This case study presents an evaluation framework to assess the facilitating and constraining factors that influenced the emergency response, operation, and management of a Special Needs Shelter Program in Monroe County, Florida during Hurricane Irma in 2017. A qualitative analysis of key documents and discussions with agencies directly involved in the Monroe County Special Needs Shelter Program was used to assess four major emergency response processes: notifications and communications, evacuation and transportation, sheltering, and interagency coordination. A critical cross-cutting theme emerged, which was a lack of a common definition for populations with "special needs" across different agencies resulting in uncertainties about who should be admitted to the Special Needs Shelter and have access to their services. We generate public health and emergency management lessons to inform future adaptation, preparedness, and response plans to extreme weather events for populations with access and functional needs in Monroe County and Florida's coastal communities more broadly.