This paper begins by providing a history of Japanese law pertaining to special education and its change towards a more inclusive education with the ratification of United Nations Conventions of the Rights of People with Disabilities. With the changes in laws, more children with constant medical care needs in Japan have the opportunity to attend mainstream schools. The recent court case, "Kosuge v. Kanagawa prefecture and Kawasaki city," ruled against a child with medical care needs to attend mainstream school and made the judgment that a special needs school ("tokubetsushien gakko") is the appropriate placement for the child based on the child's disability type and degree of disability rather than needs and regardless of the wishes of the child's parents. This paper explores the case judgement and discusses where Japanese special education laws fall short similar to that of the US system based on Individuals with Disabilities Education Act. We suggest the need to keep inclusion as the basic human rights aligned with the Article 24 of the UNCRPD rather than focusing on the continuum of education principle in IDEA, and operationalise the law into practice to make integration of children with disabilities, including children with constant medical care needs, into mainstream education schools.