October 24, 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.

IT'S OCTOBER!

Cooler temperatures, crisp air, falling leaves, carving pumpkins, apple cider, flannel shirts, Trick or Treat, and

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 three months.

So this is when we start gathering our nuts for the Winter.

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

Over the next two and a half months, we promise to send you a multitude of reasons to donate, to renew your membership, to make end-of-year tax deductions,

to Give us a Tuesday, remember our families during the holidays, share with you the joys and sorrows that bring us together for this important, important cause and to celebrate the good work we do together!

We will try to make our campaigns enjoyable, interesting, touching, and inspiring.

VOR's Fall / Winter Fundraising Campaign:

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

The idea is not to replace our regular appeal for donations and new memberships.

(We hope you will continue to donate as always, through our website)

But we like to enhance our fundraising efforts by offering delicious See's Candies to our supporters who wish to send gifts to family and friends over the holidays.

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

Can't think of the right thing to send to Aunt Millie this year?

Need a little something to bring to Thanksgiving dinner?

Maybe some Peanut Brittle to share at Hanukkah?

How about bringing several

Big Box of Chocolates to the

Wonderful DSPs

at your facility for the care and kindness

they provide throughout the year?

You can 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)

or use this QR Code with your phone's camera

VOR Podcasts!

Hosted by Casey Henry and Brenna Redfearn

on our YouTube page!

The real fraud isn’t in Medicaid — it’s in the profits of corporate insurers

By Ellen Allen, West Virginia Watch, October 23, 2025

Congress loves to talk about “waste, fraud and abuse” in government health programs. It’s the all-purpose excuse for pushing through the largest cuts to health care in history. But the truth is that the real waste and abuse aren’t coming from poor families on Medicaid or from overworked state officials. It’s coming from the corporate insurers who profit from the very programs Congress claims to be protecting.

Take the recent West Virginia audit that discovered about $32 million in overpayments related to people who were ineligible — including some who were incarcerated or deceased. Yes, this is significant and must be corrected. Eligible West Virginians should not be denied access to health care based on administrative inconsistencies and errors. 

The $32 million pales when compared to multi-billion-dollar abuses, improper payments, overbilling and overcharging by private insurers that are documented in dozens of cases across the U.S.

Here are real examples:

• In August 2024, Humana, a major insurer, agreed to pay $90 million to settle a whistleblower lawsuit that claimed it overcharged the federal government in its Medicare Part D drug program. The accusations included misrepresenting costs to get a more favorable contract, which led to higher payments from taxpayers. 
• Earlier in 2025, the U.S. Department of Justice filed a False Claims Act complaint against three national insurers — Aetna, Elevance Health and Humana — and three large broker organizations. The government alleges that from 2016 through at least 2021, these insurers paid hundreds of millions of dollars in illegal kickbacks to brokers in exchange for enrolling people into their Medicare Advantage plans. These kickbacks apparently skewed enrollments away from people who might be costlier to cover, including those with disabilities. 
• There are “ghost networks” in provider directories: directories that insurers are required to maintain but are misleading. For example, in New York, an investigation found that 86% of mental health provider entries in some insurers’ directories were “ghosts” — providers either unreachable, not accepting patients, or not in-network in practice.
• Insurers are also using diagnosis coding strategies (“upcoding”) and questionable documentation to receive higher payments from Medicare. For instance, Medicare Advantage organizations have been accused of submitting inflated diagnoses for enrollees — some of which have little or no basis in the patients’ records — in order to make patients appear sicker and thus receive higher payments from Medicare. Some of these practices reportedly cost billions. 

These are not isolated mistakes. They are systemic practices by large private entities profiting from public dollars and public needs.

Unlike public programs, which are accountable to taxpayers and lawmakers, private insurers are accountable only to their shareholders. Their incentives are backward: every claim denied, every appointment delayed, every patient discouraged from seeking care is a win for the bottom line. Studies routinely show that administrative waste and inefficiency within private insurance add up to tens or even hundreds of billions of dollars every year — a staggering sum compared to the $32 million mistake in West Virginia.

So when Congress says it’s cutting “waste, fraud and abuse” and state lawmakers use audits like West Virginia’s to justify slashing health care programs, what they’re doing is redirecting attention away from the big money abuses that they seldom touch. The moral framing gets flipped: those insisting on safety nets are painted as wasteful; the profit-seeking firms pulling strings behind the scenes are barely scrutinized.

The West Virginia audit shouldn’t be weaponized to slash care. Oversight should be intensified against insurers, not increased burdens placed on patients. Reforms should target kickback schemes, inflated diagnosis codes, ghost networks, denials of care and massive administrative waste. And before any more cuts are made to health care programs for vulnerable populations, there must be full accountability for where the real losses are happening.

Read the full article here

AG Drummond presses for answers in failed managed Medicaid care in Oklahoma

By Terré Gables, KFOR News, October 23, 2025

OKLAHOMA CITY (KFOR) – Oklahoma Attorney General Gentner Drummond is pressing for answers regarding the failed managed Medicaid care in Oklahoma, also known as SoonerCare.

Drummond is insisting that the Oklahoma Health Care Authority (OHCA) provide answers in a letter sent detailing that the program’s community-based providers, who care for Oklahoma kids, are being squeezed financially while out-of-state corporations profit.

“Without immediate correction, these failures will destroy Oklahoma’s pediatric network, leaving SoonerCare children across Oklahoma’s 77 counties without access to care,” Drummond wrote.

Drummond additionally cited alarming trends among Oklahoma-based healthcare providers are facing in providing critical healthcare services to Medicaid-enrolled pediatric patients, including reductions in reimbursements for direct pediatric care, payment withholdings, and bureaucratic delays.

Drummond is asking OHCA to provide its contracts with the following MCOs:

• Aetna Medicaid Administrators LLC (Aetna Better Health of Oklahoma)
• Humana Inc. (Humana Health Horizons of Oklahoma)
• Centene Corp. (Oklahoma Complete Health)

Drummond has also instructed a review of provider reimbursement failures and remedies to the managed care deficiencies.

Read the full article here

Missouri can save money and improve care by cutting the middleman out of Medicaid

By Ed Weisbart, The Missouri Independent, October 21, 2025

What would you say if I told you it’s possible to cut $250 million from the Missouri Medicaid budget while also improving the health of people on Medicaid? All we need to do is cut out the middleman by not renewing our state contracts with insurance corporations like Centene, Blue Cross and United Healthcare.

Over the past decade, the corporations running Medicaid nationally averaged an astronomical overhead rate of 13%. On top of that, Missouri spends untold millions of dollars overseeing these corporations.

All this waste disappears if we switch to an enhanced form of the fee-for-service model that Missouri Medicaid currently uses for our aged, blind and disabled people. Other states, such as Connecticut, have cut out the middleman and run their Medicaid programs with a total overhead of 4-6%. Since 2012, that tiny state has saved $4 billion.

Connecticut did this without a significant increase in state agency staffing by outsourcing much of the work to private commercial businesses called “Administrative Services Organizations” that are paid a flat fee for a defined service, avoiding the conflicts of interest inherent in so-called “managed care” organizations.

States like Missouri that allow insurance corporations to run their Medicaid program have consistently seen higher and more rapidly growing expenses. Between 2004 and 2015, counties that outsourced their Medicaid program to insurance corporations had their costs rise $1,584 per person per year above what was being spent in comparable counties that avoided this trap.

By switching to enhanced fee for service, we would have to absorb some of the administrative functions done by insurers, but we would also stop spending anything on insurance company overhead and oversight. On balance, we could expect a modest increase in administrative expenses but save between 10-17% of total costs.

In total, after accounting for the portion of savings that would go back to the federal government (they fund the majority of Medicaid), our state would save between 152 and 258 million dollars per year, in 2023 dollars.

We’re not the only state in this position. Nationwide deprivatization of Medicaid would annually save all states combined as much as $34 billion and the federal government as much as $43 billion, for a total of $77 billion for the country.

To be clear, that’s not enough to completely mitigate the recent federal cuts to Medicaid funding – but it would go a long way. Without this approach, we face a range of unpalatable alternatives.

We could instead cut the “optional” Medicaid benefits like pharmacy, dentistry, physical therapy, occupational therapy, and hospice care. Sadly, many states facing a budget crisis decide to cut long-term home health services, a self-defeating strategy as these are the very services that keep people from being institutionalized at even higher costs to the state.

Or we could cut more people from Medicaid.

Or we could cut back on what we pay doctors, though many people on Medicaid already have difficulty finding a physician who accepts Missouri’s paltry Medicaid fee schedule.

Or we could cut back on what we pay hospitals, but Missouri already has too many hospitals at risk of closure. Cutting their funding would accelerate the crisis, particularly in rural communities.

Or we could reduce state funding for other essential services, like education.

Or we could raise taxes.

None of these choices are acceptable. Removing managed care organizations from Medicaid would protect the entire healthcare system while saving us hundreds of millions of dollars per year.

Continued

Ed Department Making Plans To Offload Special Education

By Michelle Diament, Disability Scoop, October 23, 2025

The U.S. Department of Education is in talks to move oversight of special education programs to another federal agency.

An Education Department official said this week that the agency is working to make good on pledges from President Donald Trump and Secretary of Education Linda McMahon to close the department and send special education elsewhere.

“Secretary McMahon has been very clear that her goal is to put herself out of a job by shutting down the Department of Education and returning education to the states,” said Madi Biedermann, deputy assistant secretary for communications at the Education Department. “The department is exploring additional partnerships with federal agencies to support special education programs without any interruption or impact on students with disabilities, but no agreement has been signed.”

Trump said in March that he would move “special needs” programs to the Department of Health and Human Services. At the time, the administration offered no details about which programs would move, what the process would look like or when it would occur.

HHS officials referred an inquiry this week about the matter to the Education Department.

Biedermann did not respond to questions about which agencies the Education Department is in talks with, exactly which programs could be affected or when this might happen, but she indicated that funding should not be impacted.

“Secretary McMahon is fully committed to protecting the federal funding streams that support our nation’s students with disabilities,” Biedermann said.

The possible changes come as the federal role in special education is already in upheaval. Earlier this month, 121 employees were let go from the Education Department’s Office of Special Education and Rehabilitative Services leaving no more than a handful of staff in the agency’s Office of Special Education Programs, which administers funding and oversees implementation of the Individuals with Disabilities Education Act.

The layoffs were temporarily paused by a federal judge, but disability advocates said that if the job cuts go through there is no way that such a skeleton staff could fulfill the statutory requirements of IDEA.

“Moving special education out of the Department of Education demonstrates a disregard for the educational needs of students with disabilities,” said Sasha Pudelski, director of advocacy for AASA, The School Superintendents Association. “America’s special education students are embedded at every level, in every program that the department oversees. Siloing these supports, funding and services in a separate agency undermines the achievements of the last 50 years to fully include special education students in every aspect of public education. It’s a step backward for education and for our country.”

Nicole Fuller, associate director of policy and advocacy at the National Center for Learning Disabilities, noted that the Education Department has experts on IDEA, data collection, monitoring of states and more. She likened moving special education from the Education Department to HHS to expecting a child’s pediatrician to teach them.

There are also questions about the legality of transferring special education programs out of the Education Department.

“The Individuals with Disabilities Education Act (IDEA) clearly designates the Secretary of Education as the only agency head responsible for ensuring states and agencies meet the conditions and requirements in IDEA,” said Stephanie Smith Lee, co-director of policy and advocacy at the National Down Syndrome Congress, who served as director of the Education Department’s Office of Special Education Programs, or OSEP, under President George W. Bush. “Moving OSEP would have a detrimental impact on students with disabilities, teachers and schools.”

Read the full article here

Trump’s attempt to gut special education office has some conservative parents on edge

By Sara Luterman, The 19th News, October 17, 2025

The Trump administration’s decision to lay off most employees within the U.S. Department of Education’s special education office was described by the president this week as part of cuts to “Democrat programs that we were opposed to.” This was news to many conservative parents of disabled children, as well as disability policy experts. 

More than 7.3 million children in all 50 states rely on special education services, which are partially funded and enforced by the federal government.

“Special education is a nonpartisan program. Special education services are provided to any student with a disability, regardless of political party,” said Maria Town, president of the nonpartisan American Association of People with Disabilities. 

A federal district court judge in Northern California on Wednesday granted an emergency order to temporarily pause the mass layoffs that occurred throughout the federal government. If the gutting of the Office of Special Education and Rehabilitative Services, or OSERS, proceeds, Town and other disability advocates said there is no way the Department of Education can continue to fulfill its responsibilities to enforce the Individuals with Disabilities Education Act. The act — known by its acronym, IDEA — guarantees students with disabilities the same right to public education as students without disabilities. 

Town pointed out that during the first term of President Donald Trump, a Republican, the office determined that Texas, a Republican-led state, had illegally placed a cap on the number of students who could receive special education services in each district. Texas lawmakers lifted the cap in 2017, after receiving pressure from the Department of Education. 

Many of the biggest legislative victories for students with disabilities happened under Republican administrations. 

“Education for people with disabilities goes hand in hand with conservative ideals,” wrote disabled journalist Eric Garcia in a recent MSNBC column. “While that may seem counterintuitive, having people with disabilities integrated into larger society is a way to reduce the chance that they have to depend on the government.”. 

Former Republican President Gerald Ford signed the first iteration of the Individuals with Disabilities Education Act, then-called the Handicapped Children Act. It required that students with disabilities receive “individualized education plans” and established that they have a right to a “free, appropriate public education.” Republican President George H.W. Bush signed the Americans with Disabilities Act into law in 1990. The Individuals with Disabilities Education Act was later expanded and reauthorized by a Republican-majority Congress and signed by Republican President George W. Bush in 2004. 

Across some of the largest special education and parent groups on Facebook, debate has raged about what this recent move will mean for disabled children. Among conservative-leaning parents, opinions roughly fell into three categories: denial, hopefulness and a sense of betrayal. 

Continued

Federal cuts end Napa County-led program training California teachers to support children with disabilities.

By Tarini Mehta, The Press Democrat, October 21, 2025

A $10.5 million federal grant that trained California educators to better support children with disabilities has been abruptly canceled — three years before its funding was set to expire — because it conflicted with “the priorities of the current administration,” officials say.

The Partnerships for Effective Practices in Transition and Inclusion, or PEPTI Project, had been funded since 2023 through a five-year grant from the U.S. Department of Education. The money supported statewide training for child care practitioners and teachers to help children with disabilities transition into preschool and succeed in the classroom. The effort was facilitated by the Napa County Office of Education on behalf of the California Department of Education.

Now, after training more than a hundred educators across the state, the program is being shut down.

“This cancellation puts all this work in jeopardy and cuts short planned future impacts,” said Seana Wagner, spokesperson for the Napa County Office of Education.

In September, the California Department of Education received notice that the federal government was ending the PEPTI Project. The state appealed the decision, and education groups including the California School Boards Association and the Association of California School Administrators sent letters of support. But the U.S. Department of Education denied the appeal.

According to a report prepared for that appeal, much of the state’s training infrastructure for early childhood special education will now disappear. The Napa County Office of Education anticipates some of the eight staff members employed on the project will lose their jobs.

Of the total $10.5 million grant, California had already received $6.5 million before the cancellation, resulting in a $4 million loss.

Continued

Oklahoma should add special education support amid federal uncertainty, state lawmaker says

By Nuria Martinez-Keel, For Oklahoma Voice via The Journal Record, October 17, 2025

While the U.S. Department of Education proposes mass layoffs in its special education office, an Oklahoma lawmaker said he intends to bolster state-level support for students with disabilities. 

Sen. Adam Pugh, R-Edmond, said he plans to file legislation to give families of special education students an outlet at the state level to seek recourse when their children aren’t receiving the proper services guaranteed to them by law.

Although funding for special education is secure, the federal employees whose jobs could be eliminated are responsible for holding states accountable to upholding the rights of students with disabilities.

“I was hearing from a lot of parents with children with special needs,” said Pugh, who leads two committees on K-12 schools. “I felt like there was a need for us to act on their behalf because what you don’t want is a parent in a situation where they don’t feel like the system is working for them and there’s no recourse when that occurs.”

A key part of his legislation would be to ensure families don’t have to hire an attorney when pursuing complaints through the state, Pugh said. He also aims to set clear timelines to address each case, so parents aren’t dragged into a lengthy “bureaucratic nightmare,” he said.

“I think there’s the assurance from the state to parents that, ‘Hey, we’re not going to let your child’s rights be violated here and then force you to foot the bill to fight that through the legal system,’” Pugh said.

The deadline for lawmakers to file bills before the 2026 legislative session is Jan. 15. 

Lawmakers convene their legislative session Feb. 2. Meanwhile, Pugh also is running as a Republican candidate in the 2026 election for state superintendent.

Last month, the U.S. Department of Education distributed $181 million to Oklahoma for special education through the Individuals with Disabilities Education Act (IDEA). That amount covers 14% to 15% of the cost to educate children with disabilities in Oklahoma public schools, Pugh said. 

Amid an ongoing government shutdown, the Trump administration attempted sweeping layoffs at multiple federal agencies, including cutting 466 jobs at the U.S. Department of Education. That reduction in force would eliminate almost the entire Office of Special Education and Rehabilitative Services.

A California federal judge on Wednesday temporarily blocked the layoffs from moving forward. 

The Oklahoma State Department of Education assured families that federal cuts wouldn’t mean oversight of special education programs would disappear. 

The state agency also monitors these services to make sure local school districts comply with IDEA and state standards, Deputy Superintendent Romel Muex-Pullen wrote in a statewide letter this week.

The state Education Department also offers assistance with dispute resolution, she wrote.

“Despite changes at the federal level, our mission, responsibility, and dedication remain unchanged,” Muex-Pullen wrote. “Oklahoma will continue to ensure that all students with disabilities receive the educational services, protections, and opportunities guaranteed under IDEA.”

Continued

Trump Administration Severely Limits Rural Health Transformation Funds for Rural Hospitals and Clinics – Capped at 15%

By Adam Searing, Georgetown University McCourt School of Public Policy, October 21, 2025

Passage of the budget reconciliation law signed into law by President Trump (HR1) will result in a gross reduction of $990 billion in federal Medicaid and CHIP spending over 10 years and an increase in the number of uninsured Americans of 10 million. These are the largest health cuts in Medicaid’s history, and passage of the bill was delayed by worries that rural hospitals across the United States would be put at further risk of closing because so many of their patients rely on Medicaid. KFF estimates that HR1 will reduce federal Medicaid spending in rural areas across all states by $137 billion over 10 years.

To ensure passage, Congress included a $50 billion “Rural Health Transformation Fund” (or RHTF). For more information see our other CCF blogs on the RHTF including background, analysis of the state application process, the need to address maternal health shortages, and the importance of addressing the needs of children and families in rural areas. While there was nothing in the bill’s language in HR1 requiring that the funding in the RHTF be provided to rural hospitals to protect them from large Medicaid cuts, there was also no prohibition against states using RHTF funding for that purpose—and members of Congress who voted yes in the end repeatedly cited the fund’s ability to protect their rural hospitals. 

Unfortunately, the ambiguity members of Congress left in HR1 about whether or not to actually help fund rural hospitals and health clinics was resolved last month by the federal Centers for Medicare and Medicaid Service (CMS). CMS released the state “Notice of Funding Opportunity” detailing for states how they could apply for RHTF funds and what the restrictions would be. CMS lists as a condition of funding that states cannot exceed use of 15% of federal funding awarded to the state for health provider payments – including payments to rural hospitals.

This limitation on funding should come as a surprise to many of the politicians who took every opportunity to characterize their support for a bill with the largest health care cuts in Medicaid’s history as actually support for rural hospitals in their states.

For example, Senate Finance Committee Chair Mike Crapo (R-Idaho) characterized the funding as the “$50 billion rural hospital fund” and said it was “arguably the single largest investment in rural health care in more than 20 years.” Likewise Senator John Barrasso (R-WY) used similar language, calling it the “rural hospital fund” with “$50 billion designated for rural hospitals all across America.” And Senator Jerry Moran (R-Kansas) characterized HR1 as creating “a $50 billion fund to provide emergency assistance for rural hospitals at risk of closure…” while Representative Jule Fedorchak (R-North Dakota) also characterized the program as the “Rural Hospital Fund.” Senator Lisa Murkowski (R-Alaska) only voted for the bill after the RHTF was increased to an amount she felt could help prevent rural Alaska hospitals from closing. And Senator Josh Hawley (R-Missouri) reversed his opposition to the bill after what was characterized as the “$50 billion rural hospital fund” was included.

In the end, what was characterized by many as a “rural hospital fund” is really nothing of the sort. The vast majority of RHTF funding is actually prohibited from directly benefiting health care providers, including rural hospitals. Members of Congress may have had different motivations for passing HR1, but the implementation of the law around the RHTF is different than the assurances around help for rural hospitals many policymakers gave the public.

Read the full article here

States Jostle Over $50B Rural Health Fund as Trump’s Medicaid Cuts Trigger Scramble

By Sarah Jane Tribble, KFF Health News, October 17, 2025

Nationwide, states are racing to win their share of a new $50 billion rural health fund. But helping rural hospitals, as originally envisioned, is quickly becoming a quaint idea.

Rather, states should submit applications that “rebuild and reshape” how health care is delivered in rural communities, Centers for Medicare & Medicaid Services official Abe Sutton said late last month during a daylong meeting at Washington, D.C.’s Watergate Hotel. Simply changing the way government pays hospitals has been tried and has failed, Sutton told the audience of more than 40 governors’ office staffers and state health agency leaders — some from as far away as Hawaii.

“This isn’t a backfill of operating budgets,” said Sutton, CMS’ innovation director. “We’ve been really clear on that.”

Rural hospitals and clinics nationwide face a looming financial catastrophe, with President Donald Trump’s massive tax-and-spending law expected to slash federal Medicaid spending on health care in rural areas by $137 billion over 10 years. Congressional Republicans added the one-time, five-year Rural Health Transformation Program as a last-minute sweetener to win the support of conservative holdouts who worried about the bill’s financial fallout for rural hospitals.

Yet, the words used by CMS Administrator Mehmet Oz and his agency’s leaders to describe the new pot of cash are generating tension between legacy hospital and clinic providers and new technology-focused companies stepping in to offer new ways to deliver health care.

It’s “what I would call incumbents versus insurgents in the rural space,” said Kody Kinsley, a senior policy adviser at the Institute for Policy Solutions at the Johns Hopkins School of Nursing.

Applications are due Nov. 5. The money will be awarded to states by the end of the year and distributed over five years.

Half of the $50 billion will be divided equally among all states with an approved application; the other half will go to states that win points. Of the second half, $12.5 billion will be allotted based on a formula that calculates each state’s rurality. The remaining $12.5 billion will go to states that score well on initiatives and policies that mirror the Trump administration’s “Make America Healthy Again” objectives.

The application identifies specific policy goals such as implementing the Presidential Fitness Test and restrictions to food assistance, as well as broader investment strategies around remote care services, data infrastructure, and consumer-facing technology tools, which CMS identified as “symptom checkers and AI chatbots.”

In September, after CMS officials released the application, Republican members of Congress from states with Democratic governors called for fairness, concerned their states might direct the money to urban areas. In a letter to Oz and Health and Human Services Secretary Robert F. Kennedy Jr., they said the money “will serve as a lifeline for rural and at-risk hospitals in our communities that are already struggling to keep their doors open.”

Smaller hospitals fear they will get “a tiny little slice” of each state’s share, said Emily Felder, who leads the health care practice at Brownstein Hyatt Farber Schreck, a law firm whose clients include rural hospital systems.

Read the full article here

Commentary: Cuts to Medicaid and to Insurance Subsidies Will Push ERs Past the Brink

By Eric Snoey, Los Angeles Times via Journal of Emergency Medical Services, October 20,2025

Back in 2007, President George W. Bush was being challenged on his opposition to the Children’s Health Insurance Program — which provides health coverage for children in families too poor to afford private insurance, yet too “wealthy” to qualify for Medicaid. His response was honest, if characteristically clumsy: “People have access to health care in America. After all, you just go to an emergency room.”

In a way, he wasn’t wrong. By law, ERs must evaluate and stabilize every patient who walks through the door, regardless of complaint or ability to pay. But by saying the quiet part out loud, Bush laid bare an uncomfortable truth: Emergency departments are not just for emergencies, and never have been.

I’ve been an ER doctor at an inner-city trauma center for 35 years. And while I’ve seen plenty of gunshot wounds, drug overdoses and heart attacks, true emergencies — the kind that animate medical dramas on television — are a comparatively small part of what I do. It’s the “worried well,” the “sick and stoic” and everyone in between who keep us busy. They’re all resigned to using the ER as a stand-in for unavailable primary care.

ER docs like me hear it every day: “My doc is booked up and can’t see me for three months.” “The nurse line told me to come because the office is closed.” “It’s probably nothing, but I’m worried.” “I don’t have insurance, a doctor or my medicine.”

When there is no place else to go, everything is an emergency. Offering high-quality, sophisticated care, day or night, without a reservation, ERs have long served as spackle for a gap-riddled health care system. But emergency care of any kind is costly, resource intensive and increasingly being swamped by unmet needs for primary care: issues best handled elsewhere that end up in the ER for lack of better options.

ERs now operate in a sort of siege mentality — hold the line at all costs — because, by design, they are the last line of defense. I write these lines fresh off three successive ER shifts in which I thought, at several moments, we were just a patient or two away from a “breach”: the moment when demand outstrips capacity and the rationing of care begins. These are not rare events. In communities across the country, ERs and their staff are straining under a burden of too many patients, too few beds and a stubborn dearth of viable solutions to stem the tide.

And things are about to get worse.

The budget standoff in Washington, which has already triggered a government shutdown, centers on whether to renew federal insurance subsidies that are scheduled to expire on Dec. 31. If Congress fails to preserve the subsidies, premiums in the Affordable Care Act marketplace are expected to surge beyond the reach of millions of patients who currently depend on the program— especially people who work for small businesses and people in red states that have declined to expand Medicaid.

Just a year later, a second shock is set to arrive. The Big Beautiful Bill Act — the third-largest tax cut in U.S. history, passed by Congress last summer — will be “paid for” in part through draconian cuts in Medicaid, SNAP food assistance and noncitizen services. By design, these cuts do not take effect until after next year’s midterm elections. But when they do, the consequences will be severe: an estimated 11 million people will lose Medicaid coverage, while those who remain will face stricter eligibility hurdles. Disabled patients could see Medicaid-funded home care eliminated, forcing many into hospitals because of a lack of long-term care options. Meanwhile, 14 million unauthorized residents will lose access to all services, and another 8 million legal noncitizens may face the same fate.

Which is to say, the “just go” ER will soon be the shadow insurance for more than 33 million people living in America about to lose their health coverage, two-thirds of whom are either citizens or legal residents. The consequences of these cuts can’t be overstated. That’s 33 million patients who will forgo trips to the doctor, health screening for cancer and infectious disease, vaccinations, medication refills for chronic diseases like diabetes, hypertension and asthma.

Unlike ERs, doctors’ offices and clinics are under no obligation to “evaluate and stabilize” patients regardless of ability to pay. And they won’t, save for the occasional self-pay. But these patients aren’t going away. They are day laborers, house cleaners, workers at restaurants, hotels and home care agencies. They work in construction, agriculture and small businesses. They are the working poor, many one illness away from losing their jobs or their homes.

Inevitably, they will end up in the emergency room — sicker, with advanced, expensive conditions beyond the reach of easy fixes. They’ll have stopped taking their blood pressure medications, leading to strokes, heart attacks and kidney failure. Diabetics will see their glucose soar out of control. Untreated asthma and emphysema will render patients breathless and on death’s door. Flu and COVID will flourish. Measles, mumps, rubella, H-flu and meningitis outbreaks will become the new normal.

And care for affected individuals will fall to a health care system already operating on life support. Costs will be passed on to other customers, raising premiums and co-pays. Hospitals, many in rural areas, will look to cut services or close entirely, further expanding health care deserts.

Leaving aside the human suffering, the financial logic is delusional: Disease in 33 million residents will not vanish. It can either be managed inexpensively in doctors’ offices and clinics — or at orders of magnitude greater expense in ERs and hospitals. It becomes an elaborate game of cost shifting away from the federal government and onto state and local governments and hospitals.

Don’t think that you will be unaffected just because you have insurance, a doctor and an unassailable citizenship status. For one thing, you’ll be paying for the care that is no longer provided through federally subsidized insurance. And for another, “fortress” America has a poor record of insulating itself from the vagaries of disease: Think COVID, the opiate crisis, gun violence, etc. This is not a problem of haves versus have-nots. It will affect all of us. Costs will rise. Access will shrink. Your 911 call may be placed on hold. Ambulances will take longer to arrive. ER waiting rooms, already resembling bus stations, will be fortified with chairs and cots. Why? Because the hospital wards are full, rendering the ER a holding area for admitted patients, most of whom will end up completing their treatment on a gurney, never seeing a hospital ward.

Illness is an innate part of the human experience — one that, in civil society, we share with others in a sort of universal pact. The unmet health care needs of one affect us all. To believe otherwise is to divert one’s gaze, naively, hoping others will manage the problem, keeping it from your doorstep — in defiance of the medicine and simple math.

Read the full editorial here

Walmart Accused Of Denying Job Coach To Employee With Intellectual Disability

By Shaun Heasley, Disability Scoop, October 21, 2025

The nation’s largest retailer is facing legal action after supervisors allegedly harassed employees with intellectual disabilities and were unwilling to accommodate a job coach.

The U.S. Equal Employment Opportunity Commission says that Walmart violated the Americans with Disabilities Act with its treatment of two employees with intellectual disabilities at a location in Mount Pleasant, Wis.

Supervisors at the store allegedly called the employees, who worked as cart pushers, “stupid” and “slow.” One of the employees said that a supervisor called him a “retard” and closed a door on him, sending him home early, according to the suit filed recently in the U.S. District Court for the Eastern District of Wisconsin.

That employee ultimately quit after learning that the store manager would not do anything about the situation, the EEOC said.

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Arkansas - Employee fired, 11 others on leave from Human Development Center in Warren after resident’s death

By I.C. Murrell, The Pine Bluff Commercial, October 18, 2025

Eleven employees have been placed on administrative leave and another has been terminated resulting from an investigation into the death of an adult resident at the Southeast Arkansas Human Development Center in Warren.

The Arkansas Department of Human Services on Friday released a 148-page report into a "behavior incident" that led to the adult resident's death Sept. 7. DHS said in a news release that the incident led staff to use physical and chemical restraints and added that a review found that staff did not follow protocol.

DHS did not name either the deceased resident or any of the staff members. It said in the release it is limited in specific information because of ongoing investigations and to respect the privacy of the deceased.

Raven Fuller, the assistant superintendent of the Conway Human Development Center, has been named interim superintendent of the Southeast Arkansas facility, according to DHS communications chief Gavin Lesnick. 

"As DHS' investigation continues, the agency will take additional steps to hold staff who did not follow procedure accountable and to implement recommended changes at this facility," DHS said in a news release. The department added that recommendations would also be applied to other Human Development Centers in the state "to ensure best practices are followed throughout the system."

DHS Secretary Janet Mann said in the release: "The loss of one of the residents entrusted to our care at the Southeast Arkansas Human Development Center was wholly unacceptable and is not reflective of the level of care we work to provide Arkansans every day. We offer our deepest sympathies to the individual's family and are working to both hold accountable those responsible for this incident and make changes throughout our system to prevent future tragedies."

Read the full article here

Read a related article here

Download the full 148 page report here

Waitlist for disability services in WV climbs to more than 1,000; mostly children waiting for help

The state’s Intellectual and/or Developmental Disability Waiver program has a long waitlist spurred in part by a shortage of workers who can help adults and kids with disabilities.

By Amelia Ferrell Knisely, West Virginia Watch, October 23, 2025

More than 1,000 West Virginians with disabilities — mostly children — are on a waitlist for help and services as the state doesn’t have the capacity to serve them right now. 

The state’s Intellectual and/or Developmental Disability Waiver program had only 139 slots earlier this year, according to the Department of Human Services. The program provides funding to help teach and support people with disabilities and helps eligible adults live with assistance in community settings.

The IDD waitlist was 1,031 people as of Oct. 7.

“Seven-hundred-and-eighty-nine individuals who are on the waitlist are under the age of 18,” said DoHS spokesperson Angelica Hightower.

Medicaid-eligible children 3 and older with a diagnosed disability can receive speech therapy, crisis services and more.

“I have major concerns that most of these are children. We do not have the proper level or amount of care in this state to provide services to that many children, but keeping them on a waitlist when they need help is very concerning,” said House Health Chair Evan Worrell, R-Cabell.

The program also provides respite care for parents and caregivers.

“I know one family in Wayne County, she’s not had a respite worker in three years,” said Brad Story, CEO of the West Virginia Behavioral Healthcare Providers Association. “It’s concerning.”

DoHS didn’t provide an answer when asked about what was being done to address the waitlist issue.

Worrell said lawmakers may have to step in and force DoHS to use the allocated IDD waiver funds strictly on people with disabilities. Lawmakers could amend budget legislation that mandates how DoHS spends the money.

“There was testimony last year that for over five years, Medicaid had not spent the allocated [IDD waiver] funds on that program,” Worrell said. “They transferred the funds to other areas of their agency to use for other items. That should not be allowed.”

Read the full article here

Federal audit faults Indiana for group home health and safety violations

By Dan Carden, Munster Times of Northwest Indiana / Indiana Economic Digest, October 17, 2025

A scathing federal audit slams the state of Indiana's oversight of group homes for individuals with developmental disabilities after finding multiple health and safety issues in some residences that put clients at risk.

The 40-page report includes photos showing group homes with water damage and mold on ceilings and walls, a toilet with mold and a missing seat, used bedside urinals left in a sink, an unlocked medicine cabinet containing a controlled substance, a missing smoke detector, a broken window, peeling paint and a heavy grate blocking an emergency exit, among other violations.

Altogether, 29 of the 30 residences visited by inspectors from the U.S. Department of Health and Human Services were noncompliant with one or more state health, safety or record-keeping requirements, including 116 health and safety violations found at 27 group homes.

The audit does not identify the specific group homes visited or the entities operating them. However, HHS said it conducted fieldwork for its audit in Crown Point, LaPorte, Merrillville, Michigan City, Portage and Valparaiso, among other locations across the state.

Dozens of instances of administrative noncompliance were also listed in the audit, including providers that didn't obtain proof of insurance for staff who drove clients, compile vehicle maintenance records or conduct criminal history checks on employees providing direct care to individuals with developmental disabilities.

Federal investigators faulted the Indiana Family and Social Services Administration for permitting lapses in health, safety and record-keeping standards at group homes based on the state's obligation to protect the health and welfare of individuals with developmental disabilities served by the Medicaid health program in non-institutional settings.

"Residential providers did not always meet the needs of program participants or maintain compliance with state requirements, and the state agency's inspections of the residential settings were insufficient to ensure a safe environment. As a result, participants with developmental disabilities who received supported living services were at risk," the audit said.

Holly Wimsatt, FSSA director of the Bureau of Disabilities Services, said the state agency has worked closely with residential providers since the autumn 2024 federal inspections to remedy the 246 total instances of noncompliance identified in the audit.

Continued

Download the inspector General's report here

HHS Inspector General Report:

Connecticut Could Better Ensure That Intermediate Care Facilities for Individuals With Intellectual Disabilities Comply With Federal Requirements for Life Safety, Emergency Preparedness, and Infection Control         

From the Office of the U.S., Department of Health and Human Services, Office of the Inspector General

Why OIG Did This Audit

• Intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs) that participate in Medicaid are required by CMS to comply with requirements intended to protect residents. This includes requirements related to fire safety and emergency preparedness plans. Facilities are also required to develop infection control programs.
• In Connecticut, the State’s Department of Public Health (State agency) conducts surveys of ICF/IIDs for compliance with Federal requirements.
• This audit is part of a series of audits that assesses compliance with CMS’s life safety, emergency preparedness, and infection control requirements for ICF/IIDs.

What OIG Found

We identified 80 deficiencies related to life safety, emergency preparedness, and infection control at the 15 ICF/IIDs that we reviewed in Connecticut.

These deficiencies put the health and safety of residents, staff, and visitors at an increased risk of injury or death during a fire or other emergency, or in the event of an infectious disease outbreak.

What OIG Recommends

We recommend that Connecticut:

1. Follow up with the 15 ICF/IIDs reviewed to verify that they have taken corrective actions on the life safety, emergency preparedness, and infection control deficiencies identified during the audit.
2. Work with CMS to develop standardized life safety training for ICF/IID staff.

Connecticut concurred with our first recommendation and stated that it has already followed up with the 15 ICF/IIDs reviewed. Connecticut did not indicate concurrence or nonconcurrence with our second recommendation.

Read the report here

Intellectual Disability and Behavioral Issues in Fragile X

From Bioengineer, October 24, 2025

In recent years, there has been a growing interest in understanding the complexities surrounding intellectual disabilities and their association with behavioral comorbidities. One prominent area of study has been Fragile X Syndrome (FXS), which is the leading genetic cause of autism and intellectual disabilities. In a groundbreaking paper led by researchers Kaufmann, Horn, and Budimirovic, an in-depth exploration into the relationship between intellectual disabilities and behavioral comorbidity in children afflicted with FXS reveals critical insights that could influence future therapeutic approaches and educational strategies.

Fragile X Syndrome is a genetic mutation of the FMR1 gene, leading to an array of developmental issues, particularly impacting learning and behavior. The syndrome often manifests in a spectrum of behavioral challenges such as anxiety, social withdrawal, aggression, and attention deficits. The study emphasizes the high prevalence of anxiety and mood disorders among children with FXS, suggesting that these behavioral comorbidities significantly complicate the clinical picture.

The research categorically highlights that children with FXS are not merely defined by their intellectual disabilities; their behavioral landscapes are thoroughly interwoven into their overall developmental profiles. This comprehensive approach underlines the necessity for a multidimensional care framework. Professionals across various disciplines, from psychologists to educators, must conceptualize interventions that account for both the cognitive and emotional challenges faced by these children.

The study employed an innovative methodology, encompassing a large cohort of children diagnosed with FXS. This large sample size provides robust data that underpins the study’s findings, allowing for generalizations that are critical in understanding the collective challenges within this population. The researchers employed various assessment tools to evaluate different facets of intellectual functioning, alongside standardized measures for behavioral assessment.

Results showcased a marked correlation between levels of intellectual disability and the severity of behavioral problems. Children exhibiting more pronounced intellectual disabilities were also more likely to experience higher rates of anxiety and mood disorders. This connection raises important questions about the intersection of cognitive and emotional health, suggesting that interventions targeting one area may not suffice without addressing both simultaneously.

In conclusion, the research by Kaufmann, Horn, and Budimirovic offers a nuanced understanding of the often-overlooked connection between intellectual disabilities and behavioral comorbidities in children with Fragile X Syndrome. The study serves as a clarion call for a holistic approach in both clinical practice and educational frameworks that embrace the multifaceted challenges these children face. A comprehensive understanding of their needs is crucial not only for developing effective interventions but also for ensuring that these children can thrive in all aspects of life.

Read the full article here

Tear down the wall between neurology and psychiatry

The way medicine separates the mind from the brain is deeply flawed

Opinion by Shaheen E. Lakhan, STAT, October 23, 2025

The brain is the seat of the self. When it breaks, it doesn’t just wound, it distorts, erodes, and often erases. I’ve spent a lifetime witnessing that erasure, not with clinical detachment but in the intimacy of family meals, dark hospital corridors, and my own internal unraveling.

My father’s brain betrayed him. A military service-related stroke left him locked-in, fully conscious but paralyzed, able to communicate only by blinking. I learned from the age of 7 to interpret those blinks, each word an act of endurance. He was present yet unreachable, alive yet inaccessible. It taught me that neurology is not always a science of rescue. Sometimes it’s a practice of bearing witness.

My older brother’s decline was insidious. He was finishing high school when schizophrenia began to surface. It started subtly, a quiet withdrawal, then evolved into paranoia, voices, and cognitive fragmentation. He lost insight long before he lost everything.

Today my brother is unhoused, not by choice, because his brain can’t acknowledge what it’s taken from him. He bounces between emergency rooms, psych wards, and the street. To psychiatry he’s “noncompliant.” To neurology, he’s invisible. The system isn’t designed for complexity. He lingers at the edge of categories and falls through the cracks. Yet when I pass him on the street, I see not just his suffering but the stubborn humanity that medicine failed to reach.

Decades later, my mother unraveled in her own way. It started with trivial lapses: misplacing her car, leaving the stove on. Then came changes in gait and affect, fragmented sleep, and hallucinations of relatives. Knowing what was happening offered clarity but did nothing to blunt the heartbreak. No diagnosis can restore familiarity. Mourning begins long before death, grieving the slow disappearance of the person she was.

I used to think my father’s stroke, my brother’s psychosis, and my mother’s dementia were separate stories. Now I see them as branches of the same broken tree.

We don’t talk about things like this in medicine. We’re trained to remain calm and objective in the storm. Yet no scan could reveal what I felt. Neurology teaches precision, but living with a neurologic illness is an exercise in ambiguity. In conference halls we discuss receptors and pathways, but rarely admit how often we have little more to offer than our presence and comfort. The myth of mastery permeates our profession, yet mastery often eludes us, not for lack of knowledge but because so much of brain medicine remains uncertain, in gray zones that resist reduction.

My experiences taught me what textbooks did not: the way we structure brain care is fundamentally flawed. We’ve carved neurology away from psychiatry, isolating mind from brain as if they are separate. But the brain itself doesn’t honor these divisions, and neither do our patients’ lives. It’s time to tear down this artificial wall and reunite neurology and psychiatry into a single discipline of brain medicine.

Fragmentation is woven into every part of care — how we train, how we diagnose, and how we treat, often leaving the whole person unseen. My brother fell into the no-man’s-land between psychiatry and neurology, and my mother’s hallucinations were dismissed as “just psychiatric” until a tremor proved otherwise. My own migraines were written off as stress, and my father, though fully aware inside his paralyzed body, was reduced to a list of checkboxes that didn’t capture his reality.

What we need is not another protocol but a reimagining of brain care, one that embraces the brain’s messy, interconnected reality. We must abandon the illusion of tidy compartments, make space for patients who don’t fit the mold and for clinicians who falter, and admit without stigma that we too live in vulnerable bodies and imperfect minds.

We should reconsider how we measure outcomes: symptom scales and checklists are useful but not sufficient for lives as unique as our patients’. What matters most to one person may never show up on a standard metric. Restoring agency, dignity, and a coherent life narrative should be among our goals.

I’ve learned that the most radical act we can take is to rehumanize brain care. Healing demands more than medication or imaging; it requires attention, attunement, and a willingness to sit with uncertainty. This isn’t sentimentality, it’s a scientific imperative rooted in the complexity of the organ we serve.

The future of brain care lies not in silos but in circuits, in integrated models instead of split specialties, in approaches that reflect the often incoherent reality of brain illness. I no longer see my migraines as a liability. It was an initiation, a reminder that even those trained to heal are not immune from breaking. Often it’s our own fractures that reveal where the system fails and how we must evolve.

Read the full editorial here

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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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