May 8, 2026

VOR's Weekly News Update

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Will the Coming Cuts to Medicaid Spare the 'Truly Needy'?

By Joyce Frieden, MedPage Today, May 4, 2026

Based on prior history, cuts to federal healthcare programs as part of the One Big Beautiful Bill Act (OBBBA) and the expiration of Affordable Care Act (ACA) enhanced premium subsidies will result in big drops in public coverage that will worsen existing problems in the health insurance marketplace, authors of a study found.

"The experience of these prior coverage contractions ... [predicts] that widespread insurance loss will lead to a reduction in care utilization, an increase in household financial strain, and worsened physical and mental health for low-income individuals," Adam Gaffney, MD, of Harvard Medical School in Boston, and colleagues wrote in the Milbank Quarterly. "These coverage contractions additionally suggest that most who lose Medicaid coverage will not find alternative coverage; that work requirements will impose burdensome administrative costs on states; that states are unlikely to offset reductions in federal Medicaid funding with internal funds; and that the second-order effects of coverage losses may, in some instances, be greater (in magnitude) than the benefits seen after coverage expansions."

The coming decade will usher in the largest healthcare coverage contractions in history, the authors noted in their introduction. This includes 10 million who will become uninsured by 2034 due to the Medicaid funding cuts under the OBBBA and another 4 million more who are projected to lose coverage due to the expiration of the ACA subsidies.

Supporters of the cuts, including the Trump administration and congressional Republicans, say that the cuts will not affect the "truly needy."

"This rhetoric echoes previous defenses of Medicaid cuts," the authors wrote. "'Our spending cuts will not be at the expense of the truly needy,' President Ronald Reagan stated in a February 1981 address, shortly before signing the Omnibus Budget Reconciliation Act (OBRA), which delivered historic Medicaid cuts."

Four Coverage Contractions Examined

But did that turn out to be true? To answer that question, the investigators examined the experience of four major previous coverage contractions:

• President Reagan's 1981 OBRA cuts
• A large state-level Medicaid contraction in Tennessee in 2005
• The 2018 Medicaid contraction in Arkansas due to the imposition of work requirements
• The "Medicaid Unwinding" of the 2020s due to the expiration of the pandemic-era rule prohibiting states from disenrolling people from Medicaid

Continued

What To Do About Medicaid’s Long-Term Care Benefit?

By Howard Gleckman, Forbes, May 5, 2026

There seems to be a growing consensus among policymakers that there is something very wrong with Medicaid’s long-term care benefit for frail older adults and younger people with disabilities. But there is deep disagreement about what to do about the program’s long-term services and supports benefit, called LTSS.

President Trump and many congressional Republicans believe Medicaid LTSS is inefficient and riddled with fraud. And they have taken multiple steps to slash the assistance, which is available only for those with few financial assets and a significant need for personal care and other help. But most seem uninterested in finding an alternative.

Democrats, by contrast, are split among three possible solutions. Some want to enhance the Medicaid benefit for home-based long-term care. Others prefer to shift home and community-based care, or HCBS, from Medicaid to Medicare. Yet a third group, which has the support of a few Republicans, would replace much of the Medicaid benefit with a universal, public long-term care insurance program.

None of these ideas are new. Here is a valuable review of the many reform plans that have been proposed in recent years. Nearly all either enhance Medicaid LTSS or largely replace it with a social insurance-like program.

Each of three most recent ideas comes with their own pros and cons. Here is a quick look them.

Cutting Medicaid

Last year’s big budget bill will slash Medicaid spending for all enrollees by nearly $1 trillion over the next decade and impose new paperwork requirements aimed at making it harder to enroll and stay eligible. Now, in the name of cracking down on fraud, the Administration is moving to cut Medicaid benefits even more deeply, including for HCBS services.

Directly or indirectly, these steps will further shred an already porous Medicaid safety net for six million vulnerable older adults and younger people with disabilities. The White House has yet to say how these people would receive care absent Medicaid assistance. This is especially a challenge for the many with physical or cognitive limitations who have no family to care for them.

Expanding Medicaid HCBS

Representatives Debbie Dingell (D-MI), Jan Schakowsky (D-IL), and others believe the solution is to strengthen Medicaid LTSS, especially for those receiving care in the community. Last week, they introduced two bills, Home and Community-Based Services (HCBS) Access Act and the Long-Term Care Workforce Support Act intended to shore up the Medicaid safety net.

The titles are pretty self-explanatory. While the bill texts are not yet available, the first one reportedly would make HCBS a mandatory benefit under Medicaid and shift the cost of that assistance to the federal government. The measures also would enhance opportunities for direct care workers.

Currently, Medicaid costs are shared by the states and feds and while nursing home care is a required benefit, home-based care is not. Dingell and Schakowsky would guarantee access to Medicaid home-based care and make the federal government responsible for all HCBS costs.

This would not only reverse the cuts made by last summer’s budget bill, it would substantially increase spending for Medicaid HCBS. In effect, it would require Congress to abandon the Medicaid policy it created last year, and then add billions of dollars more to a program it just cut.

Replacing Medicaid HCBS With Medicare

Another alternative, recently proposed by a group of experts affiliated with the Brookings Institution, also would make HCBS a fully federal benefit, but primarily as part of Medicare, not Medicaid.

It would maintain a Medicaid LTSS benefit for nursing home care and for those ineligible for the new Medicare home care benefit. But, mostly, federal responsibility for long-term care would move to Medicare.

The plan is intended to be self-funded, thus would not add to federal deficits. And while the amount of its home care benefit would be tied to a beneficiary’s income and assets, everyone who is medically eligible would get at least some assistance. Thus, this model would look more like a social insurance program than welfare-like Medicaid.

Public Long-Term Care Insurance

The third alternative would create a public long-term care insurance program. Washington State already has created one, which is funded with a modest payroll tax. It will pay the first $36,500 in LTSS benefits starting in July.

In Congress, Representative Tom Suozzi (D-NY) is developing his own universal public insurance benefit, called the WISH Act. Unlike the Washington State program, it would provide an unlimited catastrophic benefit, though not until after people have paid for their own care for a set period of time. That could be, say, a year for low-income people and three years for those with higher incomes.

It also could provide a cash benefit, which would give people maximum flexibility in how they use their assistance, without being constrained by Medicaid or even Medicare rules.

There are endless variations on these ideas, both on the benefits they provide and the way they are funded. But in the end, policymakers will have to decide among four basic LTSS models: Medicaid; Medicare; public insurance; or leaving older adults, people with disabilities, and their families to fend for themselves

Read the full article here

National Hotline For IDD Caregivers Proposed

By Shaun Heasley, Disability Scoop, May 8, 2026

A group of federal lawmakers if pushing to establish a first-ever national hotline for caregivers of those with developmental disabilities.

The toll-free number would operate around the clock and be staffed by trained professionals equipped to provide emotional support, brief intervention and mental health referrals, according to U.S. Rep. Rob Menendez, D-N.J., who introduced a bill to establish the hotline.

The legislation known as the Caregiver Access to Resources and Emotional Support, or CARES, Hotline Act also calls for the government to create and maintain a national database of caregiver resources and offer peer-to-peer counseling allowing caregivers to connect with others with similar experiences.

Menendez said the bill was inspired by his conversations with representatives at Whole Spectrum Autism, an autism advocacy group in New Jersey, who told him about the unique challenges facing caregivers.

“No family should be told to figure autism out alone, yet that is the reality for far too many. The CARES Hotline is a critical step toward changing that by giving caregivers a real place to turn in moments of stress, uncertainty and isolation. This is about more than support, it is about access, guidance and making sure families are no longer navigating this journey without help.”

[T]he bill is co-sponsored by Reps. Lou Correa, D-Calif., Zoe Lofgren, D-Calif., Bennie Thompson, D-Miss., and Frederica Wilson, D-Fla., as well as Del. Eleanor Holmes Norton, D-D.C.

Read the full article here

Researchers Identify the Most Common Recessive Neurodevelopmental Disorder Ever Discovered 

By Mount Sinai Hospital School of Medicine, May 5, 2026

Scientists at the Icahn School of Medicine at Mount Sinai in New York have identified a newly recognized recessive neurodevelopmental disorder (NDD) that may be the most common of its kind discovered so far. The condition is linked to mutations in a small noncoding gene called RNU2-2. Researchers estimate it affects thousands of people in the United States and may account for about 10 percent of all recessive NDD cases with a known genetic cause.

The research involved collaboration with teams in the Undiagnosed Diseases Network, led by Stanford University, as well as partners in the United Kingdom, the Netherlands, Belgium, and Italy. The results were published in Nature Genetics and offer long-awaited answers for many families while pointing toward possible future treatments.

Investigators determined that the disorder results from a near-total loss of U2-2 RNA, a molecule produced by the RNU2-2 gene. Affected children usually inherit one altered copy of the gene from each parent, though some mutations arise spontaneously. Parents typically show no symptoms, but having two altered copies disrupts brain development in their children.

Genetic Cause and Symptom Spectrum

Symptoms vary widely depending on the specific genetic changes. Common signs include low muscle tone, developmental delays, and limited speech. Some children experience mild learning challenges or autism-related traits, while others develop epilepsy, movement disorders, or difficulty walking.

Brain scans may appear normal early in life, but can show changes later. In more severe cases, children may also face feeding difficulties or breathing problems. This broad range of outcomes reflects how differently the loss of U2-2 RNA can affect each individual.

“Our discovery gives families something they’ve often waited years for—a clear molecular explanation for their child’s condition,” says the study’s first author, Daniel Greene, PhD, Assistant Professor of Genetics and Genomic Sciences at the Icahn School of Medicine. “For many families, that clarity can be profoundly meaningful after a long and uncertain diagnostic journey. At the same time, it gives the research community a concrete biological target to guide future therapeutics.”

Continued

Advances in genetic medicine took center stage at INSAR

By Alison Singer, Transmitter, May 5, 2026

At this year’s meeting of the International Society for Autism Research (INSAR) in Prague, one theme stood out above the rest for me: We are entering a new era of genetic medicine for autism. 

Much of the attention focused on rare genetic variants, such as changes in SCN2A, SHANK3 or UBE3A, that are known to be associated with autism. About 20 percent of people with autism have a condition linked to these or other variants.

For families affected by autism, including my own, the progress is deeply meaningful and is cause for hope, because for the first time we are seeing actual improvement in clinical symptoms by addressing the underlying biology.

Researchers described methods using tools such as CRISPR to correct variants in the DNA or RNA. Another approach is epigenome editing, which leaves the DNA code intact but changes how genes are switched on or off. That can be especially powerful when a healthy copy of a gene exists but has been silenced.

One of the most moving presentations I saw came from Allyson Berent, chief science officer at the Foundation for Angelman Syndrome Therapeutics, who spoke about progress in Angelman syndrome clinical trials and shared examples of improvements seen in patient participants. Scientists are using antisense oligonucleotides, or ASOs, to un-silence a functional copy of the UBE3A gene that has been turned off. The goal is to restore missing protein function by waking up what is already there. 

In these trials, progress is visible in participants across the lifespan, not just in young children but in adults as well. Berent gave examples around enhanced cognition, first words being spoken, a reduction in challenging behaviors, sleeping through the night, self-feeding, toileting—a new level of independence that was only a pipe dream for many families. 

I cried during her talk. I cried for all the years that our family and others have waited, for all the battles we have fought, and for the sheer joy that soon some children may have options that many families were told would never come.

But discovering a treatment is only half the battle. Delivery matters. Families want to know: How is it given? How often? How long will it work for? 

Continued

Virginia - Before medical center closes, VA lawmakers want patient families' thoughts

By Bill Atkinson, Petersburg Progress-Index, May 8, 2026

A legislative panel is offering a glimmer of hope to families of patients in a state-owned medical center who oppose a proposed closure and relocation to other facilities around Virginia. 

The Joint Commission on Health Care listened May 7 to all of the reasons why the Department of Behavioral Health & Developmental Services pleaded its case to close Hiram W. Davis Medical Center, adjacent to Central State Hospital in Dinwiddie County. For the better part of an hour, they heard a DBHDS official run down the current HWDMC shortcomings and why it would be more beneficial to relocate the 32 patients currently in the hospital to other locations in both the public and private sectors than it would be to retrofit the 52-year-old building to make it more state-of-the-art. 

But what the JCHC did not hear from at the meeting were patients’ family members plead with them to not rubber-stamp the two-year-old proposal and instead find an alternative to patient relocation some 80 miles east to Chesapeake. 

And that bothered many of them to the point that commission members agreed to tour HWDMC for themselves and also give those family members a chance to speak their minds at the commission’s June meeting. 

Del. Otto Wachsmann Jr., R-Sussex County and a member of the commission, said “what I heard today was the same thing I heard my first day on the commission” two years ago – that DBHDS wants to close it. Since that first day, though, Wachsmann said he has toured the facility, and he is not so sure that closing it is the only alternative. 

“Having been there and actually seeing some of the patients and talking with some of the family members, I have a lot of concerns,” Wachsmann said. He admitted that entering the medical center “felt like you were walking back into 1970” but what he saw on his own tour “was quite a different picture than what we were told here.”  

'I don't want to lose another'

Martha Bryant, whose 32-year-old son Taylor transferred there when the state shut down a similar facility in Nottoway County nine years ago, is part of a consortium of family members who don’t want to see HWDMC shut down. She routinely drives more than two hours from her home in Amherst County to visit her son, and if he is relocated to Southeastern Virginia Training Center in Chesapeake, that will add another two hours one way. 

“I’d be on the road for nine hours to see him,” Bryant said after Thursday’s commission meeting. Taylor, his mother said, needs round-the-clock skilled nursing and medical care, and the Chesapeake facility does not have that. 

“He’s one of the most complex. Most at-risk people to transition,” Bryant, a retired registered nurse, said. “We got some new information today, but we also got some conflicting information, and we have lots of questions.” 

Bryant said she was “really glad” that the commission plans to visit HWDMC and give family members a chance to share their stories. Asked what she hopes will come from the commission’s visit, she replied, “I want a Central Virginia location with comparable care and on-site services, and I think a shared campus [with Central State Hospital] makes the most sense.” 

CSH is amid its own renovation, converting from a multi-building spread over its campus to a multi-million-dollar, 460,000-square foot, 252-bed facility due to be finished in 2027. DBHDS says some of Davis Medical’s services could be absorbed by the new CSH, but it would not be as major a solution as relocation. 

“I already lost one son to the system,” Bryant said, noting the death of Taylor’s brother. “I don’t want to lose another.”

Bipartisan concern over families being heard

Several of Wachsmann’s colleagues on the commission shared his concerns about the impact of the relocation on families. 

“I think there needs to be time to hear the public comment and then for us to follow up on what we hear,” said Sen. David Suetterlein, R-Roanoke. “I just feel strong about that.” 

Sen. Stella Pekarsky, D-Fairfax County, said she agreed with Wachsmann’s suggestion that the commission needs to hear from families. 

“I think this is a very difficult decision,” Pekarsky said. “I think we are talking about people who have very high, complex needs.” 

Adding to her concerns was the impact that relocation would have on medical center staff. As it stands now, about a quarter of the current staff would relocate to CSH, with the rest either shifting to other positions within DBHDS, quitting or retiring. 

“The reason the employee portion of this was so important to be and really jumped out at me, is because when you have these people, the relationships with their caregivers are so incredibly important. They’re going to have new people who have to learn their needs, how to make them comfortable, et cetera, et cetera. And that, to me, is just incredibly, incredibly worrisome.” 

In addition to the public comment period, the commission also asked to tour HWDMC between now and July when it has to make its recommendation to the General Assembly about the future. 

Read the full article here

Massachusetts - House leadership rejects the right to care at Wrentham and Hogan Centers

By David Kassel, The COFAR Blog, May 4, 2026

Under the state Legislature’s less-than-fully-democratic state budget process, our budget amendments to preserve the Wrentham and Hogan Intermediate Care Facilities (ICFs) were rejected last week in the House of Representatives without either a vote or debate on any of them.

It was frustrating because our amendments had garnered bipartisan support before each was stripped of its language by the House leadership. There were 18 cosponsors of our primary amendment, including 12 Democrats and 6 Republicans. There were 16 cosponsors of each of two other amendments that had been filed on our behalf.

The good news is the battle to preserve the ICFs now shifts to the state Senate, which is scheduled to debate its version of the Fiscal Year 2027 state budget starting the week of May 18. The bad news is, it might be difficult to find a senator to file our primary amendment, which would affirm a federally sanctioned right to residential placements in ICFs such as Wrentham and Hogan.

Last week, the leadership in the House decided not to include our proposed budget language in a large “consolidated amendment,” which included dozens of amendments involving “public health and mental health and disability services.”

Our primary amendment, which had been filed Representative Marcus Vaughn, would ensure a choice and right to ICF care for those who have been found to be eligible for it. That amendment and our two related amendments were filed on our behalf by Vaughn, whose district includes Wrentham.

We think the reason our amendments were rejected has to do with the likely opposition to them by the Department of Developmental Services (DDS). As we have reported, the administration rarely allows admissions to either Wrentham or Hogan, and has been allowing those facilities to die by attrition. Yet these facilities are Medicaid certified centers that provide residential care, which the late federal District Court Judge Joseph Tauro described as “second to none anywhere in the world.”

Read the full blogpost here

Nebraskan with Disabilities, Backed by Four Nonprofits, Sues State Over New Disabilities Assessment System

National Health Law Program, May 8, 2026

Legal Aid of Nebraska, joined by Nebraska Appleseed, the National Health Law Program, and TechTonic Justice, has filed a lawsuit against the Nebraska Department of Health and Human Services (DHHS), challenging the State’s use of its new assessment system, which uses an algorithm to cut Medicaid home-care services for many individuals with intellectual and developmental disabilities.

The lawsuit is filed on behalf of Nicholas Bessey, a Nebraskan with developmental disabilities who relies on Medicaid services provided by the State to remain in the community. These services allow Nicholas to live closer to friends and family and in his community, rather than in an institution at greater expense to the State.

Nicholas’ condition has not improved since last year. But, after DHHS conducted an assessment using the new interRAI system, the State determined the amount of funding Nicholas receives should be reduced by 35 percent.

“Nicholas has had services at the high level of care for 14 years,” said Angela Bessey, Nicholas’ sister and guardian. “Before he had access to this level of care, he was not able to enjoy simple aspects of life that most people take for granted, including his love of going to the park. Without needed services, Nicholas may need to be placed in an institutional setting to get the care he needs.”

The lawsuit alleges that the State’s use of the interRAI assessment tool to determine level of care and individualized budgets violates due process and state law by failing to explain the reason for the funding cut, relying on secret criteria, processes, and policies that have not been properly adopted through required rulemaking procedures. As a result, individuals and families are left without a meaningful way to understand or challenge reductions in services that are essential to daily life.

The lawsuit seeks to ensure that Nebraskans with disabilities are afforded basic legal protections, including clear notice of how decisions are made and a meaningful opportunity to challenge those decisions.

“Nebraska is the latest state to turn to dangerous AI-related technologies like these algorithms to cut Medicaid and other public benefits,” said TechTonic Justice President Kevin De Liban. “Everywhere these technologies are used, people lose health care, go hungry, or can’t pay bills”

Nicholas Bessey is asking the court to require DHHS to implement an objective assessment process that complies with state law and constitutional due process, and to prohibit the State from continuing to use the current process until it meets those requirements.

interRAI tools and similar assessment systems have been linked to major cuts in services for disabled Medicaid recipients in other places, too, including Arkansas and Washington D.C.

Read the full article here

House approves bill to address abuse in New Hampshire’s disability system

By William Skipworth, New Hampshire Bulletin, May , 2026

On Thursday, New Hampshire House lawmakers approved a bill aimed at addressing rampant and systemic abuse and neglect in New Hampshire’s disability care system.

State Sen. David Rochefort, a Littleton Republican, said the “genesis” of Senate Bill 670 was a series of articles published by the Bulletin in November.

New Hampshire’s Bureau of Developmental Services oversees taxpayer-funded care for people with intellectual and developmental disabilities. According to state records obtained by the Bulletin, there were 548 credible reports of abuse, neglect, and exploitation in this system (though state officials told the Bulletin in March that they discovered their own data may include overcounts, but has yet to provide an updated figure) from 2023 through 2025. There were 144 deaths in this system across the same time period, per the records. The victims include people with disabilities who were physically beaten by caregivers, at least one who was violently raped, and a young man who died from from suspected hypothermia in the snowy woods behind his care home.

To address this, SB 670 creates a Developmental Services Oversight Commission made up of lawmakers, state officials, and people with disabilities themselves (among others); increases data sharing between state officials and agencies in an effort to spot issues sooner; and requires suspected abusers to be put on a state registry quicker.

The bill has now passed both chambers of the Legislature. However, because the House slightly amended the bill to alter the composition of the oversight commission and require the commission to collaborate with another state committee related to the system, the bill will need to return to the Senate for approval with the amendment. If they pass the amended bill, it will be sent to Gov. Kelly Ayotte for final approval. If they decline, the two chambers can enter the committee of conference process where negotiators from each chamber meet to hash out their differences.

Continued

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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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