The U.S. Supreme Court case Alexander, Governor of Tennessee, et al. v. Choate et al., 1984 revolved around the issue of whether a reduction in the number of annual hospital days covered by Medicaid constituted discrimination against disabled individuals under Section 504 of the Rehabilitation Act of 1973. The plaintiffs argued that this policy disproportionately affected those with disabilities who often require longer hospital stays and thus was discriminatory based on their disability status. However, the court ruled in favor of Tennessee's governor Lamar Alexander and other state officials (defendants), stating that while Section 504 ensures disabled individuals are not denied benefits solely because they're disabled, it does not guarantee them an absolute right to receive a certain level or quality service equal to non-disabled people. The ruling clarified that policies neutral on their face but having disparate impact on disabled persons do not necessarily violate Section 504 unless it can be proven such policies were intentionally discriminatory or effectively excluded handicapped people due to thoughtless indifference.

In the dissenting opinion for Alexander v. Choate, Justice Thurgood Marshall argued that the majority's decision failed to adequately protect disabled individuals from discriminatory practices. He criticized the court's narrow interpretation of Section 504 of the Rehabilitation Act, which prohibits discrimination against disabled people by federally funded programs or activities. According to Marshall, this ruling allowed states to implement policies that disproportionately affected those with disabilities without sufficient justification. He contended that Tennessee’s reduction in hospitalization days unfairly impacted disabled patients who typically require longer stays than non-disabled patients and thus constituted a form of indirect discrimination not addressed by the majority’s verdict. Furthermore, he expressed concern about how this decision could set a precedent allowing similar discriminatory actions in other areas such as education and employment services for individuals with disabilities.