living;
7. Failing to provide intermittent, short-term, or emergent community-based services, such as crisis support or respite;
8. Policies — such as requiring reliance on informal, unpaid supports — that restrict the ability of an individual to live independently in the community and lead an independent life;
9. Failing to have a formal process ensuring individuals are offered community-based LTSS before institutionalization, and that those services are actually provided if chosen;
10. Failing to regularly notify institutionalized individuals of the community-based alternative and provide it if selected;
11. Failing to make reasonable modifications necessary for an individual to receive community-based LTSS; and
12. Failing to ensure access to affordable, accessible, integrated housing — including housing where receipt of LTSS is not tied to tenancy.

This last prohibition, item (12), codifies a principle central to the disability rights movement's housing advocacy: people should not have to accept a service provider as their landlord, because a provider who is also the landlord can use that leverage to undercut the very autonomy the services are meant to support. LRFA does not eliminate provider-operated housing — it makes it discriminatory to deny someone a genuinely independent housing alternative.

Construction

Section 4(c) clarifies that the discrimination provisions do not require any public entity or LTSS insurance provider to reduce services below this floor, do not limit rights under any other law, do not force a more integrated setting on someone who prefers a less integrated one, do not create a right to remain in a specific institution, and do not prohibit managed care techniques generally — only managed care techniques that have the effect of discriminating under this Act.

Section 5 — Administration

Section 5 divides administrative responsibility between the Department of Justice and the Department of Health and Human Services. The Attorney General is responsible for investigating and taking enforcement action under the Act. HHS, acting through the Administrator of the Administration for Community Living (ACL), reviews and approves state and provider transition plans, and — new to LRFA relative to earlier DIA versions — establishes a dedicated task force to study the socio-demographic and geographic barriers and disparities that keep people out of community-based LTSS, reporting to Congress within two years of enactment. Federal agencies covered by Executive Order 13217 are also directed to cooperate with DOJ and ACL in furthering the Act's purposes.

Section 6 — Regulations

Section 6 is the bill's implementation engine, extending the self-evaluation and transition-plan model already used for ADA Title II compliance. The Attorney General must issue final regulations within two years of enactment. Those regulations must, at minimum, require public entities and LTSS insurance providers to:

• Offer and provide community-based LTSS to any individual with an LTSS disability who would otherwise qualify for institutional placement;
• Provide hands-on assistance, training, cueing, and safety monitoring (including backup systems) for ADLs, IADLs, and health-related tasks;
• Coordinate discharge planning from acute and rehabilitation facilities toward the most integrated setting the individual chooses;
• Promote self-direction and consumer-directed services across all populations served, and support informal caregivers;
• Conduct a public participation process — public hearing, public comment, and consultation with individuals with LTSS disabilities — in preparing self-evaluations and transition plans;
• Complete a self-evaluation within 36 months of enactment, including baseline demographic data disaggregated by race, veteran status, and other factors, a review of community capacity and transportation access, and an inventory of funding sources; publish that self-evaluation on the entity's website;
• Evaluate and improve affordable, accessible, integrated housing capacity, including funding home modifications and prioritizing the lowest-income individuals with LTSS disabilities until unmet housing need is addressed;
• Designate a responsible employee to coordinate compliance and investigate complaints, and adopt published grievance procedures;
• Submit a transition plan to ACL — if full compliance cannot be demonstrated through self-evaluation — no later than 54 months after enactment, with full implementation required as soon as practicable and no later than 12 years after enactment; and
• File annual public progress reports against the transition plan's measurable objectives and targets.

ACL must review a submitted transition plan within 90 days, and if it disapproves the plan, the entity has 90 days to resubmit a corrected version, which ACL then has another 90 days to review.

The 12-year outside deadline for full transition-plan implementation, and the 54-month deadline to submit a plan, are LRFA-specific timelines; the disparities task force and its demographic-data requirements in Sections 5 and 6 are the clearest substantive additions distinguishing LRFA from the original DIA framework.

Section 7 — Exemptions for Religious Organizations

Religious organizations, associations, or societies are permitted to give preference in providing community-based LTSS to individuals of the particular religion connected with their beliefs. This is modeled on the equivalent religious exemption in the Fair Housing Act.

Section 8 — Enforcement

Individuals with LTSS disabilities — or someone acting on their behalf — may bring a civil action for preventive relief once the Act has been in effect for two years, without first exhausting any administrative process ("futile gesture" is not required if the entity has already signaled it will not comply). Courts may appoint counsel and waive fees, costs, or security for plaintiffs who need it.

Available remedies include actual and punitive damages, immediate injunctive relief to prevent institutionalization, and any other order the court finds appropriate — including an order to immediately provide or maintain community-based LTSS to prevent institutionalization. Courts may award reasonable attorney's fees, and the United States is liable for costs on the same basis as a private party.

The Attorney General has independent authority to investigate alleged violations, conduct periodic compliance reviews, and bring civil actions where there is a pattern or practice of violations, or where an individual violation raises a matter of general public importance. In DOJ-initiated cases, courts may grant equitable relief, award damages to affected individuals at DOJ's request, and assess civil penalties of up to $100,000 for a first violation and up to $200,000 for subsequent violations, with multiple violations resolved in a single action or settlement counted as one violation for this purpose.

Section 9 — Construction

Section 9 directs courts interpreting five specific provisions of LRFA to look to the established case law under closely analogous ADA and civil rights statute provisions: the housing-tenancy prohibition in Section 4(b)(11) alongside ADA §302(b)(2)(A)(ii); the self-evaluation standard in Section 6(b)(5)(A) alongside 28 C.F.R. §35.105(a); the religious exemption in Section 7 alongside the Fair Housing Act's §807(a); and the enforcement provisions in Sections 8(a)(2) and 8(d)(1)(B) alongside their ADA Title III analogues. This grounds LRFA's newer language in decades of existing judicial interpretation rather than asking courts to interpret it from scratch.