Céline Gounder, KFF Health News’ editor-at-large for public health, discussed the FDA’s phasing out of fluoride drops and tablets for children on CBS’ “CBS Mornings” on May 15.

• Click here to watch Gounder on “CBS Mornings.”

KFF Health News Southern correspondent Sam Whitehead discussed what Medicaid cuts could mean for Georgia on The Atlanta Journal-Constitution’s “Politically Georgia” on May 14. Whitehead then discussed Georgia health bills on WUGA’s “The Georgia Health Report” on May 9. He also joined WNHN FM 94.7’s “The Attitude With Arnie Arnesen” to discuss Medicaid and work requirements on May 8.

• Click here to hear Whitehead on “Politically Georgia.”
• Read Whitehead and Renuka Rayasam’s “Government Watchdog Expects Medicaid Work Requirement Analysis by Fall.”
• Click here to hear Whitehead on “The Georgia Health Report.”
• Click here to hear Whitehead on “The Attitude with Arnie Arnesen.”
• Read Rayasam and Whitehead’s “Work Requirements Might Cut Medicaid Spending. But at What Cost?”

KFF Health News chief Washington correspondent Julie Rovner discussed drug prices on CBS News 24/7 on May 12.

• Click here to hear Rovner on CBS News 24/7.

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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NEW YORK — On a recent visit to Federal Plaza in Lower Manhattan, some floors in the mammoth office building bustled with people seeking services or facing legal proceedings at federal agencies such as the Social Security Administration and Immigration and Customs Enforcement. In the lobby, dozens of people took photos to celebrate becoming U.S. citizens. At the Department of Homeland Security, a man was led off the elevator in handcuffs.

But the area housing the regional office of the Department of Health and Human Services was eerily quiet.

In March, HHS announced it would close five of its 10 regional offices as part of a broad restructuring to consolidate the department’s work and reduce the number of staff by 20,000, to 62,000. The HHS Region 2 office in New York City, which has served New Jersey, New York, Puerto Rico, and the U.S. Virgin Islands, was among those getting the ax.

Public health experts and advocates say that HHS regional offices, like the one in New York City, form the connective tissue between the federal government and many locally based services. Whether ensuring local social service programs like Head Start get their federal grants, investigating Medicare claims complaints, or facilitating hospital and health system provider enrollment in Medicare and Medicaid programs, regional offices provide a key federal access point for people and organizations. Consolidating regional offices could have serious consequences for the nation’s public health system, they warn.

“All public health is local,” said Georges Benjamin, executive director of the American Public Health Association. “When you have relative proximity to the folks you’re liaising to, they have a sense of the needs of those communities, and they have a sense of the political issues that are going on in these communities.”

The other offices slated to close are in Boston, Chicago, San Francisco, and Seattle. Together, the five serve 22 states and a handful of U.S. territories. Services for the shuttered regional offices will be divvied up among the remaining regional offices in Atlanta, Dallas, Denver, Kansas City, and Philadelphia.

The elimination of regional HHS offices has already had an outsize impact on Head Start, a long-standing federal program that provides free child care and supportive services to children from many of the nation’s poorest families. It is among the examples cited in the lawsuit against the federal government challenging the HHS restructuring brought by New York, 18 other states, and the District of Columbia, which notes that, as a result, “many programs are at imminent risk of being forced to pause or cease operations.”

The HHS site included a regional Head Start office that was closed and laid off staff last month. The Trump administration had sought to wipe out funding for Head Start, according to a draft budget document that outlines dramatic cuts at HHS, which Congress would need to approve. Recent news reports indicate the administration may be stepping back from this plan; however, other childhood and early-development programs could still be on the chopping block.

Bonnie Eggenburg, president of the New Jersey Head Start Association, said her organization has long relied on the HHS regional office to be “our boots on the ground for the federal government.” During challenging times, such as the covid-19 pandemic or Hurricanes Sandy and Maria, the regional office helped Head Start programs design services to meet the needs of children and families. “They work with us to make sure we have all the support we can get,” she said.

In recent weeks, payroll and other operational payments have been delayed, and employees have been asked to justify why they need the money as part of a new “Defend the Spend” initiative instituted by the Elon Musk-led Department of Government Efficiency, created by President Donald Trump through an executive order.

“Right now, most programs don’t have anyone to talk to and are unsure as to whether or not that notice of award is coming through as expected,” Eggenburg said.

HHS regional office employees who worked on Head Start helped providers fix technical issues, address budget questions, and discuss local issues, like the city’s growing population of migrant children, said Susan Stamler, executive director of United Neighborhood Houses. Based in New York City, the organization represents dozens of neighborhood settlement houses — community groups that provide services to local families such as language classes, housing assistance, and early-childhood support, including some Head Start programs.

“Today, the real problem is people weren’t given a human contact,” she said of the regional office closure. “They were given a website.”

To Stamler, closing the regional Head Start hub without a clear transition plan “demonstrates a lack of respect for the people who are running these programs and services,” while leaving families uncertain about their child care and other services.

“It’s astonishing to think that the federal government might be reexamining this investment that pays off so deeply with families and in their communities,” she said.

Without regional offices, HHS will be less informed about which health initiatives are needed locally, said Zach Hennessey, chief strategy officer of Public Health Solutions, a nonprofit provider of health services in New York City.

“Where it really matters is within HHS itself,” he said. “Those are the folks that are now blind — but their decisions will ultimately affect us.”

Dara Kass, an emergency physician who was the HHS Region 2 director under the Biden administration, described the job as being an ambassador.

“The office is really about ensuring that the community members and constituents had access to everything that was available to them from HHS,” Kass said.

At HHS Region 2, division offices for the Administration for Community Living, the FDA’s Office of Inspections and Investigations, and the Substance Abuse and Mental Health Services Administration have already closed or are slated to close, along with several other division offices.

HHS did not provide an on-the-record response to a request for comment but has maintained that shuttering regional offices will not hurt services.

Under the reorganization, many HHS agencies are either being eliminated or folded into other agencies, including the recently created Administration for a Healthy America, under HHS Secretary Robert F. Kennedy Jr.

“We aren’t just reducing bureaucratic sprawl. We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic,” Kennedy said in a press release announcing the reorganization.

Regional office staffers were laid off at the beginning of April. Now there appears to be a skeleton crew shutting down the offices. On a recent day, an Administration for Children and Families worker who answered a visitor’s buzz at the entrance estimated that only about 15 people remained. When asked what’s next, the employee shrugged.

The Trump administration’s downsizing effort will also eliminate six of 10 regional outposts of the HHS Office of the General Counsel, a squad of lawyers supporting the Centers for Medicare & Medicaid Services and other agencies in beneficiary coverage disputes and issues related to provider enrollment and participation in federal programs.

Unlike private health insurance companies, Medicare is a federal health program governed by statutes and regulations, said Andrew Tsui, a partner at Arnall Golden Gregory who has co-written about the regional office closings.

“When you have the largest federal health insurance program on the planet, to the extent there could be ambiguity or appeals or grievances,” Tsui said, “resolving them necessarily requires the expertise of federal lawyers, trained in federal law.”

Overall, the loss of the regional HHS offices is just one more blow to public health efforts at the state and local levels.

State health officials are confronting the “total disorganization of the federal transition” and cuts to key federal partners like the Centers for Disease Control and Prevention, CMS, and the FDA, said James McDonald, the New York state health commissioner.

“What I’m seeing is, right now, it’s not clear who our people ought to contact, what information we’re supposed to get,” he said. “We’re just not seeing the same partnership that we so relied on in the past.”

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OAKLAND, Calif. — With a Starbucks coffee cup in her hand and a half gallon of milk under her arm, Florence Owens let herself into Carol Crooks’ apartment on a Monday morning, announced herself with a cheery “hello,” walked through the book-filled living room, and got to work in the kitchen.

“I see you went popcorn-crazy this weekend,” Owens teased as she brushed kernels off the counter into a garbage can. Crooks, who relies on a walker or wheelchair, can steady herself against the counter while waiting for corn to pop. But back, knee, and foot problems have left the 77-year-old silver-haired retired teacher incapable of most food preparation and cleanup.

Like nearly 800,000 other Californians, Crooks depends on aides from In-Home Supportive Services, a program funded through Medi-Cal, California’s version of Medicaid. Owens has worked as Crooks’ aide for almost three years. In addition to cooking and cleaning, she helps her shower, shops for groceries, drives her to medical appointments, and runs other errands.

For more than 50 years, low-income seniors and disabled people have been able to stay in their California homes — and out of more costly nursing facilities — with help from government-paid aides. But in their latest bid to renew President Donald Trump’s tax cuts, House Republicans released a plan on May 11 that would axe about $625 billion over 10 years from Medicaid, and could threaten funding for Owens and other In-Home Supportive Services workers.

While a major structural overhaul of Medicaid appears increasingly unlikely, Republicans continue to wrestle with how to cut the budget. Several proposals would disproportionately target California, according to Larry Levitt, KFF’s executive vice president for health policy. Federal cuts, coupled with the state’s existing budget woes, could inflict a “double whammy for California and trigger reductions in Medi-Cal and other state programs,” he said. KFF is a health information nonprofit that includes KFF Health News.

Although federal law compels states to offer certain services, such as nursing home care, they’re under no obligation to cover home-based care for low-income seniors and disabled people like Crooks, leaving the in-home services program particularly vulnerable to cuts, said Amber Christ, managing director of health advocacy for the nonprofit legal group Justice in Aging.

In the wake of the Great Recession, California made a series of funding cuts to in-home support aides. Lawsuits temporarily stopped the bulk of the cuts, but a court settlement led to an 8% reduction in 2013 and an additional 7% cut in 2014.

Further reducing these services would inevitably force more people to move into nursing homes, Christ said. “It would be an enormous setback from the progress we have made to provide care in the home and the community to support older adults and their families,” she said. “I think it will cost people’s lives.”

Owens supports herself and her teenage son with what she earns working 136 hours a month for Crooks. She’s confident she can figure out another way to make a living, so she’s less worried about losing her $20-an-hour income than she is about Crooks’ losing her independence.

“I absolutely adore Carol,” said Owens, 36, as she chopped onions for Crooks’ breakfast. “I look at her as a grandma.”

From a makeshift desk where she’d been scrolling through emails, Crooks affectionately eyed Owens and announced, “You’re adopted.”

In his May 14 budget proposal, Gov. Gavin Newsom trimmed funding for In-Home Supportive Services, most notably by putting weekly caps of 50 hours on provider overtime and travel, reinstating an asset limit, and eliminating the service for immigrant adults without legal status who aren’t already enrolled.

The proposed changes are unlikely to affect Crooks, but if congressional Republicans slash Medicaid spending, the Democratic governor warned May 14, California could not afford to backfill all the proposed federal cuts. Almost two-thirds of the $28.3 billion California has budgeted for the in-home support program is supposed to come from endangered federal Medicaid funding. The state legislature must pass a balanced budget by June 15, regardless of the status of federal funding negotiations.

Owens delivered an omelet and a mug of coffee to Crooks. “I know these are politicians,” she said, “but they still have to understand the elders are our roots. And I’m sure they have to have some kind of heart.”

Crooks is less certain, more anxious. “If they start messing with my programs,” she said, “I’m in trouble.”

Burt Conell, 64, is also worried. A paraplegic, he’s been confined to a wheelchair for 30 years, since, despondent after his girlfriend left him, he jumped in front of a train. He relies on in-home aides to help him bathe and clean his San Francisco apartment.

When he heard the government might cut his funding, he imagined being unable to shower, getting rashes and bedsores, and having to move into a nursing home. Again, he contemplated suicide.

“It made me feel like I was using so much resources that I shouldn’t exist,” he said.

At an April meeting of San Francisco’s Disability and Aging Services Commission, Commissioner Sascha Bittner asked about the fate of In-Home Supportive Services, on which she relies. “We don’t know what’s going to happen,” Executive Director Kelly Dearman replied, adding that Medicaid cuts could result in a decrease in the number of hours San Francisco beneficiaries, like Conell and Bittner, who is quadriplegic with a speech disability, receive. “It’ll be dire,” Dearman concluded.

Every day, around 30 people contact California Advocates for Nursing Home Reform seeking advice on how to get in-home help, said Maura Gibney, the nonprofit’s executive director. These days, the group frequently hears from recipients who have achieved a semblance of normalcy in the aftermath of a major setback, such as a stroke, but fear they’ll lose their benefits, she said.

“It’s hard to really give people reassurance at this time because I don’t think any of us know what will happen,” Gibney said.

Lately, when she hears from people looking for in-home help for the first time, Gibney wonders if their efforts will end up being pointless. “It feels a little bit like trying to show somebody how to get into the building as the top floor is on fire,” she said.

Paul Dunaway, who directs Sonoma County’s Adult and Aging Division, described the dearth of information he and his staff have to offer older and disabled people about future services as “anxiety-provoking.”

“There’s a lot of chaos happening and not much to really grab onto yet about the funding on the federal level,” Dunaway said.

Uncertainty and fear about service cuts, coupled with weaning off pain medicine from a back surgery, left Crooks — who retired from teaching after being diagnosed with bipolar disorder — unable to sleep, she said, and she spiraled into her first manic episode in more than a decade.

Owens was sweeping the living room but stopped to listen as Crooks talked about being tired, worried, and feeling out of control. “I told her, ‘Regardless, I’m gonna always be here for you, no matter what,’” Owens said.

Crooks, wearing a T-shirt picturing the Statue of Liberty with her hands covering her face, nodded. “It helped a lot,” she said.

Nonetheless, without an in-home aide, Crooks said, she would have no choice but to move into a nursing home — a fate she cannot bear to consider.

“It wouldn’t be a home,” she said. “It’s where people go to die.”

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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It has been nearly eight years since Sen. John McCain’s middle-of-the-night thumbs-down vote torpedoed Republican efforts to repeal the Affordable Care Act and make drastic cuts to Medicaid.

With Donald Trump back in the White House and the GOP back in control of Congress, Republicans again have their eyes on Medicaid, the government health program for those with low incomes or disabilities. A GOP proposal unveiled this week would require many enrollees to prove they are working, volunteering, or studying, and to shoulder more of the costs of their care. It would also curtail taxes levied on providers that help states draw down billions in additional federal money.

Changes are needed, conservative lawmakers say, because the program is broken and costs too much. Medicaid’s annual price tag has soared from about $590 billion in 2017 to nearly $900 billion today.

If this script sounds familiar, it’s because Republicans made the same proposals and arguments in 2017, when they last had narrow control of Congress and Trump in the White House.

But while the 2025 Medicaid debate on Capitol Hill feels like a 2017 replay, the GOP’s latest effort toward a massive transformation could be more of a long shot, several health policy experts say. In the past eight years, Medicaid enrollment has surged to a record high, with the covid-19 pandemic driving numbers up and nine more states expanding the program to cover more low-income Americans, including six controlled by Republicans.

More enrollees, particularly in red states, means more constituents who rely on Medicaid to cover their health costs — making it harder for lawmakers to approve cuts.

“More red states have more skin in the game,” said Christine Eibner, a senior economist at Rand Corp., a nonprofit research organization.

More than three-quarters of the public opposes major cuts to Medicaid, including 55% of Republicans, according to a recent poll from KFF, a health information nonprofit that includes KFF Health News.

With the expansion of coverage to more Americans, Medicaid has grown more popular and important, said Krista Drobac, a health policy consultant who formerly worked for the National Governors Association. “Cutting it is not as politically palatable, even though Congress has moved further to the right.”

After months of saying little beyond citing a need to cut “waste, fraud, and abuse,” Republicans on the House Energy and Commerce Committee released legislation May 11 outlining their plans.

The bill does not include some of the most controversial proposals the GOP considered, such as eliminating the extra federal funding that allowed states to dramatically expand the program. Nonetheless, the changes it does propose amount to hundreds of billions of dollars in Medicaid spending cuts and could cause at least 8.6 million Americans to lose their health coverage, according to a preliminary estimate by the Congressional Budget Office released by the committee’s Democrats.

Some of the proposals are more targeted, such as a new financial penalty on states such as California that use their own money to cover people living in the country without legal permission.

Others would have widespread implications. In addition to requiring low-income people to prove their eligibility every six months, the GOP proposal would mandate that nondisabled enrollees younger than 65, with some exceptions, show that they work, volunteer, or attend school at least 80 hours per month.

A work requirement is an easier sell politically because it is not seen as cutting benefits, Billy Wynne, a Colorado-based health consultant, said in an interview before the legislation was unveiled.

But unlike in 2017, when the GOP also proposed implementing work requirements, such a policy is no longer just a theory: Arkansas’ program, which was suspended by a federal judge in 2019 after less than a year, left 18,000 people without coverage — with no indication the policy led to more people working. And Georgia’s program has been plagued by administrative burdens and cost overruns.

In fact, most Medicaid enrollees are already employed — just 8% of those who would be required to work are not already doing so, according to KFF.

Awareness about Medicaid and its beneficiaries has improved since 2017, Wynne said. “These are working families, and they vote.”

During a marathon House committee debate on the legislation that started Tuesday afternoon and continued through Wednesday morning, Rep. Jake Auchincloss of Massachusetts, a Democrat, voiced concern that burdensome new paperwork requirements would lead to many low-income people dropping or losing their coverage.

“These aren’t work requirements,” he said. “They’re paperwork requirements.”

Another complication for the GOP’s current effort is that the focus is not fixing the health system, as it was with the past push to repeal Obamacare. This time, Republicans’ main goal is offsetting the cost of extending $4 trillion in tax cuts passed under Trump in 2017 — separately from the repeal effort — that will otherwise expire at the end of this year.

Enrollment in Medicaid and its related Children’s Health Insurance Program swelled to over 93 million during the pandemic, a record high. Enrollment had fallen below 79 million as of December, but that was still about 5 million more people than were covered during the repeal debate in the summer of 2017.

Medicaid and CHIP cover more than 1 in 5 Americans, as well as 40% of children, 41% of births, and long-term care for 62% of nursing home residents.

Congressional Republicans for decades have sought to rein in Medicaid costs by capping federal spending but have faced resistance from Democrats, states, and the health industry.

The 2010 Affordable Care Act provided billions in federal Medicaid funding that enabled 40 states and the District of Columbia to expand the program to over 21 million nondisabled adults. But the law passed with no Republican votes, leaving Medicaid expansion open to partisan squabbling.

The new GOP proposal would require Medicaid enrollees making poverty-level wages or higher to pay copayments of as much as $35 per health care service.

Medicaid usually doesn’t require copays, and advocates for low-income people say any out-of-pocket charge at the doctor’s office could discourage them from seeking care.

Republican members of Congress face more pressure to avoid coverage cuts for their constituents, with many now representing expansion states, including key Senate leaders from South Dakota (Majority Leader John Thune) and Idaho (Finance Committee Chairman Michael Crapo).

There’s also pressure coming from an unusual source: Trump voters.

Last fall, Trump attracted more low-income voters than usual for a GOP presidential candidate.

Those voters are more likely to depend on Medicaid for health coverage. Matt Salo, a Washington, D.C.-based health consultant who was formerly executive director of the National Association of Medicaid Directors, said Trump voters have been telling Republicans at town hall meetings that they did not vote for benefit cuts.

“MAGA voters and people on Medicaid and their family members overlap in ways that have never been true before,” Salo said, referring to Trump’s “Make America Great Again” movement.

Republicans also face unfavorable odds of curtailing a long-standing practice by nearly every state — known as provider taxes — through which states pay some of their share of Medicaid costs by taxing hospitals, nursing homes, and other providers. Those funds then help states collect more matching dollars from the federal government.

For decades, Republicans have sought to limit Medicaid provider taxes, and their latest proposal would effectively freeze the taxes at current rates, squeezing state programs as costs continue to rise. Since 2017, such taxes have become more commonplace, and some states now rely on the funding for nearly a third of their Medicaid budgets.

Conservative groups and some GOP lawmakers have begun referring to these taxes as “money-laundering” schemes, even though they are legal and the taxes are approved by the federal government before states implement them.

One thing that hasn’t changed since 2017 is the strong defense of Medicaid from Democrats, hospital executives, and consumer groups, who argue the GOP’s plan will leave more people uninsured or unable to pay their bills, and force hospitals to close, worsening access to care.

Yet the Trump White House is better staffed to work with Congress than it was in 2017, and more members of the party, whether out of fear or loyalty, are likely to side with the president. So far this year, the Republican caucus has had just enough votes to confirm Trump’s Cabinet and pass a budget framework to tee up legislation to extend his tax cuts.

While the House GOP’s plan would amount to major changes for Medicaid, its legislation left out some of the more ground-shifting ideas like capping federal funding per enrollee or nixing extra expansion funding altogether — and it still needs to earn the approval of Senate Republicans.

Medicaid’s chief backers could end up breathing a sigh of relief, just as they did in summer 2017.

KFF Health News’ Julie Rovner contributed to this report.

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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SPENCER, Iowa — This town’s hospital is a holdout on behalf of people going through mental health crises. The facility’s leaders have pledged not to shutter their inpatient psychiatric unit, as dozens of other U.S. hospitals have.

Keeping that promise could soon get tougher if Congress slashes Medicaid funding. The joint federal-state health program covers an unusually large share of mental health patients, and hospital industry leaders say spending cuts could accelerate a decades-long wave of psychiatric unit closures.

At least eight other Iowa hospitals have stopped offering inpatient mental health care since 2007, forcing people in crisis to seek help in distant facilities. Spencer Hospital is one of the smallest in Iowa still offering the service.

CEO Brenda Tiefenthaler said 40% of her hospital’s psychiatric inpatients are covered by Medicaid, compared with about 12% of all inpatients. An additional 10% of the hospital’s psychiatric inpatients are uninsured. National experts say such disparities are common.

Tiefenthaler vows to keep her nonprofit hospital’s 14-bed psychiatric unit open, even though it loses $2 million per year. That’s a significant loss for an organization with an overall annual budget of about $120 million. But the people who use the psychiatric unit need medical care, “just like people who have chest pains,” Tiefenthaler said.

Medicaid covers health care for about 72 million Americans with low incomes or disabilities. Tiefenthaler predicts that if some of them are kicked off the program and left without insurance coverage, more people would delay treatment for mental health problems until their lives spin out of control.

“Then they’re going to enter through the emergency room when they’re in a crisis,” she said. “That’s not really a solution to what we have going on in our country.”

Republican congressional leaders have vowed to protect Medicaid for people who need it, but they also have called for billions of dollars in cuts to areas of the federal budget that include the program.

The U.S. already faces a deep shortage of inpatient mental health services, many of which were reduced or eliminated by private hospitals and public institutions, said Jennifer Snow, director of government relations and policy for the National Alliance on Mental Illness. At the same time, the number of people experiencing mental problems has climbed.

“I don’t even want to think about how much worse it could get,” she said.

The American Hospital Association estimates nearly 100 U.S. hospitals have shuttered their inpatient mental health services in the past decade.

Such closures are often attributed to mental health services being more likely to lose money than many other types of health care. “I’m not blaming the hospitals,” Snow said. “They need to keep their doors open.”

Medicaid generally pays hospitals lower rates for services than they receive from private insurance or from Medicare, the federal program that mostly covers people 65 or older. And Medicaid recipients are particularly likely to need mental health care. More than a third of nonelderly Medicaid enrollees have some sort of mental illness, according to a report from KFF, a nonprofit health policy organization that includes KFF Health News. Iowa has the highest rate of mental illness among nonelderly Medicaid recipients, at 51%.

As of February, just 20 of Iowa’s 116 community hospitals had inpatient psychiatric units, according to a state registry. Iowa also has four freestanding mental hospitals, including two run by the state.

Iowa, with 3.2 million residents, has a total of about 760 inpatient mental health beds that are staffed to care for patients, the state reports. The Treatment Advocacy Center, a national group seeking improved mental health care, says the “absolute minimum” of such beds would translate to about 960 for Iowa’s population, and the optimal number would be about 1,920.

Most of Iowa’s psychiatric beds are in metro areas, and it can take several days for a slot to come open. In the meantime, patients routinely wait in emergency departments.

Sheriff’s deputies often are assigned to transport patients to available facilities when treatment is court-ordered.

“It’s not uncommon for us to drive five or six hours,” said Clay County Sheriff Chris Raveling, whose northwestern Iowa county includes Spencer, a city of 11,000 people.

He said Spencer Hospital’s mental health unit often is too full to accept new patients and, like many such facilities, it declines to take patients who are violent or charged with crimes.

The result is that people are held in jail on minor charges stemming from their mental illnesses or addictions, the sheriff said. “They really shouldn’t be in jail,” he said. “Did they commit a crime? Yes. But I don’t think they did it on purpose.”

Raveling said authorities in many cases decide to hold people in jail so they don’t hurt themselves or others while awaiting treatment. He has seen the problems worsen in his 25 years in law enforcement.

Most people with mental health issues can be treated as outpatients, but many of those services also depend heavily on Medicaid and could be vulnerable to budget cuts.

Jon Ulven, a psychologist who practices in Moorhead, Minnesota, and neighboring Fargo, North Dakota, said he’s particularly worried about patients who develop psychosis, which often begins in the teenage years or early adulthood. If they’re started right away on medication and therapy, “we can have a dramatic influence on that person for the rest of their life,” he said. But if treatment is delayed, their symptoms often become harder to reverse.

Ulven, who helps oversee mental health services in his region for the multistate Sanford Health system, said he’s also concerned about people with other mental health challenges, including depression. He noted a study published in 2022 that showed suicide rates rose faster in states that declined to expand their Medicaid programs than in states that agreed to expand their programs to cover more low-income adults. If Medicaid rolls are reduced again, he said, more people would be uninsured and fewer services would be available. That could lead to more suicides.

Nationally, Medicaid covered nearly 41% of psychiatric inpatients cared for in 2024 by a sample of 680 hospitals, according to an analysis done for KFF Health News by the financial consulting company Strata. In contrast, just 13% of inpatients in those hospitals’ cancer programs and 9% of inpatients in their cardiac programs were covered by Medicaid.

If Medicaid participants have mental crises after losing their coverage, hospitals or clinics would have to treat many of them for little or no payment. “These are not wealthy people. They don’t have a lot of assets,” said Steve Wasson, Strata’s chief data and intelligence officer. Even though Medicaid pays hospitals relatively low rates, he said, “it’s better than nothing.”

Birthing units, which also have been plagued by closures, face similar challenges. In the Strata sample, 37% of those units’ patients were on Medicaid in 2024.

Spencer Hospital, which has a total of 63 inpatient beds, has maintained both its birthing unit and its psychiatric unit, and its leaders plan to keep them open. Amid a critical shortage of mental health professionals, it employs two psychiatric nurse practitioners and two psychiatrists, including one providing care via video from North Carolina.

Local resident David Jacobsen appreciates the hospital’s efforts to preserve services. His son Alex was assisted by the facility’s mental health professionals during years of struggles before he died by suicide in 2020.

David Jacobsen knows how reliant such services are on Medicaid, and he worries that more hospitals will curtail mental health offerings if national leaders cut the program. “They’re hurting the people who need help the most,” he said.

People on Medicaid aren’t the only ones affected when hospitals reduce services or close treatment units. Everyone in the community loses access to care.

Alex Jacobsen’s family saw how common the need is. “If we can learn anything from my Alex,” one of his sisters wrote in his obituary, “it’s that mental illness is real, it doesn’t discriminate, and it takes some of the best people down in its ugly swirling drain.”

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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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.”

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 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

To hear all our podcasts, click here.

And subscribe to KFF Health News’ “What the Health?” on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts.

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).

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.

Congress returns from spring break next week and will get to work crafting a bill that would cut taxes and boost immigration enforcement — but that also could cut at least $880 billion over the next decade from a pool of funding that includes Medicaid. Some Republicans, however, are starting to question the political wisdom of making such large cuts to a program that provides health coverage to so many of their constituents.

Meanwhile, the Supreme Court heard arguments in a case challenging the requirement that most private insurance cover certain preventive services with no out-of-pocket cost for patients.

This week’s panelists are Julie Rovner of KFF Health News, Sarah Karlin-Smith of the Pink Sheet, Tami Luhby of CNN, and Alice Miranda Ollstein of Politico.

Panelists Sarah Karlin-Smith Pink Sheet @SarahKarlin Read Sarah's stories. Tami Luhby CNN @Luhby Read Tami's stories. Alice Miranda Ollstein Politico @AliceOllstein Read Alice's stories.

Among the takeaways from this week’s episode:

• On the hunt for ways to pay for an extension of President Donald Trump’s tax cuts, many congressional Republicans are choosing their words carefully as they describe potential cuts to Medicaid — cuts that, considering heavy reliance on the program, especially in red states, could be politically unpopular.
• Amid the buzz over Medicaid cuts, another federal program that helps millions of Americans afford health care is also on the chopping block: the enhanced government subsidies introduced under the Biden administration that help pay premiums for Affordable Care Act plans. The subsidies expire at the end of this year, and Congress has yet to address extending them.
• One little-discussed option for achieving deep government spending cuts is Medicare Advantage, the private alternative to traditional Medicare that offers a variety of extra benefits for those over 65 — but that also costs the federal government a bundle. Even Mehmet Oz, the new head of the Centers for Medicare & Medicaid Services who once pushed Medicare Advantage plans as a TV personality, has cast sidelong glances at private insurers over how much they charge the government.
• And the Supreme Court heard oral arguments this week in a case that challenges the U.S. Preventive Services Task Force and could hold major implications for preventive care coverage nationwide. The justices’ questioning suggests the court could side with the government and preserve the task force’s authority — though that decision would also give more power over preventive care to Robert F. Kennedy Jr., the health and human services secretary.

Also this week, Rovner interviews KFF Health News’ Rae Ellen Bichell about her story on how care for transgender minors is changing in Colorado.

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

Julie Rovner: MedPage Today’s “Medical Journals Get Letters From DOJ,” by Kristina Fiore.

Sarah Karlin-Smith: The Tampa Bay Times’ “Countering DeSantis, $10M Hope Florida Donation Came From Medicaid, Draft Shows,” by Alexandra Glorioso and Lawrence Mower.

Tami Luhby: Stat’s “In Ireland, a Global Hub for the Pharma Industry, Trump Tariffs Are a Source of Deep Worry,” by Andrew Joseph.

Alice Miranda Ollstein: The New York Times’ “A Scientist Is Paid to Study Maple Syrup. He’s Also Paid to Promote It,” by Will Evans, Ellen Gabler, and Anjali Tsui.

Also mentioned in this week’s podcast:

• Stat’s “New England Journal of Medicine Gets Swept Up in U.S. Attorney Inquiry Into Alleged Bias,” by Anil Oza.
• KFF’s “KFF Tracking Poll on Health Information and Trust: The Public’s Views on Measles Outbreaks and Misinformation,” by Alex Montero, Grace Sparks, Julian Montalvo III, Ashley Kirzinger, and Liz Hamel.
• Bloomberg News’ “Food Industry Says There’s No Agreement With US Health Agency to Cut Dyes,” by Rachel Cohrs Zhang.
• Politico’s “RFK Jr. Eyes Reversing CDC’s Covid-19 Vaccine Recommendation for Children,” by Adam Cancryn.
• The New Yorker’s “The Cost of Defunding Harvard,” by Atul Gawande.
• The Wall Street Journal’s “Trump’s FDA Sends a Bullish Signal to Biotech,” by David Wainer

Credits Francis Ying Audio producer Emmarie Huetteman Editor

To hear all our podcasts, click here.

And subscribe to KFF Health News’ “What the Health?” on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts.

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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SACRAMENTO, California. — Medi-Cal, el complejo programa de Medicaid de California, con un valor de $174.6 mil millones, ofrece seguro de salud a casi 15 millones de residentes con bajos ingresos y discapacidades.

California inscribe al doble de personas que Nueva York y a más del triple que Texas, los dos estados con el mayor número de participantes en Medicaid después de California.

La alta tasa de inscripción se debe a que el estado va más allá de los requisitos federales de elegibilidad: ha expandido Medi-Cal a más residentes de bajos ingresos. También ofrece una amplia gama de beneficios, como atención oftalmológica, dental y de maternidad, algunos de los cuales se financian en gran parte con fondos federales, pero que también afectan el gasto estatal.

Sin embargo, últimamente, Medi-Cal ha estado en la mira política.

Los demócratas afirman que la mayor amenaza para Medi-Cal son los recortes presupuestarios republicanos de $880 mil millones que se están considerando en Washington, DC, y que, según expertos en salud, requerirían restricciones de elegibilidad, como requisitos laborales, o recortes de programas para generar ahorros suficientes a lo largo de una década.

Los republicanos argumentan que los costos de Medicaid se han disparado a causa del fraude y el abuso, y critican a los demócratas estatales por permitir que el beneficio esté disponible para inmigrantes sin importar su estatus legal.

En marzo, la administración del gobernador Gavin Newsom solicitó un préstamo de $3.4 mil millones para cubrir excedente de gasto inesperado en Medi-Cal, y en abril los legisladores asignaron $2.8 mil millones adicionales para el resto del año fiscal.

Si bien el gobernador demócrata reconoció la necesidad de ajustes, ha defendido los esfuerzos del estado para que más personas tengan cobertura. En 2022, la tasa de personas de menos de 65 años sin seguro en el estado bajó a un mínimo histórico del 6.2%, según la California Health Care Foundation.

Mientras los legisladores debaten la financiación del programa de la red de seguridad, esto es lo que está en juego para el mayor programa de salud de California.

¿Quién está cubierto?

Más de un tercio de los californianos dependen de Medi-Cal, o del Programa de Seguro de Salud Infantil (CHIP) relacionado, para consultar con un médico, terapeuta o dentista. También lo utilizan para obtener medicamentos y acceder a tratamiento.

Medi-Cal tambien representa una ayuda para las familias, ya que permite que las personas con discapacidad y los adultos mayores permanezcan en sus hogares, proporcionando cobertura a sus cuidadores. Además, financia la atención de enfermería para este ultimo grupo.

La gran mayoría de los afiliados califican porque ganan el 138% o menos del nivel federal de pobreza: $21.597 anuales para una persona o $44.367 para una familia de cuatro. Si bien es un monto bajo para un estado donde el ingreso familiar promedio supera los $96.000, es mucho más generoso que el límite de elegibilidad familiar de Alabama, que es del 18% del nivel federal de pobreza, o el de Florida, 26%.

A diferencia de Alabama o Florida, California extiende la cobertura a adultos de bajos ingresos sin dependientes. También cubre a más personas con discapacidad que trabajan, reclusos y otros residentes que no calificarían para el programa de beneficios si los legisladores estatales no lo hubieran ampliado más allá de lo requerido por el gobierno federal.

Según estimaciones estatales, Medi-Cal cubre a aproximadamente 7.3 millones de familias de bajos ingresos y a otros 5 millones de adultos, la mayoría sin dependientes. Un millón adicional de personas con discapacidades dependen del programa.

Medi-Cal también cubre los gastos de 1.4 millones de residentes mayores de 65 años que no están cubiertos por Medicare, como atención a largo plazo y servicios dentales, de audición y de la vista.

La mayoría de los beneficiarios adultos menores de 65 años de Medi-Cal trabajan, según una revisión de KFF de los datos del censo de marzo de 2024. En California, aproximadamente el 42% de los adultos sin discapacidades que reciben Medi-Cal trabajan a tiempo completo y un 20% adicional tiene empleos de medio tiempo. Aquellos que no tienen trabajo suelen cuidar a un familiar, ir a la escuela o estar enfermos.

Según los datos estatales de inscripción, poco más de la mitad de los beneficiarios de Medi-Cal son latinos, aproximadamente el 16% blancos no hispanos, el 9% asiáticos o habitantes de las islas del Pacífico y el 7% negros no hispanos. Esto difiere de los porcentajes totales nacionales, donde aproximadamente el 40% de las personas menores de 65 años que usan Medicaid son blancos no hispanos, el 30% hispanos, el 19% negros no hispanos y el 1% nativos americanos.

¿De dónde proviene el dinero para Medi-Cal?

El gobierno federal financia aproximadamente el 60% del programa. De su presupuesto de casi $175 mil millones para este año fiscal, se espera que Washington, DC, contribuya con $107.5 mil millones.

Unos $37.6 mil millones adicionales provienen del fondo general del estado. Los $29.500 millones restantes llegan desde otras fuentes, como las tarifas hospitalarias, un impuesto a las organizaciones de atención médica administrada, los ingresos fiscales del tabaco y los reembolsos de medicamentos.

California recibe el 50% de fondos federales de contrapartida para servicios básicos, como la cobertura para niños y mujeres embarazadas de bajos ingresos. Sin embargo, recibe un 9% de contrapartida para los aproximadamente 5 millones de californianos que ha incorporado a sus registros gracias a la expansión de Medicaid bajo la Ley de Cuidado de salud a Bajo Precio (ACA, también conocida como Obamacare).

¿Adónde se destina el dinero?

En promedio, Medi-Cal cuesta $8.000 por beneficiario, pero los costos varían ampliamente, según un análisis realizado en marzo por la Oficina del Analista Legislativo de California.

Por ejemplo, las personas con discapacidad representan el 7% de los afiliados pero el 19% del gasto de Medi-Cal, con un costo anual promedio de $21.626.

Mientras tanto, el costo para cubrir a las personas mayores rondea los $15.000. Y la inscripción de adultos mayores, de 1.4 millones, se ha disparado, aumentando un 40% desde 2020, a medida que los legisladores flexibilizaron las normas sobre la cantidad de bienes que las personas de 65 años o más pueden tener para seguir siendo elegibles para el programa.

California también cubre gran parte de la atención de salud de alrededor de 1.6 millones de inmigrantes sin papeles: aproximadamente $8,4 mil millones de los $9,5 mil millones, según declaró Guadalupe Manríquez, gerenta de presupuesto del programa del Departamento de Finanzas, durante una reciente audiencia del Comité de Presupuesto de la Asamblea.

¿Qué recortes podría haber?

En marzo, el presidente Donald Trump afirmó que no tocaría el Seguro Social, Medicare ni Medicaid, sino que se centraría en erradicar el fraude. Sin embargo, expertos en salud afirman que los servicios de Medicaid se verían desmantelados si el Congreso implementa recortes masivos de gastos para financiar la extensión de los recortes de impuestos de Trump.

Los republicanos del Congreso han debatido la implementación de requisitos de trabajo para adultos sin discapacidades, lo que podría afectar al menos a un millón de beneficiarios de Medicaid en California, la mayor cantidad en cualquier estado, según un análisis del Urban Institute.

Los legisladores también podrían revertir la expansión de Medicaid bajo ACA, aprobada en 2010 y que permitió que más personas calificaran para Medicaid según sus ingresos. California, otros 39 estados y Washington, DC, han optado por adoptar la “expansión de Medicaid”, en la que el gobierno federal cubre el 90% de la cobertura de esos beneficiarios.

Si optara por mantener la cobertura para los aproximadamente 5 millones de beneficiarios adicionales que la han obtenido gracias a la expansion, le costaría a California miles de millones de dólares cada año.

Los republicanos también podrían hacer difícil que estados como California siguieran recibiendo ayuda federal a través de impuestos a proveedores, como el impuesto a las MCO, algo que propuso la primera administración Trump pero que posteriormente descartó. El impuesto a los planes de atención médica administrada genera alrededor de $5 mil millones al año y fue respaldado por los votantes en una iniciativa electoral el otoño pasado.

Sin embargo, el gobierno federal lleva años quejándose de cómo los estados aplican dichos impuestos a los planes de seguro y a los hospitales. Si restringe la forma en que los estados recaudan estos impuestos, probablemente provocaría un déficit de financiación en California.

Funcionarion de Newsom reconocen que, si se producen recortes federales, el estado no podría absorber el costo de los programas existentes. Los republicanos están presionando a los demócratas que controlan la Legislatura para que pongan fin a la cobertura de Medi-Cal para los residentes sin papeles, algo que ni Newsom ni los líderes legislativos demócratas han expresado su disposición a hacer.

Los líderes estatales también podrían verse obligados a recortar beneficios opcionales como la atención dental y la optometría, reducir los servicios destinados a mejorar la calidad de vida de los beneficiarios o los pagos a los planes de atención médica administrada que cubren al 94% de los beneficiarios de Medi-Cal.

Eso fue lo que hicieron los legisladores californianos durante la Gran Recesión: recortaron las tasas de reembolso a los proveedores y eliminaron beneficios, como la atención oftalmológica y dental para adultos. El entonces gobernador, el republicano Arnold Schwarzenegger, fue aún más lejos, recortando $61 millones de la financiación de Medi-Cal de los condados en una sangría presupuestaria que, según él, contenía “lo bueno, lo malo y lo feo”.

Esta historia fue producida por Kaiser Health News, que publica California Healthline, un servicio editorialmente independiente de la 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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