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A State Gave Sheriffs 20% of Its Opioid Settlement Cash. We Followed the Money.

Aneri Pattani — Thu, 27 Aug 2026 09:00:00 +0000

�Թϲ�� worked with three Louisiana news outlets — , , and — to ask all 64 sheriffs in the state how they’ve spent their opioid settlement funds. The responses were shared and presented in a data table for all four newsrooms to use. Reporters then conducted individual reporting for separate articles.

Every state is from companies accused of flooding the nation with prescription painkillers and fueling overdose deaths. But only one state is directing 20% of those payouts to sheriffs — the largest carve-out for law enforcement nationwide.

In Louisiana, sheriffs are elected, do not serve at the pleasure of another local official, and have independent budgets. They’re also not required to proactively report to the public or another authority how they spend billions in opioid settlement cash.

Short of filing public records requests or waiting for official audits, that has made it difficult for the average person to track the windfall. Many consider the dollars to be “blood money” and believe the spirit of the settlements is to spend it all on abating the addiction crisis.

�Թϲ�� worked with three Louisiana news outlets — , , and — to track those dollars. The newsrooms contacted all 64 Louisiana sheriffs over five months, often filing public records requests, to produce the first detailed accounting of millions spent.

The findings include:

Thirty-eight sheriffs reported spending more than $8.1 million total. Much of it went to crime-fighting equipment, such as surveillance cameras and drug detection products, though smaller amounts funded mobile apps, addiction treatment in jails, and educational programs for youth.
$5.4 million, about 66% of reported spending, was deemed inappropriate by a three-person review panel. The panel, assembled by �Թϲ�� and its partners, included a Louisiana resident in recovery who lost his son to a fentanyl overdose, an addiction medicine doctor, and a public health policy analyst who has been tracking settlement dollars since 2022. They judged the expenditures using their professional and personal expertise. Expenditures the panel disapproved of included salaries and overtime pay for homicide detectives and officers conducting jail shakedowns to find contraband.
$4.7 million, nearly 60% of reported spending, went to items or services that other states say should not be purchased with opioid cash. Six states have , such as technology to extract data from cellphones and automated external defibrillators, which are . Although Louisiana does not have its own “unallowable” list, the state’s — a five-member body that advises sheriffs and parishes but does not control the money — said it has shared the guidance from other states.
Nine sheriffs stood out for promising uses: All of their expenditures, totaling nearly $1.8 million, were deemed appropriate by the review panel and allowable in other states. These included providing addiction treatment in jail, training officers to respond to overdoses, and increasing public awareness of addiction resources.
Twenty sheriffs did not provide their expenditures, leaving roughly $10.7 million that hidden from public view. The Jefferson Parish Sheriff’s Office, which covers an area just outside New Orleans and was allotted the highest amount — nearly $4 million through 2025 — did not respond to more than a dozen calls and emails.

Nationwide, debates over law enforcement’s role with opioid settlement money have been underway since the funds began flowing significantly in 2022 and have continued as the pool of money has grown. Purdue Pharma, , finalized its this year, and various settlements are set to pay out for an additional decade-plus.

Since the earliest days, these dollars have been viewed across government agencies and the private sector as a pot of gold for which many are vying.

Law enforcement agencies are part of this scrum. They say seizing drugs and arresting dealers save lives, but that costs money and the addiction crisis has burdened their budgets. However, many recovery advocates staunchly oppose any opioid cash flowing to what they see as the .

Since there are few guardrails on how the money is spent, decisions often come down to how local politicians and residents see addiction and what type of approach they believe will be effective in combating it.

Louisiana provides a natural experiment to see which priorities prevail when money is handed directly to sheriffs.

First Public Look at How Louisiana Sheriffs Have Spent Over $8M in Opioid Settlement Cash

In Louisiana, sheriffs receive 20% of the state's opioid settlement cash — the largest carve-out for law enforcement nationwide. But since sheriffs are not required to proactively report how they spend the money, it's hard to track. Reporters from �Թϲ��, The Current, Gulf States Newsroom, and Verite News contacted all 64 sheriffs to uncover spending details.

Click column headings to sort the table.

Note: In some cases, the amount of money spent exceeds the amount allocated because sheriffs may have reported spending that included their 2026 allocations or because sheriffs combined their opioid settlement dollars with the share received by parish governments or other funding sources. Descriptions of spending are based on emails or phone calls with the sheriffs' offices and have been lightly edited.
Source: The money allocated to sheriffs was obtained by summing values for years 1-5, representing 2021-2025, from the Louisiana Opioid Abatement Task Force’s public spreadsheet. Data on money spent was collected by �Թϲ��, The Current, Gulf States Newsroom, and Verite News. • /download-the-data-louisiana-sheriffs-opioid-settlement-expenditures/" target="_blank" style="color:#0071ce">Download the data.
Credit: �Թϲ��' Lydia Zuraw and Aneri Pattani, The Current’s Alena Maschke, Gulf States Newsroom’s Drew Hawkins, and Verite News’ Katie Jane Fernelius

The state’s agreement with parishes and sheriffs receiving settlement cash contains broad categories for , including “law enforcement expenditures relating to the opioid epidemic.”

But even if the sheriffs’ spending is legal, that doesn’t mean it’s appropriate or effective, addiction and public health experts say.

“What’s happening here is they have a lot of money and they want to distribute it to all the wrong places,” said Danny Bolner Jr., a Jefferson Parish resident who has been in recovery from addiction for more than two decades and lost his 28-year-old son to a fentanyl overdose in 2016. On the panel that reviewed expenditures, Bolner represented the view of families who have lost loved ones to the crisis.

The purchase of drones and vehicles struck a nerve for him. He’d prefer for opioid cash to support programs that educate youth about healthy ways to process emotions, provide job training to people in recovery, and distribute overdose reversal medications.

“This money is what we have to save lives,” he said. If sheriffs use it in other ways, the finite pot “is going to be gone and then they won’t have nothing to help.”

Danny Bolner Jr. is a Jefferson Parish, Louisiana, resident who has been in recovery from addiction for more than two decades. Bolner lost his 28-year-old son to a fentanyl overdose in 2016. (Christiana Botic/Verite News and CatchLight Local/Report for America)

A Safe, a Scanner, and Surveillance Cameras

For , a public health policy analyst and national opioid settlement expert who was a member of the review panel, determining if expenditures fit the spirit of the settlements often centered on whether they facilitated arrests or prevented overdoses.

“The impetus of this opioid settlement money is to spend on innovative ways to not let this happen again,” she said, referring to the overdose crisis that has claimed since 2000. She said sheriffs should be asking, “How could we use this to reinvest in the community, not just build up our office?”

Many of the sheriffs’ equipment purchases didn’t meet her bar.

For example, the East Baton Rouge Sheriff’s Office bought a safe to store evidence from opioid investigations and a scanner for their traffic division to identify narcotics in hidden compartments. The Terrebonne Parish Sheriff’s Office spent $465,000 on , which are automated license plate readers that capture data about passing vehicles and share them with law enforcement agencies nationwide. The Bossier Parish Sheriff’s Office purchased 130 body cameras and 50 dash cameras.

Sheriffs already receive taxpayer dollars and federal grants to buy law enforcement tools, Christensen said. Opioid cash, which is finite and has a specific purpose, should not be used for that, she and the other reviewers said. In fact, some states don’t allow it.

13 Louisiana Sheriffs Spent 100% of Opioid Settlement Money Inappropriately, per an Expert Panel

The expenditures were reviewed by Tricia Christensen, a public health policy analyst who has been tracking opioid settlement spending since 2022; Stephen Loyd, an addiction medicine doctor and a person in recovery who serves as West Virginia's drug czar; and Danny Bolner Jr., a person in recovery who lost his son to a fentanyl overdose and is raising his son’s daughter in Jefferson Parish, Louisiana. A majority vote determined which expenditures were appropriate.

The map depicts the percentage of money each sheriff spent on expenditures disapproved by the reviewers.

Note: The reviewers voted on the propriety of each expenditure based on their own views of the purpose of opioid settlement money. The rates of opioid-involved deaths are age-adjusted. Rates based on counts <5 were suppressed by the Louisiana Department of Health to protect privacy. "Opioid-involved deaths" include deaths in which opioids were present in the body and/or contributed to death, even if they were not the sole cause of death.
Sources: Settlement spending and reviewer opinions collected by �Թϲ��, The Current, Gulf States Newsroom, and Verite News; opioid-involved death rates from the Louisiana Department of Health
Credit: �Թϲ��' Lydia Zuraw and Aneri Pattani, The Current’s Alena Maschke, Gulf States Newsroom’s Drew Hawkins, and Verite News’ Katie Jane Fernelius

But taxpayer money may not cover everything sheriffs need, said , executive director of the Louisiana Sheriffs’ Association. “Our budgets are overloaded,” he said.

Complex investigations to dismantle drug trafficking syndicates can require advanced equipment, , a spokesperson for the East Baton Rouge Sheriff’s Office, wrote in a statement.

“While treatment and recovery services are indispensable components of addressing opioid addiction, they address the consequences of addiction after these drugs have already reached our community,” she wrote. “Law enforcement has a different, but equally essential, responsibility: preventing those deadly drugs from reaching potential victims in the first place.”

First Lt. Blake Tabor, a spokesperson for the Terrebonne sheriff’s office, similarly wrote, “Our role as a law enforcement agency is primarily focused on disrupting the criminal activity that fuels addiction in our community.” That effort complements other entities’ work in prevention, treatment, and recovery, he added.

The Bossier Parish Sheriff’s Office declined to comment.

Where Public Health Meets Public Safety

Not all sheriffs spent the money on enforcement.

Acadia Parish Sheriff directed all his settlement cash to provide treatment in jail. He said he hopes to break cycles of addiction and crime.

“I want people back into society, being productive,” he said.

Research shows for opioid use disorder behind bars and .

In St. Martin Parish, settlement funds helped launch a of officers that connects people with substance use disorders or related mental illness to treatment, said Chester Cedars, chief legal counsel for its sheriff’s office. Officers also try to coordinate support services for family members and assist with questions around paying for care.

“We’re not clinicians,” Cedars said, but we “serve as a broker” between people who need services and those who provide them.

, an addiction medicine doctor and the West Virginia drug czar, who was the third member of the review panel, said he loved the comprehensive nature of the program. Addiction “is a family issue,” he said. “Every time that phone rings, it’s a potential family crisis.”

Bolner and his granddaughter sit on a bench dedicated to his son and her father, Daniel, at Lafreniere Park in Metairie, Louisiana. Daniel died of a fentanyl overdose in 2016 on his 28th birthday. (Christiana Botic/Verite News and CatchLight Local/Report for America)

It’s not a coincidence that these parishes earned top marks from the reviewers. Cedars is the former chair of the , and Gibson is the current chair. That’s the body meant to guide others on priority uses of settlement cash.

Cedars was clear that the St. Martin sheriff’s office was not using “one penny for any enforcement activity,” because that’s not what the settlement “intended to accomplish.”

Gibson was more hesitant, saying the legal guidelines are broad and “I’m not here to criticize anybody.”

He has advised about a dozen sheriffs who have reached out with questions, but he knows they’re not required to heed his guidance.

A from the Louisiana Legislative Auditor found that the task force has no teeth to enforce its recommendations.

If people want stronger guardrails on the opioid cash, state lawmakers need to enact new rules, Gibson said.

Stepping Up Oversight

The Louisiana state legislature in May calling for the legislative auditor to review how all parishes and sheriffs are handling their opioid settlement money and report to lawmakers prior to the 2027 legislative session.

State Sen. , a Republican who co-authored the resolution, said the goal is to shed light on where dollars are flowing, if jurisdictions are spending them at all, and which funded programs are effective.

With that information, Myers said, he and others could “absolutely” introduce bills “to tighten up how funding is spent.”

Louisiana Sheriffs Spent $4.7M in Opioid Settlement Cash on Items, Activities Deemed Unallowable in Other States

Six states — California, Indiana, Kansas, Michigan, South Carolina, and Virginia — have created lists of items and services that they say opioid settlement funds should not be spent on, including surveillance cameras and vehicles. Although Louisiana does not have its own "unallowable" list, the state's Opioid Abatement Task Force said it has shared other states' guidance with some sheriffs. Yet nearly 60% of the sheriffs' spending involves items found on such lists.

Note: Unallowable lists may not be legally binding in each state but are considered strong guidance.
Source: Data collection by �Թϲ��, The Current, Gulf States Newsroom, and Verite News
Credit: �Թϲ��' Lydia Zuraw and Aneri Pattani

Meanwhile, the Louisiana Opioid Abatement Task Force is trying to strengthen its oversight.

Curtis Nelson is executive counsel for the Louisiana Opioid Abatement Administration Corporation, a nonprofit that supports the task force. He said the body is seeking quotes from accountants to conduct ongoing forensic audits of parishes and sheriffs. The goal is to audit 10 to 15 entities annually, starting with those receiving the most money. If the audits turn up misuse, the task force could withhold future payments from those parishes or sheriffs, Nelson said.

The task force is also exploring creating its own unallowable list, like those in other states, Nelson said.

Louisiana Gov. Jeff Landry and Attorney General Liz Murrill did not respond to questions about whether they’d support an unallowable list or take other actions to address opioid settlement spending.

But many advocates are hopeful that an unallowable list could curb spending they found concerning.

“You’re keeping them on the track when you tell them what they can’t use it for,” said Bolner, the Jefferson Parish resident who lost his son to overdose and is raising his son’s daughter.

While he awaits greater oversight for sheriffs, Bolner plans to continue the work he’s been doing for years: distributing overdose reversal medications at schools, hospitals, and bars; participating in grief support groups with other families; and showing up at community events to raise awareness about addiction. He said he’ll keep speaking with sheriffs and parishes about what he considers the best use of settlement money.

“If I save one life, it’s accomplished,” he said.

Methodology

Reporters from �Թϲ��, The Current, Gulf States Newsroom, and Verite News worked together to contact all 64 sheriffs’ offices in Louisiana and ask how they’d spent opioid settlement funds. The outreach involved dozens of emails and phone calls from March to July.

If a sheriff’s office did not respond or did not provide specific dollar amounts spent on programs or services, it was labeled “Did not provide expenditures.” All other responses were summarized in a data table.

The amount of settlement money each sheriff’s office received through 2025 was obtained from the Louisiana Opioid Abatement Task Force’s . Allocations for years 1 through 5 were summed, representing 2021 through 2025.

In the few cases in which a sheriff’s office reported spending more money than the task force said it had been allocated, it was often because the sheriff’s office had combined its share of opioid settlement dollars with the share received by the parish government or another funding source. Some sheriffs may have also reported money spent from their 2026 allocation.

Once all the data was collected, the reporters used two methods to analyze the results.

For the first, the reporters created an unduplicated list of expenditures and de-identified them by removing the sheriffs’ offices names. That list was shared with three reviewers: , a public health policy expert who has been tracking opioid settlement spending since 2022; , an addiction medicine doctor and a person in recovery who previously served as chair of Tennessee’s Opioid Abatement Council and is currently West Virginia’s drug czar; and Danny Bolner Jr., a person in recovery from addiction who lost his son to a fentanyl overdose and is raising his son’s daughter in Jefferson Parish, Louisiana.

Each reviewer voted on each expenditure description as an appropriate or inappropriate use of opioid settlement money. The majority vote determined the final designation.

Reporters calculated how much of the money spent by each sheriff’s office went to expenditures the review panel deemed inappropriate. This value was divided by the total spent to determine the percentage of expenditures deemed inappropriate by the panel. The second approach to analyzing the sheriffs’ spending was as follows: Six states (, , , , , and ) have created lists of items and services that they say opioid settlement funds should not be spent on, often known as “unallowable lists.” �Թϲ�� calculated how much money spent by each Louisiana sheriff’s office went to expenditures on one of these lists. This value was divided by the total spent to determine the percentage of expenditures that would have been unallowable or not recommended in one or more of these states.

The Current’s Alena Maschke, Gulf States Newsroom’s Drew Hawkins, and Verite News’ Katie Jane Fernelius contributed to the database featured in this article.

�Թϲ�� is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on �Թϲ�� and is republished here under a .

Where Florida’s Gun Violence Exacts Its Biggest Toll on Black and Latino Children

Tue, 25 Aug 2026 09:00:00 +0000

JACKSONVILLE, Fla. — Just west of the St. Johns River, which divides this sprawling city racially and economically, 2-year-old A’mahri Robinson was murdered in his mother’s arms.

Ladonna Johnson was rocking A’mahri to sleep in March when he was shot in the head with a gun she kept for protection.

A’mahri loved going outdoors and taking rides in his pull-along wagon. His mother called the toddler “sweet” and “affectionate.” When he was around, she said, “you just felt love.”

The child was close with Steven Dodson Jr., his mother’s boyfriend, who had reached for the gun during an argument. Dodson, 21, in June to murder and aggravated child abuse and was sentenced to life in prison.

A’mahri died in one of Florida’s most violent places for children: Jacksonville. This city has three ZIP codes that rank among the 10 worst in the state for firearm injuries involving children.

Two-year-old A’mahri Robinson was murdered while in his mother’s arms in March. (Ladonna Johnson)

Every year, hundreds of children are hospitalized in Florida with gunshot wounds, and overwhelmingly, they come from a tiny number of ZIP codes, an exclusive analysis of hospital data by �Թϲ�� and The Trace found.

Hospital billing data obtained from the Florida Agency for Health Care Administration shows that from 2018 to 2024 more than 4,000 children 17 or younger were hospitalized for firearm injuries — a rate of about 1.5 a day.

The newsrooms gathered data that the state’s hospitals use to collect payments from insurance companies or the government. The information does not identify patients but includes details about where they lived and their age, race, and other demographics.

The number of children killed in Jacksonville has grown so large that , Families of Slain Children, built a “Wall of Compassion” memorial listing hundreds of people killed by gunfire in the city. Memorial organizers have stood up a second wall nearby that is filling with names.

The Jacksonville nonprofit Families of Slain Children has built a memorial called the “Wall of Compassion” that lists the names of hundreds of people who have been killed by gun violence in the city. (Daniel Chang/�Թϲ��)

The numbers reflect how Florida’s long history of racial discrimination and permissive gun laws undermine public health, said researchers, public officials, community activists, and grieving parents.

Jacksonville kids were shot most often in racially segregated neighborhoods — a legacy from the early 20th century of state-sanctioned discrimination in housing, banking, and investment. These areas today are plagued by pollution from defunct city-run trash incinerators, garbage-strewn lots, dilapidated housing, poverty, and other problems that local leaders have been promising to fix for more than 50 years.

Nearly all the Florida ZIP codes with the highest rates of firearm injuries for children have large Black or Latino populations.

Perhaps nowhere is the toll of gun violence more evident than at UF Health Jacksonville, a safety net hospital and the only Level I trauma center in northeastern Florida.

As chief of acute care surgery, sees firsthand the toll exacted by guns.

“You see it day in and day out,” Madbak said. “I’m working tonight, and I suspect I’ll see a couple victims.”

Florida ZIP Codes With Highest Youth Gunshot Wound Hospitalizations

A table of Florida zip codes with city and county columns, ranked by the number of under-18 gunshot wound patients from 2018 through 2024. A column of the rate of U18 GSW patients per 100k children per year is shaded blue, darker for higher rates, lighter for lower ones.

ZIP codes with 1-10 youth GSW hospitalizations over the 2018-2024 period are omitted due to privacy laws.

GSW = gunshot wound

Florida Agency for Health Care Administration

, a UF Health pediatrician and former health director for Duval County, which includes Jacksonville, said state and local leaders have failed to address what he called the “root causes” of preventable firearm injuries and deaths, such as poverty, lack of opportunity, and neglect.

“The bottom line is nobody gives a flying f— about these young men,” Goldhagen said.

Gun violence victims and their families of depression, anxiety, post-traumatic stress disorder, and other mental health problems.

Throughout U.S. history, local governments have pushed industrial plants, , and highways through Black neighborhoods even as to increased risks of cardiovascular and respiratory diseases, cancer, preterm births, and gun violence.

But the Florida Department of Health does not focus on gun violence as a public health threat, Goldhagen said, despite its being the nation’s for children and teens.

The , a set of goals developed by the health department and an advisory committee, does not mention guns, the toll they take on children, or efforts to reduce firearm deaths and injuries to young people.

Instead, its goals include preventing or reducing sudden unexpected infant deaths and youth drownings, emergency room visits for motor vehicle crashes, and hospitalizations for traumatic brain injuries.

And yet, no one with the authority to address this public health crisis would agree to talk to �Թϲ�� about gun violence and its toll on Jacksonville’s children — not the Florida health department, Gov. Ron DeSantis, Mayor Donna Deegan, or 18 of 19 members of the Jacksonville City Council.

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Only Council member Jimmy Peluso responded. Peluso said the city has long ignored the needs of neighborhoods with high rates of firearm injuries among children.

“A lot of these neighborhoods have just felt like the wealth has left them,” he said, “and the city didn’t come in to put in the amount of work they needed to.”

DeSantis, a Republican, in public comments has called for few limits on how people purchase or carry firearms. He to allow Floridians to carry concealed weapons without a permit.

When then-U.S. Surgeon General Vivek Murthy declared firearm violence a public health crisis in 2024, DeSantis called the advisory an “.”

DeSantis said Florida would not follow the advisory, which recommended policies including universal background checks for gun purchases and requirements for secure storage.

DeSantis spokesperson Molly Best declined an interview request and to answer questions about the governor’s gun policies.

“There isn’t an agenda to end gun violence in the state of Florida,” said Jean Francis, a former pediatric nurse who leads the Jacksonville chapter of Moms Demand Action, part of a nonprofit that advocates for stronger firearm laws.

Research has linked increases in pediatric gun deaths from 2011 to 2023 to state-level gun policies.

States with permissive gun policies, such as “stand your ground” and open carry laws, reported higher rates of firearm deaths among children than states with strict regulations, such as weapon and age restrictions, according to a .

The study ranked Florida among a group of 30 states with the most permissive gun policies. Four states with comparatively strict gun laws — California, Maryland, New York, and Rhode Island — saw a decrease in pediatric gun deaths over the same time period.

prevents cities and counties from enacting stricter gun safety measures.

kids in disadvantaged neighborhoods are up to 20 times more likely to suffer firearm injuries than their peers in the most advantaged areas.

“It’s disheartening,” Madbak said. UF Health Jacksonville treated 255 patients for gunshot wounds in 2024, including 32 who were 17 or younger, he said.

In Some Florida Neighborhoods,
Child Gunshot Hospitalizations Are Common

A zip code choropleth map of Florida shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21,21-44,44-79,79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with 1-10 hospitalizations have data suppressed or represented as ranges to comply with privacy laws.

GSW = gunshot wound

Florida Agency for Health Care Administration

In Some Broward County Neighborhoods,
Child Gunshot Hospitalizations Are Common

A zip code choropleth map of the Fort Lauderdale area shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21, 21-44, 44-79, 79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with 1-10 hospitalizations have data suppressed or represented as ranges to comply with privacy laws.

GSW = gunshot wound

Florida Agency for Health Care Administration

In Some Duval County Neighborhoods,
Child Gunshot Hospitalizations Are Common

A zip code choropleth map of the Jacksonville area shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21,21-44,44-79,79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with 1-10 hospitalizations have data suppressed or represented as ranges to comply with privacy laws.

GSW = gunshot wound

Florida Agency for Health Care Administration

In Some Miami-Dade County Neighborhoods,
Child Gunshot Hospitalizations Are Common

A ZIP code choropleth map of the Miami area shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21,21-44,44-79,79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with 1-10 hospitalizations have data suppressed or represented as ranges to comply with privacy laws.

GSW = gunshot wound

Florida Agency for Health Care Administration

In Some Orange County Neighborhoods,
Child Gunshot Hospitalizations Are Common

A zip code choropleth map of the Orlando area shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21,21-44,44-79,79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with 1-10 hospitalizations have data suppressed or represented as ranges to comply with privacy laws.

GSW = gunshot wound

Florida Agency for Health Care Administration

In Some Palm Beach County Neighborhoods,
Child Gunshot Hospitalizations Are Common

A zip code choropleth map of the Palm Beach area shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21, 21-44, 44-79, 79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with fewer than 10 hospitalizations are suppressed or represented as ranges to comply with privacy laws.

GSW = gunshot wound

Florida Agency for Health Care Administration

In Some Escambia County Neighborhoods,
Child Gunshot Hospitalizations Are Common

A zip code choropleth map of the Pensacola area shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21, 21-44, 44-79, 79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with 1-10 hospitalizations have data suppressed or represented as ranges to comply with privacy laws.

GSW = gunshot wound

Florida Agency for Health Care Administration

In Some Manatee and Sarasota County Neighborhoods,
Child Gunshot Hospitalizations Are Common

A zip code choropleth map of the Sarasota area shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21, 21-44, 44-79, 79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with 1-10 hospitalizations have data suppressed or represented as ranges to comply with privacy laws.

GSW = gunshot wound

Florida Agency for Health Care Administration

In Some Pinellas County Neighborhoods,
Child Gunshot Hospitalizations Are Common

A zip code choropleth map of the Saint Petersburg area shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21, 21-44, 44-79, 79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with 1-10 hospitalizations have data suppressed or represented as ranges to comply with privacy laws.

GSW = gunshot wound

Florida Agency for Health Care Administration

In Some Leon County Neighborhoods,
Child Gunshot Hospitalizations Are Common

A zip code choropleth map of the Tallahassee area shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21, 21-44, 44-79, 79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with 1-10 hospitalizations have data suppressed or represented as ranges to comply with privacy laws.

GSW = gunshot wound

Florida Agency for Health Care Administration

In Some Hillsborough County Neighborhoods,
Child Gunshot Hospitalizations Are Common

A zip code choropleth map of the Tampa area shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21, 21-44, 44-79, 79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with 1-10 hospitalizations have data suppressed or represented as ranges to comply with privacy laws.

GSW = gunshot wound

Florida Agency for Health Care Administration

In 2025, the hospital treated 269 patients for firearm injuries, including 22 who were under 18, according to Dan Leveton, a hospital spokesperson. As of Aug. 19, the hospital has treated 137 patients for gunshot wounds this year, including 18 who were 17 or younger.

Preventing gun violence “shouldn’t be a political issue, even though it is,” Madbak said, adding that there is a lot of room for more effective advocacy for violence prevention.

“It’s really an American issue,” Madbak said, “and our state has been impacted tremendously by this kind of violence.”

The Pain of Mothers, Grandmothers, and Aunts

Kim Crow, grandmother of Bryce Williams, who died at age 17 from being shot in a neighborhood park in an Orlando suburb in 2018. Crow says her grandson’s death has left a void in her life. “I’m not me anymore,” she says. (WFTV)

In Orlando, one ZIP code — 32805 — had the state’s highest rate of children under 18 hospitalized for a gunshot wound from 2018 through 2024, with a total of 25 children, or 125.8 per 100,000.

On New Year’s Day 2018, Bryce Williams, 17, was in Casselberry, an Orlando suburb. He was found dead after crashing his blue Kia into a home near the park.

Williams’ death devastated his family, his grandmother Kim Crow told WFTV in Orlando.

“First off, you can’t believe that someone is taken from you so violently,” Crow said. “It’s heartbreaking.”

In April, Daesean Moctezuma Orland, 18, was while attending a house party outside Orlando. Two others wounded in the shooting were taken to the hospital. Police arrested a 16-year-old boy about a month after the shooting and charged him with Moctezuma Orland’s death.

Moctezuma Orland’s grandmother Iveliz Moctezuma told WFTV that a friend of her grandson’s called her and daughter Noemi Moctezuma to tell them that he had been shot. The women drove to four hospitals, including one in Tampa, searching for him.

Iveliz Moctezuma, grandmother of Daesean Moctezuma Orland, who was shot and killed at age 18 at a house party in Davenport, Florida, in April. “It was the hardest night of my life,” she says. “They ripped him away from us.” (Keary Croskrey/WFTV)

“My every day is crumbled,” Iveliz Moctezuma said. “It’s hard to work. You sit there and you watch the news. You’re like, oh my God, there goes another kid getting killed by gun violence.”

“It’s a hole in my chest, a hole in my mind,” Noemi Moctezuma said. “It’s like the biggest void that you could ever possibly imagine, that not even the happiest moments can fill a void like that.”

Jacksonville, a city of about 1 million, is particularly treacherous for children living in areas north and west of downtown.

The victims include a gunned down while playing in front of a house, a fatally wounded coming home from a football tryout, and a killed by a stray bullet as she sat in a parked car.

Advocates for victims said that gun violence has ripped any sense of normalcy from families and entire neighborhoods. Grieving mothers fear fireworks and other loud noises that sound like gunshots. Grappling with their own emotions, they said, they sometimes struggle to help their surviving children cope with the loss.

“When you hear their stories, you think, ‘This is the worst thing I have ever heard,’” Francis said, “until you hear the next one.”

Hours after graduating from Jacksonville’s Raines High School in May 2022, , 18, was shot and killed while arriving at a friend’s celebration. Fields was walking into the party when a car pulled up and opened fire, his mother, Yvonne Fields, told Action News Jax in an interview.

A defensive lineman on his high school football team, Fields had been offered a full scholarship to play for Keiser University in West Palm Beach. His parents were planning a party for the following day to celebrate his graduation.

“Everybody loved him,” Yvonne Fields said of her youngest son, calling him “the life of the party.”

Yvonne Fields of Jacksonville talks about the death of her son, Rashaud Fields, 18, who was shot and killed in May 2022 at a high school graduation party. (Kevin Jordan/Action News Jax)

“Rashaud loved to dance. He was a joke teller. He was funny,” Fields said.

At the time, Rashaud Fields was at least the ninth 17- to 19-year-old homicide victim in the city that year, according to the , the local newspaper. Yvonne Fields said she has kept her son’s room exactly as he left it the day he was killed. She smells his shirt every day.

“I know he’s not coming back,” she said, “but I can feel the spirit.”

Two days after celebrating his 18th birthday, Maurice Hobbs was fatally shot in January 2017 as he waited for his mother to pick him up.

“I was not even a block away,” Latasha Hobbs said to Action News Jax.

Latasha Hobbs receives a hug at a gathering to end gun violence in Jacksonville on Aug. 27, 2018. Her son, Maurice Hobbs, was shot and killed two days after celebrating his 18th birthday in January 2017. (Joe Raedle/Getty Images)

A singer, rapper, and poet, Maurice Hobbs wanted to perform and launch a clothing line. He dreamt of making enough money to give homes to everyone in his family so they could all live on the same street.

His mom recalled celebrating his birthday with cake and dancing in the kitchen and his reaction to turning 18.

“He was like, ‘Oh my God, Mom, I made it to 18,’” Latasha Hobbs said. “So it’s hard to swallow knowing that my baby didn’t make it to 19. It’s not fair. My baby deserves to be here.”

Pamela Howard has struggled for nearly two decades with the pain of the killing of her son Derrell Baker at age 17.

Howard, a mother of five, called her son energetic and an anchor for his younger siblings. Baker excelled at football, she said, and was on track to graduate high school despite having severe attention-deficit/hyperactivity disorder.

Someone shot Baker in September 2008 as he walked to school. A passerby found him by the road.

Pamela Howard has spent nearly two decades trying to help police find the person who killed her son Derrell Baker, 17, as he walked to school in 2008. (Malcolm Jackson for �Թϲ��)

Howard said she thought Baker was at school and later football practice. The family learned something might be wrong only when a sibling heard that Baker had been shot.

Howard called area hospitals in search of her son. By the time she found him at UF Health Jacksonville, it was too late, she said: He had died hours earlier.

“I don’t remember anything after they told me” he was dead, Howard said. “My friends say they just heard me scream.”

For the mothers Fields, Hobbs, and Howard, the sudden, unexpected death of their children cut deep. The lack of closure is painful. Police have not made an arrest in any of the cases.

“When I get justice,” Yvonne Fields said, “maybe I’ll be a little at peace.”

()

Leading Cause of Death

, chief of pediatric surgery and trauma at Children’s Hospital of Philadelphia, said there has to be an appetite in state capitals to regulate firearms and protect children from gun violence.

Nance co-authored a in JAMA Pediatrics finding that the number of states where guns were the leading cause of death for children and teens increased from zero over the period 2004 to 2008 to 24 from 2019 to 2023.

Motor vehicle deaths among children, once the leading cause of death in that group, have declined primarily because of safety interventions undertaken by governments and car manufacturers, he said, from seat belt laws and speed limits to air bags and antilock brakes.

“That progress has been pretty universal across the U.S.,” he said, “but firearm stuff is just all over the map.”

Guns don’t have federal safety standards, Nance noted. They aren’t regulated by the Consumer Product Safety Commission, a federal agency that protects the public from dangerous products, and they can’t be recalled the way unsafe toys or cars can be.

“We’ve really done almost nothing to change the trajectory of firearm injuries in kids,” Nance said.

Goldhagen, the UF Health pediatrician, said Jacksonville leaders tried to address gun violence through the Jacksonville Journey, an initiative launched in 2008 — when Duval County was the murder capital of Florida — under former Mayor John Peyton.

The program for children at risk of violence provided mentorship, summer camps, job training, and nonpolice strategies such as neighborhood beautification projects and community center programs. The Journey also partnered with the Jacksonville Sheriff’s Office on gang intervention focused on young people.

Officials credited the effort with a nearly 40% reduction in homicides in Duval County in its first four years.

After Peyton left office in 2011, program spending of about $15 million was slashed to $8.6 million in 2012 and about $2.3 million in 2014. The scaled-back program was eventually combined with another children’s initiative to form the , which uses city, state, and federal grants to fund youth services and intervention programs.

Duval County is the only large county in Florida that does not have a child services tax dedicated to programs for children, including efforts to reduce youth crime.

City leaders believe “public safety is about fire and police, but not social services,” said Vicki Waytowich, executive director of the , a nonprofit funded through grants and contracts that provides health and juvenile justice services for children and families in Jacksonville.

“There is absolutely zero political will to do anything that remotely resembles a child services tax,” she said.

In 2024, on a gun violence prevention program called Cure Violence, which tried to squash beefs between youths before they escalated to shootings. A city Office of Inspector General report and sound financial practices.

“We have a public health system that doesn’t focus on this as a public health or population health issue,” Goldhagen said.

Waytowich said crime is a symptom of much deeper problems on the north side of Jacksonville, from neighborhood decay to generational trauma and lack of job opportunities.

“We don’t really have the funds to address the root causes,” she said. “What we’re doing is slapping a band-aid on things.”

Unlike in Mandarin, a predominantly white neighborhood on the south side of Jacksonville with easy access to about seven grocery stores, children of the city’s north side have poor nutrition, Waytowich said, and many walk more than a mile to get to school.

“We can see that kids don’t have hope,” Waytowich said. “When kids believe they’re going to die at 21, then what’s the use of goal-setting and résumé-building workshops?”

In 2025, Jacksonville Mayor Deegan launched a program to address gun violence called .

But like its predecessor, Journey Forward does not have a dedicated, ongoing source of funding.

Hard Memory

On March 22, Ladonna Johnson said, she broke up with Dodson because she saw that he was sharing location information with other women on his cellphone.

She said she went into a bedroom where A’mahri and his sister were watching television and put her son on her lap. Dodson followed Johnson into the room, she said, then went into a closet and retrieved the gun.

“He just kept asking me, ‘What are we doing?’” Johnson said.

Moments later, Johnson said, she heard a loud bang. Her daughter started to cry.

They will both need therapy, she said. She is dedicated to preserving A’mahri’s memory: “I want people to know how adorable and sweet my son was.”

Still, she said, “I feel like I will never be OK.”

Methodology

To find that more than 4,000 children under 18 had been treated in Florida hospitals for gunshot wounds from 2018 to 2024, The Trace and �Թϲ�� analyzed two datasets obtained from the Florida Agency for Health Care Administration via a data request:

In the emergency department file, which contained records of 67,565,314 ER visits that did not result in an inpatient admission, we identified 37,415 gunshot wound cases using the Centers for Disease Control and Prevention’s .
In the inpatient file, which contained records of 21,857,664 hospital visits in which patients were admitted, we identified 28,149 gunshot wound cases using the CDC definition.

We defined children as 17 and under and filtered the patient age column to find that 2,340 children had been treated in ERs and 1,684 admitted to hospitals with gunshot wounds. To avoid double-counting, we excluded patients from the emergency department file whose records indicated that they were transferred to a different inpatient facility.

Demographic breakdowns were generated using the race and ethnicity columns in the datasets.

To examine the geographic distribution of the burden of gun violence, we grouped child gunshot wound victims by the ZIP code provided. Importantly, this ZIP code is the location not of the shooting but of the child’s residence. A small number of children in the data had out-of-state ZIP codes, or placeholder ZIP codes indicating they were homeless or from a foreign country. These children are included in statewide totals as children treated in Florida hospitals but not in ZIP-level results.

This data does not include children who were shot but died at the scene or before reaching the hospital or who never received medical treatment.

�Թϲ�� data editor Holly K. Hacker contributed to this report.

This report was produced by �Թϲ��, The Trace, Action News Jax in Jacksonville, and WFTV in Orlando.

This article first appeared on �Թϲ�� and is republished here under a .

Earlier Lifeline for Rural Hospitals Faces Test Under ‘Big Beautiful’ Law

Sarah Jane Tribble and Tony Leys — Mon, 03 Aug 2026 09:00:00 +0000

A century-old hospital near Michigan’s southern border was one of the nation’s first to convert into a new emergency-focused model Congress created to save rural care.

Afterward, though, use of Sturgis Hospital’s emergency department fell, according to data collected at the state level. In June, three years after taking the federal lifeline, the hospital closed, leaving residents of Sturgis, a town of about 11,000 people, without critical healthcare. Its leaders had tried “every reasonable option” to remain open, including seeking a buyer, according to a

The closure “could be kind of a canary in the coal mine” for rural healthcare, said Lauren LaPine-Ray, the vice president of policy and rural health at the Michigan Health & Hospital Association.

Federal leaders have spent decades trying to prop up rural hospitals, which face persistent staffing shortages, low federal payment rates, and declining patient numbers.

About 1,700 hospitals nationwide are eligible to convert to the stripped-down Rural Emergency Hospital model. So far, more than 50 rural hospitals in over 20 states have signed on, but LaPine-Ray and other hospital leaders nationwide fear Sturgis’ failure is a sign the new model won’t be enough to keep doors open when the anticipated federal funding losses arrive from President Donald Trump’s signature One Big Beautiful Bill Act.

Last year, the survival of rural hospitals became as Congress debated the massive tax and spending law, which is expected to reduce Medicaid funding by more than $900 billion over 10 years. The reductions are expected to have a substantial impact in rural areas that often have high Medicaid enrollment. Republicans added the new $50 billion Rural Health Transformation Program to win votes from a few holdouts in their ranks.

Sturgis’ facility is the only rural U.S. hospital to in 2026. The day before it shuttered, four senators — including Maine Republican Susan Collins, an architect of the rural health fund — sent a letter to Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services. said the way his agency structured the fund “may unintentionally disadvantage many of the rural hospitals and clinics the program was intended to support.”

Congress created the emergency hospital model, which took effect in 2023, as “a whole new way of providing care,” said George Pink, a senior research fellow at the Cecil G. Sheps Center for Health Services Research at the University of North Carolina-Chapel Hill. The Sheps Center tracks rural hospital closures and conversions, and Pink recently released early research showing converted hospitals reporting improved finances, though some are not yet in the black.

Hospitals that convert to the emergency model get a 5% boost in Medicare payments plus an extra monthly facility payment, totaling about $3.6 million a year, according to the Rural Health Redesign Center. In return, the hospitals must offer emergency services and give up their inpatient beds. They can continue offering outpatient services.

Janice Walters, CEO of the Rural Health Redesign Center, which has received federal funding to help hospitals change to the new model, said dozens of hospitals had reached out about converting during the first five months of 2026. It’s reasonable, she said, to presume that 10 or 11 might convert this year.

Rural Hospitals Grab Federal Financial Lifeline

More than 50 rural hospitals have converted into the rural emergency hospital model, a federal payment program that went into effect in January 2023. Two closed after converting. Three remain open but no longer participate in the model.

Note: Data as of July 8, 2026

Source: The Cecil G. Sheps Center for Health Services Research

‘No Easy Answers’

More than 40% of all rural hospitals lose money, and hundreds have eliminated obstetrics, general surgery, and chemotherapy services, the healthcare consulting group Chartis.

Sen. Chuck Grassley (R-Iowa) sponsored the legislation that created the emergency hospital model. He touted the program last fall, pointing to hospitals such as Landmann-Jungman Memorial Hospital Avera in South Dakota, which he said would be able to use the model to enhance local health services.

Melissa Gale, the chief executive of the Scotland, South Dakota, hospital, said the facility averaged less than one inpatient a day and was “a little above or below break-even year-over-year for decades.”

Today, with additional federal funding from the emergency model, Gale said, the hospital could try to draw in more patients for mammograms and may add a wound care program. In the past year, the hospital has improved employee benefits and reinvested in the building, upgrading plumbing and the heating and air conditioning, she said.

“No one wants to see rural health fail,” Gale said, adding, “There’s no easy answers.”

Federal lawmakers have tried, and thus far failed, to update the emergency hospital model. One proposal, which is expected to be reintroduced, would allow converted hospitals to offer new services, such as beds for patients who need short-term recovery and in-house obstetric labor and delivery units. Another, which is in committee, would allow hospitals to use a federal drug discount program that many facilities use to generate revenue.

The current law is a “critical start, but it must evolve,” said Carrie Cochran-McClain, the chief policy officer for the National Rural Health Association, whose members include hospitals and clinics.

Residents of the southeastern Iowa town of Keokuk continue to hope their shuttered hospital will reopen under the program. The effort has been plagued by delays.

The Keokuk hospital went out of business in 2022 and was later purchased by a Michigan company that pledged to reopen it.

“It’s been a slower process than we envisioned,” said Insight Health Systems Vice President Dayne Walling. Many of the delays have been related to improvements needed to the aging building, he said. Without the emergency hospital model, Walling said, his company would not see a realistic path to reviving the hospital.

Walling said the emergency model would be even better if Congress approved the bill that would allow hospitals to make extra income from prescription medications.

Dierdra Sorrell, the CEO of Clifton-Fine Hospital in Star Lake, New York, said converting to an emergency hospital was not a “silver-bullet, magic pill.” But it “put us in a much better place.”

The 20-bed hospital lost more than $2.5 million annually before 2024, when it became New York’s first emergency hospital, Sorrell said. While converting, the hospital shut down inpatient beds and cut 20 employees.

The first year, Clifton-Fine lost only $600,000, and its emergency patient visits were “rock solid,” Sorrell said. The hospital also won state grant money to update its two-bed emergency room and pay for additions that could house visiting specialty doctors or new lines of services, such as a dental hygienist.

If Clifton-Fine had not converted, Sorrell said, anticipated Medicaid losses could have “put us under.”

‘One Important Tool’

Timothy Foster, a spokesperson for the Centers for Medicare & Medicaid Services, said the emergency model is “one important tool” for rural hospitals, “but each facility must determine whether this care model is appropriate.” Foster also said that the new five-year, $50 billion rural health fund was created to support “innovative, system-wide reforms” that strengthen the rural healthcare delivery system.

Of the 56 hospitals that have converted to the rural emergency model, two have closed, and three remain open but have changed what services they offer, according to Sheps.

In Holly Springs, Mississippi, Alliance HealthCare System was one of the first to convert to the emergency hospital designation, laying off staff and shutting down inpatient beds.

Then, federal officials said they and required the hospital to recertify as a new hospital, a delay that cost an estimated $1.5 million in federal reimbursement, CEO Kenneth Williams said.

The hospital is “a shell of what it once was,” Williams said. The ER remains closed.

“We have survived, but survival has come at a tremendous cost,” he said.

Williams said he is closely watching the impact of upcoming Medicaid changes because cuts in insurance coverage or payments “ultimately affect patient access,” he said.

Sen. Josh Hawley (R-Mo.), who voted for the One Big Beautiful Bill Act — which included both the rural health fund and the Medicaid spending reductions — has asked for more support for rural hospitals. Ten full-service rural hospitals in Missouri have closed in the past 12 years, according to the Sheps Center.

Last year, Hawley introduced legislation to . This June, he to announce that he wanted to pay rural hospitals $1 million annually, or more if needed, to keep emergency rooms operating. A spokesperson said the bill would apply to all rural hospitals, including those using the emergency model.

Michigan’s Sturgis Hospital faced “some significant challenges” in 2023 when it converted to the emergency hospital model, said LaPine-Ray, of the state hospital association. In the news release, hospital officials said the closure was due to declining reimbursement rates, rising costs, and declining patient numbers. Bobby Morin, a former chief operating and financial officer at the hospital, declined to comment.

The hospital’s ER patient volume dropped 13% in the two years after it converted, LaPine-Ray said. Five rural hospitals have closed in the past 20 years in Michigan, and LaPine-Ray said she doubts the rural health fund Congress approved last year will stop the closures. The association, which worked with the governor’s office on the funding, expects less than 10% of Michigan’s $173 million in first-year rural health funding to trickle down to rural hospitals.

That money will pay for “very specific programs where rural hospitals have to create basically a new program and implement it with no funding on the front end,” LaPine-Ray said.

At the same time, she said, the association expects Michigan hospitals to lose $6 billion in Medicaid payments over the next decade because of the One Big Beautiful Bill Act.

“What’s it going to look like in the coming years?” LaPine-Ray said.

This article first appeared on �Թϲ�� and is republished here under a .

Trump Administration Demands Hospitals Share Emergency Room Records

Amanda Seitz, Maia Rosenfeld and Darius Tahir — Mon, 27 Jul 2026 09:00:00 +0000

A tiny federal agency tasked with protecting the public from injuries caused by lawn mowers and coffeemakers is demanding that some of the nation’s biggest health systems turn over detailed, personally identifiable medical records of all patients who seek help at their emergency rooms.

The Consumer Product Safety Commission, responsible for tracking and issuing recalls of dangerous products sold in the U.S., began discreetly pressuring hospital executives this year to share personally identifiable health data with a private contractor. But hospital lawyers and other industry experts have questioned the agency’s authority to collect, its ability to safeguard such a swath of sensitive information, and whether it has followed the legal process to overhaul its surveillance system.

After �Թϲ�� asked the CPSC about the new system, the the program on July 21. Left unmentioned, however, is the alarm it has raised among hospital executives, as well as the nature and extent of the agency’s data demands.

In a stark departure from its product-focused mission, the agency’s goal is to obtain millions of Americans’ medical records from emergency room visits for most injuries, from a broken bone to a childhood vaccine reaction or even a suicide attempt, according to documents and emails obtained by �Թϲ��, as well as interviews with five people involved or familiar with the discussions.

A CPSC official also insisted in the emails that the institutions provide all ER patients’ identifiable information — such as names, addresses, diagnoses, and other personal details — to the contractor, Konza Health, for analysis. In correspondence with , Konza representatives described participation as “mandatory” or “required.”

As a condition of viewing the correspondence, �Թϲ�� agreed not to republish some of the emails it obtained.

The CPSC wants at least 100 hospitals to start sending detailed medical records by the end of this year, according to an .

“The whole thing is troubling,” said Sharona Hoffman, a professor of health law at Case Western Reserve University who noted that giving a private entity access to a sweeping collection of data will introduce risks to patient privacy. “If this company really is collecting identifiable information, that is worrisome for patients.”

The new project was launched amid upheaval at the traditionally independent agency, which is without a governing board since President Donald Trump fired the CPSC’s three Democratic board members. Nearly 1 in 5 career staffers left the CPSC in the first 16 months of the new administration, according to a �Թϲ�� analysis of federal workforce data.

The initiative also comes as the Trump administration has sought unprecedented access to millions of Americans’ medical records, with the Office of Personnel Management requesting federal workers’ sensitive health information and Health and Human Services Secretary Robert F. Kennedy Jr. using a private organization to collect more medical records for his studies on vaccines and autism.

Steve Roney, CPSC spokesperson, said in an emailed statement on July 10 that the CPSC is “modernizing” its surveillance system. Asked whether the CPSC will file complaints against hospitals that do not participate, he said only that while the previous system “operated as a voluntary program, the ability of hospitals to opt out limited the sample size and usefulness of the data.”

Roney also acknowledged that the agency had not yet notified the public, as “required by law.”

Federal law requires the agency to provide notice and a public comment period before requesting information from 10 or more entities, a step it has not taken despite plans for 100 hospitals to join the surveillance system. �Թϲ�� independently confirmed with over a dozen hospitals that they had been approached.

Federal public health authorities that private health data be reported. But CPSC officials have that if hospitals decline to share data with the new surveillance system, they could be subject to strict penalties from a data-sharing regulation known as “information blocking.”

Yet some hospital executives say they are reluctant to share patients’ sensitive data because they’re concerned about a different violation — that of .

AI Takes Over

Dozens of ERs across the country already participate in the CPSC’s voluntary National Electronic Injury Surveillance System, or NEISS, through which trained hospital workers report injuries involving consumer products, almost always stripped of patients’ identifiable information. The system helps the CPSC identify products, such as baby loungers, toys, and household appliances, with a pattern of injuring consumers.

The new injury surveillance program goes much further.

At a toy industry trade event in February, acting CPSC Chairman Peter Feldman said the agency is “investing in AI-enabled workflows that improve the quality and quantity of injury surveillance data, while also building up digital infrastructure to handle a massive new volume of electronic health records.”

Konza Health, a Kansas-based organization that runs the state’s health data exchange, will automatically pull and analyze medical records of all patient visits from ERs nationwide. Konza won a worth up to $15.9 million with the CPSC last fall.

In email correspondence with hospital technology officials, Konza Health President and CEO Laura McCrary also has described ERs’ participation as “required,” stipulating that they share patients’ records with identifying information.

McCrary told �Թϲ�� by email that the company is not using AI to process the records it receives, saying instead that Konza will use “advanced analytic parsing and filtering capabilities.” Roney, the CPSC spokesperson, did not answer questions about the .

For years, agency officials moving away from human contractors and automating NEISS to save time and money.

But without workers on-site, hospital staffers may no longer receive training to determine what clinical information is important to include for the CPSC. In short, the changes could dilute the quality of the product safety data the agency collects.

“They want to suck in as much data as possible, but I’m not sure how thoughtful they’re being about what is collected and what is actually needed by the agency,” said former CPSC chair Alexander Hoehn-Saric, one of the Democratic appointees Trump fired last year.

Record Number of Career Staff Left CPSC Last Year

The Consumer Product Safety Commission overhauled its National Electronic Injury Surveillance System on the heels of its largest exodus of career employees in at least a decade.

Source:

Wanted: Injuries From Vaccines and Stingrays

The CPSC’s new data collection appears to contradict its own 214-page , which instructs hospitals not to include identifiable information “such as names, birthdates, or addresses” when reporting cases.

The agency is supposed to receive patients’ identifying information only when needed for follow-up investigations, which happens in fewer than 1% of reported cases, according to the manual.

The CPSC has also historically limited the records it collects to minimize privacy violations in case of a data breach.

The risk is not hypothetical: From 2017 to 2019, the agency improperly released personal health information of around 30,000 people, a disclosure that a top Republican at the time

Konza, however, will receive even more sensitive information on many more people. McCrary said in a statement that Konza will remove patients’ names, addresses, and medical information “not needed by CPSC” before sharing records with the agency.

Leaving a private organization to collect sensitive information introduces risks, including that it could be stolen or used for business purposes, said Hoffman, the Case Western professor.

“Very often, they will use information for marketing because now they’re going to know what conditions people have,” she said.

Roney said that its contract with Konza, which has not been made public, prohibits the organization from selling or marketing the data it collects.

The CPSC’s manual also identifies types of ER visits that should not be reported to the CPSC, which has jurisdiction over only certain consumer products. Excluded injuries are those caused by food, illegal drugs, medical devices, alcohol, or plants, as well as injuries that did not involve consumer products — such as a cut from a rock or broken bones from a fall on the ground — and suicide attempts by adults.

But in a to one hospital and reviewed by �Թϲ��, Konza set no such limits on the information it would gather from ER records and said it would hold on to patient health information for at least 30 days.

In an email sent to hospital technology officials, McCrary wrote that Konza would provide the CPSC with records when a patient is treated in the ER for any of more than 10,000 conditions. The expansive list of diagnostic codes Konza provided in the email includes injuries that do not involve consumer products.

Child injuries resulting from “poisoning by” vaccines or contact with stingrays, neither of which is regulated by the CPSC, are included in the list.

A limited number of hospitals once shared deidentified data on all injuries — regardless of product involvement — through the NEISS using the Centers for Disease Control and Prevention’s injury-tracking program. But the CDC halted that data collection, after funding and staffing were cut last year, and has not restarted it.

Pressure on Hospitals

CPSC Chief Data Officer Elizabeth Puchek, who joined the agency late last year after engineering U.S. Citizenship and Immigration Services’ data system, has told hospitals in emails that they must seek an exemption from the program if they decline to share patients’ emergency room records with Konza.

The CPSC’s targeted outreach has included some of the nation’s largest urban and rural health systems, as well as small, publicly owned hospitals.

Staff members at Mary Greeley Medical Center in Ames, Iowa, said that Konza and federal officials told them their participation in the new program was mandatory. The hospital, which has long participated in NEISS, signed a new contract in April to share its ER records with Konza.

Yet the hospital is reevaluating its participation after being notified that the funds it received to participate in NEISS were “no longer available,” spokesperson Steve Sullivan said.

Several hospital executives, lawyers, and others have raised doubts about the CPSC’s claimed authority.

Harborview Medical Center spokesperson Susan Gregg said the Seattle hospital’s emergency room has “voluntarily submitted de-identified data for many years, but we are not obligated to report this information.”

In Boston, Mass General Brigham has declined to participate in the new program, with spokesperson Kelly Mitchell saying that “to protect patient privacy, we are unable to provide these medical records.”

Henry Ford Health in Detroit; St. Luke’s in Boise, Idaho; and Sanford Health based in Sioux Falls, South Dakota — which together handle over a million ER visits a year — are among the health systems that have been approached but not yet entered into an agreement with Konza, according to representatives. Several of the nation’s busiest hospital systems targeted for the program — including the Mayo Clinic in Minnesota, Yale New Haven Hospital in Connecticut, Nationwide Children’s Hospital and the Cleveland Clinic in Ohio, and Baylor Scott & White Health in Texas — declined to answer questions about whether they’re participating.

Hoehn-Saric, the agency’s former chairman, said he was surprised that the CPSC would insist that hospitals provide identifiable records from all emergency room visits.

“This idea that they can simply demand patient information from a hospital and that the hospital would provide it — I really don’t understand the basis for that,” he said.

This article first appeared on �Թϲ�� and is republished here under a .

Tracking State Rural Health Transformation Plans

Mon, 27 Jul 2026 09:00:00 +0000

The five-year, $50 billion Rural Health Transformation Program was created as part of the One Big Beautiful Bill Act to expand access to healthcare. States competed to win funding with first-year allocations ranging from $147 million for New Jersey to $281 million for Texas. Find links to available public documents for each state below.

Source: Centers for Medicare & Medicaid Services

�Թϲ�� will update this database as more states respond to emails and public records requests for their documents.

Note: Data collected as of Aug. 18, 2026. �Թϲ�� reporters searched state websites, requested documents, and filed public records requests. �Թϲ�� continues to collect documents.

Sources: Documents publicly posted online or released in response to �Թϲ�� requests; Centers for Medicare & Medicaid Services

This article first appeared on �Թϲ�� and is republished here under a .

Affordable Care Act Insurers Want More Premium Increases as Enrollment Sags

Rachel Spears — Wed, 08 Jul 2026 09:01:00 +0000

For the second year in a row, many Affordable Care Act insurers are proposing double-digit premium increases, driven by rising medical costs as well as policy changes by Congress and the Trump administration.

In preliminary filings with state regulators, insurers are seeking a median rate increase of 14% for 2027, according to in 16 states and the District of Columbia by the Peterson-KFF Health System Tracker.

If those rates are ultimately approved, it would be the second-highest increase since 2018.

That would be a “triple whammy” for consumers, said Cynthia Cox, a senior vice president and the director of the Program on the ACA at KFF, because they have already had to pay higher premiums in 2026 and saw the expiration of more generous tax credits to offset their premiums at the end of last year.

President Joe Biden sought to bolster the program known as Obamacare by enacting more generous tax subsidies, driving down out-of-pocket costs for consumers and increasing enrollment to more than 20 million Americans. But under President Donald Trump, Republicans have sought to scale back taxpayer support for ACA coverage, allowing the Biden-era enhanced subsidies to expire.

As of February, ACA enrollment had fallen by about 3 million people compared with the same time last year. While Cox and other policy experts say that’s because increased costs for the plans drove out people who feel they can get by without insurance, the Trump administration asserts that much of the enrollment growth under Biden .

The main factor driving proposed premium increases for 2027, as in most years, is the rising cost and use of medical care.

There’s growing demand for costly specialty medications and for the weight loss drugs known as GLP-1s, the Peterson-KFF report notes.

But the report also said that about 4 percentage points’ worth of the premium increases insurers proposed are due to lasting effects of the expiration of enhanced subsidies. Insurers expect that with young and healthy people leaving the program rather than paying higher premiums, their remaining customers will be older, sicker, and therefore costlier on average.

“It’s likely that the people who dropped their coverage were also the healthier people, because sicker people were probably going to try to make it work however they could, to stretch their budget to keep their health insurance,” said Cox, of KFF, a health information nonprofit that includes �Թϲ��.

In their rate filings, some insurers also said they had to raise premiums partly because of policy changes by the Trump administration that are expected to make it harder for some people to enroll.

Together with the expiration of the larger subsidies, the new rules “account for 12.7% of the requested rate change,” the insurer UnitedHealthcare wrote in its rate filing with New York state, according to the Peterson-KFF report.

More ACA Price Hikes: Obamacare Insurers Are Proposing a Median Premium Increase of About 14% in 2027

Preliminary filings from 77 Affordable Care Act marketplace insurers in 16 states and the District of Columbia indicate a likely second consecutive year of double-digit increases.

Distribution of proposed 2027 rate changes among the insurers:

Source: KFF analysis of data from insurer rate filings
Credit: �Թϲ��

“It is not surprising insurance conglomerates that profited massively off of Biden-era fraud are complaining about efforts to clean up the program,” White House spokesperson Kush Desai said in a statement. He added that the administration “has made it clear that it will not follow its predecessors in giving out taxpayer funded subsidies to big insurance companies through the form of fraudulent and corrupt policies” and that it would “hold big insurance companies accountable.”

Another driver of higher premiums cited by several insurers is that claims submitted on behalf of patients have tended to be for more intense — and costly — levels of care than in the past. Such increased severity may be because patients are actually sicker, or it may reflect that hospitals or doctors are using artificial intelligence to find billing codes that can maximize their payments, the report noted.

The use of AI to maximize bills is also a factor driving up the cost of health coverage offered by employers, the consulting firm PwC, which has forecasted that the cost of caring for people with job-based coverage will rise by 9% in 2027.

In the ACA, premium increases will primarily affect enrollees with incomes just above 400% of the federal poverty level, amounting to about $62,600 this year for an individual. That’s because they’re no longer eligible for subsidies following the expiration of the enhanced tax credits.

People below that level get tax credits to help pay their monthly premium, based on how much they earn and the cost of a “benchmark” ACA plan where they live. As a result, as premiums rise, so do subsidies, shielding many consumers from rising prices but also raising costs for the federal government.

They may have to shop around when enrollment opens for 2027 coverage in October, however. Depending on their particular plan’s premium, they may need to switch plans to keep premiums fixed, said Matthew Fiedler, a senior fellow at the Brookings Institution.

�Թϲ�� senior correspondent Julie Appleby contributed to this report.

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Copay Assistance Is Meant To Defray Patient Drug Costs. Some Insurers Keep It Instead.

Daniel Chang — Tue, 07 Jul 2026 09:00:00 +0000

For 16 years, Larry Gruber, a fitness coach from Wilton Manors, Florida, received a coupon card to help him pay for a psoriatic arthritis medication he needs that costs more than $7,700 a month.

Each year, Amgen, which makes the drug, called , sent the coupon card worth thousands of dollars, and that counted toward Gruber’s health insurance deductible and out-of-pocket maximum.

Using the card, Gruber usually met that maximum by February, leaving his health insurance to fully cover his in-network medical costs and reducing his cost for the drug to $0 for the rest of the year.

But this year, his new health insurer, , pocketed the coupon card and required Gruber to pay for the drug until he satisfied the cost-sharing requirements on his own.

If Oscar Health had applied Amgen’s coupon toward Gruber’s cost sharing, he would have been on the hook for about $3,000 in covered services. Without it, he had to use his savings to meet the plan’s $10,600 out-of-pocket maximum.

“The real insult here is that they’re taking the money that’s intended to help you,” said Gruber, who had planned to buy a home next year with his savings. “I feel desperate, pressed against the wall, and squeezed.”

Oscar Health is one of many commercial health insurers that use what are often called copay accumulator programs to keep funds that are meant to defray patients’ out-of-pocket costs for expensive specialty drugs. Over the past decade, more insurers have to reduce their prescription drug costs, according to Avalere Health, a consulting company.

Patients who rely on copay assistance from drugmakers are typically heavy users of healthcare for whom delays in treatment or worsening conditions can lead to higher costs, according to patient advocates.

, Florida market president for Oscar Health, did not comment on the specifics of Gruber’s case. He said the company uses copay accumulators to manage rising medical and prescription costs and “to keep monthly premiums as low as possible.”

Drugmakers argue that insurers and pharmacy benefit managers use copay accumulators and other strategies to delay or deny care and steer patients toward medicines that insurers prefer instead. Insurers counter that coupon cards and other patient financial assistance from drug manufacturers drive up premiums and encourage patients to use higher-priced, brand-name drugs instead of less-expensive generics.

Meanwhile, patient advocates say it’s difficult for consumers to find out if their plan uses a copay accumulator or to understand how they work. Not only do the programs make medications unaffordable for consumers, critics argue, but they allow insurers to double-dip.

“They’re collecting the money twice and they’re hurting patients,” said , executive director of the HIV+Hepatitis Policy Institute, a patient advocacy group.

“Why does it make a difference to Oscar if they get the money from a drug company or, you know, his mother or him?” he said of Gruber’s experience. “They’re still getting the money.”

Gruber teaches a fitness class. (Scott McIntyre for �Թϲ��)

Controlling Costs or Harming Patients?

Not all insurance types use copay accumulators. Medicare and Medicaid prohibit copay assistance because federal anti-kickback laws forbid drug manufacturers from offering financial incentives to influence patients’ choices. And the Internal Revenue Service prohibits such help for high-deductible plans with health savings accounts. But individual and commercial group plans can use them.

Regulation of copay accumulator programs has fallen largely to states, which oversee individual and small-group plans sold on the Affordable Care Act marketplace.

For 2026, of ACA marketplace plans have such a program, according to a review from The AIDS Institute, a nonprofit group that opposes the programs. Of the 16 insurers that sell plans on the marketplace in Florida, 10 use copay accumulator programs, the review found.

Patients who take brand-name specialty drugs for conditions such as autoimmune disorders, multiple sclerosis, diabetes, HIV, and cancer are most likely to encounter these programs. Health insurers say that making patients share the costs for specialty drugs encourages them to choose value over brand.

But Gruber doesn’t have a choice because there is no medically equivalent generic for Enbrel. Gruber’s livelihood as a trainer depends on his athleticism. The weekly injections, which he has to take for the rest of his life, prevent his joints from getting stiff. When he was diagnosed in 2010, Gruber said, he couldn’t shake hands or lift his knee to get into bed. Without treatment, he said, “I ache from my neck down to my toes.”

Gruber’s new health insurer won’t apply a coupon card for Enbrel, making him spend $10,600 to meet the cost-sharing requirement. (Scott McIntyre for �Թϲ��)

If manufacturers priced their drugs affordably, patients like Gruber wouldn’t need financial assistance, said , a senior vice president for AHIP, a trade association representing insurers.

“Drugmakers offer short-term ‘discounts’ to justify overcharging Americans in the long term, driving up healthcare costs for everyone,” he said in a statement. “Research shows limiting copay coupons can reduce premiums and lower consumers’ out-of-pocket costs.”

Sarah Ryan, a spokesperson for Pharmaceutical Research and Manufacturers of America, a trade association for the pharmaceutical industry, said copay assistance helps patients access medications free of charge or at reduced cost.

“Health insurance is supposed to protect patients,” Ryan said, adding that insurers and pharmacy benefit managers that refuse to count copay assistance toward cost sharing are “leaving patients facing unexpected costs and disrupting their care.”

Insurance companies already have tools to control costs without keeping financial assistance intended for patients, said , deputy executive director for The AIDS Institute.

Insurers choose what drugs to cover, whether they are medically necessary, and if a patient must try a cheaper alternative first.

“They are the ones making the decisions,” Klein said. “Now the individual is left trying to figure out how they’re going to pay for it.”

Consumers Stuck in the Middle

Weekly injections of Enbrel prevent Larry Gruber’s joints from getting stiff, which is vital for his work as a fitness coach. The drug costs more than $7,700 a month, and he has to take it for the rest of his life. (Scott McIntyre for �Թϲ��)

Before moving to Florida in 2024, Gruber said, he had bought coverage on the ACA marketplaces in Illinois and Louisiana, which prohibit copay accumulators. Gruber said he hadn’t encountered one until his experience with Oscar Health.

He complained to the office of Florida’s insurance consumer advocate, which informed him that the practice is legal in the state and that Oscar Health had disclosed its use of a copay accumulator program. Page 127 of his 168-page evidence of coverage states, “Third party assistance will not count towards your out-of-pocket maximum or deductible.”

Gruber said he selected his coverage using a tool on that listed all the Florida ACA plans that cover Enbrel. “I always choose the one with the highest deductible to get the lowest premium,” he said, “because I know I’m going to meet it.” His monthly premium is about $315 after subsidies.

Adding to Gruber’s confusion, he said, was that his patient portal with Oscar Health was counting his coupon card at first. He said he met his out-of-pocket maximum in February, and in March Oscar covered all the cost for the medication.

But when he ordered his refill for April, the pharmacy told him that Oscar would cover only $1,000 of the medication’s cost for that month. He would have to pay the remaining $6,700.

Gruber then received a letter from Oscar Health, telling him that an incorrect amount had been applied to his deductible.

“They sent me a letter that basically stated they made a mistake,” he said. “The fact that they’re allowed to sort of change things midstream is also, I think, a little galling.”

He began rationing the injections, taking them every other week instead of weekly. By May, he had dipped into his savings to pay for the drug.

States Step Up While Federal Oversight Stalls

The first state laws banning copay accumulators were adopted in 2019, and since then more states have moved to regulate the programs, said , public policy director for the Alliance for Patient Access, an advocacy group.

“The goal is to build upon that progress at the federal level and to continue to drive this momentum forward,” he said.

Twenty-six states, Washington, D.C., and Puerto Rico have adopted laws banning copay accumulators or prohibiting them for drugs that do not have a generic equivalent. Colorado also prohibits copay accumulators for drugs without a biosimilar. In states that have not banned or restricted the programs, insurance companies decide whether to use them.

Half of States Restrict Insurers From Pocketing Copay Assistance

Some health insurers use copay accumulator programs to keep funds that are meant to defray patients’ out-of-pocket costs for expensive specialty drugs, such as those that treat chronic conditions. These programs are restricted for individual and small-group health plans in 26 states and Washington, D.C.

Sources: The AIDS Institute; America’s Health Rankings; KFF

But federal regulation of the programs, which would apply to all states, remains at a standstill.

A federal court in 2023 struck down a policy enacted during President Donald Trump’s first term that had permitted insurers to use copay accumulator programs. As a result, the Department of Health and Human Services reverted to that restricts their use to brand-name drugs with a medically appropriate generic equivalent.

After the court ruling, the Biden administration pledged to address copay accumulators in future rulemaking. But HHS has yet to do so, said Schmid, whose group, the HIV+Hepatitis Policy Institute, led a coalition of patient advocacy groups that sued to overturn the rule.

“The Trump administration can stop this once and for all at the national level,” Schmid said. “If they really care about patient affordability, this is something they can do.”

Bipartisan legislation in Congress called the would require financial assistance to count toward deductibles and other out-of-pocket costs on plans regulated by the federal government, including much employer-sponsored coverage.

Schmid said the bill has not gotten “enough traction on the Hill yet.”

Other ways to obtain medication don’t help patients facing copay accumulators either. The president’s , an online platform through which consumers can buy prescription drugs at a discount, requires patients to pay out-of-pocket, and the cost does not count toward their plan’s cost-sharing requirements.

Christopher Krepich, a Centers for Medicare & Medicaid Services spokesperson, said that HHS, along with the departments of Labor and the Treasury, intend to address the issue of whether copay assistance must apply toward health plan cost sharing.

Until then, he wrote, “the Departments do not intend to take any enforcement action against health insurance issuers or group health plans based on their treatment of such manufacturer assistance.”

Outside of government regulation, consumers have few protections or alternatives.

Patients who rely on expensive medications — and who have a choice in their health insurance plan — should research their coverage options and choose wisely so they’re not caught by surprise, Clingham said.

That may mean reading plan benefit explanation packages, contacting their state’s insurance regulator, or calling an insurance company to ask if their plans use copay accumulator programs.

For Gruber, the extra expense means he won’t take a vacation this year. He’s also concerned that the money he was saving for a home will now go to his medication costs instead.

“It’s the first thing I think of when I wake up in the morning,” he said. “If this happens every year, it would be financially devastating.”

(Scott McIntyre for �Թϲ��)

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Florida Hospitals Act Fast To Discharge Gun Victims — Especially if They’re Not Insured

Daniel Chang, Fred Clasen-Kelly and Olga Pierce, The Trace — Mon, 29 Jun 2026 09:00:00 +0000

Alea Bates wasn’t ready to leave Tallahassee Memorial HealthCare’s main hospital four days after a stranger shot her seven times at close range. Miraculously, hospital records show, none of the bullets damaged her internal organs.

But after surgery, Bates said, she couldn’t get out of bed or walk to the bathroom without help. She complained of intense pain radiating down her left leg, weakness in her knee, and a numbing sensation below it, according to hospital records. Bates, who worked as an Uber Eats driver, didn’t have the strength to drive a car.

Still, Bates said, the hospital told her it was time to go.

“They didn’t do any further X-rays or CTs or MRIs to figure out why my knee was numb,” she said. “And they were just like, you know, ‘It’ll go away.’”

Doctors said she was medically stable, Bates said, and because she had no health insurance, they could not send her to a rehabilitation hospital or a skilled nursing facility, which can charge thousands of dollars a day for such care.

“They were just like, We need the bed for somebody who has insurance,” she said. “That’s of course, you know, what they say without saying it.”

At least one firearm injury is treated in an American emergency room every . Tens of thousands die from their injuries every year. Many more, like Bates, are left to face long recoveries, steep medical debt, and enduring trauma.

How insurance affects the care of gunshot wound victims has remained shrouded in mystery — until now, due to a new analysis by The Trace and �Թϲ�� of data that Florida hospitals compile to collect payments from insurance companies and file with the state.

When uninsured patients arrive at hospitals in Florida with gunshot wounds, on average they spend significantly fewer days in the hospital — in some cases half the time — than those with health insurance, according to the data analysis.

Among the most severely injured patients, the uninsured stayed three fewer days in the hospital on average than their counterparts with insurance.

Uninsured Gunshot Wound Patients Stay Fewer Days Than Those With Insurance at Many Hospitals

A dot plot showing the average hospital stay of gunshot wound patients admitted to Florida hospitals, grouped by hospital, and uninsured vs. private insurance vs. medicaid. Sorted by shortest average uninsured stay.

◆◆Top three by gunshot wound patients admitted, 2018-2024

Florida Agency for Health Care Administration,
The Trace and �Թϲ�� analysis

The data was obtained exclusively for this reporting on gun violence hospitalizations in the state, aided by Florida state law.

The newsrooms spent more than a year analyzing the records, which did not identify patients. The data contained patients’ insurance status, their residential ZIP code, their race, and other demographic info. Reporters reviewed academic studies and government documents and interviewed health policy experts, doctors, activists, and victims of gun violence or their relatives.

The results are a first-of-its-kind look at what happens to the insured and the uninsured who are shot and admitted to the hospital for treatment.

Across Florida, the analysis of hospital billing data from 2018 to 2024 obtained from the Florida Agency for Health Care Administration shows:

Uninsured patients make up a quarter of the more than 20,000 gunshot wound hospitalizations identified, making them the largest single group treated for firearm injuries.
Uninsured gunshot victims had hospital stays of about six days on average, only three-quarters of the time spent by patients with private insurance and less than half the average stay for patients on traditional Medicaid, the public health insurance program for poor and disabled people.
The gap in hospital care persisted regardless of hospital size, location, or ownership type, including at facilities that receive taxpayer money with a mandate to treat all patients regardless of their ability to pay.
Of the gunshot wound patients, nearly half were Black, making the group highly overrepresented. About a quarter of nonwhite patients were uninsured, versus fewer than a fifth of white patients.

The inequality echoes a in U.S. healthcare against Black and Latino patients, groups that and a .

The U.S. has deaths than other wealthy nations, and no group suffers more than Black Americans like Bates. Black people are far to become victims of a firearm homicide than white people, according to the Johns Hopkins Bloomberg School of Public Health.

Handguns for sale at a gun shop in Delray Beach, Florida. Florida law allows eligible residents to carry a concealed firearm and to openly carry a firearm without a state-issued license. (Joe Raedle/Getty Images)

Patient outreach workers say hospital personnel might perceive gunshot victims as gang members or troublemakers who deserve blame for getting shot. rehab centers refuse to admit gunshot victims more often than other patients, and some medical records from hospitals were littered with racist or insensitive descriptions of patients and their behavior.

The damage can be lasting: Patients who after a traumatic injury have a higher risk of serious complications, including infection, hemorrhage, nerve damage, and death, especially if wounds — and mental health concerns — are left untreated.

, a University of Florida professor and vice chair for research in community health and family medicine, said there’s evidence that financial incentives drive care — for patients and for hospitals.

Regardless of how often the care team is told to follow quality protocols, Mainous said, “ultimately there’s a business aspect to it, whether the physician is thinking about it or not, whether the nurses think about it or not. But somebody is.”

The Florida data findings come at a time when Republican Gov. Ron DeSantis and state lawmakers have pushed to make guns cheaper and more widely available, despite a in the state from 2014 to 2023, and when President Donald Trump’s administration has rolled back legislation from the Joe Biden presidency to curb gun violence and .

Florida Gov. Ron DeSantis at a Hooksett, New Hampshire, gun shop in 2023. DeSantis has pushed to make guns cheaper and more widely available, despite a 19% increase in gun deaths in Florida from 2014 to 2023. (Sophie Park/Bloomberg via Getty Images)

allows eligible residents to carry a concealed firearm and to openly carry a firearm without a state-issued license. State law also prevents cities and counties from enacting stricter gun control measures.

In early June, Florida Attorney General James Uthmeier to strike down the state’s three-day waiting period for receiving a purchased gun, arguing it is unconstitutional. Uthmeier’s request is part of a proposed settlement of a lawsuit brought by the National Rifle Association.

�Թϲ�� and The Trace requested to speak with administrators at nine of Florida’s large hospital systems to ask why the disparities exist. None agreed to an interview.

Sarah Cannon, communications director at Tallahassee Memorial HealthCare, would not agree to an interview or address Bates’ account of her care for gunshot injuries.

“Clinical decisions, including acute medical intervention, readiness for discharge, and post-acute care needs, are guided by the patient’s condition and response to treatment,” she said in an email.

Cannon said the hospital offers support to patients after discharge, including from social workers who coordinate care and access to services including post-acute care placement, home healthcare, and primary care or specialty follow-up.

Bates said she had to coordinate her own care after being released from the hospital. She said nobody called to schedule a follow-up test of her leg’s muscle function, and her medical records show she did not receive one.

“If I had had insurance,” she said, “they would have definitely kept me there for at least another week to work with me on my standing and walking.”

Tallahassee Memorial Hospital, where Bates was admitted after being shot seven times in 2019. She was discharged after four days. (Miguel J. Rodríguez Carrillo/Getty Images)

‘It’s a Business’

Some of Florida’s largest hospitals showed huge differences in length of stay for gun injuries, the �Թϲ��-Trace analysis showed. In Miami at Jackson Memorial, the average number of days in the hospital for uninsured patients was 6.6; for those with private insurance, it was 10.7; and for those on traditional Medicaid, it was 15.4. Jackson Memorial did not respond to requests for comment.

Tampa General Hospital reported 4.9 days for uninsured patients, 8 days for those with private insurance, and 13.6 days for Medicaid patients. “To suggest that care decisions for trauma-related patients, and in this case, gun shot victims, are influenced by insurance status is not only absurd, it’s inaccurate,” Amanda Bevis, a hospital spokesperson, said in a written statement. “At Tampa General, every patient is treated equally, based on clinical need and urgency, not insurance coverage.”

And at UF Health Jacksonville, it was 7.2 days for the uninsured, 8.5 days for the privately insured, and 13.8 days for patients on traditional Medicaid. UF Health declined to comment.

Broward Health in Fort Lauderdale reported 7.5 days for uninsured patients, 10.5 days for privately insured patients, and 12.2 days for those on traditional Medicaid. “Insurance status does not impact treatment plans for patients,” Jennifer Smith, a Broward Health spokesperson, said in an email. “Our physicians always proceed in the best interest of the patient regardless of reimbursement or what length of stay may be required.”

Memorial Regional Hospital in Hollywood reported 6.7 days for uninsured patients, 8.8 days for privately insured patients, and 9.5 days for those on traditional Medicaid. Tania Ordaz, a hospital spokesperson, said in an email that she disagreed with the findings: “Treatment decisions are based on the patient’s clinical condition and what is necessary to ensure a safe and appropriate transition of care, not on the patient’s insurance status.”

Shorter Stays for Uninsured Gunshot Wound Patients at Dozens of Florida Hospitals

A bubble map of Florida hospitals sized by number of gun shot wound patients. The top three hospitals are orange, the rest are blue. Selecting a bubble displays the average stay for these patients by payer type: uninsured, commercial insurance and Medicaid.

Florida Agency for Health Care Administration,
The Trace and �Թϲ�� analysis

Trauma surgeons and academics said the Florida data aligns with research nationwide on where gun violence occurs and who’s most affected. Some said they fear the differences contribute to long-standing disparities in America’s healthcare system along the lines of race and class.

The Florida hospital data showed gunshot injuries are concentrated in a handful of ZIP codes marked by poverty, disinvestment, redlining, and other injustices stemming from racial discrimination.

“Why would people without insurance be discharged earlier?” Mainous said. “Because they’re in better health? I think we’ve got a lot of data that would suggest that’s not true.”

Once they leave the hospital, people with commercial insurance or traditional Medicaid are more than twice as likely to receive follow-up care from another provider — such as a rehab center or home health service — as uninsured patients.

Those patients are staying longer, in part, because hospital case managers coordinate their transfers to other facilities, which can be time-consuming and take days.

“You have to go through insurance authorization and approval,” said , a trauma surgeon formerly at Jackson Memorial in Miami who now practices in Oregon. He said patients with private insurance might have access to rehab, preventive care, and training for both the patient and their caregiver to “help them transition to a completely new phase of life.”

For patients without insurance, he said, “sometimes our hands are a little bit tied.”

“The hospital is telling us that this patient has to leave the hospital because they’re medically ready,” he said, “and so I guess we’re discharging them to their car or to their tent, and it doesn’t feel right, but I think that would probably explain some of the differences” in length of stay.

, a trauma surgeon at Jackson Memorial, said hospital staff work to ensure that uninsured patients with long recoveries learn to care for wounds and to enlist family help at home.

Valenzuela said the county-owned hospital does not send uninsured patients home to fend for themselves. She goes into neighborhoods and follows up with patients as part of a Miami-Dade County violence intervention program, whose social workers help them access food, employment, and more to heal and feel safe.

“We know that full recovery is beyond just the hospital and even the rehab centers, even the best ones,” Valenzuela said, pointing to housing and navigating the healthcare system as factors.

runs the Miami-Dade program, which connects victims of gun violence with social workers who visit bedside at the hospital and an intensive care unit-trained nurse who visits at home to provide wound care and other services.

Rawlins said young, Black gunshot patients without health insurance are often at a loss when they leave the hospital about how to schedule a follow-up appointment or manage their mental health.

“After they have been shot and they’re getting out of the hospital and they’re still in crisis,” he said, “their concern is more: How am I going to now pay the rent? How am I going to live? Who’s going to take care of me?”

Often, he said, his uninsured clients leave the hospital before they are ready.

“That’s the reality of it: It’s a business,” he said. “It’s like a hotel. You know, checkout time: You got to go. We got to make room for someone, for a next customer.”

How Long Is Long Enough?

Alea Bates said the hospital discharged her with crutches and one prescription: a seven-day supply of the painkiller Percocet.

A family member drove Bates home. She wore a leg brace, with bandages on her back, stomach, hand, forearm, and feet. When she tried to get out of the car, Bates said, her knee gave and she fell.

Surgeons, health policy experts, and researchers say physicians follow evidence-based best practices for treating gunshot wounds and that a shorter hospital stay does not necessarily reflect a lower-level of care.

, an assistant professor of surgery at the University of Pennsylvania who conducts research on violence reduction, offered one explanation.

In published in The Journal of Trauma and Acute Care Surgery, Kaufman and colleagues found that patients who were admitted while uninsured but then enrolled in Medicaid during their hospitalization — and who needed ongoing rehabilitative care after discharge — spent more time in the hospital and had higher costs.

“I have personally been in situations where I felt like I did the best I could for a patient, but they would say, ‘You’re kicking me out,’” she said. “Sometimes, what the doctor is telling you doesn’t match what you are feeling in your body.”

But Kaufman said: “I’m not going to tell you hospitals never discriminate. That would not be realistic. I would say it is more indirect.”

Uninsured Florida Gunshot Patients Discharged Fastest

A box and whisker plot of admitted gunshot wound patient stays in Florida by insurance payer type. Uninsured patients have the shortest average stays.

Florida Agency for Health Care Administration,
The Trace and �Թϲ�� analysis

Kaufman said she couldn’t judge whether Bates stayed in the hospital long enough because she was not her doctor. Still, she said, Bates “didn’t get what she needed from our healthcare system.”

Unlike many states, Florida excludes most single adults without children, like Bates, from Medicaid eligibility, making it exceedingly uncommon for a Medicaid patient to have been admitted as an uninsured adult.

Gunshot survivors endure bleeding and oozing flesh wounds and pain, and they experience . “These experiences are common, but they are not talked about,” Kaufman said. “Mental health is part of the recovery process.”

Recovering the ability to walk or use an arm or a leg after a gunshot wound requires rehab and physical therapy that can be out of financial reach for uninsured patients, said , a pediatric surgeon and an associate professor at the University of Maryland who that uninsured patients hospitalized for traumatic injuries have shorter stays than insured patients.

Bates was shot seven times at close range — twice in the back and once each in the pelvis, stomach, left forearm, right thumb, and right foot. (Alea Bates)

Bates took this photo of her left forearm after surgery. (Alea Bates)

A shorter stay, he said, “suggests that these patients are not getting the same level of care, and that’s going to put them at risk for functional deficits down the road.”

He said it is impossible to arrive at a set number of days that any patient should remain in a hospital. Factors include the severity of their injury, their age, and any other illnesses they have.

“We’re looking for that Goldilocks length of stay,” Englum said, “and unfortunately, it is not perfectly defined for any specific admission, and it’s not perfectly defined for any specific patient.”

‘Oh, Shit. He Shot Me.’

Police found Bates lying on the ground in the breezeway of an apartment building the night she was shot seven times after making a food delivery in December 2019. Crime scene photos documented blood and bullet casings from the assault. (Tallahassee Police Department)

Bates had delivered her last order for the night when she was shot. It was December 2019: As she was walking back to her car, she heard two loud bangs. Just kids playing pranks, she thought to herself. Then she turned toward the sound and saw a gun pointed at her.

“In that split second it registered in my mind, like, ‘Oh, shit. He shot me,’” Bates said. “I had some brief, like, burning, but it wasn’t registering in my brain right away what it was.”

Within seconds, Bates said, the stranger emptied the clip of his handgun into her body, even after she fell to the ground. He shot her seven times — twice in the back and once each in the pelvis, stomach, left forearm, right thumb, and right foot.

Bates screamed. She reached for her cellphone to call 911. She said residents came out of their apartments. Someone took her phone to tell the emergency dispatcher the address. Another person pressed towels on her wounds to slow the bleeding. An ambulance rushed her to Tallahassee Memorial.

Bates had descended the stairs of an apartment complex and was walking back to her car when a stranger opened fire. (Tallahassee Police Department)

A bullet hole in the bedroom window of an apartment near the breezeway where Bates was shot in 2019. (Tallahassee Police Department)

Bates said she did not believe race was a factor in the care she received. But she believed that the circumstances surrounding her shooting — that it happened while she was working, and that she did not know the shooter — affected the way doctors and nurses viewed her.

Language in medical records can sometimes signal a bias in clinicians and perpetuate differences in care that patients receive, said , an associate professor at the Boston University School of Public Health who conducts research on exposure to gun violence.

Jay said bias based on patients’ race, income, or insurance status can deny some people necessary treatment once they leave the hospital.

He said his research suggests the healthcare system treats gunshot survivors and motor vehicle accident victims differently based on perceptions of “whether the victim was in no way at fault. They made assumptions when a person was violently shot.”

“The results are consistent with what we hear so much from hospital outreach workers for gunshot victims,” he said. “They say there is substantial bias. There is an assumption that they contributed to their condition with risky behavior.”

The preoperative notes in Bates’ medical records describe her as “a pleasant 39-year-old female who sustained multiple gunshot wounds to her abdomen, pelvis and extremities last night after performing Uber Eats delivery.”

Bates said it mattered to her caregivers what she was doing when she was shot.

“The nurses and doctors, they all talk about that stuff,” she said. “They were like, ‘Oh, my God, you were ambushed. That’s so scary.’

“I was working. Like, I don’t know these people. And the fact that they were teenagers, I think that that is what maybe changed the narrative,” she said. “Because I feel a lot of times people blame you for what happened.

“But when I was asked and I told them what happened and my story and how I got there,” she said, “I think just the shock in people’s eyes of like, ‘Oh, my God. So you really were, like, you know, minding your business.’”

She added: “And it also wasn’t in a sketchy part of town, if I can just say that. I was in a predominantly white complex. So I think that’s what saved me.”

Bates was uninsured when surgeons removed bullets and fragments from her body after a stranger shot her seven times. She went home from the hospital after four days with about $60,000 in bills. (Alicia Devine for �Թϲ��)

‘Less Than a Human Being’

Bates had received care at the hospital before as an insured patient.

She had lost her job in the legal department of a state agency — along with her insurance — two months before she was shot.

As an uninsured patient, Bates said, “they kind of just dismiss you. It makes you feel like less than a human being.”

She said she felt ignored when she told doctors she didn’t feel safe going home after four days. She said the physical therapist working with her at the hospital had persuaded the facility to let her stay an extra day.

“We would like, as a medical community, I think as a society, to see everybody get the same care,” said Englum, the University of Maryland trauma surgeon. “Regardless of what color their skin is, what insurance status they have — we want them to get appropriate care.”

The reason for racial or ethnic differences in care is hard to tease out, Englum said. Is it that there’s mistrust of the medical system in some Black and Latino communities, leading people to avoid going to rehab because they don’t want to be there? Is it an income issue? Is it that medical providers see some patients and, due to implicit or explicit bias, think, “That’s as good as they’re going to get?”

“Getting that care is what you need to get your full functional outcome back. And if you’re not getting it,” he said, “patients are suffering that didn’t have to.”

At home, Bates said, she depended on family members to help her out of bed, drive her places, even help her feel safe out in public.

“I really didn’t know how to stand or move or walk around,” she said. “I had to figure it out.”

She still fears loud noises, which remind her of being shot. Bates said she and her dog stay indoors on July Fourth and New Year’s Eve.

“The fireworks were going off, and I was paralyzed,” Bates said of her first New Year’s Eve after being shot. “I was literally sitting there crying. My cousin actually came outside and put my noise-canceling headphones on and turned the music on so that I couldn’t hear anymore. That’s the only way that I could move from outside to inside.”

Bates didn’t have the strength to walk after being hospitalized for seven gunshot wounds. Still, after four days, the hospital told Bates it was time to go. (Alicia Devine for �Թϲ��)

Bates said her follow-up care included getting her stitches removed at an orthopedic clinic that has physicians who work at the hospital and had performed the initial surgery.

During the visit, Bates said, the orthopedic clinic’s staff reminded her of the unpaid balance from her surgery, which was about $1,200 for physician services. She still owed the hospital $52,000 for treatment, according to her medical bills, and an additional $5,300 for the anesthesiologist. Bates was not working at the time.

Bates said a community outpatient clinic provided physical therapy at a reduced cost and that the victim advocate unit at the Tallahassee Police Department helped find her mental health counseling and get her financial aid from Florida’s .

By 2021, Bates developed a cyst on the gunshot wound to her right thumb, which required surgery. But, she said, the clinic would not perform the surgery until she paid her $1,200 balance. She said friends paid the bill so she could have the surgery.

Bates’ knee bothered her. “Even with going through physical therapy,” she said, “it was still like I couldn’t feel it.”

Bates said she now has private health insurance that pays for her mental health therapy. She pays for physical therapy out-of-pocket.

“It’s crazy that in this country somebody else can hurt you,” Bates said, and “you have to pay for what they did to you.”

“So it’s like you’re triple-paying: You’re paying every day mentally, you’re paying with the bills, and you’re paying by them saying, We know that this is not your fault, but we still have to make our money.”

Methodology

The Trace and �Թϲ�� examined more than 20 million inpatient hospitalizations in Florida from 2018 to 2024, using data obtained from the Florida Agency for Health Care Administration. We identified 20,255 gunshot wound-related visits using the Centers for Disease Control and Prevention’s injury surveillance case definition, which relies on diagnosis codes. We limited the analysis to initial encounters and excluded patients who died in the hospital or left against medical advice. We excluded cases in the top 1% for hospital length of stay (68 days or more) to prevent these outliers from disproportionately influencing results.

Our primary finding compares the average length of stay of uninsured patients with that of privately insured patients. We chose privately insured patients as the reference group because many researchers believe their care on average is long enough to be effective but not longer than medically necessary. Overall, uninsured patients had hospital stays that were about 25% shorter on average than privately insured patients’ and 50% shorter than those of patients on traditional Medicaid. In most cases we also found that, within the same hospital, uninsured patients had shorter stays than privately insured ones.

To assess whether age or injury severity explained the shorter lengths of stay for uninsured patients, we calculated and fit regression models for Florida’s highest-volume gunshot wound hospitals. We found that, in nearly all cases, the gap narrowed slightly but did not disappear.

�Թϲ�� data editor Holly K. Hacker contributed to this report.

This article was produced in partnership with The Trace, a nonprofit newsroom covering gun violence in America. .

This article first appeared on �Թϲ�� and is republished here under a .

Festering Infections to Untreated Cancer: ICE Detainees Describe Medical Neglect Across US

Tue, 02 Jun 2026 13:00:00 +0000

An Albanian man’s pain grew so unbearable, he said, he pulled out his own tooth as he languished for months in a New Mexico immigration detention center. A Honduran mother of two said she was hospitalized for a heart problem after she was denied blood pressure medications while held in Florida. A said his leg grew purple and swollen from flesh-eating bacteria when staffers at a Vermont facility did not bring him to a scheduled doctor appointment.

Hundreds of detainees across at least 33 states allege in federal suits that immigration detention facilities are failing to provide adequate medical care, an investigation by �Թϲ�� and The Associated Press found. Detainees say they didn’t get medications on time — or at all — for conditions including high blood pressure, diabetes, depression, epilepsy, Parkinson’s, and HIV. Requests for help went unanswered for weeks. Blood sugars rose. Infections festered. Cancers remained untreated. Detainees collapsed and had seizures.

U.S. jails and immigration detention centers have to meet the medical needs of the people in their charge. But the system is sagging under an influx of detentions since President Donald Trump returned to office: More than 75,000 immigrants were being detained by U.S. Immigration and Customs Enforcement , up from around 40,000 a year earlier.

�Թϲ�� and AP analyzed thousands of court cases filed since Trump’s second inauguration that use a legal route known as habeas corpus to argue people are being held illegally by ICE. The records offer a rare window into how those detained say, often under penalty of perjury, ICE is handling their medical needs. Reporters also interviewed more than 50 detainees, family members, and lawyers.

The investigation revealed that medical neglect is alleged across the sprawling detention system, including in offices not designed to house people, county jails, and quickly staged sites with nicknames such as “Alligator Alcatraz.”

ICE custody is deadlier than it has been in two decades, researchers wrote in April. The Department of Homeland Security reported 51 people had died in detention since the start of Trump’s second administration — with suicides .

�Թϲ�� and AP asked DHS to respond to the findings six days before publication, but it did not provide comment. The department’s acting chief medical officer, Sean Conley, has “it is both policy and longstanding practice for aliens to receive timely and appropriate medical care from the moment they enter ICE custody” and that the agency recruits healthcare professionals to maintain high standards. “This is better, more responsive healthcare than many aliens have ever received in their entire lives,” he has said.

Individual facilities and private prison companies contracting with DHS that responded to requests for comment said they follow ICE standards and detainees receive medical care when it is required. Some said they were unfamiliar with the allegations outlined in court documents; others blamed some detainees for lapses in their medical care.

“I have never seen such disregard or medical neglect like this anywhere,” Vardan Gukasian, a political dissident and former paramedic who spent years behind bars in Armenia, wrote in in March to contest his detention in Henderson, Nevada, as it stretched to 13 months despite health problems.

Madeleine Skains, a spokesperson for the city of Henderson, said medical care is always available at the facility and that the court had not ordered changes to his care.

Last June, as Gukasian experienced the symptoms of uncontrolled high blood pressure — dizziness, a nosebleed, and a headache — his cellmate banged on their door for help.

“When it did not arrive, the rest of the block banged on their doors,” he wrote. Gukasian was hospitalized that day.

‘Brazen Indifference to Really Obvious Problems’

The administration’s mass deportation effort has swept up during routine immigration check-ins, at traffic stops, at their homes, and in hospitals.

About have no criminal conviction. Their immigration proceedings are civil, not criminal.

“I couldn’t understand why they treated me so harshly,” said a father of six in Georgia. He said he was injured while shackled in custody when the vehicle transporting him to an Atlanta facility jolted, throwing him out of his seat and into a metal armrest. His wound became infected with E. coli, he said, because he had to sleep on a dirty concrete floor amid leaking toilets.

Like other detainees interviewed, he spoke on the condition of anonymity; they said they fear for their safety, for the safety of their families, or that speaking out would jeopardize their immigration cases. The AP and �Թϲ�� are not naming anyone identified in court documents without their consent.

Staffers at Stewart Detention Center in rural Lumpkin, Georgia, didn’t adequately respond to that man’s request for medical help, , until he passed out and was taken to a hospital about an hour away. There, he said, a doctor told him he’d narrowly escaped amputation of his left leg. Medical staff found no records of a case matching this description, according to Brian Todd, a spokesperson for CoreCivic, which runs the facility.

The 48-year-old, who moved to the U.S. from Guatemala more than two decades ago, was released in October and is now a legal permanent resident. But he is unsure if he’ll be able to return to his job in construction because, he said, he can no longer lift heavy things due to his injury.

A man in the Atlanta area was injured while in U.S. Immigration and Customs Enforcement custody and developed an E. coli infection. “I couldn’t understand why they treated me so harshly,” says the father of six U.S. citizens, who is now a legal permanent resident but did not want to be named to avoid potential retaliation against his family. (Brynn Anderson/AP)

Some detainees or their lawyers said even basic care was denied: gauze to protect an open foot wound, prenatal care for a high-risk pregnancy, a pillow to ease the pain of sleeping with advanced stomach cancer, sanitary pads for postpartum bleeding.

“I would like to believe the government has the best interest of those it holds in detention for whatever period of time,” Judge Benita Pearson, a federal judge in Ohio, said during a hearing in October concerning a 70-year-old who alleged the government lost her glasses during her arrest. “If one is unable to see due to the loss of glasses when detained, that should be fixed.”

, who worked for ICE and now serves as a special adviser to the American Bar Association, said case law requires the government to treat people in immigration detention with the same care it affords those in traditional jails awaiting trial. But administrators are granted discretion and medical care standards vary.

Detainees are frequently moved across the country, often without warning, interrupting treatment. A woman from El Salvador said she missed a week of HIV medication when she was transferred from Colorado to a county jail in Wyoming.

A Russian man wrote that, while detained in Texas, he saw a gastroenterologist about his painful gallstones and scheduled an appointment with a surgeon. “Unfortunately, I never got to see him, due to my being moved around various detention centers.”

Advocates say that even obvious disabilities, like legal blindness, are ignored.

A detainee who lost one eye and had severe glaucoma in the other required twice-daily drops to maintain what vision remained. But, he said, some days the drops never came.

“Now I can only see a little bit straight in front. It now often looks like I’m seeing through gauze,” the man wrote in a court declaration. “This makes me very afraid that one of these times I am going to open my eyes and not be able to see anything at all.”

He wrote that he was scared he wouldn’t be able to see his infant son grow up.

“It’s just sort of brazen indifference to really obvious problems, things you would have thought absurd a decade ago — like the fact that you can’t see,” the man’s attorney, Brian Hoffman, said. “Before, you could attempt to work with folks on the government side and maybe shame them into doing the right thing. Now, it’s sort of like anything you want done you have to go to court and sue over.”

Even court orders aren’t always enough. One California judge ordered the government to take a man showing signs of prostate cancer to a specialist for diagnosis and treatment. Records show they did not take him.

Lawyers representing ICE told the judge that officials missed the appointment because of an “internal scheduling error.” CoreCivic, which runs that facility, said it was unable to comment on active litigation.

A Surge in Cases

When immigrants file habeas corpus petitions, they exercise a right to challenge unlawful imprisonment that dates to .

More than 40,000 such petitions have been filed during Trump’s second term, fueled by decisions last year to deny bond to many people held on immigration charges. Judges are split on whether that’s legal; the question appears headed to the Supreme Court.

Many habeas claims , but judges typically cite reasons unrelated to the medical neglect described in the petitions, such as detainees’ being held too long before being deported.

The more than 300 medical neglect claims found in this investigation represent a fraction of the problem. The details of habeas corpus cases are often hidden due to a federal rule barring the public from viewing such documents online. �Թϲ�� and AP obtained some documents from courthouses and received records on 4,400 cases from , a project of the nonprofit Immigration Justice Transparency Initiative. But tens of thousands more remain largely inaccessible.

Some judges have written that the habeas process is not how to raise allegations of medical neglect and have declined to release detainees over those claims. Not every detainee who believes they experienced medical neglect files a habeas petition or cites their medical issues if they do.

Jose-Antonio Segismundo’s petition made no mention of being unable to see an oncologist for the cancer in his abdomen while detained for more than seven months at the Florida detention facility known as Alligator Alcatraz and Folkston D Ray ICE Processing Center in Georgia. Medical records in his court filings show he was arrested about five weeks before his scheduled appointment with a cancer specialist.

His wife, Maria Jose Gonzalez, said he didn’t receive any treatment even though she sent his medical records and explained his condition to officials at Folkston. When his stomach pain erupted, often suddenly and intensely, she said, they gave him Tylenol.

Geo Group, which runs Folkston, follows ICE standards and provides healthcare and access to off-site medical specialists when needed, spokesperson Christopher Ferreira said.

This spring, Segismundo, 48, was deported to Mexico, a country he left nearly 30 years ago, Gonzalez said. Now, she said, he will have to restart his search for care in the Oaxacan village where he grew up.

Maria Jose Gonzalez of Wimauma, Florida, holds a photo of her husband, Jose-Antonio Segismundo, who was detained in U.S. Immigration and Customs Enforcement custody for more than seven months in Florida and Georgia before being deported to Mexico. Medical records show he was arrested about five weeks before his scheduled appointment with a specialist to treat his abdominal cancer. (Chris O'Meara/AP)

Watching Loved Ones Deteriorate

Detainees receiving inadequate healthcare have little recourse. The Department of Homeland Security last year gutted the Office of the Immigration Detention Ombudsman. In early May, it shut the office entirely, arguing that Congress didn’t fund it.

Previously, ombudsman staffers could help facilitate medical care or look into complaints of neglect, according to Matt Boles, an immigration attorney in Georgia. Now, he said, there’s no one to call.

Meanwhile, detainees’ families said they feel helpless, making desperate calls to facilities, the government, and their legislators while watching their loved ones deteriorate.

Riya Khan saw her mother get sicker at the California City Detention Facility, which is owned by CoreCivic. When she visited a week after her mother arrived at the facility in the Mojave Desert, Riya said, the 64-year-old woman stumbled into her seat. She was shaking and her breathing was labored.

Masuma Khan came to the U.S. from Bangladesh in 1997. She has no criminal history, her records say, and was detained in October when she showed up for her regular ICE check-in.

For the month she was detained, according to her daughter, she only intermittently received her medications for conditions including high blood pressure, hypothyroidism, and prediabetes. CoreCivic treats chronic conditions in line with applicable medical standards, Todd said.

“Nothing matters more to CoreCivic than the health, safety and well-being of the people in our care,” Todd said.

Khan said she got her asthma medication for the first time two days before she was released and that her eye drops for glaucoma never arrived. Staffers told Khan she needed to buy some of her medications from the commissary but it didn’t stock them, her daughter said.

Before ICE detained Masuma Khan, she made friends with everyone, her daughter said. She had worked for years at Lucky Boy, an iconic Pasadena fast-food restaurant, and in her free time fed birds and left out fruit for bees that visited her apartment’s balcony.

Now she’s too scared to go outside. She still must regularly check in with ICE, and she’s terrified each time.

Masuma Khan (center) waits in line with her attorney Laboni Hoq (left of Khan) to enter a federal building in Los Angeles for an appointment on April 21. (Jae C. Hong/AP)

Khan (second from right in the front row) and her daughter, Riya (fourth from right in the front row), pose with supporters outside a federal building in Los Angeles on April 21. (Jae C. Hong/AP)

Khan (right) came to the U.S. from Bangladesh in 1997 and was detained for a month after she showed up for a regular check-in with U.S. Immigration and Customs Enforcement in October. Here, she hugs her daughter, Riya (left). (Jae C. Hong/AP)

A “Welcome Home” balloon that was left at the front door of Khan’s apartment in Altadena, California, after she was released from an immigration detention facility. (Jae C. Hong/AP)

Khan’s daughter says that her mother has nightmares and is scared to go outside after being held at an immigration detention facility for a month in 2025. (Jae C. Hong/AP)

A Stroke on a Video Call

Previously, detainees with serious medical needs would likely have been released on humanitarian parole, in part to avoid the cost of their care, Vermont attorney Andrew Pelcher said.

In fiscal year 2023 — before the detained population soared — ICE spent more than $390 million on healthcare for detained noncitizens, according to its to Congress. In May, Todd Lyons, then acting director of ICE, said at a conference that the agency had already spent “almost half a billion dollars” on detainee healthcare this year.

Now, under “mandatory detention,” people are staying locked up with serious — and expensive — conditions.

A Romanian citizen underwent several heart surgeries, including an emergency triple bypass in April 2025, before he was arrested in July. As part of his recovery, the 52-year-old was required to take 16 daily medications. While at an ICE field office in Baltimore, his court filings allege, he went two days without any medication before officials moved him to a facility in New Jersey.

He was hospitalized three times while detained, complaining of chest pains — in part, medical records and court documents say, because despite “countless requests,” the detention center did not provide all his medications. Hospital discharge papers cited by his lawyer show he received only eight of the 16 medications after his second release from the hospital.

“Can you please talk to the ICE facility to make sure they give him his medications?” his treatment providers wrote in medical records included in his court filings. “He was admitted last week for chest pain and today he was readmitted again for chest pain secondary to non compliance for medications.”

Several weeks later in August, he had a stroke while on a video call with his daughter, according to court filings. “He was struggling to breathe, and was pointing at his chest where he was again experiencing pain, and suddenly stopped speaking.” His daughter screamed for help through the video monitor, according to his petition. “Eventually an officer came in to assist him and cut the feed.”

The man lost his ability to speak for four days, the document says. He was returned to detention, where he remained until a federal judge ordered his release in November.

Khan holds medication she takes daily. While detained, she says, she only intermittently received her medications for multiple conditions including high blood pressure, hypothyroidism, and prediabetes. (Jae C. Hong/AP)

Impossible Choices

Cassandra Amador waits for the phone to ring every morning, desperate to ask her husband the question that’s woken her up every night for months: “Did you get your medicine?”

Her husband, Pedro Javier Amador Gutierrez, 36, has high blood pressure and depends on the state-run facility in Florida nicknamed “Deportation Depot” to administer the prescriptions that have kept him alive for years. Many mornings, he tells his wife he did not get them.

When she talks to him, she said, he sounds weaker and more scared every day, not like the upbeat man who would take her kids out for ice cream.

“You can hear in his voice how he feels,” she said.

Now, she said, he’s considering returning to Cuba, which he fled because of political persecution, out of fear that he will die in detention without his medicines. Amador and her children would go with him, she said, even though she was born in New Jersey, has never been to Cuba, and doesn’t speak much Spanish.

But he’s already collapsed twice at the Baker Correctional Institution in Sanderson, Florida, his wife said. She’s terrified that the next time, he won’t get up.

Methodology

�Թϲ�� and The Associated Press sifted through thousands of immigration habeas corpus claims to find allegations of medical neglect from people detained by U.S. Immigration and Customs Enforcement during the second Trump administration.

Without a comprehensive, publicly available dataset of medical complaints by those in ICE custody, we used immigration habeas corpus claims to identify detainees’ healthcare-related allegations raised in federal court. Although the intended purpose of habeas corpus is to challenge the legality of a petitioner’s detention — rather than conditions of their confinement — these filings sometimes include detainees’ claims of inadequate healthcare.

But habeas corpus filings are not always publicly available. Federal rules restrict how members of the public can access habeas petitions filed by people in immigration detention. For most of these cases, court websites publish only court orders and dockets describing other filings. The initial petitions are available only through in-person visits to federal courthouses across the country. Habeas Dockets, a project of the nonprofit Immigration Justice Transparency Initiative, coordinates a nationwide network of volunteers to gather these petitions and make them available online.

�Թϲ�� and AP analyzed the dockets of roughly 33,000 cases filed by detainees from Jan. 20, 2025, through March 2026. The vast majority of cases had only basic procedural information, like dates of court filings and rulings. Only about 4,400 included the original petitions.

We also gathered a few dozen case files from courthouses, lawyers, and the Massachusetts federal district court website, which posts most petitions under a unique standing order.

We ran keyword and semantic searches of court records, including petitions, motions, and orders, for terms and phrases potentially related to medical neglect, such as surgery, medications, inadequate medical care, and treatment for chronic conditions such as diabetes and high blood pressure.

We found about 500 cases potentially alleging medical neglect. At least two reporters reviewed each case manually, yielding more than 300 cases containing specific allegations in sworn filings of delayed, denied, or deficient healthcare.

To be conservative, we excluded dozens of cases that alleged inadequate medical care but lacked specifics, for example a petitioner writing, “I have been sick and don’t get proper treatment,” or a judge noting a petitioner “complains that ICE is ignoring his medical problems.” We also excluded cases in which petitioners claimed only that they were denied special diets, exercise, or other accommodations that they said were key to managing their health conditions, such as a petitioner writing, “I suffer from Parkinson’s and cannot properly exercise,” or claiming that the food provided was unfit for a person with diabetes.

The cases we analyzed were neither randomly selected nor representative of immigration habeas filings nationwide. The claims were not independently verified. Many filings are not publicly available, and not all detainees raise medical concerns in court, so our account of cases represents a limited window into the landscape of claims, rather than a comprehensive picture.

Associated Press journalists Garance Burke, Valerie Gonzalez, and Tim Sullivan as well as �Թϲ�� correspondent Kate Wells contributed to this report.

This report is a collaboration between The Associated Press and �Թϲ��.

This article first appeared on �Թϲ�� and is republished here under a .

As Ranks of Uninsured Grow, Minnesota’s Hospitals Are Among Least Charitable in Nation

Noam N. Levey and Jeremy Olson, The Minnesota Star Tribune — Mon, 11 May 2026 09:00:00 +0000

ST. CLOUD, Minn. — Cori Roberts was living in a rented basement four years ago when she was diagnosed with early-stage cervical cancer.

Recently divorced, the former stay-at-home mother had started working again in her mid-40s, taking a human resources job that paid $41,000 a year. Then, despite having insurance, she was hit with more than $8,000 in medical bills.

“I had my car and a basket of clothes,” Roberts recalled. “Medical bills were not something I could have afforded.”

Roberts sought financial assistance from CentraCare, the St. Cloud-based health system that treated her. It’s a nonprofit charity that receives millions of dollars in federal, state, and local tax breaks. In exchange, it’s obliged to offer charity care to patients who can’t afford their medical bills. But Roberts said CentraCare told her she made too much to qualify.

Roberts instead scrimped on groceries and Christmas gifts for her kids and paid off more than $6,000 over two years. Then CentraCare sued her last year because she hadn’t paid off all the debt.

“They’re supposed to be a nonprofit,” Roberts said. “It’s like, ‘Come on!’”

CentraCare earmarks a tiny fraction of its budget for helping patients with medical bills they can’t pay, but it’s not alone, a Minnesota Star Tribune-�Թϲ�� investigation found.

Minnesota’s hospitals and health systems are among the least charitable in the country, the investigation found, providing less financial aid as a percentage of their operating budgets on average than hospitals in almost every other state, including Illinois, Iowa, Nevada, and Texas.

The investigation drew on a detailed review of every hospital charity care program in the state, an analysis of five years of hospital financial data, and dozens of interviews with patients, hospital executives, and state officials.

Nationally, hospitals spend an average of about 2.4% of their operating budgets on charity care, according to federal hospital data compiled by Hossein Zare, a researcher at Johns Hopkins University. Minnesota hospitals spend about a third of that, on average.

Charity care remains minimal at most Minnesota hospitals

Charity care makes up a sliver of operating expenses for Minnesota hospitals, some of which have higher income limits and require patients to submit detailed applications.

�Թϲ��/Star Tribune analysis of Minnesota Department of Health data

Some spend considerably less. Of Minnesota’s 123 general hospitals, 62 devoted less than 0.5% of their operating budgets to charity care from 2020 through 2024, the Star Tribune-�Թϲ�� investigation found.

“The system is not working,” said Erin Hartung, director of legal services at Cancer Legal Care, a Minnesota nonprofit that helps patients with medical debt and other financial challenges. “And the burden is falling hardest on the people who are least able to bear it.”

CentraCare’s flagship St. Cloud Hospital spent less than 0.25%, according to the analysis. That works out to $25 in patient aid for every $10,000 spent on hospital operations.

Charity care will become even more vital in coming years as Minnesotans lose health coverage or can’t afford rising copays and deductibles. The state’s uninsured rate rose sharply last year, since 2017, and it’s expected to increase further as budget cuts pushed by President Donald Trump force states to pare Medicaid and other safety net programs. Charity care is also critical to many people with health insurance who can’t afford their bills.

Hospital officials say it’s unfair to expect them to solve this affordability problem when many of their facilities are financially strained. “No amount of charity care from hospitals will ever fully meet the needs of uninsured or underinsured Minnesotans. The need is simply too great,” Minnesota Hospital Association spokesperson Tim Nelson said in a statement.

But state Attorney General Keith Ellison said hospitals have a duty to boost charitable help for all needy patients in exchange for the tax breaks they receive.

“There is a benefit you get from being a nonprofit hospital in the state of Minnesota,” he said. “But do the people get the benefit?”

Several small Minnesota hospitals give financial aid to fewer than two dozen patients a year. Mahnomen Health Center, which recently converted to a rural emergency center, didn’t provide any charity care in eight years, despite serving one of Minnesota’s . Other hospitals serving large low-income populations were among those providing the least charity care, the analysis found.

Several factors help explain why Minnesota hospitals provide so little financial aid. For one, job-based insurance and an expanded Medicaid program offer broad coverage. Hospitals in states with less government assistance and more uninsured people typically spend more on charity care.

But Minnesota patients also face significant barriers accessing financial aid at many hospitals, including inconsistent eligibility standards and extensive applications, the Star Tribune-�Թϲ�� investigation found.

To qualify at many hospitals, patients must submit detailed personal information, including bank statements, retirement accounts, mortgage documents, and estimates of other assets such as cars, homes, or livestock.

And because Minnesota has not standardized the criteria for charity care, patients might receive aid at one hospital but not another. The investigation found that some hospitals give free care to patients with an annual household income of $47,000, while others cap it at about $15,000.

Had Roberts driven 30 miles east to Princeton or 35 miles north to Little Falls, she would have found medical providers with more generous financial aid policies than CentraCare. But she didn’t know to look.

Roberts, now 49, has remarried and lives in a split-level home in St. Cloud decorated with inspirational plaques such as “Faith, Family, Friends.” CentraCare recently dropped the lawsuit against her, but only after she took out a loan against her retirement plan to pay off the medical debt. “It just feels very unfair,” she said.

Roberts thumbs through copies of her payment records at home. (Anthony Soufflé/The Minnesota Star Tribune)

CentraCare’s flagship hospital in St. Cloud earmarks only a fraction of its budget for helping patients who can’t pay their medical bills. (Anthony Soufflé/The Minnesota Star Tribune)

‘We Have To Defend Being Paid’

CentraCare spokesperson Karna Fronden said medical privacy laws prevented her from discussing Roberts’ case. She also declined interview requests about the health system’s charity care spending.

In a statement, Fronden said CentraCare provides assistance in addition to charity care, such as helping enroll patients in insurance. “This helps provide broader, longer-term protection for patients,” she said.

Other hospital leaders said they serve their communities in ways besides forgiving medical bills, including training doctors and nurses and preserving money-losing services such as obstetrics and mental health care.

“Rural hospitals like ours are often portrayed as though we are sitting on piles of cash and simply choosing not to spend it on charity care. That is far from the reality,” said Robert Pastor, chief executive of Rainy Lake Medical Center in International Falls.

“We are the second- or third-largest employer in town, running on razor-thin margins while navigating escalating labor and supply costs and routine underpayment by public programs,” Pastor said. “Meanwhile, many health insurers post billions in profits.”

Hospitals typically are paid less for care provided to Medicare and Medicaid patients. More than 80% of Rainy Lake’s patients are on one of those government programs.

Minnesota hospitals collectively write off about $200 million of what’s deemed bad debt every year after trying unsuccessfully to collect unpaid bills from patients through calls, letters, and even lawsuits. By comparison, they devote about $163 million annually to charity care, state figures show. In 2024, hospitals collectively posted $2.4 billion in net income.

“I feel like I’m put in the position, being the hospital, where we have to defend being paid,” said Patti Banks, the head of Ely-Bloomenson Community Hospital and a senior Minnesota Hospital Association board member.

Some hospitals face intense financial pressures. Thirty-one have lost money on operations in four of the past eight years. HCMC in Minneapolis — the state’s largest safety net hospital, which provides the most charity care — is losing so much money that, without additional taxpayer support, .

But larger health systems such as Mayo Clinic, Essentia Health, and Sanford Health have remained financially sound. And the operating margins at most CentraCare hospitals exceeded 10% in 2024, state data shows.

Medical Debt’s High Toll

Abby Kelley-Hands is a special education coordinator in St. Paul with a rare immune condition that causes frequent, severe allergic reactions. She says that after she lost health coverage for a month because of an insurance snafu a few years ago, she was hit with more than $20,000 in bills from Mayo Clinic and denied financial aid. (Jeff Wheeler/The Minnesota Star Tribune)

Nationwide, health care debt — much of it from hospitals — burdens an estimated 100 million people, increasing their stress and even leading to premature deaths, .

Abby Kelley-Hands, a special education coordinator in St. Paul, has a rare immune condition that causes frequent, severe allergic reactions. Her illness can be controlled only with a costly drug, which a Mayo Clinic doctor prescribed.

When Kelley-Hands briefly lost health coverage in 2021 in an insurance mix-up, she was hit with more than $20,000 in bills. And although she and her husband earned less than $100,000 a year, Kelley-Hands said Mayo denied her financial assistance because she earned too much.

“I was in tears,” Kelley-Hands said. “It was so scary and so hard. And it causes all of this additional stress, which then makes you sicker and less able to even figure things out.”

Kelley-Hands and her husband sold a car and agreed to a payment plan before Mayo would resume her treatment, she said. Her husband now bikes 5 miles to work. They have no dishwasher. And she and her husband took a honeymoon only last fall, seven years after their wedding. “We live very simply,” she said.

Mayo spokesperson Kristyn Jacobson declined to discuss Kelley-Hands’ case.

In 2024, state lawmakers from denying care to patients with outstanding debt. And in 2025, Attorney General Ellison reached an agreement with Mayo to overhaul its charity care program after an investigation found the multibillion-dollar institution was systematically discouraging patients from applying.

After the state began investigating Mayo, the system’s , topping 1.5% of operating expenses in 2024.

‘Optimized To Get Payment’

Complying with a 2023 , Minnesota hospitals now post their financial aid policies online, although several, including CCM Health in Montevideo and Northfield Hospital, did so only after being contacted by the Star Tribune or �Թϲ��.

But many hospitals make financial aid more difficult to find than information about paying bills, said Jared Walker, founder of Dollar For, a nonprofit that helps patients nationally apply for charity care.

“Hospitals have optimized to get payment,” he said. “If you want to get on a payment plan, if you want to get on a credit card, it’s so easy.”

Glacial Ridge Health System in Glenwood posts a “Bill Pay” tab at the . But it takes several clicks to find the hospital’s financial assistance plan. The information couldn’t be found on the site searching for “charity care” or “financial assistance.” The public hospital 130 miles northwest of Minneapolis devoted less than 0.7% of its operating budget to charity care from 2019 to 2024.

Patients in interviews frequently said they weren’t told about charity care.

Joe Robling, 29, was treated at St. Francis Regional Medical Center in Shakopee for a broken pelvis and fractured spine after a 2024 motorcycle accident. His mother, Janet, who helped him navigate the bills, said the hospital never informed him about financial aid.

“They didn’t offer any of that,” she said.

Robling, a construction worker in Henderson, was between jobs and uninsured. “He had zippo,” Janet Robling said. “What he had in reserves were all depleted.”

The Allina Health-affiliated hospital billed him more than $19,000, the Roblings said.

An internet ad connected the family to Dollar For, which helped Robling qualify for charity care five months after his accident.

Allina spokesperson Jennifer Steingas declined to comment on the case, citing medical privacy restrictions, but said the health system has since reached out to the family.

In another case, M Health Fairview’s University of Minnesota Medical Center didn’t offer financial aid to an unemployed and uninsured man from Idaho while he was hospitalized for two months for psychiatric care and amassed $150,000 in bills.

Attorney Margaret Henehan, who represented the man, said the hospital instead offered him a two-year payment plan at $6,500 a month. “He had no income, which he told Fairview,” Henehan said.

The man, who is not identified because of his mental health condition, eventually received charity care after his sister, a doctor, reached out to Henehan for help.

Aimee Jordan, a Fairview spokesperson, said she couldn’t comment on the case because of patient privacy laws, but she said patients who are offered payment plans can always apply for charity care, even after a hospitalization.

M Health Fairview University of Minnesota Medical Center in Minneapolis, pictured in March 2013. (Joel Koyama/The Minnesota Star Tribune)

A Maze of Standards

State law prohibits hospitals from making “unreasonable” demands of patients when they apply for charity care. But the law sets few specific standards.

The result is a dizzying array of policies, including 11 income thresholds used by Minnesota hospitals to determine whether patients qualify for free care, the Minnesota Star-Tribune-�Թϲ�� review found.

HCMC parent company in Minneapolis and Olmsted Medical Center in Rochester offer the highest threshold for free care, at — almost $48,000 a year for an individual.

Sometimes standards vary even between neighboring hospitals. Madelia Health in south-central Minnesota to patients who make less than twice the federal poverty level. About 13 miles away at Mayo’s hospital in St. James, can qualify for aid.

Most hospitals limit charity care to those in poverty

Minnesota hospitals use a patient’s income in relation to the federal poverty line to determine whether to grant discounted or free care, but where they set the limit is wildly variable.

*Hospitals in the other category use fixed household income amounts rather than poverty levels to determine eligibility for discounted care, or base decisions on the size of medical bills.

�Թϲ��/Star Tribune analysis of Minnesota Department of Health data

To determine eligibility, some Minnesota hospitals consider only income, but most demand information about patients’ bank accounts as well. More than two-thirds require even more information, including the value of retirement accounts, life insurance policies, property, and vehicles. Madelia’s “may be required to sell recreational vehicles.”

Stringent requirements ensure that limited resources go to patients who need them, said Travis Olsen, chief executive of Hendricks Community Hospital, near the South Dakota border. “We don’t feel it’s fair for someone with lower annual income but yet owns numerous acres of land, debt-free, to be able to qualify for charity care.”

In addition to copies of tax returns, W-2 forms, pay stubs, and bank statements, 53 questions about their finances. These include questions about the make, model, and value of vehicles; the current market value of farm equipment, livestock, and land; and the purchase price and square footage of homes.

Other hospital applications ask patients to detail their monthly spending on food, utilities, and other medical bills.

Olsen said community pressure is more of a deterrent to applying for aid than the application: “People are too proud to pick up an application. We all know each other.”

But Walker at Dollar For said the biggest barrier is complexity. “The drop-off rates are much higher the more questions you ask and the more documentation you have to provide,” he said.

Arleen Mullenax had a cancerous tumor removed from her neck at Mayo in Rochester. Assembling her aid application and following up with the hospital billing department amid her “cancer fog” was almost more than she could take, she said.

“I knew as a former office manager I had to stay on top of it,” she said. “But it was the most daunting thing I had to do as a patient.”

The Mayo Clinic campus in Rochester, Minnesota. Last year, the multibillion-dollar institution overhauled its charity care program after an investigation found it was systematically discouraging patients from applying. (Aaron Lavinsky/The Minnesota Star Tribune)

Fixing the System

Ellison and several state lawmakers say Minnesota’s hospitals should make it simpler for patients to access charity care.

They’ve called for, among other things, common eligibility standards and a standard application across hospitals. New York and Maryland already have both.

“Eliminating as many barriers as possible for people is really important,” said state Sen. Liz Boldon, who also said she hopes lawmakers can enact these standards next session.

The Minnesota Hospital Association has opposed standardizing financial assistance, saying hospital boards are in the best position to assess the need for charity care in their communities. “Adding mandates for providers across the state will not close that gap, and will only increase bureaucratic and procedural barriers to patient care,” spokesperson Nelson said.

Ellison also has pushed to require hospitals to use a process that automatically screens and qualifies low-income patients for financial aid without requiring an application.

Minnesota Attorney General Keith Ellison says Minnesota hospitals should provide more financial assistance to patients to justify their tax-exempt status. (Alex Kormann/The Minnesota Star Tribune)

Some hospital systems, including South Dakota-based Sanford Health, already use software that checks patients’ eligibility based on information such as their credit history, said Nick Olson, the system’s chief financial officer. At Sanford Health’s 10 hospitals in Minnesota, about a quarter of the patients who receive financial aid get it this way, he said.

Nearly all Sanford hospitals devote more than 1% of their operating expenditures to charity care — higher than most hospitals in the state.

Screening software can be costly. Several executives at small Minnesota hospitals said they can’t afford it. But there are other options. In California, Los Angeles County is developing a public system to allow hospitals to quickly assess patients’ eligibility so they don’t have to buy a system themselves.

Other states — including Texas and Nevada — have laws requiring hospitals to provide minimum amounts of charity care.

Back in St. Cloud, Roberts said that when she drives past CentraCare’s $200 million expansion at its Plaza campus in St. Cloud, she wonders why Minnesota hospitals don’t live up to higher standards themselves.

“They have all the money,” she said. “But they can’t grant a good person some grace?”

Minnesota Star Tribune staff writers Bill Lukitsch and Victor Stefanescu contributed to this report.

Roberts incurred more than $8,000 in medical bills after she was diagnosed at CentraCare with early-stage cervical cancer. She says the health system told her she made too much — about $41,000 a year — to qualify for financial aid. (Anthony Soufflé/The Minnesota Star Tribune)

This article first appeared on �Թϲ�� and is republished here under a .

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