Legislation Archives - ³Ô¹Ï²»´òìÈ /tag/legislation/ ³Ô¹Ï²»´òìÈ produces in-depth journalism on health issues and is a core operating program of KFF. Thu, 27 Aug 2026 16:51:09 +0000 en-US hourly 1 https://wordpress.org/?v=6.8.8 /wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=32 Legislation Archives - ³Ô¹Ï²»´òìÈ /tag/legislation/ 32 32 161476233 In Toss-Up House District, Voters Crave Leadership To Fix Broken Healthcare /elections/california-22nd-congressional-district-valadao-villegas-healthcare-affordability/ Wed, 26 Aug 2026 12:00:00 +0000 /?p=2275994 ³Ô¹Ï²»´òìÈ 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 ³Ô¹Ï²»´òìÈ and is republished here under a .

]]> 2275994 Trump Team’s Use of Arcane Budget Rule Threatens Medicaid Coverage /medicaid/trump-cms-medicaid-expansion-1115-waivers-budget-neutrality-arkansas/ Fri, 14 Aug 2026 09:00:00 +0000 /?p=2273141 About 200,000 low-income Arkansans could see major changes to their health coverage next year after the Trump administration recently informed state officials it will not renew a key Medicaid agreement with the federal government.

The decision by federal officials, citing authority granted under President Donald Trump’s signature tax-and-spending law, suggests the GOP-led state’s predicament could foretell other repercussions in how states are allowed to run the program under federal waivers.

Nearly every state has at least one waiver to run its Medicaid program differently than required by federal law, such as allowing the use of private managed-care plans or expanding eligibility for mental health or long-term care services. Some Medicaid waivers have stretched decades, renewed by presidential administrations of both parties, effectively making the demonstration programs they created permanent.

Arkansas is one of a dozen states with a waiver expiring Dec. 31 that face the additional restrictions the Trump administration has placed on new or renewed waivers.

Though it has yet to finalize its decision, the federal Centers for Medicare & Medicaid Services said Arkansas’ 13-year-old waiver does not comply with new “budget neutrality” rules that take effect in January, said Gavin Lesnick, a spokesperson for the Arkansas Department of Human Services. The rules tighten a policy forbidding Medicaid waivers from increasing federal spending on the program beyond what it would have increased without the waiver.

The state is now seeking a two-year extension after hearing from CMS that its request for a five-year renewal would not be granted. If its Medicaid expansion waiver is not renewed, Arkansas officials have said they will continue offering expanded eligibility through existing Medicaid law, a change that could leave enrollees with access to fewer doctors and other health providers.

Rather than place more people in its traditional Medicaid program serving largely children, pregnant women, and disabled people, Arkansas obtained a waiver to buy Affordable Care Act marketplace policies from private insurers for adults covered by the Medicaid expansion. This “private option” gave enrollees greater choice of doctors and other health providers, because some doctors are more willing to see patients with private coverage, which generally pays more than regular Medicaid.

The move helped cut the state’s uninsured rate by nearly half, but it also ended up costing more than if beneficiaries were covered under Medicaid’s traditional, fee-for-service program.

Critics characterize the new waiver rules as part of a Trump administration effort to dramatically shrink Medicaid, the government program for those who are low-income or disabled, which grew rapidly under Presidents Barack Obama and Joe Biden.

“What we have here is a sneaky way to cut Medicaid expansion and the Medicaid program,” said Nicole Huberfeld, a professor of health law at Boston University.

Medicaid enrollees won’t know whom to blame if they lose coverage because the administration is using arcane regulatory processes to make the changes, Huberfeld said.

At issue are waivers granted by the government that allow states flexibility from existing Medicaid law in how they cover low-income residents, as long as the changes will not increase what Medicaid costs the federal government.

Pivoting from the long-standing practice of checking only retroactively whether states were keeping their budget promises, the Trump administration that it would not renew or approve any waivers unless CMS first certified that they would not increase costs to the federal government.

In its , the agency said the new waiver rules are expected to reduce federal spending.

“Characterizing enforcement of a statutory budget neutrality requirement as a cut misrepresents both the law and this guidance,” CMS spokesperson Timothy Foster said in an email to ³Ô¹Ï²»´òìÈ. The federal waivers are intended “to test innovative approaches to delivering care, not provide an open-ended mechanism for increasing federal spending.”

Other states with waivers expiring at the end of December include Georgia, which has added about 18,000 low-income people to Medicaid under its waiver, and California, which has used its waiver to expand coverage of social services including food and housing.

California and Georgia Medicaid officials told ³Ô¹Ï²»´òìÈ that they are still working with CMS in hopes of renewing their waivers. The loss of federal waiver approval could cause states to curtail benefits or eligibility expansions.

In Arkansas, it would mean redesigning the state’s Medicaid expansion program.

Arkansas’ initial waiver was granted in 2013, when its Democratic governor at the time worked with a Republican-controlled legislature to adopt a pioneering style of Medicaid expansion under the Affordable Care Act.

It was one of the first Southern states to expand Medicaid, granting coverage to many low-income residents. Forty states and Washington, D.C., have also fully expanded Medicaid to cover more low-income adults under the law also known as Obamacare.

The state’s Medicaid expansion enrollees were already facing a confusing time. Starting in January, they will need to prove they work or meet an exemption to be eligible for coverage under Trump’s law, the One Big Beautiful Bill Act. And one of the state program’s two private health insurers — Centene — announced in July that it was pulling out at the end of the year.

Sam Dubke, a spokesperson for Republican Arkansas Gov. Sarah Huckabee Sanders, told ³Ô¹Ï²»´òìÈ that the Sanders administration is trying to negotiate a temporary extension of its waiver “to ensure impacted Arkansans maintain access to quality, affordable healthcare during this transition period.”

“Looking ahead to the next legislative session, CMS has provided the state with an opportunity for bold, conservative healthcare reform, and the governor will work with her partners in the legislature to build a sustainable model that maintains the same high quality of care and saves taxpayer dollars,” Dubke said.

The Trump administration’s new restrictions on waivers, implemented under the same law that imposes work requirements as a condition of eligibility and reduces Medicaid spending by about $900 billion over a decade, could affect millions of enrollees and billions in spending. About a third of the almost $600 billion in federal spending on Medicaid and the Children’s Health Insurance Program in 2024 supported programs created by waivers, according to CMS.

In a , the Government Accountability Office found that the three-year spending limit the federal government approved for Arkansas’ Medicaid waiver was nearly $800 million more than what the state would have spent through its traditional Medicaid program.

Arkansas is one of several states that expanded Medicaid under the ACA using a waiver, with others including Indiana, Michigan, New Hampshire, and Iowa.

States will have to clear several more bureaucratic hurdles to retain waivers under the new CMS guidance, said Alice Lam, a managing director with consulting and legal firm Manatt. That could lead to fewer benefits or reduce the number of people eligible for Medicaid, she said.

Robert Nelb, director of policy at America’s Essential Hospitals, which represents safety net hospitals, said he and most experts believed when it passed that the One Big Beautiful Bill Act was merely codifying CMS policy on budget neutrality.

But the Trump administration has interpreted the law to restrict states’ use of waivers, he said.

Nelb said many long-standing waivers that have been renewed multiple times are now at risk and that the loss of state waivers could threaten money hospitals rely on to cover uninsured patients and improve care in their communities.

“There is a real concern that this will put added burdens on states up front and slow down new innovations in Medicaid,” Nelb said.

In 2025, the Trump administration told states it would no longer renew Medicaid waivers to help enrollees with job training or to allow continuous eligibility for adults and children for specific time periods without verifying their income eligibility.

³Ô¹Ï²»´òìÈ 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 ³Ô¹Ï²»´òìÈ and is republished here under a .

]]> 2273141 People With Disabilities Say Medicaid’s Limits on Income Stifle Career Advancement /insurance/medicaid-disabled-work-requirements-income-limits-iowa/ Thu, 13 Aug 2026 09:00:00 +0000 /?p=2269888 MACY, Neb. — Erica Carter is passionate about her job, and she has seven acres of flowers and vegetables to show for it.

Carter’s specialty is reeling in grants to support students in the Omaha Nation school district, where she is a finance manager. One paid for the garden that sits next to the district’s campus. Another allowed the school system, in one of Nebraska’s lowest-income counties, to pay students to maintain it.

“They’re out in the sun. They’re watering plants,” she said. “It’s the first time they get a paycheck in their life.”

Carter, 41, is paralyzed from the chest down, an injury she’s lived with since a fall in her early 20s. It didn’t slow her down as she built her accounting career and got a master’s degree in human resource management.

But in November 2023, Carter — who lives in Sioux City, Iowa — got a letter from Iowa’s Department of Health and Human Services. It said that her income was too high for her to stay on Medicaid and that she might lose her benefits in two weeks if she didn’t take action.

States are scrambling to get ready for a new federal requirement to double-check that many people on Medicaid qualify for the benefit, by showing they are working, volunteering, or studying at least 80 hours per month. Politicians’ focus on requiring work has angered many people with disabilities who have Medicaid and say current policies that apply to them have the opposite effect — making them choose between working or receiving benefits.

‘I Have No Options’

When Carter got the letter, she was making $110,000 a year, well above Iowa’s 2023 income limit for working people with disabilities: $36,450 for a household of one.

“I had no time at all to prepare,” she said. “I had a decision to make.”

At the time, Carter got her health coverage through Iowa’s , a buy-in program that allows working disabled Iowans to pay part of their income to the state to maintain access to Medicaid benefits. Forty-seven states offer , but eligibility through limits on income and assets.

For years, disability rights advocates have pushed state legislatures to change the limits, arguing they prevent people like Carter from accepting raises or building savings, for fear of losing crucial medical benefits. Massachusetts, Minnesota, New Jersey, and Rhode Island have eliminated such limits over the past five years.

To keep her Medicaid coverage, Carter would’ve had to find a job paying her far less than she was making. Or she could drop her Medicaid coverage and enroll in the school district’s health plan. But that plan didn’t cover many of the disability-related expenses that Medicaid did.

Carter decided to keep her job and leave the Medicaid buy-in program. In the end, the decision felt like a no-brainer, she said.

“I like getting up and going to work every day, and I really like what I do,” she said. “Why would I throw that away?”

Erica Carter in her wheelchair seated next to a playground.
Carter says she has helped write grants for projects such as a student-run garden and a new playground for the Omaha Nation public school district in Nebraska. She chose to give up her Medicaid coverage rather than quit her job as a district finance manager when her income surpassed the cap allowed for beneficiaries in an Iowa program for workers with disabilities. (Natalie Krebs/Iowa Public Radio)

But it’s been hard on her finances. Carter said she now spends about $35,000 a year out-of-pocket for expenses her old plan covered, such as the nurse who visits her three times a week, modifications to her car, and wheelchair repairs.

“I had the motors go out on my wheelchair,” she said. “So that was like $4,000 to fix.”

Over the next year, Carter picked up extra jobs and cashed in some of her retirement savings.

“I want to pay my own way. I don’t mind paying taxes,” she said. She doesn’t want to hide her income, either. “I just want an option,” she said. “I have no options right now.”

A Program Intended To Encourage Work

Congress to create Medicaid buy-in programs in the 1990s, intending to incentivize more people with disabilities to work. Iowa was one of the first states to adopt the program.

According to state data, 11,640 Iowans were participating in the buy-in program as of late January, or 1.7% of all Medicaid recipients in Iowa.

The income caps have inched up since Carter got her letter. , set at 250% of the federal poverty level, is $39,900 for a household of one this year.

The rules also restrict recipients from accumulating too much in assets. The is $12,000 for an individual or $24,000 for a married couple, excluding some assets, such as a primary home or vehicle.

Carlyn Crowe, the public policy manager at the , said the limits can prevent disabled Iowans from reaching their goals. “Work full-time and be able to buy a house, live in the community, buy a car,” she said. “Those limits placed on what they can earn and save are keeping them from doing that.”

Crowe’s organization, which has counterparts in every state, is and advocates for people with disabilities. In Iowa, such advocates have asked legislators to drop the hard limits on income and assets. Instead, they suggest that disabled Iowans pay 6% of their income to buy into the Medicaid program, an approach modeled after a 2024 that created a Medicaid buy-in program with no income and asset limits. (Tennessee is waiting on federal approval before starting its program.)

In recent years, these efforts have built bipartisan support and gained traction. An Iowa House committee unanimously in 2025 to remove the income and asset caps, but the bill died after failing to move forward during this spring’s legislative session.

State legislatures now in Medicaid spending estimated at more than $900 billion over 10 years, as part of the One Big Beautiful Bill Act.

, an associate director of KFF’s Program on Medicaid and the Uninsured, said the specific worry is that buy-in programs, though they’re a small part of the larger Medicaid system, could increase overall Medicaid spending if eligibility changes.

“The premiums charged in buy-in programs are nowhere near close to the expected costs of covering people,” Burns said. (KFF is a health policy research, polling, and news organization that includes ³Ô¹Ï²»´òìÈ.)

Focusing on initial cost increases is myopic, said , the director of disability policy at at Iowa’s Drake University. More workers mean additional income tax revenue for states. It also enables some people with disabilities to earn enough to transition off other government assistance programs, such as the Supplemental Nutrition Assistance Program.

“Three, five, seven years from now, you may be recouping those expenses by having people be able to work their way off,” Van Sant said.

Falling Through the Cracks

Iowa lawmakers tried a more modest adjustment during this year’s legislative session. Instead of removing the income limit entirely, they introduced legislation that would raise the cap to 300% of the federal poverty level and exempt pension accounts and a spouse’s income, among other things, from the asset cap.

In the end, the provision was stripped from a wide-ranging public assistance bill. If it had passed, the new income limit would have been one of the for a buy-in program, according to KFF.

, a former City Council member in Sioux City who was paralyzed from the chest down after a diving accident, told state lawmakers during a hearing in February that the proposal was a step in the right direction, but not enough.

“I fear that we’re going to lose people to other states,” said Watters, who added that he was considering moving to Minnesota, which never had an income cap and eliminated asset caps for its in 2024.

Even if Iowa had raised its income limit, Carter would still have been ineligible.

Carter remains committed to her primary job at the school district. She plans to keep working there and taking on additional jobs, seven days a week, so she can pay for her medical needs and continue helping students.

Erica Carter is seen next to the cafeteria in a school building.
Carter makes her way through the cafeteria at the Omaha Nation Public Schools campus, where she works as a finance manager. (Natalie Krebs/Iowa Public Radio)

This article is from a partnership that includes , , and .

³Ô¹Ï²»´òìÈ 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 ³Ô¹Ï²»´òìÈ and is republished here under a .

]]> 2269888 Watch: Why Abortions Are on the Rise Since ‘Roe’ Was Overturned /courts/video-five-things-abortions-increase-since-roe-overturned/ Fri, 07 Aug 2026 09:00:00 +0000 /?p=2264199 Say you live in deep-red Louisiana, a state that has effectively banned abortion. It may be easier for you to get abortion pills now than before the Supreme Court overturned Roe v. Wade. Here’s why — and what it means for future battles over abortion access.

And as a federal court mulls a case that could result in significant restrictions on a pill used in most abortions, healthcare providers say they have alternatives to preserve access even in states with bans in place. Read more here.

³Ô¹Ï²»´òìÈ 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 ³Ô¹Ï²»´òìÈ and is republished here under a .

]]> 2264199 A Sales Tax on Doctor Visits and Medicine? In Missouri, Some Worry /health-care-costs/sales-tax-healthcare-services-missouri-state-amendment-revenue/ Thu, 16 Jul 2026 09:00:00 +0000 /?p=2259065 ST. LOUIS — Missouri healthcare advocate Leslie Ortbals and her husband want to start a family, but she worries they can’t afford it. The 27-year-old said she takes 10 medications daily to manage multiple chronic illnesses.

Now she worries the cost of those drugs could rise — not because of price increases, but because of a tax system revamp put on the ballot by the state’s Republican-dominated legislature and backed by the Republican governor.

Prescription drugs and doctor visits are currently exempt from taxes in the state. But in August, Missouri voters will weigh in on a proposed constitutional amendment to give the legislature the power to replace the state’s income tax with expanded sales taxes, including on goods and services currently exempt.

“Politicians want Missourians to trust them when they say not to worry about our medications and healthcare being up for grabs,” Ortbals said at a June press event organized by Progress MO, a progressive advocacy group.

“I have spent enough time in Jefferson City to know better,” said Ortbals, who works for a Democratic state legislator but was speaking in her personal capacity. “I have watched them speak about protecting life while making lifesaving healthcare less accessible.”

Taxes on healthcare are unusual in the United States but not unprecedented. Most states over-the-counter drugs. Illinois, Missouri’s neighbor, prescription drugs. Delaware, Hawai‘i, New Mexico, and Washington all on services by physicians, dentists, out-of-hospital nursing providers, and medical laboratories.

Critics of the amendment to eliminate income tax in Missouri say it’d be difficult to make up the lost revenue without also imposing taxes on healthcare. Nearly two-thirds of the state’s general revenue budget comes from income taxes, about $8.7 billion in 2026. Failing to make up that revenue could lead to steep cuts in state services.

The proposed tax cut comes at an already precarious time for the state budget. Missouri Gov. Mike Kehoe in spending in this year’s budget over concerns of lagging revenues. The state legislature has passed a since 2022, including . Federal covid aid has propped up the budget in recent years, but the that the surplus is dwindling. And the state is projected to in federal Medicaid funding over 10 years due to cuts from President Donald Trump’s signature One Big Beautiful Bill Act.

Proponents of the Missouri income tax proposal, such as of the Show-Me Institute, a conservative think tank, say the cut would in the state, both of which have been flat in recent years. He doubts healthcare would be among the things subject to sales tax. But even if it were, he said, it could be done in ways that wouldn’t target lower-income residents. New Jersey, for example, (excluding reconstructive surgeries), which tend to be performed on wealthier people.

In a statement to ³Ô¹Ï²»´òìÈ, Kehoe spokesperson Gabby Picard said the governor “will never support extending sales taxes on agriculture, healthcare, or real estate,” noting that the legislature would have to decide what to exempt if the ballot measure passes.

Federal law already prohibits states from imposing taxes on many healthcare services covered by government programs such as Medicare, the federal health insurance program for seniors, and Medicaid, the joint state-federal health insurance program for people with low incomes or disabilities, Picard wrote. More than were insured through those two programs in 2024.

But Jay Hardenbrook, advocacy director for AARP Missouri, argued that raising taxes on healthcare, real estate, and agriculture is the for the amendment, considering the legislature doesn’t need special permission to cut income taxes. He cautioned that because the amendment opens the door to new taxes on anything, it could unleash a “weird feeding frenzy” with special-interest groups lobbying for exemptions.

“Let’s say we do protect prescription drugs from a tax increase; does that mean that the cost of food goes up?” Hardenbrook said.

And if the Missouri measure passes and the legislature exempts healthcare and real estate from new taxes, Hardenbrook worries about cuts to state-funded services like home and community-based care.

“When I talk about taxes going up, and the price of every good and services going up, that’s the best-case scenario,” Hardenbrook said. “The worst-case scenario is that the income tax just goes away, and we just don’t have the money to do the things that we need to do.”

have no income tax, and Washington taxes only capital gains, but of the Institute on Taxation and Economic Policy, a progressive think tank, said the way Missouri is going about its elimination is nearly unprecedented. Only Alaska has repealed a broad-based personal income tax that had previously accounted for a significant portion of the state budget, Davis said.

“The situation in Alaska was they struck oil, and they had this gusher of economic activity and tax revenue that resulted from that,” Davis said. “Missouri has not struck oil.”

A 2012 tax cut in Kansas that reduced income taxes for individuals and eliminated them for some types of businesses created a large budget hole, prompting lawmakers there to the cuts five years later.

Tsapelas of the Show-Me Institute said Missouri’s income tax elimination wouldn’t happen overnight but would instead be more akin to in the state: phased in and tied to revenue targets that would shield the state from massive budget gaps.

“It’s not as doom and gloom as some people are worried about,” Tsapelas said.

But Ortbals, the healthcare advocate, said too many Missourians are already delaying medical care because of costs.

“I want a Missouri where young people can afford to stay, where families can afford to grow, where chronic illness does not become financial ruin,” Ortbals said.

³Ô¹Ï²»´òìÈ 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 ³Ô¹Ï²»´òìÈ and is republished here under a .

]]> 2259065 Facing Funding Losses, States Call Out Big Businesses With Employees on Medicaid /medicaid/medicaid-work-requirement-big-business-employee-enrollees-states-name-shame/ Wed, 15 Jul 2026 09:00:00 +0000 /?p=2258056 As the Trump administration’s January deadline looms for states to enforce new Medicaid work requirements, some state lawmakers are turning the tables by pushing to publicly name the largest companies that have employees enrolled in the government program covering low-income and disabled people.

California lawmakers an expired law that would require the state to identify companies that employ 100 or more people and have employees enrolled in Medi-Cal, the state’s Medicaid program. Nevada has had a similar law in place since 2017, though a proposal for one in Oregon stalled when its legislative session ended in March.

The California bill author, Democratic state Sen. Lola Smallwood-Cuevas, said she is deeply troubled by what is going to happen when work requirements kick in. According to the state, out of more than on Medi-Cal will be subject to the rule.

“We think this is a bill that’s about fairness,” Smallwood-Cuevas said. “It’s a basic principle that taxpayers deserve transparency about which large employers are shifting their healthcare costs onto the public.”

Large employers that regularly top Nevada’s list, such as Walmart and Amazon, have said that the state included part-time and seasonal workers in their counts and that their full-time hourly employees to qualify for Medicaid.

Walmart spokesperson Katrina Proffitt said that the company offers affordable medical coverage to most employees, including eligible part-time workers, and that most of its plans include no-cost virtual care options.

“Healthcare affordability and access to quality care remain real barriers for many Americans, and Walmart continues to be committed to being part of the solution,” Proffitt said.

The push to name and shame companies reflects dueling narratives about the biggest abusers of the joint state-federal Medicaid program, which reached nearly in government spending in 2024. The Trump administration, led by Centers for Medicare & Medicaid Services Administrator Mehmet Oz, has called out blue states for not doing enough to fight insurer fraud and abuse. State Democratic leaders, meanwhile, are pushing back by calling attention to big employers that don’t offer affordable health benefits, which leaves taxpayers subsidizing healthcare costs for the low-wage workforce.

Some states have considered financial penalties. Democratic New Jersey Gov. Mikie Sherrill signed a bill in June that have at least 50 Medicaid-enrolled employees. Companies with 50 to 249 workers on Medicaid per person, and those with at least 500 will pay $725.

Bills that would have penalized companies with workers enrolled in Medicaid failed in this year.

In Sacramento, California, Democrats want to figure out a way to make large businesses pay for their employees’ health coverage. State lawmakers struck a deal with Democratic Gov. Gavin Newsom, who is contemplating a presidential bid as he wraps up his final year in the governor’s office, to explore tax options. Any tax hike would be up to the new governor.

States face of dollars under HR 1, the GOP tax-and-spending law known as the One Big Beautiful Bill Act, notably through that requires nondisabled Medicaid enrollees ages 19 to 64 in most states to prove they are working, volunteering, or going to school at least 80 hours a month to keep their coverage.

Yet federal work requirements are projected to increase the number of uninsured people nationwide by more than 5 million by 2034, according to the . Nebraska and Montana have begun enforcing the rule.

One health policy researcher said employer Medicaid reports highlight the lack of affordable healthcare options available to low-wage workers. More than half of adults enrolled in Medicaid who don’t have dependent children already meet the 80-hour-a-month requirement or face challenges that would likely qualify them for an exemption, .

“There’s a whole set of people who are working — they may not satisfy the work requirement provisions, they may not get the exemption that they’re qualified for, and they don’t have access to that employer-sponsored insurance either,” said Edwin Park, a research professor at the Center for Children and Families at Georgetown University.

Employers Push Back

While employer lists haven’t succeeded in bringing down Medicaid costs, supporters say measuring the burden can be the first step and help lawmakers make the case for further action.

In Nevada, Amazon has employed more Medicaid enrollees than any other company since 2020, according to the state’s report . For state fiscal year 2025, Walmart, the Clark County School District, the state government, and Tesla rounded out the top five.

Employers that the reports are misleading because they have included part-time and seasonal employees. The state’s includes only full-time employees, plus those who could not be confirmed as either full- or part-time employees.

That came to 4,914 Amazon employees and 3,503 Walmart workers in Nevada on Medicaid in 2025.

There are no penalties for companies on the list.

Amazon said it pays its workers more than double the $7.25-an-hour federal minimum wage and noted that Medicaid eligibility is based on household income and size rather than an individual’s wage. That means two employees who earn the same pay may have different eligibility depending on whether they have children or live with parents.

“Pointing fingers at Amazon over Medicaid is a red herring,” said spokesperson Alisa Carroll. “What really needs to happen is a significant and large increase in the federal minimum wage — that would be a big boost for American families.”

Nevada Medicaid spent nearly $950 million on healthcare for more than 133,000 full-time employees and more than 140,000 of their dependents. While the total amount spent dipped in fiscal year 2025, the average cost per member per year increased by nearly 17%.

Yvanna Cancela, a former Nevada lawmaker who sponsored the legislation on Medicaid work reports, said the annual reports force an important conversation “about whether or not this is the kind of economy we want and whether or not it is right or just that people who work full-time don’t make enough to have health insurance.”

A Fraying Safety Net

Health researchers say that uninsured people delay or skip and that their children may end up losing coverage, too.

One analysis found that more than were enrolled in Medicaid and the Children’s Health Insurance Program this April than in January 2025. California is among the states with the among children.

The loss in healthcare coverage among residents will be compounded by the loss of public food assistance benefits, Smallwood-Cuevas said. is pending in the legislature.

She compared Medi-Cal to a trampoline that has become a “very tattered kind of fishnet” overwhelmed by people falling into it. President Donald Trump’s spending-and-tax law pulls and rips at the safety net, she said.

When people lose food assistance and health benefits, they must choose between paying for medicine and paying for rent, Smallwood-Cuevas said.

“We’re going to see more people in their cars, more people on the street, and a lot more people in the emergency room,” she said. “That is dangerous for all of California.”

³Ô¹Ï²»´òìÈ 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 ³Ô¹Ï²»´òìÈ and is republished here under a .

]]> 2258056 Lawmakers Look To Make Abortion Shield Laws Less Dependent on Who’s Governor /courts/shield-laws-abortion-pills-extradition-doctors-governor-california-newsom-hilton-becerra/ Tue, 14 Jul 2026 09:00:00 +0000 /?p=2257779 Your browser does not support the audio element.

Can’t see the audio player? Visit kffhealthnews.org to listen.

When Gov. Gavin Newsom, using his , refused to extradite a physician accused of prescribing and mailing abortion pills to a Louisiana woman, he said California would “not ever” allow “extremist politicians” to punish its doctors.

Newsom, who is considering a run for president, has long championed reproductive rights, but state lawmakers in the Democratically controlled California legislature know future governors might not have the same political beliefs.

Republican gubernatorial candidate Steve Hilton, a former Fox News host endorsed by President Donald Trump, has vowed to honor these types of extradition requests from other states if he’s elected, Louisiana “is trying to uphold what its people voted for, and California is undermining it.” His opponent, Democrat Xavier Becerra, has said he would deny the requests.

Legislation advancing in Sacramento is the latest chapter in a tit for tat that’s been happening between conservative and liberal states since 2022, when the U.S. Supreme Court overturned Roe v. Wade, ending federal legal protections for abortion.

by state Assembly member Rebecca Bauer-Kahan, which is being heard in committee, would take some decisions out of the governor’s hands, requiring governors to deny extradition requests for healthcare providers who prescribe abortion medication or administer gender-affirming care. It would also shield anyone in California who helped patients travel to California or another state to receive legal care. While opponents cast “shield laws” as an incursion on other states’ authority, supporters of the bill view it as insurance — even with Becerra leading Hilton 52% to 31%, according to by the University of California-Berkeley Institute of Government Studies.

Newsom spokesperson Marissa Saldivar said the governor doesn’t comment on pending legislation. Hilton and Becerra didn’t return calls for comment.

“Protecting providers from prosecution should not rely on shifting political winds or a single person’s decision,” said Alyssa Sherer, a nurse practitioner who spoke in support of the bill at a Senate committee hearing in June. Sherer is also the medical director at Hey Jane, a telehealth medication abortion provider. 

Thirteen states have banned abortion outright, and 28 other states ban abortion somewhere between six weeks and viability. At the same time, other states that allow abortion have enacted shield laws to protect doctors and nurses from liability when they prescribe across state lines.

People living in states with total abortion bans are increasingly getting abortion pills prescribed via telehealth, from 74,000 abortions in 2024 to 92,000 abortions in 2025, according to the Guttmacher Institute, citing numbers from its Monthly Abortion Provision Study.

Critics of shield laws say that states have a legitimate interest in enforcing their own statutes and that such laws represent an attempt by some states, like California, to nullify the legal decisions of others.

“If California says, ‘We’re not going to honor any other state’s laws. We’re going to ship abortion pills into your states. You can’t have a law that says abortion is illegal,’ I don’t know — that doesn’t seem like a workable situation,” said Greg Burt, who is vice president of the California Family Council and has spoken in opposition to shield laws at the State Capitol.

Twenty-one other states and Washington, D.C., have similar shield laws, but Arizona, California, Michigan, North Carolina, and Pennsylvania’s rely on an executive order, which could be reversed by a successor, according to the Guttmacher Institute.

Amanda Barrow, a senior staff attorney at the Center on Reproductive Health, Law, and Policy at UCLA Law, said passing extradition protections would put California on firmer footing, because an executive order “could be revoked by a governor who is anti-abortion or anti-gender-affirming-care.”

Hilton has said he would do just that if elected.

“Just as I wouldn’t want to see Louisiana coming in and undermining something that we voted for here in California,” the GOP candidate told KQED in January. 

During a , Becerra said he was strident about protecting reproductive rights as the state’s attorney general. “Absolutely no,” Becerra said of allowing California physicians to be extradited. 

This year, Hawai‘i to its existing shield laws. And Oregon , including banning law enforcement from cooperating with out-of-state or federal investigations into care that’s legal in the state.

But Republican legislators in conservative states have cast telehealth visits as an end run around their laws. And some have moved to restrict abortion pill access.

The governors of , , and have signed bills this year that criminalize the sale, purchase, or distribution of medication that induces an abortion. Those states make it a felony to provide medication abortion drugs to people who are seeking to end a pregnancy. The laws impose up to 10 years in prison with potentially tens of thousands of dollars in fines.

Mississippi amended the state’s controlled substances code to add abortion pills as a criminal category. Although the state already prohibits abortion broadly, the measure specifically addresses distribution, which could subject out-of-state providers to prosecution.

In January, Louisiana a California doctor, Remy Coeytaux, mailing abortion pills to a patient. Newsom denied the request. Likewise, New York Gov. Kathy Hochul denied Louisiana’s February 2025 extradition request for a .

Texas has taken a slightly different legal tact. Attorney General Ken Paxton, a Republican running for the U.S. Senate, obtained a default judgment of more than $100,000 against the New York doctor targeted by Louisiana, but a , citing New York’s shield law. Neither Paxton nor Louisiana Attorney General Liz Murrill responded to requests for comment. 

Fear of being charged with a crime for providing quality medical care is contributing to physicians leaving medicine, said Sacramento emergency room doctor Kamara Graham, who is vice president of the California chapter of the American College of Emergency Physicians, which is supporting the bill.

“It’s really conflicting and hard for us to weigh that concern of: Will I get extradited and charged and potentially be taken away from my family? Or do I do the right thing for my patient?” Graham said.

The availability of medication used in most abortions could soon change nationwide. Under the leadership of Health and Human Services Secretary Robert F. Kennedy Jr., the Food and Drug Administration it is conducting a safety review of mifepristone, one of two medications in pill form that is used in most U.S. abortions. The FDA maintains the drug is safe and effective.

If the FDA were to decide that mifepristone is not safe, such a ruling would supersede state laws, even in states where abortion is legal. If mifepristone is restricted, many telehealth groups have said they would switch to using only the other medication, misoprostol.

“The elephant in the room is whether the Trump administration, particularly after the midterms, makes some kind of move to put national limits on access to abortions,” said Mary Ziegler, a law professor at UC-Davis who has written several books on reproductive health law.

“Not everything is something that the legislature can solve for,” Ziegler said, “because there’s some uncertainty about how the federal courts are going to react to all of this.”

³Ô¹Ï²»´òìÈ 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 ³Ô¹Ï²»´òìÈ and is republished here under a .

]]> 2257779 My ³Ô¹Ï²»´òìÈ for a Psychiatric Bed in an Overburdened Health System /health-industry/psychiatric-bed-shortage-overburdened-health-system/ Thu, 09 Jul 2026 09:00:00 +0000 /?p=2245238

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”

Eight days before my 33rd birthday in April, a social worker at a crisis clinic near Denver determined I was an imminent danger to myself. She placed me on an involuntary 72-hour mental health hold.

What came next wasn’t treatment, but a search for a bed. Clinic staffers called area hospitals with inpatient psychiatric units, asking if they had available beds. They didn’t. So, I was told I had to spend the night at the clinic, which is open 24/7. I settled into a recliner, trying to make myself comfortable as my mind drifted in a blank, disassociated haze. Sleep came in brief bursts.

Since the 1950s, the United States has seen a nationwide due in part to deinstitutionalization and the rise of antipsychotics. But that has created a critical shortage for those needing help. From 2011 to 2023, the number of hospitals with inpatient psychiatric units , according to a 2025 study. Another study from that year found that this country has 28.4 inpatient psychiatric beds per 100,000 people — not even half the 60-bed ratio researchers frequently refer to as the .

The shortage has created what the American Psychiatric Association : emergency rooms overwhelmed with people suffering from severe mental health illnesses, inpatient stays prematurely shortened to speed up bed turnover, and acutely ill individuals left without critical care.

A pen-and-ink illustration shows a scene in three panels. 1 (left): A woman looks up, concerned. She then looks down at her hands, which are shaking over an intake form on a clipboard. 2 (center): An intake nurse talks to the woman, who is sitting in a chair with one leg folded over the other. 3 (right): She tries to answer a question on the form, which is obscured but hints at "why do you feel like you want to..." She scribbles out an answer and tries again. Below, she's seen nervously twirling her hair around her fingers. In the margins of the page, a thunderstorm fills the borders.
(Oona Zenda/³Ô¹Ï²»´òìÈ)

“Where are these people going?” said , an assistant health policy professor at Rutgers University, who co-authored those 2025 studies. “For people who don’t receive this care, they don’t just go away. How is it affecting them? Society? Their families?”

Meanwhile, the White House shut down the part of the national suicide hotline catering to LGBTQ+ youth, President Donald Trump’s 2027 budget proposal calls for cuts to agencies , and Health and Human Services Secretary Robert F. Kennedy Jr. recently announced a plan to .”

A Fractured System

I was already intimately familiar with the country’s fractured mental healthcare system before I was involuntarily committed. What I had yet to experience myself, I saw through my wife: waitlists, outpatient programs stretched beyond capacity, and inpatient psychiatric care so scarce that access often depends on surviving a crisis severe enough to justify it.

She died by suicide after we had separated.

As the years passed, grief and anxiety pushed me from observer to patient.

At the crisis clinic, I woke up the following morning disoriented and groggy. In the bathroom — its door deliberately unable to latch, swinging both ways so staffers could enter in case of an emergency — I stood at the sink and watched the faucet run, trying to piece together how I had ended up here.

A hand-drawn pen and ink illustration. Three panels are set up in a triptych style. 1 (left): We see a scene, through a bathroom mirror, from a memorial of the main character's wife. The wife's picture is obscured by a large flower. There's a condolence card and medical bill on the table in front of the picture frame. 2 (center): The main character's face is reflected in a bathroom mirror as she washes her hands in rushing water. 3 (right): Medical bills, legislation, and a hand holding a pill bottle are all visible in a collage. Around the three panels, water gushes down from above and floods the bottom half of the page.
(Oona Zenda/³Ô¹Ï²»´òìÈ)

America’s history of treating mental illness is long and complicated.

The 19th and 20th centuries saw the removal of people with severe mental disorders from jails and — squalid facilities designed to house the poor — to state asylums that (though they ultimately became ). From the 1860s to the 1930s, the number of psychiatric hospitals increased dramatically, according to the American Psychiatric Association, and by 1955, the number of psychiatric beds in the U.S. peaked at more than half a million.

However, owing to the development of antipsychotics, the belief that psychiatric institutions were inhumane, and President John F. Kennedy’s 1963 to free thousands of Americans from a life in institutions, many state hospitals shut down. An estimated for adults and kids are left in a country where more than 14 million experience severe mental illness each year.

Two years after JFK’s legislation passed, a new policy prohibited federal Medicaid funds from covering inpatient psychiatric care in facilities . The goal was to encourage states to move patients out of large, often substandard psychiatric institutions into community-based care settings.

The consequences of these changes, however, have been far-ranging. People with severe mental illnesses are often forced to as they wait for a bed to open. The length of stay in state psychiatric hospitals , according to research by the Treatment Advocacy Center, a national organization focused on eliminating barriers to the treatment of severe mental illness. And some people with mental illness .

From 1986 to 2014, as the behavioral health crisis intensified, mental health expenditures in the U.S. rose from $32 billion to $186 billion — though the proportion of that spending allocated to inpatient care .

This period also recorded major policy shifts affecting inpatient hospitalization rates, notably the 1999 U.S. Supreme Court decision in Olmstead v. L.C. The ruling shifted care away from psychiatric facilities by mandating states to people with developmental and mental disabilities.

“The road to hell is paved with good intentions,” said Leslie Carpenter, legislative advocacy manager at the Treatment Advocacy Center. “A lot of these bills, including the Community Mental Health Act, were really well intended and ended up with adverse consequences.”

For me, that next day at the clinic passed both painfully slowly and in a blur. A staff member I hadn’t met before told me they were still reaching out to hospitals across the region. The search for a bed continued.

A hand-drawn pen and ink illustration. Three panels are set up in a triptych style. In each, the main character is trying to figure out a comfortable way to sleep in the medical recliner. Dali-esque melting clocks float around her. Paper legislation frames the bottom of the page.
(Oona Zenda/³Ô¹Ï²»´òìÈ)

‘No One Wants To Pay for Any of This Care’

Last year, members of Congress introduced two bills to change the 16-bed Medicaid funding cap at inpatient psychiatric facilities, the and the , which would increase the cap to 36 beds. Both have stalled in the House.

According to the Congressional Budget Office, a federal agency that analyzes budgetary and economic issues, eliminating the 16-bed limit would increase Medicaid expenditures from 2024 to 2033.

“No one wants to pay for any of this care that people need,” said Colorado state Sen. , a Democrat who has witnessed limitations to Colorado’s mental healthcare system firsthand because her son has schizoaffective disorder.

In lieu of federal action, states are stepping up to bridge the gaps.

Colorado, 15 other states, and Washington, D.C., now operate under waivers allowing Medicaid to fund inpatient facilities for mental health treatment, according to KFF data. Seven additional states have waivers pending. One 2025 study found that these waivers may be tied to fewer hospitalizations, emergency department visits, and incarcerations .

Yet even local efforts to improve mental healthcare face resistance. In California, Colorado, Iowa, Missouri, Nebraska, and New York, locals have pushed back against proposed psychiatric facilities for minors, claiming such facilities will worsen safety and lower property values. Behavioral health advocates have disputed these claims and argued they are rooted in stigma.

That psychiatric facility in Colorado was . The state has nearly 20 inpatient beds per 100,000 people, , according to 2022 data across all 50 states plus Washington, D.C., collected by the Treatment Advocacy Center. Wyoming ranked first with 47.3 beds per 100,000 residents, although, as the least populous state, it has only 275 total inpatient beds compared with California’s 5,703. Minnesota ranked last, with only 4.3 inpatient beds per 100,000 residents.

While increasing the number of inpatient psychiatric beds is vital, mental health advocates are also calling for , such as peer support specialists and clubhouses, where people with serious mental illnesses can learn life skills and find community.

A hand-drawn pen and ink illustration. Three panels are set up in a triptych style. 1 (left): The main character is lying in bed, discussing her mental health with a doctor who sits at her bedside. 2 (center): The main character is sleeping peacefully in a hospital bed. 3 (right), top panel: A warm handshake radiates good vibrations. Bottom panel: An empty hospital bed with a hand-written note that says "thank you" on its pillow. In the margins/borders of the page, a moon and sun radiate in the background, while new flowers bloom after the drenching storm of the previous images.
(Oona Zenda/³Ô¹Ï²»´òìÈ)

When it came time for me to use our mental health safety net, I was among the fortunate ones: At noon the day after my hold began, a bed opened at a hospital in Denver — a rare stroke of luck in a system in which many people wait days or weeks for the care they need. An ambulance transferred me to the hospital at 3 p.m., marking 21 hours into my 72-hour hold.

Two days later, on my last day at the psychiatric hospital, I stood outside the nurse’s station awaiting discharge papers.

A man I had not seen before looked at me and asked, “Are you leaving?”

“Yes,” I said. “Are you being admitted?”

“Yeah,” he responded. “This is my third time being hospitalized in a year.”

I shook his hand. “Good luck,” I said, and I walked out the door.

³Ô¹Ï²»´òìÈ 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 ³Ô¹Ï²»´òìÈ and is republished here under a .

]]> 2245238 Newsom Vowed To Transform Kids’ Mental Health. Many California Schools Are Still Waiting. /mental-health/newsom-children-mental-health-initiative-schools-left-waiting/ Wed, 01 Jul 2026 09:00:00 +0000 /?p=2251609

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”

QUINCY, Calif. — When Taletha Washburn and the staff at Plumas Charter School first heard that California wanted to help schools treat more kids struggling with mental health, it felt like a well-timed remedy for a rural community where families struggle to find care.

Getting the program funding up and running, however, has proved difficult.

Employees spent two years “spinning our wheels,” attending state-led webinars, filling out countless forms, and researching electronic health record systems to prepare, said Washburn, the school’s executive director. When they reached out for assistance, she said, they waited months for a state response.

The school received its first reimbursement check in April. Washburn said the school has been reimbursed $8,000 and has at least $12,000 in outstanding claims. For a program Washburn had thought could be a game changer in her small rural town, it’s been a disappointing bust.

Plumas Charter is among roughly 1,000 public schools, community colleges, and universities that participate in Gov. Gavin Newsom’s first-in-the-nation initiative requiring that health insurance companies reimburse them for on-campus behavioral healthcare. California schools have been adding counselors, therapists, and psychiatrists to provide services where young people spend most of their time, making mental health treatment more accessible to kids whose families might have spent months waiting to see private therapists.

Five years after the program’s launch, Washburn and other California school officials say they have encountered a rollout fraught with inadequate guidance from the state, an incomplete billing infrastructure, a lack of standardized forms, and persistent delays signing up and getting paid. More than half of California’s school systems and colleges don’t participate in the billing program. Of those that do, fewer than one-fifth as of June 1, according to the latest state data.

An exterior photo of Plumas Charter School.
Plumas Charter School students have experienced trauma from the covid-19 pandemic and recent wildfires. (Christine Mai-Duc/³Ô¹Ï²»´òìÈ)
Plumas Charter School Executive Director Taletha Washburn says the school’s experiences navigating the state’s new behavioral health billing program soured it on the initiative. (Christine Mai-Duc/³Ô¹Ï²»´òìÈ)

The program hasn’t come close to bringing in the half-billion dollars in promised revenue to cover the salaries of thousands of counselors, therapists, and wellness coaches, many of whom school districts hired with a deluge of federal covid pandemic funding. As a result, schools across California have issued amid local budget cuts.

“One of the things that makes people hate government is when we make a promise and then we struggle to keep that promise because we can’t get the administrative part of it up and running,” said state lawmaker Dawn Addis, a former special education teacher and Democrat who has criticized the program’s slow implementation.

Newsom’s office declined to make the governor available for an interview for this article. At a May press conference to release his final state budget proposal, the Democratic governor pointed to the “unprecedented” initiative, saying “no other state in the nation has done more.”

“We have a lot more work to do to deal with the crisis of our time,” Newsom said. “Making investments in wellness, not just physical health, but mental health for our kids, is a good investment.”

He did not answer when asked whether he considered the program a success.

Tom Insel, the former head of the National Institute of Mental Health, who has advised Newsom, said the rocky rollout, in many ways, reflects the groundbreaking nature of what California is trying to do. Still, given the level of investment so far, he too had expected clearer evidence of dramatic improvement.

“What we struggle with in California is: We spend the money, but we don’t always see the outcomes. It’s sobering to realize, especially as an advocate, that you could actually get the programs, get the money, get everything that you want from the policy side, but the execution just isn’t there.”

A First-in-the-Nation Plan?

In 2021, 1 in 10 high school students nationwide said they’d attempted suicide, by then the second-leading cause of death for young people ages 10 to 24.

In response, Newsom announced a “Master Plan for Kids’ Mental Health,” promising an overhaul of California’s behavioral health system that he said would be transformative. National mental health experts said Newsom’s initiative was the most ambitious attempt of any state to tackle a youth mental health crisis that had metastasized during the pandemic.

The state funneled $730 million in one-time funding into workforce efforts, such as campaigns to recruit mental health workers and programs to repay student loans. An additional $220 million has gone to facilitate partnerships between local governments and school officials, and $381 million was distributed in grants to schools and community groups for facilities or services, according to an analysis of program funding by ³Ô¹Ï²»´òìÈ.

The state has spent roughly $532 million to date on digital apps designed to connect families with counseling and provide a consultation service for primary care physicians handling behavioral health issues outside their expertise, while an additional $232 million has gone toward state operations and program evaluations.

And the state has added 1,855 school counselors since 2021, according to statistics from the American School Counselor Association, which in recent years has integrated mental health into professional standards. That’s well below the 10,000 Newsom had pledged by the end of this year as part of his initiative.

The of Newsom’s Children and Youth Behavioral Health Initiative focused on schools and was designed to increase behavioral health services on campus — at no cost to families. Schools would be able to bill health insurers, who would be required to reimburse them.

Some $1.3 billion — nearly a third of the total investment — has gone toward setting up campus wellness centers, new billing infrastructure, and beefing up school-based mental health support in other ways.

Filing claims became an administrative nightmare for schools unfamiliar with the complex world of medical billing.

A green binder labelled "Children & Youth Behavioral Health."
Plumas Charter School staffers collected paperwork, webinar printouts, and other documents over the two years it took them to enroll and start billing for services in the Children and Youth Behavioral Health Initiative. (Christine Mai-Duc/³Ô¹Ï²»´òìÈ)

In February 2025, when the Fresno County Office of Education launched its medical billing, it felt “like building the plane while flying it,” Trina Frazier, assistant superintendent of student services, told lawmakers in a public hearing a couple of months later. The delays were so acute that lawmakers last year authorized $20 million in grants to Fresno and 170 other school systems so they wouldn’t have to lay off newly hired mental health staffers while waiting for reimbursements.

Anaheim Elementary School District in Orange County, which state officials called a “champion” of the program, has recouped more than $1.1 million since its 23 campuses began billing student insurance in February 2025, said program specialist Shirley Diaz.

Still, that accounts for less than 30% of the behavioral health services the district has provided to students over that time. It’s not just the complexity of medical billing that has hampered the claims process. Parents have also been reluctant to provide health insurance information in the largely Latino district, where residents have been fearful of immigration raids carried out by the Trump administration.

To help administer claims across California, the state signed a $65 million contract with Carelon Behavioral Health, a service , one of the nation’s largest health insurers. But schools have struggled to get claims cleared, and many have spent hundreds of thousands of dollars to troubleshoot and bill claims.

As of June 1, the Boston-based administrator has approved about 232,100 claims totaling more than $11.3 million to 186 school districts and educational agencies, according to the Department of Health Care Services.

That’s a small fraction of the thousands of entities the state had hoped would participate and far from the $500 million a year state officials told schools the program could eventually provide for school-based mental health services.

“We probably were given the impression that this was going to happen more quickly and now there’s this reality of a kind of slow growth,” said Amy Blackshaw, behavioral health project director for the California School-Based Health Alliance.

Two binders rest on a shelf. The left one is labelled "Carelon." The one of the right is labelled "Qualifacts."
Binders full of documentation for the Children and Youth Behavioral Health Initiative sit in the office of Maggie Hennessy, business manager for Plumas Charter School. (Christine Mai-Duc/³Ô¹Ï²»´òìÈ)

Carelon contract manager Christina Kim declined to comment to ³Ô¹Ï²»´òìÈ and referred questions to the state. Autumn Boylan, deputy director of the Office of Strategic Partnerships at DHCS, said staff members incorporated early feedback from school districts and extended claim deadlines, loosened onboarding requirements, and hosted webinars and office hours. But changes of this magnitude, she said, take time.

“We’re trying to help the school districts increase their scale,” Boylan told lawmakers at a May 4 hearing. “It’s not a problem of claims being submitted and not paid. It’s a problem of claims not yet being submitted for payment.”

Boylan noted the volume of reimbursements has increased exponentially since the first claims were filed in November 2024.

Meanwhile, children and youths continue to struggle and have trouble accessing care. In 2024, nearly ages 12-17, for example, reported delaying or skipping mental healthcare because they couldn’t get an appointment, while 1 in 4 teens said they did so because of cost, up from roughly 6.5% the previous year, according to data from the California Health Interview Survey.

The share of young adults 18-24 who reported ever seriously considering suicide has stabilized but remains higher than pre-pandemic, according to the annual survey, conducted by the UCLA Center for Health Policy Research.

And while the suicide rate among Californians ages 12-25 has dropped from its high in 2021, this mirrors national trends, and state rates for female and Black youths increased from 2023 to 2024. “We have to have high expectations that when we invest in the magnitude of billions as this program did, we would have results to show,” said Assembly member David Alvarez, a Democrat in San Diego.

Other states have taken note of California’s implementation difficulties, some adopting a few strategies rather than the dozens California chose to roll out at once, said Sharon Hoover, formerly the co-director of the National Center for School Mental Health at the University of Maryland. Illinois, for instance, has focused on universal mental health screenings for schoolchildren while Colorado has expanded coverage of some behavioral health services for youths who lack a formal diagnosis.

“It’s always hard to be first, and someone has to be brave enough and hopeful enough to take that leap,” Hoover said.

Launching its reimbursement program before billing infrastructure was in place, Hoover said, created momentum but also posed challenges to school districts and providers. Still, she added, Newsom’s focus on prevention and early intervention became one of the biggest national policy shifts in years.

“We’re going to look back on this thinking it was one of the most progressive actions in the history of public systems,” said Alex Briscoe, a principal at the nonprofit Public Works Alliance who has pushed for system reform in kids’ mental health. “We spent a significant amount of money preparing for it. I just don’t think we did that very well or strategically.”

Rural Schools Struggle Most

A photo of a street lined with small shops in a Northern California mountain town. Fog rises over the treetops in the distance.
Quincy, California, at the heart of what’s known as the “Lost Sierra,” is a remote Northern California town where kids’ behavioral health needs are high and wait times to get help are long. (Christine Mai-Duc/³Ô¹Ï²»´òìÈ)

Students at Plumas Charter School had endured a relentless wave of trauma by fall 2021. Wildfires, covid shutdowns, and, weeks into the school year, a car accident that killed a classmate and left two others severely injured. Teachers saw signs of depression, anxiety, and frequent outbursts among their K-12 students. Nine kids that year reported considering suicide, an all-time high.

So, the school hired a full-time therapist and wellness coach with temporary federal funds.

Senior Will Coelho wasn’t there for any of it, but by the time he arrived in the remote California logging town of Quincy a year later, he’d been through plenty of his own loss.

Days before the pandemic lockdowns, a friend had died in a . Isolated at home, Coelho struggled to process his grief, he said. That year, his stepfather became increasingly violent and, after a bitter, years-long custody fight, Coelho left the Central Valley to move in with his dad in the remote town in Northern California, just weeks before starting high school.

One day, he found himself chatting with a faculty adviser, the new kid half-joking about therapy. At her suggestion, Coelho started seeing the school therapist weekly, on campus and free of charge.

“It has had a large impact on the way I process emotions and my outlook on life,” he said.

Behind the scenes, school officials struggled with how they would continue to cover the therapist’s salary.

Twice, the state rejected the school’s application to the state’s landmark billing program, telling school officials they hadn’t met all the requirements, such as having sufficient systems to bill private insurers and collect student insurance information.

When school staffers flagged difficulties filing claims online, Washburn added, state officials suggested they submit paper claims instead.

The experience has soured Washburn and her staff on the program, which she said doesn’t work for small rural districts like hers where the human resources director is also the office business manager, and the faculty member who manages discipline also teaches PE.

DHCS spokesperson Tony Cava said that many charter schools are small and wouldn’t be expected to participate. While charter schools make up about half of eligible entities, Cava said, they serve only 12% of California’s students.

Lawmakers who represent small, rural districts have argued the program should be able to serve all kids. Early this year, Addis proposed legislation that would give intensive technical help to school officials who need it.

Even if it passes, it may be too late to help Plumas Charter. Washburn is unsure her school will reap enough revenue to pay for their therapist. “In theory, this should be a good program,” Washburn said. “We’re too small, and our funds are too limited to just keep waiting.”

³Ô¹Ï²»´òìÈ 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 ³Ô¹Ï²»´òìÈ and is republished here under a .

]]> 2251609 Efforts To End School Vaccine Mandates Hit a Wall in Florida /health-industry/ending-vaccine-mandates-schools-florida-joseph-ladapo-measles/ Fri, 26 Jun 2026 09:00:00 +0000 /?p=2251623 Every state, along with Washington, D.C., requires children to obtain certain vaccinations before they can attend school or childcare. These mandates date back decades, and many public health experts consider them a foundational defense against infectious disease.

Since the summer of 2025, Florida leaders have aimed to make the state the first to drop some of those vaccine mandates. The anti-vaccine rhetoric has often been positioned as a push for “medical freedom.” Related efforts to revise laws and regulations rumbled along at the state health department and in the legislature for months.

But by the end of April, the fight seemed to have stalled out.

In the opening minutes of a special session on April 28, the Republican speaker of the Florida House, Daniel Perez, refused to bring the vaccine issue to the floor.

“There is some concern here, on my behalf, about children being in school without measles, mumps, polio, and chickenpox vaccines that have been working for decades,” Perez told reporters afterward.

For now, at least, the push to end childhood vaccine mandates has failed in Florida, and that outcome could offer insights into such efforts’ chances in other states. An Associated Press analysis found that at least 350 anti-vaccine bills in state legislatures last year. Many focused on relaxing requirements for vaccines in schools.

Ladapo: Mandates Are Bodily ‘Slavery’

Last September, Gov. Ron DeSantis and Florida Surgeon General Joseph Ladapo set the stage for the anti-vaccine campaign. They held a news conference at a private Christian school east of Tampa, where the state would work to end all vaccine mandates in Florida law.

“Every last one of them is wrong and drips with disdain and slavery,” he said.

“Who am I, as a government or anyone else,” Ladapo said, “or who am I as a man standing here now, to tell you what you should put in your body?”

Political analysts say that the prospects for efforts to cut back on vaccine mandates are closely tied to the political prospects of Republicans trying to maintain their majorities at the state and federal levels. DeSantis is term-limited, and his governorship ends in January. And the congressional midterms are in November.

“For Republicans, they’re a little bit leery,” said , an associate professor of political science at the University of Central Florida. “They know we’re in an election cycle. They know political history. And it’s pretty clear that the president’s party tends to lose seats in the midterm election.”

Although hundreds of anti-vaccine bills have been introduced in state legislatures, the noisy rhetoric and splashy headlines don’t guarantee passage, said , an associate professor of health policy at Georgetown University.

In many states, including Florida, “there’s a disconnect between what we hear a lot from a potentially vocal minority about how they feel about vaccines compared to where the majority of people really are,” Whitener said.

“For most people,” she said, ”they still support the idea of near-universal vaccination, still understand the importance of vaccinating children to protect people who can’t be vaccinated.”

A last year by KFF and The Washington Post showed 81% of parents supported school vaccine requirements.

“They support these vaccines,” said , a senior vice president at KFF, a health information nonprofit that includes ³Ô¹Ï²»´òìÈ. “They support protecting their kids through these mandates. And that includes Florida parents.”

Unwinding Mandates by Law, and by Regulation

To undo some of the vaccine mandates, Florida’s legislature would have to pass new bills. Others could be changed by a rulemaking process at the state Department of Health, including for chickenpox, hepatitis B, pneumococcal conjugate, and Haemophilus influenzae type B.

At a Dec. 12 forum in Panama City hosted by the health department, public comment went on for hours, with those who wanted to keep the mandates slightly outnumbering those who opposed them.

“This is about freedom,” said one speaker, Larry Downs Jr. “The default setting should be freedom, not these corporate chemical vaccine injections.”

Florida schoolteacher Marion Fesmire has worked overseas. She defended vaccine requirements in part because of some of the suffering she has seen.

“I’ve seen kids with polio. I’ve seen blind kids. I’ve seen kids die before they’re even 10 years old. It’s heartbreaking,” Fesmire said.

The health department hasn’t held any more public forums on vaccines since then.

Nor has the department filed the paperwork needed to change the vaccination rules, including a statement of regulatory costs. In that, the department must estimate whether changing the rules could affect personal income, the number of visitors to the state, or the size of the Florida workforce.

In an April 13 email, the health department said that it is “currently in the rulemaking process” and that any updates would be posted in the Florida Administrative Registrar.

Pushing for a New Exemption

During the winter legislative session, a , didn’t include removing mandates but did feature a new kind of exemption. In addition to a religious or medical exemption, a parent could exempt a child for reasons of personal conscience. This type of exemption is .

Democrats, the minority in the Florida Legislature, came out against it.

“It’s currently very easy to opt out for religious reasons from school immunizations,” state Sen. (D) said while speaking from the chamber floor. “Why is this bill necessary? Given that context, is your bill just about giving people more options to ignore school immunizations, or is it intended to solve a public health problem?”

A few Republicans also opposed the bill. State Sen. (R) brought up the measles outbreak. Florida is the state with the number of measles cases this year, with 155 as of June 6.

“I truly believe that this is a dangerous bill, and I cannot vote for it,” Harrell said.

The bill also included a permanent ban on mandates for any mRNA-based vaccines and would have allowed nonprescription sales of ivermectin. That anti-parasite medication rose to popularity as an alternative treatment for covid, although the Food and Drug Administration determined that the available clinical trial data does not demonstrate effectiveness against covid in humans.

Florida’s previous surgeon general, Scott Rivkees, , calling it “the equivalent of walking into a pharmacy and requesting amoxicillin for a self-diagnosed infection.”

In the end, when the failed to make it to committee.

Yet, people on both sides say the Florida fight is far from over, especially given the lingering mistrust of the medical establishment after the covid pandemic.

“There are many more people now who have skepticism about the wisdom of public health policy and law,” said Barbara Loe Fisher, an anti-vaccine activist who has been working to end mandates since the early 1980s.

“I don’t think that that’s going to disappear,” she said. “I think it’s going to grow.”

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