This article addresses the issue of institutional ableism as a central challenge for public policies and social services, starting from a critical analysis of the experience of the Tuscany Region in adopting a participatory governance model. Framed within the international debate on Disability Studies and the human rights-based approach, the article reflects on the tensions between welfare-based approaches and the promotion of self-determination for people with disabilities. Through a qualitative analysis of local policies and practices, the article offers insights for rethinking local welfare models in an anti-oppressive key and for the full recognition of the rights of people with disabilities. The Tuscan case, while representing a significant example of social