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Accessibility & Section 1557

Accessible healthcare web, built to the bar and the deadline.

WCAG audits and remediation across sites, portals, and patient tools: keyboard access, color contrast, alt text, labeled fields, and captions, with conformance documentation you can keep on file. We build to WCAG 2.2 AA, which also satisfies the WCAG 2.1 AA that HHS Section 1557 and DOJ ADA Title II reference, so the work meets the current bar and the one just ahead of it. Accessibility is fully studio-deliverable, which makes it one of the cleanest healthcare projects to start with.

// we build the technical layer to WCAG, but legal Section 1557 and ADA conformance also depends on your organization's ongoing process and content. We own the build and the documentation; keeping the content and process accessible over time is a posture only your organization can hold.

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WCAG 2.2 AA SECTION 1557 & 504 DOJ ADA TITLE II
The overview

Accessibility is care made operable.

In healthcare, an inaccessible site is not a cosmetic flaw. It is a patient who cannot book an appointment with a keyboard, a low-vision user who cannot read appointment details against weak contrast, a screen-reader user locked out of the portal where their results live. Accessibility is the work of making the site operable by everyone who needs it, and for a practice that is the whole point of being on the web. We audit and remediate across the full surface, from the marketing pages to the portal and the patient tools, because the barrier is wherever a real person hits it.

We build to WCAG 2.2 AA. That is the Web Content Accessibility Guidelines at the AA conformance level, version 2.2, and it sits one step ahead of the WCAG 2.1 AA that the federal rules currently reference. Building to the newer version means the work satisfies the bar the regulations cite today and the bar just over the horizon, so you are not remediating the same site twice. The substance is concrete: keyboard access, color contrast, meaningful alt text, programmatically labeled form fields, and accurate captions, each tested and then documented.

The honest framing matters here as much as the code. We build the technical layer to WCAG, but legal Section 1557 and ADA conformance also depends on your organization's ongoing process and content. A site we deliver conformant can drift the moment an unlabeled PDF or an uncaptioned video goes up, so conformance is a posture to maintain rather than a certificate to frame. We are candid about that line because pretending accessibility is a one-time deliverable is exactly how a practice ends up out of conformance a year after launch.

The line we hold

Accessibility runs on the same clean division of responsibility as the rest of our healthcare work.

  • We own the audit, the remediation, and the WCAG conformance
  • We own the conformance documentation you keep on file
  • We own the accessible patterns and components we hand over
  • You own keeping new content accessible as it is published
  • You own the ongoing process that keeps conformance from drifting
What is included

A real audit, real remediation, and the paperwork.

An accessibility engagement is not a scanner run and a green badge. We audit the full surface, hand you a prioritized findings list, remediate against it, and document what was done so you have conformance evidence on file. The work spans the marketing site, the patient portal, and any patient tools, because the barriers hide on the interactive surfaces as often as the content ones.

Automated tooling is where we start, not where we stop. The scanners catch a slice of the issues; the rest only surface under real keyboard navigation and a screen reader, walked by a person. That manual layer is the difference between a site that passes a checker and a site a patient can actually use.

What is included

  • A full WCAG 2.2 AA audit across sites, portals, and tools
  • Keyboard access and a sensible focus order, end to end
  • Color contrast remediated to the AA thresholds
  • Meaningful alt text, with decorative images hidden properly
  • Programmatically labeled form fields and announced errors
  • Accurate captions and working media controls
  • Screen-reader testing of the real, lived experience
  • Accessible custom widgets the scanners cannot reason about
  • A prioritized findings list and remediation against it
  • Conformance documentation you can keep on file

// automated scanners are the starting point, not the audit

The drivers

Real rules, real dates, no scare tactics.

Two federal drivers set the bar for healthcare accessibility, and both point at WCAG 2.1 AA on extended deadlines. We build to WCAG 2.2 AA, which satisfies them and the next version too. Knowing the actual dates keeps the work calm and properly scoped rather than rushed or oversold.

// the deadlines are extended, which is time to do this properly

HHS

Section 1557 & Section 504

HHS Section 1557 and Section 504 require web content and mobile applications to meet WCAG 2.1 AA. The deadlines are extended and split by size: organizations with 15 or more employees have until May 11, 2027, and smaller ones until May 10, 2028.

This is the driver most healthcare providers fall under, because it reaches recipients of federal health funding. We build to WCAG 2.2 AA against it, so the work clears the cited 2.1 AA bar with margin to spare.

DOJ

DOJ ADA Title II

The DOJ ADA Title II rule covers state and local government entities, which includes public health departments and many public hospital and clinic systems. It also adopts WCAG 2.1 AA, on the same size split: April 26, 2027 for larger entities and April 26, 2028 for smaller ones.

If you are a public entity you may be answering to both drivers at once. Building to a single WCAG 2.2 AA standard satisfies both, so there is no need to chase two separate targets.

How we work

Audit, prioritize, remediate, document.

We start by finding every barrier across the real surface, then we fix them in the order that matters, with the interactive and clinical paths first. We hand back a conformant site and the documentation to prove it, plus the patterns and guidance you need to keep it that way as content keeps arriving.

// fix the barriers a patient hits first, document the rest

  1. Audit the real surfaceWe test the marketing site, the portal, and the patient tools the way they are actually used: with a keyboard, with a screen reader, and against the AA thresholds for contrast and labeling. Automated tooling flags the obvious issues; the manual pass finds the keyboard traps, the unlabeled custom controls, and the updates assistive technology never hears about.
  2. Prioritize by patient impactWe hand you a findings list ordered by what actually blocks people, not by what is easiest to close. Barriers on the booking flow, the portal login, the results view, and the intake forms come first, because those are the paths where an inaccessible site stops someone from getting care rather than just inconveniencing them.
  3. Remediate against the listWe fix the findings: contrast corrected, alt text and labels added, focus order untangled, media captioned, and the custom widgets rebuilt to expose their state to assistive technology. Where a component is too brittle to patch, we say so and rebuild that part rather than billing endless fixes against a foundation that cannot hold them.
  4. Document the conformanceWe produce conformance documentation covering what was tested, what was fixed, and how it maps to WCAG 2.2 AA, so you have evidence on file against the Section 1557 and ADA deadlines. This is documentation of the technical work, stated plainly, not a legal certification we are not in a position to issue.
  5. Hand over the means to hold itWe deliver accessible patterns, documented components, and guidance for whoever publishes content, so conformance does not quietly drift the next time a PDF or a video goes up. Where you want it, our maintenance retainer re-checks the accessibility posture as content and the rules change. The ongoing content and process stay yours to own.
Questions, answered honestly

Frequently asked questions

We make the technical layer conformant and we document it, but legal conformance is not a thing a web studio can hand you as a finished certificate. We build to WCAG 2.2 AA, which also satisfies the WCAG 2.1 AA that Section 1557 and Section 504 reference, and we produce conformance documentation for keyboard access, contrast, alt text, labeled fields, and captions. Here is the honest hedge: legal Section 1557 and ADA conformance also depends on your organization's ongoing process and content. A site we deliver conformant can drift the moment someone uploads an unlabeled PDF or an uncaptioned video, so conformance is a posture to maintain, not a one-time stamp. We own the code and the documentation; your organization owns keeping the content and the process accessible over time.

They are extended, and knowing the real dates keeps the work from being rushed or oversold. HHS Section 1557 and Section 504 require WCAG 2.1 AA by May 11, 2027 for organizations with 15 or more employees and by May 10, 2028 for smaller ones. DOJ ADA Title II, which covers state and local government entities including public health departments and many public hospital systems, lands on April 26, 2027 and April 26, 2028 on the same size split. We build to WCAG 2.2 AA today, which is one version ahead of what the rules cite, so the work meets the current bar and the one just ahead of it. The deadlines give a practice time to do this properly rather than scrambling, and we would rather you start early and calmly than late and in a panic.

A real audit goes well past an automated scanner, because the scanners catch only a fraction of what matters. We test keyboard access end to end, so every interactive element can be reached and operated without a mouse and the focus order makes sense. We measure color contrast against the AA thresholds for text and interface components. We check that images carry meaningful alt text and that decorative ones are hidden from assistive technology. We confirm form fields have programmatic labels, that errors are announced, and that nothing depends on color alone. We verify video has captions and that media controls work. And we walk the site with a screen reader, because the lived experience is the test that counts. Automated tooling is a starting point, not the audit.

Both, and the portal is often where the harder accessibility work lives. A marketing site is mostly content, so its accessibility is largely about structure, contrast, labels, and captions. A patient portal is an application: dynamic forms, scheduling widgets, secure messaging, results tables, and state that changes as the user acts. Those interactive surfaces are where keyboard traps, unlabeled custom controls, and unannounced updates tend to hide. We audit and remediate across sites, portals, and patient tools, and we treat the application surfaces with the extra care they need, because an inaccessible portal locks patients out of exactly the care interactions a portal exists to provide.

Usually, yes, and remediation is the common case. Most accessibility work is fixing an existing site rather than starting over: correcting contrast, adding the missing labels and alt text, untangling keyboard and focus order, captioning media, and repairing the custom widgets that scanners cannot reason about. We audit what you have, hand you a prioritized findings list, and remediate against it. Occasionally a site is built on something so brittle that fixing it costs more than rebuilding the affected parts, and we will tell you plainly if that is the situation rather than billing endless patches against a foundation that cannot hold them. But the default assumption is remediation, not a rebuild.

Only if the content and the process stay accessible, which is the part that lives with your organization. We can deliver a site at full WCAG 2.2 AA conformance and document it, but accessibility drifts the moment new content arrives: an unlabeled PDF, an uncaptioned video, an image with no alt text, a new third-party widget that ships its own barriers. That is why we are careful to call conformance a posture rather than a certificate. We can set you up to hold it, with patterns, documented components, and guidance for whoever publishes content, and our Healthcare Security Maintenance retainer can re-check the accessibility posture as content and the rules change. But the ongoing part is genuinely yours to own, and we will not pretend otherwise.

It is fully studio-deliverable on its own, which makes it one of the cleanest projects to start with. Accessibility does not touch protected health information the way a portal or an intake form does, so there is no BAA gate and no PHI-scope question to work through first. That means we can audit and remediate an existing site, portal, or patient tool as a focused engagement, hand you the conformance documentation, and be done, without dragging the rest of a healthcare web program along with it. Many practices come to us for exactly this, with a Section 1557 or ADA deadline approaching and an existing site that needs to meet it.
The rest of the codex

Related services

Accessibility sits alongside the rest of our HIPAA-aware healthcare work. If you are building or fixing more than the accessibility layer, these are the neighboring pieces, and the Insights article lays out the wider picture.

THE HUB HIPAA-aware Healthcare Web Overview of HIPAA-aware Healthcare Web services
Healthcare Website Development HIPAA-aware practice and clinic sites, kept out of PHI scope
Patient Portals & EHR Integration Custom portals with EHR/FHIR integration, MFA, and audit logging
Secure Forms & Intake Encrypted intake and consent forms routed only to BAA-covered vendors
Tracking & Analytics Governance Pixel, tag, and analytics audits so patient pages do not leak PHI
Healthcare Security Maintenance Security patching, scans, and monitoring for healthcare sites

Further reading: What "HIPAA-compliant" actually means for a website (and what it does not).

Have a Section 1557 or ADA deadline and a site that has to meet it?

Tell us what you are working with. We will audit the site, the portal, and the patient tools, hand you a prioritized findings list, remediate to WCAG 2.2 AA, and document the conformance, with an honest read on what stays yours to maintain afterward.

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