The U.S. Department of Justice (DOJ) has asked the Eleventh Circuit to vacate its March 2026 opinion in United States v. Florida and return the case to the district court.

The August 13 motion reflects a change in the DOJ’s position on whether Title II of the Americans with Disabilities Act (ADA) protects people who face a serious risk of unnecessary institutionalization. Florida conditionally does not oppose remand: it agrees if the court first grants rehearing en banc and vacates the panel opinion.

The DOJ filed the case in 2013, alleging that Florida’s administration of services for children with complex medical needs unnecessarily institutionalized some children and placed others at serious risk of institutionalization.

Following a 2023 trial, the U.S. District Court for the Southern District of Florida found that Florida had violated the ADA’s integration mandate, as recognized in Olmstead v. L.C. The court found that inadequate access to private duty nursing (PDN) prevented some children from remaining at home or leaving nursing facilities.

The 2023 injunction required Florida to improve PDN access, care coordination, transition planning, data collection and oversight. It established a benchmark requiring all PDN children to receive at least 90% of their adjusted authorized hours, excluding hours refused by families or missed during hospitalizations.

The injunction also required data collection on authorized and delivered PDN hours and provider reimbursement. It identified several possible compliance tools, including higher fee-for-service rates, minimum managed-care reimbursement rates, stronger network-adequacy standards and incentives for providers to share coverage of authorized hours.

In March 2026, a divided Eleventh Circuit panel generally affirmed the district court’s liability findings and most of the injunction. The panel agreed that Title II may protect people facing a serious risk of unnecessary institutionalization, while vacating parts of the injunction and remanding the case.

Justice Department's Change in Position

In July, the DOJ clarified in the Federal Register that its 2011 Olmstead guidance does not have the force of law and is not enforceable. Citing the Supreme Court’s 2024 decision in Loper Bright Enterprises v. Raimondo, the DOJ said it would reconsider the guidance and would no longer rely on it when enforcing Title II.

The DOJ now argues that the Eleventh Circuit should vacate its opinion because the federal government no longer wishes to enforce liability based on the “at-risk” theory. On remand, the DOJ says it would seek to terminate or modify portions of the injunction premised on that theory.

The Justice Department also characterizes its position as a decision not to take further enforcement action against Florida. The outcome, however, depends on how the Eleventh Circuit and district court respond.

The motion itself does not vacate the appellate opinion, dissolve the injunction or change Florida Medicaid coverage, contracts, reimbursement rates, authorization requirements or billing procedures.

What This Means for Providers

If the injunction is ultimately narrowed or terminated, Florida could face less federal oversight and judicial pressure concerning:

• PDN workforce shortages and unfilled authorized hours
• Provider-network adequacy and care coordination
• Data collection and reporting
• Reimbursement and access barriers
• Transitions from nursing facilities to home and community settings

Providers should continue documenting unfilled authorized hours, workforce and reimbursement barriers, delayed discharges, network problems and authorization or care-coordination issues.

The DOJ’s policy change does not repeal the ADA, overturn Olmstead or change Florida’s Medicaid coverage obligations. Florida’s current Private Duty Nursing and Family Home Health Aide Services Coverage Policy continues to cover medically necessary services for eligible recipients under age 21. The policy remains a minimum covered service for Managed Medical Assistance plans.

Providers should continue following current coverage policies, authorization requirements, plan contracts and billing procedures unless the Agency for Health Care Administration (AHCA) or a Medicaid health plan formally changes them.

HCAF will monitor the appellate and district-court proceedings and continue advocating for policies, networks and reimbursement structures that support reliable care at home. Providers experiencing persistent PDN staffing, transition or managed-care problems are encouraged to share specific examples with HCAF.