There are two completely different things happening under the heading of "ADA website compliance," and almost nobody explains the difference. One is a private litigation industry that will send you a demand letter because your alt text is missing. The other is a federal regulatory obligation with a real deadline that applies to a lot of healthcare practices whether or not anyone ever sues them.
They require different responses. Confusing them costs money in both directions: people panic-pay a settlement they might not have owed, and the same people ignore a rule that is actually going to apply to them next year.
Here is the honest version of both.
First, the scale
Digital accessibility litigation is not a niche anymore.
Plaintiffs filed 4,928 web accessibility lawsuits in 2025 across federal and state courts. Federal filings alone hit 3,117, a 27 percent increase over 2024. From 2018 through 2025, more than 25,000 of these cases have been filed.
2026 is running hotter. UsableNet's midyear analysis has filings on pace to pass 6,000 this year, which would be close to a 20 percent jump and a record. Their read on why is worth sitting with: when federal enforcement slows through rule delays and reduced agency activity, private plaintiffs move into the space.
Healthcare is not the top target. E-commerce and retail absorb the overwhelming majority. But the medical and health category is showing up steadily now, and the trend line is the wrong direction.
Track one: the private litigation machine
This is the part people mean when they say they got sued by "one of those people."
It is extremely concentrated. In January 2026, 93 plaintiffs filed 347 ADA website lawsuits, and 16 of them accounted for 178 of those cases. Just over half the filings came from about a sixth of the plaintiffs. At the firm level it is tighter: the top ten plaintiff firms filed 83 percent of everything.
That is not enforcement. That is a business model with a filing calendar.
It is geographically concentrated. Florida, California, New York, and now Illinois dominate. Illinois has surged this year largely on the volume of a single plaintiff firm.
It is platform-driven. In that same January sample, Shopify sites accounted for 136 of the suits and WordPress a large share of the rest. Plaintiff firms run automated scans against site fingerprints. Your site was very likely found by a crawler, not by a patient.
Getting sued once does not clear you. Roughly 45 to 46 percent of 2025 federal filings named defendants who had already been sued before over web accessibility. Settling is not a vaccine.
California has its own accelerant. The Unruh Civil Rights Act provides statutory damages with a $4,000 minimum per violation, which is what makes California state court attractive to filers. Note the counterintuitive wrinkle: both federal and state appellate courts in California have concluded that online-only businesses are not covered by the ADA, which is why California's federal website numbers run lower than New York's despite the volume of state filings. If you have a physical location, that shelter does not apply to you.
The economics are deliberate. A demand letter or early settlement typically lands well below the cost of defending, which is precisely the point. The letter is priced to make paying the rational choice.
I want to be careful here, because there is a version of this conversation that turns into contempt for disabled plaintiffs, and that is not what I am saying. Websites that screen readers cannot navigate are a real barrier, and in healthcare they are a barrier to care. The underlying right is legitimate. The industrial filing apparatus built on top of it is a separate thing, and you can hold both thoughts at once.
Track two: what the government actually requires
This is the part that gets ignored, and for healthcare it is the more consequential one.
There is no ADA regulation setting a technical standard for private business websites. Title III has no adopted web standard. That vacuum is exactly why the private litigation is so messy: courts are improvising, and different circuits have reached different conclusions about whether a website alone is a place of public accommodation.
But healthcare organizations are not governed only by Title III. There is a separate track, and it does have a standard and a deadline.
The HHS Section 504 rule. On May 9, 2024, HHS's Office for Civil Rights published a final rule under Section 504 of the Rehabilitation Act. It took effect July 8, 2024. It requires that web content and mobile applications conform to WCAG 2.1, Levels A and AA.
The scope is broad. It reaches the main website, patient portals, telehealth platforms, online forms, patient education materials, social media accounts, and mobile apps, whether built in-house or provided by a third-party vendor.
The deadlines moved, and only the deadlines. On May 7, 2026, OCR issued an interim final rule extending the compliance dates after reports that community health centers, hospitals, and primary care practices could not meet the original timeline.
| Recipient size | New compliance deadline |
|---|---|
| 15 or more employees | May 11, 2027 |
| Fewer than 15 employees | May 10, 2028 |
DOJ issued a parallel extension on its Title II rule for state and local government entities, and HHS said its extension was meant to align with it.
What did not move is anything else. Section 504's underlying prohibition on disability discrimination has been in force since 1973 and is fully active right now. A complaint filed today does not have to wait for 2027. The rule also closed the old escape hatch: pointing patients to a phone line or an in-person alternative is not a substitute for an accessible digital pathway.
The coverage trigger is the part practices get wrong. Section 504 applies to recipients of federal financial assistance from HHS. That includes Medicaid, CHIP, and HHS grant funding. The 15-employee threshold determines your deadline, not whether you are covered. A practice with eight employees that accepts Medicaid is subject to the rule. It simply has until 2028. Federal procurement contracts and contracts of insurance or guaranty are not federal financial assistance under the rule.
Section 1557 sits alongside it. The Affordable Care Act's nondiscrimination provision carries its own disability requirements, including effective communication and auxiliary aids, and applies to covered entities on its own terms. Meeting one of these rules does not automatically satisfy the other.
Where this leaves a cash-pay telehealth practice
This is the case I get asked about most, so let me take it head on.
If you are pure cash-pay, take no Medicaid, hold no HHS grants, and receive no federal financial assistance, you are probably outside the Section 504 web rule. You are still inside Title III to the extent it reaches you, and you are still a target for track one. The private plaintiff does not check your payer mix before running the scan.
If you take Medicaid anywhere in your footprint, you are on the regulatory track and you have a date. Put it in your calendar.
If you are somewhere in between, or if you are planning to add Medicaid or grant funding within the next two years, build to WCAG 2.1 AA now. Retrofitting a site is meaningfully more expensive than building it right, and you will not want to redo the whole thing eighteen months after launch.
About the widget
If someone sold you an accessibility overlay, a plugin that adds a little accessibility icon in the corner and promises automatic compliance, you need to know what happened to that industry.
In January 2025, the FTC announced an action against accessiBe, the largest overlay vendor, over claims that its product could make any website WCAG compliant. The FTC alleged the claims were false, misleading, or unsubstantiated. The final order, approved in April 2025, required a $1 million payment and bars the company from making compliance claims without supporting evidence. It was a non-admission settlement.
The practical consequence is worse than the fine. Plaintiff firms now treat an overlay as a target rather than a defense. In the first half of 2025, roughly 22.6 percent of U.S. web accessibility lawsuits named sites that had an overlay installed. The argument being made is that the widget demonstrates the operator knew about accessibility and chose a cosmetic fix. Awareness without remediation is a worse posture than ignorance.
Nothing about an overlay satisfies the HHS rule either. The standard is WCAG 2.1 AA conformance of the content itself.
What to do if you get a demand letter or a complaint
In order.
- Do not respond directly, and do not call the plaintiff's firm yourself. Route it to counsel. Anything you say about your site can be used to establish knowledge.
- Do not immediately change your website. This is counterintuitive, but preserve the current state first. Your counsel will want a record of what the site looked like on the date of the claim. Take full screenshots and save a copy of the codebase before touching anything.
- Check whether it is a demand letter or a filed complaint. These are different postures with different deadlines. A filed complaint has a response clock. Miss it and you have a default judgment problem on top of an accessibility problem.
- Find out who else got the same letter. Search the plaintiff's name and the firm's name. If they filed two hundred cases last year, that is context your counsel will use, and it changes the settlement conversation.
- Get an actual audit, immediately. Not an automated scan alone. Automated tools catch roughly a third of issues. You want a manual audit against WCAG 2.1 AA, ideally including screen reader testing, from someone who will put their findings in writing.
- Build a remediation plan with dates and start executing it. Documented, in-progress remediation is the single most useful thing you can bring to a settlement discussion. It changes the calculus for a plaintiff whose business model depends on speed.
- Look at your vendor contracts. If your site, booking tool, patient portal, or payment flow was built or is operated by a vendor, read the indemnification and warranty terms. Sometimes this is their problem. Usually the contract is silent, which is its own lesson.
- Check your insurance. Some general liability, media liability, or cyber policies pick up ADA defense costs. Most do not. Find out now rather than after you have paid counsel out of pocket.
- Decide settle versus defend with real numbers. This is a business decision, not a moral one. Your counsel can tell you what defense actually costs in your jurisdiction. Understand that settling does not prevent a second filer from finding you next quarter, which is why remediation has to happen either way.
- If you are a Section 504 recipient, treat the private claim as an early warning. The same defects that drew the lawsuit are the ones OCR would look at. Fix them once and solve both problems.
What to do before anyone contacts you
- Determine which track you are on. Do you receive federal financial assistance from HHS? If yes, find your deadline: May 11, 2027 at 15 or more employees, May 10, 2028 below that.
- Inventory everything patient-facing. Main site, patient portal, intake forms, scheduling tool, telehealth platform, mobile app, PDFs, videos, and any subdomain. Third-party tools count. A vendor-built booking widget is your exposure, not theirs.
- Get a baseline audit against WCAG 2.1 AA. Automated scan plus manual testing. Keep the report.
- Fix the high-frequency items first. Missing alt text, unlabeled form fields, poor color contrast, keyboard traps, videos without captions, and content that cannot be reached without a mouse. These are the items that show up in the overwhelming majority of complaints and they are usually the cheapest to fix.
- Put accessibility into your vendor contracts. Require WCAG 2.1 AA conformance in the deliverable, require it on updates, and put an indemnity in. Do this on the next renewal at the latest.
- Publish an accessibility statement with a real contact method, and actually staff it. Someone should answer.
- Build it into your release process. Accessibility checks at design, code review, and QA, with retesting of key flows after every release. A site is only compliant on the day you tested it.
- Keep records of all of it. Audit reports, remediation tickets, training, vendor correspondence. Documented ongoing effort is what a defense looks like.
- Do not buy an overlay and call it done.
My take
The rule delay is not relief. It is a scheduling change on one deadline, and every day of it is a day the private bar is filling the gap, which is precisely what the filing data shows happening right now.
The thing I would push back on hardest is the instinct to treat this as a legal problem to be managed rather than a build problem to be solved. If you are launching a practice in the next year, put WCAG 2.1 AA in the scope of work from day one. It adds a modest amount to a build. Retrofitting a finished site costs several times that, and it will not stop the first demand letter from arriving in the meantime.
Your patients are, disproportionately, the people who need this to work. That is the actual reason to do it. The litigation environment is just the expensive reminder.
How Camino helps
We treat accessibility as part of the operating build, not a bolt-on. That means confirming whether Section 504 applies to your entity and payer mix, inventorying every patient-facing surface including vendor tools, writing WCAG 2.1 AA into your vendor scopes and renewals, and putting the audit-remediate-document loop into your compliance calendar so you have a record before anyone asks for one.
If you are launching or scaling a practice and want accessibility handled in the foundation instead of after the demand letter, tell us what you are building.
References
Litigation data
- ADA Compliance Website Lawsuit Tracker, UsableNet
- Inside the 2026 Midyear Numbers, UsableNet
- Federal Court Website Accessibility Lawsuit Filings Bounce Back in 2025, Seyfarth Shaw ADA Title III blog
- ADA Website Accessibility Lawsuits January 2026 Report, EcomBack
- ADA Lawsuit Statistics 2025 to 2026, WCAGsafe
Federal regulatory requirements
- HHS Office for Civil Rights Extends Web and Mobile Accessibility Compliance Deadline, HHS, May 7, 2026
- Compliance Deadlines for Digital Accessibility Under Section 504 of the Rehabilitation Act, Alston & Bird
- HHS Extends Compliance Deadlines for Web and Mobile Accessibility Requirements, Feldesman
- Dear Colleague Letter on Section 504 and Section 1557 Disability Provisions, HHS Office for Civil Rights
- HHS Section 504 Final Rule: Digital Accessibility Deadlines, Healthcare Law Insights
- Web Content Accessibility Guidelines (WCAG) 2.1, W3C
On overlays
- FTC Order Requires Online Marketer to Pay $1 Million for Deceptive Claims, Federal Trade Commission, January 2025
- FTC Approves Final Order Requiring accessiBe to Pay $1 Million, Federal Trade Commission, April 2025
- FTC Targets Deceptive Accessibility Claims: Key Takeaways for Businesses Using Accessibility Widgets, Hinckley Allen
This post is for general informational purposes and is not legal advice. If you have received a demand letter or been served with a complaint, contact qualified counsel promptly. Deadlines, coverage determinations, and litigation strategy depend on facts specific to your organization and jurisdiction.