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HHS’ Healthy Food Agenda Puts Hospitals on Notice About Patients’ Meals

Stephanie Armour — Mon, 04 May 2026 09:00:00 +0000

Complaints about hospital food are certainly not new, and Jell-O and fruit juice are often the butt of related jokes. But the Trump administration has recently upped the ante.

It is urging the public to report hospitals and nursing homes that serve sugary drinks, nutrition shakes, or meals that it says don’t meet dietary guidelines established last year by the U.S. Department of Agriculture, with officials vowing to withhold millions of dollars in federal funding if violations occur.

The initiative from Health and Human Services Secretary Robert F. Kennedy Jr. is spurring backlash from some doctors and medical providers who say it fails to account for patients’ unique dietary needs and is anathema to Republicans who have long embraced an anti-regulatory stance.

It’s also not clear that HHS has the regulatory authority to enforce its threat without going through a formal rulemaking process, lawyers and dietitians say.

“Most of this is political theater. HHS doesn’t have the power to do much,” said , a dietitian and research scientist who is an assistant professor at the University of Toronto. “Also, if it’s to the point that you’re trying to control people’s choices, well, you look a little fascist.”

The agency to hospitals asking them to align their food purchases with the administration’s 2025-30 dietary guidelines to ensure continued eligibility for Medicaid and Medicare payments, Kennedy said at a March 30 press event.

“We are going to bring all the hospitals in the country in line with good food,” he said, describing the instructions as “essentially a .”

“If a hospital is serving patients sugary drinks, they are out of compliance with government standards and are putting their reimbursements in jeopardy,” top Kennedy adviser Calley Means “If you see patients being served sugary drinks, please post information below or let CMS know.”

The comment included a link to an HHS webpage with a toll-free number for reporting complaints typically used for medical bills. Withholding federal funding from hospitals is one of the most extreme enforcement tools available to regulators, one the Centers for Medicare & Medicaid Services has seldom deployed.

Even serving liquid nutrition products like Ensure to patients could put hospitals in jeopardy, Means warned. “They need to change or lose reimbursement. Please report them if you see it,” he told an X user.

Medicare and Medicaid, combined, are the of hospital expenditures.

The notice came in the form of a “Conditions of Participation” update released by CMS to ensure hospital patients’ food adheres to the dietary guidelines, HHS spokesperson Andrew Nixon said. “We commend the many hospitals who have made commitments to improve their food offerings, and expect every hospital system to do so,” he said.

Means did not respond directly to requests for comment from ��ýҕ�l Health News, instead posting on X shortly after he was contacted: “‘Trump Derangement Syndrome’ has led Democrats to defend the medical importance of mass-serving soda and junk food to American patients.” In a text with ��ýҕ�l Health News, he said, “That’s to cite if you want. I don’t have a comment.”

Still, some administration officials have made it clear they will not shy away from halting federal funding, a rarely taken step that can imperil the ability of a hospital to remain open.

A Carrot and a Stick

HHS can withhold or threaten federal funding if hospitals violate mandatory minimum health and safety standards set by the agency. The standards stipulate that hospitals must protect patient privacy, for example, and uphold infection control.

The standards do address hospital food, but they don’t explicitly refer to the 2025-30 established by the USDA.

Rather, the standards require that “individual patient nutritional needs must be met in accordance with recognized dietary practices,” and list other requirements for hospitals, such as having access to a qualified dietitian.

“CMS has never before interpreted this requirement as mandating adherence to any set of dietary guidelines,” according to an from law firm .

The CMS memo shows the agency is taking the “notable step” to incorporate the dietary guidelines “into the hospital regulatory framework without new rulemaking,” according to the brief.

Hospitals are likely to comply because they are loath to cross the federal government and want to avoid a legal tussle or enforcement action by Kennedy, some lawyers say.

“He doesn’t have a legal basis to do this, but hospitals and nursing homes can’t afford to ignore it altogether because of what it signals about potential enforcement action,” said , a University of Michigan law professor.

If federal funding were withheld, hospitals could always sue to try and challenge HHS’ authority.

“When the agency goes to the hospital and says, We’re going to take away your money for this, the hospital can sue and say, Look, nothing requires us to fry our fries in beef tallow or whatever,” Bagley said.

For hospitals looking to comply, the agency’s memo provides examples of what should and shouldn’t be served to patients.

Food as Medicine

What the guidance calls “don’ts”: sugar-sweetened beverages or juice. And “do’s”: water, unsweetened tea, milk, or coffee. Meals suggested in the memo include grilled salmon with quinoa or bean-based entrees with leafy greens.

Some nutritionists welcomed the focus on hospital food for patients. Marion Nestle, a public health advocate and molecular biologist, lauded the initiative, saying, “These sound terrific!” in an on her blog, .

Other health leaders and doctors pushed back, noting hospitalized patients often have more individualized nutrition needs that may not conform to federal dietary recommendations.

For “a patient struggling to swallow from just having a stroke, salmon and quinoa is the worst thing for them. They’re going to risk aspirating on it,” said Klatt, the University of Toronto dietitian.

Hospitals that neglect to provide certain standards of care, such as protein shakes to treat malnutrition or an unhealthy weight loss, could open themselves up to possible legal liability. Eighty percent of malnourished elderly patients gained weight and improved muscle mass on nutritional supplements such as Ensure, according to the published in Nutrición Hospitalaria, a peer-reviewed scientific journal.

Abbott, which , makes a range of products including shakes for people who “could be malnourished due to medical treatments, such as chemotherapy, and not be getting the calories they need because they don’t have much of an appetite,” company spokesperson John Koval said in a statement.

“It’s always a struggle to get people to eat. Losing weight in the hospital raises the risk of mortality,” said Mary Talley Bowden, a , who has with Make America Healthy Again causes but on X, posting: “Give me a break Calley. A hospital snitch line for soda?”

“It’s a little tyrannical,” she said in an interview.

The focus on hospital food came in late March as part of Kennedy’s MAHA initiative, in which he has touted changes to federal dietary guidelines that emphasize protein and healthy fats while eschewing processed foods.

Kennedy has leaned heavily into his work on changing eating habits, which fits into the MAHA gestalt and polls well with both Democratic and Republican voters. Eighty-six percent of registered voters surveyed said it should be easier for every American family to access fresh fruits and vegetables, released in September by Navigator Research.

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

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She Survived 2 Shootings. Research Helps Explain Why Her Pain Persists Years Later.

Alma Beauvais, The Trace — Mon, 04 May 2026 09:00:00 +0000

In 2019, Mia Tretta, then a high school freshman at Saugus High School in Santa Clarita, California, was struck in the stomach by a round from a .45-caliber semiautomatic handgun fired by a schoolmate. Two students were killed during the attack, including her best friend, and two others were injured.

When she graduated from high school, she enrolled at Brown University, the scene of another shooting in December 2025, while she was studying for finals in her dorm room.

As messages flooded in about an active shooter on campus, she felt pain where she had been shot in the stomach. The college junior experienced a phenomenon she called “phantom bullet syndrome,” similar to phantom limb syndrome, in which someone senses something is there that is not. It occurs whenever she feels extremely stressed, she said.

“It’s crazy to say that the first time, I was the lucky one because though I got shot, I didn’t get killed,” said Tretta, now an anti-gun violence advocate who is studying public affairs and education. “And the second time, I was the lucky one because I was a few blocks away.”

Tretta represents a cohort of young people who have lived through more than one shooting. She also embodies the findings of a recent study that links gun violence exposure to chronic pain.

The study, in January, found that both direct and indirect exposure to gun violence are linked to higher rates of among American adults.

Rutgers University researchers studied six types of gun violence exposure: being shot, being threatened with a gun, hearing gunshots, witnessing a shooting, knowing a friend or family member who was shot, and knowing someone who died by firearm suicide. Using a nationally representative survey of 8,009 people, they found that 23.9% had pain most days or every day, while 18.8% said they had a lot of pain.

Daniel Semenza, the study’s lead author, told The Trace that whether someone has lost a person to gun violence or they’ve been shot themselves, their mental and physical health are inextricably linked.

“Your body, through the experience of post-traumatic stress, is going to feel as if it’s happening over and over and over again,” said Semenza, the director of research at the New Jersey Gun Violence Research Center and an associate professor at Rutgers University.

Tretta to remove the bullet, she said, and later received a nerve block to address ongoing pain from her injuries. But the bullet fragments remain in her body years later, she said.

She was also diagnosed with psoriatic arthritis — a chronic disease causing swelling, pain, and stiffness in the joints.

“I have dealt with chronic pain, immunodeficiencies, and bodily differences ever since the shooting happened,” Tretta said. “Every time I get a fever, it’s a completely different thing than anyone else I know, or even pre-shooting for me. I shake uncontrollably, and it hurts to even touch my arm.”

The is one of the first to focus on outcomes like chronic pain as part of an emerging body of work on the physical health toll of gun violence exposure.

“It highlights the fact that, for the thousands of people who are killed every year, there are lots of people who knew those folks,” Semenza said. “The toll of gun violence is much broader than we originally anticipated.”

Efrat Eichenbaum, an inpatient psychologist who has treated gun violence survivors and their families at a Level 1 trauma center in north Minneapolis, said the study accurately reflects what she has seen in her clinical work.

“You can plainly see the trauma that follows an event like that,” she said. “Not just for the survivors, but for their families. It does not even limit itself to family members. This is an issue that touches entire communities.”

David Patterson, an emeritus professor at the University of Washington whose work focuses on pain, says the study shows, in particular, just how far the impact of gun violence fans out and how costly a problem it is for society.

“Chronic pain is a major health problem in itself, and it because it’s very hard to manage,” he said. “You can’t cure it; it has to be managed.”

Back in her dorm room at Brown, Tretta explained that medical care does not end when someone leaves the hospital after a trauma like hers. It goes on for years.

“Your body will never be the same as it was before,” she said. “There’s no time that you can’t feel the 7 or 8 inches of scar tissue running through the middle of your stomach. It’s just a constant physical reminder, because you can’t leave your body.”

This article was reported by The Trace, a nonprofit newsroom covering gun violence in America. .

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Journalists Share Latest on Baby Formula Safety, Estrogen Patches, and Postcancer Costs

Sat, 02 May 2026 09:00:00 +0000

Céline Gounder, ��ýҕ�l Health News’ editor-at-large for public health, discussed the results of the FDA’s largest baby formula safety test on CBS News 24/7’s The Daily Report on April 29. She also discussed how women seeking treatment for menopause symptoms are facing a shortage of estrogen patches on CBS News’ CBS Mornings on April 27.

��ýҕ�l Health News senior correspondent Renuka Rayasam discussed the rising cost of postcancer care on WUGA’s The Georgia Health Report on April 24.

Read Rayasam’s “They’re in Remission, but Their Medical Bills Aren’t: Cancer Survivors Navigate Soaring Costs.”

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Prevention Efforts Increasingly See Suicide Through a Broader Lens

Aneri Pattani — Fri, 01 May 2026 18:30:00 +0000

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

Someone in America dies by suicide every 11 minutes. It’s that common. But that doesn’t make it normal.

Humans have evolved over centuries to survive. So when people try to kill themselves, something has gone wrong. Typically, the assumption is that something happened in the person’s mind — a mental illness.

That’s led prevention efforts to typically focus on connecting people with treatment in moments of crisis.

But that’s changing. There’s a growing movement asking a different question: What went wrong in the world around that person?

During the covid pandemic, rates of anxiety and depression spiked — not because everyone’s brain chemistry suddenly changed but because the world changed. People were out of work, isolated, struggling to make ends meet.

That led many people in the mental health advocacy world to call for a broader approach. Treatments and crisis care are vital, they say, but the goal of suicide prevention needs to expand beyond stopping people from dying to also giving them reasons to live.

Decades of research supports this idea. Interventions that improve people’s lives and prospects, such as running food banks to ensure families don’t go hungry or hosting weekly book clubs for homebound seniors to make friends, can reduce suicide.

I spoke with Chris Pawelski, a fourth-generation farmer in Orange County, New York, for this story. He told me how his dad’s passing, caring for his mom with dementia, and the struggling finances of his family’s onion farm brought him to consider suicide.

“It’s all stuff collapsing down upon you,” he said. “It’s weeks, months, years of dealing with all sorts of pressures that you can’t alleviate.”

What helped him through that time was not just family support and therapy. It was also an economic plan. He worked with an organization called NY FarmNet, which provided a free financial consultant who helped Pawelski transition from farming onions for wholesale to a new model, growing varied produce to sell directly to consumers.

Today, Pawelski’s business has stabilized, and he and his wife are paying down debt. He advocates for programs to help others in similar situations.

That can mean crisis hotlines and access to affordable therapy, Pawelski said. But what he really wants are policy changes that help people address underlying hardships before a crisis strikes.

“We need to think broader and longer-term than a helpline,” he said. That’s “a band-aid on a gunshot wound.”

ELEVEN MINUTES

Saving Lives by Changing Lives: The Next Frontier in Suicide Prevention

Someone in America dies by suicide every 11 minutes. It’s a tragic and entrenched problem. A new approach to prevention shifts the focus from stopping harm in moments of crisis to upstream policies that give people reasons to live.

By Aneri Pattani April 29, 2026

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Gavin Newsom, Early Champion of Single-Payer, Moderates in the Face of Fiscal Limits

Angela Hart — Fri, 01 May 2026 09:00:00 +0000

SACRAMENTO, Calif. — In his earliest days in the governor’s office, Democrat Gavin Newsom huddled with his advisers to consider how to realize a key campaign promise: transforming a healthcare system replete with insurance company intermediaries into the nation’s first state-run single-payer model providing comprehensive coverage to all residents, similar to those in Canada and Taiwan.

He’d need to secure tax increases to help cover the high cost of a single-payer system, once pegged at a year, and Republican President Donald Trump, then in his first term, would have to give California permission to use federal funding to convert the system of coverage from one determined by employment, age, or income.

Neither was politically feasible.

Instead, in the years that followed, Newsom muscled through a compassionate healthcare agenda that poured billions into new benefits, including Medi-Cal coverage for low-income immigrants without legal status and incarcerated people leaving jail or prison, as well as programs for people experiencing homelessness in and most populous state. Medi-Cal, the state’s Medicaid program, now includes housing services, including six months of free rent for those in need, and home-delivered healthy meals for low-income Californians with chronic health conditions. He made it a priority to expand mental health and addiction treatment, especially for the tens of thousands living on the streets.

He also tackled the soaring cost of healthcare, including by offering bigger subsidies for low- and middle-income earners to purchase insurance and empowering a new state agency to slow the rise in healthcare spending. Years before , the president’s program to lower prices for some medicines for people without insurance, Newsom signed into law a policy setting up a state-branded generic prescription drug label known as to provide lower-priced drugs. And amid a federal attack on reproductive rights, Newsom .

The liberal values that guided Newsom’s healthcare ambitions were forged early in his life and cultivated during his two terms as mayor of San Francisco. His approach in the governor’s office is described by allies as socially liberal and fiscally pragmatic. The policies he has supported offer a road map for the direction he would lead the nation, should he run for and be elected president in 2028. Now in his final term as governor, Newsom will be scrutinized for his healthcare record, criticized by liberals as too moderate and by Republicans as too radical.

Newsom, 58, is known for his all-out approach, a style that leads him to take on a barrage of flashy and complicated policy proposals at once, earning him a reputation in some political circles of overpromising and underdelivering. Newsom has notched some successes, but his record is also marked by failures. He hasn’t housed as many people as he envisioned — there are nearly in California, according to the most recent federal estimates, more than when he became governor. Medicaid spending has more than doubled under his watch, drawing criticism from Republicans, and patients around the state are experiencing problems getting timely medical appointments and quality care.

Newsom’s closest allies argue that he has balanced efforts to make healthcare more equitable, accessible, and affordable. They argue his unmet policy goals are not failures but investments and long-term strategies to better serve poor and marginalized people while containing healthcare costs.

“We would talk about how you win by losing,” said Mark Ghaly, who served as Newsom’s health and human services secretary until 2024. “The governor isn’t afraid to fail. But by failing you learn about how to make it successful.”

Although voters in the Democratic stronghold of California have supported many of his ideas, residents have grown increasingly weary in their support. An from the University of California-Berkeley Institute of Governmental Studies showed Newsom’s job approval slipping as he has focused on attacking Trump on the national stage.

have become a top concern for voters across the political spectrum. Two-thirds of the public in January said they worried about being able to afford healthcare for themselves and their families, according to a . And a recent found roughly a third of adults in America have made at least one trade-off to afford healthcare, such as driving less, skipping meals, cutting utility use, rationing prescriptions, or borrowing money.

Despite the criticisms, Newsom’s extensive record on healthcare can give him an edge in a presidential primary contest, said , a national Democratic strategist who specializes in healthcare polling. “Newsom has, by far, the most comprehensive and authentic agenda of any Democrat out there,” she said.

Universal Healthcare

Newsom has said that healthcare should be a , not a privilege. Though he backed away from single-payer, he remains steadfast in his support for a universal healthcare system that covers everybody, regardless of immigration status or ability to pay.

When he was mayor of San Francisco, in 2006, he signed into law , a universal health program that extended care to all uninsured adults who had been unable to access coverage. The program, paid for through a combination of public funds, employer contributions, and a sliding fee scale for patients based on income, became immensely popular, extending care to who had been uninsured.

Newsom also waded into the national healthcare debate leading up to the enactment of the Affordable Care Act, pushing for a government-run insurance plan to compete with commercial health insurers. “Healthcare reform without a public option is not reform,” .

In 2017, amid his two terms as lieutenant governor, Newsom had launched his run for governor and gained momentum by making healthcare a central pillar of his campaign. During the gubernatorial primary, he said healthcare “.” He set himself apart by tacking left and earned a critical endorsement from the California Nurses Association, pledging to fight for single-payer.

“It’s time for a new approach,” Newsom said during his campaign. “I’m tired of politicians saying they support single-payer but that it’s too soon, too expensive, or someone else’s problem.”

On his first day in office, he signed a series of directives to explore the feasibility of single-payer, in part by seeking federal healthcare waivers that would be needed to fund a new system. He didn’t deliver, but advisers argued he mimicked some components of single-payer, including cost containment, comprehensive benefits, and universal coverage.

“He looks much more broadly at the healthcare system, and what it can do to help people,” said Newsom Deputy Cabinet Secretary Richard Figueroa. “There is also a role for the government to play in cost containment. The governor has been trying to set up some fundamental changes to move toward a more accountable healthcare system.”

The nurses union, however, blasted Newsom for backtracking, arguing he kept the profit-driven insurance system intact and failed to deliver a critical healthcare promise.

Jasmine Ruddy, director of the National Nurses United and California Nurses Association’s community and Medicare for All campaigns, said Newsom pulled a bait and switch on Californians, purposely mixing up universal healthcare with single-payer. She pointed to commissioned by the Newsom administration that found single-payer could increase taxes but, in one scenario, would save an estimated $16 billion the first year in state healthcare costs.

“Covering everyone is important, but Newsom is supporting a system that still has insurance premiums, deductibles, and copays,” Ruddy said. “And you can still wind up with an enormous hospital bill and medical debt. That is not the same as guaranteeing healthcare for all.”

The pressure is already building for Newsom to get behind single-payer — and nationally. Ruddy said, “If he runs for president as a progressive, he has no choice but to support Medicare for all.”

A Behavioral Health Crisis

Newsom has taken an ambitious approach to homelessness, framing it as a public health crisis fueled by a lack of affordable housing and inadequate mental health and addiction care. Arguing that the state had ignored the problem for too long, he took ownership of the challenge by increasing temporary funding for cities and counties to move people off the streets and into housing. At the same time, he called for a statewide push to dislodge homeless encampments.

Although his policies rankled homeless advocates by sweeping people from their encampments without providing enough services or housing, Newsom considers it his highest calling. “The junction of mental illness, drug addiction, and homelessness was why I had even pursued a life in politics in the first place,” he wrote in his memoir, Young Man in a Hurry, published in February.

Since Newsom took office in 2019, California has doled out an unprecedented for homelessness and housing-related programs.

His interest in mental health and addiction, he said, stems from personal experience, and seeing that it touches so many Californians. “It’s not just about what’s happening on the streets and sidewalks; it’s what’s happening behind closed doors as well,” Newsom said in response to a question from ��ýҕ�l Health News in March. He referenced his grandfather, saying, “He ultimately took his life, committed suicide.”

In his memoir, Newsom alludes to those family issues. He also references his drinking as mayor of San Francisco, a time when his political celebrity was rising and he had an affair with the wife of his campaign manager. Although he , he said he stopped drinking until a family friend who operated a rehabilitation center gave him permission to drink again. For all his investments in the healthcare safety net, Newsom’s critics say his policies have weakened access to basic care and failed to solve homelessness.

“Despite all that spending, there are still so many people who can’t even get in to see a doctor, and who might be covered on paper but aren’t able to actually get the care they need,” said Rep. Kevin Kiley, a Republican-turned-independent who is running in a newly drawn House seat and served in the Democratic-controlled state legislature earlier in Newsom’s tenure as governor. “Billions of dollars have gone to immigrants, when our own citizens haven’t had access to healthcare.”

Assembly member David Tangipa, a Fresno Republican, said Newsom is bankrupting the state, referring to ballooning costs in Medi-Cal, which have grown from $100.7 billion in 2019 to $222.4 billion for the fiscal year starting July 1. “It’s baffling to see this governor attacking the president, when we have our own problems: Doctors are leaving this state, and we have hospitals on the verge of collapse,” he said.

Newsom’s healthcare record could be a political liability. “Single-payer is a perfect example of Gavin Newsom — that when things get tough, he cuts and runs,” said , a health policy fellow at the conservative-leaning Hoover Institution.

Now in his final full year in office, Newsom is confronting massive fiscal challenges.

Recent state financial deficits, worsened by the healthcare cuts in congressional Republicans’ One Big Beautiful Bill Act, have forced Newsom to on his expansion, particularly of Medi-Cal. This year, he froze new enrollments for adult immigrants living in the country without authorization.

Yet he is still framing his healthcare record as one of success. In an , Newsom proclaimed that he had achieved universal healthcare. “We delivered it,” he said.

But California does not have universal healthcare. Before passage of the One Big Beautiful Bill Act, estimates showed nearly 2.6 million , including people who chose to forgo coverage and immigrants without legal status who earned too much money to be eligible for Medi-Cal.

Projections in 2025 showed that remained uninsured, lower than the roughly 8% when Newsom took office. Yet the number of uninsured residents is as a result of Trump administration healthcare policies. Estimates show the GOP bill will cost the state an estimated over the next 10 years and result in up to 3.4 million Californians losing coverage.

Even so, Newsom has been reluctant to raise taxes. He opposes one to backfill federal healthcare funding losses through a on the state’s .

“That’s not what we need right now, at a time of so much uncertainty,” . “Quite the contrary.”

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Delays in Visa Program Threaten Placement of Hundreds of Doctors in Underserved Areas

Arielle Zionts — Fri, 01 May 2026 09:00:00 +0000

Hundreds of foreign doctors about to complete training in the U.S. will have to leave the country if the federal government doesn’t rapidly process their visa waiver applications, which have been languishing since the fall and winter, immigration attorneys say.

The waiver program, run by the Department of Health and Human Services, allows physicians who aren’t U.S. citizens to stay in the country while transitioning from the visa they used during their training to temporary worker status. In exchange, the doctors agree to work in underserved areas for at least three years.

“It will be the patients that suffer the most because in about three months, there’s going to be hundreds of places that are not going to have a physician that should have,” said a psychiatrist caught in the delay.

The doctor — whom ��ýҕ�l Health News agreed not to identify because they fear government reprisal — was among hundreds who applied this year for a J-1 visa waiver through the HHS Exchange Visitor Program.

If they receive one, the psychiatrist — who attended medical school in their home country in Europe before coming to the U.S. for their residency and fellowship — would work with vulnerable and disadvantaged patients in New York.

In recent years, the HHS program reviewed waiver applications in one to three weeks, according to two immigration attorneys.

But it currently has a backlog of hundreds of applications, which still need to be reviewed by the State Department and approved by U.S. Citizenship and Immigration Services, according to four attorneys interviewed by ��ýҕ�l Health News.

They said the foreign physicians will likely have to return to their home countries if their applications don’t advance to USCIS by July 30.

For them to reenter the U.S., their employers would have to pay a new $100,000 fee associated with the H-1B work visa. It’s a cost that many hospitals and clinics in rural and underserved areas say they can’t afford. “That’s the cliff that this train is headed for,” said Charles Wintersteen, a Chicago-based attorney who specializes in health workforce-related immigration.

HHS spokesperson Emily Hilliard didn’t answer questions about the number of pending applications or explain what caused the delays. But she said the Exchange Visitor Program has reviewed all fiscal year 2025 clinical J-1 waiver applications, as well as some from fiscal 2026.

The department is “implementing key process improvements to prevent future delays” and “working diligently” to evaluate remaining applications ahead of the July 30 deadline, she said.

The psychiatrist in limbo said employers hiring J-1 waiver physicians have to show they were unable to fill positions with American workers. If the doctors they planned to hire can’t arrive on time — or at all — patients will have to wait even longer for those vacancies to be filled, they said.

Wintersteen said postgraduate medical education positions are largely funded through Medicare and that “the taxpayers who pay for that training will not get the benefit of it.”

Physicians and immigration attorneys said HHS hasn’t explained the delays or let them know what to expect from their applications.

“Why would HHS want to take a program that is working — a program that places hundreds of U.S. trained international physicians in highly underserved parts of the country every year — and slow-walk it into non-existence,” Jennifer Minear, a Virginia-based health workforce immigration lawyer, said in an email. “How does that serve the public health? It is baffling.”

Waylaid Waivers

The U.S. healthcare system depends on foreign-born professionals to fill its ranks of doctors, nurses, technicians, and other health providers, particularly in chronically understaffed facilities in rural and low-income urban communities.

Nearly a quarter of physicians in the U.S. went to medical school outside the U.S. or Canada, according to .

Once noncitizens complete postgraduate education in the U.S., which typically ends on June 30, they must return to their home country and wait two years before applying for an H-1B work visa. Or, they can seek , which lets them remain in the U.S. on H-1B status in exchange for working for three years in a provider shortage area.

The attorneys said they’re seeing delays only in the Exchange Visitor Program, not in the other federal or state J-1 waiver programs.

The HHS clinical care program received 750 waiver applications last year, Minear and Wintersteen said, and is reserved for doctors working in pediatrics, psychiatry, family and internal medicine, or obstetrics and gynecology.

The program typically needs to forward recommendations to the State Department by mid-March, from John Whyte, CEO of the American Medical Association.

Minear said HHS stopped processing applications in late September or early October before it started forwarding them again a few months ago.

“But the pace is dramatically slower” than usual, she said.

Minear said the State Department usually takes two or three months to review HHS recommendations and must send them to USCIS before July 30 for most of the doctors to stay in the country.

If they don’t make that deadline, Wintersteen said, doctors will have to leave the country unless they obtain another kind of visa, get a J-1 waiver through another program, or extend their current visa by taking board exams or doing additional training.

The psychiatrist, who is supposed to start work on July 1, said they applied for a waiver in order to stay in the U.S with their partner, and because it would let them help the most vulnerable mental health patients. They said their future clients would likely include trafficking survivors, homeless people, and prison or jail inmates. “That’s the population I want to work with,” they said.

Waiver Delay Meets H-1B Dilemma

President Donald Trump issued a that railed against the tech industry’s use of H-1B work visas. The order created the $100,000 fee that applies to workers in all fields — not only tech — living outside the U.S. The payment doesn’t apply to those already in the country.

As of Feb. 15, employers had paid the fee for 85 workers, from USCIS. It’s unclear if any of those payments were for physicians or other medical providers.

The psychiatrist said officials at the hospital that plans to hire them said they can’t afford to pay to bring them back to the U.S. if they must go home.

“A lot of hospitals who hire J-1 waiver physicians are in underserved areas, and so they treat Medicare and Medicaid patients,” they said. “By definition, for the most part, they’re not rich hospitals.”

Barry Walker, an attorney in Tupelo, Mississippi, focused on health workforce-related immigration, said employers have already spent money on recruiters and attorneys like him to help with the waiver process.

Adding the H-1B fee is “just a deal killer, especially for the small, rural hospitals,” he said.

Attorneys said most employers will sponsor physicians in need of an H-1B visa only if they’re in lucrative specialties, such as cardiology or orthopedics, in which they can recover the cost of the fee.

They said healthcare facilities are much less likely to pay the fee to hire foreign nurses, lab technicians, and other healthcare professionals who are more likely than physicians to complete their training outside the U.S.

Employers , but attorneys said they haven’t heard of a hospital or clinic being granted one.

Fighting on Two Fronts

Physicians, hospital leaders, lawmakers, and immigration experts are trying to draw attention to the J-1 waiver delays at HHS while hoping to overturn or limit the new H-1B fee.

The Trump administration hasn’t acted on letters from , , and that requested an exception to the $100,000 fee for physicians or all healthcare workers.

In March, a bipartisan group of lawmakers that would create a healthcare exemption. It has not yet had a hearing.

At least three lawsuits — from the , a , and a that includes a company that recruits foreign nurses and a union that represents medical graduates — are seeking to end the fee entirely.

As for the J-1 waiver delays, the American Medical Association CEO asked the Exchange Visitor Program to use “emergency batch processing” for physicians with contracts to start work this summer.

Efrén Manjarrez, president of the Society of Hospital Medicine, which represents doctors who work in inpatient units, also called for emergency measures.

“Every day this backlog persists is a day that hospitalized patients in these communities face greater risk,” to the program.

Meanwhile, Canadian hospitals have been recruiting foreign physicians completing their training in the U.S, the psychiatrist said. They said one of their friends accepted an offer, withdrawing their HHS waiver application to head north.

The psychiatrist said if they must leave the U.S., they’ll be separated from their partner and out of a job for months as they work to get licensed in their home country.

Even if their employer were able to afford the H-1B fee, they’re not sure they’d want to return.

“This entire process has been so incredibly painful and just soul-crushing,” they said. “I would rather go to a country that would appreciate my motivation to work with patients.”

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When Natural Disasters Strike, Another Crisis Hits Those Recovering From Opioid Addiction

Andrew Jones — Thu, 30 Apr 2026 09:00:00 +0000

If you or someone you know is seeking help for addiction recovery, contact the free and confidential treatment referral hotline, 1-800-662-HELP, or visit findtreatment.gov.

A day after Hurricane Helene ripped through western North Carolina in late September 2024, Toni Brewer had no power or water. The storm had strewn fallen trees across most roads, wiped out phone and internet communications, and put some neighborhoods near her Asheville home underwater.

Brewer cleared out the food in her refrigerator, grabbed some clothes, and drove more than an hour southwest with her partner to Franklin, to stay with relatives.

When she arrived, she opened the center console of her car, where she kept medication, and discovered another crisis. She had only three days’ worth of Suboxone, a brand of buprenorphine, a prescription drug that eases opioid cravings. Without it, she risked relapsing into a life she described as miserable.

She recalled what it felt like to have those cravings and panicked.

“It’s terrifying just to have that feeling again of, ‘I need this, and I’ll do whatever it takes to get this,’” said Brewer, who had been in recovery from opioid addiction for 18 months at the time. She needed a new prescription but knew communication lines at her doctor’s office were down.

Now, a group of doctors is using the example of Hurricane Helene to urge federal lawmakers to help improve access to substance use medications in severe weather emergencies. Four physicians working in addiction medicine that outlines strategies for getting medication to people in recovery during natural disasters.

As climate change in the U.S., the group of doctors urged state and federal governments to act soon or risk allowing more disasters to aggravate overdoses, relapses, and deaths caused by opioid use disorder, an ongoing epidemic that has people in the U.S. since 1999.

that after Superstorm Sandy in 2012, 70% of New Yorkers who relied on recovery medications couldn’t get enough of them. In the two years following Hurricane Maria’s devastation in Puerto Rico in 2017, , another study found. The Tubbs and Camp fires in Northern California in patients’ access to opioid addiction medications, found a study published in 2022.

A combination of factors aggravates the opioid crisis in the U.S., the AJPH editorial authors noted. Mental health stressors, treatment disruptions, drug market volatility, and economic decline all create conditions in which climate-related disasters heighten the risk of overdose deaths.

“We make it so challenging for them to access treatment medications in the first place,” said , the climate health director at Rowan University’s Cooper Medical School and a co-author of the editorial. “When people are displaced or unable to get to their usual clinics or pharmacies, those challenges just become insurmountable.”

Their push comes as President Donald Trump has had a markedly different approach to substance use policy in the past year than in his first term. Trump in 2017 declared the nation’s opioid crisis a national public health emergency and, in 2018, signed a law, known as the , to expand access to treatments.

But his administration has also reduced federal resources for mental health and substance use services, cutting staffers last year at the Substance Abuse and Mental Health Services Administration and ending numerous grants to advance research on prevention efforts.

Disasters Threaten Treatment

SAMHSA works with states to ensure that access to opioid use disorder medication isn’t disrupted, Health and Human Services spokesperson Emily Hilliard said. States can approve emergency measures to allow people more flexibility to obtain their treatments, she added, .

, another co-author of the editorial, saw these access issues play out in the wake of Hurricane Helene.

Stearns, the chief medical officer at High Country Community Health in North Carolina’s Blue Ridge Mountains, said the first calls to her clinics were for buprenorphine. She said people who needed the medication traveled over mountains and crossed rivers to get to her clinics.

“The things that my patients did to be able to access their bupe,” Stearns said, “it was astonishing.”

The that the federal government work with pharmacies to allow patients to take home more medication during emergencies. They suggest keeping a registry of patients with recovery medication prescriptions who can get treatment when evacuating across state lines.

And they propose factoring the need for such medications into disaster response plans, whether that means stocking rescue vehicles with buprenorphine, adding backup generators to opioid treatment clinics, or training volunteer responders.

People with substance use disorders already must often navigate strict, complex regulations to get the medications. For example, methadone can be obtained only through an in-person visit to federally controlled opioid treatment centers, many of which closed for days or weeks after Hurricane Helene.

Buprenorphine is controlled by the Drug Enforcement Administration’s , which restricts supply when pharmacies order more than allowed under specified thresholds. The system is meant to catch potential overuse of recovery medication in a region.

Toni Brewer escaped the chaos of Hurricane Helene in 2024 only to encounter immediate barriers to getting her opioid-recovery medication. Doctors have warned that many more patients could face such obstacles as climate change intensifies and collides with regulatory issues surrounding these treatments. (Toni Brewer)

, a clinical director of substance use disorder initiatives at the Mountain Area Health Education Center in western North Carolina, said that system delayed medications numerous times in the aftermath of Helene. No exceptions were allowed, .

The agency did not respond to questions about the system.

Individual pharmacies also control who gets medication and who doesn’t. When people try to get medication for opioid use disorder far from home, it can raise alarms.

“We realized there were some pharmacies that would just be like, ‘I don’t know this person. I will only give you three days’ worth, and I’m sure they’ll be back in Asheville soon,’” Fagan said. “They didn’t want to fill a month’s worth. And in our mind, we’re sitting in the disaster, and we’re like, ‘They’re not coming back in a month.’”

Risk of Relapse

When Brewer made it to Franklin, she immediately logged in to the Mountain Area Health Education Center patient portal, dubious about whether she would be able to have her three-month Suboxone prescription refilled.

She didn’t know that her doctors had left the area, too, to get a stable internet connection. They were trying to call and email patients to fill prescriptions.

Trying to be thorough, Brewer messaged several doctors. Two responded, and one filled her prescription.

But when she went to a local Walgreens, it was out of Suboxone. So Brewer took another trip, this time to Clayton, Georgia, where she was finally able to pick up a month’s worth.

The medication that would have been mostly covered by North Carolina Medicaid if she’d stayed in-state was about $130, a high price for Brewer, who had temporarily lost her job when her workplace, a sober living facility, lost power and closed because of the storm.

Despite what little income she had at the time, Brewer said, she paid for her prescription. The thought of relapsing back to her previous life when her addiction was untreated scared her, she said.

“I would wake up every day, and the only thing on my mind was finding my next fix so I could go on about my day, or even just take care of things like feed myself, or bathe, and show up for my daughter,” she said.

Brewer recalled feeling relief after getting her prescription refilled. Her panic washed away.

“Now I can worry about everything else,” she recalled thinking as she drove home to Asheville.

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States Rush To Figure Out How To Enforce Trump’s Medicaid Work Requirements

Rachel Spears — Thu, 30 Apr 2026 09:00:00 +0000

State officials remain uncertain on how to enforce a requirement that many adult Medicaid enrollees show they’re working — even as one state launches its program this week — and they’re taking a variety of approaches to the job, including, in a handful of states, using artificial intelligence.

A from 42 states and the District of Columbia offers insights into key policy decisions state officials face as the Jan. 1, 2027, deadline for implementing the work requirement nears. Lingering questions include which diseases and illnesses will qualify Medicaid beneficiaries for exemptions and how to automate compliance verification.

Federal guidance is not expected to be released until June. But some states are moving forward with their own definitions of “medical frailty,” which under congressional Republicans’ One Big Beautiful Bill Act will allow Medicaid enrollees to escape the requirement.

The law, President Donald Trump’s signature domestic achievement, revamps Medicaid in more than 40 states that, along with Washington, D.C., fully or partially expanded the program for low-income people to cover adults without children who don’t get insurance through a job. While most adult Medicaid beneficiaries already work or are disabled, caregivers for other people, or in school, many Republicans contend that people enrolled in the program who don’t work sap resources that ought to support low-income children, pregnant women, and disabled people.

gained Medicaid coverage from the expansion, created by the Affordable Care Act — a law that most Republicans still oppose.

The new work rules require that a person be a student at least part-time or work or participate in other qualifying activities, such as community service, for at least 80 hours each month. The requirement could potentially reshape who is eligible for Medicaid and applies to people who are already enrolled.

The Congressional Budget Office will reduce federal Medicaid spending by about $326 billion over 10 years. The agency also estimates that 4.8 million more people will be uninsured in 2034 because of the work requirement.

“A lot of states are working on a super-condensed timeline,” said Amaya Diana, a policy analyst at KFF who worked on the survey. They are “still making these big decisions with less than a year before implementation.”

KFF is a health information nonprofit that includes ��ýҕ�l Health News.

The law permits short exemptions from work requirements for enrollees experiencing certain hardships — natural disasters, residing in a county with a high unemployment rate, admission to a hospital or nursing home, or having to travel for an extended period to obtain medical care.

While 28 states and Washington, D.C., will offer hardship exemptions, three of those states won’t adopt all four exemptions allowed by the law and two — Iowa and Indiana — don’t plan to adopt any.

People can also be exempted from the work requirements if they are “medically frail.” But the federal government has not told states how to define that term or how to determine whether an enrollee falls into the category.

The survey showed that 21 states, as of March, had not defined medical frailty. Nebraska, which is implementing its work requirement May 1, recently issued a list of thousands of health conditions that could qualify enrollees as “frail” and exempt them from working.

Some states plan to allow patients to self-attest to medical frailty, while others will require confirmation by a medical professional. The most common way of verifying medical frailty, which will be used in just over 30 states, is by examining Medicaid claims data.

Mehmet Oz, administrator for the federal Centers for Medicare & Medicaid Services, told ��ýҕ�l Health News in an interview this week that “we don’t like self-attesting” and that “documentation is critical.”

Many beneficiaries and their advocates have expressed concerns about losing coverage for administrative reasons. When Arkansas briefly implemented Medicaid work rules, for instance, most lost coverage not because they did not meet the requirements but for failing to correctly submit paperwork in time.

Six states plan to use AI to assist with the work requirement implementation in some way, such as for document processing or comparing beneficiary data from different sources, KFF found. Two states, Maryland and New Mexico, plan to use AI to analyze claims data.

Three states — Arkansas, Missouri, and Oklahoma — plan to use AI to interact directly with people on Medicaid and assist them with identifying and uploading verification documents and data.

Adults on Medicaid will have to reverify that they’re working, or that they’re exempt from the requirement, at least every six months. Some states plan to check quarterly.

When possible, states must use available data sources to verify exemptions or compliance with work requirements.

For example, data from the National Student Clearinghouse will be used by about 10 states to verify school attendance. Some states also plan to tap sources including the Department of Veterans Affairs, AmeriCorps, and service commissions.

But more than half of states told KFF’s researchers that they have insufficient time to add new data sources and cited ongoing costs as a challenge.

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Saving Lives by Changing Lives: The Next Frontier in Suicide Prevention

Aneri Pattani — Wed, 29 Apr 2026 09:00:00 +0000

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

Someone in America dies by suicide every 11 minutes. It’s that common. But not normal.

But in recent decades, there’s been a growing movement to ask a different question: What went wrong in the world around that person?

For Chris Pawelski, it was a torrent of factors. His dad — one of his best friends, whom he worked with daily for decades — was diagnosed with renal cancer and died six months later. Pawelski was left as the primary caregiver for his mom, who had dementia.

His family’s in New York’s Orange County — where he first worked as a 5-year-old, collecting onions that fell out of crates — was hemorrhaging money. Pawelski said he was growing roughly $200,000 worth of crops some years but took home only about $20,000, unable to negotiate higher prices with wholesale buyers that dominated the market.

Debt to suppliers and equipment vendors piled up, and the burden strained his marriage. He had little time for friends, working sunup to sundown seven days a week, desperately trying to preserve his family’s legacy.

“It’s all stuff collapsing down upon you,” he said. “It’s weeks, months, years of dealing with all sorts of pressures that you can’t alleviate.”

Pawelski started wondering what it would be like to get hit by a truck on the busy road in front of his house. “You think you’re already on your way out, so why wait?” he said.

(Jeffrey Basinger for ��ýҕ�l Health News)

After his father died, Pawelski became his mother’s primary caregiver. Meanwhile he was struggling to preserve his farm — his family’s legacy. “It’s all stuff collapsing down upon you,” he says. (Jeffrey Basinger for ��ýҕ�l Health News)

Millions of Americans have , and tens of thousands . Suicide repeatedly ranks among the — making the U.S. an .

Prevention efforts have typically focused on connecting individuals in crisis with treatment — despite therapy and medication being , the healthcare system , and a consensus that suicide is caused by a , including but not limited to mental illness.

Now, many people working to prevent suicide, including some who have tried to harm themselves or lost a loved one to it, are calling for a broader approach. Some were galvanized by the covid pandemic, when rates of — not because everyone’s brain chemistry suddenly changed but because the world changed. That led many to believe that, while treatments and crisis care are vital, the goal of suicide prevention needs to expand beyond stopping people from dying to also giving them reasons to live.

“It’s not rocket science,” said , a psychologist and internationally recognized suicide prevention researcher who lost her brother to suicide. If “you have happier, healthier people, they live longer, happier lives.”

That means suicide prevention shouldn’t be limited to answering hotlines or treating patients in psychiatric wards, she said. It should also involve running food banks to ensure families don’t go hungry or hosting weekly book clubs for homebound seniors to make friends. It can take the form of school programs that build resilience in children or housing policies that prevent evictions.

shows these — even if they don’t have the words “mental health” or “suicide” in the title — can reduce the number of people who kill themselves. They often lower rates of crime, addiction, and poverty, too.

The U.S. has lagged other countries in adopting this approach, Spencer-Thomas said, perhaps because it’s easier — and more politically palatable — to tell someone to go to therapy than it is to enact sweeping policy changes, such as an .

“As long as we have that convenient narrative that it’s just a bunch of broken people needing medicine and treatment, then we’re never accountable for fixing the broken things in our communities,” Spencer-Thomas said.

The Trump Administration’s Approach

Overhauling suicide prevention efforts to focus on broad social and economic policies might seem overwhelming and unrealistic — especially right now. This approach requires large upfront investments that lack across-the-board support, either because of budgeting realities or ideological bents.

President Donald Trump and his appointees have said little about suicide directly, but many of their policies do the opposite of what shows .

The administration has championed and the that are projected to leave and in coming years. It has injected uncertainty into the economy through , , and . It has for school-based mental health initiatives, gutted federal programs that focus on at-risk blue collar workers, and . (Suicides are the in America.)

“All of these changes are creating a firestorm,” said , the chief advocacy officer for the National Alliance on Mental Illness. They can cause “extreme stress and anxiety” in people’s lives, she added, and “when people feel desperate, that’s when crises can emerge.”

Sally Spencer-Thomas, a psychologist and researcher, says suicide prevention shouldn’t be limited to hotlines or psychiatric wards. She says it should also involve programs that help improve people’s lives and make them feel more connected to one another. (Sally Spencer-Thomas)

Federal health officials insist that suicide prevention remains a priority.

, director of the Centers for Disease Control and Prevention’s injury center, said the agency is focused on creating systems that can support people “no matter what may be happening” in the world around them. “There’s always going to be turmoil in people’s lives,” she added.

Arwady and , who leads suicide prevention work at the Substance Abuse and Mental Health Services Administration, said several of the Trump administration’s priorities align with an upstream approach.

For example, they said, its could help address the , since exercise is proven . Similarly, people who are homeless have , and the administration has been . Federal officials have also encouraged , and research shows members of faith communities are .

However, the Trump administration has made at and and has for , leading to questions about whether or how this work will continue.

A History of Medical and Crisis Care

Suicide prevention reached the national stage in the late 1990s, said , who worked at the CDC for 15 years before joining the , a nonprofit focused on teen and young-adult mental health.

As suicide rates grew among young people, a group of government officials, clinicians, and advocates gathered in Reno, Nevada, in 1998 to discuss the pressing issue. Over the next few years, the surgeon general and the federal government published its .

These documents acknowledged the role of society and economics in suicide risk but focused heavily on identifying people in crisis and increasing access to medical treatment.

Those are critical steps to suicide prevention, many mental health researchers and clinicians say. They’re also politically favorable. For elected officials, who have a few years to demonstrate their achievements before the next campaign, it’s easier to count the number of people receiving therapy than the number of people who never developed suicidal thoughts because long-term economic and social investments helped them maintain steady jobs and strong friendships.

The push for individual treatment also comes from a pervasive misconception that suicide is always the result of an underlying mental illness, said , who is the senior director of population health at Mental Health America and contributed to a .

Although how many people who die by suicide — with estimates from to — the takeaway is that mental illness is not the sole cause, Reinert said. That means treating it can’t be the sole response.

Plus, mental illnesses can be by life circumstances. Treating depressive symptoms without looking at factors such as childhood trauma, the loss of a loved one, or being laid off from a job is an incomplete approach, many mental health researchers and clinicians say.

The covid pandemic, especially, made people in the field recognize “we really need to address all of these conditions that are creating stress, anxiety, and crises,” Stone said.

In July 2022, the federal government — a shorter number for the national suicide crisis line, meant to provide an alternative to 911 for mental health emergencies.

, who led federal work on 988, said the infusion of money and attention on the hotline helped states build better crisis response systems, from centers that answer calls to mobile crisis units.

But that’s not enough to solve America’s suicide problem, she said. “You’ll never be able to build a system based on crisis alone.”

After big losses in 2020, Pawelski and his wife, Eve, decided they could no longer farm onions for wholesale buyers. They called NY FarmNet, which helped them develop a plan to change to small-scale farming and sell directly to consumers. (Jeffrey Basinger for ��ýҕ�l Health News)

Help for the Farm and the Farmer

Pawelski, the onion farmer in New York, hit his breaking point in 2020.

He had a decent crop that year, but Canadian exporters were into American markets, making it difficult for him to sell his product.

“I was having to beg people” to buy, he said. And when he managed to sell, prices were comparable to prices in the 1980s.

By the end of the season, he had incurred losses of a few hundred thousand dollars.

He said he and his wife decided, “We couldn’t afford to grow onions again.”

The idea that his family’s onion farm would end with him was “soul-crushing,” Pawelski said. He lost weight rapidly and thought about ending his life.

He and his wife called for help. Founded at Cornell University in 1986, the free program connects farmers with two consultants: a financial analyst specializing in farm planning and a social worker focused on emotional concerns and family dynamics.

Eve Pawelski encouraged her husband, Chris, to change the way their farm operates and go to therapy to improve his mental health. (Jeffrey Basinger for ��ýҕ�l Health News)

Together, they transitioned to small-scale farming, stabilized their business model, and are paying down debt. (Jeffrey Basinger for ��ýҕ�l Health News)

The financial specialist helped Pawelski develop a new business plan. Instead of farming onions for wholesale, he could grow greens, tomatoes, peppers, and eggplants at a small scale to sell directly to consumers. He could upgrade an old truck with a cooler and deliver produce to people’s doors. He would supplement that income with teaching, speaking engagements, and other work that took advantage of his master’s degree in communications.

The social worker helped him accept that new reality — equally crucial, Pawelski said. “If you’re pissed off” about the change, “no matter what kind of proposal or idea they have, it’s not going to go anywhere.”

The adjustment took months. Pawelski also saw a therapist during that time.

Then one day a neighbor noted that Pawelski seemed much happier. That “caught me off guard,” Pawelski recalled. He didn’t realize his inner transformation was so apparent.

Today, Pawelski’s business has stabilized, and he and his wife are paying down debt. Pawelski advocates for programs to help farmers’ mental health and address their .

That can mean crisis hotlines and access to affordable therapy, Pawelski said. But what he really wants are policy changes that help farmers get fair prices for their produce, debt relief, and the installation of broadband internet in rural areas so farm families and employees can be connected.

“We need to think broader and longer-term than a helpline,” he said. That’s “a band-aid on a gunshot wound.”

With his farm more financially stable, today Chris Pawelski advocates for programs to help farmers’ mental health and address their higher-than-average suicide rates. (Jeffrey Basinger for ��ýҕ�l Health News)

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Trump’s Medicaid Work Mandate Debuting in Nebraska to Much Dismay

Phil Galewitz — Wed, 29 Apr 2026 09:00:00 +0000

Schmeeka Simpson of Omaha works as a patient navigator for the American Civil Liberties Union and an administrative assistant at Nebraskans for Peace, plus picks up shifts at a Dunkin’ shop.

Still, even with three jobs, she worries about losing her health coverage when Nebraska, on May 1, becomes the first state to require certain Medicaid enrollees to work, train, or go to school under a rule mandated by congressional Republicans’ One Big Beautiful Bill Act.

Simpson, 46, has relied on Medicaid since her divorce in 2014. None of her employers offers health coverage. She said she lost her government food assistance after technical problems caused her to miss renewing in time, and she doesn’t trust the state to implement the new work rules without problems.

“Adding more barriers won’t make the program work any better,” she said.

Even though she works three jobs, Schmeeka Simpson worries about losing her health coverage when Nebraska becomes the first state to require certain Medicaid enrollees to work, train, or go to school under a new federal mandate. (Schmeeka Simpson)

Nebraska Medicaid officials say they are trying to make it as easy as possible for enrollees to comply, so people don’t lose their coverage for administrative reasons, such as failing to file the proper paperwork.

Enrollees with one of thousands of health conditions detailed by the state would be exempt.

“Our top priority is making sure members clearly understand changes to the program and how to maintain their coverage,” Drew Gonshorowski, the state’s Medicaid director, said in an early-April news release.

In a brief interview with ��ýҕ�l Health News on April 28 outside the National Press Club in Washington, D.C., Centers for Medicare & Medicaid Services Administrator Mehmet Oz said he applauds Nebraska for being the first state to begin implementing the work requirements. He acknowledged that the state is still “working out the kinks,” adding that his hope is “by the end of this year they will get into a more sophisticated place.”

But health policy analysts, advocates for the poor, and health industry groups remain skeptical, fearing thousands of Nebraska Medicaid enrollees will lose coverage and, with it, their access to health services and protection from medical debt.

Hospitals also worry an increase in uninsured patients will hurt their bottom lines, said Jeremy Nordquist, the president and CEO of the Nebraska Hospital Association.

“There is a lot of concern on many different levels,” he said. Many enrollees are unaware of the changes and might not realize they have to act to stay insured, he said.

The bill President Donald Trump signed last July requires the 42 states, along with the District of Columbia, that fully or partially expanded Medicaid under the 2010 Affordable Care Act to implement a work requirement starting in 2027. The full expansion enables adults with incomes of up to 138% of the federal poverty level — amounting to $22,025 for a single person this year — to be eligible for Medicaid, the government program covering people with low incomes or disabilities.

More than 20 million people gained coverage from Medicaid through expansion, according to KFF, a health information nonprofit that includes ��ýҕ�l Health News. The Congressional Budget Office estimates 4.8 million will become uninsured over the next decade as a result of the work requirement.

Under the law, enrollees must work or volunteer at least 80 hours a month, attend school at least part-time, or participate in job training. Or they must prove they qualify for certain exemptions, such as caring for a child 13 or younger or a disabled parent, or having a health condition that prevents employment.

Some states explored implementing work rules in the years before the GOP law passed. It gave states the option to launch their programs early.

Nebraska’s Plan

In Nebraska, which is implementing the provision eight months before the law requires, about 70,000 Medicaid enrollees will need to meet the requirement, said Collin Spilinek, a spokesperson for the Nebraska Department of Health and Human Services.

About 72% of them probably won’t have to do anything to keep their coverage, because the state already knows their work or exemption status via state or national databases, Spilinek said.

To check whether enrollees meet the requirement, Nebraska and other states plan to tap into various databases, including Medicaid claims information and data controlled by credit rating agencies. Enrollees for whom Nebraska doesn’t have data will be notified and can complete an online form to confirm they meet the new rules.

While a number of states say they plan to hire extra administrative staff, the Nebraska Medicaid agency is not adding any employees to implement its work requirement.

“The fact that they say they do not need additional resources raises questions” as to whether “they will be able to pull this off without future headaches,” Nordquist said.

Proving employment status will require documentation, but Nebraska officials say they will allow enrollees to self-attest that they volunteer, go to school, or qualify for exemptions, such as for poor health or caring for a disabled parent. “Supporting documentation, such as medical records, will not be required,” Spilinek said.

That could make it easier for enrollees to get exempted under the law’s “medical frailty” exception. The long list of health conditions that can be considered for the exemption was posted last week by the state and includes many types of cancers and mental health and heart conditions.

Kelsey Arends, senior staff attorney for Nebraska Appleseed, an advocacy group, said the state’s long list of medical billing codes for conditions that would be exempted is still not long enough. She said different levels of illness severity are not included.

The exemption is crucial for Crystal Schroer, 30, who has been on Medicaid since 2022 and unemployed since 2024. She said it has been difficult to find work near her home in Kearney, Nebraska, that will allow her to take along her psychiatric service dog, Tarot, who helps her with anxiety.

“I am insanely worried,” said Schroer, who lives with a friend. “It’s made my depression way worse.”

Whether self-attestation will broadly be allowed in other states will depend on CMS’ rules for work requirements, expected to be set this summer. Oz told ��ýҕ�l Health News that “we don’t like self-attesting” and that “documentation is critical.”

Several advocacy groups had asked the state to exempt enrollees with specific conditions, including the American Diabetes Association, HIV+Hepatitis Policy Institute, and National Bleeding Disorders Foundation. Losing coverage, the groups said, would mean losing access to medications that keep people healthy and out of the hospital.

Adding a work requirement to Medicaid has been a priority for Trump since his first term. In 2018, his administration became the first to allow states to adopt the policy, but only Arkansas implemented it. In the nine months the policy was in place before a federal judge deemed it unlawful, more than 18,000 people lost coverage — nearly 1 in 4 of those subject to the requirement.

Most lost coverage not because they did not meet the requirements but for failing to correctly submit paperwork in time.

Georgia has had a work requirement under its partial Medicaid expansion since 2023. Only about 8,000 people signed up for the coverage in its first two years — far fewer than the 25,000 that state officials predicted for the first year alone — and many have been denied benefits because of paperwork issues.

National Mandate

During the congressional debate over the law last year, Republicans pushed a work requirement for Medicaid as a way to get “able-bodied” adults benefiting from government assistance into the workforce. House Speaker Mike Johnson said it would help preserve Medicaid “for people who rightly deserve it,” not young men “sitting on their couches playing video games.”

Republicans have argued mandating employment will nudge people into finding work, leaving Medicaid to help children and people who are pregnant or have disabilities.

They were not swayed by studies showing already work or go to school or have health conditions preventing them from doing so.

A in the Annals of Internal Medicine found about one-third of adults at risk of losing coverage under the new work requirement reported that they have a physical or mental illness or disability.

“This is not a case that we have mostly healthy adults choosing not to work,” said Darshali Vyas, a study co-author and health policy researcher at Beth Israel Deaconess Medical Center in Boston. “It’s a vulnerable group, and I am not sure there are clear protections as we begin to roll out work requirements.”

In Nebraska, about two-thirds of Medicaid expansion enrollees , according to KFF. Nebraska’s unemployment rate is 3%, one of the lowest in the nation.

Andrea Skolkin, the CEO of Omaha-based One World Community Health Centers, said it’s an unsettling time for her clinic and their patients. “We are still concerned about the expanded Medicaid folks losing coverage,” she said.

About 4,000 of their 52,000 patients are covered under the Medicaid expansion, Skolkin said. She said many enrollees received letters from the state about the work requirement, but she worries many did not understand them.

Losing 10% of those patients would mean $500,000 less in revenue for the nonprofit centers, she said. To help patients, they plan to add staff to help people fill out the forms to get and maintain coverage.

Nebraska Appleseed’s Arends said she’s skeptical of the state’s promises to use automation to confirm that enrollees meet the work rules. “We remain very concerned about the early implementation,” she said.

People who lose coverage may have a harder time getting health bills covered if they reenroll in the Medicaid program, because the federal law also reduces retroactive eligibility from three months to one month for expansion enrollees.

Because many people sign up for Medicaid when seeking care for an emergency and it can take weeks or months to complete enrollment, hospitals are concerned the change will leave them to cover the costs when people lose coverage, Nordquist said.

Only two other states plan to implement the work requirement early: Montana, which plans to launch in July, and Iowa, which plans to go live in December.

Many states will be closely watching Nebraska’s implementation to see what lessons they can learn ahead of their own launches in January, said Andrea Maresca, a senior principal at Health Management Associates, a consulting firm.

States are better prepared to enact work requirements than they were when Arkansas tried in 2018, she said. After reconfirming millions of enrollees’ eligibility post-covid, they have more experience using public and private databases to automate the process and more practice communicating with enrollees, Maresca said.

Still, “it won’t be perfect,” and states will have to adapt as they go, she said.

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