HHS guidance addresses federal prohibitions on explicit and pretextual race-based discrimination and transparently identifies investigation priorities.

When the news broke on Jan. 31 that a New York physician had been indicted for shipping abortion medications to a woman in Louisiana, it stoked fear across the network of doctors and medical clinics who engage in similar work.

“It’s scary. It’s frustrating,” said Angel Foster, co-founder of the Massachusetts Medication Abortion Access Project, a clinic near Boston that mails mifepristone and misoprostol pills to patients in states with abortion bans. But, Foster added, “it’s not entirely surprising.”

Ever since the Supreme Court overturned Roe v. Wade in 2022, abortion providers like her had been expecting prosecution or another kind of legal challenge from states with abortion bans, she said.

“It was unclear when those tests would come, and would it be against an individual provider or a practice or organization?” she said. “Would it be a criminal indictment, or would it be a civil lawsuit,” or even an attack on licensure? she wondered. “All of that was kind of unknown, and we’re starting to see some of this play out.”

The indictment also sparked worry among abortion providers like Kohar Der Simonian, medical director for Maine Family Planning. The clinic doesn’t mail pills into states with bans, but it does treat patients who travel from those states to Maine for abortion care.

“It just hit home that this is real, like this could happen to anybody, at any time now, which is scary,” Der Simonian said.

Der Simonian and Foster both know the indicted doctor, Margaret Carpenter.

“I feel for her. I very much support her,” Foster said. “I feel very sad for her that she has to go through all of this.”

On Jan. 31, Carpenter became the first U.S. doctor criminally charged for providing abortion pills across state lines — a medical practice that grew after the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision on June 24, 2022, which overturned Roe.

Since Dobbs, 12 states have enacted near-total abortion bans, and an additional 10 have outlawed the procedure after a certain point in pregnancy, but before a fetus is viable.

Carpenter was indicted alongside a Louisiana mother who allegedly received the mailed package and gave the pills prescribed by Carpenter to her minor daughter.

The teen wanted to keep the pregnancy and called 911 after taking the pills, according to an NPR and KFF Health News interview with Tony Clayton, the Louisiana local district attorney prosecuting the case. When police responded, they learned about the medication, which carried the prescribing doctor’s name, Clayton said.

On Feb. 11, Louisiana’s Republican governor, Jeff Landry, signed an extradition warrant for Carpenter. He later posted a video arguing she “must face extradition to Louisiana, where she can stand trial and justice will be served.”

New York’s Democratic governor, Kathy Hochul, countered by releasing her own video, confirming she was refusing to extradite Carpenter. The charges carry a possible five-year prison sentence.

“Louisiana has changed their laws, but that has no bearing on the laws here in the state of New York,” Hochul said.

Eight states — New York, Maine, California, Colorado, Massachusetts, Rhode Island, Vermont, and Washington — have passed laws since 2022 to protect doctors who mail abortion pills out of state, and thereby block or “shield” them from extradition in such cases. But this is the first criminal test of these relatively new “shield laws.”

The telemedicine practice of consulting with remote patients and prescribing them medication abortion via the mail has grown in recent years — and is now playing a critical role in keeping abortion somewhat accessible in states with strict abortion laws, according to research from the Society of Family Planning, a group that supports abortion access.

Doctors who prescribe abortion pills across state lines describe facing a new reality in which the criminal risk is no longer hypothetical. The doctors say that if they stop, tens of thousands of patients would no longer be able to end early pregnancies safely at home, under the care of a U.S. physician. But the doctors could end up in the crosshairs of a legal clash over the interstate practice of medicine when two states disagree on whether people have a right to end a pregnancy.

Doctors on Alert but Remain Defiant

Maine Family Planning, a network of clinics across 19 locations, offers abortions, birth control, gender-affirming care, and other services. One patient recently drove over 17 hours from South Carolina, a state with a six-week abortion ban, Der Simonian said.

For Der Simonian, that case illustrates how desperate some of the practice’s patients are for abortion access. It’s why she supported Maine’s 2024 shield law, she said.

Maine Family Planning has discussed whether to start mailing abortion medication to patients in states with bans, but it has decided against it for now, according to Kat Mavengere, a clinic spokesperson.

Reflecting on Carpenter’s indictment, Der Simonian said it underscored the stakes for herself — and her clinic — of providing any abortion care to out-of-state patients. Shield laws were written to protect against the possibility that a state with an abortion ban charges and tries to extradite a doctor who performed a legal, in-person procedure on someone who had traveled there from another state, according to a review of shield laws by the Center on Reproductive Health, Law, and Policy at the UCLA School of Law.

“It is a fearful time to do this line of work in the United States right now,” Der Simonian said. “There will be a next case.” And even though Maine’s shield law protects abortion providers, she said, “you just don’t know what’s going to happen.”

Data shows that in states with total or six-week abortion bans, an average of 7,700 people a month were prescribed and took mifepristone and misoprostol to end their pregnancies by out-of-state doctors practicing in states with shield laws. The data, covering the second quarter of 2024, is part of a #WeCount report estimating the volume and types of abortions in the U.S., conducted by the Society of Family Planning.

Among Louisiana residents, nearly 60% of abortions took place via telemedicine in the second half of 2023 (the most recent period for which estimates are available), giving Louisiana the highest rate of telemedicine abortions among states that passed strict bans after Dobbs, according to the #WeCount survey.

Organizations like the Massachusetts Medication Abortion Access Project, known as the MAP, are responding to the demand for remote care. The MAP was launched after the Dobbs ruling, with the mission of writing prescriptions for patients in other states.

During 2024, the MAP says, it was mailing abortion medications to about 500 patients a month. In the new year, the monthly average has grown to 3,000 prescriptions a month, said Foster, the group’s co-founder.

The majority of the MAP’s patients — 80% — live in Texas or states in the Southeast, a region blanketed with near-total abortion restrictions, Foster said.

But the recent indictment from Louisiana will not change the MAP’s plans, Foster said. The MAP currently has four staff doctors and is hiring one more.

“I think there will be some providers who will step out of the space, and some new providers will step in. But it has not changed our practice,” Foster said. “It has not changed our intention to continue to practice.”

The MAP’s organizational structure was designed to spread potential liability, Foster said.

“The person who orders the pills is different than the person who prescribes the pills, is different from the person who ships the pills, is different from the person who does the payments,” she explained.

In 22 states and Washington, D.C., Democratic leaders helped establish shield laws or similarly protective executive orders, according to the UCLA School of Law review of shield laws.

The review found that in eight states, the shield law applies to in-person and telemedicine abortions. In the other 14 states plus Washington, D.C., the protections do not explicitly extend to abortion via telemedicine.

Most of the shield laws also apply to civil lawsuits against doctors. Over a month before Louisiana indicted Carpenter, Texas Attorney General Ken Paxton filed a civil suit against her. A Texas judge ruled against Carpenter on Feb. 13, imposing penalties of more than $100,000.

By definition, state shield laws cannot protect doctors when they leave the state. If they move or even travel elsewhere, they lose the first state’s protection and risk arrest in the destination state, and maybe extradition to a third state.

Physicians doing this type of work accept there are parts of the U.S. where they should no longer go, said Julie F. Kay, a human rights lawyer who helps doctors set up telemedicine practices.

“There’s really a commitment not to visit those banned and restricted states,” said Kay, who worked with Carpenter to help start the Abortion Coalition for Telemedicine.

“We didn’t have anybody going to the Super Bowl or Mardi Gras or anything like that,” Kay said of the doctors who practice abortion telemedicine across state lines.

She said she has talked to other interested doctors who decided against doing it “because they have an elderly parent in Florida, or a college student somewhere, or family in the South.” Any visits, even for a relative’s illness or death, would be too risky.

“I don’t use the word ‘hero’ lightly or toss it around, but it’s a pretty heroic level of providing care,” Kay said.

Governors Clash Over Doctor’s Fate

Carpenter’s case remains unresolved. New York’s rebuff of Louisiana’s extradition request shows the state’s shield law is working as designed, according to David Cohen and Rachel Rebouché, law professors with expertise in abortion laws.

Louisiana officials, for their part, have pushed back in social media posts and media interviews.

“It is not any different than if she had sent fentanyl here. It’s really not,” Louisiana Attorney General Liz Murrill told Fox 8 News in New Orleans. “She sent drugs that are illegal to send into our state.”

Louisiana’s next step would be challenging New York in federal courts, according to legal experts across the political spectrum.

NPR and KFF Health News asked Clayton, the Louisiana prosecutor who charged Carpenter, whether Louisiana has plans to do that. Clayton declined to answer.

Case Highlights Fraught New Legal Frontier

A major problem with the new shield laws is that they challenge the basic fabric of U.S. law, which relies on reciprocity between states, including in criminal cases, said Thomas Jipping, a senior legal fellow with the Heritage Foundation, which supports a national abortion ban.

“This actually tries to undermine another state’s ability to enforce its own laws, and that’s a very grave challenge to this tradition in our country,” Jipping said. “It’s unclear what legal issues, or potentially constitutional issues, it may raise.”

But other legal scholars disagree with Jipping’s interpretation. The U.S. Constitution requires extradition only for those who commit crimes in one state and then flee to another state, said Cohen, a law professor at Drexel University’s Thomas R. Kline School of Law.

Telemedicine abortion providers aren’t located in states with abortion bans and have not fled from those states — therefore they aren’t required to be extradited back to those states, Cohen said. If Louisiana tries to take its case to federal court, he said, “they’re going to lose because the Constitution is clear on this.”

“The shield laws certainly do undermine the notion of interstate cooperation, and comity, and respect for the policy choices of each state,” Cohen said, “but that has long been a part of American law and history.”

When states make different policy choices, sometimes they’re willing to give up those policy choices to cooperate with another state, and sometimes they’re not, he said.

The conflicting legal theories will be put to the test if this case goes to federal court, other legal scholars said.

“It probably puts New York and Louisiana in real conflict, potentially a conflict that the Supreme Court is going to have to decide,” said Rebouché, dean of the Temple University Beasley School of Law.

Rebouché, Cohen, and law professor Greer Donley worked together to draft a proposal for how state shield laws might work. Connecticut passed the first law — though it did not include protections specifically for telemedicine. It was signed by the state’s governor in May 2022, over a month before the Supreme Court overturned Roe, in anticipation of potential future clashes between states over abortion rights.

In some shield-law states, there’s a call to add more protections in response to Carpenter’s indictment.

New York state officials have. On Feb. 3, Hochul signed a law that allows physicians to name their clinic as the prescriber — instead of using their own names — on abortion medications they mail out of state. The intent is to make it more difficult to indict individual doctors. Der Simonian is pushing for a similar law in Maine.

Samantha Glass, a family medicine physician in New York, has written such prescriptions in a previous job, and plans to find a clinic where she could offer that again. Once a month, she travels to a clinic in Kansas to perform in-person abortions.

Carpenter’s indictment could cause some doctors to stop sending pills to states with bans, Glass said. But she believes abortion should be as accessible as any other health care.

“Someone has to do it. So why wouldn’t it be me?” Glass said. “I just think access to this care is such a lifesaving thing for so many people that I just couldn’t turn my back on it.”

This article is from a partnership that includes WWNO, NPR, and KFF Health News.

KFF Health News 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 KFF.

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JACKSON, Miss. — Storm clouds hung low above a community center in Jackson, where pastor Andre Devine invited people inside for lunch. Hoagies with smoked turkey and ham drew the crowd, but several people lingered for free preventive health care: tests for HIV and other diseases, flu shots, and blood pressure and glucose monitoring.

Between greetings, Devine, executive director of the nonprofit group Hearts for the Homeless, commiserated with his colleagues about the hundreds of thousands of dollars their groups had lost within a couple of weeks, swept up in the Trump administration’s termination of research dollars and clawback of more than $11 billion from health departments across the country.

Devine would have to scale back food distribution for people in need. And his colleagues at the nonprofit health care group My Brother’s Keeper were worried they’d have to shutter the group’s mobile clinic — an RV offering HIV tests, parked beside the community center that morning. Several employees had already been furloughed and the cuts kept coming, said June Gipson, CEO of My Brother’s Keeper.

“People can’t work without being paid,” she said.

The directors of other community-based groups in Mississippi, Alabama, Louisiana, and Tennessee told KFF Health News they too had reduced their spending on HIV testing and outreach because of delayed or slashed federal funds — or they were making plans to do so, anticipating cuts to come.

Scaling back these efforts could prove tragic, Gipson said. Without an extra boost of support to get tested or stay on treatment, many people living with HIV will grow sicker and stand a greater chance of infecting others.

President Donald Trump, in his first term, promised to end America’s HIV epidemic — and he put the resources of the federal government behind the effort. This time, he has deployed the powers of his office to gut funding, abandoning those communities at highest risk of HIV.

Trump’s earlier efforts targeted seven Southern states, including Mississippi, where funds went to community groups and health departments that tailor interventions to historically underserved communities that face discrimination and have less access to quality education, health care, stable income, and generational wealth. Such factors help explain why Black people accounted for 38% of HIV diagnoses in the United States in 2023, despite representing only 14% of the population, and also why half of the country’s new HIV infections occur in the South.

Now, Trump is undermining HIV efforts by barring funds from programs built around diversity, equity, and inclusion. A Day One executive order said they represent “immense public waste and shameful discrimination.”

Since then, his administration has cut millions of dollars in federal grants to health departments, universities, and nonprofit organizations that do HIV work. And in April, it eliminated half of the Centers for Disease Control and Prevention’s 10 HIV branch offices, according to an email to grant recipients, reviewed by KFF Health News, from the director of the CDC’s Division of HIV Prevention. The layoffs included staff who had overseen the rollout of HIV grants to health departments and community-based groups, like My Brother’s Keeper.

The CDC provides more than 90% of all federal funding for HIV prevention — about $1 billion annually. The Trump administration’s May 2 budget proposal for fiscal 2026 takes aim at DEI initiatives, including in its explanation for cutting $3.59 billion from the CDC. Although the proposal doesn’t mention HIV prevention specifically, the administration’s drafted plan for HHS, released mid-April, eliminates all prevention funding at the CDC, as well as funding for Trump’s initiative to end the epidemic.

Eliminating federal funds for HIV prevention would lead to more than 143,000 additional people in the U.S. becoming infected with HIV within five years, and about 127,000 additional people who die of AIDS-related causes, according to estimates from the Foundation for AIDS Research, a nonprofit known as amfAR. Excess medical costs would exceed $60 billion, it said.

Eldridge Dwayne Ellis, the coordinator of the mobile testing clinic at My Brother’s Keeper, said curbing the group’s services goes beyond HIV.

“People see us as their only outlet, not just for testing but for confidential conversations, for a shoulder to cry on,” he said. “I don’t understand how someone, with the stroke of a pen, could just haphazardly write off the health of millions.”

Quiet Tears

Ellis came into his role in the mobile clinic haphazardly, when he worked as a construction worker. Suddenly dizzy and unwell on a job, a co-worker suggested he visit the organization’s brick-and-mortar clinic nearby. He later applied for a position with My Brother’s Keeper, inspired by its efforts to give people support to help themselves.

For example, Ellis described a young man who visited the mobile clinic recently who had been kicked out of his home and was sleeping on couches or on the street. Ellis thought of friends he’d known in similar situations that put them at risk of HIV by increasing the likelihood of transactional sex or substance use disorders.

When a rapid test revealed HIV, the young man fell silent. “The quiet tears hurt worse — it’s the dread of mortality,” Ellis said. “I tried to be as strong as possible to let him know his life is not over, that this wasn’t a death sentence.”

Ellis and his team enrolled the man into HIV care that day and stayed in touch. Otherwise, Ellis said, he might not have had the means or fortitude to seek treatment on his own and adhere to daily HIV pills. Not only is that deadly for people with HIV, it’s bad for public health. HIV experts use the phrase “treatment as prevention” because most new infections derive from people who aren’t adhering to treatment well enough to be considered virally suppressed — which keeps the disease from spreading.

Only a third of people living with HIV in Mississippi were virally suppressed in 2022. Nationally, that number is about 65%. That’s worse than in eastern and southern Africa, where 78% of people with HIV aren’t spreading the virus because they’re on steady treatment.

My Brother’s Keeper is one of many groups improving such numbers by helping people get tested and stay on medication. But the funding cuts in Washington have curtailed their work. The first loss was a $12 million grant from the National Institutes of Health, not even two years into a 10-year project. “Programs based primarily on artificial and non-scientific categories, including amorphous equity objectives, are antithetical to the scientific inquiry,” the NIH said in a letter reviewed by KFF Health News.

My Brother’s Keeper then lost a CDC award to reduce health disparities — a grant channeled through the Mississippi state health department — that began with the group’s work during the covid pandemic but had broadened to screening and care for HIV, heart disease, and diabetes. These are some of the maladies that account for why low-income Black people in the Deep South die sooner, on average, than those who are white. According to a recent study, the former’s life expectancy was just 68 years in 2021, on par with the average in impoverished nations like Rwanda and Myanmar.

The group then lost CDC funding that covered the cost of laboratory work to detect HIV, chlamydia, gonorrhea, and syphilis in patients’ blood samples. Mississippi has the highest rate of sexually transmitted diseases among states, in part because people spread infections when they aren’t tested and treated.

“The labs are $200 to $600 per person,” Gipson said, “so now we can’t do that without passing the cost to the patient, and some can’t pay.”

Two other CDC grants on HIV prevention, together worth $841,000, were unusually delayed.

Public health specialists close to the CDC, who spoke on condition of anonymity because they fear retaliation, said they were aware of delays in HIV prevention funding, despite court orders to unfreeze payments for federal grants in January and February. “The faucet was being turned off at a higher level than at the CDC,” one specialist said. The delays have now been compounded, they said, by the gutting of that agency’s HIV workforce in April.

“I know of many organizations reliant on subcontracted federal funds who have not been paid for the work they’ve done, or whose funding has been terminated,” said Dafina Ward, executive director of the Southern AIDS Coalition.

To reach the underserved, these groups offer food, housing assistance, bus passes, disease screening, and a sense of community. A network of the groups was fostered, in part, by Trump’s initiative to end the epidemic. And it showed promise: From 2017 to 2022, new HIV infections decreased by 21% in the cities and the Southern states it targeted.

Disparities in infections were still massive, with the rate of HIV diagnoses about eight times as high for Black people as white people, and the South remained hardest hit. Ward was hopeful at the start of this year, however, as testing became more widespread and HIV prevention drugs — called preexposure prophylaxis, or PrEP — slowly gained popularity. But her outlook has shifted and she fears that grassroots organizations might not weather the funding turmoil.

“We’re seeing an about-face of what it means to truly work towards ending HIV in this country,” she said.

A Closed Clinic

Southeast of Jackson, in Hattiesburg, Sean Fortenberry tears up as he walks into a small room used until recently for HIV testing. He has kept his job at Mississippi’s AIDS Services Coalition by shifting his role but agonizes about the outcome. When Fortenberry tested positive for HIV in 2007, he said, his family and doctor saved his life.

“I never felt that I was alone, and that was really, really important,” he said. “Other people don’t have that, so when I came across this position, I was gung-ho. I wanted to help.”

But the coalition froze its HIV testing clinic and paused mobile testing at homeless shelters, colleges, and churches late last year. Kathy Garner, the group’s executive director, said the Mississippi health department — which funds the coalition with CDC’s HIV prevention dollars — told her to pause outreach in October before the state renewed the group’s annual HIV prevention contract.

Kendra Johnson, communicable diseases director at Mississippi’s health department, said that delays in HIV prevention funds were initially on the department’s end because it was short on administrative staff. Then Trump took office. “We were working with our federal partners to ensure that our new objectives were in line with new HIV prevention activities,” Johnson said. “And we ran into additional delays due to paused communications at the federal level.”

The AIDS coalition remains afloat largely because of federal money from the Ryan White HIV/AIDS Program for treatment and from the Department of Housing and Urban Development. “If most of these federal dollars are cut, we would have to close,” Garner said.

The group provides housing or housing assistance to roughly 400 people each year. Research shows that people in stable housing adhere much better to HIV treatment and are far less likely to die than unhoused people with HIV.

Funding cuts have shaken every state, but the South is acutely vulnerable when it comes to HIV, said Gregorio Millett, director of public policy at amfAR. Southern states have the highest level of poverty and a severe shortage of rural clinics, and several haven’t expanded Medicaid so that more low-income adults have health insurance.

Further, Southern states aren’t poised to make up the difference. Alabama, Louisiana, Kentucky, Mississippi, and Missouri put zero state funds into HIV prevention last year, according to NASTAD, an association of public health officials who administer HIV and hepatitis programs. In contrast, about 40% of Michigan’s HIV prevention budget is provided by the state, 50% of Colorado’s HIV prevention budget, and 88% of New York’s.

“When you are in the South, you need the federal government,” said Gipson, from My Brother’s Keeper. “When we had slavery, we needed the federal government. When we had the push for civil rights, we needed the federal government. And we still need the federal government for health care,” she said. “The red states are going to suffer, and we’re going to start suffering sooner than anyone else.”

‘So Goes Mississippi’

When asked about cuts and delays to HIV prevention funding, the CDC directed queries to HHS. The department’s director of communications, Andrew Nixon, replied in an email: “Critical HIV/AIDS programs will continue under the Administration for a Healthy America (AHA) as a part of Secretary [Robert F.] Kennedy’s vision to streamline HHS to better serve the American people.”

Nixon did not reply to a follow-up question on whether the Trump administration considers HIV prevention critical.

On April 4, Gipson received a fraction of her delayed HIV prevention funds from the CDC. But Gipson said she was afraid to hire back staff amid the turmoil.

Like the directors of many other community organizations, Gipson is going after grants from foundations and companies. Pharmaceutical firms such as Gilead and GSK that produce HIV drugs are among the largest contributors of non-governmental funds for HIV testing, prevention, and care, but private funding for HIV has never come close to the roughly $40 billion that the federal government allocated to HIV annually.

“If the federal government withdraws some or all of its support, the whole thing will collapse,” said Alice Riener, CEO of the community-based organization CrescentCare in Louisiana. “What you see in Mississippi is the beginning of that, and what’s so concerning is the infrastructure we’ve built will collapse quickly but take decades to rebuild.”

Southern health officials are reeling from cuts because state budgets are already tight. Mississippi’s state health officer, Daniel Edney, spoke with KFF Health News on the day the Trump administration terminated $11 billion in covid-era funds intended to help states improve their public health operations. “There’s not a lot of fat, and we’re cutting it to the bone right now,” Edney said.

Mississippi needed this boost, Edney said, because the state ranks among the lowest in health metrics including premature death, access to clinical care, and teen births. But Edney noted hopeful trends: The state had recently moved from 50th to 49th worst in health rankings, and its rate of new HIV cases was dropping.

“The science tells us what we need to do to identify and care for patients, and we’re improving,” he said. “But trends can change very quickly on us, so we can’t take our foot off the gas pedal.”

If that happens, researchers say, the comeback of HIV will go unnoticed at first, as people at the margins of society are infected silently before they’re hospitalized. As untreated infections spread, the rise will eventually grow large enough to make a dent in national statistics, a resurgence that will cost lives and take years, if not decades, to reverse.

Outside the community center on that stormy March morning, pastor Devine lamented not just the loss of his grant from the health department, but a $1 billion cut to food distribution programs at the U.S. Department of Agriculture. He rattled off consequences he feared: People relying on food assistance would be forced to decide between buying groceries, paying bills, or seeing a doctor, driving them further into poverty, into emergency rooms, into crime.

Deja Abdul-Haqq, a program director at My Brother’s Keeper, nodded along as he spoke. “So goes Mississippi, so goes the rest of the United States,” Abdul-Haqq said. “Struggles may start here, but they spread.”

KFF Health News 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 KFF.

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Rennie Glasgow, who has served 15 years at the Social Security Administration, is seeing something new on the job: dead people.

They’re not really dead, of course. In four instances over the past few weeks, he told KFF Health News, his Schenectady, New York, office has seen people come in for whom “there is no information on the record, just that they are dead.” So employees have to “resurrect” them — affirm that they’re living, so they can receive their benefits.

Revivals were “sporadic” before, and there’s been an uptick in such cases across upstate New York, said Glasgow. He is also an official with the American Federation of Government Employees, the union that represented 42,000 Social Security employees just before the start of President Donald Trump’s second term.

Martin O’Malley, who led the Social Security Administration toward the end of the Joe Biden administration, said in an interview that he had heard similar stories during a recent town hall in Racine, Wisconsin. “In that room of 200 people, two people raised their hands and said they each had a friend who was wrongly marked as deceased when they’re very much alive,” he said.

It’s more than just an inconvenience, because other institutions rely on Social Security numbers to do business, Glasgow said. Being declared dead “impacts their bank account. This impacts their insurance. This impacts their ability to work. This impacts their ability to get anything done in society.”

“They are terminating people’s financial lives,” O’Malley said.

Though it’s just one of the things advocates and lawyers worry about, these erroneous deaths come after a pair of initiatives from new leadership at the SSA to alter or update its databases of the living and the dead.

Holders of millions of Social Security numbers have been marked as deceased. Separately, according to The Washington Post and The New York Times, thousands of numbers belonging to immigrants have been purged, cutting them off from banks and commerce, in an effort to encourage these people to “self-deport.”

Glasgow said SSA employees received an agency email in April about the purge, instructing them how to resurrect beneficiaries wrongly marked dead. “Why don’t you just do due diligence to make sure what you’re doing in the first place is correct?” he said.

The incorrectly marked deaths are just a piece of the Trump administration’s crash program purporting to root out fraud, modernize technology, and secure the program’s future.

But KFF Health News’ interviews with more than a dozen beneficiaries, advocates, lawyers, current and former employees, and lawmakers suggest the overhaul is making the agency worse at its primary job: sending checks to seniors, orphans, widows, and those with disabilities.

Philadelphian Lisa Seda, who has cancer, has been struggling for weeks to sort out her 24-year-old niece’s difficulties with Social Security’s disability insurance program. There are two problems: first, trying to change her niece’s address; second, trying to figure out why the program is deducting roughly $400 a month for Medicare premiums, when her disability lawyer — whose firm has a policy against speaking on the record — believes they could be zero.

Since March, sometimes Social Security has direct-deposited payments to her niece’s bank account and other times mailed checks to her old address. Attempting to sort that out has been a morass of long phone calls on hold and in-person trips seeking an appointment.

Before 2025, getting the agency to process changes was usually straightforward, her lawyer said. Not anymore.

The need is dire. If the agency halts the niece’s disability payments, “then she will be homeless,” Seda recalled telling an agency employee. “I don’t know if I’m going to survive this cancer or not, but there is nobody else to help her.”

Some of the problems are technological. According to whistleblower information provided to Democrats on the House Oversight Committee, the agency’s efforts to process certain data have been failing more frequently. When that happens, “it can delay or even stop payments to Social Security recipients,” the committee recently told the agency’s inspector general.

While tech experts and former Social Security officials warn about the potential for a complete system crash, day-to-day decay can be an insidious and serious problem, said Kathleen Romig, formerly of the Social Security Administration and its advisory board and currently the director of Social Security and disability policy at the Center on Budget and Policy Priorities. Beneficiaries could struggle to get appointments or the money they’re owed, she said.

For its more than 70 million beneficiaries nationwide, Social Security is crucial. More than a third of recipients said they wouldn’t be able to afford necessities if the checks stopped coming, according to National Academy of Social Insurance survey results published in January.

Advocates and lawyers say lately Social Security is failing to deliver, to a degree that’s nearly unprecedented in their experience.

Carolyn Villers, executive director of the Massachusetts Senior Action Council, said two of her members’ March payments were several days late. “For one member that meant not being able to pay rent on time,” she said. “The delayed payment is not something I’ve heard in the last 20 years.”

When KFF Health News presented the agency with questions, Social Security officials passed them off to the White House. White House spokesperson Elizabeth Huston referred to Trump’s “resounding mandate” to make government more efficient.

“He has promised to protect social security, and every recipient will continue to receive their benefits,” Huston said in an email. She did not provide specific, on-the-record responses to questions.

Complaints about missed payments are mushrooming. The Arizona attorney general’s office had received approximately 40 complaints related to delayed or disrupted payments by early April, spokesperson Richie Taylor told KFF Health News.

A Connecticut agency assisting people on Medicare said complaints related to Social Security — which often helps administer payments and enroll patients in the government insurance program primarily for those over age 65 — had nearly doubled in March compared with last year.

Lawyers representing beneficiaries say that, while the historically underfunded agency has always had its share of errors and inefficiencies, it’s getting worse as experienced employees have been let go.

“We’re seeing more mistakes being made,” said James Ratchford, a lawyer in West Virginia with 17 years’ experience representing Social Security beneficiaries. “We’re seeing more things get dropped.”

What gets dropped, sometimes, are records of basic transactions. Kim Beavers of Independence, Missouri, tried to complete a periodic ritual in February: filling out a disability update form saying she remains unable to work. But her scheduled payments in March and April didn’t show.

She got an in-person appointment to untangle the problem — only to be told there was no record of her submission, despite her showing printouts of the relevant documents to the agency representative. Beavers has a new appointment scheduled for May, she said.

Social Security employees frequently cite missing records to explain their inability to solve problems when they meet with lawyers and beneficiaries. A disability lawyer whose firm’s policy does not allow them to be named had a particularly puzzling case: One client, a longtime Social Security disability recipient, had her benefits reassessed. After winning on appeal, the lawyer went back to the agency to have the payments restored — the recipient had been going without since February. But there was nothing there.

“To be told they’ve never been paid benefits before is just chaos, right? Unconditional chaos,” the lawyer said.

Researchers and lawyers say they have a suspicion about what’s behind the problems at Social Security: the Elon Musk-led effort to revamp the agency.

Some 7,000 SSA employees have reportedly been let go; O’Malley has estimated that 3,000 more would leave the agency. “As the workloads go up, the demoralization becomes deeper, and people burn out and leave,” he predicted in an April hearing held by House Democrats. “It’s going to mean that if you go to a field office, you’re going to see a heck of a lot more empty, closed windows.”

The departures have hit the agency’s regional payment centers hard. These centers help process and adjudicate some cases. It’s the type of behind-the-scenes work in which “the problems surface first,” Romig said. But if the staff doesn’t have enough time, “those things languish.”

Languishing can mean, in some cases, getting dropped by important programs like Medicare. Social Security often automatically deducts premiums, or otherwise administers payments, for the health program.

Lately, Melanie Lambert, a senior advocate at the Center for Medicare Advocacy, has seen an increasing number of cases in which the agency determines beneficiaries owe money to Medicare. The cash is sent to the payment centers, she said. And the checks “just sit there.”

Beneficiaries lose Medicare, and “those terminations also tend to happen sooner than they should, based on Social Security’s own rules,” putting people into a bureaucratic maze, Lambert said.

Employees’ technology is more often on the fritz. “There’s issues every single day with our system. Every day, at a certain time, our system would go down automatically,” said Glasgow, of Social Security’s Schenectady office. Those problems began in mid-March, he said.

The new problems leave Glasgow suspecting the worst. “It’s more work for less bodies, which will eventually hype up the inefficiency of our job and make us, make the agency, look as though it’s underperforming, and then a closer step to the privatization of the agency,” he said.

Jodie Fleischer of Cox Media Group contributed to this report.

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HHS announced the release of $1.1 billion in funding and new grant opportunities to provide critical services to older adults.

Reproductive rights groups in Alabama wasted no time resuming their work after a federal judge ruled in early April that the state’s attorney general can’t prosecute — or threaten to prosecute — people or organizations who help Alabama residents seek an abortion by traveling to another state.

One of the plaintiffs, the reproductive justice nonprofit Yellowhammer Fund, wasted no time in returning to one of its core missions: to provide financial support to traveling patients.

“The decision came at about 5:30. I think we funded an abortion at 5:45 — because that’s how severe the need is, that’s how urgent it is that we get back to the work that we’re doing,” said Jenice Fountain, executive director of Yellowhammer Fund, which advocates for abortion access.

On April 2, the U.S. Supreme Court heard oral arguments on whether South Carolina can remove Planned Parenthood clinics from the state’s Medicaid program. This came just days after Planned Parenthood received notice that the Trump administration would withhold funding from the Title X Family Planning Program for nine of the group’s affiliates.

“We’re just seeing kind of a multiplying of conflicts where we have unanswered questions about the meaning of the First Amendment in this context, about the right to travel in this context, about due process in this context — about these sort of clashing state laws and choosing which one applies,” said Mary Ziegler, a law professor at the University of California-Davis who specializes in the politics and history of reproductive rights.

Alabama has one of the strictest bans on abortion in the country — with no exceptions for rape or incest. The law was  approved by the state legislature in 2019 and remained at the ready should Roe v. Wade be overturned. It took effect immediately when the Supreme Court did just that on June 24, 2022, in the Dobbs v. Jackson Women’s Health Organization decision.

At the time, Yellowhammer Fund was getting about 100 calls a week from people seeking financial help with getting an abortion, Fountain said.

For more than two years, the organization has been unable to help such callers.

“The thing with the ban was it was so vague that it was incredibly hard to interpret, especially if you weren’t a person that was legally inclined,” Fountain said. “So the effect that it had, which was its intention, was a chilling effect.”

During that time, Yellowhammer continued to promote reproductive justice and maternal and infant health through community efforts such as distributing diapers, formula, menstrual supplies, and emergency contraception.

Beyond the alarm created by the statutory language in Alabama’s abortion ban, fears were stoked by Alabama’s attorney general, Steve Marshall, Fountain said.

Almost seven weeks after the 2022 Dobbs decision, Marshall said in a radio interview that groups that assist people seeking an abortion in another state could face criminal prosecution.

“There’s no doubt that this is a criminal law and the general principles that apply to a criminal law would apply to this, with its status of the Class A felony, that’s the most significant offense that we have as far as punishment goes under our criminal statue, absent a death penalty case,” Marshall said in the interview with Breitbart TV editor Jeff Poor.

“If someone was promoting themselves out as a funder of abortion out of state, then that is potentially criminally actionable for us,” Marshall said.

Marshall was explicitly referring to such groups as Yellowhammer Fund, Fountain said.

“He mentioned the group from Tuscaloosa that helps people get to care, which is Yellowhammer Fund,” Fountain said. “He all but ‘@’d us.”

Yellowhammer Fund and other abortion rights groups filed the lawsuit against Marshall on July 31, 2023.

In his ruling, U.S. District Judge Myron Thompson of the Middle District of Alabama in Montgomery, agreed with them, saying Marshall would be violating both First Amendment free speech rights and the constitutional right to travel if he tried to bring criminal charges.

Thompson also warned against overlooking the “broader, practical implications of the Attorney General’s threats,” in the matter of Alabama trying to enforce laws outside the state.

“For example,” Thompson wrote in his ruling, “the Alabama Attorney General would have within his reach the authority to prosecute Alabamians planning a Las Vegas bachelor party, complete with casinos and gambling, since casino-style gambling is outlawed in Alabama.”

Another group involved in the case, WAWC Healthcare in Tuscaloosa (formerly West Alabama Women’s Center), also resumed work that had been paused.

“We have spent the last few years worried that if we had provided any form of information to patients about where they could access a legal abortion, that that is something that the attorney general might try to prosecute us over,” said Robin Marty, WAWC’s executive director.

Before the Dobbs decision, WAWCprovided abortion as part of its services. It continues to offer free reproductive health care, including prenatal care, contraception, and HIV testing.

Clinical staffers at WAWC weren’t allowed even to suggest to someone that they could leave the state to get an abortion, Marty said.

“There is nothing harder than looking into somebody’s face when they are in crisis and saying, ‘I’m sorry, I just can’t help you anymore,’” Marty said. “That was really wearing on my staff because our job was to provide the best information possible. And to know that we could not give them the full care that they required was heartbreaking.”

With the ruling, WAWC can now offer “all-options counseling,” which includes information on how and where patients can access abortion services in other states, Marty said.

“If they do not feel like they are able to continue the pregnancy, we can tell them, ‘OK, you are this far along, so you are able to go this clinic in North Carolina, because you’re under their limit” for gestational age, “or you can go to this clinic in Illinois because you’re under their limit,’” Marty said. “We’ll be able to tell them exactly where they can go and even be able to help them with the referral process along the way.”

The attorney general could file an appeal, but now it’s unclear whether his office will do so. Marshall’s office did not respond to NPR’s request for an interview, but in a statement said, “The office is reviewing the decision to determine the state’s options.”

But legal expert Ziegler said she’d be surprised if Marshall didn’t file an appeal, given his office’s vigorous defense in the lawsuit.

In addition, the potential political costs of pursuing that kind of prosecution may have eased, because states like Texas and Louisiana have already taken legal action regarding out-of-state abortion providers, said Ziegler.

On the other hand, the attorney general might not appeal because his office was the defendant in the lawsuit, and he may not want to draw attention to the case, Ziegler said.

If Marshall did file an appeal, it would go to the U.S. Court of Appeals for the 11th Circuit, which Ziegler called conservative-leaning. The case could ultimately go to the U.S. Supreme Court, Ziegler said, which may have to weigh in more on abortion-related cases, such as when it temporarily allowed emergency abortions in Idaho in June 2024.

“I think the takeaway is that the U.S. Supreme Court is going to be more involved than ever in fights about reproduction and abortion, not less, notwithstanding the fact that Roe is gone,” Ziegler said.

This article is from a partnership that includes Gulf States Newsroom, NPR and KFF Health News.

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The Trump administration’s unprecedented $500 million grant for a broadly protective flu shot has confounded vaccine and pandemic preparedness experts, who said the project was in early stages, relied on old technology, and was just one of more than 200 such efforts.

Health and Human Services Secretary Robert F. Kennedy Jr. shifted the money from a pandemic preparedness fund to a vaccine development program led by two scientists whom the administration recently named to senior positions at the National Institutes of Health.

While some experts were pleased that Kennedy had supported any vaccine project, they said the May 1 announcement contravened sound scientific policy, appeared arbitrary, and raised the kinds of questions about conflicts of interest that have dogged many of President Donald Trump’s actions.

Focusing vast resources on a single vaccine candidate “is a little like going to the Kentucky Derby and putting all your money on one horse,” said William Schaffner, a Vanderbilt University professor and past president of the National Foundation for Infectious Diseases. “In science we normally put money on a number of different horses because we can’t be entirely sure who’s going to win.”

Others were mystified by the decision, since the candidate vaccine uses technology that was largely abandoned in the 1970s and eschews techniques developed in recent decades through funding from the Department of Health and Human Services and the Defense Department.

“This is not a next-generation vaccine,” said Rick Bright, who led HHS’ Biomedical Advanced Research and Development Authority, or BARDA, in the first Trump administration. “It’s so last-generation, or first-generation, it’s mind-blowing.”

The vaccine is being developed at the National Institute for Allergy and Infectious Diseases by Jeffery Taubenberger, whom Trump named as acting chief of the institute in late April, and his colleague Matthew Memoli, a critic of U.S. covid-19 policy whom Trump picked to lead the NIH until April 1, when Jay Bhattacharya took office. Bhattacharya named Memoli his principal deputy.

Taubenberger gained fame as an Armed Forces Institute of Pathology scientist in 1997 when his lab sequenced the genome of the 1918 pandemic influenza virus, using tissue samples from U.S. troops who died in that plague. He joined the NIH in 2006.

In a May 1 news release, HHS called the Taubenberger-Memoli vaccine initiative “Generation Gold Standard,” saying it represented “a decisive shift toward transparency, effectiveness, and comprehensive preparedness.” Bhattacharya said it represented a “paradigm shift.”

But the NIH vaccine-makers’ goal of creating a shot that protects against multiple or all strains of influenza — currently vaccines must be given each year to account for shifts in the virus — is not new.

Then-NIAID Director Anthony Fauci launched a network of academic researchers in pursuit of a broadly protective flu vaccine in 2019. In addition to that NIH-led consortium, more than 200 flu vaccines are under development in the U.S. and other countries.

Many use newer technologies, and some are at more advanced stages of human testing than the Taubenberger vaccine, whose approach appears basically the same as the one used in flu vaccines starting in 1944, Bright said.

In the news release, HHS described the vaccine as “in advanced trials” and said it would induce “robust” responses and “long-lasting protection.” But Taubenberger and his colleagues haven’t published a complete human study of the vaccine yet. A study showing the vaccine protected mice from the flu appeared in 2022.

For Operation Warp Speed, which led to the creation of the covid vaccine during Trump’s first term, government scientists reviewed detailed plans and data from academic and commercial laboratories vying for federal money, said Greg Poland, a flu expert and president of the Atria Health Academy of Science and Medicine. “If that’s happening here, it’s opaque to me,” he said.

When asked what data beyond its press release supported the decision, HHS spokesperson Andrew Nixon pointed to the agency’s one-page statement. Asked whether the decision would curtail funding for the Fauci-created consortium or other universal vaccine approaches, Nixon did not specifically respond. “Generation Gold Standard is the most promising,” he said in an email.

Taubenberger did not respond to a request for comment. Nixon and NIH spokesperson Amanda Fine did not respond to requests for an interview with Taubenberger or Memoli.

The HHS statement stressed that by developing the vaccine in-house, the government “ensures radical transparency, public accountability, and freedom from commercial conflicts of interest.” While any vaccine would eventually have to be made commercially, NIH involvement through more stages of development could give the government greater influence on any vaccine’s eventual price, Schaffner said.

If the mRNA-based covid shots produced by Moderna and Pfizer-BioNTech represented the cutting edge of vaccine technology, applying ultra-sophisticated approaches never before seen in an inoculation, the approach by Taubenberger and Memoli represents a blast from the past.

Their vaccine is made by inactivating influenza viruses with a carcinogenic chemical called beta-propiolactone. Scientists have used the chemical to neutralize viruses since at least the 1950s. This whole-virus inactivation method, mostly using other chemicals, was the standard way to make flu vaccines into the 1970s, when it was modified, partly because whole-virus vaccines caused high fevers or even seizures in children.

The limited published data from the Taubenberger vaccine, from an initial safety trial involving 45 patients, showed no major side effects. The scientists are testing the vaccine as a regular shot and as an intranasal spray with the idea of stopping the virus in the respiratory tract before it causes a broad infection.

“The notion of a universal influenza A pandemic vaccine is a good one,” said Poland, who called Taubenberger an excellent scientist. But he added: “I’m not so sure about the platform, and the dollar amount is a puzzler. This vaccine’s in very early development.”

Paul Friedrichs, a retired Air Force general who led the Office of Pandemic Preparedness and Response Policy in President Joe Biden’s White House, said that “giving $500 million upfront with very little data to support it is unlike anything I’ve ever seen.”

“The technology for developing vaccines has tremendously evolved over many decades,” Friedrichs said. “Why would we go back to an approach historically associated with greater or more frequent adverse events?”

The government appeared to be transferring the money for the Taubenberger vaccine development from an existing $1.3 billion vaccine fund at Project NextGen, a mostly covid-focused program at BARDA, Friedrichs said. Most of that money was earmarked to support advanced research on covid and other viral vaccines, including those protecting against emerging diseases.

It is “very concerning that we’re de-emphasizing covid, which we may live to regret,” Poland said. “It assumes we won’t have a covid variant that escapes the current moderately high levels of covid immunity.”

Nixon said Project NextGen, for which some funds were earmarked for mRNA research, is under review. Kennedy is critical of mRNA vaccines, once claiming, falsely, that they are the deadliest vaccines in history.

Ted Ross, director of global vaccine development at the Cleveland Clinic, said he was “happy to see them investing in respiratory vaccines, including a universal flu vaccine, with all the programs they’ve been cutting.”

“But I don’t think this is the only approach,” Ross said. “Other universal flu vaccines are in progress, and their success and failure are not known yet.”

His team, part of the NIAID-funded flu vaccine consortium, is using artificial intelligence and computer modeling to design vaccines that produce the broadest immunity to influenza, including seasonal and pandemic strains.

As interim director, Memoli oversaw the start of the administration’s massive cuts at the NIH, with the elimination of some 800 agency grants worth over $2 billion. More than 1,200 NIH employees have been fired, and many researchers, including Ross, are in limbo.

His lab is close to testing a candidate vaccine on people, Ross said, while waiting to find out about its NIH funding. “I’m not sure whether my contract is on the chopping block,” he said.

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KFF Health News senior correspondent Aneri Pattani gave an update on how Ohio is using its opioid settlement funds on WOSU Public Media’s “All Sides with Amy Juravich” on April 30.

• Click here to hear Pattani on “All Sides with Amy Juravich.”
• Read Pattani’s coverage of opioid settlements in “Payback: Tracking the Opioid Settlement Cash.”

KFF Health News chief Washington correspondent Julie Rovner discussed the future of the Affordable Care Act on April 23, for C-SPAN’s “Washington Journal.” She also discussed Health and Human Services Secretary Robert F. Kennedy Jr.’s “Make America Healthy Again” tour on WNYC’s “The Brian Lehrer Show” on April 15.

• Click here to watch Rovner on “Washington Journal.”
• Click here to hear Rovner on “The Brian Lehrer Show.”

KFF Health News Southern correspondent Sam Whitehead discussed Medicaid work requirements on WUGA’s “The Georgia Health Report” on April 18.

• Click here to hear Whitehead on “The Georgia Health Report.”
• Read Whitehead’s “States Push Medicaid Work Rules, but Few Programs Help Enrollees Find Jobs,” with reporting from Phil Galewitz and Katheryn Houghton.

KFF Health News senior correspondent Renuka Rayasam discussed layoffs at the federal Centers for Disease Control and Prevention on WUGA’s “The Georgia Health Report” on April 4.

• Click here to hear Rayasam on “The Georgia Health Report.”
• Read Rachana Pradhan and Brett Kelman’s “Firings at Federal Health Agencies Decimate Offices That Release Public Records.”

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The FDA has rehired at least some workers tasked with releasing public records generated by the agency’s regulatory activities, two employees said. The recall reverses firings carried out roughly a month ago by the Department of Health and Human Services, which oversees the agency.

Workers who process records about medical device and tobacco regulation under the Freedom of Information Act received notices from an FDA official May 1 that they were no longer being fired as part of the department’s mass layoffs, according to the employees and documents reviewed by KFF Health News, which agreed not to name the workers because they are not authorized to speak to the press and fear retaliation.

The workers were told to return to their jobs immediately.

As part of its plans to shrink HHS by 20,000 people, officials announced in late March that 10,000 employees would be laid off across the department, which includes the Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention, the National Institutes of Health, and the FDA. More than one-third of the layoffs, 3,500, affected FDA staffers. Those firings gutted the FOIA divisions across HHS.

The layoffs decimated the workforce that processes FOIA requests across FDA centers overseeing vaccines, drugs, tobacco, medical devices, and food, said current and former employees. Operations to release public records requests largely ground to a halt, according to half a dozen current or former employees. Employees said FOIA workers were fired despite being involved in furnishing government records under court-ordered deadlines in response to litigation.

A notice from FDA to an affected FOIA staffer said the HHS’ “Reduction in Force” was being rescinded but did not provide a rationale for reinstatement, according to a copy viewed by KFF Health News. However, the worker said an FDA official had told them their job was “mission critical.”

Two current or former employees noted that the FDA missed several court-ordered deadlines to produce documents in April. Other FOIA workers were told they were being reinstated, two employees said.

HHS officials didn’t respond to a request for comment.

FOIA is a transparency law that guarantees public access to the inner workings of federal agencies by requiring officials to release government documents. The 1966 law is a crucial tool for law firms, advocates, businesses, journalists, and the public. It has been used to hold officials accountable and uncover harm, corruption, and political meddling in policymaking.

At HHS, FOIA requests are used to obtain a litany of records, including detailed CDC information about large outbreaks of food and waterborne illnesses, and reports generated by FDA inspections of facilities that make food, drugs, medical devices, and dental products.

The decision to bring back at least some FOIA staff occurred after HHS Secretary Robert F. Kennedy Jr. said officials were “restoring all the FOIA offices.” Earlier this year, HHS also laid off the entire CDC office handling that agency’s FOIA requests and significantly cut FOIA staff at the NIH.

“We’re going to make it much easier for people to get the information. We’re going to try to post as much as we can,” he said on April 22.

The HHS decision to decimate FOIA staff spurred at least one lawsuit and pushback — from Rep. Gerry Connolly (D-Va.), who sent a letter to CDC on April 24 about the firings.

CDC FOIA staff had not been reinstated as of Friday morning, one employee said. In a May 1 court filing as part of a lawsuit challenging those firings, Edward Martin, interim U.S. attorney for the District of Columbia, said the CDC and HHS “have not abandoned any of its obligations under FOIA and instead is undergoing a re-structure pursuant to a valid Executive Order.” Martin said that “streamlining inefficient operations will benefit the public by enhancing transparency and accountability to the taxpayer.”

The filing was submitted as part of a lawsuit brought in April by Citizens for Responsibility and Ethics in Washington, a legal advocacy group.

During fiscal year 2024 — October 2023 through September 2024 — the FDA provided at least some records in response to more than 12,000 requests, according to HHS’ annual FOIA report.

There were exceptions to the mass layoffs of FOIA employees, however. The cuts at FDA spared at least some workers furnishing records in response to court orders in FOIA lawsuits involving the agency’s vaccines division, which includes litigation brought by an ally of Kennedy’s who represents anti-vaccine interests, according to four current or former agency employees.

Lawyer Aaron Siri filed the FOIA lawsuits, on behalf of the nonprofit Public Health and Medical Professionals for Transparency, in 2021 and 2022 against the FDA to obtain records related to Pfizer’s and Moderna’s covid-19 vaccines. Siri was Kennedy’s lawyer during his 2024 presidential campaign and has represented prominent anti-vaccine activists in numerous lawsuits.

The FDA faces a June 30 court-ordered deadline to finish releasing documents in those cases.

We’d like to speak with current and former personnel from the Department of Health and Human Services or its component agencies who believe the public should understand the impact of what’s happening within the federal health bureaucracy. Please message KFF Health News on Signal at (415) 519-8778 or get in touch here.

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Republicans have long pushed to force working-age adults enrolled in Medicaid to show they are, in fact, working. 

Party members argue Medicaid, a taxpayer-funded program for people with low incomes and disabilities, shouldn’t cover Americans who aren’t actively trying to improve their financial situations. And Republicans are closer than ever to achieving a national work requirement, after winning the White House and both chambers of Congress, and unlocking a fast-track process to secure big spending cuts. 

A national Medicaid work requirement would slash spending by reducing the number of people covered. About 5 million adults could lose Medicaid coverage in 2026 if Congress imposes one. 

But here’s the thing: Most adults with Medicaid who can work are already working, or have some reason they can’t (such as they’re full-time caregivers). And the experiences of two states that have implemented work requirements reveal the hidden costs of adding those layers of bureaucracy.  

The nonpartisan U.S. Government Accountability Office confirmed last week that, at the request of three Democratic senators, it’ll examine the costs of running a work requirement program that Georgia spent millions of dollars to establish. 

The GAO investigation comes at a critical time, said Leo Cuello, a research professor at Georgetown University’s Center for Children and Families. 

“Congress seems to be pursuing cuts in Medicaid in a frenetic and rushed manner,” he said. The GAO report could outline for Congress the full extent of problems with work requirements “before they rush forward and do this without thinking.” 

The GAO previously found that work requirement programs can be extremely expensive for states to run — hundreds of millions of dollars, in some cases — and that federal officials failed to consider those costs when approving the programs, which are not allowed to increase Medicaid spending. 

States must introduce new technology and have enough staffers to verify whether enrollees meet complex eligibility requirements and to monitor their continued compliance. 

When Arkansas tried its work requirement program, which applied to those covered by Medicaid expansion, 18,000 people lost coverage in less than a year before a federal judge stopped it. 

So, yeah, a work requirement would cut federal spending, but potentially also anger voters. 

New polling released Thursday by KFF, a nonprofit health policy organization that includes KFF Health News, shows a majority of Americans — regardless of party — oppose funding cuts to Medicaid. 

Moderate Republicans are showing trepidation about changes to the program: House Republican Don Bacon, a key centrist from Nebraska, said this week he wouldn’t support more than half a trillion dollars in cuts to Medicaid over a decade. The House-passed version of a congressional budget resolution called for as much as $880 billion. 

While Donald Trump has emphasized his goal of rooting out waste in federal programs, he’s also asking Congress to extend his 2017 tax cuts and spend more on border security. 

That the opinion of one House member from Nebraska could draw so much attention this week underlines the hard math House Speaker Mike Johnson faces in passing those pricey priorities; he can’t lose more than a handful of GOP votes to get it done.

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HELENA, Mont. — Montana’s frayed behavioral health care system, still recovering from the effects of past budget cuts, will get a shot in the arm after state lawmakers approved sweeping changes to upgrade and expand facilities, increase community services, and revise commitment procedures.

Lawmakers backed the bulk of Republican Gov. Greg Gianforte’s multimillion-dollar vision to bolster and expand the system, which has experienced waitlists for care and has been working in recent years to reverse the loss of community-based mental health services and regain federal certification of the state psychiatric hospital, lost in 2022 after a spate of patient deaths. Legislators then went several steps further to fill what they saw as gaps in the governor’s proposals.

They agreed to build a new mental health facility in eastern Montana, add more beds at existing state facilities, fund more crisis beds in communities, revise some civil and criminal commitment procedures, and reimburse counties when criminal defendants ordered to state facilities are held in county jails.

“For our families that struggle in these systems, it gives us so much hope,” said Matt Kuntz, executive director of the National Alliance on Mental Illness’ Montana chapter, about the legislative action.

The state’s behavioral health system faced an array of problems going into the 2025 legislative session. They included shortages in community services, particularly in rural areas, created by deep cuts made in 2017 in response to a state budget shortfall, along with a backlog of criminal defendants waiting for evaluations and services at the state-run psychiatric hospital.

The prospects of the situation improving seemed dim for a long time, Kuntz said. “Then you have the governor’s office, the legislature, the counties, the county attorneys all working together to bring tangible solutions. And they got the votes,” he said.

That support built over time as the state spent money on improvements needed to regain the Montana State Hospital’s federal certification and counties came under increasing pressure due to a lack of services and treatment beds. The legislature and governor committed to review the system in 2023.

In all, lawmakers approved about $124 million in state spending and up to $40 million in federal funds over the next two years for behavioral health services, a new state-owned facility, and additional beds in existing facilities.

“The people that need our support, the people that can’t take care of themselves, the families that are struggling with their family member that can’t take care of themselves at some points in time are going to benefit from what we did,” Republican state Sen. John Esp said in summing up the legislature’s work.

The spending approved by the legislature goes well beyond the money Gianforte requested for behavioral health changes. He included 10 funding requests in his proposed state budget for the next two years that totaled about $43.5 million in state funds and $42 million in federal funds. The requests were based on recommendations from the Behavioral Health System for Future Generations Commission.

Lawmakers created that commission in 2023 to review state-funded services for people with mental illness, substance use disorders, and developmental disabilities. Legislators that year set aside $300 million to be spent in future years on recommendations made by the commission.

Even before the start of the session, some legislators questioned whether the governor’s budget did enough to address the lack of both community-based crisis services and forensic beds at the Montana State Hospital, which are for people in the criminal justice system.

Two bills introduced in January — House Bill 236 and HB 237 — sought to address lengthy jail holds experienced by some people waiting for mental health evaluations or treatment before their trials can proceed. Defendants generally obtain those services at the Montana State Hospital’s forensic unit.

Both bills failed. But testimony on the measures, as well as on the governor’s budget requests, drew attention to the backlog of people waiting in jails across the state. Legislators heard of prolonged delays — some stretching more than a year — that sometimes led to cases being dismissed because of concerns that the delays had violated the defendants’ constitutional right to a speedy trial.

By April, the legislature was considering possible fixes on several fronts. Some resulted from long hours of discussion among the parties involved.

During an April 15 hearing on Senate Bill 429 to revise criminal commitment procedures, Chad Parker, a state health department attorney, described the measure as “a very robustly negotiated bill.” Nanette Gilbertson, representing the Montana County Attorneys’ Association and the Montana Sheriffs and Peace Officers Association, said it contained elements “that I know were tough pills to swallow for both the associations I work for and the department.”

The bill would allow involuntary medication of defendants in county jails under certain circumstances — an idea state officials initially opposed — and prohibit the filing of a contempt charge if someone isn’t admitted to the Montana State Hospital for treatment because a bed isn’t available, which was important to the state to include.

Gilbertson told the House Judiciary Committee the bill was just one of several that, “taken in a package, are going to create immense change in the mental health and behavioral health system in the state of Montana.”

They include bills to reimburse counties for the costs of holding people waiting for state mental health services, allow short-term mental health holds in the community, improve delivery and payment for community services, and create more beds in state facilities for people committed through both criminal and civil procedures.

Legislators also approved money for a new mental health facility, expected to be built in eastern Montana, that will include more forensic beds.

Gianforte spokesperson Kaitlin Price said Gianforte would carefully consider the bills passed in addition to his proposals.

The governor’s original budget request focused primarily on community services. Legislators approved all but one, which would have created an electronic bed registry. The approved requests will revise reimbursement rates for developmental disability services, residential youth psychiatric treatment, and crisis and outpatient behavioral health services. They also will reopen clinics for early diagnosis of developmental disabilities in children, provide workforce incentives, and seek to improve delivery of services to people with developmental disabilities who have complex needs.

Esp, who served on the behavioral health commission and sponsored several of the bills, cautioned that the success of this year’s efforts will depend on whether future legislatures and governors spend the money needed to continue the new services.

“The problem we’ve always had around here is we look at things in two-year increments and towards the next election instead of looking at what’s the best policy for the state of Montana, long term,” he said.

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Faced with potential federal spending cuts that threaten health coverage and falling childhood vaccination rates, Monica Soni, the chief medical officer of Covered California, has a lot on her plate — and on her mind.

California’s Affordable Care Act health insurance exchange covers nearly 2 million residents and 89% of them receive federal subsidies that reduce their premiums. Many middle-income households got subsidies for the first time after Congress expanded them in 2021, which helped generate a boom in enrollment in ACA exchanges nationwide.

From the original and enhanced subsidies, Covered California enrollees currently get $563 a month on average, lowering the average monthly out-of-pocket premium from $698 to $135, according to data from Covered California.

The 2021 subsidies are set to expire at the end of this year unless Congress renews them. If they lapse, enrollees would be on the hook to pay an average of $101 a month more for health insurance — not counting any premium hikes in 2026 and beyond. And those middle-income earners who did not qualify for subsidies before would lose all financial assistance — $384 a month, on average — which Soni fears could prompt them to drop out.

At the same time, vaccination rates for children 2 and under declined among 7 of the 10 Covered California health plans subject to its new quality-of-care requirements. Soni, a Los Angeles native who came to Covered California in May 2023, oversees that program, in which health plans must meet performance targets on blood pressure control, diabetes management, colorectal cancer screening, and childhood vaccinations — or pay a financial penalty.

Lack of access to such key aspects of care disproportionately affects underserved communities, making Covered California’s effort one of health equity as well. Soni, a Harvard-trained primary care doctor who sees patients one day a week at an urgent care clinic in Los Angeles County’s public safety net health system, is familiar with the challenges those communities face.

Covered California reported last November that its health plans improved on three of the four measures in the first year of the program. But childhood immunizations for those under 2 declined by 4%. The decline is in line with a national trend, which Soni attributed to postpandemic mistrust of vaccines and “more skepticism of the entire medical industry.”

Most parents have heard at least one untrue statement about measles or the vaccine for it, and many don’t know what to believe, according to an April KFF poll.

Health plans improved on the other three measures, but not enough to avoid penalties, which yielded $15 million. The exchange is using that money to fund another effort Soni manages, which helps 6,900 Covered California households buy groceries and contributes to over 250 savings accounts for children who get routine checkups and vaccines. Some of the penalty money will also be used to support primary care practices around California.

In addition to her bifurcated professional duties, Soni is the mother of two young children, ages 4 and 7. KFF Health News senior correspondent Bernard J. Wolfson spoke with Soni about the impact of possible federal cuts and the exchange’s initiative to improve care for its enrollees. This interview has been edited for length and clarity.

Q: Covered California has record enrollment of nearly 2 million, boosted by the expanded federal subsidies passed under the Biden administration, which end after this year. What if Congress does not renew them?

A: Our estimates are that it will approach 400,000 Californians who would drop coverage immediately. We hear every day from our folks that they’re really living on the margins. Until they got some of those subsidies, they could not afford coverage.

As a primary care doctor, I am the one to treat folks who show up with preventable cancers because they were too afraid to think about what their out-of-pocket costs would be. I don’t want to go back to those days.

Q: Congress is considering billions in cuts to Medicaid. How would that affect Covered California and the state’s population more broadly, given that more than 1 in 3 Californians are on Medi-Cal, the state’s version of Medicaid?

A: Those are our neighbors, our friends. Those are the people working in the restaurants we eat at. Earlier cancer screenings, better chronic disease control, lower maternal mortality, more substance use disorder treatment: We know that Medicaid saves lives. We know it helps people live longer and better. As a physician, I would be hard-pressed to argue for rolling back anything that saves lives. It would be very distressing to watch that come to California.

Q: Why did Covered California undertake the Quality Transformation Initiative?

A: We were incredibly successful at covering nearly 2 million, but frankly we didn’t see improvements in quality, and we continue to see gaps for certain populations in terms of outcomes. So, I think the question became much more imperative: Are we getting our money’s worth out of this coverage? Are we making sure people are living longer and better, and if not, how do we up the ante to make sure they are?

Q: There’s a penalty for not meeting the targets, but no bonuses for meeting them: You meet the goals or else, right?

A: We don’t say it like that, but that is true. And we didn’t make it complicated. It’s only four measures. It’s things that as a primary care doctor I know are important, that I take care of when I see people in my practice. We said get to the 66th percentile on these four measures, and there’s no dollars that you have to pay. If you don’t, then we collect those funds.

Q: And you use the penalty money to fund the grocery assistance and child savings accounts.

A: That’s exactly right. We had this opportunity to think about what would we use these dollars for and how we actually make a difference in people’s lives. So, we cold-called hundreds of people, we sent surveys out to thousands of folks, and what we heard overwhelmingly was how expensive it is to live in California; that folks are making trade-offs between food and transportation, between child care and food — just impossible decisions.

Q: You will put up to $1,000 a child into those savings accounts, right?

A: That’s right. It’s tied to doing those healthy behaviors, going to child well visits and getting recommended vaccines. We looked at the literature, and once you get to even just $500 in an account, the likelihood of a kid going to a two- or four-year school increases significantly. It’s actually because they’re hopeful about their future, and it changes their path of upward mobility, which we know changes their health outcome.

Q: Given the rise in vaccine skepticism, are you worried that the recent measles outbreak could grow?

A: I am very concerned about it. I was actually reading some posts from a physician colleague who trained decades earlier and was talking about all the diseases that my generation of physicians have never seen. We don’t actually know how to diagnose and take care of a number of infectious diseases because they mostly have been eradicated or outbreaks have been really contained. So, I feel worried. I’ve been brushing off my old textbooks.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News 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 KFF.

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The country’s top nonpartisan government watchdog has confirmed it is examining the costs of running the nation’s only active Medicaid work requirement program, as Republican state and federal lawmakers consider similar requirements.

The U.S. Government Accountability Office told KFF Health News that its analysis of the Georgia Pathways to Coverage program could be released this fall.

In its first 100 days, the Trump administration has said rooting out waste in federal programs was a priority, allowing billionaire Elon Musk and the newly created Department of Government Efficiency broad latitude to fundamentally alter the operations of federal agencies.

The idea of a nationwide mandate that requires Medicaid enrollees to either work, study, or complete other qualifying activities to maintain coverage is gaining traction as congressional Republicans weigh proposals to cut $880 billion from the federal deficit over 10 years. The savings are intended to offset the costs of President Donald Trump’s priorities, including border security and tax cuts that would largely benefit the wealthy.

A majority of the public — regardless of political leaning — oppose funding cuts to Medicaid, according to polling released May 1 by KFF, a health information nonprofit that includes KFF Health News.

The GAO investigation comes at a critical time, said Leo Cuello, a research professor at Georgetown University’s Center for Children and Families.

“Congress seems to be pursuing cuts in Medicaid in a frenetic and rushed manner,” he said. The GAO report could outline for Congress the full extent of problems with work requirements “before they rush forward and do this without thinking.”

The experiences of Georgia and Arkansas — the only two states to have run such programs — show that work requirements depress Medicaid enrollment while adding costly layers of bureaucracy.

Now, more states are trying to get signoff from the Trump administration to approve work requirements for Medicaid, the state-federal program that offers health coverage to millions of Americans with low-incomes and disabilities.

The Centers for Medicare & Medicaid Services, which approves Medicaid pilot programs such as work requirements, did not respond to a request for comment by publication.

The GAO found in 2019 that work requirement programs can be expensive for states to run — hundreds of millions of dollars, in some cases — and that federal officials failed to consider those costs when approving the programs, which cannot increase Medicaid spending.

Still, the Trump administration has supported work requirements. The programs require state employees to manually verify whether enrollees meet eligibility requirements and monitor their continued compliance.

In 2023, more than 90% of U.S. adults eligible for Medicaid expansion were already working or could be exempt from requirements, according to KFF.

During his confirmation hearing to lead CMS, Mehmet Oz said he was in favor of work requirements but didn’t think they should be used as “an obstacle, a disingenuous effort to block people from getting on Medicaid.”

The first Trump administration approved work requirements in 13 states. Nearly all the programs were blocked by the Biden administration or federal courts.

Georgia is one of 10 states that hasn’t fully expanded Medicaid to nearly all low-income adults.

The state launched Pathways to Coverage on July 1, 2023. It’s been a main policy priority of Republican Gov. Brian Kemp, whose office engaged in a lengthy court fight with the Biden administration after it tried to block the program.

The program cost more than $57 million in state and federal dollars through the end of 2024, with much of that going toward its administration. As of April 25, 7,410 people were enrolled, a small percentage of those who would be covered by a full Medicaid expansion. Pathways has also slowed processing times for other benefit programs in the state.

When asked about the costs and benefits of Pathways, Kemp spokesperson Garrison Douglas instead pointed to Georgia’s recently launched state-based Obamacare exchange. It saw record enrollment due, in part, to enhanced subsidies passed by the Biden administration.

“We are covering more Georgians than traditional Medicaid expansion would have, and for less money,” said Douglas, referring to the state, not federal, share of spending.

The enhanced subsidies that boosted enrollment are set to expire this year. The Congressional Budget Office estimates that extending them would cost the federal government about $335 billion over 10 years.

In March, Arkansas asked the Trump administration to relaunch its Medicaid work requirement program. The federal public comment period on the program runs through May 10. A previous version was halted by a court order in 2019, but not before more than 18,000 lost coverage in less than a year.

Georgia plans to request that the White House renew its program with modest changes, including reducing how frequently enrollees must prove to the state they’re working or engaging in other qualifying activities.

The GAO investigation into Georgia’s work requirement program comes after three Democratic U.S. senators — Jon Ossoff and Raphael Warnock of Georgia and Ron Wyden of Oregon — asked the GAO in December for an investigation into the program’s costs. Their request cited reporting by KFF Health News.

“I pushed for this GAO report because I am confident its findings will further support what we already know: Pathways to Coverage costs the taxpayers more money and covers fewer people than had the state simply joined 40 other states in closing the health care coverage gap,” Warnock said in a statement.

The GAO said it aims to figure out how much Georgia has spent to run the program, how much of that was federal money, and how that spending is being tracked.

KFF Health News 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 KFF.

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El principal organismo no partidista de control gubernamental del país ha confirmado que está examinando los costos de operar el único programa de Medicaid activo con requisito de trabajo, mientras legisladores republicanos estatales y federales consideran requisitos similares.

La Oficina de Responsabilidad Gubernamental de Estados Unidos (GAO) informó a KFF Health News que su análisis del programa Georgia Pathways to Coverage podría publicarse este otoño.

En sus primeros 100 días, la administración Trump ha dicho que su prioridad era eliminar el despilfarro en los programas federales, lo que ha permitido al multimillonario Elon Musk y al recién creado Departamento de Eficiencia Gubernamental (DOGE) un amplio margen de maniobra para modificar radicalmente las operaciones de las agencias federales.

La idea de un mandato nacional que requiera que los beneficiarios de Medicaid trabajen, estudien o realicen otras actividades que cumplan los requisitos para mantener la cobertura está ganando terreno a medida que los republicanos del Congreso evalúan propuestas para recortar $880 mil millones del déficit federal a lo largo de 10 años.

Estos ahorros buscan compensar los costos de las prioridades del presidente Donald Trump, incluyendo la seguridad fronteriza y los recortes de impuestos que beneficiarían en gran medida a los más ricos.

La mayoría del público, independientemente de su orientación política, se opone a los recortes de fondos a Medicaid, según una encuesta publicada el 1 de mayo por KFF, una organización sin fines de lucro dedicada a la información sobre salud que incluye a KFF Health News.

La investigación de la GAO llega en un momento crítico, afirmó Leo Cuello, profesor de investigación del Centro para Niños y Familias de la Universidad de Georgetown.

“El Congreso parece estar implementando recortes a Medicaid de forma frenética y apresurada”, afirmó. El informe de la GAO podría explicar al Congreso la magnitud de los problemas con los requisitos de trabajo “antes de que se apresuren y lo hagan sin pensar”.

Las experiencias de Georgia y Arkansas, los dos únicos estados que han implementado programas similares, demuestran que los requisitos de trabajo reducen la inscripción en Medicaid y agregan costosas capas de burocracia.

Ahora, más estados intentan obtener la aprobación de la administración Trump para aprobar los requisitos de trabajo para Medicaid, el programa estatal-federal que ofrece cobertura médica a millones de estadounidenses con bajos ingresos y discapacidades.

Los Centros de Servicios de Medicare y Medicaid (CMS), que aprueban programas piloto de Medicaid, como los de requisitos de trabajo, no respondieron a una solicitud de comentarios.

La GAO halló en 2019 que la gestión de los programas de requisitos laborales puede resultar costosa para los estados —cientos de millones de dólares, en algunos casos— y que los funcionarios federales no consideraron esos costos al aprobarlos, lo que no puede aumentar el gasto de Medicaid.

Aun así, la administración Trump ha apoyado los requisitos laborales. Estos programas exigen que los empleados estatales verifiquen manualmente si los beneficiarios cumplen con los requisitos de elegibilidad, y supervisen su cumplimiento continuo.

En 2023, más del 90% de los adultos estadounidenses elegibles para la expansión de Medicaid ya trabajaban o podrían estar exentos de los requisitos, según KFF.

Durante su audiencia de confirmación para dirigir los CMS, Mehmet Oz afirmó estar a favor de los requisitos laborales, pero no creía que debieran utilizarse como “un obstáculo, un intento engañoso de impedir que las personas accedan a Medicaid”.

La primera administración Trump aprobó los requisitos laborales en 13 estados. Casi todos los programas fueron bloqueados por la administración Biden o por tribunales federales.

Georgia es uno de los 10 estados que no ha expandido completamente Medicaid a casi todos los adultos de bajos ingresos.

El estado lanzó Pathways to Coverage el 1 de julio de 2023. Ha sido una prioridad política del gobernador republicano Brian Kemp, cuya oficina se vio envuelta en una larga batalla legal con la administración Biden cuando intentó bloquear el programa.

El programa costó más de $57 millones estatales y federales hasta finales de 2024, gran parte de los cuales se destinaron a administrarlo. Al 25 de abril, 7.410 personas estaban inscritas, un pequeño porcentaje de las que estarían cubiertas por una expansión total de Medicaid. Pathways también ha ralentizado los tiempos de procesamiento para otros programas de beneficios en el estado.

Al ser consultado sobre los costos y beneficios de Pathways, Garrison Douglas, vocero de Kemp, señaló el reciente mercado estatal de Obamacare en Georgia. El mercado de seguros registró una inscripción récord debido, en parte, a la mejora de los subsidios aprobada por la administración Biden.

“Estamos cubriendo a más georgianos de lo que habría cubierto la expansión tradicional de Medicaid, y por menos dinero”, dijo Douglas, refiriéndose a la parte estatal, no federal, del gasto.

Los subsidios mejorados que impulsaron la inscripción expirarán este año. La Oficina de Presupuesto del Congreso estima que extenderlos costaría al gobierno federal alrededor de $335 mil millones en 10 años.

En marzo, Arkansas solicitó a la administración Trump que relanzara su programa de requisitos de trabajo de Medicaid. El período federal de comentarios públicos sobre el programa finaliza el 10 de mayo. Una versión anterior fue suspendida por una orden judicial en 2019, pero no antes de que más de 18.000 personas perdieran su cobertura en menos de un año.

Georgia planea solicitar a la Casa Blanca que renueve su programa con cambios modestos, incluyendo la reducción de la frecuencia con la que los inscritos deben demostrar al estado que están trabajando o participando en otras actividades calificadas.

La investigación de la GAO sobre el programa de requisitos de trabajo de Georgia se produce después de que tres senadores demócratas nacionales —Jon Ossoff y Raphael Warnock, de Georgia, y Ron Wyden, de Oregon— solicitaran a la GAO en diciembre una investigación sobre los costos del programa. Su solicitud citaba un informe de KFF Health News.

“Impulsé este informe de la GAO porque confío en que sus hallazgos respaldarán aún más lo que ya sabemos: Pathways to Coverage cuesta más dinero a los contribuyentes y cubre a menos personas que si el estado simplemente se uniera a otros 40 estados para cerrar la brecha en la cobertura médica”, declaró Warnock en un comunicado.

La GAO afirmó que su objetivo es determinar cuánto ha gastado Georgia en la gestión del programa, cuánto de ese dinero fue federal y cómo se está monitoreando ese gasto.

KFF Health News 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 KFF.

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El principal organismo no partidario de control gubernamental del país ha confirmado que está examinando los costos de operar el único programa de Medicaid activo con requisito de trabajo, mientras legisladores republicanos estatales y federales consideran requisitos similares.

La Oficina de Responsabilidad Gubernamental de Estados Unidos (GAO) informó a KFF Health News que su análisis del programa Georgia Pathways to Coverage podría publicarse este otoño.

En sus primeros 100 días, la administración Trump ha afirmado que eliminar el despilfarro en los programas federales era una prioridad, lo que ha permitido al multimillonario Elon Musk y al recién creado Departamento de Eficiencia Gubernamental (DOGE) un amplio margen de maniobra para modificar radicalmente las operaciones de las agencias federales.

La idea de un mandato nacional que requiera que los beneficiarios de Medicaid trabajen, estudien o realicen otras actividades que cumplan los requisitos para mantener la cobertura está ganando terreno a medida que los republicanos del Congreso evalúan propuestas para recortar $880 mil millones del déficit federal a lo largo de 10 años.

Estos ahorros buscan compensar los costos de las prioridades del presidente Donald Trump, incluyendo la seguridad fronteriza y los recortes de impuestos que beneficiarían en gran medida a los más ricos.

La mayoría del público, independientemente de su orientación política, se opone a los recortes de fondos a Medicaid, según una encuesta publicada el 1 de mayo por KFF, la organización sin fines de lucro dedicada a la información sobre salud que incluye a KFF Health News.

La investigación de la GAO llega en un momento crítico, afirmó Leo Cuello, profesor de investigación del Centro para Niños y Familias de la Universidad de Georgetown.

“El Congreso parece estar implementando recortes a Medicaid de forma frenética y apresurada”, afirmó. El informe de la GAO podría explicar al Congreso la magnitud de los problemas con los requisitos de trabajo “antes de que se apresuren y lo hagan sin pensar”.

Las experiencias de Georgia y Arkansas, los dos únicos estados que han implementado programas similares, demuestran que los requisitos de trabajo reducen la inscripción en Medicaid y agregan costosas capas de burocracia.

Ahora, más estados intentan obtener la aprobación de la administración Trump para aprobar los requisitos de trabajo para Medicaid, el programa estatal-federal que ofrece cobertura médica a millones de estadounidenses con bajos ingresos y discapacidades.

Los Centros de Servicios de Medicare y Medicaid (CMS), que aprueban programas piloto de Medicaid, como los de requisitos de trabajo, no respondieron a una solicitud de comentarios.

La GAO descubrió en 2019 que la gestión de los programas de requisitos laborales puede resultar costosa para los estados (cientos de millones de dólares, en algunos casos) y que los funcionarios federales no consideraron esos costos al aprobarlos, lo que no puede aumentar el gasto de Medicaid.

Aun así, la administración Trump ha apoyado los requisitos laborales. Estos programas exigen que los empleados estatales verifiquen manualmente si los beneficiarios cumplen con los requisitos de elegibilidad y supervisen su cumplimiento continuo.

En 2023, más del 90% de los adultos estadounidenses elegibles para la expansión de Medicaid ya trabajaban o podrían estar exentos de los requisitos, según KFF.

Durante su audiencia de confirmación para dirigir los CMS, Mehmet Oz afirmó estar a favor de los requisitos laborales, pero no creía que debieran utilizarse como “un obstáculo, un intento engañoso de impedir que las personas accedan a Medicaid”.

La primera administración Trump aprobó los requisitos laborales en 13 estados. Casi todos los programas fueron bloqueados por la administración Biden o por tribunales federales.

Georgia es uno de los 10 estados que no ha expandido completamente Medicaid a casi todos los adultos de bajos ingresos.

El estado lanzó Pathways to Coverage el 1 de julio de 2023. Ha sido una prioridad política del gobernador republicano Brian Kemp, cuya oficina se vio envuelta en una larga batalla legal con la administración Biden cuando intentó bloquear el programa.

El programa costó más de $57 millones estatales y federales hasta finales de 2024, gran parte de los cuales se destinó a administrarlo. Al 25 de abril, 7.410 personas estaban inscritas, un pequeño porcentaje de las que estarían cubiertas por una expansión total de Medicaid. Pathways también ha ralentizado los tiempos de procesamiento para otros programas de beneficios en el estado.

Al ser consultado sobre los costos y beneficios de Pathways, Garrison Douglas, vocero de Kemp, señaló el reciente mercado estatal de Obamacare en Georgia. Este registró una inscripción récord debido, en parte, a la mejora de los subsidios aprobada por la administración Biden.

“Estamos cubriendo a más georgianos de lo que habría cubierto la expansión tradicional de Medicaid, y por menos dinero”, dijo Douglas, refiriéndose a la parte estatal, no federal, del gasto.

Los subsidios mejorados que impulsaron la inscripción expirarán este año. La Oficina de Presupuesto del Congreso estima que extenderlos costaría al gobierno federal alrededor de $335 mil millones en 10 años.

En marzo, Arkansas solicitó a la administración Trump que relanzara su programa de requisitos de trabajo de Medicaid. El período federal de comentarios públicos sobre el programa finaliza el 10 de mayo. Una versión anterior fue suspendida por una orden judicial en 2019, pero no antes de que más de 18.000 personas perdieran su cobertura en menos de un año.

Georgia planea solicitar a la Casa Blanca que renueve su programa con cambios modestos, incluyendo la reducción de la frecuencia con la que los inscritos deben demostrar al estado que están trabajando o participando en otras actividades calificadas.

La investigación de la GAO sobre el programa de requisitos de trabajo de Georgia se produce después de que tres senadores demócratas estadounidenses —Jon Ossoff y Raphael Warnock, de Georgia, y Ron Wyden, de Oregon— solicitaran a la GAO en diciembre una investigación sobre los costos del programa. Su solicitud citaba un informe de KFF Health News.

“Impulsé este informe de la GAO porque confío en que sus hallazgos respaldarán aún más lo que ya sabemos: Pathways to Coverage cuesta más dinero a los contribuyentes y cubre a menos personas que si el estado simplemente se uniera a otros 40 estados para cerrar la brecha en la cobertura médica”, declaró Warnock en un comunicado.

La GAO afirmó que su objetivo es determinar cuánto ha gastado Georgia en la gestión del programa, cuánto de ese dinero fue federal y cómo se está monitoreando ese gasto.

KFF Health News 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 KFF.

USE OUR CONTENT

This story can be republished for free (details).

The Host Julie Rovner KFF Health News @jrovner Read Julie's stories. Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

Members of Congress are back in Washington this week, and Republicans are facing hard decisions on how to reduce Medicaid spending, even as new polling shows that would be unpopular among their voters.

Meanwhile, with President Donald Trump marking 100 days in office, the Department of Health and Human Services remains in a state of confusion, as programs that were hastily cut are just as hastily reinstated — or not. Even those leading the programs seem unsure about the status of many key health activities.

This week’s panelists are Julie Rovner of KFF Health News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, Alice Miranda Ollstein of Politico, and Margot Sanger-Katz of The New York Times.

Panelists Joanne Kenen Johns Hopkins University and Politico @JoanneKenen Read Joanne's stories. Alice Miranda Ollstein Politico @AliceOllstein Read Alice's stories. Margot Sanger-Katz The New York Times @sangerkatz Read Margot's stories.

Among the takeaways from this week’s episode:

• How and what congressional Republicans will propose cutting from federal government spending is still up in the air — one big reason being that the House and Senate have two separate sets of instructions to follow during the budget reconciliation process. The two chambers will need to resolve their differences eventually, and many of the ideas on the table could be politically risky for Republicans.
• GOP lawmakers are reportedly considering imposing sweeping work requirements on nondisabled adults to remain eligible for Medicaid. Only Georgia and Arkansas have tried mandating that some enrollees work, volunteer, go to school, or enroll in job training to qualify for Medicaid. Those states’ experiences showed that work requirements don’t increase employment but are effective at reducing Medicaid enrollment — because many people have trouble proving they qualify and get kicked off their coverage.
• New reporting this week sheds light on the Trump administration’s efforts to go after the accreditation of some medical student and residency programs, part of the White House’s efforts to crack down on diversity and inclusion initiatives. Yet evidence shows that increasing the diversity of medical professionals helps improve health outcomes — and that undermining medical training could further exacerbate provider shortages and worsen the quality of care.
• Trump’s upcoming budget proposal to Congress could shed light on his administration’s budget cuts and workforce reductions within — and spreading out from — federal health agencies. The proposal will be the first written documentation of the Trump White House’s intentions for the federal government.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too: 

Julie Rovner: KFF Health News’ “As a Diversity Grant Dies, Young Scientists Fear It Will Haunt Their Careers,” by Brett Kelman. 

Joanne Kenen: NJ.com’s “Many Nursing Homes Feed Residents on Less Than $10 a Day: ‘That’s Appallingly Low’” and “Inside the ‘Multibillion-Dollar Game’ To Funnel Cash From Nursing Homes to Sister Companies,” by Ted Sherman, Susan K. Livio, and Matthew Miller. 

Alice Miranda Ollstein: ProPublica’s “Utah Farmers Signed Up for Federally Funded Therapy. Then the Money Stopped,” by Jessica Schreifels, The Salt Lake Tribune.  

Margot Sanger-Katz: CNBC’s “GLP-1s Can Help Employers Lower Medical Costs in 2 Years, New Study Finds,” by Bertha Coombs.  

Also mentioned in this week’s podcast:

• MedPage Today’s “Trump Order Targets Med School, Residency Accreditors Over ‘Unlawful’ DEI Standards,” by Cheryl Clark.
• Stat’s “Despite Kennedy’s Stated Support, Funding for Women’s Health Initiative Remains in Limbo,” by Elizabeth Cooney.
• CBS News’ “FDA Head Falsely Claims No Scientists Laid Off, as Agency Shutters Food Safety Labs,” by Alexander Tin.
• The New York Times’ “F.D.A. Scientists Are Reinstated at Agency Food Safety Labs,” by Christina Jewett.

Credits Francis Ying Audio producer Emmarie Huetteman Editor

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HHS released a comprehensive review of evidence and best practices for promoting the health of youth with gender dysphoria.

Food bank shortages caused by high demand and cuts to federal aid programs have some residents of a small community that straddles Idaho and Nevada growing their own food to get by.

For those living in Duck Valley, a reservation of about 1,000 people that is home to the Shoshone-Paiute Tribes, there’s just one grocery store where prices are too high for many to afford, said Brandy Bull Chief, local director of a federal food distribution program for tribes. The next-closest grocery stores are more than 100 miles away in Mountain Home, Idaho, and Elko, Nevada. And the local food bank’s troubles are mirrored by many nationwide, squeezed between growing need and shrinking aid.

Reggie Premo, a community outreach specialist at the University of Nevada-Reno Extension, grew up cattle ranching and farming alfalfa in Duck Valley. He runs workshops to teach residents to grow produce. Premo said he has seen increased interest from tribal leaders in the state worried about high costs while living in food deserts.

“We’re just trying to bring back how it used to be in the old days,” Premo said, “when families used to grow gardens.”

Food bank managers across the country say their supplies have been strained by rising demand since the covid pandemic-era emergency Supplemental Nutrition Assistance Program benefits ended two years ago and steepening food prices. Now, they say, demand is compounded by recent cuts in federal funding to food distribution programs that supply staple food items to pantries nationwide.

In March, the U.S. Department of Agriculture cut $500 million from the Emergency Food Assistance Program, which buys food from domestic producers and sends it to pantries nationwide. The program has supplied more than 20% of the distributions by Feeding America, a nonprofit that serves a network of over 200 food banks and 60,000 meal programs.

The collision between rising demand and falling support is especially problematic for rural communities, where the federal program might cover 50% or more of food supplied to those in need, said Vince Hall, chief government relations officer of Feeding America. Deepening the challenge for local food aid organizations is an additional $500 million the Trump administration slashed from the USDA Local Food Purchase Assistance Cooperative Agreement Program, which helped state, tribal, and territorial governments buy fresh food from nearby producers.

“The urgency of this crisis cannot be overstated,” Hall said, adding that the Emergency Food Assistance Program is “rural America’s hunger lifeline.”

Farmers who benefited from the USDA programs that distributed their products to food banks and schools will also be affected. Bill Green is executive director for the Southeast region of Common Market, a nonprofit that connects farmers with organizations in the Mid-Atlantic, the Southeast, Texas, and the Great Lakes. Green said his organization won’t be able to fill the gap left by the federal cuts, but he hopes some schools and other institutions will continue buying from those farmers even after the federal support dries up.

“I think that that food access challenge has only been aggravated, and I think we just found the tip of the iceberg on that,” he said.

Food Bank for the Heartland in Omaha, Nebraska, for example, is experiencing four times the demand this year than in 2018, according to Stephanie Sullivan, its assistant director of marketing and communications. The organization expects to provide food to 580,000 households across the 93 counties it serves in Nebraska and western Iowa this fiscal year, the highest number in its history, she said.

“These numbers should be a wake-up call for all of us,” Sullivan said.

The South Plains Food Bank in Texas projects it will distribute approximately 121,000 food boxes this year to people in need across the 19 counties it serves, compared with an average 90,000 annually before the pandemic. CEO Dina Jeffries said the organization now is serving about 25% more people, while shouldering the burden of decreased funding and food products.

In Nevada, the food bank that helps serve communities in the northern part of the state, including the Shoshone-Paiute Tribes of the Duck Valley Reservation, provides food to an average of 160,000 people per month. That’s a 76% increase over its clientele before the pandemic, and the need continues to rise, said Jocelyn Lantrip, director of marketing and communications for the Food Bank of Northern Nevada.

Lantrip said one of the most troubling things for the food bank is that the USDA commodities shipped for local distribution often are foods that donations don’t usually cover — things like eggs, dairy, and meat.

“That’s really valuable food to our neighbors,” she said. “Protein is very difficult to replace.”

Forty percent of people who sought assistance from food banks during the pandemic did so for the first time, Hall said. “Many of those families have come to see their neighborhood food bank not as a temporary resource for emergency help but an essential component of their monthly budget equation.”

About 47 million people lived in food-insecure households in 2023, the most recent USDA data available.

Bull Chief, who also runs a small food pantry on the Duck Valley Reservation, said workers drive to Elko to pick up food distributed by the Food Bank of Northern Nevada. But sometimes there’s not much to choose from. In March, the food pantry cut down its operation to just two weeks a month. She said sometimes they must weigh whether it’s worth spending money on gas to pick up a small amount of food.

When the food pantry opened in 2020, Bull Chief said, it helped 10 to 20 households a month. That number is 60 or more now, made up of a broad range of community members — teens fresh out of high school and living on their own, elders, and people who don’t have permanent housing or jobs. She said providing even small amounts of food can help households make ends meet between paychecks or SNAP benefit deposits.

“Whatever they need to get to survive for the month,” Bull Chief said.

Pinched food banks, elevated need, and federal cuts mean there’s very little resiliency in the system, Hall said. Additional challenges, like an economic slowdown, policy changes to SNAP or other federal nutrition programs, or natural disasters could render food banks unable to meet needs “because they are stretched to the breaking point right now.”

A proposed budget resolution passed by the U.S. House of Representatives in April would require $1.7 trillion in net funding cuts, and anti-hunger advocates fear SNAP could be a target. More people living in rural parts of the country rely on SNAP than people in urban areas because of higher poverty rates, so they would be disproportionately affected.

An extension of the federal 2018 Farm Bill, which lasts until Sept. 30, included about $450 million for the Emergency Food Assistance Program for this year. But the funding that remains doesn’t offset the cuts, Hall said. He hopes lawmakers pass a new farm bill this year with enough money to do so.

“We don’t have a food shortage,” he said. “We have a shortage of political will.”

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Sumana Reddy, a primary care physician, struggles on thin financial margins to run Acacia Family Medical Group, the small independent practice she founded 27 years ago in Salinas, a predominantly Latino city in an agricultural valley often called “the salad bowl of the world.”

Reddy can’t match the salaries offered by larger health systems — a difficulty compounded by a widespread shortage of primary care doctors.

The shortage is tied largely to the lower pay and relative lack of prestige associated with primary care, making recruitment difficult. “It certainly is challenging to expose medical students early in their careers to the joys of this kind of integrated health care,” Reddy said. “The relationships we build and the care we provide truly allow people to live longer with a better quality of life.”

Hoping to increase revenue so Acacia can afford to pay more, Reddy has signed the practice up for alternative payment methods with health plans that offer bonuses for meeting certain primary care goals tied to child vaccinations, blood pressure control, and screenings for breast cancer, colorectal cancer, and mental health. Such pay-for-performance arrangements are among the many efforts by industry players and state officials to confront the problems plaguing primary care.

Medical students frequently opt not to go into primary care, and that’s not good for patients. People with regular primary care providers are more likely to get preventive care that avoids serious illnesses and feel more empowered to advocate for themselves. They’re also less likely to encounter language barriers, resort to costly emergency room visits, or forgo care.

Six years after the influential California Future Health Workforce Commission made a series of recommendations to plug a projected shortage of 4,100 primary care providers in 2030, a number of public and private initiatives have proliferated around the state to address the problem. They include new residency slots, debt forgiveness, waived medical school tuition, new ways of paying doctors, expanded nurse practitioner roles, and a statewide target to increase primary care spending. Hundreds of millions of taxpayer dollars have been allocated for some of these efforts.

But numerous academic experts and medical professionals believe those moves, while well intended, have been scattershot and insufficient. “The pieces are there,” said Monica Soni, chief medical officer of Covered California, the state’s Affordable Care Act health insurance marketplace. “I am worried we started a little too late, and I think it’s a little too siloed.”

A study published in 2022 by the California Health Care Foundation found that substantial progress had been made on some of those goals, including recruitment of students from low-income households and communities of color. A separate analysis from the foundation showed that, from 2020 to 2023, California jumped about 10 spots in a ranking of states by primary care residents and fellows per capita.

However, the latest state data shows nearly 15 million Californians live in areas without enough primary care providers to meet patient needs.

State budget constraints and potential federal spending cuts, especially to Medicaid, could exacerbate shortages in areas already desperate for clinicians and dampen hopes of building a robust primary care system that state officials and virtually everyone in the industry agree would be a strong defense against serious — and costly — illnesses. Federal cuts could also hit medical training and hospital systems.

“Many of us are very scared about threats from both the Trump administration and Republicans in Congress,” said Kevin Grumbach, a family community medicine professor at the University of California-San Francisco.

Acute Primary Care Shortages

California’s lack of primary care providers, including doctors, nurse practitioners, and physician assistants, is most acute in rural parts of the state, particularly in the north and the Central Valley. Entire rural counties, including Del Norte, Madera, Tulare, and Yuba, are designated shortage areas, according to state data. Some densely populated urban areas, including parts of Los Angeles, also confront shortages.

Many Californians face months-long waits for appointments or have to travel long distances or go to emergency rooms for nonurgent medical needs, which means hours spent in crowded waiting rooms for unnecessarily expensive care.

In Chico, 90 miles north of Sacramento, the emergency room at the only hospital in town has seen a sharp increase in patients over the past decade, due in part to a lack of primary care providers in the area.

“People who don’t have a primary care provider — which is a lot, because there are not enough — end up in the ER when they need routine care,” said David Alonso, a local internal medicine doctor. “The ER then says, ‘OK, you should follow up with your primary care provider,’ and they’re like, ‘We don’t have one.’”

Yalda Jabbarpour, director of the Robert Graham Center for Policy Studies, a health policy think tank, said failure to invest robustly in primary care has robbed the public of its benefits.

The field has historically been underfunded, accounting for less than 5% of national health care spending in 2022, according to the Milbank Memorial Fund, a national nonprofit focused on population health and health equity.

The consequences are clear.

The U.S. spends significantly more per capita on health care than other industrialized nations, and yet Americans aren’t any healthier. Chronic conditions such as heart disease, diabetes, arthritis, and Alzheimer's, as well as mental illness, account for 90% of the $4.5 trillion spent on health care every year.

Medical students, often faced with staggering educational debt, are increasingly choosing higher-paid specialties over primary care. The average salary of a family medicine physician is slightly over $300,000, compared with more than $565,000 for a cardiologist and over $763,000 for a neurosurgeon, according to one study.

“If you are going to pay over $300,000 to go to medical school, you want to be a neurosurgeon; you don’t want to be a family practice doctor,” said William Barcellona, executive vice president of government affairs at America’s Physician Groups, a Los Angeles-based professional association representing 360 medical groups and independent practice associations nationwide.

Barcellona said the Golden State’s high housing costs also make recruiting difficult.

But it’s not only pay that tempers enthusiasm for primary care. It’s also burnout from so many unpaid hours spent recording details of medical visits in electronic health records; haggling with insurance companies for treatment authorization; answering phone calls and emails from patients; or searching far and wide — often in a health care desert — for specialists with the right expertise.

Debby Lee, the daughter of Hmong immigrants from Laos, experienced this kind of frustration firsthand.

Cultural and linguistic barriers faced by her family motivated her to pursue internal medicine. Lee worked part of her residency at a community clinic serving Hmong in the Sacramento area. She loved the patients, as well as her co-workers. But she was burdened by outdated technology that limited the number of patients she could see. “I just saw myself kind of burning out being in that setting,” Lee said.

When the clinic invited her to stay, she declined, taking a job with a bigger health system.

Solutions to the Shortage

Besides residencies, other efforts support primary care.

The Health Plan of San Mateo offers grants to help medical practices retain and add to primary care staff. In exchange, the practices — some single physicians serving patients in California’s Medicaid program, Medi-Cal — must show they have increased their patient load and retained newly hired providers for five years.

The idea is to provide capital so doctors can hire the staff they need to run their practices efficiently, increase salaries, offer bonuses, and even take sabbaticals. Such efforts are consistent with one of the main thrusts of the 2019 workforce report: to increase investment in primary care.

California recently joined several other states, including Connecticut, Oklahoma, and Rhode Island, in setting a target to increase primary care spending. So far, those policies have yielded mixed results.

Late last year, California’s Office of Health Care Affordability set a target to make primary care account for 15% of total health care spending by 2034, more than double the current proportion. It imposes no requirements, relying on the goodwill of health plans to work with medical providers.

Greater spending on primary care would mean better pay and more people working in the field, said Richard Kronick, a public health professor at UC-San Diego and a member of the OHCA board. “That’s a big change. Will it happen? I don’t think anyone can predict the future with any certainty.”

Stephen Shortell, a professor emeritus of health policy and management at UC-Berkeley, said “some of that increase might occur, but at some point, it might need to be made mandatory.”

In its report, the workforce commission also cited the importance of alternative forms of primary care payment that offer extra cash for quality care. The affordability office has set targets to encourage such payment methods. The aim is to transform the system from one in which every medical service has a price tag to one that treats people holistically, and in which adherence to medical standards brings more money to doctors and their office staff.

Such arrangements are common among HMOs, though less so in primary care practices. Where they do exist, different health plans and other payers generally design them differently, which means primary care practices manage multiple payment models, adding to their administrative burden.

Reddy’s family practice is participating in a one-year demonstration project launched in January intended to reduce that burden by having multiple insurers work together in one payment plan.

The project brings together three large insurers — Health Net, Aetna, and Blue Shield of California — and 10 independent practices across the state with the goal of improving care while boosting revenue for the medical groups. It is administered by two industry groups, the Integrated Healthcare Association and the California Quality Collaborative.

On top of customary payments, either for services rendered or monthly per-member allotments, the medical practices receive bonuses for meeting targets or improving their performance on core measures.

Participating practices also receive monthly per-patient payments for “population health management,” which means managing the collective health of their patients. And they can search a single platform to find all their patients covered by one of the three plans.

In addition to extra payments and fewer administrative hassles, the health plans pay for a “practice coach,” whose job is to help primary care groups meet their targets and provide more seamless care.

The idea is to add more insurers and medical groups over time, said Todd May, Health Net’s medical director for commercial health plans, who is among those driving the project. “In addition to better outcomes, we’d like to see a stronger, more robust, and more satisfied primary care workforce,” he said.

Reddy hopes she can increase Acacia’s revenue by 20%, using the extra money from this and other pay-for-performance arrangements. That, she said, would enable her to raise pay for her staff and hire clinicians.

For many years, her practice has limited the number of patients it has accepted. But after searching for the better part of five years, Reddy has hired a doctor on a half-time basis and another is coming on board in June.

“This is the most hopeful I have felt in decades,” Reddy said.

Phillip Reese contributed to this report.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News 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 KFF.

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This story can be republished for free (details).