Federal legislation has led the way in defining health services for disabled children who attend school and children who are enrolled in special education programs. Four laws adopted over the past 25 years have obligated local school systems to provide care to these children so that they might participate in educational programs. These laws are:

  • Section 504, Rehabilitation Act of 1973
  • Individuals with Disabilities Education Act, 1990 · Individuals with Disabilities Education Act, 1997
  • Americans with Disabilities Act

Section 504 of the Rehabilitation Act is a civil rights law protecting the rights of individuals with disabilities to participate in programs that receive Federal financial assistance. Because public school districts receive Federal dollars, they fall within the scope of Section 504. Section 504 states that

    “No qualified handicapped individual shall, solely by reason of his handicap, be excluded from participation in, be denied benefits of, or otherwise be subjected to discrimination under any program or activity which receives or benefits from Federal financial assistance.”(10)

The law defines who is considered to have an impairment and what physical and mental impairments are for purposes of the legislation. The U.S. Department of Education has issued regulations implementing Section 504, describing the obligations of schools and the rights of students. Included in these regulations is a requirement that schools provide a written plan identifying services essential for a student to access the educational program.

The Individuals with Disabilities Education Act (IDEA) (1997), successor legislation to the Individuals with Disabilities Act of 1990 and the Education for the Handicapped Act of 1975, defines the responsibilities of school districts in providing services to ensure that children with certain specified disabilities receive free, appropriate education. Under the law, school districts must prepare an Individualized Education Program (IEP) for each eligible child. The IEP must specify all special education and related services needed. The school districts are obligated by Federal statute and court rulings to provide these services. In addition to Federal grant support for special education, Medicaid programs may pay for those related services that are specified in the Federal Medicaid statute and determined to be medically necessary by the State Medicaid agency. Related services most commonly include speech therapy, physical and occupational therapy, and child counseling. The most costly related service is transportation.

Whereas Section 504 confirms the rights of all disabled children, IDEA applies to that subset of children who not only have a disability but whose disability prevents the student from progressing in a regular classroom setting. Therefore, students who are eligible for services under Section 504 are not necessarily eligible for services under IDEA. Under IDEA (both 1990 and 1997 legislation) the school district is required to provide “related services,” that is, those that are needed to assist a student to take advantage of the special education provided. Related services may include, among others, health and mental health services. Court decisions have elaborated on the meaning of required “related services” that must be provided by school districts.

The Americans with Disabilities Act (ADA), adopted in 1990, extended the protections of the Civil Rights Act to persons with disabilities. Under the ADA, public programs must enable individuals with disabilities to have equal access and opportunity for equal enjoyment of facilities and programs. Thus, a private schoolÕs health program, which might not be within the scope of Section 504 because the school does not receive federal funding, now has the same obligations as public schools to provide access to educational services for children with disabilities.

See the resources page in this section for links to sites devoted to this topic. The Office of Special Education in the U.S. Department of Education offers a special site devoted to the interests of families and advocates: www.fape.org.