The Supreme Court this month heard a landmark case brought by a school district which is being forced to pay for the nursing and personal tutoring of a quadriplegic 16-year-old.
Meanwhile, under a federal law that takes effect on December 1, states will be held accountable for the academic progress of special-needs pupils for the first time. Local districts will be required to involve parents in all decisions about their child's placement and will have to educate disruptive pupils with disabilities who are removed from school.
Federal law states that all disabled children should receive a "free appropriate public education". The Supreme Court case will determine whether that includes 24-hour nursing care for the teenager from Cedar Rapids, Iowa, who has been paralysed from the neck down since a motorcycle accident when he was four. The teenager's education will cost 10 times more than that of his classmates'. But the justices suggested that it would be difficult for the district to evade its obligation.
"Of course the school district has a responsibility to keep the boy alive, " said Thomas Hehir, director of the US department of education office of special education programmes. "Doesn't a school have a responsibility to monitor a diabetic student's insulin injections?" But schools protest that they cannot afford the escalating annual cost of special education, which has increased from $20 billion (Pounds 12.4 billion) to $33 billion in under 10 years.
As more mentally-handicapped children are taken out of institutions the costs have grown along with the list of disabilities that qualify a student for pricey personal attention.
Meanwhile, some parents successfully apply for special education status simply so that their children can receive more individual attention and some teachers misuse the programme to rid themselves of undisciplined or inattentive pupils.
In a troubling trend, special education programmes have been used to remove black students from mainstream classes in the South, effectively re-segregating some schools.
The new regulations will require states to provide a racial breakdown of the students in special education programmes, and to regularly test their academic progress for the first time.