Section 504 and Digital Accessibility
In May 2024, the Department of Health and Human Services finalized a rule requiring all recipients of HHS federal financial assistance to meet WCAG 2.1 Level AA standards for their digital content. Here's what it means and what you need to do.
May 11, 2027
Recipients with 15 or more employees — hospitals, health systems, FQHCs, Medicare/Medicaid- participating practices, HHS-funded universities
May 10, 2028
Recipients with fewer than 15 employees — small private practices and clinics
Dates reflect the HHS Interim Final Rule extension published 2026-05-07.
What is Section 504?
Section 504 of the Rehabilitation Act of 1973 prohibits discrimination on the basis of disability by recipients of federal financial assistance. It has applied to physical spaces, programs, and services for over 50 years.
In May 2024, the HHS Office for Civil Rights published a final rule (45 CFR Part 84) extending Section 504 explicitly to digital content — websites, mobile applications, patient portals, online scheduling, telehealth platforms, and other digital materials used by HHS-funded organizations.
The rule adopts WCAG 2.1 Level AA as the technical standard — the same standard the DOJ adopted for Title II. Digital content that fails to meet WCAG 2.1 AA is presumed to be discriminatory under the rule unless an exception applies.
Coverage is broad. Any organization receiving HHS federal financial assistance is covered — including Medicare reimbursement, Medicaid reimbursement, HRSA grants, CDC funding, NIH research grants, and SAMHSA grants. Medicare Part B participation alone is sufficient to trigger coverage.
What digital content is covered?
- •Marketing and public-facing website pages
- •Patient portals and MyChart-style applications
- •Online scheduling and intake forms
- •Telehealth platforms and video appointments
- •Mobile applications (Apple and Android)
- •Patient education materials (PDFs, videos, infographics)
- •Care-finder and provider-search tools
- •Billing portals and online payment systems
Limited exceptions
- ⚠Archived content (pre-deadline, reference-only, not updated, in dedicated archive)
- ⚠Content posted by third parties without a contractual relationship
- ⚠Preexisting electronic documents not used to apply for benefits or services
- ⚠Personal devices of clinicians (BYOD scenarios)
Are you also subject to Title II?
Public hospitals, county health departments, state-run academic medical centers, and city or county clinics are dual-covered — Title II of the ADA applies because you're a state or local government entity, AND Section 504 applies because you receive HHS funding. The same WCAG 2.1 Level AA technical standard satisfies both rules; the difference is which agency enforces.
Read the Title II guide →What does WCAG 2.1 Level AA require?
WCAG 2.1 AA is organized around four principles — Perceivable, Operable, Understandable, and Robust — with 50+ specific success criteria. This is the same technical standard used by Title II.
Perceivable
- ✓Alt text for all images
- ✓Captions for video
- ✓Audio descriptions
- ✓Color not the only conveyor of information
- ✓Text resizable to 200% without loss of content
Operable
- ✓Full keyboard navigation
- ✓No content that flashes more than 3 times/second
- ✓Skip navigation links
- ✓Descriptive page titles
- ✓Focus visible at all times
Understandable
- ✓Language of page declared
- ✓Form input errors described
- ✓Labels for all form controls
- ✓Consistent navigation
- ✓Error prevention on important submissions
Robust
- ✓Valid, parseable HTML
- ✓Name, role, value for all UI components
- ✓Status messages announced to screen readers
What happens if we don't comply?
Section 504 is enforced by the HHS Office for Civil Rights (OCR). Non-compliance exposes your organization to:
- OCR complaint investigation: Triggered by a single complaint — OCR can review your entire digital footprint and request documentation
- Voluntary compliance agreement: Typical first remedy — a corrective action plan with deadlines and OCR monitoring
- Loss of federal financial assistance: Rarely invoked but available as the ultimate enforcement tool — catastrophic for any Medicare/Medicaid-dependent organization
- Referral to DOJ: OCR can refer cases for federal civil enforcement under the ADA Title III private-action provisions
- Private litigation: Section 504 provides a private right of action — disability advocacy groups have been increasingly active
What HHS OCR looks for
OCR investigators do not expect instant perfection. They look for a credible, documented compliance program demonstrating good-faith effort. That means:
- ✓A completed accessibility audit documenting known issues
- ✓A prioritized remediation plan with target dates
- ✓An active accommodation request process for patients and visitors
- ✓Evidence that accessibility requests are responded to in writing
- ✓Documentation of WCAG 2.1 AA conformance for newly-published content
- ✓Ongoing monitoring — not just a one-time audit
OctoComply documents all of this automatically — audit, requests, remediation, and validation reports.
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The free plan includes the Document Remediation widget and a 10-page scan — the two things that start your audit trail immediately.