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Press Release

Justice Department Finds State of Missouri Unnecessarily Institutionalizes Adults with Mental Health Disabilities in Skilled Nursing Facilities in Violation of the Americans with Disabilities Act and Improperly Relies on Guardianship

For Immediate Release
Office of Public Affairs
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Watch Justice Department Announces State of Missouri violated Title II of Americans with Disabilities Act on YouTube.

The Justice Department announced today its findings that the State of Missouri violated Title II of the Americans with Disabilities Act (ADA) by unnecessarily institutionalizing adults with mental health disabilities in nursing facilities. The investigation also examined the role of guardianships in such institutionalization.

The Justice Department determined that there is reasonable cause to believe Missouri violates the ADA by failing to provide the community-based services adults with mental health disabilities need in order to remain in their communities. It also found that the state is improperly relying on guardianship and that this leads to people entering nursing facilities even though community-based services are appropriate for their needs.

“People with mental health disabilities should not have to be confined to a nursing facility because they cannot access the community-based services they need,” said Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division. “The Civil Rights Division will safeguard the rights of people with disabilities to participate fully in their communities. The state’s reliance on guardianships that serve as a pipeline to nursing facilities, rather than engaging people in community-based mental health services, has led to violations of the ADA.”

The department’s investigation found Missouri fails to provide community-based mental health services for many people with mental health disabilities who need them, including services such as:

  • Assertive Community Treatment;
  • Case management;
  • Supported employment;
  • Mobile crisis response;
  • Crisis stabilization services;
  • Permanent Supportive Housing;
  • Peer support; and
  • Supported Decision-Making.

Instead, the state makes nursing facility services for these people. Missouri can reasonably modify its system to remedy this violation by expanding community-based services and implementing processes to ensure that individuals can receive those services rather than entering nursing facilities.

Individuals with information relevant to this matter can contact the department by leaving a voicemail at 833-610-1242 or emailing The Justice Department will hold two virtual community meetings on Tuesday, June 25, at 6 p.m. CT/7 p.m. ET and Wednesday, June 26, at 12 p.m. CT/1 p.m. ET. Members of the public are encouraged to attend to learn more about the findings. Please register to join these meetings by clicking on the respective link. If you need an interpreter or accommodation to attend, please email

Additional information about the Civil Rights Division of the Justice Department is available on its website at and

View the findings report here.

View the notice letter here.

Updated June 20, 2024

Civil Rights
Disability Rights
Press Release Number: 24-781