Applying the ADA to health care
Even 36 years after the signing of the Americans with Disabilities Act (ADA), access to health care remains an issue for many people with disabilities. Many barriers exist from the hospital entrance to the exam rooms and beyond.
But both government-owned and private medical facilities of all sizes have a duty under the ADA to provide individuals with disabilities full and equal access to services and facilities, along with reasonable modifications to policies, practices and procedures and effective communication.
To ensure people with disabilities understand their rights, Kaitlin Spidell, a certified ADA coordinator and ADA information specialist for the Northwest ADA Center, presented a session about ADA standards for accessible health care facilities and services during the second day of the National ADA Symposium at the JW Marriott Desert Ridge Resort & Spa in Phoenix.
Spidell says the law encompasses physical spaces, such as parking lots, entrances, exam rooms and restrooms, along with medical diagnostic equipment and access to services, appointment scheduling and communication with providers to understand medical information.
“Health care providers must ensure that the communication with patients with disabilities is just as effective as communication with patients without disabilities,” she says. “That might require auxiliary aids and services, such as interpreters, captioning, written materials, accessible electronic information or other communication supports.”
A provider also generally cannot refuse someone service because he or she has a disability, uses a wheelchair, needs transfer assistance, requires an interpreter or needs a reasonable modification to access care.
But often, patients encounter physical barriers such as inaccessible parking lots, entrances, routes through the facility, patient check-ins, restrooms, clinical exam rooms or a lack of access to service animal relief areas. In addition, communication barriers can occur when people have trouble understanding medical instructions, communicating symptoms, asking questions, giving informed consent or using patient portals to receive information in a format that works for them, Spidell says.
“The main point is that access is not just one moment,” she says. “Access is the full path of the patient experience. It’s getting into the facility. It’s entering, it’s navigating, check-ins, communicating, using the restroom, accessing equipment. That’s all part of receiving care. And when people with disabilities encounter these barriers in health care settings, the impact is not just inconvenience. These barriers can affect whether people receive timely and appropriate preventative care.”
Spidell says the 2010 ADA Standards for Accessible Design created a consistent baseline and detailed scoping and technical requirements for accessible routes, entrances, restrooms, service counters, door widths and more in newly constructed facilities and alterations to existing buildings, including health care facilities.
Another important part of health care is accessible medical diagnostic equipment, such as examination tables, chairs, weight scales, mammography equipment and X-ray machines.
“If a patient can’t transfer onto the exam table, they might be examined from their wheelchair instead, and in some situations that might affect the quality or completeness of the exam,” Spidell says. “Or if a patient can’t use a standard weight scale, the provider might not have accurate information for medical diagnosis or monitoring or treatment planning.”
The U.S. Access Board also offers specific information about accessible design requirements and detailed guidance on medical diagnostic equipment. Spidell says in 2024, the Department of Justice (DOJ) adopted the U.S. Access Board’s medical diagnostic equipment standards as enforceable under ADA’s Title II requirements for state and local governments, meaning publicly funded hospitals, clinics and health programs must comply.
Recently, the U.S. Department of Health and Human Services also implemented a regulation for Section 504 of the Rehabilitation Act of 1973 that requires physicians’ practices that use exam tables and weight scales to have at least one accessible examination table and one accessible weight scale (https://www.msms.org/news/accessible-exam-table-and-weight-scale-requirements-take-effect-july-8-2026). The rule includes stipulations for staff training in transfer assistance and equipment use.
In addition, as providers rely more and more on internet systems and telehealth, the DOJ issued a web and mobile app rule requiring state and local government entities to meet Web Content Accessibility Guidelines 2.1, Level AA standards. Public entities serving 50,000 people or more have until April 26, 2027, and those serving fewer than 50,000 people have until April 26, 2028, to comply.
“For patients with disabilities, barriers to digital tools can affect whether they can schedule care or complete intake forms or access their test results,” Spidell says.
Spidell says although these regulations only apply to Title II public entities, private facilities under Title III can use the guidelines as best practices and benchmarks for accessibility.
When it comes to reasonable modifications, Spidell says the ADA requires entities to think about what changes are needed for a specific individual to ensure he or she is provided equal access. For example, a health care facility might have a seemingly neutral “no pets allowed” policy, but under the ADA, that policy generally must be modified to allow service animals to accompany their handlers wherever members of the public can go, with some limited exceptions.
Spidell says some reasonable modifications might be denied if the requested modification would significantly change the essential nature of the service being provided or if it would create a significant risk or substantial harm to the safety of the individual or others.
Overall, Spidell says access is broader than just the medical appointment.
“I think the larger takeaway is that ADA compliance in health care is not just about knowing the rules, but it’s about having a process for recognizing access barriers, engaging with patients and identifying some practical ways to improve equal access,” she says.