When federal immigration agents descended on their city, officers deported Gabi’s father and detained her aunt.

Gabi was born in the U.S. and is an American citizen. Her best chance to stand, or even walk, someday is a complex surgery on her legs and feet that was scheduled for January. But her mother, too terrified to take out the garbage let alone venture through the city to a hospital, canceled the procedure. Ñî¹óåú´«Ã½Ò•îl Health News agreed to only partially identify the patients and their families in this article because they fear becoming targets of President Donald Trump’s immigration crackdown.

“I want more than anything for my baby to walk,” her mother said in Spanish, as Gabi cooed and wriggled in her arms, a feeding tube snaking from her stomach to an IV pole. “But with the situation that’s happening, I canceled the surgery and all the physical therapy appointments” that would have followed. “Because I’m afraid to leave.”

The Department of Homeland Security has declared an end to what it called Operation Metro Surge, carried out by officers with the Immigration and Customs Enforcement and Customs and Border Protection agencies. Even so, health care workers say, immigration agents are still camping out in hospital parking lots. And drones fly overhead in agricultural areas beyond Minneapolis, where Somali and Latino immigrants have settled in recent years.

The Minnesota crackdown revealed the sweep of the surveillance and capture system the Trump administration is using to uproot immigrant communities in the United States, and the effect of its powerful brake on the medical system.

Similar health crises surfaced wherever immigration officers massed in the past year. In Dallas, public health clinics administered about 6,000 vaccinations to Latinos last August, half as many as during a similar program a year earlier. In Chicago, doctors rerouted patients daily from clinic to clinic depending on ICE activity. Across the country, crackdowns suppressed immigrants’ health care visits.

In Minnesota, medical systems have reported cancellation and no-show rates of up to 60% since December.

Tricia McLaughlin, a spokesperson for the Department of Homeland Security, blamed protesters for the disruption. “If anyone is impeding Americans from making appointments or picking up prescriptions,” she said, “its [sic] violent agitators who are blocking roadways, ramming vehicles, and vandalizing property.”

While Minnesotans rose up to oppose the surge in the streets, doctors and nurses have quietly operated informal, underground medical networks, dodging detection to care for patients at home.

“I used to look somebody in the eyes and say, with good faith, ‘You will be fine at the hospital,’” said Emily Carroll, a nurse practitioner at HealthFinders Collaborative, a community clinic in Faribault, some 50 miles south of Minneapolis. “But now, I can’t make that guarantee.”

As thousands of federal agents move on from Minneapolis, other communities need to prepare, said Minnesota Democratic state Sen. Alice Mann, a physician.

“I know it sounds crazy,” she said, but health care providers “need to start an underground network of how to get people care in their homes. Because letting people die at home or come close to death because they are terrified to go into the hospital, in 2026, is outrageous.”

The Surge Delivers Harm

Home visits, clinicians say, may be the only way to reach those who still feel under siege. In Los Angeles, starting last June, St. John’s Community Health brought medical care to some 2,000 immigrant families too frightened to leave home during an immigration sweep after the clinic’s no-show rates ballooned to more than 30%, said Jim Mangia, the organization’s president.

Many of Minnesota’s large health institutions have relied on telemedicine and only dabbled in home care.

Not Munira Maalimisaq, co-founder of Inspire Change Clinic in Minneapolis’ Ventura Village neighborhood. After about one-third of her patients stopped showing up for appointments, “I was like, ‘We have to do something,’” the nurse practitioner said. So she called a physician friend. What if they just started seeing patients at home?

“And she’s like, ‘You know what? Let’s do it.’”

They now have about 150 doctors — a volunteer “rapid response” team that has made more than 135 home visits. The first call was a woman whose husband had been deported. She was home with her children, was 39 weeks pregnant, and was in labor. Maalimisaq called an obstetrician volunteer, and they rushed to the patient’s house.

“She was 8 centimeters dilated,” Maalimisaq said, “and did not want us to call an ambulance. She says, ‘Can I have the baby here?’”

The woman was not a good candidate for a home birth, Maalimisaq said. They persuaded her to ride to the hospital in Maalimisaq’s car, a “small Tesla, white seats. Everything that could go wrong was there.”

But they made it to the hospital in time, and the woman had a safe, healthy delivery. “If we were not there, I can only imagine what would have happened.”

Maalimisaq’s caregiving follows a Hippocratic logic: “Someone was in need. I cannot just do nothing. And we cannot call an ambulance against her will and have her shoved in there. We had no choice but to do something, and that was the only thing that we could do safely.”

In other visits, she has seen “people so stressed out they pulled the hair out of their skull.” She said she met a mother who’d been rationing her child’s seizure medicine despite the child having experienced “one seizure after another.”

The Trump administration says its Minnesota operation improved public safety. “Since Operation Metro Surge began, our brave DHS law enforcement have arrested over 4,000 criminal illegal aliens including vicious murderers, rapists, child pedophiles and incredibly dangerous individuals,” according to McLaughlin, the DHS spokesperson. DHS announced last month that McLaughlin was leaving her post.

Minnesota correctional officials say many people accused of crimes were released directly to ICE by state or county prisons and jails. And of people arrested by ICE nationwide in January had criminal convictions, according to DHS data. Far fewer were convicted of violent crimes.

Agents Outside Hospitals, Clinics

On the first day of his second term, President Donald Trump rescinded a 2011 policy that prohibited immigration enforcement in “sensitive locations” such as schools, hospitals, and churches.

In Northfield, about 45 miles south of Minneapolis, ICE agents have been sitting in their cars for hours at least twice a week outside health clinics, including one run by the local hospital, said Carroll, the nurse practitioner. Agents have made arrests in the area almost every day, Carroll and her colleagues said.

“ICE does not conduct enforcement at hospitals — period,” McLaughlin said.

One recent morning, three ICE vehicles sat in a Baptist church parking lot across the street from an elementary school in Northfield as volunteers ferried 35 children of immigrants back and forth to the school so their parents could avoid going out, Carroll said.

“ICE is not going to schools to arrest children — we are protecting children,” McLaughlin said.

Drones that Carroll and others believe are operated by immigration agents hover most nights, and sometimes during the day, over a trailer park that mostly houses immigrants who have moved to the area to work in agriculture and manufacturing over the past 15 years. Families paper over trailer windows, Carroll said.

“You cannot feel safe anywhere,” she said. “On the way to school, on the way to clinic, you might pass ICE. The sort of crushing fear and feeling of being trapped that these families are going through is outrageous.”

That fear means patients with diabetes and heart disease are missing blood sugar and blood thinner tests. Patients aren’t getting exercise, and the chronically ill are getting sicker, said Calla Brown, a Minneapolis pediatrician.

At the Faribault clinic where Carroll works, staff members deliver medicine, food, and other necessities to patients. A staffer drives 12 middle and high school kids to and from class every day in a clinic van.

Some patients are treated at home. Carroll recently diagnosed a baby with influenza, telling the parents it wasn’t an immediate threat — yet.

“‘If you see the baby struggling to breathe, if the baby’s not eating, if the baby isn’t making wet diapers, you have to go to the hospital,’” Carroll said she told them. “‘I cannot promise it’s safe. But you’ve got to go.’”

‘We’re Nice to Each Other’

In Minneapolis, nurse-midwife Fernanda Honebrink spends most of her daylight hours calling, coordinating, and shuttling between a ballooning group of fearful people stuck in their homes. She prefers not to call it a medical underground.

“It’s more like, that’s how we function in Minnesota,” said Honebrink, a U.S. citizen who emigrated from Ecuador 23 years ago. “We’re nice to each other.”

Honebrink spent a recent afternoon at the home of a family with a baby boy. His parents, Alex and Isa, desperately want him to receive vaccinations and blood tests at his one-year well-child appointment.

But they haven’t left their apartment for more than a month. “You don’t know what is most important: whether to go out for his well-being, or to go out and think that you might not come back,” Alex said.

The couple, who were interviewed in Spanish, entered the U.S. legally from Venezuela in 2024 under a program called Humanitarian Parole, which Trump ended in May. Since then, federal agents have detained and deported workers at a company where Alex, a mechanical engineer by training, worked in construction.

Alex and Isa have seen government vehicles outside their home. They knew of a man, they said, who had legitimate work papers but was picked up while walking to church one Sunday, flown to Texas, then put on a plane to Venezuela. It was a terrifying prospect for those who’ve fled that country’s dictatorship and economic chaos.

“It feels like a psychological attack,” Alex said. “The possibility of being separated from your family.”

Isa, a lawyer back in Venezuela, has endured postpartum depression, cooped up for weeks in their apartment. The state program that provided health insurance to all immigrants ended Jan. 1. A therapist checks in occasionally by phone, free of charge.

She has tried to keep the family afloat by selling homemade cakes and necklaces, and babysitting.

Her worst fear is being separated from her son, who was born in the U.S. and is a citizen. The possibility hadn’t occurred to her until an acquaintance urged her to to designate someone to have temporary custody if she were deported.

“It was something I never imagined,” said Isa, who sobbed as she recalled the moment. “He’s my baby! He’s not someone else’s! What? My baby would remain here with someone?’’

Honebrink suddenly piped up: “I will guarantee him. I’ll sign the form.”

She later told a reporter, “I told my husband I wouldn’t do that. I’ve already signed as a sponsor for four kids.”

As soon as she left the apartment, Honebrink jumped back on the phone and traded favors with local pediatricians, clinic schedulers, and volunteers. Within hours, she’d set up a new well-child visit for the baby and found a vetted driver to transport the family.

“A white person,” Honebrink explained.

Two days later, Honebrink sent a picture of her small victory: Alex and Isa’s baby boy with a Band-Aid on his legs. “He got his vaccines,” she said via text. “I’m so happy.”

But other medical needs cannot be as swiftly addressed. One February evening, Honebrink greeted Gabi and her mother with a trunk full of donated baby wipes, diapers, and toys.

Gabi’s surgery is rescheduled for August. Her mother said she hoped by then it would be safe to leave home.

“I used to take the kids to the park, but now we don’t leave at all,” she said. “They grab people, they mistreat them. How I wish it would end soon!”

Ñî¹óåú´«Ã½Ò•îl Health News’ Jackie Fortiér contributed to this report.

Ñî¹óåú´«Ã½Ò•îl 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 .

USE OUR CONTENT

This story can be republished for free (details).

LODGE GRASS, Mont. — Brothers Lonny and Teyon Fritzler walked amid the tall grass and cottonwood trees surrounding their boarded-up childhood home near the Little Bighorn River and daydreamed about ways to rebuild.

The rolling prairie outside the single-story clapboard home is where Lonny learned from their grandfather how to break horses. It’s where Teyon learned from their grandmother how to harvest buffalo berries. It’s also where they watched their father get addicted to meth.

Teyon, now 34, began using the drug at 15 with their dad. Lonny, 41, started after college, which he said was partly due to the stress of caring for their grandfather with dementia. Their own addictions to meth persisted for years, outlasting the lives of both their father and grandfather.

It took leaving their home in Lodge Grass, a town of about 500 people on the Crow Indian Reservation, to recover. Here, methamphetamine use is widespread.

The brothers stayed with an aunt in Oklahoma as they learned to live without meth. Their family property has sat empty for years — the horse corral’s beams are broken and its roof caved in, the garage tilts, and the house needs extensive repairs. Such crumbling structures are common in this Native American community, hammered by the effects of meth addiction. Lonny said some homes in disrepair would cost too much to fix. It’s typical for multiple generations to crowd under one roof, sometimes for cultural reasons but also due to the area’s housing shortage.

“We have broken-down houses, a burnt one over here, a lot of houses that are not livable,” Lonny said as he described the few neighboring homes.

In Lodge Grass, an estimated 60% of the residents age 14 and older struggle with drug or alcohol addictions, according to a local survey contracted by the Mountain Shadow Association, a local, Native-led nonprofit. For many in the community, the buildings in disrepair are symbols of that struggle. But signs of renewal are emerging. In recent years, the town has torn down more than two dozen abandoned buildings. Now, for the first time in decades, new businesses are going up and have become new symbols — those of the town’s effort to recover from the effects of meth.

One of those new buildings, a day care center, arrived in October 2024. A parade of people followed the small, wooden building through town as it was delivered on the back of a truck. It replaced a formerly abandoned home that had tested positive for traces of meth.

“People were crying,” said Megkian Doyle, who heads the Mountain Shadow Association, which opened the center. “It was the first time that you could see new and tangible things that pulled into town.”

The nonprofit is also behind the town’s latest construction project: a place where families together can heal from addiction. The plan is to build an entire campus in town that provides mental health resources, housing for kids whose parents need treatment elsewhere, and housing for families working to live without drugs and alcohol.

Though the project is years away from completion, locals often stop by to watch the progress.

“There is a ground-level swell of hope that’s starting to come up around your ankles,” Doyle said.

Two of the builders on that project are Lonny and Teyon Fritzler. They see the work as a chance to help rebuild their community within the Apsáalooke Nation, also known as the Crow Tribe.

“When I got into construction work, I actually thought God was punishing me,” Lonny said. “But now, coming back, building these walls, I’m like, ‘Wow. This is ours now.’”

Meth ‘Never Left’

Meth use is a throughout the U.S. and a growing contributor to the nation’s . The drug had been devastating in Indian Country, that encompasses tribal jurisdictions and certain areas with Native American populations.

Native Americans face the in the U.S. compared with any other demographic group.

“Meth has never left our communities,” said A.C. Locklear, CEO of the , a nonprofit that works to improve health in Indian Country.

Many reservations are in rural areas, which have of meth use compared with cities. As a group, Native Americans face high rates of poverty, chronic disease, and mental illness — all are . These conditions are rooted in , a byproduct of colonization. Meanwhile, the Indian Health Service, which provides health care to Native Americans, has been chronically underfunded. Cutbacks under the Trump administration have shrunk health programs nationwide.

LeeAnn Bruised Head, a recently retired public health adviser with the U.S. Public Health Service Commissioned Corps, said that despite the challenges, tribal nations have developed strong survival skills drawing from their traditions. For example, Crow people have held onto their nation’s language; neighbors are often family, or considered such; and many tribal members rely on their clans to mentor children, who eventually become mentors themselves for the next generation.

“The strength here, the support here,” said Bruised Head, who is part of the Crow Tribe. “You can’t get that anywhere else.”

Signs of Rebuilding

On a fall day, Quincy Dabney greeted people arriving for lunch at the Lodge Grass drop-in center. The center recently opened in a former church as a place where people can come for help to stay sober or for a free meal. Dabney volunteers at the center. He’s also the town’s mayor.

Dabney helped organize community cleanup days starting in 2017, during which people picked up trash in yards and alongside roads. The focus eventually shifted to tearing down empty, condemned houses, which Dabney said had become spots to sell, distribute, and use meth, often during the day as children played nearby.

“There was nothing stopping it here,” Dabney said.

The problem hasn’t disappeared, though. In 2024, officials broke up a multistate based on the Crow reservation that distributed drugs to other Montana reservations. It was one example of how drug traffickers as sales and distribution hubs.

A few blocks from where Dabney spoke stood the remains of a stone building where someone had spray-painted “Stop Meth” on its roofless walls. Still, there are signs of change, he said.

Dabney pointed across the street to a field where a trailer had sat empty for years before the town removed it. The town was halfway through tearing down another home in disrepair on the next block. Another house on the same street was being cleaned up for an incoming renter: a new mental health worker at the drop-in center.

Just down the road, work was underway on the new campus for addiction recovery, called Kaala’s Village. Kaala means “grandmother” in Crow.

The site’s first building going up is a therapeutic foster home. Plans include housing to gradually reunite families, a community garden, and a place to hold ceremonies. Doyle said the goal is that, eventually, residents can help build their own small homes, working with experienced builders trained to provide mental health support.

She said one of the most important aspects of this work “is that we finish it.”

Tribal citizens and organizations have said the political chaos of Trump’s first year back in office shows the problem with relying on federal programs. It underscores the need for more grassroots efforts, like what’s unfolding in Lodge Grass. But a reliable system to fund those efforts still doesn’t exist. Last year’s federal grant and program cuts also fueled competition for philanthropic dollars.

Kaala’s Village is expected to cost $5 million. The association is building in phases as money comes in. Doyle said the group hopes to open the foster home by spring, and family housing the following year.

The site is a few minutes’ drive from Lonny and Teyon’s childhood home. In addition to building the new facility’s walls, they’re getting training to offer mental health support. Eventually, they hope to work alongside people who come home to Kaala’s Village.

As for their own home, they hope to restore it — one room at a time.

“Just piece by piece,” Lonny said. “We’ve got to do something. We’ve got these young ones watching.”

Ñî¹óåú´«Ã½Ò•îl 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 .

USE OUR CONTENT

This story can be republished for free (details).

That includes about 8,400 cases involving allegations of discrimination against students with disabilities, who have struggled to recover academically from the pandemic.Ìý

Under , public schools must provide children with disabilities a “free appropriate public education,” to give them the same opportunity to learn as other kids.Ìý

But pleas for federal intervention are in limbo as President Donald Trump’s administration moves to dismantle the Education Department.Ìý

The agency helps oversee schools and colleges and has the authority to protect students from discrimination based on race, sex, religion, or disability. Its Office for Civil Rights investigates accusations against schools and negotiates corrective actions.Ìý

On March 11, the it was reducing its workforce by nearly half. Authorities closed seven of the 12 regional civil rights offices, leaving behind too few staffers to investigate thousands of cases, according to attorneys and advocates for disabled people.Ìý

“We had problems already, and now we are going to have more problems,” said Hannah Russell, a former special education teacher who works with parents in North Carolina trying to obtain educational services for their children with disabilities. The civil rights office is “the only thing that upholds accountability.”Ìý

In March, Trump signed an to eliminate the Education Department, which he said had failed children and become a bloated bureaucracy.Ìý

He instructed officials to “return authority over education to the States and local communities while ensuring the effective and uninterrupted delivery of services, programs, and benefits on which Americans rely.”Ìý

A group of states and the District of Columbia has sued to halt the cuts, but the Supreme Court ruled in July that the Trump administration could forge ahead while the case moves through the courts. But parents like Emma Miller of North Carolina fear there will be no authority left to intervene on their behalf.Ìý

Miller filed a complaint with the federal Office for Civil Rights against the public school system in Wake County, alleging her two kids were denied their civil rights. She said her son is in 10th grade but cannot read or write. His twin sister was bullied by classmates and became suicidal, Miller said.Ìý

Wake County school officials declined an interview to answer questions about Miller’s complaints, citing privacy laws. In a written statement, spokesperson Matthew Dees said the district worked to reach an agreement with Miller on multiple issues and remedied complaints that were substantiated.Ìý

Federal officials refused to investigate, according to a letter she received in March. Spokespeople for the Education Department and the White House declined to comment.Ìý

“No one is taking responsibility,” Miller said. “It has been a nightmare.”Ìý

Ñî¹óåú´«Ã½Ò•îl 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 .

USE OUR CONTENT

This story can be republished for free (details).

How Jette can independently support such aspirations as an adult is something Sather and her son have been discussing for years, alongside a team of educators from his public high school in Anaconda, Montana. Jette experienced significant speech and motor delays early in life, Sather said, and he has attention-deficit/hyperactivity disorder. He’s among of public school students nationwide who depend on special education services through the federal Individuals with Disabilities Education Act — services that include programs to chart the transition from school to adulthood.

“Once Tucker learns how to do a job or learns a process, he’s very successful at doing that. It’s the initial learning phase for him and the expectations that are difficult,” said Sather, a former school-based physical therapist who spent 16 years working with students supported under IDEA. “Without that initial support, he probably would not be successful.”

In August, a federal judge in Montana between the state’s education agency and disability rights advocates that will enable eligible Montana students to continue receiving special education services through age 22. Despite existing legal precedent and recent attempts at a legislative fix, Montana remained one of the last states where local school districts could disenroll students with special needs after age 18. Now students are guaranteed an additional four years of public school eligibility and, by extension, access to school-based services that have helped recent graduates like Jette move toward independence.

, executive director of the federally funded Montana Empowerment Center, said it’s critical to do as much as possible for students with special needs before they leave the public school system.

“Early childhood, there are a lot of resources,” Gibson said. “But once transition hits, they fall off a cliff for services. Anything we can do to make that path a little bit easier, we’re going to have better outcomes for more successful adults.”

Demand for employment assistance services for people with disabilities has grown threefold since 2020, according to the Montana Department of Public Health and Human Services. Approximately 4,000 people in the state are enrolled in the federally backed , which helps students with disabilities transition from school to the workforce and provides job coaching and training for people of any age with disabilities. An additional 3,000 public school students are , Pre-Employment Transition Services, that serves as an on-ramp to vocational rehabilitation.

In July, a month before the court ruling that ensured services for young adults up to 22, the department began placing vocational rehabilitation applicants on a waitlist, while prioritizing services for those with the most severe disabilities. As of early September, nearly 260 people were on the list.

Now, parents, school administrators, and disability rights advocates worry the booming demand for services is on a crash course with grant and workforce cuts by the U.S. Education Department, which provides funding to states for such transition services. And they are attempting to rally the public to protect those programs.

In March, President Donald Trump directing Education Secretary Linda McMahon to “facilitate the closure” of her department. Since then, the Education Department has laid off roughly half of its staff, for K-12 schools through much of the summer, and canceled grants designed to aid schools in hiring mental health workers.

, CEO of the Council of Parent Attorneys and Advocates, a national civil and legal defense organization for children with disabilities, said those cuts have introduced chaos and uncertainty into special education programming. But, she said, the current landscape does not diminish the legal rights of students with disabilities and their families.

“The laws remain strong, they remain in place, and we are urging everyone to contact their senators, their congressmen and women, their local officials, whoever, to hold that strong so we do not see — nor will we accept — a retreat from those rights,” Marshall said.

Montana’s state education agency, the Office of Public Instruction, has seen “minimal impacts, if any,” from federal spending and workforce cuts on transition supports for students with special needs, according to spokesperson McKenna Gregg. Agency officials announced in May that federal IDEA allocations for Montana this year were on par with 2024, when the state received roughly $46 million in IDEA funding.

Chad Berg, special education director for one of the state’s larger public school districts, in Bozeman, said federal IDEA funding levels appear to be stable for now, but he said the gradual dismantling of the Education Department presents longer-term questions.

“It raises concerns that the expertise that’s been involved at the federal level that provides support to states in implementing this may no longer be there,” Berg said. “We’ve not seen anything directly at this point. It’s more about the uncertainty of what could come.”

When the Montana Legislature met earlier this year, advocates for individuals with disabilities rallied inside the Capitol in Helena, urging lawmakers to help safeguard the basic services many citizens rely on for their independence.

is director of advocacy at Disability Rights Montana, the nonprofit that sued the state seeking the continuation of special education services until age 22. He said federal budget talks have included proposals to cut funding for independent living centers and university-based assistance programs, threatening to erode a system critical to the lives of 7.5 million American children.

“What IDEA did is create the one place in the life of a person with a disability where all of these services are mandated to come together under one roof,” Goldin said. “That doesn’t happen anywhere in the adult system.”

Sather is thankful that, for the time being, her son’s access to transition services hasn’t been interrupted. Even so, she said, the uncertainty around federal support for students with disabilities is “exceptionally scary.” She’s not alone in her concern.

In the small central Montana town of Simms, Laurie Frank has struggled to find adequate services for her seven adopted children, including her 19-year-old daughter, Angel, who has Down syndrome and autism. Angel is caring, social, and “loves to help people,” Frank said, and her high school provides her with some specialized support.

But Frank is also aware of how limited those services often are — a reality she’s lived not just as a parent but as a former special education teacher and family support specialist. Any potential for further destabilization, Frank added, “scares the heck out of me.”

“I just really hope and pray that people on the state and federal level will really stop and think about what’s in the best interest of these kids and how we can help them be successful,” Frank said. “Sometimes I feel like some of them fall through the cracks, and people don’t think about the fact that they have needs and wants and they want to have success, too.”

Ñî¹óåú´«Ã½Ò•îl 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 .

USE OUR CONTENT

This story can be republished for free (details).

Céline Gounder, Ñî¹óåú´«Ã½Ò•îl Health News’ editor-at-large for public health,ÌýdiscussedÌýrecommendations for covid-19 vaccinations for children on NPR’s “Morning Edition” on Aug. 20. Gounder then discussed the infant mortality crisis in Mississippi on CBS News’ “CBS Evening News Plus” on Aug. 22. She also discussed the resignation of top Centers for Disease Control and Prevention officials after the ousting of agency director Susan Monarez on CBS News’ “CBS Mornings” on Aug. 28.

• Read Gounder’s “Senior CDC Officials Resign After Monarez’s Ouster, Citing Concerns Over Scientific Independence.”

Ñî¹óåú´«Ã½Ò•îl Health News national public health correspondent Amy Maxmen discussed how Trump administration officials interfered in the CDC’s ability to respond to the West Texas measles outbreak on CBS News’ “CBS News Chicago” on Aug. 25 and on WNYC’s “The Brian Lehrer Show” on Sept. 2.

• Read Maxmen’s “As Measles Exploded, Officials in Texas Looked to CDC Scientists. Under Trump, No One Answered.”

Ñî¹óåú´«Ã½Ò•îl Health News Nevada correspondent Jazmin Orozco Rodriguez discussed how Medicaid changes may affect Native American communities on KPFA’s “UpFront” on Aug. 27.

• Read Orozco Rodriguez’s “Native Americans Want To Avoid Past Medicaid Enrollment Snafus as Work Requirements Loom.”

Ñî¹óåú´«Ã½Ò•îl Health News chief Washington correspondent Julie Rovner discussed Health and Human Services Secretary Robert F. Kennedy Jr.’s latest appearance in front of a Senate committee on WBUR’s “Here & Now” on Sept. 4.

Ñî¹óåú´«Ã½Ò•îl 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 .

USE OUR CONTENT

This story can be republished for free (details).

For more than two decades, the community health worker has supported hundreds of families throughout southeast Los Angeles by helping them sign up for food assistance, sharing information about affordable health coverage, and managing medications for their chronic illnesses. She’s guided by the expression “an ounce of prevention is worth a pound of cure.”

But she makes only around $20 an hour from a community health organization and must hold down a second job to make ends meet. “They pay us very little and expect too much,” she said in Spanish. “We build trust. We offer support. We’re the shoulder people rely on, but we don’t get fair wages.”

California looked to professionalize thousands of community health workers such as Hernández to improve the health of immigrant populations, particularly Hispanic residents, who often experience of chronic diseases, are more , and face more cultural and linguistic barriers when trying to access services. Studies show their work hospitalizations as well as emergency room and urgent care visits.

The state hewed closely to a series of put out in 2019 to standardize training and certification, integrate these workers into the health care workforce, and provide fair wages, including reimbursements through Medi-Cal, the state’s Medicaid health insurance program, to compensate for work that traditionally has been done on a volunteer basis or for low pay. But six years in, California has backed out of many of those initiatives.

The state has eliminated a certification program and rolled back nearly all funding to train and expand this workforce even though it set a goal of by this year. Although Medi-Cal began covering their services, participating health plans set uneven billing requirements, making it difficult for workers to get reimbursed. And the state didn’t follow through on a planned pay raise.

With federal funding cuts just passed and President Donald Trump targeting immigrants for deportation — even with the Department of Homeland Security — advocates fear California is abandoning its health equity initiative for immigrants, people of color, and people with low incomes when they say that effort is needed most.

“We’re in a very dire situation right now,” said Cary Sanders, senior policy director for the California Pan-Ethnic Health Network, a statewide health equity advocacy group.

A spokesperson for Gov. Gavin Newsom, Elana Ross, said “the state has taken difficult but necessary steps to ensure fiscal stability” and that the administration continues to have a dialogue with community health workers. Ross added that the Democratic governor, a , remains committed to defending immigrants being targeted by the Trump administration.

‘Our Office Is on the Street’

There are more than 60,000 community health workers nationwide, including roughly 9,200 in California, and this workforce is projected to grow 13% over the next decade, three times as fast as for all occupations, according to from the U.S Bureau of Labor Statistics. But experts say these numbers are an undercount given the various titles community health workers hold and that many work outside of health care and governmental institutions.

Community health worker is an umbrella term that includes peer supporters and community health representatives. These workers, often known as promotores, who work in clinics, hospitals, public health departments, and local nonprofits, places where they are trusted and have a grasp of their community’s most pressing health needs.

Besides helping people manage chronic illnesses such as heart disease and diabetes, they promote reproductive health, children’s health, and oral hygiene, and they help prevent injuries and review medications. They can make people feel safe when reporting domestic violence and other abuses. They also connect people to housing and food assistance. “The community health worker is not sitting at a desk,” Hernández said. “Our office is on the street.”

Back in 2019, the California Future Health Workforce Commission recommended integrating community health workers into the health care system, and in 2022, the state authorized over three years for the California Department of Health Care Access and Information, which oversees health care workforce development, to recruit, train, and certify them.

The agency sought to standardize training and certification, but some community groups feared that would create barriers to entry by not giving enough credit for lived experiences and cultural competency. But just as the agency offered more flexibility and allowed community-based training, the state slashed $250 million in funding last year due to budget constraints. This year, the certification program was officially eliminated.

Spokesperson Andrew DiLuccia said the agency is now considering a program to accredit community organizations rather than individual workers and plans to spend its remaining $12 million on technical assistance, workforce development, and salaries for those working with immigrant communities.

According to the National Academy for State Health Policy, offer a voluntary or mandatory community health worker certification program.

Some community health advocates say California’s missing an opportunity to carve a career path for this workforce. Currently, some courses offered by nonprofits, counties, and colleges , a degree, English fluency, or prior experience. Most are concentrated in the San Francisco or Los Angeles area, leaving in much of the state.

Lourdes Bernis, a dentist from Ecuador, is a model for how community health workers could be integrated into the health care system. She began as a volunteer promotora more than a decade ago and in 2019 received free training from Los Angeles County, allowing her to move into a full-time job with benefits for the county’s Department of Mental Health to help Spanish-speaking women manage depression and anxiety as they recover from drug use.

Bernis now plans to become a peer-to-peer support specialist inside hospitals and clinics. Meanwhile, many of her colleagues with decades of experience remain stuck in low-paying roles and can’t afford training to advance. “There are promotoras who have 20 to 25 years of experience, but they are still volunteering,” Bernis said in Spanish.

Medi-Cal’s Role

To pay community health workers, Medi-Cal began covering their services in July 2022, but California for them after voters approved Proposition 35, which hiked the pay of physicians, hospitals, community clinics, and other providers instead. Since then, the state has yet to establish a uniform system for how health plans should contract with organizations that employ community health workers.

“We have to jump through hoops,” said Maria Lemus, executive director at Visión y Compromiso, a Los Angeles-based nonprofit representing community health workers. “It just causes havoc, because each plan could have different requirements.”

Lemus said it took the organization nearly six months to establish payment with one health plan.

And though Medi-Cal reimbursements are tied to individual tasks, ranging from $9.46 to $27.54 for 30 minutes of work, advocates say they aren’t fully compensated for the time they spend building trust and following up with patients. Advocates say these workers should earn at least $30 a visit, with benefits, but many earn about , often without benefits.

Advocates say they’re surprised by how infrequently these services are used in a program with 15 million Californians. More than 16,000 Medi-Cal enrollees used these services in the first year, rising to 68,000 last year, according to state data. “I don’t think it’s reached the potential that the governor talked about, and that we all imagined that it could possibly achieve,” Sanders said.

Griselda Melgoza, a spokesperson for the California Department of Health Care Services, said the agency, which administers Medi-Cal, has seen “a steady, upward trend” and believes the data underestimates utilization because the benefit is sometimes bundled with other services.

to assess whether Medi-Cal managed care plans are doing enough outreach and education to enrollees about community health services died this year.

More Crucial Than Ever

With health funding cuts from the Trump administration and passage of the GOP’s tax and spending legislation, advocates fear there will be even less funding and support for community health worker positions, shrinking a workforce tackling health disparities. Already, Fresno County’s Department of Public Health said it has cut its community health workers by more than half, from 49 positions to 20.

Yet, outreach is more crucial than ever. As the Trump administration continues immigration raids, which appear to have targeted in the state, advocates and policy researchers say community health workers could act as intermediaries for immigrant patients afraid to seek medical care in hospitals and clinics.

Without a state certification program, no raises, and dwindling training funds, the path to professionalizing community health workers is unclear, leaving workers feeling left behind.

“The community trusts me,” said Hernández, the veteran community health worker, “but at the government level, there’s still a long way to go before this work is valued and fairly compensated.”

This article was produced by Ñî¹óåú´«Ã½Ò•îl Health News, which publishes , an editorially independent service of the .Ìý

Ñî¹óåú´«Ã½Ò•îl 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 .

USE OUR CONTENT

This story can be republished for free (details).

Durante más de dos décadas, esta trabajadora de salud comunitaria ha ayudado a cientos de familias del sureste de Los Ángeles a inscribirse en programas de ayuda alimentaria, ha informado sobre seguros médicos asequibles y ha ayudado con medicamentos para sus afecciones crónicas. Su frase favorita: “más vale prevenir que curar”.

Pero sólo gana unos $20 la hora en una organización de salud comunitaria y tiene un segundo trabajo para poder llegar a fin de mes. “Nos pagan muy poco y esperan demasiado”, dijo. “Generamos confianza. Ofrecemos apoyo. Somos el hombro en el que muchos se apoyan, pero no recibimos un salario justo”.

California buscaba profesionalizar a miles de trabajadores de salud comunitarios como Hernández. La meta era mejorar la salud de las poblaciones inmigrantes, en particular los residentes hispanos, que a menudo padecen de enfermedades crónicas, son más y se enfrentan a más barreras culturales y lingüísticas para acceder a servicios.

Estudios demuestran que su trabajo las hospitalizaciones, y las visitas a las salas de emergencias y a las clínicas de urgencias.

El estado siguió al pie de la letra una serie de publicadas en 2019 para estandarizar la formación y la certificación de estos profesionales. Así, poder integrarlos a las plantillas de trabajadores de salud y ofrecerles salarios justos, incluyendo reembolsos a través de Medi-Cal, el Medicaid estatal, para compensar el trabajo que tradicionalmente se ha realizado de forma voluntaria o con salarios bajos.

Pero seis años después, California ha dado marcha atrás en muchas de esas iniciativas.

El estado ha eliminado un programa de certificación y ha recortado casi toda la financiación para formar y ampliar esta plantilla, a pesar de que se había fijado el objetivo de contar con para este año.

Aunque Medi-Cal comenzó a cubrir sus servicios, los planes de salud participantes establecieron requisitos de facturación desiguales, lo que dificulta que los trabajadores obtengan el reembolso. Además, el estado no cumplió con el aumento salarial previsto.

Con los recortes de fondos federales recién aprobados y el foco del presidente Donald Trump en la deportación de inmigrantes, incluso con el Departamento de Seguridad Nacional, los activistas temen que California abandone su iniciativa de equidad en la salud para los inmigrantes, las personas de color y las personas con bajos ingresos. En un momento en el que, aseguran, esa labor es más necesaria que nunca.

“Estamos en una situación muy grave en este momento”, afirmó Cary Sanders, directora en la California Pan-Ethnic Health Network, una organización estatal que aboga por la equidad en la salud.

Elana Ross, vocera del gobernador Gavin Newsom, dijo que “el estado ha tomado medidas difíciles pero necesarias para garantizar la estabilidad fiscal” y que la administración sigue dialogando con los trabajadores de salud comunitarios.

Ross agregó que el gobernador demócrata, , sigue comprometido con la defensa de los inmigrantes perseguidos por la administración Trump.

“Nuestra oficina está en la calle”

Hay más de 60.000 trabajadores de salud comunitarios en todo el país, incluidos unos 9.200 en California, y se prevé que esta fuerza laboral crezca un 13% en la próxima década, tres veces más rápido que el conjunto de todas las profesiones, según de la Oficina de Estadísticas Laborales de Estados Unidos.

Sin embargo, expertos afirman que estas cifras están subvaloradas, dada la variedad de títulos que poseen estos trabajadores y el hecho de que muchos no trabajan en el cuidado de salud propiamente dicho ni en instituciones gubernamentales.

“Trabajador de salud comunitario” es un término genérico que incluye a distintos tipos de trabajadores. A menudo conocidos como promotores, que trabajan en clínicas, hospitales, departamentos de salud pública y organizaciones sin fines de lucro locales, en lugares en los que se les tiene confianza y donde conocen las necesidades más urgentes de su comunidad.

Además de ayudar a las personas a controlar afecciones crónicas como las cardiopatías y la diabetes, promueven la salud reproductiva, la salud infantil y la higiene bucal, y ayudan a a prevenir lesiones y manejar sus medicamentos.

Pueden hacer que las personas se sientan seguras al denunciar la violencia doméstica y otros abusos. También las conectan con servicios de asistencia para la vivienda y la alimentación. “El trabajador de salud comunitario no se sienta en un escritorio”, dijo Hernández. “Nuestra oficina está en la calle”.

En 2019, la California Future Health Workforce Commission recomendó integrar a estos trabajadores en el sistema de salud, y en 2022, el estado autorizó durante tres años para el Departamento de Acceso e Información de Salud de California, que supervisa el desarrollo del personal de este sector, con el fin de reclutar, formar y certificar a estos trabajadores.

La agencia trató de estandarizar la formación y la certificación, pero algunos grupos comunitarios temían que eso creara barreras de acceso al no dar suficiente crédito a la experiencia y a la competencia cultural.

Pero el año pasado, justo cuando la agencia ofrecía más flexibilidad y permitía la formación basada en el trabajo comunitario, el estado recortó $250 millones en financiación debido a restricciones presupuestarias. Este año, el programa de certificación ha sido oficialmente eliminado.

El vocero Andrew DiLuccia señaló que la agencia establecerá un programa para acreditar a las organizaciones comunitarias en lugar de a los trabajadores individuales y que tiene previsto gastar los $12 millones restantes en asistencia técnica, desarrollo de la fuerza laboral y salarios para quienes trabajan con las comunidades inmigrantes.

Según la National Academy for State Health Policy, ofrecen algún tipo de programa de certificación para trabajadores de salud comunitarios ya sea voluntario o bien obligatorio.

Algunos activistas afirman que California está perdiendo la oportunidad de establecer una trayectoria profesional para esta mano de obra. Muchos de los cursos que ofrecen hoy en día por organizaciones sin fines de lucro, condados y universidades , un título, dominio del inglés o experiencia previa. La mayoría se concentran en el área de San Francisco o Los Ángeles, lo que crea en gran parte del estado.

Lourdes Bernis, una dentista de Ecuador, es un ejemplo de cómo los trabajadores de salud comunitarios podrían integrarse en el sistema de salud. Comenzó como promotora voluntaria hace más de una década y en 2019 recibió formación gratuita del condado de Los Ángeles, lo que le permitió conseguir un trabajo a tiempo completo, con beneficios, en el Departamento de Salud Mental del condado para ayudar a mujeres hispanohablantes a gestionar la depresión y la ansiedad mientras se recuperan del consumo de drogas.

Bernis ahora quiere convertirse en especialista de apoyo entre pares en hospitales y clínicas. Mientras tanto, muchos de sus colegas con décadas de experiencia siguen atrapados en puestos mal pagados y no pueden permitirse costear cursos de formación para avanzar. “Hay promotoras que tienen entre 20 y 25 años de experiencia, pero siguen trabajando como voluntarias”, dijo Bernis.

El papel de Medi-Cal

Para pagar a los trabajadores de salud comunitarios, Medi-Cal comenzó a cubrir sus servicios en julio de 2022, pero California previsto para ellos después que los votantes aprobaran la Proposición 35, que aumentaba los pagos a médicos, hospitales, clínicas comunitarias y otros proveedores.

Desde entonces, el estado aún no ha establecido un sistema uniforme sobre cómo los planes de salud deben contratar a las organizaciones que emplean a trabajadores de salud comunitarios.

“Tenemos que hacer malabares”, dijo María Lemus, directora ejecutiva de Visión y Compromiso, una organización sin fines de lucro con sede en Los Ángeles que representa a estos trabajadores. “Esto sólo causa caos, porque cada plan puede tener requisitos diferentes”.

Lemus agregó que la organización tardó casi seis meses en establecer el pago con un plan de salud.

Y aunque los reembolsos de Medi-Cal están vinculados a tareas individuales, que oscilan entre $9.46 y $27.54 por 30 minutos de trabajo, los activistas afirman que no se les compensa totalmente por el tiempo que dedican a ganarse la confianza de los pacientes y a hacer seguimiento.

Según los activistas, estos trabajadores deberían ganar al menos $30 por visita, con beneficios, pero muchos ganan unos $21 la hora, a menudo sin beneficios.

Lo que sorprende a los activistas es la poca frecuencia con la que se utilizan estos servicios en un programa que cuenta con 15 millones de californianos. Más de 16,000 afiliados a Medi-Cal utilizaron estos servicios durante el primer año, cifra que aumentó a 68,000 el año pasado, según datos del estado. “No creo que se haya alcanzado el potencial del que hablaba el gobernador y que todos imaginábamos que se podría alcanzar”, señaló Sanders.

Griselda Melgoza, vocera del Departamento de Servicios de Salud de California, dijo que la agencia, que administra Medi-Cal, ha observado “una tendencia constante al alza” y cree que los datos subestiman la utilización porque este beneficio a veces se incluye en otros servicios.

Este año se rechazó una para evaluar si los planes de atención médica gestionada de Medi-Cal realizan la divulgación y educación suficiente entre los afiliados sobre los servicios de salud comunitarios.

Más crucial que nunca

Con los recortes a la financiación de la salud por parte de la administración Trump y la aprobación de la legislación fiscal y de gasto del Partido Republicano, los activistas temen que haya aún menos fondos y apoyo para estos puestos, lo que reduciría las plantillas que se ocupan de las desigualdades en materia de salud.

El Departamento de Salud Pública del condado de Fresno ya ha anunciado el recorte de más de la mitad de sus trabajadores comunitarios: pasarán de 49 puestos a 20.

Sin embargo, la divulgación es más crucial que nunca. Mientras la administración Trump continúa con las redadas de inmigración, que parecen haber tenido como objetivo en el estado, los activistas y los investigadores advierten que los trabajadores de salud comunitarios podrían actuar como intermediarios para los pacientes inmigrantes que temen buscar atención médica en hospitales y clínicas.

Sin un programa de certificación estatal, sin aumentos salariales y con fondos de capacitación cada vez más escasos, el camino hacia la profesionalización es incierto, lo que hace que esta fuerza laboral se sienta abandonada.

“La comunidad confía en mí”, afirmó Hernández, una veterana trabajadora de salud comunitaria, “pero a nivel gubernamental aún queda mucho camino por recorrer antes de que este trabajo sea valorado y pagado como se merece”.

Esta historia fue producida porÌý, que publicaÌý, un servicio editorialmente independiente de laÌý.

Ñî¹óåú´«Ã½Ò•îl 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 .

USE OUR CONTENT

This story can be republished for free (details).

In a to NIH Director Jay Bhattacharya, NIH workers said they felt “compelled to speak up when our leadership prioritizes political momentum over human safety and faithful stewardship of public resources.”

“For staff across the National Institutes of Health (NIH), we dissent to Administration policies that undermine the NIH mission, waste public resources, and harm the health of Americans and people across the globe,” they said.

The letter is an extraordinary rebuke of the Trump administration’s actions against the NIH, which include: terminating hundreds of grants funding scientific and biomedical research; firing more than 1,000 employees this year; and moving to end billions in funds to partner institutions overseas, a move current and former NIH workers say will harm research on rare cancers and infectious diseases, as well as research that aims to minimize tobacco use and related chronic illnesses, among other areas.

Some NIH workers signed their names publicly, openly daring to challenge a president who has sought to purgeÌýthe government of employees he views as disloyal to him. Others signed anonymously.

“It’s about the harm that these policies are having on research participants and American public health, and global public health,” said Jenna Norton, who works at the National Institute of Diabetes and Digestive and Kidney Diseases, one of NIH’s 27 institutes. “There are research participants who generously decide to donate their time and literal pieces of their body, with the understanding that that service is going to help advance research for diseases that they are living with and help the next person who comes along with that disease.”

“These policies are preventing us from delivering on the promise we made to them and honoring the commitment that they made, and putting them at risk,” she said.

The workers wrote that they hope Bhattacharya welcomes their criticisms given his and to respect dissenting views as leader of the NIH, which is based in Bethesda, Maryland. Its authors called it the “Bethesda Declaration” — a play on the controversial “Great Barrington Declaration” that Bhattacharya co-authored during the covid-19 pandemic.

Bhattacharya’s declaration advocated against lockdown measures and proposed that widespread immunity against covid could be achieved by allowing healthy people to get infected with the virus and instituting protective measures only for medically vulnerable people. It was criticized at the time by Francis Collins, then-director of the NIH, who called Bhattacharya and his co-authors “fringe epidemiologists,” the American Institute for Economic Research obtained through a Freedom of Information Act request.

In their letter, NIH workers demanded that Bhattacharya restore grants that were “delayed or terminated for political reasons.” Those grants funded a range of projects, including those addressing Alzheimer’s disease, ways to boost vaccination rates, and efforts to combat health disparities or health misinformation.

“Academic freedom should not be applied selectively based on political ideology. To achieve political aims, NIH has targeted multiple universities with indiscriminate grant terminations, payment freezes for ongoing research, and blanket holds on awards regardless of the quality, progress, or impact of the science,” the NIH workers wrote.

The funding terminations, they said, “throw away years of hard work and millions of dollars,” “risk participant health,” and “damage hard-earned public trust, counter to your stated goal to improve trust in NIH.”

In an emailed comment, Bhattacharya said, “The Bethesda Declaration has some fundamental misconceptions about the policy directions the NIH has taken in recent months, including the continuing support of the NIH for international collaboration. Nevertheless, respectful dissent in science is productive. We all want the NIH to succeed.”

The NIH’s nearly $48 billion budget makes it the world’s largest public funder of scientific research. Its work has led to countless scientific discoveries that have helped improve health and save lives around the globe. But it hasn’t been without controversies, including instances of and grant awards and the related research.

Researchers and some states have sued NIH and HHS over the grant cuts. An April 3 deposition by NIH official Michelle Bulls said Rachel Riley, a senior adviser at HHS who is part of the Department of Government Efficiency created by executive order, provided NIH officials lists of grants to terminate and language for termination notices. Elon Musk, the world’s richest person, led DOGE through May.

Norton has worked at the NIH as a federal employee or contractor for about a decade. She said the current administration’s policies are “definitely unethical and very likely illegal,” listing a string of developments Ìýin recent months. They include terminating studies early and putting participating patients at risk because they have had to abruptly stop taking medications, and holding up research that would predominantly or exclusively recruit participants from minority races and ethnicities, who have historically been underrepresented in medical research.

“They’re saying that doing studies exclusively on Black Americans to try to develop interventions that work for that population, or interventions that are culturally tailored to Hispanic-Latino populations — that that kind of research can’t go forward is extremely problematic,” Norton said. “And, as a matter of fact, studies that over-recruit from white people have been allowed to go forward.”

The NIH workers also demanded that Bhattacharya reinstate workers who were dismissed under recent mass firings and allow research that is done in partnership with institutions in foreign countries “to continue without disruption.” The NIH works with organizations around the globe to combat major public health issues, including types of cancer, tobacco-related illnesses, and HIV.

In addition to the firing of probationary workers, NIH fired 1,200 civil servants as part of a rapid “reduction in force” at federal health agencies. During a May 19 town hall meeting with NIH staff, a recording of which was obtained by Ñî¹óåú´«Ã½Ò•îl Health News, Bhattacharya said the decisions about RIFs “happened before I got here. I actually don’t have any transparency into how those decisions were made.”

He started at NIH on April 1, the day many workers at NIH and other agencies were told they were fired. Other workers have been fired since Bhattacharya took the helm — nearly all the National Cancer Institute’s communications staff were fired in early May, three former employees told Ñî¹óåú´«Ã½Ò•îl Health News.

The letter is the latest salvo in a growing movement by scientists and others against the Trump administration’s actions. In addition to in-person protests outside HHS headquarters and elsewhere, some former employees are organizing patients to get involved.

Peter Garrett, who led the National Cancer Institute’s communications work, has created an advocacy nonprofit called Patient Action for Cancer Research. The aim is to engage patients “in the conversation and federal funding and science policymaking,” he said in an interview.

His group aims to get patients and their relatives to speak out about how federal cancer research affects them directly, he said — a “guerrilla lobbying” effort to put the issue squarely before members of Congress. Garrett said he retired early from the cancer institute because of concerns about political interference.

Career officials routinely work under both Republican and Democratic presidents. It is par for the course for their priorities and assignments to evolve when a new president, Cabinet secretaries, and other political appointees take over. Usually, those changes occur without much protest.

This time, workers said the upheaval and harm done to the NIH is so extensive that they felt they had no choice but to protest.

In 11 years at NIH, Norton said, “I’ve never seen anything that comes anywhere near this.”

In the June 9 letter, the workers said, “Many have raised these concerns to NIH leadership, yet we remain pressured to implement harmful measures.”

“It’s not about our jobs,” said one NIH worker who signed the letter anonymously. “It is about humanity. It is about the future.”

Senior correspondent Arthur Allen contributed to this report.

We’d like to speak with current and former personnel from the Department of Health and Human Services or its component agencies who believe the public should understand the impact of what’s happening within the federal health bureaucracy. Please message Ñî¹óåú´«Ã½Ò•îl Health News on Signal at (415) 519-8778 or .

Ñî¹óåú´«Ã½Ò•îl 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 .

USE OUR CONTENT

This story can be republished for free (details).

“I’m comfortable here, but I’m having health issues,” said the 68-year-old, who retired from her job as a school cook several years ago after having a stroke. “Things are failing me.”

Her trailer sits halfway up a ridge miles from town and the local health clinic. Her phone and internet are “wacky sometimes,” she said. Adkins — who is fiercely independent and calls herself a “Mountain Momma” — worries she won’t be able to call for help if service goes out, which happens often.

To Frontier Communications, the telecommunications company that owns the line to her home, Adkins says: “Please come and hook me right.”

But she might be waiting years for better service, frustrated by her internet provider and left behind by troubled federal grant programs.

A quarter of West Virginia counties — including Lincoln, where the Mud River bends its way through hollows and past cattle farms — face two barriers to health care: They lack high-speed internet and have a shortage of primary care providers and behavioral health specialists, according to a Ñî¹óåú´«Ã½Ò•îl Health News analysis.

Years of Republican and Democratic administrations have tried to fix the nation’s broadband woes, through flawed attempts. Bad mapping, weak standards, and flimsy oversight have left Adkins and nearly 3 million other rural Americans in dead zones — with eroded health care services and where telehealth doesn’t reach.

Blair Levin, a former executive director of the Federal Communications Commission’s National Broadband Plan, called one rural program rollout during the first Trump administration “a disaster.”

It was launched before it was ready, he said, using unreliable federal maps and a reverse-auction process to select internet carriers. Locations went to the lowest bidder, but the agency failed to ensure winners had the knowledge and resources to build networks, said Levin, who is now an equity analyst with New Street Research.

The fund initially announced awards of $9.2 billion to build infrastructure in 49 states. By 2025, $3.3 billion of those awards were in default and, as a result, the program won’t connect 1.9 million homes and businesses, .

A $42 billion Biden-era initiative still may not help Adkins and many others shortchanged by earlier federal broadband grants. The new wave of funding, the Broadband Equity, Access, and Deployment Program, or BEAD, has an anti-waste provision and won’t provide service in places where previous grants were awarded — even if companies haven’t delivered on their commitments.

The use of federal money to get people connected is “really essential” for rural areas, said Ross DeVol, CEO and chairman of the board of Heartland Forward, a nonpartisan think tank based in Bentonville, Arkansas, that specializes in state and local economic development.

“Internet service providers look at the economics of trying to go into some of these communities and there just isn’t enough purchasing power in their minds,” DeVol said, adding that broadband expansion is analogous to rural electrification. Without high-speed internet, “you’re simply at a distinct disadvantage,” he added. “I’ll call it economic discrimination.”

‘I Got Books Full’

Adkins keeps spiral-bound notebooks and calendars filled with handwritten records of phone and internet outages.

In January, while bean soup warmed on the stove, she opened a notebook: “I got books full. Hang on.”

Her finger traced the page as she recounted outages that occurred about once a month last year. Adkins said she lost connectivity twice in November, again in October, and in July, May, and March. Each time she went for days without service.

Adkins pays Frontier Communications $102.13 a month for a “bundle” that includes a connection for her house phone and wireless internet access on her cellphone. Frontier did not respond to requests for comment on Adkins’ and other customers’ service.

Adkins, a widow, spends most of her time at home and said she would do video calls with her doctors if she could. She said she still has numbness on one side of her body after the stroke. She also has high blood pressure and arthritis and uses over-the-counter pain patches when needed, such as after she carries 30-pound dog food bags into the house.

She does not own a four-wheel-drive truck and, for three weeks in January, the snow and ice were so severe she couldn’t leave. “I’m stranded up here,” she said, adding that neighbors check in: “‘Do you have electric? Have you got water? Are you OK?’”

The neighbors have all seen Adkins’ line. The pale-yellow cord was tied off with green plastic ties around a pole outside her trailer. As it ran down the hill, it was knotted around tree trunks and branches, frayed in places, and, finally, collapsed on the ground under gravel, snow, and ice at the bottom of the hill.

Adkins said a deer stepping on the line has interrupted her phone service.

David and Billi Belcher’s double-wide modular home sits near the top of the ridge past Adkins’ home. Inside, an old hunting dog sleeps on the floor. Belcher pointed out a window toward where he said Frontier’s cable has remained unrepaired for years: “It’s laying on the ground in the woods,” he said.

Frontier is West Virginia’s legacy carrier, controlling most of the state’s old landlines since in 2010. Twelve years later, the company won nearly $248 million to install high-speed internet to West Virginia through the Rural Digital Opportunity Fund, an initiative launched during President Donald Trump’s first term.

“Big Daddy,” as local transit driver Bruce Perry called Trump, is popular with the people of Lincoln County. About 80% of the county’s voters picked the Republican in the last election.

The Trump administration awarded Frontier money to build high-speed internet to Upper Mud River Road residents, like Adkins, . Frontier has until , to build.

But the Belchers needed better internet access for work and could afford to pay $700 for a Starlink satellite internet kit and insurance, they said. Their monthly Starlink bill is $120 — a price many cannot manage, especially since Congress sunset an earlier program that helped offset the cost of high-speed plans for consumers.

Meanwhile, the latest broadband program to connect rural Americans is ensnared in Trump administration policy shifts.

The National Telecommunications and Information Administration, which administers the program, in April for states to finalize their plans during a “comprehensive review” of the program.

West Viriginia Gov. Patrick Morrisey, a Republican, would take an extension. The move, though, doesn’t make a lot of sense, said Evan Feinman, who left the agency in March after directing the broadband program for the past three years.

Calling the work already done in West Virginia an “incredible triumph,” Feinman said the state had completed the planning, mapping, and the initial selection of companies. The plan that was in place would have brought high-speed fiber lines to homes ahead of schedule and under budget, he said.

“They could be building today, and it’s just deeply disappointing that they’re not,” Feinman said.

When Feinman resigned in March, he stating that the new administration wants to take fiber away from homes and businesses and substitute it with satellite connections. The move, he said, would be more expensive for consumers and hurt rural and small-town America.

Morrisey, whose office declined to respond to requests for comment, said in his announcement that he wants to ensure West Virginia spends the money in a manner “consistent with program changes being proposed by the Trump Administration” and “evaluate a broader range of technology options.”

Commissioners from Grant County supporting fiber-optic cables rather than satellite-based connections like those provided by Elon Musk’s Starlink. Nationwide, 115 lawmakers from 28 states to federal leaders stating that changes could “delay broadband deployment by a year or more.”

For Adkins and others, the wait has been long enough.

While legislators in Washington and across the country bickered over the broadband program, Adkins went without phone and internet. By late March, she said, her 42-year-old son was increasingly worried, noting “you’re getting up in age.” He told her: “Mom, move out, get off of that hill.”

Worst-Case Scenario

A few miles from Upper Mud River Road, past the McDonald’s and across the road from the local library, Brian Vance sat in his downtown Hamlin, West Virginia, office. He said his company has been trying to “build up there for a while.”

Vance is a general manager for Armstrong Telephone and Cable, a regional telecommunications provider that competes with Frontier. He grew up in the community, and parents of a high school friend live off Upper Mud River. But he said “it’s very difficult” to build fiber along the rocky terrain to homes where “you are hoping that people will hook up, and if they don’t, well, you’ve lost a lot of money.”

A found that stringing fiber-optic lines along telephone poles would cost more than $5,000 per connection in some areas — work that would need big federal subsidies to be feasible.

Yet Vance said Armstrong cannot apply for the latest BEAD funding to help finance connections. And while he likes that the federal government is “being responsible” by not handing out two federal grants for the same area, Vance said, “we want to see people deliver on the grants they have.”

If Frontier hadn’t already gotten federal funds from the earlier Trump program, “we definitely would have applied to that area,” Vance said.

The 2022 assessment noted the community’s economy would not be sustainable without “ubiquitous broadband.”

High-speed internet brings more jobs and less poverty, said Claudia Persico, an associate professor at American University. Persico, who is also a research associate with the National Bureau of Economic Research, that found increased broadband internet leads to a reduction in the number of suicides as well as improvements in self-reported mental and physical health.

More than 30% of Lincoln County’s population reports cases of depression, according to data from the Centers for Disease Control and Prevention. The rate of opioid prescriptions dispensed in Lincoln County is down about 60% from 2014 to 2024 — but still higher than the state average, according to the West Virginia Board of Pharmacy.

Twenty percent of the county’s population lives below the poverty line, and residents are also more likely than the national average to experience heart disease, diabetes, and obesity.

Lincoln Primary Care Center offers telehealth services such as electronic medical records on a patient portal and a pharmacy app, said Jill Adkins, chief quality and risk officer at Southern West Virginia Health System, which operates the clinic.

But because of limited access, only about 7% of patients use telehealth, she said.

Della Vance was a patient at the clinic but said she has never used a patient portal. If she could, Vance said, she would check records on the baby she is expecting.

“You can’t really get on if you don’t have good service and no internet,” she said. “It makes me angry, honestly.”

Vance and her husband, Isaiah, live off a gravel road that veers from Upper Mud River. There is a tall pole with black wires dangling across the road from their small home. Pointing to the cables, Isaiah Vance said he couldn’t get phone service anymore.

Verizon announced plans last year to buy Frontier . The deal, which must be approved by federal and state regulators, is expected to be completed in early 2026, according to an .

In its federal , Frontier stated that it had taken on too much debt after emerging from bankruptcy and that debt would make it difficult to finish the work of installing fiber to customers in 25 states.

In West Virginia, Frontier’s Allison Ellis , seeking approval for the merger from state regulators, that Verizon will honor the rural program commitments. The previous month, in February, Frontier with the state public service commission to keep the number of customers using copper lines and the faster fiber-optic lines confidential.

Kelly Workman, West Virginia’s broadband director, said during a November interview that her office has asked federal regulators for “greater visibility” into Frontier’s rural program construction, particularly because those locations cannot win the Biden-era infrastructure money when it's available.

“The worst-case scenario would be for any of these locations to be left behind,” Workman said.

‘Money Cow’

Frontier’s progress installing fiber-optic lines and its unreliable service have frustrated West Virginians for years. In to the FCC, U.S. Sen. Shelley Moore Capito (R-W.Va.) cited “the failure of Frontier to deliver on promises to federal partners” and its “mismanagement” of federal dollars, which forced the state to pay back $4.7 million because of improper use and missed deadlines.

Michael Holstine, a longtime member of the West Virginia Broadband Enhancement Council, said the company has “just used West Virginia as a money cow.” Holstine has been fighting for the construction of fiber-optic lines in Pocahontas County for years. “I really just hope I get it before I die.”

Across the state, people like Holstine and Adkins are eager for updated networks, according to interviews as well as letters released under a public records request.

Chrissy Murray, vice president of Frontier’s external communications, acknowledged that the company was “building back our community efforts” in West Virginia after a bankruptcy filing and reorganization. She said there has been a “notable decline” in consumer complaints, though she did not provide specific numbers.

Murray said Frontier built fiber-optic cables to 20% of its designated rural funds locations as of the end of 2024. It has also invested in other infrastructure projects across the state, she said in a January email, adding that the company to West Virginia University’s rural Jackson’s Mill campus.

According to , Frontier has connected 6,100 — or fewer than 10% — of the more than 79,000 locations it was awarded in the Rural Digital Opportunity Fund program.

The FCC oversees the rural fund. The agency did not respond to a request for comment. Frontier expects to receive $37 million annually from the agency through 2032, .

In April, a from West Virginia residents filed as “support” for Frontier’s merger with Verizon appeared in the state regulatory docket:

“My support for this case depends on whether Verizon plans to upgrade or replace the existing Frontier infrastructure,” wrote one customer in Summers County, in the far southern corner of the state, adding, “West Virginians in my neck of the woods have been held hostage by Frontier for a generation now because no other providers exist.”

A customer from Hardy County, in the state’s northeastern corner, wrote: “This is [a] move by frontier to to [sic] escape its responsibility to continue services.”

‘D±ð±ð±è-¸é´Ç´Ç³Ù±ð»å’

Adkins moved to Upper Mud River with her husband, Bobby, decades ago.

For years, Bobby and Ada Carol Adkins ran a “carry-out” on Upper Mud River Road. The old building is still at the rock quarry just down the hill and around the curve from where her trailer sits.

It was the type of store where locals kept a tab — which Bobby treated too much like a “charity,” Adkins said. They sold cigarettes, beer, bread, bags of chips, and some food items like potatoes and rice. “Whatever the community would want,” she said.

Then, Bobby Adkins’ “health started deteriorating and money got tighter,” Adkins said. He died at 62 years old.

Now, Adkins said, “I’m having kidney problems. I got arthritis, they’re treating me for high blood pressure.”

Her doctor has begun sending notes over the internet to refill her blood pressure medicine and, Adkins said, “I love that!”

But Adkins’ internet was out again in early April, and she can’t afford Starlink like her neighbors. Even as Adkins said she is “deep-rooted,” her son’s request is on her mind.

“I’m having health problems,” Adkins said. “He makes a lot of sense.”

Ñî¹óåú´«Ã½Ò•îl 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 .

USE OUR CONTENT

This story can be republished for free (details).

But after years of studying biology and genetics, Tovar finally got proof that she belonged. Last fall, the National Institutes of Health . It would fund her research and put her on track to be a university professor and eventually launch a laboratory of her own.

“I felt like receiving the award was a form of acceptance, like I had finally made it,” Tovar said. “But I think many of us now fear that this is going to poison the rest of our careers.”

Tovar is one of nearly 200 young scientists across the nation whose research and job prospects have been jeopardized by the sudden termination of the NIH’s MOSAIC grant program, one of many ended by sweeping cuts across the federal scientific agencies. The grant was created by the first Trump administration to foster a new generation of diverse scientists in biomedical research, then defunded in the second Trump administration’s ongoing purge of diversity, equity, and inclusion programs.

In interviews with Ñî¹óåú´«Ã½Ò•îl Health News, Tovar and three other grant recipients worried that the loss of funding — coupled with President Donald Trump’s crusade against diversity programs — may transform a grant that was supposed to jump-start their careers into a blemish on their résumés that could cost them the jobs and funding that make their research possible.

“We might end up blacklisted by the NIH because of having this award — for who we are,” said Erica Rodriguez, 35, a grant recipient at Columbia University who conducts brain research that could lead to a better understanding of psychiatric disorders.

“Because not only is it for people with diverse backgrounds,” she said, “but it’s for people who advocate for other people with diverse backgrounds.”

The MOSAIC program — short for “” — was created in 2019 to provide early-career support to promising scientists from “underrepresented backgrounds” with a long-term goal to “enhance diversity in the biomedical research workforce,” according to NIH grant documents.

The five-year grant was awarded to scientists who have finished their doctorates and work in research laboratories at universities across the country. In the first two years, scientists generally receive $100,000 to $150,000, which is largely used to pay their salaries.

By the third year, the scientists are expected to have been hired as a professor, likely at a different university, where the grant funding helps them launch their own research lab. In the final three years of the grant, funding increases to about $250,000 a year, which is used to buy supplies and hire other young scientists to work in the lab, completing the cycle.

MOSAIC awardees were chosen using a broad definition of diversity beyond race, gender, and disability. It includes those who grew up in poor households or rural areas or were raised by parents who do not have college degrees. Many of those chosen for the grant also have a history of supporting other budding scientists from underrepresented backgrounds.

MOSAIC funds research on cancer, Alzheimer’s disease, spinal cord injuries, cochlear implants, fentanyl overdoses, stroke recovery, neurodevelopmental disorders, and more.

But in recent weeks the NIH has notified most MOSAIC recipients that the program was “terminated” and their funding will end by this summer, regardless of the years left on their grant, according to NIH emails reviewed by Ñî¹óåú´«Ã½Ò•îl Health News. Other awardees have received no official notification and only learned through word of mouth that their funding was canceled.

Vianca Rodriguez Feliciano, a spokesperson for the Department of Health and Human Services, confirmed in an email statement to Ñî¹óåú´«Ã½Ò•îl Health News that MOSAIC had been defunded. She said the grants “no longer align” with agency priorities or the “eliminating wasteful, ideologically driven DEI initiatives.”

Trump signed one of those orders on his first day back in the White House, instructing the entire federal government to end programs that promoted diversity, referring to them as “shameful,” “immoral,” and an “immense public waste.”

Diversity programs have been slashed across the government, including at the NIH and other HHS agencies, which have canceled hundreds of grants worth billions of dollars since March. On April 21, the NIH that banned recipients from receiving grants if they have DEI programs and said the agency could “recover all funds” from those that do not comply.

“At HHS, we are dedicated to restoring our agencies to their tradition of gold-standard, evidence-based science – not one driven by political ideology,” Rodriguez Feliciano said. “We will leave no stone unturned in identifying the root causes of the chronic disease epidemic as part of our mission to Make America Healthy Again.”

Many MOSAIC scientists are focused on chronic diseases. Tovar, for example, researches specific genes that make people more susceptible to diabetes, which affects .

“We have a lot of treatments for diabetes that are great for the people that they work for,” Tovar said. “In my research, I use genetics to help find better drug targets so we can find medicines for people who don’t already have therapies that work.”

In interviews, Tovar and the other MOSAIC recipients described how the sudden loss of funding will throw research and careers into upheaval: Some postdoctoral researchers may lose their current jobs when funding runs dry in months; awardees competing for professor jobs will lose research funding that made them stronger candidates; and those already hired will have less money for salaries and supplies in their research labs.

Ashley Albright, 32, who grew up poor in rural North Carolina, is now a scientist at the University of California-San Francisco, where she studies Stentor coeruleus, a large single-celled organism with regenerative abilities. She plans to start applying for professor jobs this fall.

Albright said MOSAIC funding would have given her a “better shot at my dream,” which was to give other scientists from diverse backgrounds opportunities to work in her research lab.

“I feel crushed,” she said. “I feel like someone is stepping on half of my life. … I’ve spent the last 10 years in grad school and my postdoc working toward this so I can do science, but also help other people do science.”

Hannah Grunwald, 33, a grant recipient at Harvard who studies eyeless cave fish to better understand complex genetic traits, said one of her worst fears was that universities won’t hire MOSAIC awardees at a time when the White House is ordering schools to abandon DEI programs and withholding billions from those that do not bend to the Trump agenda.

“There has been an enormous debate in our community about what we should say on our résumés,” Grunwald said. “I just don’t know if having my grant canceled because it had to do with diversity is going to limit my ability to get funding in the future.”

The termination of MOSAIC drew quick condemnation from several scientific organizations that receive grant funding to work closely with the awarded scientists, with some calling it “” and “.”

Mary Munson, president of the American Society for Cell Biology, who has mentored awardees since MOSAIC began, became choked up and covered her face with her hands as she considered the possibility the grant could end up holding them back.

“Taking this grant away now does not take away the fact that they won this competitive award. It doesn’t take away that they are amazing scientists,” Munson said. “I hope that institutions will still see that nonetheless.”

Stefano Bertuzzi, CEO of the American Society for Microbiology, which also mentors grant awardees, said the mass termination of MOSAIC and other NIH grants may have a cumulative effect that will stifle scientific innovation for decades.

Bertuzzi, who immigrated from Italy in the ’90s because of America’s robust funding for science, said scientists will not stay in or flock to a nation where research funding vanishes on a political whim.

“We are going to be losing a full generation of scientists,” Bertuzzi said. “Other countries in the world will thrive.”

Ñî¹óåú´«Ã½Ò•îl 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 .

USE OUR CONTENT

This story can be republished for free (details).