Charlotte Cravins, left, attends an event with her husband, Calvin Bell, and their children, infant son Landry Bell and daughter Lyric Bell. Landry was born with Down syndrome and is blind in one eye. Charlotte is worried that a lawsuit challenging part of a 50-year-old federal disability rights law could remove protections for children with disabilities, like Landry. (Courtesy of Charlotte Cravins)

A push by Republican attorneys general in 17 states to strike down part of a federal law that protects disabled people from discrimination has prompted an outcry from advocates, parents and some local officials.

The GOP-led lawsuit targets certain protections for transgender people. But some experts warn it has the potential to weaken federal protections for all people with disabilities.

Texas GOP Attorney General Ken Paxton sued the federal government in September over the Biden administration’s addition of a gender identity-related disorder to the disabilities protected under a section of a 1973 federal law.

Republican attorneys general from 16 other states joined the lawsuit: Alaska, Alabama, Arkansas, Florida, Georgia, Indiana, Iowa, Kansas, Louisiana, Missouri, Montana, Nebraska, South Carolina, South Dakota, Utah and West Virginia.

But the AGs face a growing public backlash that stems from conflicting messages about what the lawsuit would actually do.

“The disability community is outraged and scared,” said Charlotte Cravins, a Baton Rouge, Louisiana, attorney whose 1-year-old son has Down syndrome and is blind in one eye.

Cravins and other parents and advocates point to parts of the lawsuit in which the plaintiffs ask the court to find an entire section of the law unconstitutional. If the court agrees, they think it would allow schools, workplaces, hospitals and other entities to refuse to provide accommodations they’ve been required to provide for the past 50 years.

“It would affect so many people that every person in our state — really, in our country — should be concerned,” Cravins said. “If they can erase protections for disabled children, then who’s next?”

The provision in question, Section 504 of the federal Rehabilitation Act of 1973, prohibits entities that receive federal funding from discriminating based on disability. For example, the law prohibits hospitals from denying organ transplants to people because they have a disability. It requires schools to allow deaf students to use speech-to-text technology. The law covers a wide range of disabilities, including vision and hearing impairments, autism, diabetes, Down syndrome, dyslexia and ADHD.

Last May, the Biden administration issued a rule that added to the covered disabilities “gender dysphoria,” the psychological distress that people may experience when their gender identity doesn’t match their sex assigned at birth. Gender dysphoria is defined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

In recent days, national disability rights groups — including the American Council of the Blind, the National Down Syndrome Society, the National Association of the Deaf and the Disability Rights Education and Defense Fund — have encouraged the public to speak out, sparking a surge of activity on social media and calls to state lawmakers.

AGs respond

Despite the public backlash, some state AGs are digging in their heels.

Georgia Republican Attorney General Chris Carr insists the lawsuit wouldn’t affect existing disability protections. Instead, he said, it merely aims to reverse the Biden administration’s addition of gender dysphoria to the law’s protected disabilities.

“The constitutionality of 504 was never in question,” Carr said in a statement to Stateline. “We are fighting one woke policy added by Biden for virtue signaling.”

He said most Georgians don’t believe gender dysphoria should be treated as an eligible disability “as if it’s the same as Down syndrome or dyslexia or autism.”

Arkansas Republican Attorney General Tim Griffin issued a statement last week claiming that if the states win the lawsuit, “regulations would go back to what they were” before gender dysphoria was added to the law. He said that a ruling declaring Section 504 unconstitutional would only mean the federal government couldn’t revoke funding over a failure to comply with the part of the law protecting gender dysphoria.

But Erwin Chemerinsky, a constitutional law expert and the dean of the UC Berkeley School of Law, wrote in an email that the lawsuit clearly asks the court to declare the entirety of Section 504 unconstitutional. He called the request “truly stunning.”

The lawsuit is currently on hold. Shortly after President Donald Trump took office on Jan. 20, the parties in the case agreed to pause litigation while the new administration reevaluates the federal government’s position. Status reports are due to a judge later this month. Some of the AGs involved in the lawsuit, including Georgia’s Carr and West Virginia Republican Attorney General J.B. McCuskey, have said they expect the Trump administration to reverse the Biden rule. That could cause the AGs’ lawsuit to be dropped.

Meanwhile, as public pressure escalates, some AGs are distancing themselves from the suit.

South Carolina Republican Attorney General Alan Wilson said in a statement last week that Trump’s Jan. 20 executive order stating that “it is the policy of the United States to recognize two sexes, male and female” resolved his concerns. “Our mission is complete,” Wilson said. Some advocates understood his statement to mean he might withdraw South Carolina from the lawsuit.

However, a spokesperson for his office told Stateline that South Carolina would not be withdrawing from the lawsuit, but would be filing a notice with the court this week to clarify that the state is not asking for Section 504 to be declared unconstitutional.

Utah Republican Attorney General Derek Brown said in a statement that Utah joined the lawsuit before he took office and that he doesn’t think Section 504 will be invalidated because “the Trump administration will soon withdraw the regulation” that added gender dysphoria to the list of disabilities.

The AGs argue that established federal law does not consider gender identity disorders to be disabilities. They say allowing the Biden rule to remain in place would let the government withhold federal funding from schools unless they allow transgender students to compete in sports or use locker rooms that match their gender identity.

Grassroots efforts

Cravins, the Louisiana attorney and mother, sent a letter this week to Louisiana Republican Attorney General Liz Murrill, asking her to drop Louisiana from the lawsuit.

Murrill issued a statement Wednesday expressing support for people with disabilities and saying her office is “actively seeking a resolution with the Trump administration” to withdraw the Biden rule while keeping the law’s previous protections intact.

Cravins said her son depends on Section 504 protections to access specialized therapies, and will rely on those protections even more as he approaches school age. Section 504 will help ensure he receives access to vision-related support, therapy and other accommodations in school.

Cravins believes the AGs that signed onto the lawsuit aren’t being honest about its potential impact to protections for all people with disabilities.

“For them to say one thing and the lawsuit to say another, I can’t imagine it’s anything other than them being disingenuous with their constituents,” she said.

Ryan Renaud, a school board representative for one of the largest public school districts in Alabama, said a concerned parent who also is an attorney contacted him last week, after reading a story about Alabama Republican Attorney General Steve Marshall joining the lawsuit. More calls soon followed.

“We’ve been hearing from dozens of parents in the last couple of days,” Renaud told Stateline. Without Section 504 protections, he said, students could lose access to a wide range of accommodations, from classroom aides to extra time to take tests.

The impacts could extend beyond what most people think of when they think of special education, he said.

“This includes students with ADHD, heart disease, depression, visual impairment, diabetes,” Renaud said. “Accommodations that come with those health concerns also fall under 504 plan protection.

“When a student doesn’t have those accommodations, they become less secure in class and teachers are less able to manage their classrooms.”

He’s also worried that the funding from the U.S. Department of Education that helps pay for those accommodations could vanish if federal law no longer requires them. Trump has vowed to dismantle the agency.

“We spend on average $30 million a year or more on special education, and more than a quarter of that is provided by the federal government,” he said. “If [accommodations] aren’t federally protected and the Department of Education doesn’t have the authority to disburse the funds, we have to assume we’d have to pick up that slack through local or state funding.

“And it’s hard to believe Alabama would cough up tens or hundreds of millions of dollars to supplement these costs.”

Last year, the U.S. Department of Education reported that 1.6 million students with disabilities were served under Section 504 nationwide during the 2020-2021 school year.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.

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Republican state Rep. Jordan Redman speaks on the Idaho House floor in March 2024. This month, Redman reintroduced a bill that would repeal Medicaid expansion next year unless a set of strict conditions are met. Legislators in other states are also considering shrinking or eliminating Medicaid expansion. (Photo by Kyle Pfannenstiel/Idaho Capital Sun)

Republican lawmakers in several states have Medicaid expansion in their crosshairs, energized by President Donald Trump’s return to the White House and a GOP-controlled Congress set on reducing spending on the public health insurance program for low-income people.

As the feds consider cuts to Medicaid, some states are already moving to end or shrink their expanded Medicaid programs.

Legislators in Idaho have introduced a bill that would repeal voter-approved expansion, while Republicans in Montana are considering allowing their expanded program to expire. Some South Dakota lawmakers want to ask voters to let the state end expansion if federal aid declines. Nine other states already have trigger laws that will end their expansion programs if Congress cuts federal funding.

Meanwhile, discussions have stalled in non-expansion states such as Alabama, as lawmakers wait to see what the Trump administration will do.

Many conservatives argue that Medicaid expansion has created a heavy financial burden for states and that reliance on so much federal funding is risky. They argue that expansion shifts resources away from more vulnerable groups, such as children and the disabled, to low-income adults who could potentially get jobs.

In South Dakota, where voters approved Medicaid expansion in 2022 by a constitutional amendment, Republican state Sen. Casey Crabtree wants to bring expansion before voters again with a trigger measure. He told Stateline via text that his proposed amendment to the state constitution “empowers voters to maintain financial accountability, ensuring that if federal funding drops below the agreed 90%, the legislature can responsibly assess the state’s financial capacity and the impact on taxpayers while still honoring the will of the people.”

But even some Republicans are uneasy about what repealing expansion would mean for their constituents.

“Quite honestly, I have received hundreds of emails from constituents that have said, ‘please do not repeal.’ I have received zero asking me to repeal, which I think is very telling,” said Idaho state Rep. Lori McCann, a Republican who represents a swing district in the northern part of the state.

McCann said she’s interested in reining in Medicaid costs, but skeptical about a full expansion repeal. More than 89,000 Idahoans could lose their coverage if the state repeals its expansion, according to the latest numbers from the Idaho Department of Health and Welfare. McCann said she learned this month that only a fraction of those would qualify to buy discounted insurance on the state exchange.

“For the rest, what’s going to happen to them? They will utilize the emergency rooms again, and we’ll be back to the same problems we had prior to the Medicaid expansion.”

Before President Barack Obama signed the Affordable Care Act into law in 2010, traditional Medicaid insurance was mainly available to children and their caregivers, people with disabilities and pregnant women. But under the ACA’s Medicaid expansion program, states can extend coverage to adults making up to 138% of the federal poverty level — about $21,000 a year for a single person — and the federal government will cover 90% of the costs for those newly eligible enrollees. States kick in the rest.

All but 10 states, most of them controlled by Republicans, have taken the deal. Nationwide, more than 21 million people with low incomes get their health insurance because of expanded Medicaid eligibility.

(In Wisconsin, the state Legislature’s Republican majority has rejected repeated efforts since 2019 by Gov. Tony Evers and Democratic lawmakers to expand Medicaid, known as BadgerCare, in the state.)

But the Trump administration and a Republican-controlled Congress are seriously considering options for shrinking Medicaid as they look for ways to pay for extending tax cuts enacted during Trump’s first term in office. Proposals include reducing the federal 90% funding match, which could shift a greater chunk of Medicaid spending onto states, and greenlighting extra hurdles such as requiring enrollees to work in order to qualify for coverage.

Under Trump, many states might pursue Medicaid work requirements

The swirl of uncertainty at the federal level is supercharging efforts by Republican state lawmakers who have long opposed the program, despite its popularity.

In a public address last month, Arkansas Gov. Sarah Huckabee Sanders, a Republican, announced the state would ask the federal government for permission to institute work requirements for adults to qualify for coverage.

“If you want to receive free health care — paid for by your fellow taxpayer — able-bodied, working-age adults have to work, go to school, volunteer or be home to take care of their kids” she said.

Sanders argued coverage without such requirements discourages people from working and being self-sufficient.

But advocates and experts point to a wide body of research that links Medicaid expansion to lower uninsured rates, better health care outcomes and economic benefits for states, hospitals and other providers.

Without expansion, they say, many of the working poor who don’t have employer-sponsored insurance exist in a coverage gap: They don’t earn enough to afford private insurance, and yet they earn too much to qualify for traditional Medicaid. Expansion bridges that gap.

And, advocates argue, yanking health insurance from tens of thousands of people in a state would have far-reaching consequences for families, hospitals and state finances.

“It would be absolutely disastrous for everybody at all levels of the state,” said Idaho Democratic state Rep. Ilana Rubel, the House minority leader, who is on the committee considering bills that could repeal the state’s Medicaid expansion.

“We would go right back to people being unable to seek preventative care until it’s too late, back to loss of life, loss of health and financial catastrophe.”

A coordinated national effort

Many of the attempts to repeal Medicaid expansion in states such as Idaho and Montana are coordinated by national conservative-backed groups, said Joan Alker, executive director of Georgetown University’s Center for Children and Families.

“It’s important to understand this is part of a well-orchestrated and financed effort to undermine Medicaid generally, especially for adults,” said Alker, who is also a research professor at Georgetown’s McCourt School of Public Policy, where her work focuses on Medicaid and the Children’s Health Insurance Program.

Conservative-backed think tanks, including the Foundation for Government Accountability and the Paragon Health Institute, have testified before several state legislatures against Medicaid expansion and have worked to thwart state ballot initiatives.

In Montana, where Medicaid expansion is set to expire this year unless the legislature and governor opt to renew it, representatives from the foundation and the institute urged state lawmakers to scrap Medicaid expansion. Montana Republican state Rep. Jane Gillette, a dentist, appeared in a video produced by the foundation advocating for the state to allow its expansion to expire.

Neither organization responded to interview requests.

In Idaho last year, state Rep. Jordan Redman, a Republican, ceded most of his time introducing his Medicaid bill to a representative from the Foundation for Government Accountability. That bill later failed to advance out of committee after intense public pushback.

‘Repeal in sheep’s clothing’

This month, Redman revived his Medicaid bill. It would repeal Medicaid expansion next year if the federal government does not maintain the 90% match and the state does not receive federal permission to enact work requirements and a host of other new restrictions, including a 50,000 cap on expansion enrollment — just over half of its current enrollment — and a three-year limit on receiving benefits.

“This safeguard approach will strengthen Idaho’s Medicaid program while maintaining flexibility,” Redman told the Idaho House Health & Welfare Committee earlier this month. “If the federal government or state agencies fail to meet the program’s safeguards, this legislation ensures those Medicaid dollars will be redirected to serve the truly needy.” Redman did not respond to an interview request from Stateline.

Rubel, the Democratic leader, described Redman’s bill as “Medicaid repeal in sheep’s clothing.”

“It’s a type of trigger law with incredibly unlikely-to-be-met conditions,” she said. “Basically, they’re saying unless you can fly a unicorn to the moon and back, Medicaid expansion will be repealed.”

Idaho voters approved Medicaid expansion by ballot measure in 2018, with nearly 61% in favor. The law took effect in 2020.

Conservative lawmakers in Idaho have tried without success to repeal Medicaid expansion ever since, including introducing another repeal bill last month. But this could be conservatives’ year. Before the session, Idaho’s Republican House speaker expanded the committee from 13 seats to 15. It’s a move that some state Democrats say was an effort to ram through Medicaid expansion repeal. At least eight committee members have pledged support for the Idaho Republican Party’s platform, which calls for repeal of Medicaid expansion.

Medicaid is popular nationally, in expansion and non-expansion states. Three-fourths of Americans have a favorable view of Medicaid, according to a January 2025 health tracking poll from KFF, a health research organization. It’s a preference that crosses political boundaries: 63% of Republicans, 81% of independents and 87% of Democrats view it favorably.

Polling in Idaho in 2023 found 75% of voters — including 69% of Republican voters — held a favorable view of Medicaid.

“Citizens should not have to work this hard to get something passed that they want and need so desperately, and then keep imploring legislators not to take it away again,” said Rubel.

Trigger laws

If Congress reduces the 90% federal match rate for Medicaid expansion, more than 3 million adults could immediately lose their health coverage.

That’s because nine states have so-called trigger laws that would automatically end Medicaid expansion if federal funding is cut: Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah and Virginia. Three additional states — Iowa, Idaho and New Mexico — would require the government to take cost-saving steps to ease the financial impact of federal cuts.

Alker is skeptical that Congress would be able to get such legislation passed before most state legislative sessions end this spring. But if cuts are made, the impacts could start showing up in 2026.

Regardless of possible cuts at the federal level, states including Arkansas and Idaho are looking at ways to reduce the number of Medicaid-eligible people by instituting work requirements or benefit caps.

States need federal approval to impose such additional conditions on Medicaid eligibility.

The first Trump administration approved work requirements in 13 states, but the courts later struck those down and the Biden administration rejected such requests. States, including Arkansas, are trying again, hoping they’re more likely to get what they want under the new Trump administration.

Redman told Idaho legislators that he expects the Trump administration to grant the waivers that would be needed under his proposed bill.

“I actually spoke to several folks at the new federal administration, and they said they’re looking for waivers that are unique and creative, that they want to grant,” he said.

Meanwhile, Republican lawmakers in non-expansion states have in recent years warmed to the idea of expansion. It was arguably the biggest issue of last year’s legislative session in solidly red Mississippi, and was backed by Republican Lt. Gov. Delbert Hosemann. Expansion is back on the table this year, though lawmakers have said they won’t consider a plan unless it includes work requirements.

But in Alabama last month, House Speaker Nathaniel Ledbetter, a Republican, said expansion would no longer be a priority this session because Medicaid was likely to see changes at the federal level.

“I think we are better off seeing what they are going to do,” he told reporters.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.

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