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Despite Their Successes, Some Mobile Crisis Response Teams Are in Crisis

Aaron Bolton, MTPR — Wed, 04 Mar 2026 10:00:00 +0000

It was a snowy afternoon in Bozeman, a city of nearly 60,000 nestled among the mountains of southern Montana. Temperatures hovered in the mid-30s.

The city’s mobile crisis team had just gotten a call about a man walking around outside without shoes. The man’s family told the team he was having a mental health crisis and wouldn’t come inside.

As they drove down the highway toward the city’s outskirts, team member Evan Thiessen spoke with the relative who had reached out.

“You’re doing the right thing, and we’re going to make sure he gets help today, OK?” he said.

They pulled up the man’s police record on a laptop and saw that he did have a record of some previous encounters with police, including some that had turned violent.

, a licensed therapist, had that in mind as they pulled into a neighborhood of single-family homes. He stepped out of the Ford Bronco and headed toward the front door.

A Funding Problem

Many communities around the country send out teams like this one to help people in psychiatric crisis, rather than dispatching regular police.

A found there were at least 1,800 mobile teams nationwide in 2023. But financial support for them is often inadequate and inconsistent, leaving many communities struggling to keep the teams operating.

Two programs — one in Great Falls, in central Montana, and one in Billings, in south-central Montana — recently shut down. Six units remain in Montana.

The strategy in Eugene, Oregon, but gained momentum nationally over the past 10 years.

Recent about police killing people who are experiencing a psychiatric crisis have sparked conversations about how to safely and effectively respond. Most police officers are not trained to deal with people experiencing delusions or hallucinations, nor to de-escalate situations involving threatening behaviors to themselves or others.

An across 27 states found that about a third of the victims showed signs of being in crisis. Another study found that people with a serious mental illness were at least to experience use of force by police as those without.

By contrast, crisis response teams have been trained to de-escalate such situations and provide appropriate therapeutic care.

When the team arrived at the house in Bozeman, the man had already gone back inside. The team then talked with the man’s family for about half an hour and helped them devise a plan to keep him at home — and safe. Before they left, team members determined the man wasn’t a threat to himself or others.

Also, they planned to follow up within a few days to connect him with ongoing mental health care. After an encounter with the team, some clients might need follow-up therapy, assistance with psychiatric medications, or help finding treatment for substance abuse.

The Bozeman team is available 12 hours a day, seven days a week, and costs roughly $1 million a year to run.

Police departments are generally funded by local taxpayers. Mobile crisis teams don’t have a single, reliable source of funding.

Some, despite successful operations and , are or have closed entirely. One that shuttered was Oregon’s .

Most crisis calls end with people staying where they are, avoiding a trip to the emergency room or going to jail, according to , which runs the mobile crisis program in Bozeman.

Beyond police and firefighters, members of the public can call the team directly.

“I’ve been out on calls where individuals have barricaded themselves in residences or in their vehicles with a firearm. So, helping to assist not only law enforcement, the negotiators, but consulting on the behavioral health side of that,” said Ryan Mattson, who leads the Bozeman crisis team.

Crisis team members Evan Thiessen (left) and Luke Forney document calls and follow-up care for patients. In Montana, such administrative work isn’t reimbursed by private insurers or Medicaid. (Ruth Eddy/Yellowstone Public Radio)

The program has reduced the time that Bozeman police officers must spend on mental health calls by nearly 80%, according to Mattson, and prevented unnecessary ER visits.

Residents and political leaders see that value, he said, but finding a way to pay for the service has been difficult.

“I’m confident we’ll be here through next fiscal year. That’s about as confident as I am at this point,” Mattson said.

Mobile crisis programs in Montana, which began operating about five years ago, have cost more than the state originally projected.

Health insurance is sometimes a revenue source for mobile crisis teams. That’s because a crisis call is a type of mental health service, provided by trained professionals such as therapists or crisis intervention specialists. Still, many private insurance companies don’t reimburse for mobile crisis services.

What Medicaid Pays For — And Doesn’t

Medicaid, the government-funded insurance program for low-income and disabled Americans, is another funding source. Two-thirds of states allow Medicaid reimbursement for such calls, but rates vary.

In Montana, Medicaid reimburses the team only for the time they spend responding to a call in the field. Additional time spent on a case — documenting the encounters, or waiting for the next call — isn’t reimbursed.

“You need to pay for the capacity to be at the ready, just like we do with fire or police, regardless of whether somebody is going to be called out,” said of Inseparable, a nonprofit that advocates for mental health policy reform.

It’s not feasible for mobile crisis teams to rely solely on reimbursement from insurance companies, she said.

To deal with the shortfalls, many mobile teams rely on a patchwork of grants and other funding, according to , who studies Medicaid policy at �鶹Ů��, a health information nonprofit that includes �鶹Ů�� Health News.

Some state governments have stepped in to help.

Eight states, including New Jersey, California, and Washington, mandate that private insurers cover the cost of mobile crisis calls for people on their plans, according to Kimball. At least 10 states have implemented fees on cellphone bills to help pay for service.

Montana hasn’t followed suit.

The state provides about $2 million annually in supplemental funds to help the mobile teams pay for service calls that aren’t reimbursed through Medicaid, according to an emailed statement from Jon Ebelt, a state health department spokesperson.

But program managers counter that the paperwork to access that funding is complicated and often isn’t worth the staff time.

Will Montana Step In?

Despite this state support, mobile teams are still struggling to stay afloat, Ebelt acknowledged. He said Montana officials are considering boosting what Medicaid reimburses for each service call.

In Missoula, the mobile crisis team turned to local taxpayers for additional help. Their annual expenditure is $1.4 million, but Medicaid reimbursements were covering only about 20% of the cost, according to program manager John LaRocque. Even with local tax dollars, the program faces a $250,000 shortfall, so LaRocque is looking for grants.

Forney (left) and Thiessen head out on a crisis call. The Gallatin County Mobile Crisis Team has an office at the Bozeman police headquarters. (Ruth Eddy/Yellowstone Public Radio)

Mobile crisis is still a relatively new concept, and growing pains are to be expected, said Sierra Riesberg, director of the .

Still, abrupt closures create instability and lead some patients to the ER, placing financial pressure on another distressed part of the local health system.

“A much-needed service is available and then not available, available and then not available. These things need to be taken into consideration when developing programs in communities,” she said.

If more mobile crisis teams shut down, that might interfere with Montana’s recent efforts to overhaul an outdated and underfunded mental health system. The state’s only psychiatric hospital hasn’t kept up with the to the facility.

Later this year, Montana hopes to join a federal pilot program to open a new type of clinic: , or CCBHCs. Those clinics will receive boosted levels of federal funding, but they are required to offer round-the-clock mobile crisis services as well as other crisis care.

That could be a tall order for rural communities, said , an executive at in Great Falls.

Alluvion used to operate the mobile crisis team in Great Falls before it shuttered the service. One major reason it closed was that the expected Medicaid payments covered less than anticipated. Before Alluvion would consider getting involved again, the state would need to “completely revamp” the way the service is funded, Schreiner said.

“Is it a priority for our state or not?” he asked.

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New Orleans Brings Back the House Call, Sending Nurses To Visit Newborns and Moms

Rosemary Westwood, WWNO — Mon, 23 Feb 2026 10:00:00 +0000

When Lisa Bonfield gave birth to daughter Adele in late November, she was thrust into the new world of parenting, and faced an onslaught of challenges and skills to learn: breastfeeding, diapering, sleep routines, colic, crying, and all the little warning signs that something could be wrong with the baby.

But unlike parents in most of the U.S., she had extra help that was once much more common: house calls.

Adele was only a few weeks old when a registered nurse showed up at Bonfield’s door on Dec. 10 to check on them and offer hands-on help and advice.

As a city resident who had recently given birth, she was eligible for up to three home visits from , a program of the city health department.

She didn’t need to feed and change the baby before packing everything up for a car trip to the pediatrician or a clinic. It was a relief; Bonfield was exhausted and was still trying to figure out how to use the infant car seat.

“Everything is so abstract before you have a baby,” Bonfield said. “You are going to have questions you never even thought about.”

Louisiana is among the worst-performing states in maternal and infant health outcomes. So New Orleans is trying to catch health issues early — and get families off to an easier start — by adding health visits during the crucial first months of life.

The hope is that health outcomes can be improved by returning to the old-fashioned medical practice of house calls.

The Family Connects model has been tried in communities . It began in Durham, North Carolina, in 2008, as a partnership with Duke University. In 2023, New Orleans’ health director, , helped launch a local version of the program.

Avegno was concerned by Louisiana’s particularly grim statistics for maternal and infant health.

The state has some of the highest rates of preterm births, unnecessary cesarean sections, and maternal and infant deaths, according to the . A from the United Health Foundation found that Louisiana was the “least healthy” state for women and children.

“We got to do some real things real differently, unless you like being No. 50 all the time,” Avegno said.

The home visits are free and available to anyone who has just given birth in a New Orleans hospital, no matter their insurance status or income level.

Avegno describes the home visits as going “back to the future,” replicating a practice that was far more common a hundred years ago.

“There is no more critical time and vulnerable time than right at birth and in the few weeks to months following birth,” Avegno said.

The nurses arrive with diaper bags filled with newborn essentials, from diapers to nipple cream. They weigh, measure, and examine the babies, and check in with the mothers about their health and well-being. They offer referrals to other programs across the city.

They ask if the family has enough food, and whether there are guns in the house and how they’re stored, Avegno said.

In Bonfield’s case, the nurse stayed for over two hours. Bonfield especially liked their conversation about how to safely store breastmilk.

“I’ve never felt so well taken care of and listened to,” she said.

Broad Support

Louisiana has struggled a long time with poor maternal and infant health outcomes, but the problem has been complicated by the .

The 2022 law led to risky medical delays and in obstetrical care, and confusion among doctors about what’s allowed in ending dangerous pregnancies or .

Avegno opposes the state’s abortion policies, believing they are harmful to women’s health. But she says that Family Connects offers other ways to preserve and expand care for women. For example, the visiting nurse can check in with the mother about whether she needs help with birth control.

“We can’t give them abortion access,” she said. “That’s not the goal of this program, and that wouldn’t be possible anyway. But we can make sure they’re healthy and understand what their options are for reproductive health care.”

Abortion politics aside, the postpartum home visits seem to have bipartisan support in Louisiana, and state lawmakers want to expand their availability.

Last year, the Republican-dominated legislature requiring private insurance plans to cover the visits.

The new law is another way that Louisiana officials can be “pro-life,” said state , who, as a Republican and an abortion opponent, sponsored the legislation.

“One of the slings used against advocates against abortion is that we’re pro-birth, and not truly pro-life,” Bayham said. “And this bill is proof that we care about the overall well-being of our mothers and our newborns.”

Improving Health and Help for Postpartum Depression

Two years in, there are already promising signs that the program is improving health.

Early data analyzed by researchers at Tulane University showed that families who got the visits were more likely to stick to the recommended schedule of pediatric and postpartum checkups. Moms and babies were also less likely to need hospitalization, and overall health care spending was down among families insured by Medicaid.

Research on Family Connects programs elsewhere has found similar results. In North Carolina, one study showed that three to seven home visits in the year before a baby turned 1.

But the statistic that most excited Avegno related to the program’s role in screening mothers for postpartum depression.

The visiting nurses are helping spot more cases of postpartum depression — earlier — so that new moms can get treatment. About 10% of moms participating in the New Orleans program were eventually diagnosed with postpartum depression, compared with 6% of moms who did not get the visits.

Timely diagnosis is important to prevent depression symptoms from worsening, or leading to more , such as suicidal thoughts, thoughts of harming the baby, or problems bonding with their newborn.

Lizzie Frederick was one of the New Orleans mothers whose postpartum symptoms were caught early by a visiting nurse.

When she was pregnant, she and her husband took all the childbirth and newborn classes they could. They hired a doula to help with the birth. But Frederick still wasn’t prepared for the stresses of the postpartum period, she said.

“I don’t think there are enough classes out there to prepare you for all the different scenarios,” Frederick said.

When her son, James, was born in May, he had trouble breastfeeding. He was sleeping for only 90-minute stretches at night.

When the nurse arrived for the first visit a few weeks later, Frederick was busy trying to feed James. But the nurse reassured her that there was no rush. She could wait.

“I am here to support you and take care of you,” Frederick recalled the nurse saying.

The nurse weighed James, and Frederick was relieved to learn he was gaining weight. But for most of the visit, the nurse focused on Frederick’s needs. She was exhausted, anxious, and had started hearing what she called phantom cries.

The nurse walked her through a mental health questionnaire. Then she recommended that Frederick see a counselor and consider attending group therapy sessions for perinatal women.

Frederick followed up on these suggestions and was eventually diagnosed with postpartum depression.

“I think that I would have felt a lot more alone if I hadn’t had this visit, and struggled in other ways without the resources that the nurse provided,” Frederick said.

Home Visits Save Money

, an assistant professor at Tulane’s School of Public Health, helped interview over 90 families participating in the Family Connects New Orleans program.

“It was overwhelmingly positive experiences,” she said. “This is like a gold-standard public health project, in my opinion.”

To operate, Family Connects costs the city about $1.5 million a year, or $700 per birth, according to Avegno. But the program also has the potential to save money: Research on North Carolina’s program in the program saved $3.17 in health care billing before the child turned 2.

That’s another reason to require the visits statewide, according to state Rep. Bayham.

“The nurses and medical practitioners will be able to monitor potential problems on the front end, so that they could be handled without a trip to the emergency room or something even more drastic,” he said.

Avegno is advocating that the program be included in Louisiana’s Medicaid program, since more than in the state are covered by Medicaid. A recent made the same recommendation.

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NIH Grant Disruptions Slow Down Breast Cancer Research

Martha Bebinger, WBUR — Tue, 03 Feb 2026 10:00:00 +0000

Inside a cancer research laboratory on the campus of Harvard Medical School, two dozen small jars with pink plastic lids sat on a metal counter. Inside these humble-looking jars is the core of ’s current multiyear research project.

Brugge lifted up one of the jars and gazed at it with reverence. Each jar holds samples of breast tissue donated by patients after they underwent a tissue biopsy or breast surgery — samples that may reveal a new way to prevent breast cancer.

Brugge and her research team have analyzed the cell structure of more than 100 samples.

Using high-powered microscopes and complex computer algorithms, they diagram each stage in the development of breast cancer: from the first sign of cell mutation to the formation of tiny clusters, well before they are large enough to be considered tumors.

Their quest is to prevent breast cancer, a disease that afflicts roughly 1 in 8 U.S. women over their lifetimes, as well as some men. Their ultimate goal is to relieve the pain, suffering, and risk of death that accompany this disease. And their painstaking work, unspooling across six years of a seven-year, , has yielded results.

In late 2024, Brugge and her colleagues in breast tissue that contain the genetic seeds of breast tumors.

And they discovered that these “seed cells” are surprisingly common. In fact, they are present in the normal, healthy tissue of every breast sample her lab has examined, Brugge said, including samples from patients who haven’t had breast cancer but have had surgery for other reasons, such as breast reduction or a biopsy that proved benign.

The next research challenge for Brugge’s lab is clear: Find ways to detect, isolate, and terminate the mutant cells before they can spread and form tumors.

“I’m excited about what we’re doing right now,” Brugge said. “I think we could make a difference, so I don’t want to stop.”

Brugge holds samples of breast tissue that are part of a multiyear research project at Harvard Medical School funded by a grant from the National Cancer Institute. (Robin Lubbock/WBUR)

Work in Brugge’s lab slowed significantly last year. In April, her from the National Cancer Institute at the National Institutes of Health was frozen, along with virtually all other federal money awarded to Harvard researchers.

The Trump administration said it was withholding the funds of antisemitism on campus.

Some of Brugge’s lab staff lost federal fellowships that funded their work. Brugge told others funded through the NIH grant that she couldn’t guarantee their salaries. In all, Brugge lost seven of her 18 lab employees.

In September, the funding for the NIH grant was restored. But in the intervening months, the Trump administration said Brugge and other Harvard researchers for the next round of multiyear grants.

A federal judge , but Brugge had missed the deadline to apply for renewal. So her current funding will end in August.

Brugge scrambled to secure private funding from foundations and philanthropists. She was then able to reinstate two positions for at least a year — but job applicants are wary.

Across the United States, the future of federal funding for cancer research is uncertain.

President Donald Trump has proposed by nearly 40% in the 2026 fiscal year.

In a , the White House said the “NIH has broken the trust of the American people with wasteful spending, misleading information, risky research, and the promotion of dangerous ideologies that undermine public health.”

But Congress has other plans: The released on Jan. 20 that would set the NIH’s budget at $48.7 billion, $415 million more than in the 2025 fiscal year.

In the meantime, advocates such as with the are reminding lawmakers that the cancer death rate has declined — — due in part to federally funded research advances.

“But we still have an incredible ways to go before we can say that we’ve changed the trajectory of cancer,” Fleury said. “There are still cancer types that are fairly lethal, and there are still populations of people for whom their experience of cancer is vastly different from other groups.”

Reductions in research funding will have a direct impact on treatment options for patients, Fleury said. For example, a 10% cut to the NIH budget would eventually result in two fewer new drugs or treatments per year, according to from the nonpartisan Congressional Budget Office.

A recent study looked at drugs that were developed through NIH-funded research and approved by the Food and Drug Administration since 2000. More than half those drugs would probably if the NIH had been operating with a 40% smaller budget.

“We can’t say, ‘But for that grant, that [specific] drug would not have come into existence,’” said , a co-author of the study and a professor at the Massachusetts Institute of Technology. But fewer drugs would have made it to market, he said. “It makes us at least want to pause and say, ‘What are we doing here? Are we shooting ourselves in the foot?’”

Amid all the uncertainty, Brugge has trouble focusing on her goal of finding new ways to prevent breast cancer.

Nowadays, she spends about half her time searching for new sources of funding, managing her remaining employees’ anxieties, and monitoring the most recent news about Harvard, the Trump administration, and the NIH and other federal agencies that have experienced grant freezes, staff layoffs, and other disruptions.

She’d rather return her attention to her ongoing investigations, which she’s confident could eventually save lives.

Brugge discusses an image from a gene-testing experiment with a colleague at her lab at Harvard Medical School. (Robin Lubbock/WBUR)

The breakdown of Brugge’s lab highlights another problem: The U.S. is kneecapping the next generation of cancer researchers. Her employees included , postdocs, and graduate students. Of the seven who left the lab in 2025, one left the U.S., one took a job at a health care management company, four went back to school, and one is still looking for work.

One of Brugge’s former staffers, Y., is a computational biologist. She helped design and run a tool that analyzes millions of breast tissue cells from the samples in the pink-lidded jars.

Y. moved to Switzerland in October to begin a PhD program. �鶹Ů�� Health News and NPR are identifying her by her middle initial because she plans to return to the U.S. for scientific conferences and worries that speaking publicly about her experience could risk future visa approvals.

“I thought the U.S. would be a safe place for scientists to learn and grow,” said Y., who moved to Boston from abroad for Harvard’s master’s degree program in bioinformatics. “I really hope that those who have the opportunities to study this further can fill in those missing pieces in cancer research.”

Brugge is no longer accepting job applicants from outside the U.S., even if they are top candidates, because she can’t afford to pay the Trump administration’s on visas for some foreign researchers.

The Association of American Universities and the U.S. Chamber of Commerce have , claiming the fee is misguided and illegal. The Trump administration said the fee would and improve opportunities for Americans.

Brugge doubts work in her lab will ever return to normal.

“There’ll always be, now, this existential threat to the research,” Brugge said. “I will definitely be concerned because we don’t know what’s going to happen in the future that might trigger a similar kind of action.”

Brugge has thought about shutting down her lab. But she still employs staff members whose future scientific careers are tied to finishing some of the research. And when she looks at those pink-lidded jars, she still sees so much promise.

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Millions of Americans Are Expected To Drop Their Affordable Care Act Plans. They’re Looking for a Plan B.

Blake Farmer, Nashville Public Radio — Mon, 12 Jan 2026 10:00:00 +0000

Robert Sory feeds a treat to a blind, albino raccoon named Cricket. Russian foxes, African porcupines, emus, bobcats, and goats are also part of his menagerie. (Blake Farmer/WPLN)

It’s feeding time for the animals on this property outside Nashville, Tennessee. An albino raccoon named Cricket reaches through the wires of its cage to grab an animal cracker, an appetizer treat right before the evening meal.

“Cricket is blind,” said Robert Sory, who is trying to open a nonprofit animal sanctuary along with his wife, Emily. “A lot of our animals come to us with issues.”

The menagerie in Thompson’s Station includes Russian foxes, African porcupines, emus, bobcats, and some well-fed goats.

The Sorys are passionate about their pets and seem to put the animals’ needs before their own.

Both Robert and Emily started 2026 without health insurance.

Robert had been covered through a marketplace plan subsidized through the Affordable Care Act. His share of the monthly premiums was $0. When he looked up the rates for 2026, he saw that a barebones “bronze”-level plan would cost him at least $70 a month. He decided to forgo coverage altogether.

“When you don’t have any income coming in, it doesn’t matter how cheap it is,” he said. “It’s not affordable.”

Emily and Robert Sory are trying to open a nonprofit animal sanctuary at their home in Thompson’s Station, Tennessee. They have forgone health insurance this year and are looking for ways to pay for their care without coverage. (Blake Farmer/WPLN)

Dumping Coverage

Marketplace plans from the Affordable Care Act no longer feel very affordable to many people, because Congress did not extend a package of enhanced subsidies that expired at the end of 2025. Last week, the House did pass legislation to extend the expired subsidies, and negotiations have moved to the Senate. Without a deal, an estimated will go without coverage this year.

But even without a health plan, people will still need medical care. Many, like the Sorys, have been thinking through their plan B to maintain their health.

The Sorys both lost jobs in November, within days of each other. Robert worked as a farmhand. Emily worked at a staffing firm and lost her insurance along with her position.

“It’s a horrible, horrible market right now. Really tough,” she said.

The first time she had to pay out-of-pocket for her three monthly prescriptions, the cost was $184.

“To equate that to kind of how we think about it, you’re talking about 350 pounds of food for these animals,” Robert said. He pointed to his bobcats, who eat only meat.

A bobcat waits for a meaty meal served by Robert Sory. (Blake Farmer/WPLN)

Workarounds for the Newly Uninsured

To keep kibble in the food bowls, the Sorys are prepping for an uninsured future. They see the same psychiatrist and met with him to make a plan. He was willing to work with them by charging $125 per visit. They’ll have to go every three months to keep their prescriptions current.

And if other medical problems emerge? They’re hoping for the best.

“I’m not somebody who gets sick super often, thank God,” Robert said. “And if I do, generally I go to an emergency room where they’re going to bill me later.” Robert said he would arrange a repayment plan for bills like that.

Emily has costly health conditions and has already taken on substantial medical debt. “It’s just sitting there, and I’ve racked up money,” she said. “But I’ve had to go to the doctor.”

Donated Drugs and Sliding Scales

Hospitals and clinics are of newly uninsured patients. They’re also concerned that people won’t know about alternative ways to get medical care.

“We don’t have marketing dollars, so you’re not going to see big billboards or radio ads,” said , CEO of in Nashville. It’s one of the country’s 1,400 federally qualified health centers, also called FQHCs.

FQHCs are by the federal government. Although they do not usually offer free care, their fees tend to be lower or on a sliding scale.

Uninsured people who get care receive a bill, Beard said, “but the bill will be based on their ability to pay.”

FQHCs often have on-site pharmacies, and some offer prescription medications free of charge through a partnership with the , a Nashville-based nonprofit.

Many hospital pharmacies also partner with the nonprofit, which has donated by pharmaceutical companies to 277 sites in 38 states. must make the medicine available free of charge to people without insurance who have annual incomes below 300% of the federal poverty limit.

The organization primarily sources medications for chronic conditions such as high blood pressure, diabetes, and mental health. Demand is expected to outstrip supply in the new year, according to .

“We’re projecting and engaging with our manufacturers and asking them, ‘Are you willing to help support, for this future status that we are anticipating?’” he said. “By and large,” he said, pharmaceutical companies have said they’re willing to step up.

“It’s a continuous conversation that we’re having,” Cornwell said.

Emily Sory readies the foxes’ supper. (Blake Farmer/WPLN)

A Medicaid ‘Gap’ in 10 States

Hospitals will also have to find a way to care for more patients who cannot pay. Industry groups such as the have been vocal about the threat to hospitals’ financial health and have urged Congress to extend the enhanced subsidies, which take the form of tax credits.

The impact might be most acute in states like Tennessee that have not expanded Medicaid to cover people who work but do not have job-based insurance and cannot afford it on their own.

Ten states have chosen not to expand Medicaid to uninsured, low-income adults — an optional provision of the ACA that is mainly paid for by federal funds.

This Medicaid “gap” is , at the high end of the spectrum, by as much as 65% in Mississippi and by 50% in South Carolina, according to the Urban Institute.

As Emily Sory pets a Russian fox, she admits she is keenly aware that she will soon become part of this growing population. After all, her last job involved health care staffing. Her mother is a nurse.

“I understand the system. And I get it’s people like me that don’t pay their bill are why it suffers. And I feel bad,” she said. “But at the same time, I don’t have the money to pay it.”

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Homeless Shelters for Seniors Pop Up, Catering to Older Adults’ Medical Needs

Aaron Bolton, MTPR — Wed, 07 Jan 2026 10:00:00 +0000

SANDY, Utah — Just outside Salt Lake City sits an old, two-story, brick hotel. It’s been given new life as a homeless shelter for seniors. The Medically Vulnerable People shelter — or , as it’s known — is for people 62 and older or for younger adults with chronic health issues.

Residents share rooms designed to be accessible to those with mobility issues. There are also private bathrooms, which are a big deal for seniors struggling with incontinence.

Unlike the MVP, most homeless shelters aren’t equipped to help seniors, especially those 65 and older. They are the fastest-growing homeless population nationwide, according to , a researcher at the University of Pennsylvania. Not only are people who struggle with chronic homelessness aging, but many seniors are becoming homeless for the first time in their lives.

Getting in and out of bunks, managing medications, and making it to a shared bathroom in time are among the major challenges of shelter life for older adults. Staff at traditional shelters sometimes ask seniors to leave if they’re unable to care for themselves.

The MVP is unusual among shelters because it provides on-site medical care to better serve its residents as they age.

Last spring, Jamie Mangum, who is in her 50s and has lung cancer, tripped and fell in her room. To visit with an emergency medical technician, she needed only to make it downstairs. Her swollen wrist was quickly wrapped, and she returned to her room. She said that wouldn’t have been possible at other shelters she’s stayed in.

“There, I’d have to wait hours as opposed to come in here, be seen,” Mangum said.

Mangum said that in other shelters she’d likely have had to find her own way to an urgent care office or get an ambulance ride. Specialized case managers at the MVP have helped her get treatment for lung cancer as well.

“We have clients that need memory care. Maybe they were living independently before, but they were unable to maintain that and got evicted due to dementia or different things like that,” said Baleigh Dellos, who manages the MVP shelter for , a local nonprofit.

Specialized medical case managers work at the shelter. Primary care doctors and therapists visit weekly. Residents can even receive physical therapy in private spaces on-site.

On-site emergency medical technician Emily Woolsey wraps the swollen wrist of MVP shelter resident Jamie Mangum after a fall. Mangum says that in other shelters, she’d likely have had to find her own way to an urgent care office to get treatment. She credits the shelter for helping her deal with all her medical issues. (Aaron Bolton/Montana Public Radio)

A Path to Stability

The MVP partnered with the to offer medical care.

The first thing most new residents need help with is medication, said Matt Haroldsen with the Fourth Street Clinic, which provides health services at the shelter.

For people living on the streets, just keeping hold of regular medications is a challenge. “Their medications get jacked when they’re in their camps,” he said.

Diabetes patients without homes often bury their insulin to keep it cold. Haroldsen said they might forget where they buried it, or the vials might get too warm and spoil.

Helping residents at the shelter get those medications can stabilize their conditions, allowing them to focus on other priorities, such as getting an ID and other documents they need to apply for disability, Social Security, and various programs that can help them secure housing.

Nonprofits and local governments have opened similar shelters in Florida, California, and Arizona to meet the needs of older unhoused adults.

Having access to specialized shelters can be the difference between life and death, said , assistant director of the National Health Care for the Homeless Council.

In cold-weather states, denying seniors a bed because of mobility and other health issues can be especially risky. In 2022, a Bozeman, Montana, after he was asked to leave a shelter because of incontinence.

Complex medical needs can pose a danger to other residents that most shelters aren’t prepared to manage.

“A typical shelter doesn’t allow somebody on oxygen to come in because that’s such a fire hazard and risk,” she said.

Synovec said giving seniors better access to health care inside shelters is the best way to help them succeed once they get housing. Health issues are a common reason seniors can’t afford or maintain housing, she said.

A Growing Model

The MVP model is showing promise, both in Utah and elsewhere.

“Over 80% of the people who’ve stayed in our program this past year have moved into stable or permanent housing,” said , vice president of programs for the TaskForce for Ending Homelessness in Fort Lauderdale, Florida. The nonprofit runs a shelter called .

The MVP shelter near Salt Lake City is also marking success. It was able to permanently house 36 seniors as of late last year.

Still, there are more seniors in need of shelter than it can accommodate. Dellos, the shelter’s manager, said the MVP’s waitlist hovers around 200 people. She said the shelter prioritizes people based on medical need, not time spent on the waitlist.

For residents who do get a room, it’s life-changing.

Last spring, 62-year-old Jeff Gregg was playing fetch with his dog, Ruffy, just beyond the lawn in front of the MVP.

An old back injury forced Gregg to hunch over as he threw the ball. It also fueled a decades-long addiction to opioids. That cycle was hard to escape, he said.

Jeff Gregg plays fetch with his dog, Ruffy, outside the MVP shelter in Sandy, Utah. He says the specialized medical services helped him stop using opioids and get surgery for chronic back pain. He hopes that will allow him to get a job and afford an apartment. (Aaron Bolton/Montana Public Radio)

“Fighting that, having a job, insurance, then losing the job, not having insurance, going out to the streets and being back in that crap, and I’d be back in the same position,” he said.

Gregg said sobriety took a back seat to more immediate needs like finding food and a bed in a shelter. He said the MVP was the first place where he could relax and focus on recovery.

“I was able to get clean. It took me a couple months, but I just kept plucking away,” he said.

He said the experience paved the way for him to get back surgery. He hopes that with less back pain, he can eventually get a job to help him afford an apartment.

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As Sports Betting Explodes, States Try To Set Limits To Stop Gambling Addiction

Karen Brown, New England Public Media — Mon, 27 Oct 2025 09:00:00 +0000

It isn’t easy to promote moderation and financial discipline from the bowels of a casino.

But that’s what Massachusetts state workers try to do every day, amid the clanging bells and flashing lights of the slot machines.

At the MGM Springfield in western Massachusetts, workers wearing green polos stand outside their small office, right off the casino floor.

Above them, a the state’s signature program to curb problem gambling. A mounted screen cycles through messages such as “Keep sports betting fun. Set a budget and stick to it.”

The workers hand out free luggage tags and travel-size tissues to encourage people to stop and chat. If they succeed, they give customers brochures displaying the state’s gambling helpline number and website. They can even enroll them in a which allows customers to set monthly spending limits on how much they gamble.

Outside the casinos, GameSense is marketed on social media and on and websites. Meanwhile, the state’s Department of Public Health puts its own on buses and billboards.

“That’s a big movement in 12 years,” said , who oversees the GameSense program in Massachusetts.

An ad for GameSense, a “responsible gaming” program for Massachusetts residents, appears on a screen at the MGM Springfield casino. (Karen Brown/New England Public Media)

Massachusetts’ first casino opened in 2015, and as the gaming industry grew, the state developed what it calls a “responsible gaming” program, funded by a surtax on gambling industry profits.

At first, tried various strategies to educate customers about the addictive nature of gambling, as well as the financial risks.

“It was much more about making sure that there are brochures that are available that explained the odds of whatever game it was,” Vander Linden said.

Since then, Massachusetts has put in place on a booming industry that now includes widespread sports betting. For example, there’s no betting on Massachusetts college teams, and no gambling by credit card. All gambling companies must allow customers to set voluntary limits and sign up for a “voluntary self-exclusion list” that bans them from casinos or sports betting over various time intervals.

A Patchwork of State Policies

Some states have set similar limits to curb problem gambling, but others have very few. In the absence of a nationwide policy, or a national gambling commission to oversee the industry, each state is on its own.

A growing number of addiction researchers and policymakers say it’s time to take bolder — and more unified — steps to combat gambling disorders. They point to the explosion of the gaming industry since 2018, when the U.S. Supreme Court for states to and unleashed an aggressive industry, now legal in 39 states. (Forty-eight states have legalized at least some form of gambling, including lotteries.)

Compared with the U.S., several other countries have the gambling industry, and some experts in the U.S. are looking to them as potential models.

For example, has a monopoly on all slot machines so it can control the types of games offered, and every gambler in the country is limited to losing 20,000 kroner (about $2,000) a month.

In the , most adults are limited to on every spin on a slot machine, and gambling companies are subject to a 1% levy that goes into a fund for treatment and prevention of gambling disorders.

Last year, a report published in the medical journal called on international health leaders to act quickly on regulations before gambling disorders become widespread and common — and that much harder to stop.

But policy leaders point out that the U.S. has less appetite for corporate regulation than many other countries, especially under the Trump administration. At the same time, they warn that doing nothing could pose a serious public health threat, especially now that sports betting apps allow people to gamble anywhere and anytime.

Fears That More Gambling Means More Addiction

Even before the marriage of online gaming and cellphones, researchers had estimated to of Americans already had a gambling disorder, and an additional 8% of people were of developing one.

Some U.S. politicians fear the problem will only get worse.

“The sophistication and complexity of betting has become staggering,” said Democratic of Connecticut. “And that’s why we need protections that will enable an individual to say no.”

Blumenthal has cosponsored the , legislation that would impose federal standards on sports betting companies.

The bill proposes a ban on gambling ads during live sporting events, mandatory “affordability checks” for high-spending customers, limits on VIP membership schemes, a ban on artificial intelligence tracking for marketing, and the creation of a national “self-exclusion” database, among other rules.

“States are unable to protect their consumers from the excessive and abusive offers, and sometimes misleading pitches,” Blumenthal said. “They simply don’t have the resources or the jurisdiction.”

The gambling industry is strongly opposed to the SAFE Bet Act. Federal standards would be a “slap in the face” to state regulators, said Joe Maloney, a spokesperson for the .

“You have the potential to just dramatically, one, usurp the states’ authority and then, two, freeze the industry in place,” he said.

‘Responsible Gaming’ Versus the Public Health Approach

New regulations are also unnecessary, Maloney said. The industry acknowledges that gambling is addictive for some people, he said, which is why it developed an outreach/awareness initiative known as “.”

That includes messages on buses and billboards warning people to stop playing when it’s no longer fun and reminding them the odds of winning are very low.

“There’s very direct messages, such as, ‘You will lose money here,’” Maloney said.

He said his industry group does not collect data on whether such measures reduce addiction rates. But he said gambling restrictions are not the answer.

“If you suddenly start to pick and choose what can be legal or banned, you’re driving bettors out of the legal market and into the illegal market,” Maloney said.

Public health leaders argue that the industry’s “responsible gaming” model doesn’t work.

“You need regulation when the industry has shown an inability and unwillingness to police itself,” said , director of gambling policy for the at the Northeastern University School of Law in Boston.

One reason the industry’s approach is “ethically and scientifically flawed” is that it puts all the blame and responsibility on individuals with a gambling disorder, Levant said. “You can’t say to a person who is struggling with addiction, ‘Well, just don’t do that anymore.’”

Harry Levant (left) and Mark Gottlieb, both of the Public Health Advocacy Institute at the Northeastern University School of Law in Boston, are advocating for stronger gambling regulations nationwide. (Karen Brown/New England Public Media)

Levant comes to the issue from personal experience. He is in recovery from a gambling addiction. A former lawyer, Levant was for stealing clients’ money to fund his betting habit. Since then, he not only has become an advocate for stronger regulations but also is a trained addiction therapist.

The American Gaming Association said it supports treatment for gambling disorders and helps pay for some referral and treatment services through state taxes. But Levant called that “the moral equivalent of Big Tobacco saying, ‘Let us do whatever we want for our cigarettes, as long as we pay for chemotherapy and hospice.’”

Instead, Levant advocates for a public health approach that would help prevent addiction from the get-go. That means putting limits on marketing and on the types, and frequency, of gambling — for everyone, not just those already in trouble.

To make his case, Levant opens his laptop and pulls up a corporate infomercial produced by Simplebet, a .

In the video, the company boasts about getting more people to gamble on sports through what’s called microbetting during live games. “We drive fan engagement by making every moment of every game a betting opportunity. Automatic, algorithmic, powered by machine learning and AI,” the voiceover said.

That’s the kind of constant engagement that promotes addiction, Levant said. (Contacted by �鶹Ů�� Health News and NPR, DraftKings declined to comment, instead sending a link to its .)

Lawmakers Want To ‘Stop the Worst Excesses’ Before the Next Gambling Trend

Some of those gambling mechanisms would be limited by the SAFE Bet Act, which Levant and his colleagues at the Public Health Advocacy Institute helped write.

But if the legislation doesn’t get through the current regulation-averse Congress, then states need to take strong action on their own, Levant said.

The Massachusetts Legislature is currently considering the “,” which would impose additional rules on sports betting companies.

“The goal is not to stop gambling entirely,” said Massachusetts state , a cosponsor of the bill. “It’s to stop the worst excesses of online sports betting.”

The MGM Springfield casino is located in the south end of Springfield, Massachusetts. (Karen Brown/New England Public Media)

The Massachusetts bill includes components of the federal legislation, such as mandatory “affordability checks.” Those would cap how much money some gamblers can lose. Affordability checks are modeled on a in the United Kingdom.

“If you’re only allowed to have two drinks, we know that you’re not going to get drunk, right?” Sabadosa said. “If you’re only allowed to gamble $100 a day because that’s an affordable amount, you’re not going to go broke. You’re still going to be able to pay the rent.”

The Bettor Health Act would also ban “prop” bets, which are wagers placed during a live game, such as who makes the first shot in basketball, or who hits the first home run in baseball.

But from sports betting rose to $2.8 billion in 2024 — a welcome source of funding for struggling state budgets. Because of that potential boost, Levant fears that state legislatures will shy away from further regulation.

States may even be tempted by the promise of additional revenue from new types of gambling, such as “iGaming.” That refers to online versions of roulette, blackjack, and other casino-style games, playable at any hour, from the comfort of home.

IGaming is currently legal in seven states, but pending legislation in other states, , could expand its markets.

“We have empathy for how hard it is for states to balance their budgets in this current political environment,” Levant said, “but states are starting to recognize that the answer to that problem is not to further push a known addictive product.”

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Wary of RFK Jr., Colorado Started Revamping Its Vaccine Policies in the Spring

John Daley, Colorado Public Radio — Tue, 07 Oct 2025 09:00:00 +0000

As Health and Human Services Secretary Robert F. Kennedy Jr.’s dismantling of federal vaccine policy continues to roil the Centers for Disease Control and Prevention, some Democratic-led states have struck out on their own, setting up new systems to help them assess the science and maintain immunization access for their residents.

Four western states — California, Hawaii, Oregon, and Washington — have created a collaborative to . Several northeastern states have done the same.

New York’s governor declared a “” that allows pharmacists to give covid-19 vaccines without a separate prescription. Minnesota made a similar change, and Massachusetts is to pay for vaccines recommended by its health department, not only those recommended by the CDC.

The changes represent a significant shift in public health authority from the federal government to the states. Traditionally, states have looked to the CDC for expertise and guidance on public health issues — including, in addition to vaccines, workplace safety, water fluoridation, vaping, and sexually transmitted infections.

Now, amid concerns that Kennedy is in vaccines and public health science, some states are charting new paths, seeking out new sources of scientific consensus and changing how they regulate insurance companies, prescribers, and pharmacists.

Colorado has been at the front of this wave. On Sept. 3, state officials issued a to let pharmacists provide covid shots .

“I will not allow ridiculous and costly red tape or decisions made far away in Washington to keep Coloradans from accessing vaccines,” said .

But Colorado’s leadership had already been clearing the way for more autonomy on vaccine policy for months.

In March, the state legislature voted to so the state could consider scientific sources other than the federal government when setting school vaccine requirements.

“You could see the writing on the wall that it was just becoming overly politicized rather than relying on actual science with this new HHS director,” said .

Mullica, who co-sponsored the new law, is a Democrat and works as an emergency room nurse in the Denver area.

Colorado is among the first states to change its laws to allow it to recommend vaccines based on sources other than the CDC. The state health board can now also consult leading medical groups, like the , , and .

“We decided to protect Colorado,” Mullica said, so it “wouldn’t be as vulnerable to political upheaval that we’re seeing right now.”

The Democratic-led legislature passed the bill in a near-party-line vote. Polis signed it into law in April, despite Kennedy’s selection last fall.

“Colorado I think is really leading the way on this,” said , a pediatrician at the University of Colorado who was part of a stakeholder group that helped craft the bill.

Higgins pointed to a , signed in May, that he said makes Colorado’s push even stronger. It deals with insurance coverage for preventive health care services, aiming to ensure state-regulated insurance plans cover the cost of some vaccines, regardless of future moves by the CDC.

“Effectively, it’s meant to help ensure that Coloradans will still have access to vaccines,” he said.

The Colorado chapter of Children’s Health Defense, the anti-vaccine advocacy group that Kennedy led before taking over HHS, did not respond to a request for comment.

Another co-sponsor of the first bill, Democratic state , said the circulation of so much false information about vaccines, including for covid, makes it important to hear from a range of trusted medical experts.

Colorado had previously looked to the CDC for scientific guidance on vaccines, particularly for children entering school. Like other states, it had tracked the recommendations of a CDC panel known as Advisory Committee on Immunization Practices.

all 17 members in June and replaced them with 12 new appointees, some of whom critics warn are vaccine skeptics and aren’t qualified to provide critical guidance for Americans.

“I think where the confusion will lie is the difference in the recommendations between the ACIP, who we traditionally defer to, and then everyone else,” said Ned Calonge, Colorado’s chief medical officer.

He expects that the national professional physician groups that Colorado is now empowered to consult will likely be aligned in their overall guidance and will “look at the last evidence-based recommendations that were provided by the ACIP” before Kennedy replaced its members.

In May, the federal government had removed covid vaccines from the list of shots recommended for healthy pregnant women and children.

But Colorado is still recommending a covid vaccine during pregnancy, Calonge said.

“There’s been no new evidence of issues of safety in that population,” . “So, we’re telling providers that our recommendation is to continue to follow the recommendation as it was in place in January of 2025.”

In on its website, the American College of Obstetricians and Gynecologists strongly recommended pregnant individuals get vaccinated against covid. “ACOG continues to recommend that all pregnant and lactating individuals receive an updated COVID-19 vaccine or ‘booster,'” it said.

Likewise, the American Academy of Pediatrics that all children from 6 to 23 months old get vaccinated against covid, as well as older children in certain risk groups.

For now, Colorado is following the same immunization recommendations it used last year.

The most recent ACIP meeting, on Sept. 18 and 19, was chaotic, with members admitting they did not understand what they were voting on and even opting to redo a vote on pediatric MMRV vaccine access. The next ACIP meeting is scheduled to take place Oct. 22 and 23 and could result in additional changes to vaccine recommendations.

Doctors and vaccine scientists have expressed alarm at the splintering national consensus on vaccines.

“There’s now going to be much more confusion and distrust of vaccines among the public,” said , a professor of pediatrics at the University of Colorado School of Medicine, who served on ACIP from 2013 to 2018.

Still, she said she’s glad Colorado is forging ahead with its own recommendations.

This article is from a partnership that includes , , and �鶹Ů�� Health News.

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Listen: The Surprising Power of Pushback When Health Insurance Won’t Pay

Jackie Fortiér — Fri, 19 Sep 2025 09:00:00 +0000

Being denied insurance coverage can be both confusing and, at times, enraging. But mounting a skillful challenge can turn a “no” into “yes.”

From confusing policy language to coding errors to shifting insurer rules, a new episode of NPR’s “Life Kit” podcast explores why denials happen and how to avoid common pitfalls.

�鶹Ů�� Health News reporter Jackie Fortiér and “Life Kit” host Marielle Segarra discuss the intricate and sometimes infuriating process of dealing with denied health claims. It’s an issue lots of people run into — but don’t necessarily talk about.

Fortiér and Segarra offer tips backed by real-life examples and expert advice, so you’ll know whom to call, what to say, and how being a pest in the right way might save you money.

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Ticks Are Migrating, Raising Disease Risks if They Can’t Be Tracked Quickly Enough

Aaron Bolton, MTPR — Thu, 18 Sep 2025 09:00:00 +0000

Biologist came to this small meadow in the mountains outside Condon, Montana, to look for ticks. A hiking path crossed the expanse of long grasses and berry bushes.

As Hokit walked the path, he carried a handmade tool made of plastic pipes taped together to hold a large rectangle of white flannel cloth.

He poked fun at this “sophisticated” device, but the scientific survey was quite serious: He was sweeping the cloth over the shrubs and grass, hoping that “questing” ticks would latch on.

Along the summer trail, ticks dangle from blades of grass, sticking their legs out and waiting for a passing mammal.

“We got one,” Hokit said.

“So that came off of this sedge grass right here,” he said. “Simply pick them off with our fingers. We’ve got a vial that we pop them in.”

Any captured ticks would go back to Hokit’s lab in Helena for identification. Most of them would probably be identified as Rocky Mountain wood ticks.

But Hokit also wanted to find out whether new species are making their way into the state.

As human-driven climate change makes winters shorter, ticks are spending less time hibernating and have more active months when they can hitch rides on animals and people. Sometimes the ticks carry themselves — — to new parts of the country.

Hokit found in northeastern Montana earlier this year. Deer ticks are infamous for transmitting Lyme disease and can infect people with .

Knowing a new species like the deer tick has arrived in Montana or other states is important for doctors.

is an infectious disease specialist at the Billings Clinic in eastern Montana. He said most patients don’t come in right after they get bitten by a tick. They usually show up later, when they start feeling sick from a tick-borne illness.

“Fever, some chills, they may just feel bad, similar to many infections we may encounter throughout the year,” he said.

It’s rare that patients connect a tick bite to those symptoms, and even more rare that they capture and keep the tick that bit them. Sorting out whether someone might have a tick-borne illness can be complicated.

Knowing what kinds of ticks are in the region will help doctors know that they might start encountering patients infected with new diseases after a tick bite, Ku said.

That’s partially why the state is on the hunt for new tick species.

“The more we know about what’s in Montana, the better we can inform our physicians, the better care you can receive,” said , a zoonotic illness and vector-borne disease epidemiologist with the Montana Department of Public Health and Human Services.

Cozart collects and tests the ticks from field surveys in Montana to see whether they are carrying any pathogens.

Hokit drags a white cloth through brush outside Condon looking for ticks. These surveys help public health officials understand where ticks are in Montana and detect new species that have migrated on large mammals like deer. Hokit found deer ticks, which are known to carry Lyme disease, earlier this year in northeastern Montana. (Aaron Bolton/Montana Public Radio)

Whether a tick can get a human sick depends on the species, but the kind of mammal it feeds on also plays a role.

“Usually it’s a rodent that might be carrying, for example, Rocky Mountain spotted fever,” she said. “So, the tick will feed on that rodent, then will get the pathogen as well.”

Because the prevalence of a particular disease can vary in mammal populations, ticks in one part of the state could be more or less likely to get you sick. That’s also important information for medical providers, Cozart said.

This kind of surveillance and testing isn’t happening in every county or state. A of nearly 500 health departments throughout the country found that roughly a quarter do some kind of tick surveillance.

Not all are equal, said , director of environmental health at the National Association of City and County Health Officials.

Field surveys can be expensive. For numerous local and state health departments, tick surveillance relies on a less expensive, more passive approach: Concerned patients, veterinarians, and doctors must collect and send in ticks for identification.

“It does provide a little information about what ticks are actually interacting with people and animals, but it doesn’t get into the weeds of how common ticks are in that area and how often do those ticks carry pathogens,” Gridley-Smith said.

She said more health departments want to start tick surveillance, but getting funding is hard — and might get harder as federal public health grants from agencies like the Centers for Disease Control and Prevention dry up.

Montana receives about $60,000 from a federal grant annually, but the bulk of that funding goes toward mosquito surveillance, which is more intensive and costly. What’s left funds trips into the field to look for ticks.

Hokit said he doesn’t have enough funding for his small team to survey everywhere he would like to in a state as large as Montana. That means he’s unable to monitor emerging populations of deer ticks as closely as he would like.

He found those new deer ticks in two Montana counties, but he doesn’t have enough data to determine whether they have begun reproducing there, establishing a local population.

In the meantime, Hokit uses data on climate and vegetation to make predictions about where deer ticks might thrive in the state. He has his eye on particular areas of western Montana, like the Flathead Valley.

He said that will help him and his team narrow down where to look next so they can let the public know when deer ticks — and the diseases they can carry — arrive.

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Medicaid Cuts Could Have Vast Ripple Effects in This Rural Colorado Community

John Daley, Colorado Public Radio — Wed, 13 Aug 2025 09:00:00 +0000

In southern Colorado’s , clouds billow above the towering mountains of the Sangre de Cristo range. A chorus of blackbirds whistle as they flit among the reeds of a wildlife refuge. Big, circular fields of crops, interspersed with native shrubs, give it a feel of bucolic quiet.

But amid the stark beauty in one of the state’s most , there was a sense of unease among the community’s leaders as Congress debated a budget bill that could radically reshape for low-income people.

“I’m trying to be worried and optimistic,” said Konnie Martin, CEO of in Alamosa, Colorado, the hub for health care services for 50,000 people in six rural counties.

Martin said Medicaid is vital to rural health care.

“I think in Colorado right now, nearly 70% of rural hospitals are operating in a negative margin,” in the red, Martin said.

The health system’s annual budget is $140 million, and Medicaid revenue makes up nearly a third of that, according to Shane Mortensen, chief financial officer for SLV Health.

The operating margin is razor-thin, so federal cuts to Medicaid could force difficult cuts at SLV. “It will be devastating to us,” Mortensen said.

is one of the state’s poorest. In Alamosa County, residents are enrolled in , the state’s Medicaid program.

It’s a lifeline, especially for people who wouldn’t otherwise have easy access to health care. That includes low-income seniors who need supplemental coverage in addition to Medicare, and people of all ages with disabilities.

Envisioning a future with deep Medicaid cutbacks leaves many patients on edge.

“I looked into our insurance and, oh my goodness, it’s just going to take half my check to pay insurance,” said Julianna Mascarenas, a mother of six. She said Medicaid has helped her cover her family for years. Mascarenas works as a counselor treating people with substance use disorders. Her ex-husband farms — potatoes and cattle — for employers that don’t offer health insurance.

Julianna Mascarenas, a mother of six, says Medicaid has helped cover health care for her family for years. (Hart Van Denburg/CPR News)

Across the state, Medicaid covers , .

That includes children in foster care.

“We’ve had 13 kids in and out of our home, six of which have been born here at this hospital with drugs in their system,” foster parent Chance Padilla said, referring to SLV’s flagship hospital in Alamosa.

“Medicaid has played a huge part in just being able to give them the normal life that they deserve,” he said. “These kids require a lot of medical intervention.”

Chris Padilla, Chance’s husband, said: “At one point, we had a preteen that needed to be seen three times a week by a mental health professional. There’s no way that we could have done that without Medicaid.”

Staff and administrators at SLV Health wonder whether federal cuts will make it hard for the system to keep its cancer center running.

“It could be pretty dramatically affected,” said Carmelo Hernandez, SLV’s chief medical officer.

The hospital in Alamosa has its own labor and delivery unit, the type of service that other rural hospitals across the U.S. . About 85% of the hospital’s labor and delivery patients are covered by Medicaid, Hernandez said.

Carmelo Hernandez, chief medical officer at San Luis Valley Health in Alamosa, Colorado, specializes in obstetrics and gynecology. He and other hospital leaders wonder if some services, including obstetrics, can survive deep Medicaid cuts. (Hart Van Denburg/CPR News)

“If we don’t have obstetric services here, then where are they going to go?” said Hernandez, whose specialty is obstetrics and gynecology. “They’re going to travel an hour and 20 minutes north to Salida to get health care. Or they can travel to Pueblo, another two-hour drive over a mountain pass.”

Tiffany Martinez, 34, was recently forced to think about that possibility after giving birth to her fourth child.

Her pregnancy was high-risk, requiring twice-a-week ultrasounds and stress tests at the hospital. She’s enrolled in Medicaid.

“Everything down here is low-pay,” Martinez said. “It’s not like we have money to just be able to pay for the doctor. It’s not like we have money to travel often to go to the doctor. So it’s definitely beneficial.”

Providing Health Care — And Jobs

With 750 workers, the health system is the . Clint Sowards, a primary care physician, said having less Medicaid funds will make it harder to attract the next generation of doctors, nurses, and other health care workers.

Certain medical specialties might no longer be available, Sowards said. “People will have to leave. They will have to leave the San Luis Valley.”

Kristina Steinberg is a family medicine physician with , a network of small clinics serving thousands in the region. She said Medicaid covers most nursing home residents in the area. “If seniors lost access to Medicaid for long-term care, we would lose some nursing homes,” she said. “They would consolidate.”

Audrey Reich Loy, a licensed social worker and SLV Health’s director of programs, said the system utilizes Medicaid “as sort of the backbone of our infrastructure.”

“It doesn’t just support those that are recipients of Medicaid,” she said. “But as a result of what it brings to our community, it allows us to ensure that we have sort of a safety net of services that we can then expand upon and provide for the entire community.”

Konnie Martin is CEO of San Luis Valley Health in Alamosa. (Hart Van Denburg/CPR News)

Seeking More Efficiency

Republicans in Congress who pushed for the big spending and tax law, which estimates suggest will result in large cuts to Medicaid, say they want to save money and make the government more efficient.

Many in the Alamosa County region “He’s potentially affecting his voter base pretty dramatically,” Hernandez said.

He said Medicaid cuts could give President Trump’s supporters second thoughts, but he noted that politics is a sensitive topic that he mostly doesn’t discuss with patients.

Sowards said he understands that some people believe the Medicaid system is ailing and costly. But he said he has grave doubts about the proposed cure.

“Losing Medicaid would have drastic repercussions that we can’t foresee,” Sowards said.

Cuts Would Create Ripple Effect

SLV Health’s regional economic impact is , with Medicaid accounting for a major part of that, Martin said.

Any Medicaid cuts would hit the health system hard, but they would also affect small businesses and their employees. The region is feeling economic stress from other changes, like recent cuts the Trump administration made to the federal workforce.

The San Luis Valley is home to the Monte Vista National Wildlife Refuge, Great Sand Dunes National Park, and other federally managed lands.

Joe Martinez, president of , said that recently laid-off federal workers are already coming to banks saying: “‘Can I find a way to get my next two months’ mortgage payments forgiven? Or can we do an extension?’ Or: ‘I lost my job. What can we do to make sure that I don’t lose my vehicle?’”

Ty Coleman, , traveled to Washington, D.C., in April to talk to Colorado’s congressional delegation. He said his message about Medicaid cuts was straightforward: “It can have a devastating economic impact.” Coleman put together a long list of possible troubles: More chronic disease and higher mortality rates. Longer wait times for care. Medical debt and financial strain on families.

“It’s not just our rural community but the communities, rural communities, across Colorado as well, and the United States,” Coleman said. “And I don’t think people are getting it.”

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