Karen Vaughn has lived in the community for decades with the nursing and other services she needs. In 2016 she went to the hospital for what was expected to be a short stay but then could not find the Medicaid-funded nursing services she needed to return home. Ms. Vaughn filed a complaint against the Indiana Medicaid agency, Indiana Family and Social Services Administration, alleging violations of the community integration mandate of the ADA and Section 504, and of the reasonable promptness requirement of the Medicaid Act. Ms. Vaughn had requested community-based services and had suggested, among other things, that she be allowed to self-direct her nursing services and the nurse delegation be allowed. The district court granted summary judgment to Karen in June 2018 and a permanent injunction in January 2019 that ordered the Defendants to arrange for Ms. Vaughn’s community-based services within 21 days. The Defendants appealed these decisions.