The big picture: Two skilled nursing facilities in North Carolina reached a settlement that bars them from discriminating against people with a history of substance use, potentially setting a precedent for how long-term care facilities treat people with SUD.

• It is believed to be the first case in the U.S. to successfully challenge long-term care facilities’ systemic admissions denials to people with SUD.
• It is the latest in a string of recent legal developments that have expanded applications of the Americans with Disabilities Act to apply more broadly to people in recovery, taking medications for opioid use disorder (MOUD), or who use illicit drugs. During the Biden administration, the Department of Justice (DOJ) issued guidance warning that the denial of MOUD to people with opioid use disorder (OUD) would violate the Americans with Disabilities Act and reached settlements with several state health care and justice/carceral systems.

The details:

• This lawsuit was brought by Legal Action Center and Disability Rights North Carolina on behalf of an anonymous client who was denied admission to two facilities in North Carolina.
• Under the settlement, facilities are to adopt new antidiscrimination admissions policies and apply reasonable judgement to individual applicants, instead of automatically denying them based on past substance use. The policies apply to people taking MOUD, as well as those who currently use illegal drugs.
• It does not require facilities to admit potentially disruptive patients but requires them to treat all applicants equally and not automatically reject those with a history of substance use.

What’s coming:

• The settlement does not create new doctrine for skilled nursing facilities elsewhere in the state or country, but it lays the groundwork for similar lawsuits in the future.
• It is unclear wither DOJ under Trump will continue efforts to roll back discrimination against people with OUD.