November 7, 2025

VOR's Weekly News Update

VOR is a national non-profit organization

run by families of people with I/DD and autism

for families of people with I/DD and autism.

VOR's Annual Fall Fundraising Campaign!

This is the most important time of year for our fundraising.

Most of our membership renewals and donations

will come in the next eight weeks.

It's Make-It-Or-Break-It Season for VOR.

Like that little squirrel pictured above, gathering nuts for the months ahead, so it is with VOR.

The contributions we receive in the our fall/winter fundraising campaign cover a significant portion of our expenses in the year ahead.

Please contribute,

so that we may continue to help families like yours.

The Autumn Edition of the VOR Voice

is now available on our website

Express your gratitude to the

Direct Support Professionals

in your life

with a little something extra this year...

Once again, we have partnered with See's Candies in our 2025 Year-End Fundraising Campaign.

See's has agreed to give us a share of the profits for each box sold.

The idea is not to replace our regular appeal for donations,

but to enhance our fundraising efforts by offering delicious See's Candies to our folks who wish to send gifts to family and friends over the holidays.

You may start ordering now.

Candy will begin shipping on November 10, 2025

The last day to order is December 5, 2025

~~ Free Shipping on all orders over $75 ~~

(Except to PO Boxes as extra packaging is required)

VOR Podcasts!

Hosted by Casey Henry and Brenna Redfearn

on our YouTube page!

Much has been said lately about the conjecture from proponents of the One Big Beautiful Bill that the $911 billion cuts to Medicaid will are not intended to take away services from people with I/DD and autism, and will not affect those living in institutional settings like ICFs.

Who can say for sure?

Families of people with I/DD and autism have learned that you always hope for the best while preparing for the worst. And while we continue to hope for the best, it would be unwise not to acknowledge the dark clouds hanging over the horizon.

Who knows? Maybe one trillion dollars isn't all that much these days. Indeed, Tesla just voted to give Elon Musk a one trillion dollar pay package over the next ten years. Just about the same amount that the OBBBA is taking from Medicaid over the same period of time.

It's remarkable that there are people who think that this all balances out.

Below are a few articles that might make all of this make better sense.

First, a word from the Cato Institute:

Medicaid: Dishonest Budgeting, Excessive Spending

By Michael F. Cannon, The Cato Institute Blog, October 31, 2025

Congressional Democrats are refusing to support a resumption of the few federal operations that the current “government shutdown” has paused. Among Democrats’ demands is that Congress rescind the meager Medicaid spending restraints in the recent Republican budget, and thus increase federal Medicaid grants to states.

Economists Martin B. Hackmann, Juan S. Rojas, and Nicolas R. Ziebarth offer a useful perspective. In a recent working paper, they find that Congress is already spending more on Medicaid than it told voters it would:

This paper studies the misallocation of Medicaid funds and its implications for patients and providers in the context of the nursing home industry. Combining comprehensive audit reports with survey data on nursing homes, we first document that many states use creative financing schemes. The schemes inflated nominal spending by about 30% while diverting at least $17 billion in Medicaid funds between 2000 and 2002. This diversion of funds increased the effective federal cost share (FMAP) by 16 percentage points, significantly more than previously documented.

One way to interpret these findings is that the federal government is spending too much on Medicaid. Congress enacted laws saying that the federal government will finance, for example, 50 percent of Medicaid spending in states like New York and California. Hackmann, Rojas, and Ziebarth find that state misbehavior and insufficient federal oversight have pushed that share to perhaps 66 percent, even though Congress told voters it was 50 percent. 

The recent Republican budget didn’t even cut Medicaid. It merely (maybe) restrained the growth of federal Medicaid spending. Congress should not increase Medicaid spending. For reasons of transparency, fiscal responsibility, sustainability, democratic accountability, and better health care,

Congress should cut Medicaid spending immediately and dramatically.

Read the article (with links) here

On the other hand,

How Medicaid Policies Shape County Health-Care Performance

A new study explores the factors shaping strong health systems in the United States, including Medicaid expansion

By Allison Krugman, Think Global Health, November 4, 2025

As November begins, the U.S. government shutdown shows few signs of a resolution, as fierce disagreements continue over health-care spending.   

The budget impasse centers around enhanced subsidies introduced under the Affordable Care Act (ACA), which are due to expire at year's end, making coverage even more expensive and inaccessible for low-income families. Democrats refuse to back to a continuing budget resolution without health-care guarantees in part because the One Big Beautiful Bill Act (OBBBA), signed into law in July 2025 by Republican President Donald Trump, reduces federal Medicaid spending by $911 billion and could increase the number of uninsured by 10 million people over the next 10 years.  

A new study from the Institute for Health Metrics and Evaluation (IHME) underscores the pitfalls of cutting federal insurance programs, that expanded Medicaid coverage was associated with higher scores on the Triple Aim test—a metric that rewards positive patient experience, stronger health outcomes, and lower health-care spending per capita. This finding held firm after adjusting for characteristics such as wealth, education, obesity, and smoking. The study indicates that although health disparities persist between states and counties, evidence-based design can still deliver high quality care and improve outcomes relative to a county's demographics.  

"More than 85% of the counties in Idaho, Iowa, Maine, Washington, and Wisconsin all had positive adjusted performance scores," said Haley Lescinsky, a managing research scientist at IHME and the lead author on the study. "Meaning that within these states, most of the counties are doing better than you would expect given the population characteristics."  

IHME's findings indicate that to improve health-care performance, states and counties will need to challenge existing trends, including hospital and insurance consolidation and shrinking Medicaid coverage. 

Measuring Health-Care Performance  

Created in 2008, the Triple Aim framework gauges health-care performance along the dimensions of life expectancy, patient experience, and health spending. Governments have used this framework to evaluate system performance and guide decision-making in the United States, Canada, Ghana, and the Netherlands. The IHME study scores U.S. counties on their progress toward Triple Aim.  

As a country, the United States performs poorly. Health-care spending was nearly 17% of U.S. GDP in 2023, or more than $13,000 per capita. On average, comparable high-income countries spent about $7,000 per capita on health—roughly half the U.S. mark. Despite the high costs of care, the United States has the lowest life expectancy and poorest care experience among its peer countries.  

Beyond the national level, however, variation between U.S. states and counties is widespread. IHME's study sought to measure those differences and identify which characteristics and policy levers drive them.   

Consistent with other research on the social determinants of health, IHME found that high-scoring counties were generally wealthier and more educated, and had lower rates of obesity and smoking. They were also primarily urban.  

"Income and education matter," said Joseph Dieleman, a professor who coauthored the study and leads IHME's health resource tracking team. "Essentially, privilege was associated with better performance." 

Challenges Ahead for States and Counties   

The OBBBA cuts will largely affect those benefiting from expanded Medicaid, including young people who otherwise would not have qualified based on income alone. Those populations are set to face higher out-of-pocket costs and limited access to care.   

In one measure currently being challenged in the federal district court of Massachusetts, the OBBBA prohibits Medicaid funding from some providers offering reproductive health care or family planning, which will disproportionately affect young women.  

"Achieving the Triple Aim is not about just achieving low spending to the detriment of the people in the health system," said Dieleman. "It requires a nuanced policy perspective in both service delivery and health system design."  

Major changes to the U.S. health system at the federal level could force states to develop creative approaches to meet the needs of their populations, such as leveraging emergency reserves or tobacco taxes to serve low-income populations.   

Read the full article (with links) here

But to those who must qualify for Medicaid benefits, and for those who will determine who qualifies and who does not, there's a real world that lies beyond the political theorizing.

How Medicaid’s New Work Requirement Will Work

By Margo Sanger-Katz and Sarah Kliff, The New York Times, November 3, 2025

Medicaid, the public health insurance program for the poor and disabled, will undergo its biggest transformation in more than a decade when a new work requirement is added to the program in 2027.

The new policy, passed as part of Republicans’ big domestic policy bill this summer, means that millions of Americans will have to regularly prove to their states that they are working or volunteering in order to receive coverage. The change, intended to nudge more poor Americans into the work force, is expected to cause nearly five million people to lose coverage and will increase burdens on both individuals and state governments. Republican leaders contend that reshaping the program in this way will save the government money, and refocus the program on people they say contribute more to their communities.

Here’s what to expect.

Who will be affected?

Around 70 million Americans are enrolled in Medicaid. And about 16 million of them are poor adults who first became eligible for the program in the 40 states that agreed to expand Medicaid under the Affordable Care Act. Those states will be most affected by the changes, as will two states, Georgia and Wisconsin, that have not fully expanded but cover some of the same population.

Most States Need to Set Up a Medicaid Work Requirement

The new requirement applies to poor childless adults between 18 and 64 without disabilities, and the parents of older teenagers.

Those people will either need to prove to their state that they worked, volunteered or attended school for at least 80 hours a month, or that they qualify for one of a long list of exceptions. The exceptions include being a caregiver for a disabled relative, having a substance-abuse disorder or being too medically frail to work.

How will states enforce the new rules?

The law requires states to check work hours at least twice a year, though states are allowed to check more often. People signing up for Medicaid will need to produce documentation that they qualify for an exception or evidence that they met the work hours in the last month.

States are still setting up the systems to achieve this, and the federal government is still working on the precise rules for what kinds of proof count. States will be able to evaluate whether some people are eligible automatically — by connecting directly to a university database, for instance. Other people may need to produce documents each time they apply or renew.

What will it mean for Medicaid enrollment?

The Congressional Budget Office, which advises Congress on the effects of legislation, estimated that nearly five million people will become uninsured over the next decade as a result of this policy.

Research has shown that many eligible people will lose benefits because they won’t be able to meet paperwork burdens. Most of the coverage loss from this policy is expected to come from this group.

How hard will this be for states to do?

Many state Medicaid officials describe the work requirement as a major undertaking. It requires dozens of states to quickly build expensive and complex software systems that can measure and track who is eligible. They will also probably need to create sweeping outreach campaigns — to make Medicaid enrollees aware of the changes — and increase call center staffing to handle an influx of questions about the new rules.

States will be working on a sped-up timeline. The original Republican policy bill envisioned 2029 as the starting point for work requirements, but the date was moved up by two years to appease more conservative legislators seeking larger budgetary savings.

How much will it cost states to set up?

In the handful of states that previously put in Medicaid work requirements or almost did, most spent tens of millions of dollars each to set up their systems. But the Senate version of the bill allots only $200 million for all 50 states and D.C. to divvy up.

Kentucky, one of the states where the first Trump administration approved a work requirement, spent about $100 million in 2018 developing its program, but a court stopped it before it could begin. Arkansas spent around $25 million before its program was shut down. Georgia’s work requirement has cost $80 million so far.

But in the long run, states will probably save more money — on reduced medical benefits as their residents lose coverage — than they spend on new administrative functions to evaluate their eligibility.

Read the full article here

How can we possibly do this?

States struggle with short timeline to implement Medicaid work requirements

States want early and clear guidance from CMS so they can move forward with system upgrades ahead of the Jan. 1, 2027, deadline.

By Jeff Lagasse, Healthcare Finance, November 6, 2025

States are bracing for a short timeline to implement Medicaid work requirements that were included in the One Big Beautiful Bill Act, and they'll have their work cut out for them to be ready, according to a new study from KFF.

One big concern for states is that they'll have to make significant changes to eligibility systems to be able to verify compliance with work, school and other qualifying activities. 

States have expressed concern over having to make such major system changes in a short timeframe, noting the long lead times typically needed to design, procure and build new systems. Adding to the challenge will be the need to make key system design and workflow decisions before CMS releases guidance, the study found.

Another priority many states mentioned is enhancing capabilities to collect and match data from multiple agencies and external sources, such as claims and enrollment data. States said the data sharing infrastructure is limited, and establishing interfaces to accurately share that data will take time to put in place. 

Other policy changes require significant system changes, according to several states, including restrictions on eligibility for lawfully present immigrants, six-month eligibility redeterminations for expansion enrollees and limits to retroactive Medicaid coverage.

Some states also mentioned the challenge of aligning different work requirements across Medicaid, the Supplemental Nutrition Assistance Program and Temporary Assistance for Needy Families, as well as having to make complex systems and eligibility policy changes for SNAP – changes that may be particularly complicated for states with integrated Medicaid and SNAP eligibility systems, according to the study. 

What's the impact? 

States have just over a year to prepare to implement work requirements for the Jan. 1, 2027, deadline and have less than a year before they will need to begin outreach to notify individuals of the new requirements in September 2026. The law directs the Secretary of Health and Human Services to issue an interim final rule on implementing work requirements by June 1, 2026.

This short timeline intensifies the pressure to move quickly with system upgrades, authors said, particularly given the often lengthy vendor procurement process, as well as other factors. 

At the same time, several states emphasized the risks of moving forward in the absence of clear guidance, saying that if state decisions are not aligned with the federal expectations, the resulting rework would increase costs and potentially delay meeting important deadlines.

Some states described the implementation deadline as unrealistic, noting that it increases the risk of errors that could lead to unnecessary coverage losses.

Due to these risks, some states said early and clear guidance from CMS would be helpful, especially on issues such as the definition of medical frailty and other exemptions or the permissibility of self-attestation that could affect systems decisions.

Continued

Please pay no attention to the men behind the curtain,

Managed care plans offer recommendations to CMS on rollout of Medicaid work requirements

By Paige Minemyer, Fierce Healthcare, November 3, 2025

Two leading organizations representing Medicaid managed care plans are offering several key suggestions to the Trump administration for managing the rollout of work requirements in the program.

In the letter, experts at Medicaid Health Plans of America (MHPA) and the Association for Community-Affiliated Plans (ACAP) urged the Centers for Medicare & Medicaid Services (CMS) to allow insurers to deploy more modern communication methods and to enable critical data sharing to support the launch of the requirements.

The agency and states are set to begin rolling out a slew of reforms to the Medicaid program that were enacted under the One Big Beautiful Bill Act (OBBBA). Mandatory work requirements would be in place nationwide Jan. 1, 2027, as part of the law.

The letter notes that, under the OBBBA's model, Medicaid managed care organizations (MCOs) are not able to stand in as the compliance entity for the work requirements. However, the organizations said insurers can play a major role in referring members to key resources and keeping them informed about the program.

"We request that CMS clarify that MCOs can serve in this function," they wrote. "Medicaid MCOs can serve as an important resource for enrollees to ensure that eligible individuals who are compliant with community engagement requirements continue receiving Medicaid benefits."

The payer groups are also recommending that the administration make it easier for states to share key information with the Social Security Administration and other agencies, as that can ensure the work requirements are managed more efficiently.

Read the full article here

So who really benefits?

‘A Big Positive’: How One Company Plans to Profit From Medicaid Cuts

New work requirements are expected to leave millions of poor Americans uninsured. For Equifax, which charges states steep prices for its trove of employment data, it is a business opportunity.

By Sarah Kliff, Margot Sanger-Katz, and Asmaa Elkeurti, The New York Times, November 3, 2025

When Equifax’s chief executive spoke to investors this summer, he described a “just massive” new business opportunity: helping states enforce the Medicaid work requirement that is expected to leave millions of poor people without health insurance.

Equifax has, for years, dominated the business of verifying Americans’ incomes, a crucial piece of data for banks writing mortgages or landlords renting apartments. The giant domestic policy bill that congressional Republicans passed this summer is about to make the company’s services even more lucrative.

Beginning in 2027, states must verify that tens of millions of low-income adults work, volunteer or take classes at least 80 hours a month before giving them Medicaid or food assistance. The work requirements and other new restrictions on public benefits are designed to save the federal government nearly $400 billion by significantly reducing the number of poor people eligible for the programs.

For Equifax and a handful of businesses, the change also represents the chance to become a lot richer.

Equifax already has a robust business providing income data to states, which some critics say borders on a monopoly. The company has made a practice of steeply and frequently increasing prices without improving its product, according to interviews with government officials, legal records and contracts reviewed by The New York Times.

“They own a product that has become a core piece of the safety net,” said Luke Farrell, who worked in the U.S. Digital Service, a federal agency, during the Biden administration supporting state Medicaid programs. “I’ve never seen another vendor do such price hikes across public benefits.”

Through exclusive contracts with payroll contractors and other employers, Equifax has built a vast database with current information on 99 million workers and over 750 million records. To check an applicant, a state worker can enter a Social Security number and almost instantly pull up wages and work hours — at prices that run as high as $15 for each data match, according to state records.

Continued

Oh, and while you're spending all that money to collect data, could you just do us this one little favor?

Trump’s HHS Orders State Medicaid Programs To Help Find Undocumented Immigrants

By Phil Galewitz, KFF Health News, November 3, 3025

The Trump administration has ordered states to investigate certain individuals enrolled in Medicaid to determine whether they are ineligible because of their immigration status, with five states reporting they’ve together received more than 170,000 names — an “unprecedented” step by the federal government that ensnares the state-federal health program in the president’s immigration crackdown.

Advocates say the push burdens states with duplicative verification checks and could lead people to lose coverage just for missing paperwork deadlines. But the administrator of the Centers for Medicare & Medicaid Services, Mehmet Oz, said in a post on the social platform X on Oct. 31 that more than $1 billion “of federal taxpayer dollars were being spent on funding Medicaid for illegal immigrants” in five states and Washington, D.C.

Medicaid’s overall spending topped $900 billion in fiscal year 2024.

It wasn’t clear from Oz’s statement or an accompanying video over what period the spending happened, and CMS spokespeople did not immediately respond to questions, either for an earlier version of this article or after Oz’s statement was posted.

Several states disputed Oz’s comments.

As part of the administration’s crackdown on people in the U.S. without authorization, President Donald Trump in February directed federal agencies to take action to ensure they are not obtaining benefits in violation of federal law.

In June, advisers to Health and Human Services Secretary Robert F. Kennedy Jr. ordered CMS to share information about Medicaid enrollees with the Department of Homeland Security, drawing a lawsuit by some states alarmed that the administration would use the information for its deportation campaign against unauthorized residents.

In August, a federal judge ordered HHS to stop sharing the information with immigration authorities.

State Medicaid agencies use databases maintained by the Social Security Administration and Department of Homeland Security to verify enrollees’ immigration status.

If states need to go back to individuals to reverify their citizenship or immigration status, it could lead some to fall off the rolls unnecessarily — for example, if they don’t see a letter requesting paperwork or fail to meet a deadline to respond.

“I am not sure that evidence suggests there really is a need for this” extra verification, said Marian Jarlenski, a health policy professor at the University of Pittsburgh School of Public Health.

Leonardo Cuello, a research professor at Georgetown University’s Center for Children and Families, called the CMS order to states “unprecedented” in the Medicaid program’s 60-year history.

The verification checks create an added burden for state Medicaid agencies that are already busy preparing to implement the tax and policy law Trump signed in July. The measure, which Republicans call the One Big Beautiful Bill Act, makes many changes to Medicaid, including adding a work requirement in most states starting by 2027. The law also requires most states to more frequently check the eligibility of many adult Medicaid enrollees — at least twice a year.

“I fear states may do unnecessary checks that create a burden for some enrollees who will lose health coverage who should not,” Cuello said. “It’s going to be a whole lot of work for CMS and states for very little pay dirt.”

Cuello said the effort may have “greater political value than actual value.”

Read the full article here

Disability Advocates Cry Foul Over Dismantling Of Special Ed: ‘Our World Is On Fire’

By Michelle Diament, Disability Scoop, November 6, 2025

Efforts to gut the U.S. Department of Education’s special education office and move the program to another agency are already causing “immediate harm” to students with disabilities, advocates warn.

Nearly a month after the Education Department moved to lay off nearly every staffer in its Office of Special Education Programs, some of the nation’s most prominent disability and special education groups say that the message from the Trump administration is clear.

“Given the recent actions of the administration, the only conclusion that we can draw is that this administration doesn’t believe in educating children with disabilities,” said Chad Rummel, executive director of the Council for Exceptional Children, or CEC.

In addition to the layoffs in the special education office, which a judge has blocked, Rummel cited sweeping cuts at the Education Department’s Office for Civil Rights, the cancellation of millions of dollars in grants issued under the Individuals with Disabilities Education Act and the agency’s efforts to move special education oversight to another federal agency.

“Our world is on fire,” Rummel said. “There’s not gonna be another red flag. We’re there.”

At the moment, advocates believe that fewer than 10 staffers are left to do the work that was handled by more than 100 people at the Office of Special Education Programs and they said that nothing is getting done. It’s unclear how many people remain at the Office for Civil Rights, which handles complaints of disability discrimination.

Secretary of Education Linda McMahon has repeatedly indicated that it is her mission to put herself out of a job by closing the Education Department and she said last month that the ongoing government shutdown is evidence that the agency is unneeded.

But, disability advocates say that states are ill-equipped to administer special education without the institutional knowledge, technical assistance and oversight of the federal government.

“This isn’t about handing power to states. It’s about walking away my responsibility to children, and hoping that no one notices,” said Jacqueline Rodriguez, CEO of the National Center for Learning Disabilities. “States have always held the reins, but history shows what happens when they’re left to steer them alone. Millions of students with disabilities were left simply behind.”

Read the full article here

Opinion: The Hidden Cost of Dismantling Special Education 

By Elizabeth Palley, The Hill, October 31, 2025

Why are we now considering eliminating support for the most vulnerable children?  

Amid a wave of proposed federal cuts, the Trump administration is considering eliminating the Office of Special Education Programs, the agency responsible for ensuring that children with disabilities receive the education they are entitled to under federal law. The Office of Special Education Programs isn’t just a bureaucratic office; it’s the backbone of special education oversight in the United States. It guides states and school districts, supports families, and allocates $15 billion in funding for special education services nationwide.

Compared to the attention given to potential cuts to Medicaid or food assistance, this move has flown under the radar. Yet the consequences could be devastating. Education is not a luxury; it is a lifeline. For millions of children with disabilities, it’s their best chance at independence and future success. 

Since 1975, the Individuals with Disabilities Education Act has guaranteed that children with disabilities cannot be excluded from public education. Today, approximately 10 percent of students — roughly 6.6 million children aged 6 to 21 — receive special education and related services under the Individuals with Disabilities Education Act. Nearly half a million infants and toddlers receive early education services to help reduce lifelong learning challenges. 

But the federal government has never lived up to its commitment to fully fund these services. The original law promised to cover 40 percent of special education costs; today, the federal share is only about 10 to 15 percent. States and school districts make up the difference, leaving many children without the support they’re entitled to. 

Eliminating the Office of Special Education Programs’ oversight and coordination would exacerbate an already dire situation. Without federal leadership, responsibility for compliance and funding would fall to a patchwork of state systems, some capable, others not. Families would have little recourse but to pursue costly private litigation to secure services, a route inaccessible to most. 

Before the Individuals with Disabilities Education Act became law, many children with disabilities were shut out of public schools or left to fail in classrooms unequipped to meet their needs. As a lawyer representing children with disabilities, I saw firsthand how proper support can change a child’s life.

I represented dyslexic students who were failing and developing anxiety until they received the right interventions, after which they flourished, graduated and attended college. I worked with parents of children with severe disabilities who, through specialized education and therapy, gained the ability to walk, feed themselves, or communicate. These are not isolated stories; they are the everyday results of federal investment in special education.

If the Office of Special Education Programs is dismantled, who will ensure those outcomes remain possible? Without coordination and accountability, we risk creating a generation of children left behind; children who could have become self-sufficient, taxpaying adults, but instead fall into cycles of dependency or involvement with the criminal justice system.

Cutting special education oversight sends a cruel message: that the futures of children with disabilities matter less. America can — and must — do better. Fully funding and protecting the Individuals with Disabilities Education Act isn’t charity; it’s an investment in human potential. Every child deserves the chance to learn, to thrive and to contribute; we just need to give them a chance.

Read the full article here

Special education enforcement would be up to states under Trump plan

Some states have failed to provide adequate special education services.

By Anna Claire Vollers, The Tucson Sentinel, November 5, 2025

In its quest to dismantle the U.S. Department of Education, the Trump administration wants to let states police themselves when it comes to educating students with disabilities, a move many teachers and parents fear will strip away crucial federal oversight and deny vulnerable children the services they’re guaranteed under law.

In October, the Trump administration fired nearly all the employees in the U.S. Department of Education office that’s responsible for enforcing the Individuals with Disabilities Education Act (IDEA), the landmark federal civil rights law that guarantees students with disabilities the right to a free and quality public education. A federal judge blocked the layoffs a few days later, in response to a lawsuit filed by federal workers unions.

In addition to making sure states and school districts follow the law, the office distributes billions in federal funding to help states educate students with disabilities such as autism, deafness, developmental delays and dyslexia.

The court ruling halting the layoffs is likely just a temporary setback as Trump proceeds with his broader mission of closing the federal department. Trump and Education Secretary Linda McMahon have said their goals are to reduce bureaucracy and return more education responsibilities to the states.

Neither the Department of Education nor the White House, which are operating with fewer communications officers because of the government shutdown, responded to Stateline requests for comment.

Congress has never fully funded special education at 40% per-pupil costs promised to states under IDEA. Funding has fluctuated over the years; in 2024, it was about 10.9%. Federal IDEA funding is expected to continue, though without federal oversight from the Education Department.

Disability rights and education advocates worry that most states don’t have the resources — or, in some cases, the will — to adequately police and protect the rights of students with disabilities.

Some states in recent years have failed to provide adequate special education services, prompting investigation from the feds. Just 19 states meet the requirements for serving students with disabilities from ages 3 through 21, according to the most recent annual review from the Department of Education, released in June.

Shifting all of that to the state and away from the feds is not something we’ve been able to wrap our heads around,” said Quinn Perry, the deputy director of the Idaho School Boards Association.

“Our state education department are excellent people, but that is a huge, drastic shift in workload they’d have to do on compliance,” she said, adding that Idaho is already facing a budget shortfall.

In Iowa, Democratic state Rep. Jennifer Konfrst, the former House minority leader, said she’s concerned that without federal oversight, the state would not hold schools accountable for providing special education services. She pointed to state lawmakers’ willingness to pass Iowa’s relatively new school choice program, which directs taxpayer funding to private school tuition but does not require private schools to provide services to students with disabilities.

“There are no provisions with private school vouchers that they have to provide special education,” she said. “Those kids are left at the public schools, which have been underfunded.”

Continued

Arizona Autism to Lay Off Nearly 3,000 Employees, Converts Some to Contractors

By Chris Larson, Behavioral Health Business, November 5, 2025

Arizona Autism has announced it will lay off nearly 3,000 employees, transitioning some portion of them to contract positions.

The Phoenix-based applied behavior analysis (ABA) and intellectual/developmental disabilities services provider told employees and disclosed to the Arizona state government that it provided notice to employees on Oct. 30. Information published online by the state shows that the move impacted 2,792 people. 

Multiple requests for comment have not been returned.

Details remain sparse regarding the type of roles that will be impacted. Federal law requires that mass layoffs be disclosed in writing and detail the number and job title of employees impacted, the date of separation, whether or not the separation is permanent, and whether or not a union and bumping rights are involved. The Arizona state agency has not returned what records it has from Arizona Autism, disclosing the development.

Arizona Autism operates four ABA centers, in-home pediatric supporting care, in-home therapy, group homes and developmental homes.

Ryker Martin, the CEO and co-owner of Arizona Autism, said in an unlisted YouTube video that the company is transitioning all of its home- and community-based services workers to contractors. Such a move eliminates the company’s many obligations to employees and to pay certain taxes. Together, these include paying taxes for Medicare and Social Security, providing health care benefits, following minimum wage laws, overtime laws and workers’ compensation insurance payments.

It’s not clear how many of the nearly 3,000 impacted employees will have their status reworked and how many are simply eliminated from the Arizona Autism workforce.

Martin points to an austerity measure by the Arizona state government that reworks how and how much services disabled people can get on the state’s dime. According to local reporting, these moves are not a true cut to budgets for services. Rather, reworking the assessment standards will result in $133 million less spent on services. 

“In response, we are updating our structure to align with the state level and federal requirements, while ensuring that your work continues in a way that benefits you and the individuals that you serve,” Ryker said.

He added that he would recommend that the employees-turned-contractors engage with tax professionals to assess how they could benefit from the change in status, effectively pushing them to become entrepreneurs and owners of their own businesses. 

In the case of Arizona, the state government has seen supportive services balloon for vulnerable populations, such as children with severe disabilities that need daily support for basic needs. In some ways, the pattern of huge increases in benefit use, spending exploding and government austerity follows a familiar pattern for autism therapy organizations. In Medicaid, states such as Nebraska and Indiana have responded to huge increases in ABA service costs by limiting hours and reimbursement rates.

These budget constraints come even before a looming wave of reforms could put even greater pressure on behavioral health providers that work with state agencies. The One Big Beautiful Bill Act introduced several changes to Medicaid enrollment and redetermination and slashed several health care-related programs.

Read the full article here

Lawmakers: N.Y. must modernize disability housing policies

By Kate Lisa, Spectrum 1 News NY State, November 3, 2025

Lawmakers said the state legislature must act to give New Yorkers with disabilities more housing options and force the state agency that oversees congregate facilities to modernize its policies.

About 80% of New Yorkers with intellectual or developmental disabilities live with a caretaker older than 60, or over 100,000 people of the roughly 130,000 served by the state Office for People with Developmental Disabilities.

The statistic alarmed state assemblymembers who held a hearing about the issue Monday in Albany.

"The system we have now was designed for years ago [but] the modern-time needs are entirely different," said Assemblyman Angelo Santabarbara, a Democrat who chairs the People with Disabilities Committee. "Every other agency has adapted, has changed. OPWDD has not."

Santabarbara has a 24-year-old adult son with autism and knows the struggles of finding suitable housing in the state.

People with intellectual or developmental disabilities are waiting years for housing, and the assemblyman said existing regulations prevent many New Yorkers from living independently.

Current law sets narrow parameters to place people in a residence. The agency often resists more than four people with disabilities living in the same place.

"OPWDD wants to keep the system the way it is, the way it's operating," Santabarbara said. "It's hard to change things once the system has been operating like this for so long, but it's not their job to dictate policy. It's not their job to decide what legislation we are and are not going to pass."

Other rules hinder OPWDD from connecting people to non-certified housing.

State law restricts families from creating an independent living option with a caretaker. Several lawmakers said the agency worked to defeat legislation this session that would have changed that, and it didn't clear both houses.

"Non-certified housing ... is where most people with disabilities want to live, but OPWDD is not facilitating that — they're hindering it," said Tom Abinanti, a former state assemblymember who has an adult son with autism. "OPWDD is stuck in the past."

The agency has deinstitutionalized people and developed programs, but lacks a modern housing policy, Abinanti said.

"They insist that only their staff can determine who is qualified, who is high-enough functioning to be able to live on their own," he added. "How do they know what a person can do or can't do? If you're person-centered, then let the person or the person's circle of support determine where that person should live. OPWDD should not be intruding itself on making those decisions."

Assemblyman Andrew Hevesi, who chairs the Assembly Children & Families Committee, blames much of the current shortage of years of cuts to services for disabled people under former Gov. Andrew Cuomo.

"Andrew Cuomo imposed 12 years of mind-bogglingly stupid financial austerity for no reason, and the consequence here today is that we now have families coming in and talking about they have no place to put their kids, there are no services, we have to put them out of state," Hevesi said. "... That was the catalyst for most of our major problems here."

Lawmakers said they want to compromise with the Office for People with Developmental Disabilities about which rules to change to help thousands of people with aging caretakers.

Hevesi said vague regulations and a lack of funding prevent the agency from doing more.

Continued

North Carolina - ‘We are desperate’: Stein calls session on Medicaid funding as cuts hit

By Marshall Keely, Spectrum News Central NC,, November 6, 2025

As a budget stalemate continues in Raleigh, Gov. Josh Stein is renewing calls for the General Assembly to get back to work on a deal.

With no budget, the North Carolina Department of Health and Human Services cut Medicaid reimbursement rates, saying it needed to make up for a gap in funding.

Now, some of those cuts are being pulled back by a judge’s order.

Health care providers saw Medicaid reimbursement rates drop less than a week ago.

On Wednesday, Superior Court Judge G. Bryan Collins issued a temporary restraining order that puts a pause on cuts to Medicaid reimbursement rates for behavioral health treatments.

It included a 10% rate decrease to research-based behavioral health treatments.

Twenty-two parents of children diagnosed with autism or who are receiving therapy sued DHHS, saying the cuts would keep kids from being treated.

They said it’s a violation of the state’s constitution.

The plaintiffs in the lawsuit against DHHS filed a motion for a preliminary injunction.

That would keep the Medicaid rates for behavioral health services in place until the case is decided in court.

A judge will choose whether to grant that request in a hearing on Nov. 10.

Stein did not address that lawsuit in a press conference outside the state capitol on Thursday but acknowledged the cuts' potential impact to people with autism and vulnerable populations.

He called on lawmakers to come back to Raleigh for an extra session on Nov. 17 to hammer out a deal to fund Medicaid.

“We are desperate to restore the funding levels to where they were before, but by law we cannot spend money that we do not have, nor should we spend money that we do not have,” Stein said. “The legislature has not fully funded Medicaid, they know they’ve not fully funded Medicaid.”

Continued

Beyond the ramp: These New Jersey clinics are redefining disability access in health care

By Gene Myers and Scott Fallon, North Jersey . com, November 7, 2025

The front entrance now includes a ramp. The exam room has a height-adjustable table and transfer board. If the waiting room is too loud, patients can go outside.

None of this happened by accident. It came from listening.

At the Freehold Family Health Center, a patient advisory council of people with disabilities, caregivers and health care professionals mapped the barriers preventing access to the clinic and then took steps to fix them — from re-striping the lot for more accessible parking to moving a curb cut, adding equipment and providing more training.

“We wanted to go above and beyond" compliance with the federal Americans with Disabilities Act, said Jenna Sistad, project manager with the Ocean Monmouth Health Alliance, which helped lead the work with grant funding.

“True inclusion means more than wide doors and push-button entries. It means designing systems and spaces with disability justice in mind,” Sistad said.

The center serves an estimated 4,000 patients per year from Freehold and the Monmouth County area. The renovations have supported about 100 new patients who need accessible care each year, Sistad said. Grants totaling $370,000 over three years made it possible.

Researchers have warned for years that inaccessible health care has deadly consequences. A 2013 British study found that men with intellectual disabilities died an average of 13 years earlier and women 20 years earlier than the general population, often from preventable causes.

In the U.S., the National Council on Disability summarized data showing that Americans with disabilities have higher rates of chronic illness and avoidable deaths because of poor access to care.

Dr. Greg Costello is medical director at Hope Christian Services in Wyckoff, where residents with developmental disabilities receive primary and specialty care. He designed a medical suite entirely around accessibility.

“From the ground up, the room is designed specifically for people with developmental disabilities,” Costello said during a recent tour.

The suite, which cost about $120,000, includes a ceiling-mounted lift that can help wheelchair users get into an exam chair and a modular work area that can transform into a dental station or an ophthalmology setup. Costello can do blood work, presurgical clearances, ultrasounds and EKGs.

The facility, while a model of accessibility, is also a rarity, said CEO Daryl Rogers. There are only five like it in the state, he estimated. Meanwhile, tens of thousands of New Jerseyans could benefit from such attention to these details.

“Education has to come first,” Costello said. “Once doctors stop being afraid to take care of people with disabilities, the rest — the equipment, the space — can follow.”

Costello said fellow physicians shy away from treating people with developmental or significant physical disabilities for a mix of reasons.

The most common is fear: What do they do if a patient can’t communicate, acts out or behaves unpredictably? Most medical schools offer little to no training in disability care, he said. As a result, doctors often feel unprepared and anxious about saying or doing the wrong thing.

Another barrier is the way insurance pays for a doctor’s time. A visit that might take 45 minutes for a patient with disabilities pays the same as an appointment that might take only 10 minutes for someone else.

Costello said some colleagues also worried that people with disabilities would scare other patients, with one doctor bluntly telling him, “I don’t want your people in my waiting room.”

Read the full article here

NJ files neglect charges against one of state's largest group home operators in rare move

By Ashely Balcderzak and Jean Rimbach, North Jesey . com, November 3, 2025

In a rare move, the New Jersey Office of the Attorney General brought neglect charges against one of the state’s largest operators of group homes for adults with developmental disabilities — and six of its employees — after workers allegedly left a resident on the floor for nearly seven hours without offering assistance. 

The state’s charges in May against the provider, Elwyn, came around the same time another state agency took the uncommon action of banning Elwyn from accepting new group home residents amid state concerns about staff shortages and deaths. Elwyn has 51 group homes in New Jersey that can house more than 200 people. 

Both moves came days after NorthJersey .com published its Hidden at Home series, which revealed serious ongoing problems in the $1.5 billion group home system, including a lack of basic care for residents, dozens of preventable deaths, and regulators who rarely punish poorly-performing providers. 

The state’s Medicaid Fraud Control Unit within the Office of the Insurance Fraud Prosecutor filed criminal complaints in May, centering around two falls caught on surveillance footage of S.K., a woman who was 60 years old or older, at a Vineland group home run by Elwyn two years earlier, in April 2023. The woman’s full name was not included in the complaints. 

“The safety of the individuals we serve is our highest priority. Elwyn denies any criminal conduct in its management of this facility, and anticipates resolving this matter through a non-criminal, administrative resolution mutually acceptable with Elwyn and the New Jersey attorney general,” said Kurt Knaus, an Elwyn spokesperson.  

He also pointed to an accreditation Elwyn recently received in abuse prevention that took two years to complete.  

The Attorney General’s Office did not respond to questions posed in writing three weeks ago. 

S.K.’s falls 

On April 13, 2023, S.K. fell in the living room of her Elwyn group home around 4 p.m. She remained on the floor for three hours; two direct care workers and a manager did not make any effort to help her up or ask if she was OK, said Deputy Attorney General Laura Bryant, according to court audio obtained by NorthJersey. com. 

S.K. — who had an unspecified intellectual disability — wore a helmet and a gait belt and was supposed to be supervised at all times according to her service plan, Bryant said.  

Despite that supervision requirement, two days later S.K. entered the bathroom alone and fell around 12:15 p.m. She was left there until 7 in the evening, Bryant said.  

When one worker — not charged by the state — called a director asking for help, the director told the worker to leave her on the floor, the deputy attorney general said.  

Another worker arrived at her shift after S.K. had been on the floor for several hours. Camera footage shows she dragged S.K. into another room, Bryant said. 

When S.K. crawled out, covered in fecal matter and urine because she had soiled herself, the same worker dragged S.K. back into the bathroom across the tile, showered her while she was still on the floor, and dragged her out, Bryant said. 

Once in the hallway, she hit S.K., according to camera footage, Bryant said.  

The worker admitted Elwyn did not train her to hold or drag residents in that way, Bryant said.  

The state also charged Elwyn’s director of operations, alleging he failed to implement policies and procedures so S.K.’s fall could have been prevented.  

S.K. has since died. Bryant said the state is not alleging that the April 2023 falls contributed to her death.  

All six workers originally pleaded not guilty during their arraignments, according to court audio. 

For most of the workers, the state said in court proceedings, it was offering a plea deal for pretrial intervention and 100 hours of community service. The state would also want workers to commit not to work in direct support positions where they are caring for vulnerable populations such as children or people with disabilities or mental illness, Bryant said. 

Court records show one worker was admitted into pretrial intervention in September.

It’s unclear how many defendants requested pretrial intervention and whether the state accepted those applications. The program, offered generally to first-time offenders, allows charges to be dismissed if defendants meet certain conditions and take advantage of rehabilitative services, under the supervision of probation officers.  

It’s also unclear how many defendants, if any, were added to New Jersey’s Central Registry of Offenders — a list of caregivers found to have exploited, abused or neglected someone with intellectual or developmental disabilities. Those on the registry are banned from working with this population in state-overseen programs.    

The no-hire list of names is not available to the public.  

NorthJersey. com obtained data that includes the date when a staff member was added, and the last company where he or she worked before being banned. Ten former Elwyn workers were added to the registry between 2011 and December of 2024.  

Elwyn entered a not guilty plea in the case in October. 

In the most recent court proceeding, Elwyn’s attorney and the state indicated they were negotiating a civil resolution, which would mean criminal charges would likely be dropped, depending on the agreement.  

One other company charged by prosecutors 

NorthJersey. com identified only one other similar case since 2018 in which prosecutors charged a company that operates group homes and day programs for adults with developmental disabilities.  

Middlesex County charged Just Home Adult Medical Care — also known as Broadway — and five of its workers with assault, abandonment and neglect, and endangerment in 2019.  

Continued

This mom has three children with autism. She’s spent thousands on false hope.

By Trisha Thadani, The Washington Post, November 2, 2025

Wrangling three children with autism consumed Dana Paduchowski’s days in a chaotic swirl, her weeks dissolving into a blur of routines and meltdowns. When the house finally quieted at night, the mother would stay awake for hours scouring the internet for a magic treatment that didn’t exist.

Instead of finding answers, Paduchowski said, she constantly stumbled into expensive “rabbit holes of broken promises.”

Over the past few years, Paduchowski estimates, she and her husband have spent at least $30,000 on unproven alternative treatments for her children: An intravenous therapy to remove heavy metals from her son’s body. A clinic with hyperbaric oxygen chambers. Supplements, new diets and naturopathic doctors. While some helped in small ways, others made no difference. In a few cases, she said, her children became “sick and pale” or regressed.

“I just thought, ‘Oh, we’re gonna get this test, and then we’re gonna get results, and then we’re going to fix this one thing and then he’s going to talk and break out of his autism shell,’” she said on a recent afternoon standing in her kitchen, as 15-year-old Caleb, her oldest, jumped and flapped his arms to an episode of “Sesame Street” blaring on the TV.

“But none of that has ever happened,” she said.

Paduchowski’s journey into unproven and sometimes risky treatments highlights how parents of autistic children frequently navigate a confounding mix of conflicting advice, purported “miracle” treatments and false hope in a bid to improve symptoms of a mostly genetic disorder that has no cure. Experts say only behavioral therapy has been shown to address the core symptoms of the disorder, while medications, like antidepressants or antipsychotics, can help co-occurring symptoms such as anxiety or irritability. Now, as Health Secretary Robert F. Kennedy Jr. makes autism a central focus of his “Make America Healthy Again” agenda — and pushes unsubstantiated causes and cures in the process — Paduchowski said there’s a new layer of confusion on whom to trust and where to turn.

Fringe treatments for autism have long tempted some individuals and families struggling with the disorder, which is a neurodevelopmental condition that presents itself differently in each person. There’s little evidence of effectiveness for common alternatives to behavioral therapy that are widely cited on the internet, according to a study this year in the Nature Human Behavior journal. Still, the study found, up to 90 percent of autistic individuals reported having tried some type of alternative treatment at least once in their lifetime.

Medical professionals who treat children with autism said in interviews that parents often ask about supplements or off-label medications they heard about on the internet — even more frequently since the Trump administration elevated the issue. Some have seen parents turn toward extremes: enemas of diluted bleach solutions, raw camel’s milk, costly trips abroad for stem cell treatments not backed by solid evidence.

“There’s danger and then there is just the overall cost,” said Shafali Jeste, chair of pediatrics at the UCLA David Geffen School of Medicine and a child neurologist specializing in autism. “Cost doesn’t just mean money, but cost in time, in energy, in emotional investment.”

These days, Jeste said, many parents are asking her about leucovorin, a form of vitamin B9, to treat autism in children, which has shown some promise but lacks rigorous clinical trials proving benefit. Kennedy and President Donald Trump have widely promoted the generic cancer drug, and the Food and Drug Administration recently said it will approve it for patients with cerebral folate deficiency, often associated with the symptoms of autism. The move set off a wave of hope among families coping with autism but also drew warnings about the many unknowns. Kennedy and Trump have also promoted the debunked theory that vaccines cause autism.

Continued

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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.

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VOR SUPPORTS:

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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