ReportWire

Tag: Access to health care

  • Georgia Medicaid program with work requirement has enrolled only 1,343 residents in 3 months

    Georgia Medicaid program with work requirement has enrolled only 1,343 residents in 3 months

    ATLANTA — Georgia Gov. Brian Kemp’s new health plan for low-income adults has enrolled only 1,343 people through the end of September about three months after launching, The Atlanta Journal-Constitution reports.

    The Georgia Department of Community Health has projected up to 100,000 people could eventually benefit from Georgia Pathways to Coverage. But the nation’s only Medicaid program that makes recipients meet a work requirement is off to a very slow start.

    “We will continue working to educate Georgians about Pathways’ innovative, first-of-its-kind opportunity and enroll more individuals in the months to come,” Kemp’s office said in a statement.

    The program’s creeping progress reflects fundamental flaws as compared to Medicaid expansions in other states, including the extra burden of submitting and verifying work hours, experts say. And some critics note it’s happening just as the state, as part of a federally mandated review, is kicking tens of thousands of people off its Medicaid rolls — at least some of whom could be eligible for Pathways.

    “Pathways to Coverage is falling well short of these commitments to uninsured Georgians. Medicaid expansion would be a more effective way to meaningfully cover state residents and connect them to care,” Laura Colbert, executive director of the advocacy group Georgians for a Healthy Future, said in a statement Friday.

    The state Department of Community Health had declined to provide sign-up numbers to the newspaper until the Journal-Constitution told Kemp’s office it would report that the state appeared to be violating its open records law. The department then provided the records, but denies violating the law.

    The Biden administration has already tried to revoke Georgia’s Medicaid plan once and is monitoring it, so any missteps could have broader consequences. They could also hamper future efforts by Republicans to make Medicaid eligibility dependent on work.

    The state launched Pathways on July 1 just as it began a review of Medicaid eligibility following the end of the COVID-19 public health emergency. Federal law prohibited states from removing people from Medicaid during the three-year emergency.

    The state previously said it delayed the reevaluations of 160,000 people who were no longer eligible for traditional Medicaid but could qualify for Pathways to help them try to maintain health coverage. But observers have said they have detected little public outreach to target populations.

    Thirty-nine states have expanded Medicaid eligibility to nearly all adults with incomes up to 138% of the federal poverty level, $20,120 annually for a single person and $41,400 for a family of four. North Carolina will become the 40th state to do so in December. None of those states require recipients to work in order to qualify.

    That broader Medicaid expansion was a key part of President Barack Obama’s health care overhaul in 2010, but many Republican governors, including Kemp, rejected it. In addition to imposing a work requirement, Pathways limits coverage to able-bodied adults earning up to 100% of the poverty line — $14,580 for a single person or $30,000 for a family of four.

    Kemp has argued full expansion would cost too much money. State officials and supporters of Pathways say the work requirement will also help transition Medicaid recipients to better, private health insurance, and argue that working, studying or volunteering leads to improved health.

    Critics say many low-income people struggle to document the required 80 hours a month of work, volunteer activity, study or vocational rehabilitation.

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  • Gates Foundation commits $200 million to pay for medical supplies and contraception

    Gates Foundation commits $200 million to pay for medical supplies and contraception

    NEW YORK — The Bill & Melinda Gates Foundation pledged $200 million to help save the lives of mothers and children during child birth, as the largest American philanthropic donor throws its weight behind the issue during the nonprofit’s annual Goalkeepers conference on the sidelines of the U.N. General Assembly.

    Melinda French Gates, who says the issue is personal to her, smiled broadly as she introduced herself not just as the co-founder and co-chair of the foundation but as “Nona,” or grandmother, gesturing to her oldest daughter, Jennifer, who was seated in the audience in New York on Wednesday.

    The foundation pledged $100 million each to health products manufacturer Unitaid, and UNFPA, the U.N. agency for reproductive health, to fund access to health care and contraceptive supplies and information in low- and middle-income countries. The Gates Foundation has been a major supporter of Unitaid, donating $50 million in each 2012 and 2017, according to the foundation’s grant database.

    Founded in 2017, the Goalkeepers initiative is how the foundation tracks progress toward the Sustainable Development Goals, which U.N. member countries agreed in 2015 to meet by 2030. The goals set lofty targets to reduce poverty, improve health and education and protect the environment, though progress toward achieving them has fallen significantly off track, especially following the pandemic and the war in Ukraine.

    In an effort to reach an audience outside of government officials, experts and policy circles, the foundation hosted an award ceremony in New York Tuesday evening and recruited social media influencers to cover it, said Blessing Omakwu, who leads the Goalkeepers initiative.

    “My goal is they go back and take these things that we said in a very policy way and make it accessible to their followings and say, ‘Look, this matters. You should care about maternal health,’” she said.

    French Gates recognized former President Jimmy Carter and former First Lady Rosalynn Carter with a lifetime achievement award, pointing in part Carter’s long commitment to the elimination of guinea worm disease. Singer Bono also received a special award for his work advocating over many years for access to health care in developing countries and for the role he played in launching the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR.

    The program to combat HIV/AIDS was created by President George W. Bush and the U.S. Congress two decades ago and is credited with saving 25 million lives. The fate of the program, set to expire at the end of September, is uncertain because of a demand from Republican lawmakers to bar nongovernmental organizations that used any funding from providing or promoting abortion services.

    Bill Gates was absent from the award ceremony Tuesday because he had been invited to attend an event with President Joe Biden, French Gates said on stage. The two announced their divorce in 2021 but committed to continuing to work together at the foundation.

    Speaking of the future of PEPFAR on Wednesday, Bill Gates said the idea the program would not continue is quite scary, given that it continues to provide life saving medications for millions of people around the world.

    “It’s a shame that, at least temporarily, this is caught up in sort of a, ‘Does the U.S. reach out to the world and help the world?’ — some of those controversies. I think we will overcome that because the U.S. has a lot to be proud on this one,” Gates said.

    Gates also made the case for a suite of interventions to prevent the deaths of children in the year after they are born, which he said was one of the first priorities of the foundation. He spoke with emotion about a visit he made to a South African clinic, where doctors asked the mother of a child who had died that day if she would allow them to try to determine more specifically the cause of the baby’s death as a part of a larger study. Cumulatively, the results of that study, which the foundation funded, has advanced knowledge about the causes of infant mortality.

    The foundation also recognized the leaders of projects they said exemplified the aims of the development goals, including Eden Tadesse from Ethiopia, who designed a platform to provide job opportunities to refugees, and Aidan Reilly, Ben Collier, and James Kanoff, who started a project that delivers vegetables and produce that otherwise would be thrown out to food banks in the U.S.

    Award winner Ashu Martha Agbornyenty, a midwife from Cameroon, called the foundation’s recognition of her work a victory for those who study to become midwives and for the health of women in her country.

    “Everyone around me was like, ‘There’s nothing for midwifery. Midwifery is just a layman’s profession. There’s no future for midwifery.’ But me being here in New York today, it’s victory,” she said standing on a red carpet.

    The Gates Foundation was not alone in announcing new commitments to support progress toward the development goals. On Tuesday, the IKEA Foundation pledged $20 million to help workers and communities who may lose jobs in the transition to renewal energy sources in Vietnam, South Africa and Indonesia. The Rockefeller Foundation announced last week that it will focus 75% of its resources over five years on what it calls climate solutions in energy, health, agriculture and finance, committing $1 billion in granted funds. And the Clinton Global Initiative announced that gender equity would now be a pillar of its work.

    Last year, the Gates Foundation put the spotlight on hunger and promoted its support for crops engineered to adapt to climate change and resist agricultural pests, which have been criticized by farming groups and researchers who say that conflicts with worldwide efforts to protect the environment.

    ___

    Associated Press coverage of philanthropy and nonprofits receives support through the AP’s collaboration with The Conversation US, with funding from Lilly Endowment Inc. The AP is solely responsible for this content. For all of AP’s philanthropy coverage, visit https://apnews.com/hub/philanthropy.

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  • Georgia Medicaid program with work requirement off to slow start even as thousands lose coverage

    Georgia Medicaid program with work requirement off to slow start even as thousands lose coverage

    ATLANTA — Georgia Gov. Brian Kemp signed paperwork creating a new state health plan for low-income residents to much fanfare at the state Capitol three years ago.

    But public health experts and advocates say since it launched on July 1, state officials appear to be doing little to promote or enroll people in the nation’s only Medicaid program that makes recipients meet a work requirement.

    The Georgia Department of Community Health, which has projected up to 100,000 people could eventually benefit from Georgia Pathways to Coverage, had approved just 265 applications by early August.

    “If we’re talking about directed outreach to the population that would most likely be eligible and interested, I haven’t seen anything,” said Harry Heiman, a health policy professor at Georgia State University.

    Heiman and other experts say the program’s slow start reflects fundamental flaws missing from Medicaid expansions in other states, including the extra burden of submitting and verifying work hours. And some critics note it’s happening just as the state, as part of a federally mandated review, is kicking tens of thousands of people off its Medicaid rolls — at least some of whom could be eligible for Pathways.

    “We’ve chosen a much more complicated and lengthy process that will take a long time even for the few folks who get coverage,” said Laura Colbert, executive director of the advocacy group Georgians for a Healthy Future.

    The Biden administration has already tried to revoke Georgia’s Medicaid plan once and will be monitoring it, so any missteps could have broader consequences. They could also hamper future efforts by Republicans to make Medicaid eligibility dependent on work.

    A spokesman for the governor’s office, Garrison Douglas, said enrollment would grow as applications continue to be reviewed.

    “While the federal government initiated and dictated a process for re-determining the qualifications of traditional Medicaid recipients, Georgia is the only state in the country simultaneously offering a new pathway to healthcare coverage and opportunity,” he said in a statement.

    The state’s department of community health said it was engaging stakeholders, community partners and others to help get the word out about the program. It did not provide details about that effort.

    “There’s still some more work that we have to do for Pathways,” Lynnette Rhodes, executive director of DCH’s Medical Assistance Plans division, said at a meeting this month. “But overall…the program is working.”

    The state launched Pathways just as it began a review of Medicaid eligibility following the end of the COVID-19 public health emergency. Federal law prohibited states from removing people from Medicaid during the three-year emergency.

    Georgia has already cut more than 170,000 adults and kids from Medicaid and is expected to remove thousands more as the yearlong review of all 2.7 million Medicaid recipients in the state continues. Nationwide, more than a million people have been dropped from Medicaid, most for failing to fill out paperwork.

    The department of community health said it delayed the reevaluations of 160,000 people who were no longer eligible for traditional Medicaid but could qualify for Pathways to help them try to maintain health coverage. It was not immediately clear whether the state reached out to those people and helped guide them to apply for Pathways.

    “From what we have seen thus far, they are not doing anything affirmatively to get these people enrolled in Pathways,” said Cynthia Gibson, an attorney with the Georgia Legal Services Program who helps people obtain Medicaid coverage.

    In contrast, Oklahoma officials implementing a voter-approved expansion of Medicaid in 2021 moved people in existing state insurance programs directly into the expansion pool without the need for a new application, according to the Oklahoma Health Care Authority. Nearly 100,000 people were enrolled in the expanded program within days of its launch.

    “States have a lot of tools that they can use to help make this process go more smoothly,” said Lucy Dagneau, an advocate for Medicaid expansion with the American Cancer Society Cancer Action Network.

    Oklahoma and 39 other states have expanded Medicaid eligibility to nearly all adults with incomes up to 138% of the federal poverty level, $20,120 annually for a single person and $41,400 for a family of four. None of those states require recipients to work in order to qualify.

    That broader Medicaid expansion was a key part of President Barack Obama’s health care overhaul in 2010, but many Republican governors, including Kemp, rejected it. In addition to imposing a work requirement, Pathways limits coverage to able-bodied adults earning up to 100% of the poverty line — $14,580 for a single person or $30,000 for a family of four.

    Kemp has argued full expansion would cost too much money. State officials and supporters of Pathways say the work requirement will also help transition Medicaid recipients to better, private health insurance, and working, studying or volunteering leads to improved health.

    “I’m excited we’re moving forward in this direction,” said Jason Bearden, president of CareSource Georgia, one of the state’s Medicaid health plans. “This is good progress.”

    Critics say many low-income people work informal jobs and have fluctuating hours that will make it hard for them to document the required 80 hours a month of work, volunteer activity, study or vocational rehabilitation. They also blast the lack of an exemption to the work requirement for parents and other caregivers.

    For Amanda Lucas, the work requirement is insurmountable right now.

    Lucas said she had no idea Pathways started in July, but even if she did, she would not qualify because she has to take care of her 84-year-old father in Warner Robins, a city about 100 miles (160 km) south of Atlanta. He had a stroke and needs her to buy groceries, make food, pick up prescriptions, pay bills and manage myriad other tasks, she said.

    With risk factors for skin cancer, she worries about living without health insurance.

    “I try to keep an eye on my own moles,” she said. “I’m increasingly anxious because I’m 46.”

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  • Attacks at US medical centers show why health care is one of the nation’s most violent fields

    Attacks at US medical centers show why health care is one of the nation’s most violent fields

    Word spread through an Oregon hospital last month that a visitor was causing trouble in the maternity ward, and nurses were warned the man might try to abduct his partner’s newborn.

    Hours later, the visitor opened fire, killing a security guard and sending patients, nurses and doctors scrambling for cover.

    The shooting at Legacy Good Samaritan Medical Center in Portland was part of a wave of gun violence sweeping through U.S. hospitals and medical centers, which have struggled to adapt to the growing threats.

    Such attacks have helped make health care one of the nation’s most violent fields. Data shows American health care workers now suffer more nonfatal injuries from workplace violence than workers in any other profession, including law enforcement.

    “Health care workers don’t even think about that when they decide they want to be a nurse or a doctor. But as far as actual violence goes, statistically, health care is four or five times more dangerous than any other profession,” said Michael D’Angelo, a former police officer who focuses on health care and workplace violence as a security consultant in Florida.

    Other industries outpace heath care for overall danger, including deaths.

    Similar shootings have played out in hospitals across the country.

    Last year, a man killed two workers at a Dallas hospital while there to watch his child’s birth. In May, a man opened fire in a medical center waiting room in Atlanta, killing one woman and wounding four. Late last month, a man shot and wounded a doctor at a health center in Dallas. In June 2022, a gunman killed his surgeon and three other people at a Tulsa, Oklahoma, medical office because he blamed the doctor for his continuing pain after an operation.

    It’s not just deadly shootings: Health care workers racked up 73% of all nonfatal workplace violence injuries in 2018, the most recent year for which figures are available, according to the U.S. Bureau of Labor Statistics.

    One day before the July 22 shooting in Portland, employees throughout the hospital were warned during meetings to be prepared for a possible “code amber” announcement in case the visitor attempted to kidnap the child, according to a nurse with direct knowledge of the briefing who spoke to The Associated Press. She spoke on condition of anonymity because she feared retaliation at work.

    Fifteen minutes before the shooting, someone at the hospital called 911 to report the visitor was threatening staffers, according to a timeline provided by Portland police.

    “He kind of fell through the cracks,” the nurse said. “I don’t know how many chances he received. It kind of got to the point where staff did not know what to do, or what they could or couldn’t do with him.”

    Police arrived at the maternity ward within minutes, but it was too late. Bobby Smallwood, a security guard who had been called in from another Legacy hospital to cover shifts for Good Samaritan’s understaffed security team, had been fatally shot. Another hospital employee was wounded by shrapnel. The suspect fled and was later killed by police in a nearby community.

    The hospital declined to respond to the nurse’s comments because the case is still under investigation.

    “Events like these are unpredictable, but our team exhibited professionalism and a great deal of courage in the face of extraordinarily challenging circumstances that day,” Legacy Health said in a statement to the AP.

    Legacy Health in Portland plans to install additional metal detectors, require bag searches at every hospital and send patients and visitors to controlled entrances. More security officers will be provided with stun guns, the hospital said, and bullet-slowing film is being applied to some interior glass and at main entrances.

    Around 40 states have passed laws creating or increasing penalties for violence against health care workers, according to the American Nurses Association. Hospitals have armed security officers with batons, stun guns or handguns, while some states, including Indiana, Ohio and Georgia, allow hospitals to create their own police forces.

    Critics say private hospital police can exacerbate the health care and policing inequities already experienced by Black people. They also say private police forces often don’t have to disclose information such as how often they use force or whether they disproportionately detain members of minority groups.

    Security teams cannot address all of the factors leading to violence because many of them are caused by a dysfunctional health care system, said Deborah Burger, a registered nurse and the president of National Nurses United.

    Patients and families are often bounced between emergency rooms and home, and are frustrated over high costs, limited treatment options or long wait times, Burger said.

    “Hospitals don’t really have a complaints department, so the only real target they have is the nurse or staff that are standing right in front of them,” she said.

    Understaffing forces nurses to care for more patients and affords them less time to assess each one for behavior problems. Efforts to de-escalate aggression aren’t as effective if nurses haven’t had time to bond with patients, Burger said.

    Growing nurse-to-patient ratios are an “absolutely catastrophic formula for workplace violence increasing,” D’Angelo said. “Now you don’t even have the good old buddy system of two co-workers keeping an eye out for each other.”

    Some hospital administrators encourage staff to placate aggressive visitors and patients because they are worried about getting bad reviews, Burger said. That’s because the Affordable Care Act tied a portion of federal reimbursement rates to consumer satisfaction surveys and low satisfaction means a hit to the financial bottom line.

    “The results of those surveys should never take priority over staff safety,” D’Angelo said.

    Eric Sean Clay, the president-elect of the International Association for Healthcare Security & Safety and vice president of security at Memorial Hermann Health in Houston, said the workplace violence rates attributed to health care facilities are “grossly underreported.”

    “I think that a lot of it comes down to caregivers are just very tolerant, and they come to look at it as just part of the job,” he said. “If they’re not injured, sometimes they don’t want to report it, and sometimes they don’t think there will be any change.”

    Clay’s hospital uses armed and unarmed security officers, though he hopes to have them all armed eventually.

    “We actually have our own firing range that we use,” Clay said. None of his security officers have drawn their weapons on the job in recent years, but he wants them to be ready because of the rise in gun violence.

    Clay and Memorial Hermann Health declined to answer questions about whether an armed security force could negatively affect access to health care or existing inequities.

    The nurse at the Portland hospital said the shooting left her colleagues terrified and unusually solemn. She is worried Legacy Health’s promises of increased safety will be temporary because of the cost of finding, training and retaining security officers.

    Some of her co-workers have resigned because they don’t want to face another “code silver,” the alert issued when someone at the hospital has a weapon.

    “You know, we always say these patients and their families are so vulnerable, because they’re having the worst day of their life here,” the nurse said, and that makes many staffers reluctant to demand better behavior.

    “We have to stop that narrative,” she said. “Being vulnerable is bleeding out from a bullet wound in your chest. Being vulnerable is having to barricade yourself and your patients in a room because of a code silver.’”

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  • Attacks at US medical centers show why health care is one of the nation’s most violent fields

    Attacks at US medical centers show why health care is one of the nation’s most violent fields

    Word spread through an Oregon hospital last month that a visitor was causing trouble in the maternity ward, and nurses were warned the man might try to abduct his partner’s newborn.

    Hours later, the visitor opened fire, killing a security guard and sending patients, nurses and doctors scrambling for cover.

    The shooting at Legacy Good Samaritan Medical Center in Portland was part of a wave of gun violence sweeping through U.S. hospitals and medical centers, which have struggled to adapt to the growing threats.

    Such attacks have helped make health care one of the nation’s most violent fields. Data shows American health care workers now suffer more nonfatal injuries from workplace violence than workers in any other profession, including law enforcement.

    “Health care workers don’t even think about that when they decide they want to be a nurse or a doctor. But as far as actual violence goes, statistically, health care is four or five times more dangerous than any other profession,” said Michael D’Angelo, a former police officer who focuses on health care and workplace violence as a security consultant in Florida.

    Other industries outpace heath care for overall danger, including deaths.

    Similar shootings have played out in hospitals across the country.

    Last year, a man killed two workers at a Dallas hospital while there to watch his child’s birth. In May, a man opened fire in a medical center waiting room in Atlanta, killing one woman and wounding four. Late last month, a man shot and wounded a doctor at a health center in Dallas. In June 2022, a gunman killed his surgeon and three other people at a Tulsa, Oklahoma, medical office because he blamed the doctor for his continuing pain after an operation.

    It’s not just deadly shootings: Health care workers racked up 73% of all nonfatal workplace violence injuries in 2018, the most recent year for which figures are available, according to the U.S. Bureau of Labor Statistics.

    One day before the July 22 shooting in Portland, employees throughout the hospital were warned during meetings to be prepared for a possible “code amber” announcement in case the visitor attempted to kidnap the child, according to a nurse with direct knowledge of the briefing who spoke to The Associated Press. She spoke on condition of anonymity because she feared retaliation at work.

    Fifteen minutes before the shooting, someone at the hospital called 911 to report the visitor was threatening staffers, according to a timeline provided by Portland police.

    “He kind of fell through the cracks,” the nurse said. “I don’t know how many chances he received. It kind of got to the point where staff did not know what to do, or what they could or couldn’t do with him.”

    Police arrived at the maternity ward within minutes, but it was too late. Bobby Smallwood, a security guard who had been called in from another Legacy hospital to cover shifts for Good Samaritan’s understaffed security team, had been fatally shot. Another hospital employee was wounded by shrapnel. The suspect fled and was later killed by police in a nearby community.

    The hospital declined to respond to the nurse’s comments because the case is still under investigation.

    “Events like these are unpredictable, but our team exhibited professionalism and a great deal of courage in the face of extraordinarily challenging circumstances that day,” Legacy Health said in a statement to the AP.

    Legacy Health in Portland plans to install additional metal detectors, require bag searches at every hospital and send patients and visitors to controlled entrances. More security officers will be provided with stun guns, the hospital said, and bullet-slowing film is being applied to some interior glass and at main entrances.

    Around 40 states have passed laws creating or increasing penalties for violence against health care workers, according to the American Nurses Association. Hospitals have armed security officers with batons, stun guns or handguns, while some states, including Indiana, Ohio and Georgia, allow hospitals to create their own police forces.

    Critics say private hospital police can exacerbate the health care and policing inequities already experienced by Black people. They also say private police forces often don’t have to disclose information such as how often they use force or whether they disproportionately detain members of minority groups.

    Security teams cannot address all of the factors leading to violence because many of them are caused by a dysfunctional health care system, said Deborah Burger, a registered nurse and the president of National Nurses United.

    Patients and families are often bounced between emergency rooms and home, and are frustrated over high costs, limited treatment options or long wait times, Burger said.

    “Hospitals don’t really have a complaints department, so the only real target they have is the nurse or staff that are standing right in front of them,” she said.

    Understaffing forces nurses to care for more patients and affords them less time to assess each one for behavior problems. Efforts to de-escalate aggression aren’t as effective if nurses haven’t had time to bond with patients, Burger said.

    Growing nurse-to-patient ratios are an “absolutely catastrophic formula for workplace violence increasing,” D’Angelo said. “Now you don’t even have the good old buddy system of two co-workers keeping an eye out for each other.”

    Some hospital administrators encourage staff to placate aggressive visitors and patients because they are worried about getting bad reviews, Burger said. That’s because the Affordable Care Act tied a portion of federal reimbursement rates to consumer satisfaction surveys and low satisfaction means a hit to the financial bottom line.

    “The results of those surveys should never take priority over staff safety,” D’Angelo said.

    Eric Sean Clay, the president-elect of the International Association for Healthcare Security & Safety and vice president of security at Memorial Hermann Health in Houston, said the workplace violence rates attributed to health care facilities are “grossly underreported.”

    “I think that a lot of it comes down to caregivers are just very tolerant, and they come to look at it as just part of the job,” he said. “If they’re not injured, sometimes they don’t want to report it, and sometimes they don’t think there will be any change.”

    Clay’s hospital uses armed and unarmed security officers, though he hopes to have them all armed eventually.

    “We actually have our own firing range that we use,” Clay said. None of his security officers have drawn their weapons on the job in recent years, but he wants them to be ready because of the rise in gun violence.

    Clay and Memorial Hermann Health declined to answer questions about whether an armed security force could negatively affect access to health care or existing inequities.

    The nurse at the Portland hospital said the shooting left her colleagues terrified and unusually solemn. She is worried Legacy Health’s promises of increased safety will be temporary because of the cost of finding, training and retaining security officers.

    Some of her co-workers have resigned because they don’t want to face another “code silver,” the alert issued when someone at the hospital has a weapon.

    “You know, we always say these patients and their families are so vulnerable, because they’re having the worst day of their life here,” the nurse said, and that makes many staffers reluctant to demand better behavior.

    “We have to stop that narrative,” she said. “Being vulnerable is bleeding out from a bullet wound in your chest. Being vulnerable is having to barricade yourself and your patients in a room because of a code silver.’”

    Source link

  • Attacks at US medical centers show why health care is one of the nation’s most violent fields

    Attacks at US medical centers show why health care is one of the nation’s most violent fields

    Word spread through an Oregon hospital last month that a visitor was causing trouble in the maternity ward, and nurses were warned the man might try to abduct his partner’s newborn.

    Hours later, the visitor opened fire, killing a security guard and sending patients, nurses and doctors scrambling for cover.

    The shooting at Legacy Good Samaritan Medical Center in Portland was part of a wave of gun violence sweeping through U.S. hospitals and medical centers, which have struggled to adapt to the growing threats.

    Such attacks have helped make health care one of the nation’s most violent fields. Data shows American health care workers now suffer more nonfatal injuries from workplace violence than workers in any other profession, including law enforcement.

    “Health care workers don’t even think about that when they decide they want to be a nurse or a doctor. But as far as actual violence goes, statistically, health care is four or five times more dangerous than any other profession,” said Michael D’Angelo, a former police officer who focuses on health care and workplace violence as a security consultant in Florida.

    Other industries outpace heath care for overall danger, including deaths.

    Similar shootings have played out in hospitals across the country.

    Last year, a man killed two workers at a Dallas hospital while there to watch his child’s birth. In May, a man opened fire in a medical center waiting room in Atlanta, killing one woman and wounding four. Late last month, a man shot and wounded a doctor at a health center in Dallas. In June 2022, a gunman killed his surgeon and three other people at a Tulsa, Oklahoma, medical office because he blamed the doctor for his continuing pain after an operation.

    It’s not just deadly shootings: Health care workers racked up 73% of all nonfatal workplace violence injuries in 2018, the most recent year for which figures are available, according to the U.S. Bureau of Labor Statistics.

    One day before the July 22 shooting in Portland, employees throughout the hospital were warned during meetings to be prepared for a possible “code amber” announcement in case the visitor attempted to kidnap the child, according to a nurse with direct knowledge of the briefing who spoke to The Associated Press. She spoke on condition of anonymity because she feared retaliation at work.

    Fifteen minutes before the shooting, someone at the hospital called 911 to report the visitor was threatening staffers, according to a timeline provided by Portland police.

    “He kind of fell through the cracks,” the nurse said. “I don’t know how many chances he received. It kind of got to the point where staff did not know what to do, or what they could or couldn’t do with him.”

    Police arrived at the maternity ward within minutes, but it was too late. Bobby Smallwood, a security guard who had been called in from another Legacy hospital to cover shifts for Good Samaritan’s understaffed security team, had been fatally shot. Another hospital employee was wounded by shrapnel. The suspect fled and was later killed by police in a nearby community.

    The hospital declined to respond to the nurse’s comments because the case is still under investigation.

    “Events like these are unpredictable, but our team exhibited professionalism and a great deal of courage in the face of extraordinarily challenging circumstances that day,” Legacy Health said in a statement to the AP.

    Legacy Health in Portland plans to install additional metal detectors, require bag searches at every hospital and send patients and visitors to controlled entrances. More security officers will be provided with stun guns, the hospital said, and bullet-slowing film is being applied to some interior glass and at main entrances.

    Around 40 states have passed laws creating or increasing penalties for violence against health care workers, according to the American Nurses Association. Hospitals have armed security officers with batons, stun guns or handguns, while some states, including Indiana, Ohio and Georgia, allow hospitals to create their own police forces.

    Critics say private hospital police can exacerbate the health care and policing inequities already experienced by Black people. They also say private police forces often don’t have to disclose information such as how often they use force or whether they disproportionately detain members of minority groups.

    Security teams cannot address all of the factors leading to violence because many of them are caused by a dysfunctional health care system, said Deborah Burger, a registered nurse and the president of National Nurses United.

    Patients and families are often bounced between emergency rooms and home, and are frustrated over high costs, limited treatment options or long wait times, Burger said.

    “Hospitals don’t really have a complaints department, so the only real target they have is the nurse or staff that are standing right in front of them,” she said.

    Understaffing forces nurses to care for more patients and affords them less time to assess each one for behavior problems. Efforts to de-escalate aggression aren’t as effective if nurses haven’t had time to bond with patients, Burger said.

    Growing nurse-to-patient ratios are an “absolutely catastrophic formula for workplace violence increasing,” D’Angelo said. “Now you don’t even have the good old buddy system of two co-workers keeping an eye out for each other.”

    Some hospital administrators encourage staff to placate aggressive visitors and patients because they are worried about getting bad reviews, Burger said. That’s because the Affordable Care Act tied a portion of federal reimbursement rates to consumer satisfaction surveys and low satisfaction means a hit to the financial bottom line.

    “The results of those surveys should never take priority over staff safety,” D’Angelo said.

    Eric Sean Clay, the president-elect of the International Association for Healthcare Security & Safety and vice president of security at Memorial Hermann Health in Houston, said the workplace violence rates attributed to health care facilities are “grossly underreported.”

    “I think that a lot of it comes down to caregivers are just very tolerant, and they come to look at it as just part of the job,” he said. “If they’re not injured, sometimes they don’t want to report it, and sometimes they don’t think there will be any change.”

    Clay’s hospital uses armed and unarmed security officers, though he hopes to have them all armed eventually.

    “We actually have our own firing range that we use,” Clay said. None of his security officers have drawn their weapons on the job in recent years, but he wants them to be ready because of the rise in gun violence.

    Clay and Memorial Hermann Health declined to answer questions about whether an armed security force could negatively affect access to health care or existing inequities.

    The nurse at the Portland hospital said the shooting left her colleagues terrified and unusually solemn. She is worried Legacy Health’s promises of increased safety will be temporary because of the cost of finding, training and retaining security officers.

    Some of her co-workers have resigned because they don’t want to face another “code silver,” the alert issued when someone at the hospital has a weapon.

    “You know, we always say these patients and their families are so vulnerable, because they’re having the worst day of their life here,” the nurse said, and that makes many staffers reluctant to demand better behavior.

    “We have to stop that narrative,” she said. “Being vulnerable is bleeding out from a bullet wound in your chest. Being vulnerable is having to barricade yourself and your patients in a room because of a code silver.’”

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  • Cyprus allows human COVID-19 medications to be used on cats to fight deadly virus mutation

    Cyprus allows human COVID-19 medications to be used on cats to fight deadly virus mutation

    Veterinarians in Cyprus are lauding a government decision to allow its stock of human COVID-19 medication to be used against a feline virus that has killed thousands of cats on the Mediterranean island

    FILE – A cat crosses a pedestrian road at the main linear park, in the capital Nicosia, Cyprus, on July 19, 2023. Cyprus’ veterinarians association on Friday Aug. 4, 2023 lauded a government decision to allow its stock of human coronavirus medication to be used on cats to fight a local mutation of a feline virus that has killed thousands of animals on the Mediterranean island. (AP Photo/Petros Karadjias, File)

    The Associated Press

    NICOSIA, Cyprus — Cyprus’ veterinarians association on Friday lauded a government decision to allow its stock of human coronavirus medication to be used on cats to fight a local mutation of a feline virus that has killed thousands of animals on the Mediterranean island.

    The association said in a statement that it had petitioned the government for access to the medication at “reasonable prices” from the beginning of this year, when the mutation that causes lethal Feline Infectious Peritonitis (FIP) began to noticeably crop up in the island’s cat population.

    “We want to assure that we will continue to investigate and control the rise in case of FCov-2023,” the association said.

    Local animal activists had claimed that the mutation had killed as many as 300,000 cats, but Association President Nektaria Ioannou Arsenoglou says that’s an exaggeration.

    Arsenoglou had told The Associated Press that an association survey of 35 veterinary clinics indicated an island-wide total of about 8,000 deaths.

    According to Arsenoglou, FIP is nearly always lethal if left untreated, but medication can nurse cats back to health in approximately 85% of cases in both the “wet” and “dry” forms of the illness.

    What made FIP treatment difficult was the high price of the medication that activists said put it out of reach of many cat care givers.

    Spread through contact with cat feces, neither the virus or its mutation can be passed on to humans. The feline coronavirus has been around since 1963. Previous epidemics eventually fizzled out without the use of any medication, Arsenoglou said.

    Measures have already been enacted to prevent the export of the mutation through mandatory medical check-ups of all felines destined for adoption abroad.

    It’s unclear how many feral cats live in Cyprus, where they are generally beloved and have a long history dating back thousands of years.

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  • Paperwork problems drive surge in people losing Medicaid health coverage

    Paperwork problems drive surge in people losing Medicaid health coverage

    JEFERSON CITY, Mo. — The nation’s top health official implored states to do more to keep lower-income residents enrolled in Medicaid, as the Biden administration released figures Friday confirming that many who had health coverage during the coronavirus pandemic are now losing it.

    Though a decline in Medicaid coverage was expected, health officials are raising concerns about the large numbers of people being dropped from the rolls for failing to return forms or follow procedures.

    In 18 states that began a post-pandemic review of their Medicaid rolls in April, health coverage was continued for about 1 million recipients and terminated for 715,000. Of those dropped, 4 in 5 were for procedural reasons, according to newly released data from the federal Centers for Medicare and Medicaid Services.

    Health and Human Services Secretary Xavier Becerra sent a letter Friday to all governors encouraging them to bolster efforts to retain people on Medicaid. He particularly encouraged them to use electronic information from other federal programs, such as food stamps, to automatically confirm people’s eligibility for Medicaid. That would avert the need to mail and return documents.

    “I am deeply concerned about high rates of procedural terminations due to ‘red tape’ and other paperwork issues,” Becerra told governors.

    During the pandemic, states were prohibited from ending people’s Medicaid coverage. As a result, Medicaid enrollment swelled by nearly one-third, from 71 million people in February 2020 to 93 million in February 2023. The prohibition on trimming rolls ended in April, and states now have resumed annual eligibility redeterminations that had been required before the pandemic.

    The new federal data captures only the first month of state Medicaid reviews from states that acted the most expeditiously. Since then, additional states also have submitted reports on those renewed and dropped from Medicaid in May and June.

    Though the federal government hasn’t released data from the most recent reports, information gathered by The Associated Press and health care advocacy groups show that about 3.7 million people already have lost Medicaid coverage. That includes about 500,000 in Texas, around 400,000 in Florida and 225,000 in California. Of those who lost coverage, 89% were for procedural reasons in California, 81% in Texas and 59% in Florida, according to the AP’s data.

    Many of those people may have still been eligible for Medicaid, “but they’re caught in a bureaucratic nightmare of confusing forms, notices sent to wrong addresses and other errors,” said Michelle Levander, founding director of the Center for Health Journalism at the University of Southern California,

    Top CMS officials said they have worked with several states to pause Medicaid removals and improve procedures for determining eligibility.

    South Carolina, for example, reported renewing Medicaid coverage for about 27,000 people in May while removing 118,000. Of those dropped, 95% were for procedural reasons. In a recent report to the federal government, South Carolina said it removed no one from Medicaid in June because it extended the eligibility renewal deadline from 60 days to 90 days.

    Michigan reported renewing more than 103,000 Medicaid recipients in June and removing just 12,000. It told the federal government that the state opted to delay terminations for those who failed to respond to renewal requests while instead making additional outreach attempts. As a result, the state reported more than 100,000 people whose June eligibility cases remained incomplete.

    People who are dropped from Medicaid can regain coverage retroactively if they submit information within 90 days proving their eligibility. But some advocacy groups say that still poses a challenge.

    “State government is not necessarily nimble,” said Keesa Smith, executive director of Arkansas Advocates for Children and Families. “When individuals are being disenrolled, the biggest concern … is that there is not a fast track to get those individuals back on the rolls.”

    Arkansas officials have been at the forefront of defending Medicaid cuts. They contend that many people likely don’t return forms because they no longer need Medicaid.

    People are “transitioning off of Medicaid” because “they are working, making more money, and have access to health care through their employers or the federal marketplace,” Arkansas Medicaid Director Janet Mann said earlier this month. “This should be celebrated, not criticized.”

    Insurance companies that run Medicaid programs for states said they are trying to reduce procedural terminations and enroll people in new plans.

    The Blue Cross-Blue Shield insurer Elevance Health lost 130,000 Medicaid customers during the recently completed second quarter, as Medicaid eligibility redeterminations began. Chief Financial Officer John Gallina said earlier this month that many people lost Medicaid coverage for administrative reasons but are likely to reenroll in the near future.

    Leaders of the insurer Molina Healthcare told analysts Thursday that the company lost about 93,000 Medicaid customers in the recently completed second quarter, mostly due to eligibility redeterminations. Molina officials said they are trying to switch people who no longer qualify for Medicaid to one of the individual insurance plans they sell through state-based marketplaces.

    Federal data for April indicates that some states did a better job than others at handling a crush of questions from people about their Medicaid coverage.

    In 19 states and the District of Columbia, the average Medicaid call center wait time was 1 minute or less in April. But in Idaho, the average caller to the state’s Medicaid help line waited 51 minutes. In Missouri, the average wait was 44 minutes, and in Florida 40 minutes.

    ___

    Associated Press writer Tom Murphy in Indianapolis contributed to this report.

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  • The Biden administration proposes new rules to push insurers to boost mental health coverage

    The Biden administration proposes new rules to push insurers to boost mental health coverage

    President Joe Biden’s administration has announced new rules meant to push insurance companies to increase their coverage of mental health treatments

    FILE – President Joe Biden speaks in Philadelphia, July 20, 2023. Biden’s administration is announcing new rules meant to push insurance companies to increase their coverage of mental health treatments. (AP Photo/Susan Walsh, File)

    The Associated Press

    WASHINGTON — President Joe Biden’s administration on Tuesday announced new rules meant to push insurance companies to increase their coverage of mental health treatments.

    The new regulations, which still need to go through a public comment period, would require insurers to study whether their customers have equal access to medical and mental health benefits and to take remedial action, if necessary. The Mental Health Parity and Addiction Equity Act requires that insurers provide the same level of coverage for both mental and physical health care — though the administration and advocates argue insurers’ policies restrict patient access.

    The rules, if finalized, would force insurers to study patient outcomes to ensure the benefits are administered equally, taking into account their provider network and reimbursement rates and whether prior authorization is required for care.

    “Too many Americans still struggle to find and afford the care they need,” the White House said in an emailed statement.

    The Democratic president’s administration said it’s aiming to address issues such as insurers enabling nutritional counseling for diabetes patients but making it more difficult for those with eating disorders.

    By measuring outcomes, the White House said, it will force insurers to make modifications to come into compliance with the law.

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  • The Biden administration proposes new rules to push insurers to boost mental health coverage

    The Biden administration proposes new rules to push insurers to boost mental health coverage

    President Joe Biden’s administration has announced new rules meant to push insurance companies to increase their coverage of mental health treatments

    FILE – President Joe Biden speaks in Philadelphia, July 20, 2023. Biden’s administration is announcing new rules meant to push insurance companies to increase their coverage of mental health treatments. (AP Photo/Susan Walsh, File)

    The Associated Press

    WASHINGTON — President Joe Biden’s administration on Tuesday announced new rules meant to push insurance companies to increase their coverage of mental health treatments.

    The new regulations, which still need to go through a public comment period, would require insurers to study whether their customers have equal access to medical and mental health benefits and to take remedial action, if necessary. The Mental Health Parity and Addiction Equity Act requires that insurers provide the same level of coverage for both mental and physical health care — though the administration and advocates argue insurers’ policies restrict patient access.

    The rules, if finalized, would force insurers to study patient outcomes to ensure the benefits are administered equally, taking into account their provider network and reimbursement rates and whether prior authorization is required for care.

    “Too many Americans still struggle to find and afford the care they need,” the White House said in an emailed statement.

    The Democratic president’s administration said it’s aiming to address issues such as insurers enabling nutritional counseling for diabetes patients but making it more difficult for those with eating disorders.

    By measuring outcomes, the White House said, it will force insurers to make modifications to come into compliance with the law.

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  • Deck collapse at Montana country club leaves multiple people injured, police say

    Deck collapse at Montana country club leaves multiple people injured, police say

    A deck has collapsed at a Montana country club, leaving up to 25 people injured

    BILLINGS, Mont. — A deck collapsed at a Montana country club, leaving up to 25 people injured on Saturday evening, police and news reports said.

    Emergency services responded to a report of a collapsed patio on the 3400 block of Briarwood Boulevard in Billings at 7:50 p.m., the Billings Police Department said in a statement posted on social media.

    There were “multiple individuals with injuries” but no fatalities and a large number of people were transported to local hospitals, Billings Police Lt. Matt Lennick said in the statement.

    News outlets including The Billings Gazette and KTVQ-TV identified the location as the Briarwood Country Club.

    Up to 25 people were transported to hospitals, KTVQ reported.

    Police shut down roads near the Billings Clinic and St. Vincent Healthcare to clear access to the hospitals, the Gazette reported.

    Dr. Clint Seger, CEO of the Billings Clinic, said in a statement that the hospital received six patients and was expecting another three. Another Billings Clinic official separately said 11 victims were admitted, the Gazette reported.

    “We have multiple trauma surgeons, ER physicians and the ER team along with critical care staff on site receiving patients,” Seger said.

    The Briarwood website says the club opened in 1984 and offers golf, dining and swimming.

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  • FDA Approves First Over-the-Counter Birth Control Pill

    FDA Approves First Over-the-Counter Birth Control Pill



    This is a developing story. Stayed tune for reaction to today’s FDA decision. 


    July 13, 2023 – The FDA today approved the first birth control pill for women that does not require a prescription. The product, OPill, is expected to be available early next year. 


    The over the counter OPill is the same norgestrel birth control pill that has been available by prescription for 50 years. But for the first time, women will be able to buy the contraception at a local pharmacy or other retail location without having to see a doctor first. 


    The manufacturer Perrigo Company based in Ireland has not yet announced how much the pill will cost. The price tag could have implications for how widely available this form of birth control becomes. It can be as much as 93% effective in preventing pregnancy. Perrigo says it plans to make the pill available at low or no cost to some women.


    The approval follows a

    unanimous vote

    among 17 experts on an FDA advisory committee on May 10. The panel recommended the product be made available over the counter, stating it offers more potential benefit than harm. 



    WebMD Health News


    Sources

    SOURCE: 


    FDA: “FDA Approves First Nonprescription Daily Oral Contraceptive.”

     



    © 2023 WebMD, LLC. All rights reserved.

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  • Georgia launches Medicaid expansion in closely watched test of work requirements

    Georgia launches Medicaid expansion in closely watched test of work requirements

    ATLANTA — Georgia is offering a new bargain to some adults without health insurance beginning Saturday: Go to work or school and the state will cover you.

    But advocates decry the plan, which will insure far fewer people than a full expansion of the state-federal Medicaid program, as needlessly restrictive and expensive.

    The program is likely to be closely watched as Republicans in Congress push to let states require work from some current Medicaid enrollees.

    Madeline Guth, a senior policy analyst with the Kaiser Family Foundation, said Democratic President Joe Biden’s administration is unlikely to approve work requirements, but a future Republican president could.

    “I think there will be a lot of eyes on Georgia,” Guth said.

    Georgia is one of 10 remaining states that hasn’t expanded Medicaid eligibility to include individuals and families earning up to 138% of the federal poverty line, or $20,120 annually for a single person and $41,400 for a family of four.

    Medicaid expansion was a key part of President Barack Obama’s health care overhaul in 2010, but many Republicans have fought it, including Georgia Gov. Brian Kemp, a Republican.

    Instead, Kemp is limiting expanded coverage to adults earning up to 100% of the poverty line — $14,580 for a single person or $30,000 for a family of four. And coverage is only available if able-bodied adults document they are working, volunteering, studying or in vocational rehabilitation for 80 hours per month.

    It fits Kemp’s argument, as he tries to drag his party away from former President Donald Trump, that the GOP needs to show tangible conservative achievements for everyday people

    “In our state, we want more people to be covered at a lower cost with more options for patients,” Kemp said in his State of the State speech in January.

    Those who earn more will remain eligible for subsidized coverage, often with no premium cost, on the federal marketplace. Kemp’s administration argues commercial coverage is better because it pays providers more than state-set Medicaid rates.

    The Trump administration ultimately gave permission to 13 states to impose work requirements on some Medicaid recipients. The Biden administration revoked all those waivers in 2021, ruling work isn’t a primary purpose of Medicaid. But Kemp’s administration won a federal court fight last year to preserve Georgia’s plan, in part because it applies to new enrollees and not current Medicaid recipients.

    Caylee Noggle, commissioner of the Department of Community Health, told The Associated Press this week that Pathways to Coverage is a “Georgia-specific approach” that could insure up to 100,000 people in its first year.

    But 100,000 is far less than the nearly 450,000 uninsured Georgians that the Urban Institute estimates could gain coverage with a full Medicaid expansion.

    Others say the nearly $118 million in state money, combined with another $229 million in federal money, isn’t nearly enough to reach that goal. The liberal-leaning Georgia Budget & Policy Institute estimates the funds will cover fewer than 50,000 people.

    And state taxpayers will pay much more per person. Partly at the behest of Democratic Georgia Sen. Raphael Warnock, the federal government is offering to pay 95% of any Medicaid expansion for two years and 90% afterward. Instead, refusing federal largesse, Georgia will continuing paying the same 34.2% share the state foots for its existing Medicaid program and spurn extra federal funding that has been pledged.

    “The inappropriately named ‘Pathways to Coverage’ will cost Georgia more money and cover fewer people than if the state simply joined 40 other states in expanding Medicaid,” Warnock said in a statement to the AP.

    “While state politicians continue playing games with people’s lives, Georgians are dying because they can’t afford the health care they need,” he said.

    Noggle and other Georgia officials say working, studying or volunteering leads to improved health, a key argument for why those requirements should be part of a health insurance program.

    But those who treat uninsured people say many can’t work because they are in poor health.

    “The reason they have their challenges, that they can’t work, is because they’ve got a mental illness or they’ve got a medical illness that is affecting their ability to do that,” said Dr. Reed Pitre, an addiction psychiatrist and interim chief medical officer at Mercy Care, a federally subsidized nonprofit in Atlanta.

    Enrolling people in the new program is a priority for Mercy Care, Pitre said, while noting that no one will qualify until a month after they establish compliance with the work requirement.

    The Kemp administration anticipates the program will serve people in low-wage jobs who can’t afford employer insurance, as well as students. The state also is redetermining eligibility for 2.4 million adults and children now covered by Medicaid.

    Georgia has delayed decisions on people it thinks are ineligible for regular Medicaid but could transfer to the Pathways program, Noggle said.

    Either way, once on the new program, people will have to meet activity requirements or lose coverage beginning the following month, which could impact thousands. When Arkansas imposed work requirements in 2018 for some adults, more than 18,000 people lost coverage in less than a year.

    Georgia will be different, Noggle argued, saying recipients will only have to certify for the first three months of the year.

    “I think we are going to make it as easy as possible as we can for our members to verify their eligibility,” she said.

    But only time will tell. Kemp’s expansion plan in Georgia could provide a blueprint for other states and other Republicans looking to require more from those on Medicaid.

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  • Maine House votes to ensure teens can receive gender-affirming health care

    Maine House votes to ensure teens can receive gender-affirming health care

    The Maine House has voted in favor of a bill to ensure 16- and 17-year-olds can receive gender-affirming hormone therapy without parental consent in some situations

    The morning fog lifts beyond the Burton M. Cross Building, left, and the State House, Wednesday, June 21, 2023, in Augusta, Maine. The legislature is working to wrap up the current session. (AP Photo/Robert F. Bukaty)

    The Associated Press

    AUGUSTA, Maine — The Maine House voted Monday in favor of a bill to ensure 16- and 17-year-olds can receive gender-affirming hormone therapy without parental consent if certain conditions are met.

    The bill, approved 73-60, allows those teens to undergo treatment without parental consent if they are diagnosed with gender dysphoria, are experiencing harm and have received counseling. It now goes to the Senate for further debate.

    Both chambers already voted to enshrine in law a requirement for the state’s Medicaid program to cover gender-affirming care.

    Maine’s actions come as a growing number of states seek to ban gender-affirming care.

    At least 20 states have now enacted laws restricting or banning gender-affirming medical care for transgender minors, and most of those states face lawsuits.

    A federal judge struck down Arkansas’ ban as unconstitutional last week, and federal judges have temporarily blocked bans in Alabama and Indiana. Oklahoma has agreed to not enforce its ban while opponents seek a temporary court order blocking it. A federal judge has blocked Florida from enforcing its ban on three children who have challenged the law.

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  • More than 1 million dropped from Medicaid as states start post-pandemic purge of rolls

    More than 1 million dropped from Medicaid as states start post-pandemic purge of rolls

    More than 1 million people have been dropped from Medicaid in the past couple months as some states moved swiftly to halt health care coverage following the end of the coronavirus pandemic.

    Most got dropped for not filling out paperwork.

    Though the eligibility review is required by the federal government, President’s Joe Biden’s administration isn’t too pleased at how efficiently some other states are accomplishing the task.

    “Pushing through things and rushing it will lead to eligible people — kids and families — losing coverage for some period of time,” Daniel Tsai, a top federal Medicaid official recently told reporters.

    Already, about 1.5 million people have been removed from Medicaid in more than two dozen states that started the process in April or May, according to publicly available reports and data obtained by The Associated Press.

    Florida has dropped several hundred thousand people, by far the most among states. The drop rate also has been particularly high in other states. For people whose cases were decided in May, around half or more got dropped in Arkansas, Idaho, Kansas, Nevada, New Hampshire, Oklahoma, South Dakota, Utah and West Virginia.

    By its own count, Arkansas has dropped more than 140,000 people from Medicaid.

    The eligibility redeterminations have created headaches for Jennifer Mojica, 28, who was told in April that she no longer qualified for Medicaid because Arkansas had incorrectly determined her income was above the limit.

    She got that resolved, but was then told her 5-year-old son was being dropped from Medicaid because she had requested his cancellation — something that never happened, she said. Her son’s coverage has been restored, but now Mojica says she’s been told her husband no longer qualifies. The uncertainty has been frustrating, she said.

    “It was like fixing one thing and then another problem came up, and they fixed it and then something else came up,” Mojica said.

    Arkansas officials said they have tried to renew coverage automatically for as many people as possible and placed a special emphasis on reaching families with children. But a 2021 state law requires the post-pandemic eligibility redeterminations to be completed in six months, and the state will continue “to swiftly disenroll individuals who are no longer eligible,” the Department of Human Services said in statement.

    Arkansas Gov. Sarah Huckabee Sanders has dismissed criticism of the state’s process.

    “Those who do not qualify for Medicaid are taking resources from those who need them,” Sanders said on Twitter last month. “But the pandemic is over — and we are leading the way back to normalcy.”

    More than 93 million people nationwide were enrolled in Medicaid as of the most recent available data in February — up nearly one-third from the pre-pandemic total in January 2020. The rolls swelled because federal law prohibited states from removing people from Medicaid during the health emergency in exchange for providing states with increased funding.

    Now that eligibility reviews have resumed, states have begun plowing through a backlog of cases to determine whether people’s income or life circumstances have changed. States have a year to complete the process. But tracking down responses from everyone has proved difficult, because some people have moved, changed contact information or disregarded mailings about the renewal process.

    Before dropping people from Medicaid, the Florida Department of Children and Families said it makes between five and 13 contact attempts, including texts, emails and phone calls. Yet the department said 152,600 people have been non-responsive.

    Their coverage could be restored retroactively, if people submit information showing their eligibility up to 90 days after their deadline.

    Unlike some states, Idaho continued to evaluate people’s Medicaid eligibility during the pandemic even though it didn’t remove anyone. When the enrollment freeze ended in April, Idaho started processing those cases — dropping nearly 67,000 of the 92,000 people whose cases have been decided so far.

    “I think there’s still a lot of confusion among families on what’s happening,” said Hillarie Hagen, a health policy associate at the nonprofit Idaho Voices for Children.

    She added, “We’re likely to see people showing up at a doctor’s office in the coming months not knowing they’ve lost Medicaid.”

    Advocates fear that many households losing coverage may include children who are actually still eligible, because Medicaid covers children at higher income levels than their parents or guardians. A report last year by the U.S. Department of Health and Human Services forecast that children would be disproportionately impacted, with more than half of those disenrolled still actually eligible.

    That’s difficult to confirm, however, because the federal Centers for Medicare & Medicaid Services doesn’t require states to report a demographic breakdown of those dropped. In fact, CMS has yet to release any state-by-state data. The AP obtained data directly from states and from other groups that have been collecting it.

    Medicaid recipients in numerous states have described the eligibility redetermination process as frustrating.

    Julie Talamo, of Port Richey, Florida, said she called state officials every day for weeks, spending hours on hold, when she was trying to ensure her 19-year-old special-needs son, Thomas, was going to stay on Medicaid.

    She knew her own coverage would end but was shocked to hear Thomas’ coverage would be whittled down to a different program that could force her family to pay $2,000 per month. Eventually, an activist put Talamo in contact with a senior state healthcare official who confirmed her son would stay on Medicaid.

    “This system was designed to fail people,” Talamo said of the haphazard process.

    Some states haven’t been able to complete all the eligibility determinations that are due each month. Pennsylvania reported more than 100,000 incomplete cases in both April and May. Tens of thousands of cases also remained incomplete in April or May in Arizona, Arkansas, Indiana, Iowa, New Mexico and Ohio.

    “If states are already behind in processing renewals, that’s going to snowball over time,” said Tricia Brooks, a research professor at the Georgetown University Center for Children and Families. “Once they get piles of stuff that haven’t been processed, I don’t see how they catch up easily.”

    Among those still hanging in the balance is Gary Rush, 67, who said he was notified in April that he would lose Medicaid coverage. The Pittsburgh resident said he was told that his retirement accounts make him ineligible, even though he said he doesn’t draw from them. Rush appealed with the help of an advocacy group and, at a hearing this past week, was told he has until July to get rid of about $60,000 in savings.

    Still, Rush said he doesn’t know what he will do if he loses coverage for his diabetes medication, which costs about $700 a month. Rush said he gets $1,100 a month from Social Security.

    In Indiana, Samantha Richards, 35, said she has been on Medicaid her whole life and currently works two part-time jobs as a custodian. Richards recalled receiving a letter earlier this year indicating that the pandemic-era Medicaid protection was ending. She said a local advocacy group helped her navigate the renewal process. But she remains uneasy.

    “Medicaid can be a little unpredictable,” Richards said. “There is still that concern that just out of nowhere, I will either get a letter saying that we have to reapply because we missed some paperwork, or I missed a deadline, or I’m going to show up at the doctor’s office or the pharmacy and they’re going to say, ‘Your insurance didn’t go through.’”

    ___

    Lieb reported from Jefferson City, Missouri, and DeMillo from Little Rock, Arkansas. Also contributing were AP reporters Anthony Izaguirre in Tallahassee, Florida; Marc Levy in Harrisburg, Pennsylvania; and Arleigh Rodgers in Bloomington, Indiana. Rodgers is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

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  • Transgender adults in Florida `blindsided’ that new law also limits their access to health care

    Transgender adults in Florida `blindsided’ that new law also limits their access to health care

    TALLAHASSEE, Fla. — Debate surrounding Florida’s new restrictions on gender-affirming care focused largely on transgender children. But a new law that Republican presidential candidate and Gov. Ron DeSantis signed last month also made it difficult – even impossible – for many transgender adults to get treatment.

    Eli and Lucas, trans men who are a couple, followed the discussions in the Legislature, where Democrats warned that trans children would be more prone to suicide under a ban on gender-affirming care for minors and Republicans responded with misplaced tales of mutilated kids. Eli said he and his partner felt “blindsided” when they discovered the bill contained language that would also disrupt their lives.

    “There was no communication. … Nobody was really talking about it in our circles,” said Eli, 29.

    Like many transgender adults in Florida, he and Lucas are now facing tough choices, including whether to uproot their lives so that they can continue to access gender-confirming care. Clinics are also trying to figure out how to operate under regulations that have made Florida a test case for restrictions on adults.

    Lucas, 26, lost his access to treatment when the Orlando clinic that prescribed him hormone replacement therapy stopped providing gender-affirming care altogether. The couple also worries about staying in a state that this year enacted several other bills targeting the LGBTQ+ community.

    “My entire life is here. All my friends, my family. I just got a promotion at my job, which I’m probably not to be able to keep,” Lucas, who works in a financial aid office at a college, said. “I’m losing everything except Eli and my pets moving out of here. So this was not a decision that I took lightly at all.”

    The Associated Press is not using Eli’s and Lucas’ last names because they fear reprisal. While their friends and families know they are trans, most people who meet them do not.

    The new law that bans gender-affirming care for minors also mandates that adult patients seeking trans health care sign an informed consent form. It also requires a physician to oversee any health care related to transitioning, and for people to see that doctor in person. Those rules have proven particularly onerous because many people received care from nurse practitioners and used telehealth. The law also made it a crime to violate the new requirements.

    Another new law that allows doctors and pharmacists to refuse to treat transgender people further limits their options.

    “For trans adults, it’s devastating,” said Kate Steinle, chief clinical officer at FOLX Health, which provides gender-affirming care to trans adults through telemedicine. Her company decided to open in-person clinics and hire more physicians licensed in Florida in order to continue to provide care to patients who have already enrolled, even though that represents a major change to the company’s business model.

    Eli has been seeing a physician for years and therefore still has access to care. But SPEKTRUM Health Inc., the Orlando clinic that prescribed Lucas hormone replacement therapy, has stopped providing gender-affirming care.

    “There are a lot of people looking for care that we’re no longer legally able to provide,” said Lana Dunn, SPEKTRUM Health’s chief operating officer.

    Florida has the second-largest population of transgender adults in the U.S., at an estimated 94,900 people, according to the Williams Institute at the University of California, Los Angeles School of Law. It used state-level, population-based surveys to determine its estimates. Not all transgender people seek medical interventions.

    At least 19 states have now enacted laws restricting or banning gender-affirming medical care for transgender minors. But restrictions on adults haven’t been part of the conversation in most places. Missouri’s attorney general tried to impose a rule in that state, but it was pulled back.

    Florida is “the proving ground of what they can get away with,” Dunn said.

    Her organization treats about 4,000 people — most in Florida and some out-of-state telehealth patients, she said. While SPEKTRUM has bolstered its mental health services since the law passed, it and other organizations heavily rely on nurse practitioners to provide care.

    Dunn estimates that 80% of trans adults in the state were getting their health care from a nurse practitioner and now have lost access.

    “Right now what we’re seeing in the community is just chaos,” Dunn said.

    The law also contains language that she said could scare off doctors who would be otherwise willing to treat trans patients, such as a 20-year statute of limitations to sue over care they provide.

    As a trans woman herself, Dunn is grappling with losing her own access to hormones while trying to provide support to terrified patients. That’s taken “a significant emotional toll,” she said.

    “Not only am I faced with this lack of care for myself but a lot of people within the community are also facing the same thing, and they’re reaching out to me for guidance,” Dunn said. “So I’m doing my best to help guide people and console them, but nobody’s really reaching out to me saying, ’How are you doing? Are you OK?’”

    Lucas, who transitioned eight years ago when he was 18, anticipates running out of hormone treatments in June. In the best case scenario he can foresee now, he will be able to get a new prescription in August. He fears he might start to get his period again.

    “It’s just going to be extremely difficult mentally to have your body changing in a way that doesn’t align with your brain,” Lucas said.

    Eli and Lucas have switched to a month-to-month lease and tentatively plan to relocate to Minnesota in November. They said they would leave sooner if they can afford it and started an online fundraiser to help. Moving with their dog and two cats increases the expense and difficulty of finding a new place.

    “I just never thought it could happen this way, this fast and to us,” Eli said.

    ___

    Beaty reported from New York City and Schoenbaum reported from Raleigh, North Carolina.

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  • Despite flags, Border Patrol staff didn’t review fragile 8-year-old girl’s file before she died

    Despite flags, Border Patrol staff didn’t review fragile 8-year-old girl’s file before she died

    HARLINGEN, Texas — Border Patrol medical staff declined to review the file of an 8-year-old girl with a chronic heart condition and rare blood disorder before she appeared to have a seizure and died on her ninth day in custody, an internal investigation found.

    U.S. Customs and Border Protection has said the child’s parents shared the medical history with authorities on May 10, a day after the family was taken into custody.

    But a nurse practitioner declined to review documents about the girl the day she died, CBP’s Office of Professional Responsibility said in its initial statement Thursday on the May 17 death. The nurse practitioner reported denying three or four requests from the girl’s mother for an ambulance.

    Anadith Tanay Reyes Alvarez, whose parents are Honduran, was born in Panama with congenital heart disease. She received surgery three years ago that her mother, Mabel Alvarez Benedicks, characterized as successful during a May 19 interview with The Associated Press.

    A day before she died, Anadith showed a fever of 104.9 degrees Fahrenheit (40.5 degrees Celsius), the CBP report said.

    A surveillance video system at the Harlingen, Texas, station was out of service since April 13, a violation of federal law that prevented evidence collection, according to the Office of Professional Responsibility, akin to a police department’s office of internal affairs. The system was flagged for repair but wasn’t fixed until May 23, six days after the girl died.

    Still, the report relied on interviews with Border Patrol agents and contracted medical personnel to raise a host of new and troubling questions about what went wrong during the girl’s nine days in custody, which far exceeded the agency’s own limit of 72 hours.

    Investigators gave no explanation for decisions that medical staff made and appeared to be at a loss for words.

    “Despite the girl’s condition, her mother’s concerns, and the series of treatments required to manage her condition, contracted medical personnel did not transfer her to a hospital for higher-level care,” the Office of Professional Responsibility said.

    Troy Miller, CBP’s acting commissioner, said the initial investigation “provides important new information on this tragic death” and he reaffirmed recent measures including a review of all “medically fragile” cases in custody to ensure they are out of custody as soon as possible. Average time in custody has dropped by more than half for families in two weeks, he said.

    “(This death) was a deeply upsetting and unacceptable tragedy. We can — and we will — do better to ensure this never happens again,” Miller said.

    Anadith entered Brownsville, Texas, with her parents and two older siblings May 9 when daily illegal crossings topped 10,000 as migrants rushed to beat the end of pandemic-related restrictions on seeking asylum.

    She was diagnosed with the flu May 14 at a temporary holding facility in Donna, Texas, and was moved with her family to Harlingen. Staff had about nine encounters with Anadith and her mother over the next four days at the Harlingen station until her death over concerns including high fever, flu symptoms, nausea and breathing difficulties. She was given medications, a cold pack and a cold shower, according to the Office of Professional Responsibility.

    A court-appointed monitor expressed concern in January about chronic conditions of medically fragile children not getting through to Border Patrol staff.

    Dr. Paul H. Wise, a Stanford University pediatrics professor who was in South Texas last week to look into the circumstances around what he said was a “preventable” death, said there should be little hesitation about sending ill children to the hospital, especially those with chronic conditions.

    Anadith’s mother told the AP that she informed staff of her child’s conditions, which included sickle-cell anemia, and repeatedly asked for medical assistance and an ambulance to take her daughter to a hospital but the request were denied until her child fell unconscious.

    Karla Marisol Vargas, an attorney for the Texas Civil Rights Project who is representing the family, said Border Patrol agents rejected her pleas for medicine until the day she died.

    “They refused to review documents showing the illnesses that her daughter had,” Vargas said.

    The family is living with relatives in New York City while funeral arrangements are made.

    ___

    Associated Press writer Elliot Spagat in San Diego contributed to this story.

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  • 8-year-old girl sought medical help 3 times on day she died, US immigration officials say

    8-year-old girl sought medical help 3 times on day she died, US immigration officials say

    HARLINGEN, Texas — HARLINGEN, Texas (AP) — An 8-year-old girl who died last week in Border Patrol custody was seen at least three separate times by medical personnel on the day of her death — complaining of vomiting, a stomachache and later suffering what appeared to be a seizure — before she was taken to a hospital, U.S. immigration officials said Sunday.

    The girl’s mother had previously told The Associated Press that agents had repeatedly ignored her pleas to hospitalize her medically fragile daughter, who had a history of heart problems and sick cell anemia. Anadith Tanay Reyes Alvarez, whose parents are Honduran, was born in Panama with congenital heart disease.

    “She cried and begged for her life, and they ignored her. They didn’t do anything for her,” Mabel Alvarez Benedicks, the mother of Anadith, had previously told The Associated Press during an interview Friday.

    In a statement, U.S. Customs and Border Protection said it knew about the girl’s medical history when personnel began treating her for influenza four days before her death on May 17.

    CBP Acting Commissioner Troy Miller said in a statement that while his agency awaits the results of an internal investigation, he has ordered several steps be taken to ensure appropriate care for all medically fragile people in his agency’s custody.

    These actions include reviewing cases of all known medically fragile individuals currently in custody to ensure their time being held is limited and examining medical-care practices at CBP facilities to see if more personnel are needed.

    “We must ensure that medically fragile individuals receive the best possible care and spend the minimum amount of time possible in CBP custody,” Miller said, adding his agency is “deeply saddened” by the girl’s “tragic death.”

    Anadith’s death has raised questions about whether the Border Patrol properly handled the situation. It was the second child migrant death in two weeks in U.S. government custody after a rush of illegal border crossings amid the expiration of pandemic-related asylum limits known as Title 42 severely strained holding facilities.

    According to a CBP statement, Anadith had first voiced complaints of abdominal pain, nasal congestion, and cough on the afternoon of May 14. She had a temperature of 101.8 degrees Fahrenheit (38.7 Celsius)

    After a test showed she had influenza, Anadith was given acetaminophen, ibuprofen, medicine for nausea and Tamiflu, a flu treatment, according to CBP.

    The family was then transferred from a facility in Donna, Texas, to one in Harlingen, Texas.

    She continued to be given Tamiflu for the next two days. She was also given ibuprofen, according to CBP.

    Alvarez Benedicks had told the AP her daughter’s health got progressively worse during those days and that doctors at the station denied her repeated requests for an ambulance to take the girl to a hospital.

    “I felt like they didn’t believe me,” Alvarez Benedicks said.

    On May 17, the girl and her mother went to the Harlingen Border Patrol Station’s medical unit at least three times, CBP said. In the first visit, Anadith complained of vomiting. In the second, she child complained of a stomachache. By the third visit at 1:55 p.m., “the mother was carrying the girl who appeared to be having a seizure, after which records indicate the child became unresponsive,” according to CBP.

    Medical personnel began performing CPR before she was taken to a hospital in Harlingen, where she was pronounced dead at 2:50 p.m.

    A medical examiner is waiting for additional tests before determining a cause of death.

    Her death came a week after a 17-year-old Honduran boy, Ángel Eduardo Maradiaga Espinoza, died in U.S. Health and Human Services Department custody. He was traveling alone.

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  • Rhode Island governor signs bill to fund abortion coverage for state workers and Medicaid recipients

    Rhode Island governor signs bill to fund abortion coverage for state workers and Medicaid recipients

    PROVIDENCE, R.I. — Rhode Island Gov. Daniel McKee signed a bill into law Thursday that would let state funds be used to pay for health insurance plans that cover state workers and Medicaid recipients seeking abortions.

    The signing ceremony was held almost immediately after the state Senate approved the measure, also Thursday, on a 24-12 vote following less than an hour of debate in the chamber.

    McKee, a Democrat, said he was proud to sign the bill into law and include related funding in his state budget proposal.

    “Here in Rhode Island, we will always protect a woman’s right to choose and ensure equal access to these crucial health care services,” he said.

    An identical version of the measure cleared the Democratic-controlled House of Representatives on April 27 by a 49-24 vote.

    Democratic state Sen. Bridget Valverde, one of the bill’s sponsors, said that despite a vote by Rhode Island lawmakers four years ago to enshrine the right to safe, legal abortion in the state, the work to help guarantee access to abortions was unfinished.

    “For so many the right has remained illusive,” she said. “That’s because a right to a health care service is useless if we intentionally prevent people’s health insurance from covering it.”

    Medicaid patients and state workers deserve to have the same access to care as people enrolled in private health insurance plans, she said.

    With the new law, doctors will no longer have to tell their low-income patients that their health insurance won’t cover their abortion, she added.

    Opponents said the state shouldn’t require state taxpayers, including those with moral objections to the procedure, to cover the cost of abortions.

    “For decades, the consensus has maintained that regardless of one’s view on the legality or appropriateness of abortion, taxpayers should not be forced or encouraged to pay for abortions,” said Republican Sen. Jessica de la Cruz.

    About a quarter of Rhode Islanders are covered by Medicaid, and another 30,000 are covered by state employee plans, backers of the new law said. They have had to pay out of pocket for the full cost of abortions.

    In his budget plan for fiscal year 2024, McKee includes funding to add abortion coverage to Rhode Island’s Medicaid program and to the insurance coverage for state employees, at a projected cost of $622,000.

    The legislation repeals a section of state law banning Rhode Island from including any provision that provides coverage for induced abortions in any health insurance contracts with state employees. The current law exempts instances when the life of the mother would be endangered if the fetus were carried to term, or when the pregnancy resulted from rape or incest.

    Other critics, including Democratic House Labor Committee Chair Arthur Corvese, have said it’s one thing to end a pregnancy because of rape, incest or the health of the mother, and another to do so because it was unplanned.

    The Rhode Island measure follows a pattern that has emerged during the first legislative sessions in most states since the U.S. Supreme Court overturned Roe v. Wade. Republicans are moving to make abortion restrictions tougher, while Democratic-dominated states are moving to protect access for their residents and residents of other states arriving for care.

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  • More companies help with fertility care, but it is still out of reach for many

    More companies help with fertility care, but it is still out of reach for many

    Jessica Tincopa may leave the photography business she spent 14 years building for one reason: to find coverage for fertility treatment.

    After six miscarriages, Tincopa and her husband started saving for in vitro fertilization, which can cost well over $20,000. But the pandemic wiped out their savings, and they can’t find coverage for IVF on their state’s health insurance marketplace. So, the California couple is saving again, and asking politicians to help expand access.

    “No one should ever have to go through this,” Tincopa said.

    Infertility, or the inability to get pregnant after a year or more of trying, is a common problem. The federal Centers for Disease Control and Prevention estimates that it affects nearly one in five married girls or women between the ages of 15 and 49.

    Yet coverage of fertility treatments can be hard to find in many corners of health insurance even as it grows briskly with big employers who see it as a must-have benefit to keep workers.

    It’s a divide researchers say is leading to haves and have nots for treatments, which can involve a range of prescription drugs and procedures like artificial insemination or IVF, where an embryo is created by mixing eggs and sperm in a lab dish.

    “It is still primarily for people who can afford to pay quite a bit out of pocket,” said Usha Ranji, associate director of women’s health policy at KFF, a nonprofit that studies health care issues.

    Clouding this picture are insurer concerns about cost as well as questions about how much fertility coverage should be emphasized or mandated versus helping people find other ways to build families, such as adoption.

    “If you’re going to offer one, there should be a corollary and maybe even more significant benefits for adoption,” medical ethicist Dr. Philip Rosoff said.

    A total of 54% of the biggest U.S. employers — those with 20,000 workers or more — covered IVF in 2022, according to the benefits consultant Mercer. That’s up from 36% in 2015. Walmart started offering coverage last fall and banking giant JPMorgan began this year.

    Many businesses that offer the coverage extend it beyond those with an infertility diagnosis, making it accessible to LGBTQ+ couples and single women, according to Mercer.

    The benefits consultant also said there’s big growth among employers with 500 or more workers, as 43% offered IVF coverage last year. But coverage gets spotty with smaller employers.

    Lauderhill (Florida) Fire Rescue Lt. Ame Mason estimates she and her husband have spent close to $100,000 of their own money on fertility treatments over the past few years, including several unsuccessful IVF attempts. Mason and her husband both work for the same department.

    Her brother-in-law also has a fertility issue. He works for a bigger fire department in nearby Palm Beach County and got coverage. Mason said that couple has a son.

    “It’s pretty wild. You could work a county away and have coverage,” Mason said. “There’s nothing regulating it … both government jobs.”

    Twenty-one states have laws mandating coverage of fertility treatments or fertility preservation, which some patients need before cancer treatments, according to the nonprofit patient advocacy organization Resolve. Of those states, 14 require IVF coverage.

    But most of these requirements don’t apply to individual insurance plans or coverage sold through small employers.

    “People tell us that their biggest barrier to family building is lack of insurance coverage,” Resolve CEO Barbara Collura said, adding that some insurers don’t view the care as medically necessary.

    The state and federally funded Medicaid program for people with low incomes limits coverage of fertility issues largely to diagnosis in several states, according to KFF, which says Black and Hispanic women are disproportionately affected. States also can exclude fertility drugs from prescription coverage.

    “By not covering this for poor folks, we’re saying we don’t want you to reproduce,” said medical ethicist Lisa Campo-Engelstein of the University of Texas Medical Branch in Galveston, Texas. She noted Medicaid programs do cover birth control and sterilization procedures like vasectomies.

    In California, Tincopa says she has talked to both state and federal legislators about creating some sort of option for people to purchase individual insurance with the coverage.

    The state Senate is weighing a bill that would require coverage of fertility treatments, including IVF, for large employers. But the California Association of Health Plans opposes it, just as it opposed similar bills in recent years, because of how much it might cost.

    Spokeswoman Mary Ellen Grant noted independent analysis has shown that bills like this could increase premiums by as much as $1 billion in the state. She also said it would create a coverage gap because it wouldn’t apply to the state’s Medicaid enrollees.

    “This is not about the treatment itself,” she said. “It’s strictly based on the increased costs for our members. It would impact everybody regardless of whether they received the benefit.”

    But large fertility cost estimates often overstate how many people will use the benefit, said Sean Tipton, of the American Society for Reproductive Medicine. He also said most people with fertility problems don’t need IVF.

    Tipton, who has advocated for benefit mandates in several states, said he expects to see fertility treatment coverage grow, especially with small employers who may need to offer it to attract and keep workers.

    Any states that decide to require fertility treatment coverage should also require support for adoption, said Rosoff, a retired Duke University medical school professor. He said “fairness and justice” dictate doing so, adding that adoption promotes the social good of finding homes for children.

    Many companies that have expanded fertility benefits also support adoption.

    Ame Mason’s employer helps with neither.

    Mason said she has thought about adoption, but will stick with IVF for now — scrimping wherever they can and working overtime as much as possible to pay for it. They’ve found a doctor in Florida after traveling to Barbados for care that was slightly less expensive.

    Plus, she and her husband are seeing improvements in their most recent IVF attempts. This makes her reluctant to stop trying.

    “We keep getting that glimmer of hope,” she said.

    ___

    The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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