The 11th U.S. Circuit Court of Appeals ruled on April 14, 2026, that Florida violated the Americans with Disabilities Act by institutionalizing at least 139 children with severe disabilities in nursing homes designed for elderly residents. The ruling upholds a 2023 district court decision and establishes federal precedent that inadequate Medicaid home nursing authorizations leading to institutional placement are ADA violations, not just policy disagreements.

Another 1,800 children remain at risk of the same outcome.

What the Court Found

Circuit Judge Adalberto Jordan, writing for the majority, found that Florida's Medicaid program fails to provide adequate private duty nursing services in home settings. The result: families face an impossible choice between exhausting themselves with round-the-clock care or placing their children in facilities where some have lived since infancy.

The court concluded that 94% of children with severe disabilities in Florida cannot access all approved nursing hours. This isn't a waitlist problem or a temporary staffing gap. It's systemic failure to deliver services the state has already authorized.

Judge Jordan emphasized the stakes: "Medically vulnerable children...require around-the-clock care or they may sustain significant injuries and even die." The record included a case where a baby with a breathing tube died after his tracheostomy was dislodged when his mother briefly left the room. There weren't enough nursing hours to cover the gap.

Another mother lost her home after nursing shortages forced her to miss work providing care herself, pushing her son into institutional placement.

What Florida Must Do Now

The court ordered Florida to:

• Ensure children receive at least 90% of prescribed private duty nursing hours
• Submit to independent monitoring at state expense
• Improve community-based care infrastructure to reduce institutional placements

The case has been in litigation since the Department of Justice filed suit in 2013. Six nursing homes had pediatric units that year. Only three remain.

Why This Matters for Families Outside Florida

The ADA's integration mandate applies in every state. This ruling establishes that when a state Medicaid program authorizes nursing hours but fails to deliver them, and that failure forces institutional placement, it's an ADA violation.

The legal standard is now clear: if your state has authorized private duty nursing for your child and you can't access those hours, you don't have a service delivery problem. You have a civil rights violation with federal case law backing your claim.

Matthew Dietz, a disability rights attorney, framed it directly: "Children deserve, and have a right under the Americans with Disabilities Act, to live in their homes" rather than face impossible institutional choices.

What Families Can Do Now

If you're fighting inadequate Medicaid nursing authorizations or facing pressure to institutionalize your child due to nursing shortages:

• Document every gap between authorized nursing hours and delivered hours. Keep a log with dates, times, and specific services missed. This creates the evidentiary record the court relied on in United States v. Florida.
• File a complaint with your state's protection and advocacy agency. Reference the 11th Circuit ruling (United States v. Florida, No. 23-12331, decided April 14, 2026) and cite the ADA's integration mandate under Title II.
• Contact a disability rights attorney in your state. Many work on contingency or through legal aid organizations. The precedent now exists, giving attorneys a roadmap.
• If your state Medicaid office claims nursing hours aren't available due to staffing shortages, ask them to document in writing that the hours are authorized but unavailable. That distinction is the basis of the ADA claim.

The 90% threshold isn't aspirational. It's court-ordered. If your child is authorized for 16 hours of nursing per day and receiving fewer than 14, you have a measurable violation under the standard this court applied to Florida.

Where to Find More Information

The full text of the 11th Circuit opinion is available through federal court records. The original 2023 district court decision provides additional detail on what constitutes institutional placement and how the ADA's integration mandate applies to children.

Your state protection and advocacy organization can provide guidance on filing ADA complaints related to Medicaid service failures. These offices are federally funded and exist in every state to enforce disability rights laws.