ADA website accessibility for healthcare — a WCAG 2.2 AA field guide

What Title III of the ADA requires, and how it reaches your website

The Americans with Disabilities Act of 1990 has three main titles. Title I covers employment; Title II covers state and local government services; Title III covers places of public accommodation operated by private entities. Health-care providers are enumerated as places of public accommodation at 42 USC 12181(7)(F), and Title III's general non-discrimination provision at 42 USC 12182 requires those entities to ensure that individuals with disabilities enjoy equal access to their goods, services, facilities, privileges, advantages and accommodations.

Whether the website itself is a place of public accommodation is where the circuits divide. The Third, Sixth, Ninth and Eleventh Circuits have applied a nexus test — the website is covered because it is connected to a physical place of public accommodation. The First and Seventh Circuits have taken a broader view, treating a website as directly covered. The Ninth Circuit's Robles v. Domino's Pizza decision established that the nexus test reaches provider websites and mobile apps that facilitate access to goods and services offered at a physical location, and the Supreme Court declined to review it in 2019.

The Department of Justice has consistently taken the position, since at least 1996, that Title III applies to the websites of public accommodations. DOJ's April 2024 Title II final rule for state and local governments adopted WCAG 2.1 Level AA as the technical standard. There is no equivalent Title III web-specific final rule yet, but DOJ enforcement actions have used WCAG as the yardstick since 2013.

What serial-filer complaints actually cite

Serial-filer complaints in the healthcare vertical follow a pattern. The plaintiff is typically a blind or low-vision user who visited the website using a screen reader and encountered specific barriers that prevented access to a service the website advertises. The complaint enumerates the WCAG failures with reference to the automated-tool report and, increasingly, screen-reader session recordings.

The eight highest-frequency failures cited in healthcare complaints:

• Missing or non-descriptive alt text on physician photos, treatment illustrations and infographic images (WCAG 1.1.1).
• Form fields without programmatic labels — most often on the appointment-request form, the contact form, and the insurance-verification form (WCAG 1.3.1 and 4.1.2).
• Inaccessible custom date pickers in appointment scheduling (WCAG 2.1.1 keyboard and 4.1.2 name/role/value).
• Low colour contrast on link text, button text and body copy (WCAG 1.4.3).
• Keyboard traps in modal dialogs — often the emergency-hours or insurance-accepted overlay (WCAG 2.1.2).
• PDF forms and patient-education documents without a tagged accessibility layer (WCAG 1.1.1 and 1.3.1).
• Video content without captions or transcripts on physician-introduction and procedure-explainer videos (WCAG 1.2.2 and 1.2.3).
• Auto-playing carousels with no pause or dismiss control on the homepage (WCAG 2.2.2).

Why "accessibility widget" vendors do not close the risk

Accessibility overlay widgets are JavaScript layers that inject a control panel offering font-size, contrast and reading-mode adjustments, and in some cases attempt to re-tag the underlying markup at runtime. They have been marketed as one-line accessibility solutions. They are not.

The Department of Justice has stated that the accessibility of a website is determined by the underlying code, and that using an overlay does not substitute for compliant design. The National Federation of the Blind formally resolved in 2021 that overlays are not accessible to blind users and often actively interfere with the screen readers those users have configured for themselves. Multiple 2023 and 2024 settlements have specifically required the defendant to remediate the underlying code even where an overlay was installed at the time of the complaint.

Overlays are not useless — well-designed contrast and font-size widgets can supplement conformance. They do not replace it, and any brief that presents an overlay as the primary control has priced the risk incorrectly.