July 11, 2025

VOR's Weekly News Update

VOR is a national non-profit organization

run by families of people with I/DD and autism

for families of people with I/DD and autism.

VOR Podcasts!

VOR's Casey Henry and Brenna Redfearn continue their new series!

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VOR's comments to the Department of Labor's Wage and Hour Division:

Trump Administration Squashes Plan To End Subminimum Wage Employment Of People With Disabilities

By Michelle Diament, Disability Scoop, July 10, 2025

Federal officials are giving employers the green light to continue paying many workers with disabilities less than minimum wage.

The Trump administration is withdrawing a proposed rule that sought to phase out what’s known as subminimum wage employment.

Under a federal law dating back to 1938, employers can obtain special 14(c) certificates from the U.S. Department of Labor allowing them to pay workers with disabilities less than the federal minimum of $7.25 per hour. The proposal put forth by the Biden administration late last year called for the Labor Department to stop issuing new 14(c) certificates and to phase out existing ones within three years.

The Biden administration cited a sharp drop in the number of workers earning subminimum wage and “vastly expanded” employment opportunities for individuals with disabilities in moving to end the program.

In a notice published in the Federal Register this week, the Labor Department indicated that it is pulling the proposed rule. The agency pointed to concerns from Republicans in Congress that the Labor Department does not have the statutory authority to unilaterally do away with 14(c) certificates and rejected the Biden administration’s preliminary assessment that the certificates are no longer necessary.

“While the department cited a substantial decline in the use of section 14(c) certificates — from approximately 424,000 workers in 2001 to approximately 40,579 in 2024 — this decline does not establish that no current need remains,” the notice indicates. “To the contrary, the continued existence of tens of thousands of workers utilizing the section 14(c) program suggests a nonzero population for whom section 14(c) remains necessary. That inference is bolstered by comments asserting that many individuals with significant disabilities would face unemployment, underemployment, or loss of ancillary services if 14(c) options were eliminated.”

The move is a blow to many disability advocates who have spent years calling for an end to subminimum wage. They say the practice can lead to exploitation, with some workers earning less than $1 per hour, and stifle opportunities for individuals to fully engage in the community.

“We’re deeply disappointed to see the administration take this action,” said Colin Killick, executive director of the Autistic Self Advocacy Network. “Ending 14(c) and committing to competitive integrated employment is very much a bipartisan issue, something we’ve seen not only in Congress, but at the state level, where we’ve seen not just states like California, Illinois and Oregon ban subminimum wage, but also Tennessee, South Carolina and Alaska.”

“We remain encouraged by the building momentum at the state level, including recent efforts in New York, and we are confident that the end of 14(c) at the national level is a matter of when, not if,” Killick said.

However, officials with VOR, which advocates for individuals with intellectual disabilities and their families, welcomed the Labor Department decision to keep 14(c) certificates available.

“We need to maintain and support a diverse set of options for meaningful daily activities, including but not limited to competitive integrated employment, compensatory wage programs, day programs, and farmsteads,” Hugo Dwyer, VOR’s executive director, and Joanne St. Amand, the group’s president, wrote in a letter thanking the Labor Department for withdrawing the rule. “Sheltered workshops and 14(c) programs are an important part of this spectrum of employment opportunities, and they serve a particular cohort of individuals on the spectrum.”

Read the full article here

Meanwhile, our friends at the National Council on Severe Autism and Together For Choice are making their voices heard on eliminating the Settings Rule:

Federal rules defining ‘community living’ too often prevent exactly that     

By Mark Kendall and Scott Mandel, The Washington Examiner, July 7, 2025

Elaborate federal rules defining “community living” for people with disabilities too often prevent it from happening when it comes to those with the greatest needs.

Now, as changes sweep through the federal government, we see a moral imperative for the new administration to roll back these restrictions that often work against the welfare of some of the most vulnerable members of our society.

The Home and Community-Based Services regulations — a bundle of requirements best known simply as the Settings Rule — defines and enforces where people with disabilities receiving Medicaid waiver services (the vast majority of individuals with significant impairments) are allowed to live.

As parents of young adults with significant developmental disabilities, we are all too aware of the ways that these well-intentioned federal regulations actually narrow housing choices in ways that would be unacceptable if imposed on any other group of Americans.

Compounding the harm, these requirements discourage faith-based and other organizations from even attempting to develop the types of residential settings that may best serve those with the highest support needs.

In its campaign to slash bureaucracy, the Trump administration should prioritize rescinding or significantly revamping these restrictions to give individuals with disabilities more choice in living arrangements. Encouraging disability housing innovation and entrepreneurship is urgent, as the population of people diagnosed with disabilities — such as severe autism — grows. In many states, aging parent caregivers seeking future residential options for their adult children already face long waiting lists for housing.

Set into motion during the Obama administration, slowed during the first Trump presidency and then fully implemented under President Joe Biden, the Settings Rule has roots in a much-needed movement for change that began decades ago after disturbing revelations of abuse in institutions for people with disabilities.

Early on, the goal of reforms was to guarantee rights and prevent people from facing forced segregation into institutional settings. These are essential aims that were met for more than three decades without the Settings Rule, as the vast majority of individuals with disabilities moved out of institutions and into community settings.

Over time, though, ideological overreach took hold in the form of highly-prescriptive regulations that created significant new problems. Implementation of the Settings Rule today is guided by an unwavering belief that everyone should be living in a house or apartment in a residential neighborhood. This social engineering often runs up against real life. There’s no guarantee that living in a single-family home will lead to a neighbors-showing-up-with-apple-pie sense of community particularly if, like our children, a resident needs a high level of support to engage with others.

Still, the rule often leaves individuals with the sole option of living in small, scattered group homes, which work well for some but at their worst can bring problems ranging from isolation to outright neglect and abuse. In these cases, the Settings Rule can inadvertently lead to a smaller-scale form of institutionalization.

Whatever the scale, every form of housing needs fundamental safeguards to prevent this. But the Settings Rule instead sprawls into nearly every aspect of life with blanket regulations in areas such as visitation, food, even room decoration.

It’s time to send a different signal — one that will unlock innovation and entrepreneurship to address the severe housing shortage for individuals with significant intellectual disabilities. Rolling back the Settings Rule will spur development of the types of housing suited to those with with the greatest needs. The federal government must stop defining for others what makes a true community and a good home.

Read the full editorial here

Congressional Will Be Home In August!

Your members of Congress will be back in state and district during August.

Now is a good time to make appointments with your

Members of the House and Senate

and arrange for them to tour your loved ones' homes and workplaces!

Find your member of the House here

Find your Senators here

States Brace for Added Burdens of Trump’s Tax and Spending Law

By David W. Chen and Pooja Salhotra, The New York Times, July 4, 2025

The ink is not even dry on the far-reaching domestic policy law that President Trump signed on Friday, and already state governments are bracing for impact as Washington shifts much of the burden for health care, food assistance and other programs onto them.

Gov. JB Pritzker, Democrat of Illinois, and legislative leaders might hold a special session to deal with the new law, even though the recently passed state budget already includes $100 million to cover shortfalls in federal funding.

Another Democrat, Gov. Katie Hobbs of Arizona, has warned that even her state’s $1.6 billion emergency fund will be insufficient to weather what’s coming, because “even if we cut every single thing in the state, we don’t have the money to backfill all these cuts.”

Even before the bill’s final passage, state capitals were contending with a slowing economy and federal spending cuts implemented by the Department of Government Efficiency run by Elon Musk. Now they will be expected to administer complex new work requirements for Medicaid and food aid; rework some state health insurance exchanges under the Affordable Care Act; and decide how much they can do to keep their citizens insured and fed once they start losing federal assistance.

“What’s happening in Washington, D.C., is undermining everything we’ve been working on,” said Gov. Laura Kelly of Kansas, a Democrat.

Many states, both red and blue, have enthusiastically cut taxes for residents and businesses. In the face of deep federal cuts, some states will probably be inclined to pause those reductions rather than reverse them, said Jared Walczak, the vice president of state projects at the Tax Foundation, a nonprofit tax policy group that generally favors lower taxes.

But in recent weeks, states have been balancing budgets that are fraught with uncertainties. Most state governments’ fiscal years began on Tuesday, but governors and legislators have had to keep an eye on specific provisions in the federal bill that could have outsize effects, such as a $50 billion fund for rural hospitals to offset the impact of Medicaid cuts (which was ultimately included) and the sale of millions of acres of public lands (which was not).

Now that the fine print in the president’s package is coming into focus, Carl Davis, the research director at the Institute on Taxation and Economic Policy, a left-leaning research group, said that states would have three main options for dealing with the new law.

“They can scale back their investments in health and food assistance that are directly affected by the federal legislation,” he said. “They could shuffle money around to preserve health insurance — ‘Hey, we don’t want 600,000 North Carolinians to lose health insurance, but we’re going to take money away from education to do it.’”

“Or,” he said, “we can see tax increases.”

Read the full article here

The Truth About the One Big Beautiful Bill Act’s Cuts to Medicaid and Medicare

By Mia Ives-Rublee from The Center for American Progress and Kim Musheno from The Arc, July 3, 2025

This column is a collaboration between the Center for American Progress and The Arc.

Those who need Medicaid most, including people with disabilities and the elderly, will be affected by the bill’s cuts

The nonpartisan Congressional Budget Office (CBO) estimated that the OBBBA will cut federal spending on Medicaid and Children’s Health Insurance Program (CHIP) benefits by $1.02 trillion, due in part to eliminating at least 10.5 million people from the programs by 2034. With new federal limits on Medicaid eligibility likely increasing the number of uninsured, along with other provisions that restrict states’ ability to raise revenue to fund their Medicaid programs, states will have to reevaluate their budgets to either supplement the spending or cut services. Research shows that when federal funding for Medicaid decreases, states tend to cut optional benefits such as home- and community-based (HCBS) first. It is nearly impossible to carve out a specific population, such as disabled people or elderly people, because the cuts to Medicaid funding will affect everyone due to hospital closures and health care workforce layoffs.

The bill will make it harder for states to fund home- and community-based services

The OBBBA creates a new category in 1915(c) HCBS waivers that will cover people who do not meet the existing requirement of needing an institutional level of care to receive HCBS. States would be allowed to apply to access this funding as long as their proposed program does not increase the average HCBS wait times for people who meet the need for institutional care. In order to implement this additional category, the federal government will provide $50 million in fiscal year 2026 and $100 million in fiscal year 2027. In 2020, average Medicaid per capita spending on HCBS was $36,275. Yet in the first year of the bill’s new HCBS waiver, funds from the bill would only be able to cover HCBS costs for about 27 people per state—without accounting for overhead spending or inflation. Moreover, states will be contending with massive federal funding losses due to the bill’s Medicaid cuts, which will likely lengthen wait times for HCBS, making them ineligible to establish the new category at all.

Medicaid paperwork requirements will cause eligible people to lose coverage

While some advocates of the One Big Beautiful Bill Act have claimed that it will “[stop] the subsidization of competent adults who are just choosing to not work,” the reality is that nearly all Medicaid recipients who aren’t automatically eligible based on Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) and are able to work are already working. Indeed, only 8 percent of recipients between the ages of 19 and 64 who weren’t on SSI or SSDI in 2023 “[weren’t] working due to retirement, inability to find work, or other reason[s].” Those who were not working were statistically more likely to be older women who left the workforce to care for aging parents or children.

The OBBBA requires individuals to prove that they are working, engaging in community service, or receiving work training for at least 80 hours per month—or that they are enrolled in school part time—unless they qualify for an exemption. Medicaid enrollees who are trying to find a job, are having difficulty finding employment, or who lack reliable transportation to work would be penalized under this requirement. That includes at least more than 2.6 million adults with disabilities who don’t have SSI or SSDI and have difficulty working due to disability or illness.

Research indicates that paperwork requirements such as those in the bill—particularly for Medicaid—don’t increase employment rates and often increase overhead costs. A group of researchers evaluated the first year of paperwork reporting requirements in Arkansas and found that there was a significant loss of Medicaid coverage in the initial six months among eligible people and no significant change in employment. Georgia also implemented a trial program, called Pathways, that included paperwork requirements, and state caseworkers found the monthly verification of employment overly burdensome. To date, taxpayers have spent more than $86 million on Pathways only to have 6,500 participants enrolled in the first 18 months of the program—75 percent fewer enrollees than the state had estimated would participate in year one.

The bill will put rural hospitals at risk

The OBBBA includes $50 billion in relief funding for rural hospitals over a five-year period to help reduce the disastrous impacts of the bill’s roughly $1 trillion in Medicaid cuts. As of May 2025, there were approximately 2,086 rural hospitals receiving $12.2 billion a year in net revenue from Medicaid. At the median, rural hospitals’ revenue from Medicaid is $3.9 million a year.

Rural hospitals have some of the lowest operating margins in the nation, especially compared with urban hospitals, meaning that any reductions in revenue could lead to closures. The average operating margin for rural hospitals was 3.1 percent in 2023, with 44 percent of rural hospitals operating with negative margins. As a result, more than 300 rural hospitals are currently at “immediate risk” of closure, especially now that the OBBBA is projected to cut Medicaid spending by $1.02 trillion. The relief fund designed to blunt the negative impacts caused by the bill would not come close to filling that gap. If every rural hospital in the country received an even share of the $50 billion in relief support, it would amount to only $4.5 million every year for five years. At the close of those five years, that funding would disappear altogether.

Notably, children and nonelderly adults are more likely to rely on Medicaid if they live in rural areas compared with urban areas. The prevalence rate of disability is also higher in rural areas, and disabled rural residents are more likely to be Medicaid recipients than disabled urban residents. This leaves disabled people as some of those most at risk when rural hospitals close.

Continued

Note: The following article is an analysis of the bill as passed in the Senate. This is essentially identical to the version of the bill that the president signed into law on July 4, 2025

Families USA Leaders Document Harms to Healthcare from Senate Bill

Analysis from Families USA, July 2, 2025

Families USA, a nationwide healthcare consumer advocacy organization, published a very detailed analysis of the legislation, related to its Medicaid and other health insurance and healthcare policy provisions. And its leaders held a press briefing, which Healthcare Innovation attended.

To begin with, Families USA on Wednesday published to its website a detailed analysis of the challenges facing the healthcare system and patients and families, coming out of the Senate version of the bill.

The first part of the summary focuses on individuals currently covered by Medicaid. The second part focuses on providers and the health insurance system in the U.S.

That second part focuses on “cuts to care, health services, and benefits”; the legislation, Families USA analysts contend, “[s]ignificantly restricts state use of provider taxes, a key tool for financing the state share of Medicaid (E&C Section 44132; SF Section 71117). Would prevent states from increasing provider taxes or expanding their provider tax base to additional health care provider categories. Nursing homes and intermediate care facilities are exempt in the Senate version. By freezing the ability to generate revenue to finance Medicaid coverage even as cost pressures go up, states will ultimately be forced to cut benefits for millions of people or make major cuts in provider reimbursement rates. The Senate version adds an additional provision to change the ‘safe harbor’ threshold for Medicaid expansion states from 6 percent to 3.5 percent by 2032, further penalizing expansion states and reducing their provider taxes.”

What’s more, the Families USA analysts write, “The Senate-passed version asserts that no new provider taxes can be implemented above what the safe harbor threshold was in place as of May 1, 2025. Any state that imposes new or increased taxes would result in the safe harbor limit reducing to zero. CBO [the Congressional Budget Office] estimates the House provision would cut $89.3 billion over 10 years, and the Senate version would cut $191.1 billion over 10 years.”

Further, the Senate version of the bill “[i]mposes new requirements on states limiting Medicaid provider taxes (E&C Section 44134; SF Section 71119). Would further jeopardize revenue for states by imposing new definitions that limit the structure of provider tax revenue under state Medicaid 1115 waivers. Many states will need to significantly restructure their current financing of Medicaid, including likely reductions. The Senate Finance proposal clarifies that states are allowed to make changes to provider taxes to come into compliance with the provider tax provisions of the bill. CBO estimates the House and Senate provisions would cut $34.6 billion over 10 years.”

The Senate bill also “[r]estricts the use of State-Directed Payments, a major way states keep key services open. (E&C Section 44133; SF Section 71118). Would limit states’ ability to direct higher reimbursement for rural hospitals, clinics, and other safety-net providers, by restricting state-directed payments (SDP) to 100 percent of the published Medicare payment rate for Medicaid expansion states, and 110 percent for non-Medicaid expansion states. The Senate version severely limits the ‘grandfathering clause’ established in the House bill that allows states with existing SDP arrangements to maintain those, by reducing all SDP arrangements by 10 percent each year until reaching the Medicare payment rates. These provisions would hinder states’ abilities to keep critical provider doors open, especially in rural communities. Updated Senate text pushes back the effective date by one year (Jan. 1, 2028). CBO estimates the House provision would cut $71.7 billion over 10 years, and the Senate version would cut $149.4 billion over 10 years.”

And the Senate bill “[t]hreatens federal money for key services by restricting funds from Section 1115 waivers (E&C Section 44135; SF Section 71120). Would codify standards for budget neutrality for Medicaid 1115 waivers in statute and create a path for the HHS Secretary to redefine how states spend any savings, putting certain services provided under Medicaid waivers at risk, including public health and community supports. Only minor technical changes made in the Senate bill. No CBO score currently available for the House version. CBO estimates this provision would cut $3.2 billion over 10 years. Undoes increased matching funds for new expansion states (E&C Section 44131; SF Section 71116). Would sunset (on January 1, 2026) a provision from the American Rescue Plan Act that offers a 5% increase to a state’s regular FMAP for 2 years to any state newly adopting Medicaid expansion. This boosted funding helped states like North Carolina expand Medicaid but would no longer be available to the 10 remaining non-expansion states.”

Continued

Health Provisions in the 2025 Federal Budget Reconciliation Bill

From KFF, Updated July 8, 2025

On July 3, the House passed the same version of the budget reconciliation bill passed by the Senate on July 1. On July 4, President Trump signed the legislation into law . This summary describes the health care provisions in the law (described as the Senate-passed bill) in four categories: Medicaid, the Affordable Care Act, Medicare and Health Savings Accounts (HSAs). It also compares the provisions to a earlier draft of the bill passed by the House on May 22.

View KFF's updated chart here

‘One Big Beautiful Bill Act’: Key Final Medicaid Changes Explained

By Jeanna Palmer Gunville and Tesch Leigh West, from Morgan, Lewis, and Backius, LLP, July 9., 2025

The One Big Beautiful Bill Act was signed into law on July 4 and includes significant changes to the Medicaid program, particularly with regard to state and federal financing for the program. This LawFlash provides a high-level summary of certain key provisions that will impact various Medicaid stakeholders, including states, providers, and enrollees.

Note that several provisions of the act focus on the Affordable Care Act’s Medicaid expansion, which offered enhanced federal matching funds to states that expanded Medicaid coverage to adults with incomes between 100%–138% of the federal poverty line (i.e., $21,597 for an individual in 2025). This group is referred to below as the expansion population. Currently, 41 states, including DC, have expanded Medicaid. 

IMPACT ON FEDERAL FINANCING

• Elimination of the two-year 5% increase in federal matching funds available to states under the American Rescue Plan Act as an incentive to adopt Medicaid expansion (eff. Jan. 1, 2026).
• Elimination of enhanced federal matching funds for Emergency Medicaid offered to undocumented immigrants otherwise eligible for expansion coverage (eff. Oct. 1, 2026).
• Reduction in federal financial participation for states exceeding a 3% error rate for payments made to ineligible individuals (including where there is insufficient information to confirm eligibility) and overpayments made to eligible individuals (eff. fiscal year (FY) 2030).
• Requirement for Section 1115 Demonstration Waiver approval to include certification of budget neutrality by the Chief Actuary for Centers for Medicare and Medicaid Services (CMS) (eff. Jan. 1, 2027).
• Establishment of a $50 billion rural health transformation program to be used between FYs 2026 and 2030 for payments to rural healthcare providers, expanding rural health workforces, and other system transformation purposes.

IMPACT ON STATES

• Prohibition on new or increased provider taxes to finance the state share of Medicaid spending with certain exceptions (eff. immediately with three-year transition period).
• Reduction in existing provider taxes in expansion states through an annually decreasing cap: from current level of 6% of net patient revenues to 5.5% in 2028, down to 3.5% by 2032.
• Requirement to conduct eligibility redeterminations every six months for expansion population (eff. Jan. 1, 2027).
• Requirement to conduct monthly eligibility checks of enrolled providers to screen for terminated providers (eff. Jan. 1, 2028).
• Requirement to conduct quarterly reviews of the Death Master File to determine whether enrolled providers are deceased (eff. Jan. 1, 2028).
• Requirement to obtain enrollee address information and conduct quarterly enrollee reviews against the Death Master File (eff. Jan. 1, 2027) and submit enrollee SSNs to new CMS system to prevent Medicaid enrollment in multiple states (eff. Oct. 1, 2029).

IMPACT ON PROVIDERS

• Reduction (through directed HHS rulemaking) on the upper limit for state-directed payments to managed care providers from the average commercial rate to 100% of Medicare payment rates for expansion states and 110% for non-expansion states, with phase-in for certain approved grandfathered payments.
• Prohibition on payments to 501(c)(3) nonprofit organizations if they (1) are essential community providers, (2) are providing abortions outside of the Hyde exceptions, and (3) received $800,000 or more in payments from Medicaid in 2023 (eff. immediately for one year).

Continued

North Carolina - As the Big Beautiful Bill Becomes Law, States Face a ‘Daunting’ Rollout  

By Leslie Walker, TradeOffs, July 10, 2025

What President Trump named his “One Big Beautiful Bill” is now the law of the land. 

Just before House Republicans cast their final votes to pass the legislation, Republican Speaker Mike Johnson declared, “We have a big job to finish, and that’s why we’re here.”

The work has just begun, however, for state health officials across the country. They now face the difficult task of putting many of this law’s health reforms into action — some at breakneck speed. They, alongside governors and state legislatures, will also need to grapple with what the new law’s steep funding cuts will mean for health care programs, patients and providers.

Kody Kinsley, who served as North Carolina’s health and human services secretary until earlier this year, calls the road ahead “daunting.” He’s still in touch with colleagues who lead health agencies and Medicaid programs in red and blue states across the country, and described their hopes and fears in an interview with Tradeoffs this week.

“These folks do hard things every day,” Kinsley said. “They also know that part of being in these roles is implementing the policy, whether you agree with it or not.”

Here are some of the key takeaways from our conversation:

• There’s a lot that we still don’t know about this law. Experts and lawyers are still combing through the final language, which spans more than 800 pages. States also await further guidance from the Centers for Medicare and Medicaid Services that will dictate how certain reforms must be implemented. Litigation has also already begun — starting with a provision that targets Planned Parenthood — and Kinsley expects more legal challenges to follow. “A big source of worry and fear [for state health officials] is the amount of uncertainty,” he said.

• Tight implementation timelines will challenge states — and open opportunities for creativity. States, for example, must be ready by the end of 2026 to start checking some people’s eligibility for Medicaid more frequently and verifying whether they meet the new law’s work requirements. Kinsley said that states can do more to leverage data and technology to make those processes smoother and more accurate. He expects to see states take a variety of approaches, and said it’s “absolutely” possible that some states will see fewer people lose their Medicaid, simply because those states have better software than others.

• Many states are staring down billions of dollars a year in lost federal Medicaid funding and a host of difficult decisions. Kinsley said states will need to undertake a combination of cuts to health care coverage, services and reimbursement rates. “There are just not going to be easy choices here,” Kinsley said. A state might, for example, need to decide whether to rescue a rural hospital or to continue to cover dental care for low-income adults. Some states, including Connecticut and Colorado, are already considering the need for special legislative sessions to grapple with the law’s budget implications.

Read or listen to our full conversation with Kinsley to learn more about what comes next with this law.

Continued here

President Donald Trump's budget bill cuts Medicaid. Here's what it means for Louisiana.

By Mark Ballard, The Times-Picayne / NOLA, July 5, 2025

During his nearly nine-hour floor speech opposing passage of the Republicans’ One Big Beautiful Bill Act, House Minority Leader Hakeem Jeffries used Louisiana to underscore his argument that the measure harms Medicaid.

The legislation, signed into law Friday, includes tax breaks and increased funding for Republican priorities. It pays for them, partially, by cutting spending by $1.1 trillion over the next 10 years for Medicaid and the Affordable Care Act.

That will lead to 17 million Americans losing healthcare coverage, according to the Congressional Budget Office.

“Louisiana is a state that stands to suffer mightily as a result of this all-out assault on Medicaid,” said Jefferies, D-Brooklyn. He pointed out that the Republican supermajority in the Louisiana Legislature passed a resolution asking Congress not to slash Medicaid because the state, one of the poorest in the nation, simply couldn’t afford the extra costs.

Except for New Mexico, Louisiana has the nation’s highest percentage of residents — one third — on Medicaid, which covers the cost of healthcare for low-income adults, children and seniors. The law eventually could cost Louisiana $4 billion and lead to 267,550 losing their coverage over the next 10 years, according to the Kaiser Family Foundation and other nonpartisan experts.

How Medicaid could change in Louisiana

Of the $16.4 billion annual Medicaid costs for Louisiana, state taxpayers kick in about $3 billion, according to the Legislature. The new law would halt some of the tools Louisiana uses to pay that $3 billion, requiring the state to pour in extra money or let some people go without health insurance.

Republicans cast the changes as needed to shore up the healthcare programs by ensuring services remain available only for those truly in need.

“A lot of the estimations are far overblown … especially in my district,” said House Speaker Mike Johnson, R-Benton. About 40% of his constituents are Medicaid eligible.

But U.S. Rep. Troy Carter, D-New Orleans, said the bill “represents the largest cuts to health care and nutrition assistance in American history. …It strips support from our hospitals and nursing homes,” threatening to close long-term facilities and rural hospitals. About 38% of Carter’s constituents are Medicaid eligible.

Much of the savings in the new law come from fees the state levies on hospitals, clinics and other healthcare providers. These provider taxes help the state put more money into Medicaid.

Provider taxes also have the effect of increasing the portion the federal government must pay. The new law ratchets down the provider tax rate from 6% to 4.5% over several years. But Louisiana’s rate is 4.6%, so the state has a buffer.

Some of the money raised through provider taxes goes directly to hospitals in what are called state directed payments. One state directed payment sends funds to rural hospitals whose patients – almost half in some parishes – have Medicaid, which doesn’t always cover the cost of services provided. 

The new law immediately freezes the size of state directed payments and, starting in 2028, lowers that amount by 10% each year.

The provider tax also is used to boost Medicaid payments to nursing home facilities used by seniors who need long-term nursing care but have run out of insurance and savings, which is about 60% of them in Louisiana. The bill will effectively lower payments to nursing facilities and could cause many to limit patients or close their doors.

State directed programs using provider taxes, such as those for rural hospitals and nursing homes, must be approved by U.S. Centers for Medicare & Medicaid Services, called CMS.

Wording inserted by U.S. Sen. Bill Cassidy, R-Baton Rouge, allows CMS to consider Louisiana’s state directed payment applications already in the pipeline.

“It’s a small change with huge consequences,” Cassidy wrote in a memo to state officials.

As part of the deal to persuade senators to accept restrictions on provider taxes and state directed payments, the Senate created a $50 billion fund to help rural hospitals.

Louisiana hospital officials say the fund will help but the amount is insufficient. But delaying until 2028 allows time for the provisions to be amended.

Continued

New York - Feds’ Medicaid cuts hurt the disabled

Opinion, By Dr. Michelle Morse and Joseph M. Pancari, The NY Daily News, July 10, 2025

Congress has passed President Trump’s One Big Beautiful Bill into law that includes more than $1 trillion in cuts to Medicaid over the next decade. These are estimated to take health care away from an estimated 20 million Americans and will result in the death of 51,000 people nationwide. The law exempts people with disabilities from losing individual coverage, but the scale of the cuts means many Americans will be affected.

The legislation translates to $13 billion in lost funding for New York State, more than $7 billion in economic loss for New York City, and more than 30,000 New Yorkers are expected to lose their jobs. This will inevitably impact our ability to deliver life-saving services for New Yorkers with disabilities.

The argument that vulnerable populations will be exempt relies on looking at health care in a vacuum. It assumes that individual medical coverage is an isolated variable in our broader health care system. Even taken at face value, that argument falls flat: in a system with so much red tape, not every person with a disability would retain Medicaid coverage.

For those who do retain coverage, the impact is more complicated.

The American health care system is both fragile and flawed. Medicaid is the single largest health insurance provider in the nation, covering more than 70 million Americans and four million of our fellow New Yorkers. Reducing Medicaid funding by hundreds of billions of dollars will have ripple effects on every component of the health care ecosystem.

In New York State, there are more than a million individuals with disabilities relying on Medicaid, and hundreds of thousands in New York City. We serve them every day.

Both CP Unlimited and the New York City Department of Health and Mental Hygiene are committed to the continuation and expansion of community-based health services. Our work helps avert emergency room visits, which reduces public costs and improves individual health outcomes. We’re focused on connecting people with their community, stable housing, meaningful employment, and the resources to live a fulfilling life.

That work relies on Medicaid.

In New York State, social care providers like CP Unlimited are eligible for Medicaid reimbursement for their services. We also rely on federal funding that flows through state agencies, as does the city Health Department.

CP Unlimited — as just one example — serves more than 1,000 families a year. And like so many organizations working alongside us, we are already operating on a tight budget. The disability field relies on essential staff like nurses and direct support professionals and they must be protected.

If social care and public health begin to break down, the inevitable result is that more people will seek crisis care at our hospitals. Hospitals will face significant deficits from treating ballooning numbers of uninsured people. Providers will no longer be able to bill Medicaid for patients who still desperately need care. Even if New Yorkers with disabilities retain their coverage, they will feel the strain of an underfunded system — both in their communities and at the hospital.

Under this new law estimates predict more than a million people in New York State will lose Medicaid coverage — and an estimated 600,000 of those people live in New York City. This would also have major financial impacts on New York’s Essential Plan, which expands publicly funded healthcare coverage to people who make less than 250% of the federal poverty level (in 2025, that’s a little under $40,000 a year for an individual).

In New York State, more than 700,000 Essential Plan enrollees would become ineligible for federal support and will either lose coverage or face higher costs.

It’s impossible to know the full impact of these cuts on our health care system, but one thing is clear: Medicaid is a crucial part of maintaining the infrastructure for basic care, especially for New Yorkers with disabilities. It’s an infrastructure that is already straining under pressure, and we must ensure that no matter what, New Yorkers, especially our most vulnerable, are protected.

Read the full opinion piece here

NJ's disability watchdog warns that next governor will inherit group home system in crisis

By Gene Myers, NorthJersey. com / The Bergen Record, July 8, 2025

New Jersey’s disability ombudsman released yet another blistering report Monday on failures in the state's group homes, highlighting stories of widespread neglect and unchecked abuse — and calling out a system that he said protects itself while failing thousands of vulnerable residents.

“Not a single day goes by without someone contacting us about an allegation of abuse and neglect,” Paul Aronsohn warned on July 7 in the 79-page report. “Sometimes it is about a new, terrible experience. Often it is about an ongoing situation.”

Aronsohn, a state-appointed watchdog known officially as the ombudsman for individuals with intellectual and developmental disabilities and their families, framed his annual report as a warning to the new governor set to take office in January, who will inherit a system that spends nearly $3 billion to fund care at privately run group homes.

"Simply stated, we have a full-blown crisis on our hands — one that is taking an increasing toll on all involved in terms of human and financial costs," wrote Aronsohn, a former Ridgewood mayor appointed by Gov. Phil Murphy in 2018. He acknowledged that the report could be his last, with Murphy's administration due to close at the end of this year.

The report cites numerous complaints his office has received over the past year:

A resident diagnosed with malnutrition. The walls of a youth group home scarred with holes; its main entrance reachable only by a crumbling set of stairs. Medication left unsecured on a patio table at another facility, with more drugs found on the seat of a transport van.

The findings mirror reports by NorthJersey.com and The Record in recent years, including an investigative series this spring, Hidden at Home, which highlighted abuse, neglect and deaths in the group home system and a failure by the state to punish violations. Advocates have called for stronger government oversight, more robust consequences and an independent agency to investigate complaints, among other reforms.

Medication errors are so common that families, the report says, have grown used to them. Citing a finding from the Hidden at Home series, Aronsohn noted there have been 1,620 confirmed instances of residents' drugs going missing or being administered incorrectly in the last five years alone — an average of more than six errors a week.

Many incidents likely go unreported, the ombudsman added, because loved ones no longer see the point or fear repercussions from group-home operators.

Who investigates NJ group homes?

Aronsohn's report describes a bureaucracy that often treats families as adversaries rather than partners. It is also a system flush with public dollars, he said. The budget for the state’s Community Care Program, the primary Medicaid-funded system for adults with developmental disabilities, has ballooned to nearly $3 billion — a tripling since 2017. But the number of people served has risen just 21% in that same time, Aronsohn said.

About two-thirds of that funding goes to private providers that run group homes and supervised apartments. Many of those operators receive between $250,000 and $500,000 a year for each person in their care, the report says.

But there is little transparency about how money is spent, Aronsohn said, and even less accountability when something goes wrong.

Nearly 70% of all deaths in group homes are classified as “unexpected.” But even then, the state does not automatically investigate. Most inquiries, the report says, are carried out by the same provider agencies accused of wrongdoing.

“We know abuse and neglect are under-reported. We know there are serious questions about the quality of the investigations, process as well as substance,” Aronsohn said. “We know most investigations are conducted by the provider agencies themselves and that, in the end, most allegations against them are ‘unsubstantiated.’”

Unlike hospitals and nursing homes, group home providers in New Jersey face no civil penalties when they violate rules meant to protect residents, he wrote.

Meanwhile, workers who provide daily, hands-on care are often paid wages comparable to those of entry-level retail jobs. Job listings reviewed in the report offered as little as $19.50 an hour for direct support professionals, as the workers are called. Low pay and minimal training lead to high staff turnover, Aronsohn said.

“Twenty dollars an hour to do really difficult work is not enough, and that is not just physically difficult, but emotionally difficult," he said in an interview Monday. "The work of a direct support professional is so important and can be very challenging. We still do not compensate direct support professionals as we should.”

Continued

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