June 27, 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.

Note to our members:

VOR has been speaking out for several months to prevent any and all cuts to Medicaid in the budget reconciliation bill, aka H.R.1, aka "The One Big Beautiful Bill Act".

It is our position that this bill would harm members of the community of people with I/DD and autism, cause some of the providers and hospitals that we rely on to close or cut back on services, further impact the shortage of Direct Support Professionals, and impose an even burden on family caregivers. Despite the statement by some of the people drafting the bill that no one in ICFs or Skilled Nursing Facilities will be impacted, we know from experience that this is not the case.

In the past months, we have

• Written over 50 (snail mail) letters to the Governors of every state and territory showing how these cuts will impact their budgets and their ability to serve our community.

• Sent emails to every State Director of Developmental Disability Services, asking them to coordinate with their governors in opposing these cuts.

• Rallied on Capitol Hill and presented VOR's position paper opposing Medicaid cuts to every office in the House and Senate.

• Sent emails to the staffers on the House Energy and Commerce Committee, the House Appropriations Committee, The Senate Finance Committee, The Senate Aging Committee, and the Senate HELP Committee, outlining our concerns.

• Sent further rounds of emails to every office of the Senate Republicans working on the reconciliation bill.

• Coordinated with other like-minded groups in trying to halt these drastic cuts that would harm our families

We continue to work to protect our loved ones with I/DD and autism, and to protect our families. Much of the above information is available on our website at www.vor.net

We hope that our members agree with our efforts on this matter. As always, VOR tries to avoid partisan politics, adhering to our stated mission of advocating for high quality care and human rights for all people with I/DD and autism.

We hope, too, that our members will help us in our mission by donating to VOR here.

And now, here's something that you can do later this summer:

Congressional Recess

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

It's been a hectic week in the Senate, with the Parliamentarian rejecting several of the provisions that have been added to the mix of what President Trump calls his One Big Beautiful Bill. And it's difficult to say with any certainty where things stand from one moment to the next.

Two things we know for sure is that the President will be pressuring the Senate to pass his bill, and that Senate Republicans will be working all weekend to circumvent the Parliamentarian's rulings - or to find a way to neutralize the Parliamentarian herself by overturning precedent and procedures - in order to meet their self-imposed July 4th deadline.

Meanwhile, the fate of hundreds of thousands of lives of people with I/DD and autism, and their families, lie in the balance of their decisions.

In the meantime, here are some articles from the past three days that cover some of the more recent turns of events.

Senate referee rejects key Medicaid cuts in Trump’s ‘big, beautiful bill’

By Alexander Bolton, The Hill, Junne 26, 2025

Senate Parliamentarian Elizabeth MacDonough has rejected key Medicaid provisions in the Senate GOP megabill, a ruling that appears to strike a major blow to Republicans’ strategy for cutting federal spending.

The Senate’s referee rejected a plan to cap states’ use of health care provider taxes to collect more federal Medicaid funding, a proposal that would have generated hundreds of billions of dollars in savings to offset the cost of making President Trump’s corporate tax cuts permanent, according to a Democratic summary of the parliamentarian’s ruling.

The decision could force Senate Majority Leader John Thune (R-S.D.) to reconsider his plan to bring the Senate bill up for a vote this week.

The cap on health care provider taxes in both states that expanded Medicaid and did not expand Medicaid under the Affordable Care Act was projected to save hundreds of billions of dollars over the next 10 years, but it would have forced states to shoulder substantially more of the cost for Medicaid coverage.

The provision generated strong pushback from several Senate Republicans, including Sen. Josh Hawley (R-Mo.), Susan Collins (R-Maine), Lisa Murkowski (R-Alaska) and Jerry Moran (R-Kan.), who warned deep cuts to federal Medicaid spending could cause dozens of rural hospitals in their states to close.

Hawley and Collins declined to say Wednesday whether they would vote to proceed to the bill unless Senate Republican leaders came up with a plan to save rural hospitals from bankruptcy.

Sen. Jeff Merkley (D-Ore.), the ranking Democratic on the Senate Budget Committee, hailed the ruling.

“Democrats are fighting back against Republicans’ plans to gut Medicaid, dismantle the Affordable Care Act, and kick kids, veterans, seniors, and folks with disabilities off of their health insurance – all to fund tax breaks for billionaires,” Merkley said in a statement.

The parliamentarian ruled that Sect. 71120 of the bill covering health care provider taxes violates the Byrd Rule, which determines what legislation is eligible to pass the Senate with a simple-majority vote on the budget reconciliation fast track.

Republicans could get around the parliamentarian’s rulings by holding a simple-majority vote on the floor to establish a new precedent, expanding the scope of what is eligible under reconciliation.

Or they could attempt to rewrite the cap on health care provider taxes in a way that it meets the parliamentarian’s approval.

But the parliamentarian’s decision appears to be a significant setback that could delay a vote on the bill.

The decisions prompted a furious reaction from Alabama Sen. Tommy Tuberville (R), who called on Thune to fire the parliamentarian ASAP.

“The WOKE Senate Parliamentarian, who was appointed by Harry Reid and advised Al Gore, just STRUCK DOWN a provision BANNING illegals from stealing Medicaid from American citizens. This is a perfect example of why Americans hate THE SWAMP,” Tuberville posted on X, the social media site.

“Unelected bureaucrats think they know better than U.S. Congressmen who are elected BY THE PEOPLE. Her job is not to push a woke agenda. THE SENATE PARLIAMENTARIAN SHOULD BE FIRED ASAP,” he said.

Republican Sen. John Kennedy (La.) told reporters Thursday that he doesn’t think the GOP leadership would attempt to oust the MacDonough from the parliamentarian’s office, asserting that Republicans “respect” her rulings.

“I don’t think that will happen,” he said. “We all have respect for the parliamentarian. I think that she’s very fair and I don’t think that she should be fired nor do I think she will be fired.”

Read the full article here

‘Deeply harmful’ Medicaid cuts still in ‘big beautiful’ bill after parliamentarian ruling, expert says

By Lorie Konish, CNBC, June 27, 2025

Key Points:

• Some Medicaid cuts proposed in Republicans’ “big beautiful” bill have been rejected by the Senate parliamentarian for inclusion in the legislation.
• Yet other parts of the proposed Medicaid cuts — including new work requirements of 80 hours per month and more frequent redetermination evaluations every six months — were not questioned by the Senate referee.
• The Senate bill is “deeply harmful” to the program, regardless of whether the provisions identified by the parliamentarian stay in or out, said Allison Orris, senior fellow and director of Medicaid policy at the Center on Budget and Policy Priorities.

Continued

This key provision of Trump’s big bill violates Senate rules. Here’s what to know about provider taxes

By Hannah Grabenstein, PBS, June 26- 27, 2025

One of the most significant changes Republican lawmakers had hoped to make to Medicaid in President Donald Trump’s “One Big Beautiful Bill” is freezing or cutting state taxes on health care providers.

But as congressional Republicans scramble to push through the tax cut and spending package, the nonpartisan Senate parliamentarian ruled Thursday that many of its proposals don’t adhere to the rules governing the budget process. As is, the bill cannot be passed with a simple majority.

Experts warn that getting rid of the taxes could have an outsize effect on medical coverage and access for millions of Americans.

Provider tax revenue has “played a significant role in states’ ability to support Medicaid,” said Allison Orris, senior fellow and director of Medicaid policy at the Center on Budget and Policy Priorities.

Here’s what provider taxes are, and how changes could affect patients and health care systems in dozens of states.

What are provider taxes?

In a nutshell, they’re taxes the state levies on various health care providers, such as hospitals, nursing homes, managed care organizations and even ambulances.

It may sound counterintuitive, but providers generally like these taxes, because they contribute to a state’s total spending on Medicaid, said Alice Burns, associate director of KFF’s Program on Medicaid and the Uninsured.

Because the federal government matches state spending at a rate between 50% and 80%, with no upper limit, higher provider taxes can mean higher state spending, which results in a higher federal contribution. That money can then ultimately go back to providers in the form of increased Medicaid payment rates.

Some states have also spent provider tax revenue on funding Medicaid expansion, which allows people under higher income limits or those without dependents to access health care. Other states use the funds to help keep provider reimbursement rates high enough to ensure access for Medicaid enrollees, Orris said.

The American Hospital Association “is focused like a laser beam on ensuring the preservation of legitimate provider tax and supplemental payment programs,” wrote Rick Pollack, the organization’s president and CEO, in a June 11 blog post. He added that those taxes “serve as patches to help finance a chronically underfunded Medicaid program.”

States have been taxing health care providers since the 1980s to pay for the non-federal portion of Medicaid programs. Congress restricted the use of these taxes in 1991, establishing rules still in place today for how states implement them.

The taxes must be “broad-based” and “uniform,” meaning they must apply equally to all providers equally within a specific class, such as hospitals or nursing homes. States also must not directly or indirectly guarantee that the money will go back to providers — a concept referred to as “holding harmless.”

However, the federal government currently exempts states from the hold harmless requirement on taxes up to 6% of revenues from treating patients. That limit is called the “safe harbor” limit, and according to KFF, 38 states have provider taxes higher than 5.5%. Georgia is the only state with provider taxes below 3.5%, and Alaska is the only state that has no provider taxes.

How would the House and Senate bills change the way they’re levied?

The House’s version of the “One Big Beautiful Bill” freezes provider taxes at their current rates and prevents states from increasing the taxes. The proposed changes in the Senate bill went a step further, reducing the safe harbor annually by 0.5% a year until the rate hit 3.5%, and only in states that have adopted Medicaid expansion.

The House bill would apply to all facilities, while the Senate’s version exempted nursing homes and intermediate care facilities.

What would the ripple effects be?

Twenty-two states would have to cut provider taxes under the original Senate bill, according to an analysis by KFF. That includes blue states like Oregon and New York, but also red states such as Oklahoma and Utah.

Senate Republicans may still try to redraft provider tax provisions, but it’s not clear yet how or what a new version would look like.

A Congressional Budget Office report on the House’s version of the bill estimated that a moratorium on provider tax increases would save about $89 billion in federal spending over 10 years. A freeze on taxes means states lose the flexibility they’ve traditionally been afforded, Orris said.

“If there’s an economic downturn, if the state wants to expand coverage to a different population in the future, if the state tax base for whatever reason changes, you can no longer use provider taxes to fill gaps in the system,” she said.

Without the flexibility that provider taxes provide, and in conjunction with other cuts on the table, states might ultimately be forced to cut benefits and tighten eligibility requirements, Orris said. The CBO estimates that if the House bill were enacted, 10.9 million people would lose insurance by 2034. That influx of uninsured people would likely add strain to hospitals, experts say.

States have often used provider taxes to pay hospitals that serve higher numbers of uninsured patients, Burns said. Cutting those taxes could affect rural areas, where many hospitals operate on razor-thin margins, as well as urban areas, which may also see a high percentage of Medicaid patients, Orris said.

“If a hospital is suddenly getting paid less money for every Medicaid patient it sees — and this is particularly the case under the Senate bill — it sort of defies logic to think that that hospital is going to be OK,” she said. “Then when that hospital closes, or needs to close a maternity ward, it’s not just the Medicaid enrollees who suffer. It’s the entire community.”

Read the full article here

GOP senator warns Medicaid cuts could derail Trump megabill

by Alexander Bolton, the Hill, June 24, 2025

Sen. Josh Hawley (R-Mo.) is warning that President Trump’s megabill could run off the tracks this week if Senate Republican leaders fail to address his GOP colleagues’ concerns that deep cuts to Medicaid spending would devastate rural hospitals in their home states.

Hawley said Republican leaders provided little detail Monday night about how they would help rural hospitals, nursing homes and community health care providers in rural areas.

“I am confident it will not be put on the floor as it is currently. Something will change. They’ll add something, it’s just unclear to me what it is,” he said of the pending Senate legislation.

“It’s all a work in progress,” he said, warning: “This rural hospital stuff, this could threaten the progress of the whole bill.

“Let’s resolve this and move this thing along. Otherwise, we’re going to be sitting here looking at each other in August,” he advised.

One proposal floated by Sen. Susan Collins (R-Maine) is to set up a $100 billion relief fund for rural hospitals, nursing homes and community health centers.

But Senate Majority Leader John Thune (R-S.D.) has so far declined to commit to any specific fix for rural hospitals.

Thune did not tell colleagues how much money he would be willing to allocate to a hospital relief fund, raising questions among GOP senators about whether the bill is ready to come to the floor this week.

Other Republican senators raised concerns Monday about how the debate over the Medicaid-related provisions in the bill is playing out.

“I still have concerns about a few provisions in the bill. I’m not satisfied yet,” said Sen. Jerry Moran (R-Kan.), who cited “Medicaid” as his biggest problem with the legislation.

“Broadly, Medicaid, related to the well-being of hospitals in Kansas and rural America,” he said.

Moran said he is “still making a case” to his leadership that those Medicaid provisions need to be reworked.

Collins last week floated a proposal to establish a health care provider relief fund to help rural hospitals, nursing homes and community health centers.

“I’m not sure where it stands right now,” she said of the Medicaid-related provisions in the bill. “I’m still opposed to the changes in the provider tax provisions.

“I still believe that we need $100 billion provider-relief fund to assist our distressed rural hospitals, nursing homes and community health centers,” she said.

Read the full article here

House GOP moderates tell leadership they won’t back Senate tax bill over Medicaid cuts

By Nathaniel Weixel, The Hill, June 24, 2025

More than a dozen House Republicans warned they won’t support the Senate’s version of the tax and spending bill because the proposed Medicaid cuts are too steep. 

Led by Rep. David Valadao (R-Calif.), 15 other vulnerable Republicans sent a letter to Senate Majority Leader John Thune (R-S.D.) and House Speaker Mike Johnson (R-La.) saying they support the Medicaid reforms in the House version of the legislation, but the Senate Finance Committee proposal went too far. 

“Protecting Medicaid is essential for the vulnerable constituents we were elected to represent. Therefore, we cannot support a final bill that threatens access to coverage or jeopardizes the stability of our hospitals and providers,” the lawmakers wrote. “The House’s approach reflects a more pragmatic and compassionate standard, and we urge that it be retained in the final bill.” 

The Senate Finance Committee draft seeks to clamp down on two tactics states use to boost Medicaid funding to hospitals: state-directed payments and Medicaid provider taxes. The restrictions are a major concern for rural hospitals, a key constituency for senators. 

Republicans have set an ambitious July 4 deadline to pass the bill and send it to President Trump to be signed into law. 

The letter from the lawmakers, who all voted for the bill that included $700 billion in Medicaid cuts over the next decade, is a sign that significant issues still need to be straightened out for the bill to move forward. 

Unlike the House bill, the Senate Finance Committee draft includes a significant cut to the taxes states can levy on medical providers. States impose taxes on providers to boost their federal Medicaid contributions, which they then direct back to hospitals in the form of higher reimbursements. 

The legislation would effectively cap provider taxes at 3.5 percent by 2031, down from the current 6 percent, but only for the states that expanded Medicaid under the Affordable Care Act. The cap would be phased in by lowering it 0.5 percent annually, starting in 2027.   

Non-expansion states would be prohibited from imposing new taxes, but as was true in the House-passed version, their rates would be frozen at current levels. The lower cap would not apply to nursing homes or intermediate care facilities.  

“Throughout the budget process, we have consistently affirmed our commitment to ensuring that reductions in federal spending do not come at the expense of our most vulnerable constituents. We write to reiterate that commitment to those we represent here in Washington,” the members wrote. 

They also expressed concern about “rushed implementation timelines” as well as changes to the work requirements for adults with dependents. The House bill imposes work requirements on Medicaid expansion enrollees aged 19 to 64 but exempts people with dependent children. The requirements will begin in 2027. 

Seeking additional cuts, the Senate version would put those requirements on parents with children over the age of 14. 

Read the full article here

Opinion: ‘Big beautiful bill’ will impose huge costs on disabled individuals and their families

By Allison Wohl, the Hill, June 26, 2025

Until my son Julian was born with Down syndrome in 2009, I knew nothing about the ways that disabled Americans depended on programs like Medicaid to provide the kinds of services and supports they need to live full lives in their communities.  

As I got more involved in advocating for him, I learned about the troubling history of discrimination that consigned disabled Americans to a life of abuse, neglect and institutionalization. I also learned about courageous individuals who created the disability rights movement that catalyzed the legislation, regulations and Supreme Court cases that changed the lives of millions of Americans with disabilities. 

The more I learned, the prouder I became that we lived in a country that invested in people with even the most significant disabilities. It underscores a belief system that investing in everyone’s future exemplifies what it means to be American. 

As the House budget reconciliation bill makes its way through the Senate, the GOP insists that people with disabilities will not be hurt by proposed Medicaid cuts — and, in fact, that the bill does not cut Medicaid but “strengthens” it. This is patently false. Despite claims that this bill only focuses on “waste, fraud, and abuse,” the proposed cuts will devastate the nearly 7 million seniors and people with disabilities who receive these services through Medicaid waivers — as well the 700,000 people on waiting lists for these benefits. (The cuts would trigger reductions in Medicare amounting to about $490 billion over 10 years). 

In addition to the direct loss of federal funds from the largest cut in Medicaid history, there is a second and even more significant impact of the GOP bill that will further impair states’ ability to support disabled Americans. Under the legislation, states would have no choice but to drastically reduce or eliminate Medicaid Home and Community-Based Services. These critical services — personal care assistance, employment supports, transportation, day programs, home modifications and other services — help people with disabilities avoid being placed in institutions.

Without these services, people with disabilities would face a stark choice: have family members leave the workforce to provide them unpaid assistance or be placed in nursing homes, which are significantly more expensive than Medicaid Home and Community-Based Services. These services are cost effective because they reduce both the financial and human costs of institutionalization; proposed reductions in Medicaid would also slash funding for nursing homes. 

The devil is in the details of this bill. Lowering the federal share of payments to a state for Medicaid services significantly decreases the amount of funding that a state has available. Additionally, proposed limitations on provider taxes (which states levy on providers like hospitals and nursing homes) are more severe in the Senate bill, and new administrative requirements would decimate state Medicaid budgets that are critical for funding disability services. It’s a one-two punch: slashing federal funding while making it impossible for states to fill the gap. 

Imperfect as our system for supporting people with disabilities is, no other country has one. Supporting Americans like my son to live their lives as independently as possible is what makes this country great. Helping him to be an employee, a customer, a neighbor and a taxpayer requires investment by both state and federal partners. If the GOP budget plan is enacted, however, it will undermine decades of progress and devastate this system.  

Cutting short future opportunities for millions of disabled Americans will exact enormous financial costs to individuals and their families. But there are also moral costs. Disabled Americans are our friends, neighbors and family members who contribute to our communities and our lives. It is immoral to leave them behind on a quest to cut taxes for corporations and the wealthiest among us. Congress must take a wiser and more compassionate approach and stop its destruction of our country’s social safety net. My son’s future — and the futures of disabled Americans — hangs in the balance. 

Read the full editorial here

Federal budget proposals would cut programs for West Virginians with disabilities 

By Amelia Ferrell Knisely, West Virginia Watch, June 26, 2025

A budget proposal from President Donald Trump and the “One Big, Beautiful Bill Act” that is making its way through Congress contain cuts for disability services in West Virginia — a state with the nation’s highest rate of people with disabilities. 

One in three West Virginia residents live with a disability, according to federal data. The state’s system supporting thousands of people with disabilities is already over stretched due to health care deserts and a shortage of community group homes.

The president’s spending calls for the elimination of all University Centers for Excellence in Developmental Disabilities, including the one housed at West Virginia University, through funding cuts to the Administration for Community Living. Congress will vote on this when they consider funding appropriations later this year.

“The impact will be immediate,” said Lesley Cottrell, director of the WVU Center for Excellence in Disabilities, which provides free services to 340,000 West Virginians living with a disability and their families through a network of programs and six clinics.

The budget bill contains proposed cuts to Medicaid, which Cottrell said will also impact their services in West Virginia.

The center oversees the state’s only feeding and swallowing clinic. Cottrell said that without federal funding, the clinic won’t be able to serve patients, including children, who struggle to eat. 

The programs around the state have also helped children with communication disorders interact with the world by using augmentative and alternative communication devices, supported individuals with traumatic brain injuries and helped people with disabilities find jobs.

[The President’s] proposal lumps the nationwide developmental disability programs into diversity, equity and inclusion initiatives, which leading Republicans don’t want to fund amid a GOP-crack down on diversity, equity and inclusion (DEI) programs.

Cottrell said categorizing the CED program as DEI is an unfair description. 

“Without placing any judgment on DEI programs or initiatives … We are not, by definition, a DEI program in the sense that anyone — family or individual with those disabilities — can get our services for free. We don’t separate it by age, gender, ethnicity, race,” she explained. “Some of the foundations of DEI initiatives just aren’t present.”

Continued

Cash-strapped Minnesota hospitals scramble for $1B in Medicaid money

By Jeremy Olson, Minneapolis Start Tribune, via Insurance News Net, June 20, 2025

The race is on for Minnesota to net as much as $1 billion in federal Medicaid support and help some of the state’s vulnerable hospitals stay open.

Soon, that opportunity could close. For good.

Minnesota lawmakers greenlit the effort last week when they finalized the state budget. That gave the Department of Human Services (DHS) permission to pursue a directed-payment program that would boost federal payments to hospitals without raising costs on patients or the state.

Trouble is, they left hospital and DHS leaders with only three weeks to apply for the program before Congress’ self-imposed July 4 deadline to approve a federal budget. The House version of that budget prohibits new directed-payment programs; the Senate and Trump administration are considering cuts that could make these programs less valuable.

“We do have to get it in on time,” said Joe Schindler, vice president of finance policy for the Minnesota Hospital Association. It’s “last-best option” for a struggling industry, he added.

“Hospitals are desperate, at this point,” he said.

Minnesota is late in its pursuit of directed payments. More than 40 states have added them in the past decade to help hospitals gain more money from Medicaid. A combination of federal and state tax dollars finance that health plan for 71 million disabled and low-income Americans.

Minnesota created a directed-payment program three years ago for Hennepin Healthcare, shoring up revenues for the urban trauma center that treats a high volume of uninsured and impoverished patients. Schindler said hospitals didn’t lobby for a statewide version until now because they hoped Minnesota would simply boost Medicaid payment rates and prevent the need for this complex financing mechanism.

The rapid growth of directed-payment programs made them an appealing target this year when President Donald Trump sought to eliminate more than $600 billion from Medicaid to partially offset his tax cuts and other spending priorities.

One conservative thinktank likened directed payments to government-sanctioned money-laundering, because hospitals pay special state taxes that trigger more lucrative federal reimbursements in return.

Such labels miss the point, said Charles Esler, Hennepin Healthcare’s finance vice president. Medicaid typically pays about 60 to 70 cents on the dollar for the actual cost of health care. Esler said directed-payments merely close that gap.

He said the health care system was “in a survival mode at the time” when it gained approval for directed payments.

“We would have been left making difficult choices on services and people and everything else,” Esler said. “So that additional money effectively kept us where we are at today.”

Continued

Note: The following report is cited in the resr of the articles listed below

GOP budget bill could put 338 rural hospitals at risk of closure: Report   

By Andrew Case, Becker's Hospital Review, June 13, 2025

Proposed healthcare cuts in Republicans’ “One Big Beautiful Bill Act” could place 338 financially struggling rural hospitals at risk of closure, according to the data from the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill. 

The data was prepared following a request from Senate Democrats, who released the findings June 12. 

The 338 hospitals either experienced three consecutive years of negative total margins, served the highest share of Medicaid patients, or both. 

The states with the highest number of hospitals at risk are Kentucky (35), Louisiana (33), California (28) and Oklahoma (21).

Here is the breakdown of at-risk rural hospitals by state:

• Kentucky – 35
• Louisiana – 33
• California – 28
• Oklahoma – 21
• New Mexico – 15
• Texas – 15
• Washington – 14
• Indiana – 12
• New York – 11
• Ohio – 11 
• Illinois – 9
• Tennessee – 9
• Mississippi – 8
• Montana – 8
• West Virginia – 7
• Colorado – 6
• Hawaii – 6
• Kansas – 6
• Virginia – 6
• Alabama – 5
• Alaska – 5
• Arizona – 5
• North Carolina – 5
• Pennsylvania – 5
• South Carolina – 5
• Georgia – 4
• Michigan – 4
• Missouri – 4
• Oregon – 4
• Wisconsin – 3
• Idaho – 3
• North Dakota – 3
• Utah – 3
• Iowa – 2
• Maine – 2
• Minnesota – 2
• Nebraska – 2
• Nevada – 2
• South Dakota – 2
• Wyoming – 2
•  Arkansas – 1
•  Connecticut – 1
•  Delaware – 1
•  Florida – 1
•  Massachusetts – 1
•  New Hampshire – 1

Read the full article here

Medicaid cuts in Trump tax bill could close 6 rural hospitals in Colorado, report warns  

By Meg Wingerter, The Denver Post, June 22, 2024

Six rural Colorado hospitals could close in the coming years if Congress adopts the more than $600 million in Medicaid cuts currently included in the Republican tax bill, according to projections commissioned by Senate Democrats.

The listed hospitals are spread across the state, including three on the Western Slope, one in the San Luis Valley and two on the Eastern Plains. The report is based on one version of an evolving bill, so the final result could cause financial distress for fewer, or more, Colorado hospitals than anticipated.

Other types of providers, including community mental health centers and safety net clinics in Colorado, also expect to cut services or close locations, though groups representing the clinics don’t foresee providers going under entirely. The Senate report didn’t examine effects on provider types other than hospitals.

Researchers at the University of North Carolina at Chapel Hill, in a report requested by Senate Democrats, estimated that 338 rural hospitals nationwide could close if Medicaid cuts go through, including six facilities in Colorado.

The report included hospitals that have an outsized share of patients covered by Medicaid and those that have lost money three years in a row.

The Colorado facilities on the list were:

• Delta Health Hospital in Delta
• San Luis Valley Health Conejos County Hospital in La Jara
• Grand River Health in Rifle
• Prowers Medical Center in Lamar
• Southwest Memorial Hospital in Cortez
• Arkansas Valley Regional Medical Center in La Junta

The list doesn’t include all hospitals that could struggle; Lincoln Health CEO Kevin Stansbury told NBC News that the hospital in Hugo would have to reduce services or close if significant cuts to Medicaid go through.

Read the full article here

15 rural Texas hospitals could close if Trump’s 'Big Beautiful Bill' passes, Democrats warn

“Rural hospitals are scared and getting attention because our operating margins are so thin,” said John Henderson, President and CEO of Texas Organization of Rural and Community Hospitals. “44% of rural Texas hospitals had negative margins in 2023. We will be the first provider type to feel the effects.”

Texas has 157 rural hospitals, Henderson added, and one-third of them have less than 10 days' cash on hand.

The Republican spending bill that the U.S. Senate is now considering will cut Medicaid spending by $785 billion over a decade. The House of Representatives already approved it.

The Medicaid cuts would be used in part to offset the costs of extending President Trump’s 2017 tax cuts.

WFAA contacted the 15 Texas hospitals listed in the UNC study that Democrats cited. They all acknowledged the tight financial conditions under which rural hospitals operate, but none of the facilities said they were on the precipice of closure.

Covenant hospitals in Plainview and Levelland, Texas — near Lubbock — are two of the 15 on the UNC list.

“If the One Big, Beautiful Bill Act is enacted, as proposed by the U.S. House, we anticipate our Medicaid reimbursement would decline by $1.5 billion over the next five years," a Providence spokesperson said in an emailed statement to WFAA. "Although none of our hospitals listed in the Cecil G. Sheps Center for Health Services Research are at immediate risk of closure, Providence is evaluating all aspects of its operations to ensure our health system remains sustainable and can continue to provide high-quality, affordable care for years to come,” said a Providence spokesperson in an emailed statement to WFAA.

Palacios Community Medical Center, Mid Coast Medical Center — Central in Llano, and El Campo Memorial Hospital also made the list.

The CEO of their parent company, Mid Coast Health System, said the state legislature recognizes the situation with rural healthcare and just approved legislation to assist.

“The State of Texas has approved plans that are with the governor to sign that will assist rural hospitals to improve Medicaid reimbursements. Rural healthcare has and continues to be a challenge, but our local hospital tax districts and other programs provide us with support to offset a lot of those challenges,” said Brett Kirkham, CEO of Mid Coast Health System.

Still, the UNC data states that 21 rural hospitals in Texas have already closed since 2010. 

Read the full article here

LIST: These Kentucky and Indiana hospitals could be impacted by proposed Medicaid cuts

By Margaret Vancampen, WHAS News, June 24, 2025

Dozens of rural Kentucky and Indiana hospitals could be impacted by the proposed budget cuts to Medicaid.

Kentucky hospitals potentially impacted:

• Whitesburg ARH
• Highlands Regional Medical Center
• UofL Health-Shelbyville
• T.J. Samson Community Hospital
• St. Claire Medical Center
• Middlesboro ARH
• Spring View Hospital
• Adventhealth Manchester
• Bourbon Community Hospital
• Harlan ARH
• Deaconess Henderson Hospital
• Saint Joseph Mount Sterling
• TUG Valley ARH
• Owensboro Health Twin Lakes Medical
• Baptist Health Corbin
• Clark Regional Medical Center
• Baptist Health Madisonville
• The Medical Center of Albany
• Three Rivers Medical Center
• Kentucky River Medical Center
• TJ Health Columbia
• Pineville Community Health Center
• Marcum and Wallace Memorial Hospital
• Our Lady of the Way
• Casey County Hospital
• Carroll County Memorial Hospital
• The Medical Center at Caverna
• Fort Logan Hospital
• Mary Breckinridge Hospital
• Jane Todd Crawford
• Barbourville ARH Hospital
• Saint Joseph Berea
• Russell County Hospital
• McDowell ARH
• Fleming County Hospital

Indiana hospitals:

• Daviess Community Hospital
• Memorial Hospital Logansport
• Community Hospital of Bremen Inc.
• Ascension St. Vincent Randolph
• Ascension St. Vincent Jennings
• Ascension St. Vincent Clay
• Ascension St. Vincent Salem
• IU Health Jay Hospital
• Franciscan Health Rensselaer
• Sullivan County Community Hospital
• Adams Memorial Hospital
• Harrison County Hospital

Read the full article here

Opinion: Massachusetts facing a disability workforce crisis

By Brian Cusack (Board President of the Arc of Massachusetts). The Boston Herald, June 25, 2025

Massachusetts is facing a structural failure in its disability services system, due to a failure to support the workforce. This does not only have a real human cost; it also creates an economic loss for the Commonwealth.

Direct Support Professionals (DSPs) are responsible for the daily care, safety, and well-being of individuals with intellectual and developmental disabilities (IDD) and autism. As of October 2024, in the state of Massachusetts, a staggering 19% of DSP roles were vacant, resulting in an estimated 2,400 adults with IDD and autism being unable to attend day or employment services. These programs offer critical care to individuals with IDD and autism and provide a sanctuary for them to form relationships, create routines, and work in their communities. As a result of this shortage, many are losing out on beneficial opportunities and necessary services.

Additionally, with advancements in medicine and social services, individuals with IDD and autism are living longer, and their needs are becoming more complex. As a society, we need more accessible and affordable long-term care solutions to serve this growing population of older individuals. Instead, we are seeing the opposite. Human service agencies and direct support care groups are limiting services and closing their programs, creating immense barriers and restricting care for the most vulnerable.

To address the critical worker shortage, Massachusetts must prioritize benefits and training and improve pay for DSPs. By doing so, the state government will signify the importance of community and government support in direct support roles, ultimately improving the direct support labor crisis.

Better benefits and access to comprehensive training resources will encourage more people to pursue a career in the direct support profession. Support from employers can help to improve staff morale and lower rates of employee burnout, making it easier for direct support staff to prioritize their physical and mental wellbeing. While benefits can help to improve the labor crisis by lowering rates of burnout, better pay rates are necessary to create a long-lasting solution to the shortage.

DSPs are currently paid a median rate of $20.79 an hour for life-affirming care. That is not sustainable. The physical, mental, and emotional work required of DSPs does not equal the current median pay rate and is ultimately contributing to employee burnout and turnover. According to the Association for Developmental Disabilities Providers, turnover exceeds 40% annually among direct support professionals, negatively impacting the individuals they serve.

This labor shortage is not simply a staffing issue. It is a systemic risk with fiscal and operational consequences. Insufficient staffing disrupts service delivery, increases reliance on costly emergency interventions, and drives long-term expenditures on healthcare. Every day that this problem persists, it strains the Commonwealth’s budget, threatens the viability of community-based care, and negatively impacts communities across the state. Increasing salaries is short money for the increase in benefits and savings Massachusetts will reap in return.

In her first FY26 budget draft, Governor Maura Healey proposed an increase of $34 million for human services rates – but this is not sufficient. This amount will neither stabilize the workforce, nor address the scale of the retention problem.

Read the full editorial here

Nebraska - There's a disconnect between developmental disability waiver offers and services, according to new data

By Aaron Bonderson, Nebraska Public Media, June 25, 2025

The Nebraska Department of Health and Human Services has sent more than 3,100 families state developmental disability funding offers since Gov. Jim Pillen launched an initiative last spring to end an eight-year waiting list.

About 1,400 families have accepted their offer from DHHS. Of those 1,400 families, data shows only 339, or less than 25%, are using their allocated funding for a service program, according to an email response from DHHS spokesperson Erin Maier.

That means only 11% of families so far that have been offered an intellectual or developmental disability waiver are actually using those dollars to access programs.

Maier said nearly 290 of the 1,400 families who accepted an offer are no longer receiving services or they requested to utilize their funding for a later date.

Executive Director of the Nebraska Association of Service Providers Alana Schriver said the lack of provider availability has caused the low usage numbers. Low wages and staffing levels have led to the limited capacity of services in the state, Schriver said.

During a press conference on Monday, Tony Green, director of the division on developmental disabilities at DHHS said agency staffing is always a challenge.

“But I can tell you the data that we're seeing now coming from the providers in their state of the workforce surveys are showing a positive trend in less vacant positions being there,” Green said, “and we're also seeing a reduction in the turnover, which also was plaguing some of our providers.”

Continued

State auditor joins Kentucky families in demanding accountability for Medicaid mishap

By Logan Perrone, WAVE 3 News, June 25, 2025

Months after sudden and unexpected Medicaid denials impacted families across Kentucky, the Commonwealth Office of the Ombudsman is seeking answers.

Kentucky Auditor Allison Ball announced Tuesday that the office had asked the Cabinet for Health and Family Services (CHFS) about the recent widespread denials of Home and Community Based Services (HCBS) waivers to children across the state.

In a May letter to impacted families, the CHFS said issues with a subcontractor were discovered.

“My office is committed to ensuring that critical services reach the Kentuckians who need them most,” Ball said in a press release. “We are investigating how this happened and are working to ensure safeguards are in place to prevent it from occurring again.”

Ball’s office joins parents in demanding accountability. Marion County mom Trina Martin is one parent who has asked for public records to gain more clarity into what happened.

“For me, my priority is to find out why this happened,” Martin said.

CHFS reinstated 112 of the 151 youth waivers they reassessed, including Martin’s nine-year-old daughter Ellie’s. Nearly all of those were children with Autism and or Down Syndrome.

“All of us families felt like our kids were targeted,” Martin said. “That really pushed me harder to fight to dig in and get more information and see what happened.”

Martin is still waiting for public records to be provided to her and still does not know exactly how the denials happened.

In the letter to the head of CHFS on Tuesday, Kentucky Auditor Allison Ball’s office asked the cabinet for specific factors or events that led to the denials. The office also asked how the office plans to prevent this mistake from happening again.

Read the full letter here.

Continued

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Follow up:

Error that caused Medicaid denials has been corrected, says cabinet in response to auditor letter

By Sarah Ladd, The Kentucky Lantern, June 26, 2025

Read the article here

Texas is illegally keeping people with disabilities in nursing homes, federal judge rules

By Stephen Simpson, The Texas Tribune, June 20, 2025

Texas has been violating federal law for decades by sequestering individuals with severe disabilities in poorly run nursing homes without offering them alternative living options and services in the community, a federal judge has ruled.

U.S. District Court Judge Orlando Garcia from the Western District Court of Texas ruled on Tuesday that the state has caused irreparable injury to people with intellectual and developmental disabilities by denying them specialized services, including federally-required services within the community.

“Although community programs are the most integrated setting appropriate to meet their needs, they remain unnecessarily institutionalized in nursing facilities, or at serious risk of such institutionalization. They are harmed by such institutionalization and deprived of living in a community setting and participating in integrated community programs,” Garcia said in his 475-page ruling.

The decision stems from a class action lawsuit, filed in 2010 by disability rights advocates and six institutionalized plaintiffs between the ages of 26 and 46, that alleges that state social services officials have violated the Americans with Disabilities Act by failing to provide appropriate treatment to some 4,500 Texans living in nursing homes.

Advocates say the state has consistently sent individuals who were receiving care for their disabilities at home or in the community to nursing homes by mistake after being hospitalized for an illness. Once there, they don’t receive the services they need because they haven’t been adequately screened, and they are effectively trapped, since many can’t argue for their transfer.

The state coordinates services for the severely disabled through Medicaid waiver programs. Funded by the state and federally, the programs help pay for various services, including residential support, skill development, job coaching, home modifications and specialized therapies.

Most individuals with intellectual or developmental disabilities are placed on a waitlist for one of these Medicaid waiver programs at an early age. By the time they become adults, the state funds most of their care, making them reliant on the decisions made by state agencies.

Jennifer Ruffcorn, a spokesperson for Texas Health and Human Services Commission, said in an email this week that the agency is reviewing the judge’s decision.

In 1987, the U.S. Congress passed the Nursing Home Reform Act after a study found that many nursing home residents were not receiving adequate care and that neglect and abuse were common. This also mandates nursing homes to screen all applicants for evidence of severe mental illness and IDD before admitting them. The goal was to ensure individuals with severe disabilities were not inappropriately placed in nursing homes, which degraded their overall health more quickly than if they received services in the community, according to the study.

Garcia stated in his opinion that the state’s failure to provide these services constitutes a longstanding violation of several federal laws, including the Nursing Home Reform Act, the Americans with Disabilities Act, and the Medicaid Act.

Read the full article here

Florida nonprofit founder, accountant charged with stealing over $100M from special needs victims, DOJ says

By Justice Covert, Click Orlando, June 25, 2025

Two Florida men were officially charged on Monday by the U.S. Department of Justice for allegedly employing a fraudulent scheme to steal over $100 million from a nonprofit organization that managed funds for people with special needs and disabilities, the department said.

In or around 2000, Leo Joseph Govoni, 67, of Clearwater, co-founded the Center for Special Needs Trust Administration, according to court documents. The organization grew to be one of the largest administrators of special needs trusts in the country, officials said, representing beneficiaries in every state who received court awards, settlements and other payments.

As of February 2024, the indictment alleges CSNT managed over 2,100 special needs trusts containing approximately $200 million.

Govani and John Leo Witck, 60, of Tampa, who worked at CSNT as an accountant, allegedly set up a slush fund with their co-conspirators from June 2009 through May 2025, allegedly stealing misappropriated client-beneficiary funds and concealing it through complex financial transactions, including allegedly sending fraudulent account statements with false balances to disabled victims, DOJ said.

“The scale and audacity of the alleged fraud in this case are deeply troubling,” IRS Criminal Investigation Chief Guy Ficco said. “Stealing funds intended to protect and support people with special needs is as cruel as it is criminal.”

Continued

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Direct Support Professionals!

VOR ❤️s OUR

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Our loved ones' caregivers are essential to their health, safety, and happiness.

In appreciation of their good work and kind hearts, VOR offers free digital memberships to any DSP who would like to receive our newsletter.

We encourage our members to speak with their loved ones' caregivers to extend this offer of our gratitude.

If you are a Direct Support Professional interested in receiving our newsletter and e-content, please write us at

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with your name, email address, and the name of the facility at which you work. Please include the name of the VOR member who told you of this offer.

[Please click on blue link to view information about the bill]

VOR SUPPORTS:

H.R.1950 - Rep. Mark Pocan (D-WI)

To protect benefits provided under Social Security, Medicare, and any other program of benefits administered by the Social Security Administration or the Centers for Medicare and Medicaid Services. 

H.R.869 - Rep. Susie Lee (D-NV)

To require full funding of part A of title I of the Elementary and Secondary Education Act of 1965 and the Individuals with Disabilities Education Act.

H.R.1509 - Rep. Lori Trahan (D-MA)

Accelerating Kids' Access to Care ActTo amend titles XIX and XXI of the Social Security Act to streamline the enrollment process for eligible out-of-state providers under Medicaid and CHIP.

S.752 - Sen. Chuck Grassley (R-IA)

Accelerating Kids' Access to Care Act - A bill to amend title XIX of the Social Security Act to streamline enrollment under the Medicaid program of certain providers across State lines.

S.779 & H.R.1735 - Sen. Alex Padilla (D-CA) & Rep. August Pfluger (R-TX)

To amend title XIX of the Public Health Service Act to provide for prevention and early intervention services under the Block Grants for Community Mental Health Services program

H.R.2491 & S.1227 - Rep Kat Cammack (R-FL) & Sen. Edward Markey (D-MA)

To require the Administrator of the Centers for Medicare & Medicaid Services and the Commissioner of Social Security to review and simplify the processes, procedures, forms, and communications for family caregivers to assist individuals in establishing eligibility for, enrolling in, and maintaining and utilizing coverage and benefits under the Medicare, Medicaid, CHIP, and Social Security programs



H.R.2598 - Rep Jared Huffman (D-CA)

To amend part B of the Individuals with Disabilities Education Act to provide full Federal funding of such part.

H.R.1262 & S.932 - Rep. Michael McCaul (R-TX) and Sen. Markwayne Mullin (R-OK) "Give Kids A Chance Act" - To amend the Federal Food, Drug, and Cosmetic Act with respect to molecularly targeted pediatric cancer investigations. This bill would renew research into pediatric cancers and includes increasing funding for rare diseases, some of which cause Intellual and developmental disabilities and autism.  

VOR OPPOSES:

H.R.1 - The One Big Beautiful Bill Act - Rep. Jody Arrington (R-TX) This bill contains provisions to make drastic cuts to Medicaid. The consequences of these cuts could impact HCBS services, further destabilize the DSP workforce, and even impact ICF services. In addition, the bill would add $2.4 billion to the deficit over ten years, which could result in further cuts to safety net programs, including Medicaid, Medicare, and Social Security, in the years to come.

H.R.2743 & S.1332 - Rep. Bobby Scott (D-VA) & Sen. Bernie Sanders (I-VT) Raise the Wage Act - A bill to provide increases to the Federal minimum wage and for other purposes. VOR opposes the provision in this bill that would phase out section 14(c) amd sheltered workshops for indiviiduals with I/DD and autism.