United States v. State of Florida

── United States v. State of Florida ── Case No.: 23-12331 Court: Court of Appeals for the Eleventh Circuit Date: March 31, 2026 Category: NEW USCA11 Case: 23-12331 Document: 74-1 Date Filed: 03/31/2026 Page: 1 of 115 FOR PUBLICATION In the United States Court of Appeals For the Eleventh Circuit ____________________ No. 23-12331 ____________________ UNITED STATES OF AMERICA, Plaintiff-Appellee, versus STATE OF FLORIDA, Defendant-Appellant. ____________________ Appeal from the United States District Court for the Southern District of Florida D.C. Docket No. 0:12-cv-60460-DMM ____________________ Before JORDAN, BRASHER, and ABUDU, Circuit Judges. JORDAN, Circuit Judge: This appeal arises from over a decade of litigation between the United States and Florida regarding the institutionalization USCA11 Case: 23-12331 Document: 74-1 Date Filed: 03/31/2026 Page: 2 of 115 2 Opinion of the Court 23-12331 (and risk of institutionalization) of children with medically complex conditions. In 2013, the U.S. Department of Justice filed suit against Flor- ida on behalf of hundreds of medically complex children alleging discrimination under Title II of the Americans with Disabilities Act, 42 U.S.C. §§ 12131–12134. The United States alleged that Florida discriminated against these children in violation of the ADA by fail- ing to provide care for them in the most integrated setting appro- priate to their needs. See Olmstead v. L.C. ex rel Zimring, 527 U.S. 581, 597 (1999) (“Unjustified isolation . . . is properly regarded as discrimination based on disability.”). In other words, the United States asserted that Florida was failing to provide families with the at-home or group-home care they needed, causing some children to be unnecessarily institutionalized and placing others at serious risk of institutionalization. And once a child was institutionalized, the United States claimed, Florida’s deficient care coordination and transition planning services made it difficult for their families to bring them back home. See id. (“In evaluating a State’s fundamen- tal-alteration defense, [a] [d]istrict [c]ourt must consider, in view of the resources available to the state, not only the cost of providing community-based care to the [individual], but also the range of ser- vices the state provides others with mental disabilities, and the state’s obligation to mete out those services equitably.”). 1 1 For simplicity, we use the term “parents” for both guardians and parents. USCA11 Case: 23-12331 Document: 74-1 Date Filed: 03/31/2026 Page: 3 of 115 23-12331 Opinion of the Court 3 The lawsuit slowly made its way through the legal system, including one previous trip to this court, before reaching trial. See United States v. Florida, 938 F.3d 1221, 1244–45 (11th Cir. 2019) (United States I) (holding that the Attorney General of the United States had statutory authority to sue Florida for violations of Title II of the ADA). The district court laid out the case’s procedural history in detail, and we won’t repeat it here. Following a two-week trial, the district court found that Florida’s failure to provide adequate services to medically complex children constit