Direct Support News

Policy

Medicaid, state budgets, and the rules that set direct support and I/DD services.

Policy · The Long Road Home

Willowbrook, 1972-1993: from exposé to lifelong rights

A 1972 lawsuit over New York's Willowbrook State School led to a 1975 consent judgment, a 1987 closing and rights that last for residents' lives. Judge Orrin G. Judd's findings on staffing, turnover and harm still read like a guide to what keeps people safe, and New York providers serving class members still follow the 1993 injunction.

November 14, 2026 · New York State Ass'n for Retarded Children v. Carey, 393 F. Supp. 715 (E.D.N.Y. 1975) · 6 min

Policy · Daily digest

Today in Direct Support: November 14, 2026

The Nov. 14, 2026 DSN digest: CMS lets states pause Medicaid work-rule cutoffs to June 30, and Missouri ends state-run DD case management by 2027. Also: Indiana's waiver assessments, Colorado's Medicaid budget fight and North Carolina CAP/CD rate guidance.

November 14, 2026 · Optional Hold Harmless Period for Community Engagement Implementation (SMD# 26-006) · 2 min

Policy · Missouri

Missouri to move 5,152 off state DD case management by 2027

Missouri's DD division will move the 5,152 people it still case-manages to contracted agencies by Dec. 31, 2027, the Missouri Independent reported. The state expects to save about $3 million a year; some families and advocates worry about disruption and oversight.

November 13, 2026 · Missouri to end state-run developmental disability case management · 3 min

Policy · Medicaid work rules

CMS SMD 26-006: states may pause work-rule cutoffs to June 30

CMS told states Nov. 13 they may hold off on Medicaid work-rule denials and cutoffs through June 30, 2027, if they tell CMS by Dec. 11. States must still check who meets the rule or is excluded, and the Jan. 1, 2027, start date does not change.

November 13, 2026 · Optional Hold Harmless Period for Community Engagement Implementation (SMD# 26-006) · 4 min

Policy · Daily digest

Today in Direct Support: November 13, 2026

The Nov. 13, 2026 DSN digest: Delaware's FY2028 rate asks, Connecticut CFC worries, a Massachusetts group home arrest fight and Ohio levy fallout. Also: Pallone and Wyden ask CMS to delay work rules, and Minnesota's housing benefit gap a year later.

November 13, 2026 · Advocates concerned Lamont may revisit cuts to disability services · 3 min

Policy · Delaware

Delaware FY2028: DHSS rate asks vs. $26.6M home care plea

Delaware DHSS's FY2028 request has $2.6 million for a first HCBS rate phase; home care providers asked Nov. 10 for $26.6 million. The department also wants money for 54 new residential habilitation clients and 366 new community-based services clients.

November 10, 2026 · Fiscal Year 2028 Budget Hearing: Department of Health and Social Services · 3 min

Policy · Daily digest

Today in Direct Support: November 12, 2026

The Nov. 12, 2026 DSN digest: CMS permanently denies Minnesota $112.75M in Medicaid funds, and a judge OKs New York's $162M PPL wage settlement. Also: Florida's ABA task force votes Nov. 17, Michigan families press for DSP pay, and a Cornell study on private equity in New York home care.

November 12, 2026 · Trump administration denies Minnesota more than $112M in Medicaid reimbursements · 2 min

Policy · Minnesota

Minnesota: CMS permanently denies $112.75M in Medicaid funds

CMS has permanently denied Minnesota $112.75 million in Medicaid reimbursement for services from the quarter that ended Sept. 30, 2025. The state has 60 days to appeal, and another $350 million in frozen claims is still undecided.

November 10, 2026 · Trump administration denies Minnesota more than $112M in Medicaid reimbursements · 3 min

Policy · Daily digest

Today in Direct Support: November 11, 2026

The Nov. 11, 2026 DSN digest: New Jersey DDD pauses new provider applications after Dec. 31, and North Carolina's Innovations raise now starts Oct. 1. Also: Missouri declines work-rule hardship exceptions, a Lucas County, Ohio, DD levy heads toward the ballot, and DOJ sues Lyft under the ADA.

November 11, 2026 · New Application Process for Prospective DDD/Medicaid Providers · 2 min

Policy · Daily digest

Today in Direct Support: November 10, 2026

The Nov. 10, 2026 DSN digest: Nebraska's Medicaid work rules at six months, with about 1,100 denials as of August. Also: CARE rule comments due Jan. 11, rural health year-two awards, a joint Arc-VOR statement, North Carolina's food pilot and ACL's caregiver strategy update.

November 10, 2026 · Nebraska Rushed Medicaid Work Rules. Then a Cancer Patient Was Told He’d Lost Coverage. · 2 min

Policy · Nebraska

Nebraska work rules at 6 months: 1,100 denials, call surge

Nebraska's Medicaid work rules, live since May 1, led to about 1,100 denials by August as calls to the state rose 66%, KFF Health News reported. Officials call the rollout a success; advocates say most losses come from unanswered paperwork. Here is who the rules cover and who is excluded.

November 10, 2026 · Nebraska Rushed Medicaid Work Rules. Then a Cancer Patient Was Told He’d Lost Coverage. · 5 min

Policy · Daily digest

Today in Direct Support: November 9, 2026

The Nov. 9, 2026 DSN digest: New Jersey DDD denies Goods and Services payments to some community class vendors. Also: a Lucas County, Ohio, DD levy ask, Oklahoma's DSP gap, Texas Medicaid expansion limits, the Dec. 11 funding deadline and Iowa's new senator.

November 9, 2026 · Families fear state Medicaid billing change means loss of programs for disabled adults · 2 min

Policy · New Jersey

New Jersey: DDD Goods and Services denials cut community classes

New Jersey DDD is denying Goods and Services payments to some vendors of classes for adults with I/DD, telling them to become Medicaid providers. Families say programs are disappearing; DDD says it is enforcing existing rules as federal scrutiny of Medicaid spending grows.

November 9, 2026 · Families fear state Medicaid billing change means loss of programs for disabled adults · 4 min

Policy · Daily digest

Today in Direct Support: November 8, 2026

The November 8, 2026 digest leads with a four-state lawsuit seeking to block HHS from cutting Medicaid funds over work requirements. Also covered: how states are handling short-term hardship exceptions, Medicaid expansion debates in four holdout states, and a six-month CMS extension of Arkansas ARHOME waiver.

November 8, 2026 · Complaint for Declaratory and Injunctive Relief, Oregon v. Oz, No. 6:26-cv-2435 · 3 min

Policy · Federal courts

4 states sue over Medicaid work-requirement cutoff

Oregon, Minnesota, New Mexico and Washington sued on November 5 to block HHS from cutting all Medicaid funds over new work rules. The complaint in Oregon v. Oz, filed in Eugene, asks a federal judge to treat the work rules as optional rather than a condition of keeping existing Medicaid money.

November 5, 2026 · Complaint for Declaratory and Injunctive Relief, Oregon v. Oz, No. 6:26-cv-2435 · 5 min

Policy · The Long Road Home

Pennhurst, 1908-1987: life inside and the move to group homes

Pennhurst held more than 10,500 Pennsylvanians before closing in 1987, and a federal study found people who moved to small homes did better. A 1977 court ruling documented restraint, seclusion and lost skills on understaffed wards; the 1985 Pennhurst Longitudinal Study then followed 1,154 residents into three-person community homes.

November 7, 2026 · The Pennhurst Longitudinal Study: Combined Report of Five Years of Research and Analysis · 7 min

Policy · Daily digest

Today in Direct Support: November 7, 2026

The November 7, 2026 digest leads with Arizona Legend DDD terminations after an AC outage report and KFF on home-care pay transparency. Also covered: Maine day-hab rates, Oklahoma DDS hiring, new governors, MCO enrollment drop, Colorado caregiver exceptions and Addus census.

November 7, 2026 · Family wants answers after disabled man dies following days without AC in group home amid state investigation · 2 min

Policy · Payment transparency

KFF: Medicaid pay transparency now covers home-care hourly rates

KFF says Access rule FFS pay transparency effective July 1, 2026 includes home-care hourly rates. The 68-code Medicare comparison covers only about 2% of noninstitutional FFS spending, the Nov. 6 brief finds.

November 6, 2026 · Medicaid Payment Transparency Rules: State Reporting Requirements and Limitations · 3 min

Policy · Daily digest

Today in Direct Support: November 6, 2026

The Nov. 6, 2026 DSN digest: CMS's CARE rule for ICFs/IID, KFF on 1115 budget neutrality, and SSA's paper-check phaseout. Also: HCBS sector squeeze, Alabama CWP comments due today, and home-care groups on the midterm flip.

November 6, 2026 · Medicare and Medicaid Programs; Cutting Administrative Requirements for Excellence in Patient Care (CARE) (CMS-3484-P) · 2 min

Policy · Deep dive

KFF: CMS 1115 budget rules may squeeze HCBS waivers in 2027

KFF's Nov. 5, 2026 brief warns CMS's 1115 budget-neutrality rules, effective Jan. 1, 2027, may block some HCBS demonstration renewals. Chief Actuary certification, tighter MAPS rules and limited savings rollover are the main levers.

November 5, 2026 · 1115 Waiver Watch: A Look at Budget Neutrality Policy Changes · 3 min

Policy · Deep dive

CMS CARE rule: ICF/IID pay reports trimmed; comments after Nov. 10

CMS's Nov. 5 CARE rule (CMS-3484-P) would drop ICF/IID support-staff pay reports and keep ICF direct care wage reporting. COVID staff educate-and-offer rules would also go; comments run 60 days after the Nov. 10 Federal Register date.

November 5, 2026 · Medicare and Medicaid Programs; Cutting Administrative Requirements for Excellence in Patient Care (CARE) (CMS-3484-P) · 3 min

Policy · Daily digest

Today in Direct Support: November 5, 2026

The Nov. 5, 2026 DSN digest: Ohio county DD levy results, advocates' hopes as Congress flips, and CMS's final 2027 home health rule.

November 5, 2026 · ORC 5126.0511: Payment of nonfederal share of home services · 2 min

Policy · Deep dive

Ohio: at least 5 county DD levies fail; Cuyahoga, Delaware pass

Voters in at least five Ohio counties rejected county DD board levies on Nov. 3, 2026, while Cuyahoga and Delaware counties approved theirs. Champaign, Logan, Meigs, Mahoning and Tuscarawas boards now weigh cuts or a return to the ballot.

November 4, 2026 · Bailey, Vitale win county seats; DD levy fails · 4 min

Policy · Daily digest

Today in Direct Support: November 4, 2026

The Nov. 4, 2026 DSN digest: New York's revised IDGS rules, Virginia's Question 3 result and $12.7 million in federal respite grants.

November 4, 2026 · ADM #2015-05R2 Service Documentation for Individual Directed Goods and Services (IDGS) · 2 min

Policy · Deep dive

New York OPWDD revises self-direction goods and services rules

New York's OPWDD revised its rules for Individual Directed Goods and Services, the self-direction budget line for classes, supplies and more. The Oct. 30 memo sets seven payment tests, $10 billing units, a new request form and fixed decision deadlines.

October 30, 2026 · ADM #2015-05R2 Service Documentation for Individual Directed Goods and Services (IDGS) · 5 min

Policy · Daily digest

Today in Direct Support: November 3, 2026

The Nov. 3, 2026 DSN digest: a Pittsburgh ruling on live-in overtime, new Delaware waiver services and Pennsylvania's shrinking emergency waitlist.

November 3, 2026 · Intra-National Home Care, LLC v. U.S. Department of Labor, Memorandum Opinion (ECF 128) · 2 min

Policy · Deep dive

Delaware proposes 2 new Lifespan Waiver services; comments due Dec. 15

Delaware proposes adding Integrated Supports Day Habilitation and Benefits Counseling to its DDDS Lifespan Waiver for people with IDD. Public comments are due Dec. 15, and the amendment would take effect July 1, 2027.

November 1, 2026 · DDDS Lifespan Waiver Amendment, public notice (30 DE Reg 310) · 5 min

Policy · Deep dive

Pennsylvania judge sets aside DOL live-in overtime rule for 2 agencies

A federal judge in Pittsburgh ruled Oct. 29 that the Labor Department overstepped in barring 2 home care agencies from the live-in overtime exemption. The rule's companionship section stands, the ruling covers only the two plaintiffs, and Pennsylvania wage law still requires overtime.

October 29, 2026 · Intra-National Home Care, LLC v. U.S. Department of Labor, Memorandum Opinion (ECF 128) · 5 min

Policy · Daily digest

Today in Direct Support: November 2, 2026

The Nov. 2, 2026 DSN digest: Ohio's provider enrollment freeze nears its end, Georgia scraps two IDD homes, and Medicaid work rule questions.

November 2, 2026 · Statewide New Provider Moratorium (provider bulletin) · 2 min

Policy · Daily digest

Today in Direct Support: November 1, 2026

The Nov. 1, 2026 DSN digest: a Nebraska interRAI lawsuit moves ahead, Minnesota sees new federal Medicaid fraud charges, and a New York grant.

November 1, 2026 · Order Overruling Partial Motion to Dismiss, Bessey v. Corsi et al., Case No. CI26-441 · 1 min

Policy · Deep dive

Nebraska interRAI suit survives state's bid to dismiss

A Lancaster County judge refused Oct. 29 to dismiss six claims in a suit over how Nebraska uses interRAI to set DD waiver budgets. The case, brought for a man whose yearly budget fell about 35%, now moves forward on due process and state law claims.

October 29, 2026 · Order Overruling Partial Motion to Dismiss, Bessey v. Corsi et al., Case No. CI26-441 · 5 min

Policy · The Long Road Home

Public Law 88-164 and 'Christmas in Purgatory,' 1961-66

From 1961 to 1966, a presidential panel, a 1963 construction law and a hidden-camera photo essay made institutions a national issue. Kennedy's panel counted more than 200,000 people in institutions; Public Law 88-164 paid for research centers and clinics; and Christmas in Purgatory showed the back wards the money had not reached.

October 31, 2026 · Public Law 88-164: Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963 · 7 min

Policy · Daily digest

Today in Direct Support: October 31, 2026

The Oct. 31, 2026 DSN digest: Maine opens an ICF/IID rate review, Minnesota extends its EIDBI freeze, and an Ohio DD levy goes to voters.

October 31, 2026 · MaineCare Rate Reform Expert Technical Advisory Panel (TAP) Consultation: Draft CY2027 Rate Determination Schedule · 2 min

Policy · Deep dive

Minnesota EIDBI freeze on new agencies extended to April 30

Minnesota extended its freeze on enrolling new EIDBI autism therapy agencies through April 30, 2027, after CMS approved six more months. Agencies with a provisional license approved by Dec. 31 may add sites, and new billing limits start no earlier than July 1, 2027.

October 27, 2026 · Extension of temporary moratorium on enrolling new EIDBI provider agencies · 3 min

Policy · Deep dive

Maine CY27 rate schedule: ICF/IID review, comments Nov. 24

Maine's draft 2027 MaineCare rate schedule opens the first review of ICF/IID rates since the state's rate reform law, with comments due Nov. 24. A group of HCBS rate reviews, including personal support and care coordination, carries over and is expected to finish by the end of 2026.

October 30, 2026 · MaineCare Rate Reform Expert Technical Advisory Panel (TAP) Consultation: Draft CY2027 Rate Determination Schedule · 4 min

Policy · Daily digest

Today in Direct Support: October 30, 2026

The Oct. 30, 2026 DSN digest: court strikes CMS's medically frail test, Minnesota pushes Waiver Reimagine past 2027, and EEOC drops records guidance.

October 30, 2026 · Memorandum and Order on Cross-Motions for Summary Judgment, Massachusetts et al. v. Oz, No. 1:26-cv-12962-RGS (Dkt. 147) · 3 min

Policy · Deep dive

Medicaid work rules: court strikes CMS 'medically frail' test

A federal judge ruled Oct. 29 that CMS can't make medically frail Medicaid enrollees also prove they can't meet work rules to be exempt. A 12-month lookback and a one-attestation limit stand, and the Jan. 1, 2027, start date does not move.

October 29, 2026 · Memorandum and Order on Cross-Motions for Summary Judgment, Massachusetts et al. v. Oz, No. 1:26-cv-12962-RGS (Dkt. 147) · 3 min

Policy · Daily digest

Today in Direct Support: October 29, 2026

The Oct. 29, 2026 DSN digest: Maine's ADA settlement appeal, a Nov. 3 Supreme Court case, Olmstead pushback in California and Massachusetts.

October 29, 2026 · Brief of Amici Curiae in Support of Affirmance (1st Cir. Nos. 26-1095, 26-1171) · 3 min

Policy · Deep dive

Maine ADA settlement: groups ask 1st Circuit to keep reviewer

Four disability rights groups asked the 1st Circuit on Oct. 26 to keep the independent reviewer in Maine's 2024 ADA children's services settlement. Maine and the U.S. Justice Department want the reviewer gone; a district judge refused.

October 27, 2026 · Brief of Amici Curiae Disability Rights Maine, ACLU of Maine, GLAD Law and Center for Public Representation in Support of Affirmance (1st Cir. Nos. 26-1095, 26-1171) · 5 min

Policy · Daily digest

Today in Direct Support: October 28, 2026

The Oct. 28, 2026 DSN digest: New Jersey's ABA license deadline and a Maine EVV fraud case, plus Indiana waivers, N.C.'s TCL and MFP.

October 28, 2026 · The Applied Behavior Analyst Licensing Act and Behavioral Supports Funded by the Division of Developmental Disabilities · 3 min

Policy · Deep dive

Maine: 6 charged in $600K MaineCare EVV fraud case

Federal prosecutors charged a South Portland personal care agency, its owner and five workers with faking EVV visit records to bill MaineCare. All six pleaded not guilty.

October 27, 2026 · Multiple Individuals Arrested for Health Care Fraud Conspiracy following Homeland Security Task Force Investigation · 4 min

Policy · Deep dive

New Jersey DDD: ABA license needed by May 6, 2027

New Jersey's DDD says the exemption letting unlicensed clinicians deliver funded behavior supports ends May 6, 2027. BCBA certification alone will not be enough, and agencies are told to plan now.

October 27, 2026 · The Applied Behavior Analyst Licensing Act and Behavioral Supports Funded by the Division of Developmental Disabilities · 4 min

Policy · Daily digest

Today in Direct Support: October 27, 2026

The Oct. 27, 2026 DSN digest: DOJ's Olmstead retreat and Oregon's CEN waiver, plus Choate, a Minnesota fraud ruling and NH work rules.

October 27, 2026 · Recent Changes to DOJ's Interpretation of Olmstead v. L.C. ex rel. Zimring (LSB11494) · 3 min

Policy · Deep dive

Oregon CEN waiver to serve 230 kids; comments due Nov. 25

Oregon wants to raise the cap on its paid-parent Children's Extraordinary Needs waiver from 155 to 230 children at a time, backdated to July 1. Public comments are due Nov. 25.

October 23, 2026 · Public notice and request for comment on ODDS Medicaid waiver updates · 4 min

Policy · Deep dive

Olmstead: CRS maps DOJ exits in Florida, Texas, N.C. cases

A new CRS Legal Sidebar tracks how the Justice Department has pulled back from Olmstead enforcement since June, case by case. The 1999 ruling still stands, and private suits remain possible.

October 26, 2026 · Recent Changes to DOJ's Interpretation of Olmstead v. L.C. ex rel. Zimring (LSB11494) · 4 min

Policy · Daily digest

Today in Direct Support: October 26, 2026

The Oct. 26, 2026 DSN digest: a lawsuit over Connecticut's IQ cutoff, plus Ohio home care, SSI asset limits and Florida's iBudget waitlist.

October 26, 2026 · Residents sue CT for using IQ score to deny intellectual disability services · 2 min

Policy · Deep dive

Connecticut IQ cutoff for DDS services faces lawsuit

Four Connecticut residents with intellectual disability diagnoses are suing over the IQ cutoff DDS uses to decide eligibility. A state-ordered plan for a new definition is due July 1, 2027.

October 26, 2026 · Residents sue CT for using IQ score to deny intellectual disability services · 5 min

Policy · Daily digest

Today in Direct Support: October 25, 2026

The Oct. 25, 2026 DSN digest: a New York man dies after a restraint at a QSAC group home, plus Georgia ABA rates and Pennsylvania waiting lists.

October 25, 2026 · Man dies after being found unresponsive, restrained during Harlem shelter assault call · 2 min

Policy · The Long Road Home

Fernald's 'Science Club' radiation studies, 1946-53

Between 1946 and 1953, MIT researchers gave Fernald State School residents in Massachusetts cereal with radioactive tracers, without informed consent. A 1994 task force found little health risk but a failure to protect residents; this story follows that finding, a $1.85 million settlement and Fernald's closure.

October 24, 2026 · A Report on the Use of Radioactive Materials in Human Subject Research that Involved Residents of State-Operated Facilities within the Commonwealth of Massachusetts from 1943 through 1973 · 6 min

Policy · Daily digest

Today in Direct Support: October 24, 2026

The Oct. 24, 2026 DSN digest: Florida ABA providers say Molina hasn't paid claims, and California charges 103 IHSS caregivers. Plus five more stories.

October 24, 2026 · South Florida attorney says nearly 700 ABA providers haven't been paid since Molina took over Medicaid claims · 3 min

Policy · Deep dive

California charges 103 IHSS caregivers in $4.5M Medi-Cal case

California has filed felony charges against 103 IHSS caregivers accused of defrauding Medi-Cal of more than $4.5 million. Prosecutors say they billed for care while recipients were in hospitals or nursing facilities.

October 22, 2026 · Attorney General Bonta: 103 Criminal Cases Filed Statewide for Medi-Cal Fraud · 3 min

Policy · Deep dive

Florida ABA providers say Molina hasn't paid CMS Plan claims

Florida ABA providers say claims for children in the CMS Health Plan have gone largely unpaid since Molina took over Oct. 1, and the state is investigating. An attorney says almost 700 providers report the problem.

October 23, 2026 · South Florida attorney says nearly 700 ABA providers haven't been paid since Molina took over Medicaid claims · 5 min

Policy · Daily digest

Today in Direct Support: October 23, 2026

The Oct. 23, 2026 DSN digest: a CDC study finds 1 in 5 children has a developmental disability diagnosis, plus Arizona's ABA rules and five more stories.

October 23, 2026 · Trends in Parent-Reported Developmental Disabilities: 2019-2024 · 2 min

Policy · Deep dive

Arizona ABA rules aim to save AHCCCS $46.5M a year

Arizona's Medicaid agency projects $46.5 million a year in savings from proposed ABA rules, mostly in its developmental disabilities program. The rules add six-month authorizations and extra justification above 25 hours a week.

October 22, 2026 · Notice of Proposed Exempt Rulemaking, Title 9, Chapter 22, Article 12 (Applied Behavior Analysis Services) · 3 min

Policy · Daily digest

Today in Direct Support: October 22, 2026

The Oct. 22, 2026 DSN digest: New York's adult day fraud crackdown, Maryland's stalled DDA appeals, an ABA billing probe and four more stories.

October 22, 2026 · Autism Therapy Firm Under Federal Investigation · 2 min

Policy · Deep dive

Maryland DDA appeals: CMS reviews 90-day deadline misses

CMS is reviewing complaints that Maryland's DDA let disability appeals run past the federal 90-day limit, Spotlight on Maryland reported Oct. 21. Records released in September showed 219 of 247 pending appeals had already missed it.

October 21, 2026 · Disabled Marylanders want federal government to step in on stalled appeals · 4 min

Policy · Deep dive

New York social adult day care: CMS demands a fix in 30 days

CMS gave New York 30 days on Oct. 21, 2026 to plan tighter oversight of its $500M+ social adult day benefit after a fraud probe of 100+ centers. Here is what the crackdown means for day programs, health plans and staff.

October 21, 2026 · Governor Hochul Announces Joint Effort to Protect Taxpayer Dollars and Crack Down on Fraud Within Social Adult Day Care Program · 4 min

Policy · Daily digest

Today in Direct Support: October 21, 2026

The Oct. 21, 2026 DSN digest: Ohio Medicaid audit deep dive, Midwest HCBS waitlists, a Senate home care RFI, NC housing pilots for adults with I/DD, school disability data and an FDA autism tool.

October 21, 2026 · Kansas adults and children with disabilities face years-long waitlists for Medicaid waivers · 2 min

Policy · Deep dive

Ohio Medicaid audit: what it means for I/DD providers

Ohio's Oct. 15, 2026 audit of the state Medicaid agency found no strategic plan, $145M+ in unplanned contract costs, weak claim-payment data and county eligibility problems. Here is what it means for waiver providers and DSPs.

October 15, 2026 · Ohio Department of Medicaid Performance Audit, October 2026 · 4 min

Policy · State policy

New Hampshire: up to 29,000 may lose Medicaid by 2028

Up to 29,000 New Hampshire adults could lose Medicaid by 2028 under work rules starting January 2027, a think tank said Oct. 20, 2026. The state will require documents, not self-attestation, and checks every quarter.

October 20, 2026 · New Medicaid Work Requirements Threaten Health Care Access for Up to 29,000 Granite Staters, With Several Implementation Decisions Still Left Up to the State · 1 min

Policy · Local funding

Ohio: Champaign County DD levy on Nov. 3 ballot; cuts if it fails

Champaign County, Ohio votes Nov. 3, 2026 on a 1.5-mill DD board levy; the board says services could be cut if it fails. Early intervention, behavior support and recreation are at risk, and a similar levy failed in May.

October 21, 2026 · Champaign County Board of Developmental Disabilities levy failure could trigger service cuts · 1 min

Policy · Federal policy

California: CMS defers $1.2B more in personal care funds

CMS said Oct. 20, 2026 it will withhold another $1.2 billion in federal Medicaid funds from California over growth in personal care services. It is the third such hold this year, after deferrals of $1.34 billion in May and $867.5 million in July.

October 20, 2026 · Feds hold back an additional $1.2 billion in California Medicaid reimbursements · 2 min

Policy · Federal policy

Senate Democrats seek 8 fixes for Medicaid eligibility vendors

Senate Finance Democrats urged CMS Oct. 20, 2026 to set binding rules for Medicaid eligibility vendors before work rules start Jan. 1, 2027. Their interim report lists eight steps, from error-rate reporting to independent audits.

October 20, 2026 · Paid to Process, Not to Protect: Medicaid Contractors to Receive a Taxpayer-Funded Windfall While Millions of Americans Lose Coverage and Care · 2 min

Policy · Rights

Virginia Question 3: guardianship voting rule on Nov. 3 ballot

Virginia voters decide Nov. 3, 2026 whether only a court finding that a person can't understand voting may take away the right to vote. A state law in effect since July 1 already sets that test for people under guardianship.

October 20, 2026 · Advocates Say Ballot Question Could Right Past Wrong On Voting · 2 min

Policy · Waiting lists

Virginia: DD waitlist aid up to $1,000, apply by Oct. 30

Virginians on the DD Waivers Waiting List can apply through Oct. 30, 2026 for up to $1,000 in IFSP-Funding for items that help them live at home. Priority 2 and 3 applicants can request up to $500.

October 1, 2026 · IFSP-Funding Announcement: Important dates for the Fall 2026 Funding Program · 2 min

Policy · Rates

New York judge annuls 22% EI telehealth rate cut

An Albany judge annulled New York's 22% and 10% telehealth rate cuts for early intervention, the New York Law Journal reported Oct. 16, 2026. The court found the health department didn't show how it justified the cuts.

October 16, 2026 · Judge Tosses New York State's Telehealth Rate Cuts for Early Intervention Services · 1 min

Policy · Federal policy

Wyden RFI: home care, 80/20 rule comments by Dec. 18

Senate Finance Democrats asked on Oct. 16, 2026 for comments by Dec. 18 on a universal home care benefit, HCBS wages and ending waitlists. The 81-page request covers the 80/20 rule, rate benchmarks and the HCBS Access Act.

October 16, 2026 · Request for Information: Long-Term Care · 2 min

Policy · Waivers

Alabama seeks 5-year CWP waiver renewal; comments to Nov. 6

CMS is taking comments to Nov. 6, 2026, on Alabama's request to renew its Community Waiver Program for intellectual disability to 2031. The state would drop the little-used Group 5, and CMS has extended the current demonstration to Sept. 30, 2027, while talks continue.

October 7, 2026 · 1115 Waiver Demonstration – Alabama Community Waiver Program · 3 min

Policy · Waiting lists

Kansas: I/DD waitlist at 5,383, above 4,000 cap

Kansas had 5,383 people on its I/DD waiver waitlist as of Aug. 31, 2026, KDADS told lawmakers Oct. 6, far above a 4,000-person budget cap. An inspector general audit also found missing records in most sampled waitlist files; KDADS disputes the findings.

October 7, 2026 · KDADS Update to the Bethell Joint Committee on HCBS & KanCare Oversight, October 6, 2026 · 4 min

Policy · The Long Road Home

Sonoma Developmental Center, 1891-2018

California's Sonoma Developmental Center opened on Nov. 24, 1891, and its last resident moved out on Dec. 17, 2018. This story follows one institution from two mothers' idea to a detailed closure plan.

October 17, 2026 · Plan for the Closure of Sonoma Developmental Center · 5 min

Policy

Georgia: Amerigroup cuts foster ABA rates 30%

Amerigroup cut technician ABA pay about 30% for Georgia foster Medicaid members effective Sept. 1, 2026, the Georgia Recorder reported. Some clinics stopped new intakes or dropped patients.

October 5, 2026 · Georgia cuts payments by 30% for foster children’s autism therapy · 1 min

Policy

Iowa: HCBS attendant care $6.69/15-min Oct. 1

Iowa Medicaid set unskilled attendant care at $6.69 per 15 minutes and skilled at $7.23 effective Oct. 1, 2026, under Informational Letter 2740. The rates cover the Intellectual Disability waiver and five other HCBS waivers.

October 1, 2026 · Informational Letter No. 2740-MC-FFS: SFY27 HCBS Waiver Rate Changes · 1 min

Policy

California: CMS renews 1915(i) DD SPA through 2031

CMS approved California SPA 26-0009 on Sept. 30, 2026, renewing the 1915(i) developmental-disability HCBS benefit through Sept. 30, 2031. Year one projects about 109,000 participants.

October 8, 2026 · CA-26-0009 §1915(i) HCBS state plan benefit for individuals with developmental disabilities renewal · 1 min

Policy

Colorado: CFC, LTHH group rates at 50% Jan. 1

Colorado’s Medical Services Board gave final adoption Oct. 9, 2026, to group rates for CFC personal care, homemaker and IHSS HMA, plus LTHH CNA services, set at 50% of individual rates pending a SPA for Jan. 1, 2027.

October 9, 2026 · Medical Assistance Rule Concerning LTHH & CFC Group Rates, MSB 26-04-15-A · 1 min

Policy

KFF: 120,300 SSDI enrollees used Medicaid expansion

KFF finds 120,300 SSDI beneficiaries newly entering Medicare in 2023 had prior ACA Medicaid expansion coverage, and says new work rules may threaten that bridge before Medicare starts.

October 14, 2026 · What Could Medicaid Work Requirements Mean for People with Disabilities Waiting for Medicare Coverage? · 1 min

Policy · Medicaid work rules

KFF: SSI applicants face Medicaid work-rule frailty test

People waiting on SSI could lose Medicaid under the 2027 work rules if they can't prove medical frailty, KFF said in an Oct. 14, 2026 update. In 2023, more than 106,000 new SSI enrollees aged 19 to 64 had been covered through Medicaid expansion while they waited.

October 14, 2026 · What Could Medicaid Work Requirements Mean for SSI Applicants? · 2 min

Policy · Benefits

SSI rises to $1,029 a month in 2027 after 3.6% COLA

The top federal SSI payment rises to $1,029 a month in 2027, up from $994, under a 3.6% cost-of-living increase Social Security set Oct. 14, 2026. The higher SSI amount arrives with the Dec. 31, 2026 payment; Social Security benefits rise in January.

October 14, 2026 · Social Security Announces 3.6 Percent Benefit Increase for 2027 · 1 min

Policy · State budgets

Nebraska DHHS budget request: DD waiver aid to $922M

Nebraska DHHS asked for about $922 million a year for developmental disability waiver aid in FY2028-29, up from $893.9 million now. Its 2027-29 request, reported Oct. 14, also lists cuts toward an 8% target, including a $2 million yearly trim at Beatrice State Developmental Center and a 3% Medicaid rate cut.

October 14, 2026 · Nebraska DHHS plans to cut budget by reducing services, enacting federal Medicaid changes · 2 min

Policy · HCBS waiver readiness

Maine: Lifespan waiver survey open through Oct. 16

Maine OADS opened a Lifespan Waiver provider interest survey on October 2, 2026, closing October 16 at 4 p.m. The survey targets agencies serving people 14 and older with intellectual disabilities or autism, ahead of a planned May 1, 2027, HCBS go-live pending CMS approval.

October 2, 2026 · To Providers of Adult or Children's Services to Individuals with Intellectual Disabilities (ID) or Autism · 1 min

Policy · Medicaid ABA billing

North Carolina: ABA concurrent billing limited under CCP 8F

North Carolina Medicaid limited CCP 8F ABA concurrent billing to listed exceptions on October 12, 2026. Other same-time dual billing of beneficiary-facing codes under research-based behavioral health treatment is prohibited until further notice, for both fee-for-service and managed care.

October 12, 2026 · Concurrent Billing Clarification for Research-Based Behavioral Health Treatment · 2 min

Policy · New Jersey

New Jersey draft I/DD fines: up to $25,000; comments Oct. 13

New Jersey's draft guidance for its I/DD provider penalties law sets fines of up to $25,000, and comments are due by 5 p.m. Oct. 13, 2026. Workers who don't report suspected abuse right away would owe $350 for each day it goes unreported.

October 11, 2026 · Proposed Provider Guidance on P.L. 2025, c.280 · 3 min

Policy · Texas

Texas: HHSC budget plan zeroes out $13.7M autism program

Texas HHSC's 2028-29 budget request zeroes out the $13.7 million Children's Autism Program, which pays for ABA therapy outside Medicaid. It is part of a 3% cut ordered by state leaders; HHSC says children would keep services through August 2027 if lawmakers agree.

October 12, 2026 · Legislative Appropriations Request for Fiscal Years 2028 and 2029, Volume I · 3 min

Policy · Federal

KFF: 44 states face Medicaid work rules under 2025 law

A KFF analysis published Oct. 7, 2026, finds the 2025 reconciliation law forces Medicaid eligibility changes in every state, with work rules in 44. At least 31 states have provider taxes above the 3.5% limit expansion states will face, a limit that does not apply to taxes on intermediate care facilities.

October 7, 2026 · Which States Will Be Affected by Key Medicaid Provisions in the 2025 Reconciliation Law? · 3 min

Policy · The Long Road Home

Buck v. Bell and forced sterilization

In Buck v. Bell on May 2, 1927, the Supreme Court ruled 8-1 that Virginia could sterilize Carrie Buck without her consent. This story follows the arranged test case, what it unleashed and what historians later found.

October 10, 2026 · Supreme Court of the United States · 4 min

Policy · Congress

House E&C fraud report: 37 recommendations, HCBS flagged

A House Energy and Commerce staff report released Sept. 29, 2026, names HCBS among Medicaid's high-fraud services and makes 37 recommendations. It says HCBS spending rose 50% from 2019 to 2023 and urges federal screening standards, including background checks, for personal care workers.

September 29, 2026 · The Real Costs of Fraud · 3 min

Policy · New Hampshire

New Hampshire: CFI waiver settlement wins preliminary OK

A federal court has preliminarily approved New Hampshire's Choices for Independence waiver settlement, with a final hearing set for Jan. 21, 2027. The state must track people getting under half their authorized hands-on care, review provider rates and help participants find workers.

October 7, 2026 · Class-action settlement reached in New Hampshire Medicaid HCBS case · 3 min

Policy · Federal

SMD 26-005: CMS sets rules for direct care pay reports

CMS letter SMD 26-005, issued Oct. 9, 2026, tells states how to report the share of HCBS payments spent on direct care pay starting July 9, 2028. It confirms DSPs count as direct care workers, counts overtime and benefits as pay, and sets a July 9, 2027 deadline for state readiness reports.

October 9, 2026 · Direct Care Worker Compensation (Home and Community-Based Services Payment Adequacy) Reporting Requirement (SMD 26-005) · 5 min

Policy · Benefits

Trump Accounts: SSI risk at 18 unless rolled to ABLE at 17

Trump Account money could push a young adult past SSI's $2,000 asset limit at 18, advocates warn, unless it moves to an ABLE account at 17. Treasury said Oct. 1 that every eligible child now has an account, and the law allows the ABLE rollover only in the year the child turns 17.

October 9, 2026 · Trump Accounts Could Put SSI At Risk · 2 min

Policy · Indiana

Indiana Medicaid ends ABA therapy for adults 21+ Oct. 1

Indiana Medicaid stopped paying for applied behavior analysis therapy for members 21 and older on Oct. 1, 2026, when a six-month transition ended. Adults on the Family Supports and CIH waivers can still get capped behavior support services, and another 4% ABA rate cut is set for April 1, 2027.

October 1, 2026 · IHCP bulletin BT202627: ABA therapy services policy and reimbursement changes · 2 min

Policy · Maryland

Maryland: CMS info request extends hold on DDA cuts

CMS asked Maryland on Sept. 25 for more information on its Community Pathways waiver amendment, which restarts the federal review clock. Provider rate cuts and new self-directed wage limits stay frozen at June 30, 2026, levels until CMS approves the amendment.

October 1, 2026 · Community Pathways Waiver Amendment #4 2026 · 2 min

Policy · Washington

Washington DSHS option would cut 2,655 from DD services

Washington's DSHS has floated tighter functional eligibility rules for developmental disability services that would end them for about 2,655 people. The budget option would save $13.4 million in 2027-29 and about $60.7 million a year after that, and it now goes to Gov. Bob Ferguson as he writes his December budget.

October 7, 2026 · Functional Eligibility Adjustment, 2027-29 decision package (Program 040, Developmental Disabilities) · 4 min

Policy · Arizona

Arizona DDD draft rules gather member rights; input by Nov. 5

Arizona DES wants informal comments by Nov. 5, 2026, on draft Division of Developmental Disabilities rules that put member rights in one article. The draft also moves chapter-wide definitions, including one for direct support professionals, into Article 1.

October 6, 2026 · Request for Informal Stakeholder Input on the Draft Rules for 6 A.A.C. 6, Articles 1 and 2 · 2 min

Policy · Florida

Florida: ABA Medicaid forecast falls to $2.88B from $3.86B

Florida now projects $2.88 billion in Medicaid ABA spending for fiscal 2026-27, down from a $3.86 billion forecast, Gov. DeSantis said Oct. 6, 2026. A state task force is weighing licensing ABA companies and tying pay to surveys.

October 6, 2026 · Governor Ron DeSantis Announces Results of Florida's Medicaid Integrity Initiative · 3 min

Policy · Minnesota

Minnesota: $550M Medicaid deferral may mean provider clawbacks

Minnesota says CMS could permanently reject $550 million in deferred Medicaid funds, which could mean clawbacks from providers, as of Oct. 6, 2026. In an Oct. 2 letter, the state's Medicaid director asked CMS how it flagged 870 providers as high risk.

October 6, 2026 · Minnesota DHS letter to CMS Administrator Mehmet Oz, Oct. 2, 2026 · 3 min

Policy · Pennsylvania

Pennsylvania HB 1939: DSP inflation raises clear committee 26-0

Pennsylvania's House Human Services Committee voted 26-0 on Oct. 6, 2026, to send HB 1939, which ties DSP service rates to inflation, to the House. An amendment moves the first adjustment to Oct. 1, 2027, and has agencies pass it on as total compensation rather than wages.

October 6, 2026 · House Bill 1939, Printer's No. 4004 (2025-2026 session) · 3 min

Policy · HCBS waiting lists

KFF 2026: 649,900 on HCBS waiting lists, up 7%

KFF's 2026 survey counts 649,900 people on Medicaid home care waiting or interest lists in 40 states, about 7% more than in 2025. Most have I/DD, the average wait rose to 34 months, and states start reporting their lists to CMS in July 2027.

October 5, 2026 · A Look at Waiting Lists for Medicaid Home- and Community-Based Services from 2016 to 2026 · 3 min

Policy · Medicaid work requirements

Missouri skips Medicaid work-rule hardship exceptions

Missouri will not use the optional short-term hardship exception when Medicaid work requirements start Jan. 1, 2027, its FAQ confirms. Hospital or ICF/IID stays and travel for care will instead have to fit the medically frail or caregiver exemptions. The expansion group had 344,669 adults as of Sept. 25.

October 5, 2026 · Community Engagement Requirements Frequently Asked Questions · 2 min

Policy · Medicaid rates

New York: ABA technician rate cut to $9.63 Oct. 1

New York Medicaid cut its fee for technician-delivered ABA, CPT 97153, to $9.63 per 15-minute unit on Oct. 1, its third cut in a year. Providers say the rate is now the lowest in the country; in Georgia, the Medicaid plan for foster children cut ABA pay 30% on Sept. 1.

October 5, 2026 · New York State Medicaid Update - August 2026 Volume 42 - Number 9 · 2 min

Policy · The Long Road Home

The Kallikak study and eugenics, 1912

In 1912 psychologist Henry Goddard claimed a New Jersey family proved intellectual disability was inherited, fueling calls for lifelong segregation. This story looks at the study, the woman at its center and how its claims fell apart.

October 3, 2026 · The Macmillan Company · 5 min

Policy · Waiver eligibility

Indiana: FSSA ends interRAI denial pause Oct. 5

Indiana FSSA said Oct. 2 it will end an Aug. 31 pause on interRAI ICF/IID level-of-care determinations on Monday, Oct. 5. The Arc of Indiana filed a public-records request seeking how assessment data becomes eligibility decisions.

October 2, 2026 · FSSA statement on interRAI pause ending Oct. 5, via WRTV · 1 min

Policy · CES waitlist

Arkansas: nearly 2,500 still wait as CES funding clock ticks

At an Oct. 2, 2026, hearing, families said Arkansas’s nearly 2,500-person CES waitlist needs faster help. DHS said $17 million in reserves covers supportive living only through June 30, 2027.

October 2, 2026 · Families of Arkansans with disabilities urge lawmakers for faster work on clearing waitlist · 2 min

Policy · Rates

Rhode Island: I/DD and HCBS rates rise Oct. 1

Rhode Island began phasing in Medicaid rate increases on Oct. 1, 2026, including developmental disability and home- and community-based services, with about $116.6 million in extra state and federal funding this year, the Rhode Island Current reported.

October 1, 2026 · These 5 changes for Rhode Island Medicaid take effect Oct. 1 · 1 min

Policy · Work requirements

5 governors ask HHS to delay Jan. 1 Medicaid work rules

Five governors asked HHS on Oct. 1, 2026, to delay Jan. 1, 2027, Medicaid work-reporting rules. Oregon, California, Maine, New Mexico and Virginia cited June IFR changes they say states cannot rebuild in under 100 days.

October 1, 2026 · State governors, including Oregon’s, call for more time to implement new Medicaid rules · 1 min

Policy · Medicaid

Oct. 1 Medicaid limits hit many lawfully present immigrants

Federal matching funds for many lawfully present immigrants end Oct. 1 under Section 71109; states report hundreds of thousands at risk.

October 1, 2026 · US Poised To Boot Legal Immigrants From Medicaid, Including Refugees and Sex-Trafficking Victims · 1 min

Policy · Kansas

Kansas Community Support Waiver starts Oct. 1

Kansas opens a new Medicaid HCBS waiver on Oct. 1 for up to 500 people with I/DD who need less than 24-hour support.

October 1, 2026 · Governor Kelly Announces CMS Approval of Kansas’ Community Supports Waiver Effective October 1, 2026 · 1 min

Policy · State institutions

Pennsylvania House OKs sale of Polk, White Haven centers

Pennsylvania's House voted 199-4 on Sept. 30 to let the state sell the closed Polk and White Haven centers, Woodhaven and two other surplus sites. The three former human services campuses cost about $12.6 million a year to keep, by the resolution's figures.

September 30, 2026 · House Resolution 586 (2025-2026 Regular Session), Printer's Number 3770 · 1 min

Policy · Program integrity

House package: HCBS Anti-Fraud Reporting Act among 14 bills

House Energy and Commerce Republicans on Sept. 29, 2026, unveiled 14 Medicaid integrity bills, including the HCBS Anti-Fraud Reporting Act. That bill would make states file annual 1915(c) waiver fraud, waste, and abuse reports to HHS.

September 29, 2026 · E&C Republicans Introduce Critical Fraud-Fighting Package to Protect Vulnerable Americans and Safeguard Taxpayer Dollars · 1 min

Policy · State rates

West Virginia: advocates seek ABA Medicaid rate study

West Virginia advocates say Medicaid’s ABA rates — called the nation’s lowest — leave fewer than half of about 20 centers taking Medicaid. Mountaineer Autism Project asked BMS on Sept. 29, 2026, to finish a rate study and raise reimbursements.

September 29, 2026 · Children with autism struggling to access therapy; advocates call on WV leaders to address Medicaid · 1 min

Policy · Work requirements

Nebraska: 14% of work-rule applicants denied early

Nebraska’s early Medicaid work rules denied 14% of subject new applicants and cut 7% of renewals through mid-August 2026. Most losses were non-response to paperwork; CMS has told the state to change medical-frailty checks.

September 29, 2026 · Early Medicaid Work Requirement Insights From Nebraska · 1 min

Policy · State rollout

Montana: 71,000 face Oct. 1 Medicaid work deadline

Montana is making about 71,000 Medicaid enrollees document work, school, or an exemption by October 1, 2026. That is months ahead of the January 1 federal deadline. Advocates say confusing notices and thin help lines risk coverage loss for people who already qualify, including caretakers of children with autism.

September 29, 2026 · Confusion and Angst Follow State’s Early Rollout of Medicaid Work Rules · 2 min

Policy · Civil rights

H.Res. 1586: House bill reaffirms Olmstead integration

On Sept. 28, 2026, Rep. Debbie Dingell and bipartisan cosponsors introduced H.Res. 1586 honoring Olmstead v. L.C.'s 27th anniversary and affirming that federally funded services belong in the most integrated setting appropriate.

September 28, 2026 · H. Res. 1586 — Recognizing and honoring the 27th anniversary of the Supreme Court decision in Olmstead v. L.C. · 1 min

Policy · Work requirements

Six states bar self-attestation on medical frailty

Six states will require documents — not self-attestation — for medical-frailty exemptions from Medicaid work rules in 2027. Arkansas, Idaho, Indiana, New Hampshire, North Carolina, and Ohio are tougher than the federal floor; advocates warn people who cannot quickly get a doctor's letter will lose coverage.

September 28, 2026 · As work requirements kick in for Medicaid, some states are taking a tougher stance · 2 min

Policy · How the system works

Medicaid FMAP: how federal and state money pays for I/DD services

In fiscal 2027, which starts in October 2026, the federal share of most Medicaid costs ranges from 50% to 77.32% by state, and states pay the rest. How that match works, where the state share comes from and how the money reaches I/DD providers, as of September 2026.

September 27, 2026 · Federal Matching Shares for Medicaid, the Children's Health Insurance Program, and Aid to Needy Aged, Blind, or Disabled Persons for October 1, 2026, Through September 30, 2027 · 6 min

Policy · How the system works

HCBS settings rule: what 42 CFR 441.301(c)(4) requires

The HCBS settings rule requires Medicaid community services to protect privacy, choice and community access. States' transition ended March 17, 2023. What it requires, how limits must be justified and where it stands as of September 2026.

September 27, 2026 · 42 CFR 441.301, Contents of request for a waiver · 5 min

Policy · How the system works

Medicaid rate studies: how DSP wages get into rates

A 2025 Virginia rate study built a $22.20 hourly DSP wage into proposed I/DD waiver rates, then added benefits, supervision and overhead. How rate studies work, how rate wages relate to pay and the federal rate rules in place as of September 2026.

September 27, 2026 · Virginia Department of Medical Assistance Services (DMAS) Developmental Disabilities (DD) Waiver Rate Study · 6 min

Policy · The Long Road Home

Howe's 1848 school to teach, not confine

In 1848 Massachusetts paid $2,500 a year for three years to test whether Samuel Gridley Howe could teach 10 children with intellectual disabilities. This story follows that experiment, and how a school meant to teach and send children home drifted toward lifelong custody.

September 26, 2026 · Report made to the Legislature of Massachusetts, upon Idiocy · 5 min

Policy · Rate bulletin

North Carolina: Innovations +$0.30/15-min Oct. 1

NC Medicaid adds $0.30 per 15-minute Innovations unit for listed direct care services from October 1, 2026; a Nov. 10 update dropped the earlier July 1 retroactive date. The add-on uses $21.3 million in recurring state funds ($57.2 million total with federal match after adjustments) and requires a wage-increase attestation.

September 25, 2026 · North Carolina Innovations Waiver Direct Care Worker Wage Increase · 2 min

Policy · Federal

CMS: 37 states join Medicaid quality pledge on outcomes

CMS on Sept. 25, 2026, launched a voluntary Medicaid quality pledge with 37 states focused on health outcomes over process measures. Investing in Health Outcomes prioritizes prevention, chronic disease, behavioral health, and lighter digital reporting.

September 25, 2026 · CMS Refocuses Medicaid Quality on Health Outcomes, Launches Innovative Partnership With 37 States · 1 min

Policy · How the system works

Olmstead v. L.C.: what it requires, how it's enforced

The 1999 Olmstead ruling says needless institutional isolation is disability discrimination. As of September 2026 it still stands, but federal enforcement has shifted. What it requires, how Georgia and Virginia settlements put it to work, and what changed in 2026.

September 24, 2026 · Olmstead v. L.C., 527 U.S. 581 (1999) · 6 min

Policy · Billing bulletin

Indiana: HCBS HQ+home claims deny starting Oct. 28

Indiana IHCP will deny T2033, S5151 and T2016 claims billed with modifier HQ and POS 12 (Home) for dates of service on or after Oct. 28, 2026. Bulletin BT2026155 is dated Sept. 24, 2026.

September 24, 2026 · IHCP updates billing requirements for specific waiver services and specific vision services (BT2026155) · 1 min

Policy · Congress

PACE Access Improvement Act would expand Medicaid PACE

Bipartisan H.R. 10547 would make PACE a mandatory Medicaid service, ease enrollment, and speed new PACE sites starting in 2027.

September 24, 2026 · Dingell, Moolenaar Introduce Bipartisan Legislation to Strengthen Senior Care · 1 min

Policy · Reference

Wage pass-through: how Medicaid raises reach DSPs

Pass-through rules tie a Medicaid rate increase to worker pay: providers must spend some or all of it on direct care wages, often with payroll checks.

September 23, 2026 · State Wage Pass-Through Legislation: An Analysis · 5 min

Policy · Federal

Section 504: court vacates integration rules in HHS 2024 update

A Texas federal judge on Sept. 23, 2026, vacated HHS Section 504 community-integration rules after five states and HHS asked him to. Olmstead, the ADA, and Section 504 itself still stand, advocates say, but the order applies nationwide.

September 23, 2026 · Order and Final Judgment, Texas v. Kennedy, No. 5:24-CV-225-H · 2 min

Policy · Explainer

Florida's $15 Medicaid wage floor: who counts?

Florida's 2022 budget tied over $600 million in Medicaid rate money to a $15 wage floor but never defined who counted, sparking fights until 2023. The question returns as the state minimum wage hits $15 on Sept. 30, 2026.

September 23, 2026 · Florida Medicaid Provider Minimum Wage Requirements · 6 min

Policy · How the system works

Aging out of IDEA: what ends at 21 or 22

Federal special education rights can last until about age 22, but adult disability services carry no such guarantee. What IDEA requires before school ends, how states differ and what adult systems come next, as of September 2026.

September 19, 2026 · 34 CFR 300.101, Free appropriate public education (FAPE) · 5 min

Policy · Policy

CMS sets 'medical frailty' checks for work rules

CMS guidance from early September 2026 tells states to check 12 months of claims first to spot 'medically frail' people exempt from work rules.

September 18, 2026 · As Medicaid Changes Near, Concerns Mount That People With Disabilities Will Lose Coverage · 1 min

Policy · Reference

HCBS vs. ICF/IID: community vs. facility care

Medicaid funds I/DD care two ways: capped HCBS waiver services in homes and communities, or ICF/IID facility care with 24-hour active treatment.

September 17, 2026 · Intermediate Care Facilities for Individuals with Intellectual Disability · 5 min

Policy · Federal

CMS: Money Follows the Person hits 144,651 transitions

CMS says Money Follows the Person moved 144,651 people from institutions to community living through Dec. 31, 2025.

September 17, 2026 · Money Follows the Person Demonstration: Report on Transitions · 1 min

Policy · Ohio

Ohio SB 35: supported decision-making in state law

Ohio Senate Bill 35, pending in September 2026, would give supported decision-making formal standing as an alternative to guardianship. It covers adults with developmental disabilities.

September 17, 2026 · Alternative To Guardianship Promises More Independence. Critics See Risks · 1 min

Policy · Pennsylvania

Pennsylvania lawsuit targets 40/60 caregiver and travel rules

Four Pennsylvanians with I/DD sued the state Sept. 16, 2026, over caps on paid relative caregiving and limits on where waiver services happen. The suit says the state revived rules a court voided by writing them into agreements families must sign, with a Sept. 28 re-signing deadline for some.

September 16, 2026 · Shapiro admin rules for Medicaid recipients spark lawsuit from people with disabilities · 3 min

Policy · Policy

18 governors urge DOJ to drop Olmstead memo

Governors of 18 states urged the Justice Department, in a letter reported Sept. 15, 2026, to drop efforts from a June memo questioning Olmstead.

September 15, 2026 · Governors Line Up Against Bid To Scale Back Community-Based Services · 1 min

Policy · Policy

Arkansas plans services for 2,464 on CES waitlist

Arkansas said Sept. 15, 2026, it will offer supportive living to the 2,464 people on its CES Waiver waitlist by January 2027, at about $17 million.

September 15, 2026 · Sanders Announces Framework to Assist Families on CES Waitlist · 1 min

Policy · How the system works

HCBS waiting lists: why people with I/DD wait

About 649,900 people were on Medicaid home care waiting or interest lists in 40 states in 2026, about 7% more than in 2025. Most have I/DD. Why the lists exist, how states decide who comes off them, how long people wait and what the numbers miss, as of October 2026.

September 14, 2026 · A Look at Waiting Lists for Medicaid Home- and Community-Based Services from 2016 to 2026 · 7 min

Policy · Policy

Illinois: $21.90 DSP wage plan, comments by Oct. 8

A DD waiver amendment posted Sept. 10, 2026, would lift Illinois' DSP rate-model wage to $21.90 from Jan. 1, 2027, with comments due Oct. 8.

September 10, 2026 · Public Comment Notice - Home and Community Based Services (HCBS) Waiver · 2 min

Policy · Federal

Medicaid directed payment caps: $51.8B cut in 36 states

A Health Affairs study published Sept. 9, 2026, estimates federal caps on Medicaid directed payments could cut $51.8 billion a year in 36 states. In 17 states the cut could equal 10% to 25% of total Medicaid spending. The law's cap covers hospitals, nursing facilities and some physicians, not HCBS.

September 9, 2026 · New Medicaid State-Directed Payment Limits Are Likely To Decrease Medicaid Spending By 10–25 Percent In 17 States · 2 min

Policy · How the system works

Institutions to community: Willowbrook, Pennhurst, Southbury

In 1967, 194,650 people with I/DD lived in large state institutions. Most of those places have closed, but Connecticut's Southbury still houses 84 people. How three institutions shaped today's community services and DSP jobs, as of September 2026.

September 8, 2026 · Institutionalized Adults with IDD, 1967 to 2021 (RISP Data Bytes) · 6 min

Policy · Reference

What is an HCBS waiver? Medicaid 1915(c) explained

HCBS waivers, mostly under section 1915(c), let states fund home and community care instead of institutions; about 257 were active as of Sept. 2026.

September 3, 2026 · Home & Community-Based Services 1915(c) · 5 min

Policy · New Jersey

New Jersey guardianship red flags hit 694 in 2025

Guardianship concerns flagged to New Jersey judges rose to 694 in 2025 from 252 in 2024, an NJ.com review published Aug. 27, 2026, found.

August 27, 2026 · Guardians Are Supposed To Care For Our Most Vulnerable. Why Are Exploitation Cases Skyrocketing? · 1 min

Policy · Rates

Louisiana: 3% rate rise, $9.27 DSP floor Oct. 1

Louisiana's Oct. 1, 2026, I/DD rate increase is about 3%, with the DSP wage floor rising to $9.27, far below the 14.4% its rate study modeled.

August 27, 2026 · Louisiana Medicaid disability service rates to rise 3% · 3 min

Policy · Arizona

Arizona audit: $493M in caregiver savings missed

Arizona's Auditor General found July 30, 2026, that Parents as Paid Caregivers missed up to $493 million in savings from unmet 2025 cost controls.

July 30, 2026 · Parents as Paid Caregivers Service Delivery Model · 2 min

Policy · The states

At least 18 states cut or squeeze HCBS since 2025

A Caring Across Generations brief updated July 15, 2026, counts at least 18 states cutting HCBS or risking care since the 2025 Medicaid law.

July 15, 2026 · Federal Cuts, State Choices, and the Future of Aging and Disability Care · 2 min

Policy · Maryland

Maryland delays DDA rate and wage cuts pending CMS

Maryland's DDA on June 30, 2026, froze provider rates and self-directed wages at June 30 levels until CMS approves its waiver amendment. The cuts had been set for July 1.

July 2, 2026 · Disability community left with heads 'spinning' from sudden delay of proposed wage cuts · 3 min

Policy · Ohio

Ohio lifts home modification cap to $15,000 July 1

Ohio raised its home accessibility adaptation cap from $10,000 to $15,000 per project and added it to the SELF waiver, effective July 1, 2026.

July 1, 2026 · January/July 2026 Waiver Changes · 2 min

Policy · Missouri

Missouri FY2027 budget keeps $80.7M for DD adults

The $80.7 million for adults with developmental disabilities survived in Missouri's fiscal 2027 budget, signed June 30, 2026, after a proposed cut.

June 30, 2026 · Gov. Mike Kehoe vetoes, restricts nearly $500 million from Missouri state budget · 1 min

Policy · New Jersey

New Jersey can fine I/DD providers from July 1

A 2025 law, P.L. 2025, c. 280, lets New Jersey fine I/DD community providers for serious violations starting July 1, 2026, the state said June 25.

June 25, 2026 · New Law Strengthening Oversight and Accountability of Developmental Disabilities Service Providers Takes Effect July 1 · 1 min

Policy · New York

New York OPWDD providers get 2.7% from April 1

New York's fiscal 2027 budget, signed May 28, 2026, gives nonprofit OPWDD providers a 2.7% inflationary increase effective April 1, 2026. It carries no spending restrictions.

May 29, 2026 · New York State Fiscal Year 2027 Final Budget Highlights · 1 min

Policy · Federal

CMS proposes directed payment cap, HCBS from 2029

CMS proposed May 20, 2026, to cap Medicaid state directed payments, including HCBS from 2029, at 100% of the state plan rate where Medicare has none.

May 20, 2026 · Medicaid Managed Care State Directed Payments and Medicaid Fee-For-Service Targeted Medicaid Practitioner Payments Proposed Rule (CMS-2449-P) fact sheet · 1 min

Policy · Federal

RFK Jr., Oz question Medicaid pay for family care

ANCOR and The Arc said in April 2026 that remarks by RFK Jr. and Mehmet Oz questioning Medicaid pay for family caregivers undervalue essential care.

April 23, 2026 · RFK Jr. Takes Issue With Medicaid Paying Family Caregivers · 1 min

Policy · Federal

CMS delays HCBS grievance rule to end of 2027

CMS said in a Feb. 26, 2026 bulletin it won't enforce the fee-for-service HCBS grievance requirement, due July 9, 2026, until Dec. 31, 2027.

April 17, 2026 · Long-Awaited Safeguards For Medicaid Home And Community-Based Services Put On Hold · 2 min

Policy · Colorado

Colorado sets 2% LTSS rate cut from July 1, 2026

An April 8, 2026 Colorado update set a 2% rate cut from July 1, 2026, across LTSS, HCBS and case management services. A weekly caregiver cap falls to 56 hours by July 2027.

April 8, 2026 · LTSS Sustainability Action Update Blog · 2 min

Policy · Idaho

Idaho cuts $21.8M from residential habilitation

Idaho's House Bill 863, signed in March 2026, takes $21.8 million in general funds out of residential habilitation rates for fiscal 2027. It also adds annual cost surveys.

March 27, 2026 · Idaho governor approves $22M in Medicaid disability budget cuts · 2 min

Policy · New Hampshire

New Hampshire Senate passes SB 670 oversight bill

The New Hampshire Senate passed SB 670 in March 2026, a bipartisan bill to create a Developmental Services Oversight Commission; it went to the House.

March 27, 2026 · Legislation to improve NH disability system oversight heads for House vote after Senate approval · 1 min

Policy · Pennsylvania

Pennsylvania ID/A emergency waiting list down 31%

Pennsylvania says its ID/A adult emergency waitlist is down 31% since the 2024-25 budget, and its 2026-27 plan would enroll up to 1,625 more people. The state reported the drop March 23, 2026.

March 23, 2026 · Shapiro Administration Reduces Emergency Waitlist for ID/A Services · 1 min

Policy · Iowa

Iowa waiver care hours cut as families push back

Iowa Medicaid waiver users face home care hour cuts, including a bid to cut one man's support by nearly 40%, KFF Health News reported in March 2026.

March 5, 2026 · Trump’s Cuts to Medicaid Threaten Services That Help Disabled People Live at Home · 1 min

Policy · Federal

CMS defers $259.5M in Minnesota Medicaid funds

Citing questionable personal care and HCBS claims, CMS deferred $259.5 million in Minnesota's federal Medicaid funds on Feb. 25, 2026.

February 25, 2026 · Trump Administration Prioritizes Affordability by Announcing Major Crackdown on Health Care Fraud · 1 min

Policy · Federal

Lifespan Respite renewed for 5 years with $11M

Congress gave the federal Lifespan Respite Care Program five more years in a February 2026 spending package, with $11 million this year. That is up from $10 million.

February 24, 2026 · Respite Care Program Extended Under New Federal Law · 1 min

Policy · North Carolina

North Carolina restores rates; $319M gap remains

After court orders, North Carolina undid its October Medicaid rate cuts on Dec. 10, 2025, yet warned it still faces a $319 million shortfall.

December 10, 2025 · Governor Stein Continues to Stand Up for 3 Million Medicaid Patients in North Carolina, Directs NCDHHS to Restore Rates · 2 min

Policy · Minnesota

Minnesota pauses new HCBS licenses through 2027

Minnesota's freeze on new 245D HCBS licenses began Jan. 1, 2026, and is expected to last through 2027; 2,314 pending applications were canceled.

December 5, 2025 · Providers decry state moratorium for new disability group homes, programs · 2 min

Policy · The data

KFF: 607,000 on HCBS waiting lists in 41 states

KFF counted about 607,000 people on Medicaid home care waiting lists in 41 states in 2025, up 14% from 2024, in a survey published Nov. 20, 2025. People with I/DD were 74% of them.

November 20, 2025 · A Look at Waiting Lists for Medicaid Home and Community-Based Services from 2016 to 2025 · 2 min

Policy · Pennsylvania

Pennsylvania 2025-26 budget funds 6% of caregivers

Pennsylvania's 2025-26 budget, signed in November 2025, added $21 million for participant-directed home care workers, about 6% of the workforce. Agency caregivers got nothing.

November 17, 2025 · Pennsylvania's State Budget 'Ignores 94% Of Caregivers', Home-Based Care Advocates Say · 2 min

Policy · Federal

CMS issues first guidance on provider tax limits

CMS told states Nov. 14, 2025, it will generally bar new or increased Medicaid provider taxes from Oct. 1, 2026, under the 2025 reconciliation law.

November 14, 2025 · CMS Issues Guidance to Strengthen Oversight of Medicaid Financing · 2 min

Policy · Colorado

Colorado pauses parent caregiver rate cut

Colorado on Feb. 3, 2026, shelved moving family caregivers of adults with DD to the lower host-home rate after the Joint Budget Committee tabled it. The state had projected $1.45 million in savings.

November 6, 2025 · How Medicaid cuts will hurt Colorado families caring for adult children with disabilities · 2 min

Policy · California

California HCBS cuts could add $1.17B in costs

A CHCF brief published Oct. 23, 2025, projects that 10% cuts to five Medi-Cal HCBS programs would add $1.17 billion in costs over 2026-2030.

October 23, 2025 · How Could Cuts to Medi-Cal HCBS Impact California? · 2 min

Policy · Arizona

Arizona pauses children's care-hour cuts

Arizona paused its new HCBS Needs Tool for children on Oct. 16, 2025, restoring pre-Oct. 1 care hours and adding an Extraordinary Care Review.

October 16, 2025 · Parent backlash leads to changes to Arizona's new developmental disability assessment · 2 min

Policy · Policy

North Carolina: 8% ICF-IID cut, 3% Innovations cut

North Carolina Medicaid announced Sept. 25, 2025, cuts from Oct. 1: 8% for ICF-IID and personal care, and 97% of prior rates for Innovations services.

September 25, 2025 · NC Medicaid Rate Reductions – Effective Oct. 1, 2025 · 1 min

Policy · Policy

Idaho cuts Medicaid rates 4% from Sept. 1, 2025

Idaho told Medicaid providers on Aug. 22, 2025, it would cut rates 4% for nearly all provider types from Sept. 1, 2025, after cost growth near 19%.

August 22, 2025 · IDHW reducing Medicaid provider rates by 4% · 1 min

Policy · Policy

H.R. 1 passes with nearly $1T Medicaid cut

H.R. 1, which cleared Congress July 3, 2025, cuts Medicaid by almost $1 trillion, Disability Scoop reported, and adds work requirements. It also creates a new HCBS waiver option in 2028.

July 3, 2025 · H.R. 1 (enrolled): An Act to provide for reconciliation pursuant to title II of H. Con. Res. 14 · 1 min

Policy · Policy

Arizona's $122M fix keeps DDD services running

HB 2945, signed April 24, 2025, gave Arizona's Division of Developmental Disabilities about $122 million so it would not run out of money. It also set new limits on paid parent caregivers.

April 24, 2025 · HB2945 - 571R - House Bill Summary · 1 min

Policy · Policy

House budget: $880B cut target for Medicaid panel

A 217-215 House vote on Feb. 25, 2025, set a target of at least $880 billion in 10-year cuts for Energy and Commerce, the Medicaid committee.

February 25, 2025 · H.Con.Res.14 - Establishing the congressional budget for the United States Government for fiscal year 2025 and setting forth the appropriate budgetary levels for fiscal years 2026 through 2034 · 1 min

Policy · Agencies

Labor Dept. proposes ending 14(c) subminimum wage

The Labor Department proposed Dec. 4, 2024, to phase out Section 14(c) subminimum wage certificates, affecting about 40,000 workers at 801 employers.

December 4, 2024 · Employment of Workers With Disabilities Under Section 14(c) of the Fair Labor Standards Act · 1 min

Policy · Agencies

Oklahoma cuts disability services wait to 2 years

After a $32.5 million push in 2022, Oklahoma's developmental disability services wait shrank from 13 years to two, the state said in November 2024.

November 14, 2024 · Oklahoma agency reduces waitlist for disability services from 13 years to 2 · 1 min

Policy · Agencies

Oklahoma DDS provider rates up 10%-25%, Oct. 2024

Oklahoma Human Services said Oct. 3, 2024, that DDS provider rates rose 10% to 25% on Oct. 1 and In-Home Supports Waiver limits rose 25%.

October 3, 2024 · DDS Announces Second Rate Increase for Provider Agencies · 1 min

Policy · Policy

Texas, 16 states sue over Section 504 rule (2024)

A suit filed Sept. 26, 2024, by Texas and 16 other states targets parts of HHS's 2024 Section 504 rule, including most integrated setting terms.

September 26, 2024 · Texas v. Becerra complaint (N.D. Tex., No. 5:24-cv-00225) · 1 min

Policy · Agencies

California regional centers returned $978M unspent

Unspent disability service funds returned by California's 21 regional centers topped $978 million in 2021-22, the LA Times reported in August 2024.

August 20, 2024 · Nearly $1 billion in funds left unspent by centers for disabled Californians · 1 min

Policy · Workforce

Georgia NOW/COMP rate increases approved in 2024

Georgia announced July 11, 2024, federal approval of NOW and COMP waiver amendments raising I/DD provider rates retroactive to July 1, 2024. Rate models assume a $16.70 average direct support wage.

July 11, 2024 · DBHDD, DCH Announce Approval of Historic Medicaid Provider Rate Increases Under NOW & COMP Waiver Amendments · 1 min

Policy · Policy

Minnesota: 70,000 face Waiver Reimagine shift

People with disabilities in Minnesota warned in June 2024 that merging four waivers serving about 70,000 into two could push more into group homes.

June 1, 2024 · Minnesotans fear disability benefits overhaul will lead to more institutionalization · 1 min

Policy · Policy

CMS finalizes 80% home care pay rule (April 2024)

CMS's final access rule, April 22, 2024, requires that within six years at least 80% of homemaker, aide and personal care payments go to worker pay.

April 22, 2024 · Ensuring Access to Medicaid Services Final Rule (CMS-2442-F) · 1 min

Policy · Policy

Case for Inclusion 2024: 497,354 on HCBS waitlists

The Case for Inclusion report, released March 6, 2024, counted 497,354 people on state HCBS waiting lists and a 16.5% full-time DSP vacancy rate.

March 6, 2024 · ANCOR and UCP Release Case for Inclusion 2024: A Look at I/DD Services · 1 min

Policy · Policy

Pennsylvania plans $215M for ID/A provider rates

A Feb. 6, 2024 budget plan from Gov. Josh Shapiro would put $215 million in Pennsylvania funds, plus $266 million federal, into ID/A provider rates.

February 6, 2024 · Governor Shapiro Unveils 2024-25 Budget Proposal to Get Stuff Done, Create Opportunity, and Advance Real Freedom for All Pennsylvanians · 1 min

Policy · Workforce

ARPA home care funding hits about $37B (Dec. 2023)

Over $25 billion of about $37 billion in American Rescue Plan HCBS funds was aimed at the direct care workforce, the White House said Dec. 12, 2023.

December 12, 2023 · FACT SHEET: Vice President Harris Announces that American Rescue Plan Investments in Home and Community-Based Care Services for Millions of Seniors and Americans with Disabilities Reach About $37… · 1 min

Policy · Workforce

HCBS Relief Act seeks 10-point Medicaid boost

Sen. Bob Casey and 17 Democrats introduced the HCBS Relief Act on Oct. 24, 2023, seeking a 10-point Medicaid match increase for two years. The aim is to stabilize the home care workforce.

October 24, 2023 · Casey, Colleagues Introduce Bill to Bolster Home Care Workforce · 1 min

Policy · Policy

HHS proposes Section 504 disability rule update

HHS proposed its first major Section 504 disability rule update in decades on Sept. 7, 2023, with public comments due Nov. 13. It adds medical treatment, equipment, web access and integrated setting rules.

September 7, 2023 · Discrimination on the Basis of Disability in Health and Human Service Programs or Activities · 1 min

Policy · Agencies

CMS extends Appendix K past Nov. 11, 2023

CMS said Aug. 2, 2023, that Appendix K flexibilities would last to the later of Nov. 11, 2023, or when permanent waiver amendments take effect.

August 2, 2023 · CMS Releases New Guidance to Ensure Continuity of Key Flexibilities Implemented During the COVID-19 Public Health Emergency · 1 min

Policy · Practice

CMS: 1 million I/DD homes have aging caregivers

CMS released four resources June 2, 2023, to help states plan for about 1 million U.S. homes where an adult with I/DD lives with an aging caregiver.

June 2, 2023 · Resources on Supporting Adults with I/DD and Their Aging Caregivers · 1 min

Policy · Policy

CMS proposes 80% pass-through for home care pay

CMS proposed May 3, 2023, that at least 80% of Medicaid personal care, homemaker and home health aide payments go to worker compensation. It also adds rate, waitlist and grievance requirements.

May 3, 2023 · Medicaid Program; Ensuring Access to Medicaid Services · 1 min

Policy · Policy

Biden order tells HHS to weigh HCBS access rules

Executive Order 14095, signed April 18, 2023, told federal health officials to weigh new Medicaid HCBS rules and asked Labor to study home care pay.

April 18, 2023 · Increasing Access to High-Quality Care and Supporting Caregivers · 1 min

Policy · Agencies

HCBS settings rule deadline arrives March 17, 2023

States' deadline to meet the 2014 federal HCBS settings rule arrived March 17, 2023, after two extensions, with nearly all on corrective action plans.

March 17, 2023 · Medicaid Program; State Plan Home and Community-Based Services, 5-Year Period for Waivers, Provider Payment Reassignment, and Home and Community-Based Setting Requirements for Community First Choice… · 1 min

Policy · Policy

COVID emergency set to end May 11, 2023

The Biden administration said in late January 2023 the COVID-19 emergency would end May 11, 2023, and Medicaid continuous enrollment March 31. Appendix K flexibilities end six months after the emergency.

February 6, 2023 · Statement of Administration Policy: H.R. 382 and H.J. Res. 7 · 1 min

Policy · Policy

Better Care Better Jobs Act: 10-point HCBS boost

The Better Care Better Jobs Act, reintroduced Jan. 26, 2023, would permanently raise the HCBS federal match 10 points in states meeting new standards.

January 26, 2023 · Casey, Dingell Introduce Bill to Provide Historic, Permanent Investment in Home Care for Seniors and People with Disabilities · 1 min