June 5, 2026

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.

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VOR Annual Members Meeting

July 28, 2026

2:00 - 5:30 pm Eastern / 1:00 - 4:30 Central / Noon - 3:30 Mountain / 11 am - 2:30 pm Pacific

• Board of Directors Open Meeting
• Guest Speakers - To Be Announced
• Annual State Reports Forum

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VOR's 2026 Legislative Initiative

June 8 - 10

Washington D.C.

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http://www.vor.net/legislative-voice/legislator-toolkit/2026-initiative

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CMS Requires More Restrictive Definition of Medical Frailty in New Medicaid Work Requirements Rule

By Jennifer Tolbert, KFF, June 2, 2026

On June 1, 2026, the Centers for Medicare and Medicaid Services (CMS) issued a long-anticipated interim final rule that will guide state implementation of Medicaid work requirements. The 2025 reconciliation law requires 43 states to condition Medicaid eligibility for adults in the Affordable Care Act (ACA) Medicaid expansion group and enrollees in partial expansion waiver programs (Georgia and Wisconsin) on meeting work requirements starting January 1, 2027 or sooner at state option. Most Medicaid adults are already working or face barriers to work, and the Congressional Budget Office estimates that the new requirements will not meaningfully increase employment by Medicaid enrollees, but that millions of people will end up uninsured.

At nearly 400 pages, the rule is quite long and complex and will require time to fully assess its implications. Given the complexity of the provisions in the rule, states will likely face significant challenges in operationalizing the requirements in the next six months. With the short implementation timeline, states were already making implementation decisions that may not align with the rule. These challenges present risks for states given the potential for audits and financial penalties, but also for individuals who now face greater barriers to obtaining and maintaining coverage.

Significantly, the rule adopts a restrictive definition of medical frailty that differs from states’ early expectations. States have been eagerly awaiting clarification on how to define medical frailty. Early indications from CMS offered through informal meetings with states hinted that the federal definition might mirror an existing medical frailty definition used for determining individuals who are exempt from receiving an alternative benefit package, and that states would be given flexibility to go beyond the federal definition. However, on both counts, the rule adopted a more restrictive approach, first tying medical frailty specifically to the ability to comply with the community engagement requirement (i.e., the ability to work) and prohibiting states from adding categories of individuals to the medical frailty definition. To operationalize this definition, the rule requires states to develop lists of health conditions but prohibits them from categorically exempting people with those conditions without considering an individual’s ability to meet the community engagement requirement based on their health. The rule does not provide states with a list of diagnoses or criteria for measuring severity or ability to meet new requirements. For example, the rule does not allow states to exempt all people with cancer, HIV, Parkinson’s disease, or multiple sclerosis. This significant change may pose challenges for states that had been moving forward with developing lists of diagnosis codes assuming a less restrictive definition and could make it more difficult for individuals to document medical frailty.

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Medicaid Changes Will Push People With Disabilities Off Program, Advocates Warn

By Michelle Diament, Disability Scoop, June 3, 2026

The Trump administration is unveiling long-awaited details about how new, more stringent Medicaid eligibility rules will be applied and raising fresh concerns about implications for people with disabilities.

The Centers for Medicare and Medicaid Services issued an interim final rule this week spelling out standards for Medicaid work requirements, which most states must implement by the start of next year.

The so-called “community engagement” requirements stipulate that many Medicaid beneficiaries must prove that they are working, volunteering or going to school at least 80 hours per month in order to qualify for coverage. The new mandate was part of a sweeping law approved by Congress last summer that included nearly $1 trillion in Medicaid cuts.

Under the legislation, individuals who are “medically frail” or who have “special medical needs” including those with physical, intellectual or developmental disabilities are supposed to be exempt from the work requirements. Parents, guardians, caretaker relatives and family caregivers of those with disabilities are also exempt.

Until now, however, it’s been unclear how states will determine who qualifies for the exemptions.

The 387-page rule published Wednesday indicates that individuals with physical, intellectual or developmental disabilities will be considered “medically frail” only if their condition “significantly impairs” their ability to perform at least one activity of daily living, or ADL, which includes bathing, dressing, walking, toileting, eating or getting in and out of bed or a chair.

“An individual with such a disability that does not significantly impair their ability to perform one or more ADLs would not qualify for this exclusion,” the rule states.

Other categories that can qualify as “medically frail” include people who are “blind or disabled,” individuals with substance use disorder, a “disabling mental disorder” or a serious or complex medical condition.

To be considered “disabled,” a person would have to be “unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve months.”

The Trump administration is hailing the new effort citing a study from the U.S. Department of Health and Human Services indicating that work requirements could reduce poverty by 1.6 to 2.9 million people.

“This rule helps Americans build skills and independence through work, education, job training, or community service, creating new opportunities for themselves and their families,” said CMS Administrator Mehmet Oz.

However, the rule is setting off alarm bells for disability advocates who warn that the parameters put forth by CMS for people with disabilities to claim an exemption are far more limited than the definition of disability under the Americans with Disabilities Act.

“Despite Congress’ promises that people with disabilities will be exempt from these requirements, not all people with disabilities are exempt. Disabled people will lose access to Medicaid,” said Maria Town, president and CEO of the American Association of People with Disabilities.

Advocates cited research showing that work requirements do not increase employment, but merely force people off Medicaid. When Arkansas implemented work requirements for some Medicaid recipients in 2018, they note that more than 18,000 people were cut from the program in just 7 months, in many cases because they didn’t know about the new mandate or they struggled to report work hours or obtain an exemption.

Continued

Trump’s Medicaid work rules force states to scrap plans and rework systems       

By Rachana Pradhan and Samantha Liss, KFF Health News via MM+M online, June 4, 2026

The Trump administration’s rollout of a federal mandate that millions of Americans on Medicaid must work or risk losing health benefits will force states to scrap months of preparation, according to advocates for Medicaid enrollees and consultants advising states.

And they say an overhaul — less than seven months before states must start enforcing the requirement — will be costly.

Regulations issued June 1 by the Centers for Medicare & Medicaid Services dictate many granular details about how the new work requirements will play out. They cover how states should check whether Medicaid enrollees are following the rules, and how people can claim an exemption so that their health benefits don’t hinge on work, community service, or going to school.

Next year, President Donald Trump’s One Big Beautiful Bill Act could require roughly 18.5 million adults across 42 states and the District of Columbia who receive Medicaid benefits to prove they’re working or participating in a similar activity to keep their health coverage — unless they qualify for an exemption.

Much of the verification will run through state computer systems that assess whether low-income people qualify for Medicaid and other safety net programs — technology often built and run by private companies under contracts routinely worth hundreds of millions of dollars. Many of those systems have a history of errors that can cut off benefits to eligible people.

For months, states have been communicating with federal regulators and rushing to build systems to comply with the looming mandates, said Kinda Serafi, a partner at the Manatt Health consulting and legal firm. The rules released this week represent a “significant policy pivot” from what states were expecting, Serafi said.

“The administration has actually taken what we know to be a tough situation and has just made it even worse,” Serafi said. States had already committed to paying contractors tens of millions to adjust their systems.

After Trump signed his signature tax-and-spending bill into law last July, one of the most significant remaining questions was how much discretion the federal government would give states to define exemptions for people too sick to work. The “medical frailty” exemption allows a person to claim they have a health condition that prevents them from working at least 80 hours a month, as the law requires.

To qualify, a person generally must fit into at least one of five categories: They must be blind or disabled; have a substance use disorder; have a disabling mental disorder; have a physical, intellectual, or developmental disability that significantly impairs their daily life; or have a serious medical condition. States are not allowed to add categories.

Under the new regulations, CMS said having a medical condition alone isn’t sufficient to exempt someone from the work requirements. States must assess “the severity of an individual’s condition” to determine whether they can stay on Medicaid without working — a standard that makes it more difficult for enrollees to meet the criteria.

CMS officials did not list specific conditions that qualify for exemptions, but the agency did say homelessness can’t be a reason to claim that exemption because it is not a medical condition.

To implement the law, states “will have to undo work that they did,” said Daniel Meuse, deputy director of Princeton University’s State Health and Value Strategies program, which works with state governments on various health coverage issues.

Continued

For more articles and opinions on Medical Frailty and the new Medicaid Work Rules:

Millions at Risk of Losing Health Coverage as CMS Releases Medicaid Work Reporting Requirement Rule that Creates Confusion and Chaos for States

Statement from Families USA

Click here to read

Administration’s Last-Minute Restrictions Likely to Worsen Impact of Medicaid Work Requirement

By Jennifer Wagner and Allison Orris, Center on Budget and Policy Priorities, June 3, 2026

Click here to read

Trump’s Cruel Medicaid Work Requirements: Can States Mitigate the Damage?

By Eileen Appelbaum, Center for Economic and Policy Research, June 4, 2026

Click here to read

The White House Just Made Medicaid Work Requirements Even Worse

“It’s hard not to think that the cruelty of the policy is the point.”

By Julia Métraux, Mother Jones, June 4, 2026

Click here to read

HHS funding fight kicks off

By Kelly Hooper and Sophie Gardner, Politico, June 5, 2026

House lawmakers are scheduled to mark up a bill this morning that proposes a 4 percent reduction in funding for the Department of Health and Human Services — billions less than President Donald Trump requested, but still far below funding levels Democrats would like to see.

Trump’s budget plan sought a 12.5 percent reduction for 2027, but GOP appropriators have proposed a more modest cut that would set funding for the nation’s health agencies at $110.8 billion. That compares with the $116.6 billion lawmakers approved in February for the fiscal 2026 discretionary budget.

Why it matters: Today’s markup at the House Appropriations Health Subcommittee will be the first of several meetings on the budget bill where Democrats and Republicans are expected to spar over the legislation’s funding levels and provisions.

The House bill would give a $100 million boost to the National Institutes of Health, which provides funds that universities rely on for health research. Boosting funds for the agency has been largely bipartisan in Congress as both parties hope to see funds for biomedical research sent to their states. Trump has proposed shaving $5 billion off the NIH.

“This bill balances the need for responsible fiscal stewardship, while maintaining key investments in biomedical research, America’s schools, and core public health,” said Rep. Robert Aderholt (R-Ala.), who chairs the subcommittee that funds HHS, in a news release.

But funding cuts and certain provisions in the bill have already riled up Democratic appropriators. Democrats on the Appropriations Committee released a memo Thursday contending that the proposal would jeopardize health coverage for millions of Americans, hurt women’s health and abandon ongoing health crises.

Continued

RFK Jr. Seeks To Peek At Americans’ Medical Records For Clues On Autism And Vaccines

By Amanda Seitz and Darius Tahir, KFF Health News, via Disability Scoop, June 5, 2026

U.S. health secretary Robert F. Kennedy Jr. is pursuing federal government access to most Americans’ medical records, in a quest to research a link between vaccines and autism — a connection the medical establishment studied for decades and flatly rejects.

The Department of Health and Human Services is seeking data from little-known state systems that allow hospitals and clinics to exchange detailed, identifiable patient information, KFF Health News has learned.

In private meetings, some public health leaders have objected to giving Kennedy’s team access to such data, raising doubts that it’s legal or that the information would even be useful.

They have also expressed concerns about allowing the federal government to peer into the minutiae of Americans’ medical records, which could mean viewing anything from doctors’ notes to prescription history. HHS has offered no insight into how it will protect or handle the personal health information it obtains.

But Kennedy told KFF Health News that medical records are key to investigating the cause of autism, vaccine safety, and chronic diseases. And millions of dollars in grant money has poured into a Nebraska nonprofit that has assisted Kennedy’s effort, according to state records.

Continued

Kentucky families raising children with autism demand road map for residential care

By Brooke Hasche, WHAS 11 News, June 4, 2026

They drove in from Owensboro, Louisville, Lexington and Elizabethtown. They filled a conference room at the Sawyier Public Library in Frankfort. And they waited for the people who could actually change things to show up. Most didn't.

Kentucky families raising children with profound autism gathered recently to demand answers from state officials about a crisis playing out quietly in homes across the commonwealth — children so severely impaired they require residential care that doesn't exist in Kentucky, leaving parents to send them hundreds of miles away or, in some cases, surrender custody to the state just to access help.

Top officials from the Cabinet for Health and Family Services, the Department for Medicaid Services and the Governor's office were invited. So were members of the General Assembly. Louisville State Rep. Sarah Stalker was among the few lawmakers who came.

"Where is the blueprint for this?" Stalker asked. "Where is the road map? How can we make it easier? Why have we not figured this out yet?"

'I was afraid of my own child.'

For many of the parents in the room, the path to this meeting ran through years of crisis — psychiatric hospitalizations, violent episodes at home, and a Medicaid waiver system that can take a decade or more to navigate, only to find the promised services aren't available.

Rachel Moldoveanu, a Louisville mother whose son, Frankie, was sent to a facility roughly 700 miles from home, described the moment she realized her family had reached a breaking point.

"For the first time in my life, I was afraid of my own child," she said. "He would attack us while we were driving, almost caused numerous accidents."

She used all her resources, called top officials from Medicaid and CHFS, called attorneys and the Seven Counties Crisis Hotline. The phone kept ringing. She was passed from one number to the next. When someone finally called, she was told there was nothing they could do.

"I began to network underground," Rachel said. She was approached multiple times by caseworkers who told her surrendering custody to the state was the only way to access resources. She refused.

"Leaving your child 700 miles away is devastating," she said. "It is a leap of faith that you can't even describe."

Shannon Crawford, whose son Chase is profoundly autistic and nonverbal, described years of violent episodes — broken windows, head-banging in public parking lots — before she made the ultimate decision to get him help out of state. She said a WHAS11 story on the Moldoveanu Family was the deciding factor.

"Everything I learned was through other mothers," Crawford said.

Mariam Applegate, whose daughter, Reese, is now at the same out-of-state facility as Frankie and Chase, said the process of navigating Medicaid left her with more questions than answers.

"I don't know who to call," she said. "Who is my point of contact?"

A system with no one at the helm.

Kentucky currently spends an estimated $14 million a year in Medicaid funds sending children out of state for residential care — a fraction of what advocates say is actually needed.

Dr. Sheila Schuster is the chair of the Medicaid Advisory Council and a retired child psychologist. She began her advocacy in the 1970s when autism prevalence was estimated at 1 in 10,000 children — today it is 1 in 31. She said the gap reflects both a funding problem and a political one.

"There is such a negative feeling among many legislators that Medicaid is overspending, covering people who don't need the services," she said, adding that she intended to relay what she heard to top Medicaid officials.

She said there are 17,000 Kentuckians on waiting lists for Medicaid home and community-based waivers. State lawmakers this year approved funding for 405 new slots.

Continued

Ohio - Local father, son work to change guardianship rules, prevent care delays when turning 18

By Christian Hauser, WKRC, June 3, 2026

For Ohio families raising children with special needs, turning 18 can create a sudden legal gap that delays care and leaves parents unable to make decisions for a child who cannot communicate or give consent.

In Ohio, parents cannot begin the guardianship process until a child turns 18. For families of children with disabilities such as autism or Down syndrome, that can mean waiting months for a parent to be named guardian through probate court. If the child is nonverbal or has limited communication ability, the delay can also mean delayed health care until guardianship is established.

David Kahle and his son, Parker Kahle, traveled to the Ohio Statehouse to testify in support of a proposed bill aimed at closing that gap, known as the Parker Kahle Act.

Parker Kahle was diagnosed with autism when he was about 3 years old. He is nonverbal. When he turned 18, his father said he had to wait months while a guardianship petition went through probate court before he could be named guardian and get Parker needed dental care. Under current Ohio law, once a person turns 18, parents are no longer legal guardians.

David Kahle said he contacted state Rep. Jean Schmidt about changing the law and proposed allowing families to start the guardianship filing process earlier.

“We need more filing time. We can't wait until they're 18 years old. Why can't we file at 17 years and six months? A half year gives you six months to start working into the process before they turn 18. She said, 'Great idea. Any other ideas?'” Kahle said.

He also suggested that if guardianship is not established by the time the child turns 18, the parent should remain the guardian while the application continues through probate court. In addition, he said health care benefits should continue without interruption.

“To stop everything on their 18th birthday and say, 'You can file starting today, but there's going to be a gap between everything.' That means there's a gap in their health care time, especially if they're nonverbal or non-communicative or can't handle their own affairs. That's the important class where this comes in,” Kahle said.

Continued

Ohio - Hamilton County Developmental Disabilities Services levy projected to need increase in 2028   

By Tana Weingartner, WVXU News, June 2. 2026

The Hamilton County Developmental Disabilities Services (DDS) levy is projected to need an increase before the end of its current cycle in 2029. An annual review by the Tax Levy Review Committee shows the cost of services the agency is required to provide will exceed what its levy generates in 2028.

"What we've seen recently is a significant increase in the cost of the DDS mandated services," committee member Eric Landen told county commissioners Tuesday.

That echoes concerns raised earlier this year by Hamilton County Developmental Disabilities Services Superintendent Leia Snyder in a statement. "The cost of Medicaid waivers that fund supports in the community is rising quickly, and our funding has not kept pace."

The DDS levy has brought in a flat annual amount of around $79 million since 2010. The agency was able to build up its reserve fund balance in 2023 thanks to federal funding related to the COVID-19 pandemic and a decrease in the need for services at that time. Landen says those numbers started to change in 2024.

"We saw an inflection point where that enhanced federal funding was scaled back, and we also saw state regulations significantly increase (costs)," Landen says. "In addition to that, we saw an increasing number of people who were requiring those services. Therefore, in 2025 and beyond, what we're seeing is a higher per-person cost, higher waiver costs, and state pressures in terms of them requiring these mandates but not providing the support for these services. The result of all that is we are seeing a significant reduction in that fund balance that was quite healthy at the beginning of 2025, and now we're seeing that being eaten away."

The fund is projected to be nearly $2.3 million in the red in 2028 and $42.2 million in 2029.

"The bottom line on this is we anticipate that DDS will need to go on the ballot in November 2028 instead of November 2029, and we do anticipate that DDS will likely need an increase in their millage at that point," Landen concluded, adding that how much of an increase would be needed hasn't been calculated.

Landen and Snyder say DDS has made cuts to staffing, services, and discretionary spending, as well as increasing what it charges for billable services, and is looking for other funding sources. Those cuts are projected to total $5-$9 million in annual savings. The TLRC points out many non-mandated services that may have to be cut are preventive and shown to help lower costs for mandated services down the road.

"Every single billing stream that we have available to us, we've increased, some of them up to 50%, so that includes some federal billing streams — we've been really attentive to that. We've aggressively sought out any grant revenue, and we have been successful in securing a lot of that," Snyder says.

Continued

Texas - Another Houston-area school district is consolidating special education programs for the upcoming school year

By Blanca Seward, Houston Public Media, June 2, 2026

As Houston ISD faces a federal civil rights investigation over its plans to consolidate special education services, another large district in the region is making similar changes to how it serves students with disabilities. Cy-Fair ISD, the third-largest school district in Texas, has quietly consolidated several of its special education programs for the upcoming school year.

The "Adaptive Behavior" program, which services students with emotional and behavioral difficulties, was offered at as many as 14 elementary schools in Cy-Fair ISD this year. However, starting this August, the program will be offered at eight campuses, according to a district spokesperson.

Additionally, the district will consolidate its Early Childhood Special Education program, which helps children ages 3-5 before they enter kindergarten who are at risk of not attaining academic or life skills without early intervention. Cy-Fair ISD officials say the program is currently offered at "most" elementary schools in the district.

The latter move will require transferring students to new campuses to access the specialized programs. District spokesperson Joel Weckerly said the consolidations of the early childhood program will affect approximately 200 students, and another 40 will be affected by the adjustments to the behavior program that caters to students in kindergarten and higher grade levels.

"We want to clarify that the programs are not ‘closing,' simply consolidated based on district need," Weckerly said. "The consolidations are due to the decrease in enrollment; adjustments were made where needed."

RELATED: Houston ISD plans to consolidate special education services, parent says after district meeting

Jane Friou, the co-founder of the Houston Special Education Parents Association, explained that service consolidations at the elementary level, while not ideal, are less likely to jeopardize a family’s access to a specialized program since there generally are more elementary school options in districts. Friou said CFISD's move to contain consolidations within elementary schools sets it apart from Houston ISD's restructuring.

"It’s not unheard of, but I would say the scale at which they’re doing that is concerning," Friou said of Cy-Fair ISD. "I would be panicking if it was me."

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.6137 / S.3211 - Rep. Brian Fitzpatrick (R-NJ) and Sen. Maggie Hassan (D-NH) - A bill to require the Office of Management and Budget to consider revising the Standard Occupational Classification system to establish a separate code for direct support professionals

H.R.6766 / S.3492 - Rep. Claudia Tenney (R-NY) and Sen. Richard Blumenthal (D-CT) - Essential Caregivers Act - To amend titles XVIII and XIX of the Social Security Act to require skilled nursing facilities, nursing facilities, intermediate care facilities for the intellectually disabled, and inpatient rehabilitation facilities to permit essential caregivers access during any period in which regular visitation is restricted.

H.R.4796 - Rep. Laura Friedman (D-CA) - Restoring Essential Healthcare Act -To amend Public Law 119-21 (The One Big Beautiful Bill Act) to repeal the prohibition on making payments under the Medicaid program to certain entities.

H.R.4807 - Rep Greg Landsman (D-OH) - Protect Our Hospitals Act - To amend Public Law 119-21 to repeal certain changes to provider taxes under the Medicaid program. 

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.  

H.R.1509 & S.752 - Rep. Lori Trahan (D-MA) & Sen. Chuck Grassley (R-IA)

Accelerating Kids' Access to Care Act -

This bill would 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, and streamline enrollment under the Medicaid program of certain providers across State lines.

H.R.2598 & S.1277 - Rep Jared Huffman (D-CA) and Sen Chris Van Hollen (D-MD) The IDEA Full Funding Act

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

S.2279 - Sen. Josh Hawley (R-MO)

A bill to repeal the changes to Medicaid State provider tax authority and State directed payments made by the One Big Beautiful Bill Act and provide increased funding for the rural health transformation program.

H.R.1950 - Rep. Mark Pocan (D-WI) - Protect Social Security and Medicare Act

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. 

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) - The ABC Act

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



VOR OPPOSES:

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) and sheltered workshops for indiviiduals with I/DD and autism.

S.2438 - Transformation to Competitive Employment Act (Sen. Chris Van Hollen (D-MD) - A bill to assist employers providing employment under special certificates issued under section 14(c) of the Fair Labor Standards Act of 1938 in transforming their business and program models to models that support people with disabilities through competitive integrated employment, to phase out the use of such special certificates, and for other purposes. 

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