Caroline is thrilled with her now-adult children’s care. Members of the Biden administration, however, are not.

Prominent disability advocates, who have found sympathetic ears in Biden’s cabinet, have long argued that “congregate settings,” like Heinzerling, are “segregated”—meaning, in this context, that they are predominantly inhabited by disabled people—and that government agencies should use their rulemaking and enforcement powers to disfavor and eventually close all such facilities, relocating residents to smaller, “community-based” settings. Such advocates—often higher-functioning disabled people who consider themselves spokesmen for the more severely disabled people living in institutional environments—argue that congregate settings unnecessarily limit residents’ freedom and are inherently prone to the kinds of abuse and neglect seen at some nineteenth- and twentieth-century asylums, care homes, and orphanages. The Department of Health and Human Services’ Office for Civil Rights (OCR), which interprets and enforces federal civil rights law relevant to health- and social-services providers and recipients, apparently agrees with the advocates’ position, and proposed a rule late last year that could upend the lives of millions of Americans like Henry and Elizabeth.

The proposed rule would amend OCR’s interpretation of Section 504 of the 1973 Rehabilitation Act, which bans disability-based discrimination in federally funded programs, in two major ways. First, it would bar state child-welfare agencies from considering congregate institutions, such as Heinzerling, “the most appropriate long-term placement for children, regardless of their level of disability.” Second, it would redefine “integrated settings” as those that give disabled people the “opportunity to interact with non-disabled persons to the fullest extent possible” and “are located in mainstream society.” Both changes were drafted with lawyerly precision and, if published as drafted, will eventually be leveraged by activist nonprofits and disability-rights ideologues in the Justice Department to shutter nursing homes, psychiatric hospitals, and more.