Cash-strapped Montana will be the second state to implement new federal Medicaid work rules

Montana will be the second state to implement Medicaid
work rules. (Photo by John Kakuk, Unsplash)

Despite depleted coffers, Montana is moving forward with its rollout of Medicaid's new work rules beginning on July 1. 

The state will be the second, after Nebraska, to require its residents to "prove they’re working to keep their coverage," reports Katheryn Houghton of KFF Health News. "That’s six months ahead of the federal deadline for states to implement Medicaid work rules for millions of enrollees."

The new work requirements are part of President Donald Trump's One Big Beautiful Bill Act, which Congress passed in 2025, but the onus of implementation falls on state health departments. Houghton explains, "The federal spending law requires states to check every six months whether millions of Medicaid enrollees work, go to school, or volunteer at least 80 hours a month, or qualify for an exemption."

Adding new staff and technology infrastructure to prepare for and execute work checks "takes time and money," Houghton writes. "Health policy analysts say that Montana’s budget crunch is a hint of the challenges to come nationwide."

The OBBBA also cut federal Medicaid dollars flowing to states by around $1 trillion over 10 years. The lopped-off funds represent the "largest pool of federal funding for states," Houghton explains. Joan Alker, a researcher focused on health coverage, told KFF, "States are the ones that are gonna have to do the dirty work of implementing cuts."

To address its shortfall, Montana plans to "stall rate increases for healthcare providers that were due July 1," KFF reports. However, clinicians say they need the rate bump to address staffing shortages and growing patient waitlists, which they attribute to already low Medicaid reimbursement rates.

Montana residents currently face long wait times to "access public assistance," Houghton adds. "And many can lose coverage at renewal time because of paperwork issues. … All these problems reflect a national challenge to connect people to care through strained public assistance programs."

Pennsylvania's state farm bill could serve as a blueprint for other states

Streams flow through farmland on their way to the Susquehanna River, in Union County, Pennsylvania. 
(Photo by Will Parson, Chesapeake Bay Program)

Pennsylvania hasn't been waiting for Washington lawmakers to move the stalled federal farm bill forward. In 2019, the Pennsylvania legislature passed a state farm bill that "provides farm-to-school grants, business development for farms looking to produce higher-value products, and farm workforce development," reports Lisa Held of Civil Eats. "It has been continually funded with bipartisan support — and it could serve as a model for other states."

Instead of passing a new farm bill in 2023, U.S. lawmakers have only reached agreement on repeated extensions of the expired 2018 Farm Bill; then punting, delaying, or otherwise putting the more contentious parts of a new Farm Bill on hold.

Additionally, under the Trump administration, the Department of Agriculture "has also proven willing to cancel contracts with farmers enrolled in programs funded by the federal bill," Held explains. In some cases, farmers enrolled in USDA programs were left on the hook to pay for improvements or farming changes that the USDA committed to covering through grants.

Because of its independent farm bill, Pennsylvania "is building stronger agricultural economies and communities, the kind of work a federal farm bill was designed for," Held reports. "Several other states are considering similar packages or are investing in agriculture one small bill at a time."

Even when a new federal Farm Bill is passed, it may not be what many farmers need. Pennsylvania is a state with highly diversified crops that are often left out of the national farm bill. Pennsylvania's farm bill goes further to address the unique needs of its farming communities.

“Pennsylvania has been trying really hard to create policies that broaden the reach of ag policy and include producers that have traditionally been ignored or left out," Lindsey Shapiro, a vegetable farmer and federal policy organizer for a sustainable farming company, told Held.

Many Pennsylvanians "attribute a good portion of that focus to the state’s secretary of Agriculture, Russell Redding, who has had the job for 13 (non-contiguous) years under three different governors," Held reports. "In Redding’s mind, states should start to think about their own laws as the central tool for agricultural policies, with complementary federal laws— not the other way around." 

Data portal will help policymakers and lawmakers in Tenn. 'take a deep dive into why certain rural counties struggle'

The dashboard includes research results on roughly 60 topics related to a county's quality of life.

East Tennessee State University researchers created an online dashboard containing in-depth data about the state's counties. The portal is designed to help policymakers and lawmakers "move beyond superficial data and take a deep dive into why certain rural counties struggle," reports Liz Carey of The Daily Yonder. "Of Tennessee’s 95 counties, 78 are designated as rural, and 70 counties have more than half of their residents in rural areas."

To build the Tennessee Livability Indicators Dashboard, researchers at ETSU's Center for Rural Health and Research used data collected "from various agencies about 60 topics related to the counties’ quality of life," Carey explains. Data points cover "economic development, housing, transportation, education, employment, availability of health care access, and how friendly a community is for aging residents."

Dr. Qian Huang, a research assistant professor at CRHR, told the Yonder, "By bringing these data together, we aim to equip communities, leaders, and organizations with the tools they need to make informed decisions and strengthen livability across the state."

As the state decides where federal funds from the Rural Health Transformation Program are needed most, the dashboard can provide immediate, data-informed guidance. Carey adds, "Factors covered in the dashboard, such as hospital access, teen birth rate, suicide rates, and access to dental healthcare, will also help track successes from the use of those funds."

CRHR was formed in 2019 to help build a broader understanding of and for the state's rural counties. Carey reports, "Dashboard researchers said they hoped the dashboard would be used as a model for other states to be able to drill down into data about their communities, as well."

As five states roll out 'no junk food' SNAP rules, retailers scramble to update their systems and educate SNAP users

States in green have been granted federal SNAP waivers to restrict SNAP benefit purchases. (USDA map)

State food-choice restrictions on Supplemental Nutrition Assistance Program purchases have some grocery stores in a conundrum, trying to determine which foods are allowed and which aren't.

Beginning Jan. 1, Indiana, Iowa, Nebraska, Utah and West Virginia rolled out their new "no junk food" SNAP purchase limits, but a total of "eighteen states have adopted new food-stamp restrictions," report Jesse Newman and Laura Cooper of The Wall Street Journal. As a whole, rural Americans are more likely to use SNAP benefits, but less likely to know about benefit changes because of online access limits.

Each state has limited different items and has varied its wording of restrictions, which can be confusing. For instance, in Indiana, mini-donuts can be purchased with SNAP benefits, but candy bars cannot. The Journal reports, "Grocery executives said that determining which products are food-stamp eligible and which aren’t has become a complex undertaking."

Retailers, who are working to ensure that only SNAP-allowed items can be purchased, have had "employees sifting through state-issued flow charts, scanning product bar codes and checking ingredient lists across thousands of goods in stores," Newman and Cooper explain. Allowed items have to be cataloged and entered into computer systems as well.

Beyond the labor hours needed to update their SNAP catalogs, retailers and industry groups said "guidance from USDA and many state agencies on how to implement the new restrictions has been insufficient," Newman writes.

For states that implemented their restrictions on Jan. 1, many SNAP enrollees seem unaware of the changes. Mark Griffin, chief executive of grocery chain B&R Stores, said "his company is dealing with lines at checkout counters as clerks tell longtime customers they can no longer use food stamps to buy soda or candy," the Journal reports.

The SNAP changes are part of a federal push to help Americans make healthier dietary choices; however, opponents to SNAP restrictions point out that "limiting grocery options ignores the real causes of poor diets, such as low incomes, high food prices and access to healthy food," the Journal reports. Last month, the Trump administration unveiled new dietary guidelines that it hopes can address some of the chronic diet-related diseases in Americans.

South Dakota lawmakers grapple with Rural Health Transformation funding and sustainability

Monument Health in Rapid City, S.D., will receive RHTP funding.
(Photo by Seth Tupper, South Dakota Searchlight)

Legislative and practical worries about staffing and sustainability have some South Dakota lawmakers worried that the $189.5 million the state received from the Rural Health Transformation Program won't be enough to strengthen its rural hospitals in the long term, reports Makenzie Huber of South Dakota Searchlight.

Sen. Taffy Howard, R-Rapid City, has "questions and frustrations about the funding," Huber writes. Because of the way RHTP is structured, if South Dakota lawmakers don't spend the money, "another state will spend it instead."

South Dakota's RHTP application targeted 10 initiatives, including "creating a 'data atlas' for providers and facilities to share local and state agency data, improving the rural health care workforce, improving chronic disease management, establishing regional maternal and infant health care hubs, and regionalizing behavioral health care," Huber explains. 

To support its initiatives, the state's plan includes numerous incentives designed to attract and keep needed medical staffing, such as "sign-on bonuses, relocation assistance, and rural service stipends," Huber writes. Medical professionals who accept incentives must work in their assigned rural community for at least five years.

In reviewing all the initiatives, several lawmakers "asked questions about workforce needs and how those would be addressed outside of the incentives mentioned," Huber reports. "Howard told officials that she’s skeptical about the proposal and its sustainability." Howard pointed out that infant care hubs and mental health treatment may need more than "one-time funding to operate in financially strapped rural communities."

While state lawmakers are hopeful RHTP funding can sustainably improve rural health care, many remain concerned about what the loss of federal Medicaid dollars will mean for many rural patients and hospitals. 

Rep. Erik Muckey, D-Sioux Falls, told Huber, "This still doesn’t answer the question about how to sustain quality health care going forward because of massive cuts to Medicaid.” 

A small university town in southern Illinois 'leads the nation in out-of-state abortion patients'

Adobe Stock photo

Surrounded by farmland and the vast wooded expanses of the Shawnee National Forest, Carbondale, Illinois, has become a central hub for abortion access. 

The small-sized town, which is home to Southern Illinois University Carbondale, is within “driving distance of 10 states with abortion bans,” reports Elizabeth Williamson of The New York Times. “Last year, there were nearly 11,000 abortions in this city of 21,000.”

After the Supreme Court overturned Roe v. Wade, 14 states have banned the procedure. Those bans made “geography an all-important factor in access to the procedure,” Williamson explains. “And placed Carbondale, a liberal enclave in a deeply conservative region, in a complicated position.”

Unlike many of its neighboring states, abortion remains legal in Illinois. Carbondale's location near the southern tip of Illinois makes travel from states such as Missouri, Indiana, Kentucky, Mississippi and even Louisiana possible for women seeking the procedure. Williamson writes, “Illinois now leads the nation in out-of-state abortion patients.”

Although many Carbondale residents support “its status as a safe harbor. . . the sheer number of abortions has also created some unease and worry about a backlash,” Williamson explains. 

One community member told Williamson she was concerned about the negative attention the high number of abortions could bring to the otherwise “quiet community.”

Carbondale has three women’s clinics that perform abortions, but two of the three provide other women’s health services. “Alamo Women’s Clinic only does abortions, both procedural and medication, all on-site,” Williamson reports. “Fewer than five percent of Alamo patients are from Illinois.”

While details of rural health transformation requests aren't available yet, some states are sharing their information

KFF News RHTP tracking map as of Dec. 2. Click to enlarge.

The newly formed federal Rural Health Transformation Program has $50 billion to distribute to states that met its Nov. 5 application deadline; however, a complete picture of which states applied and what they asked for isn't clear because the Centers for Medicare & Medicaid Services have "declined to publicly release the applications," report Sarah Jane Tribble and Arielle Zionts of KFF Health News.

CMS said it isn't allowed to "release grant applications to the public during the merit review process,” KFF News reports. "They've pledged to announce the allocations by Dec. 31."

RHTP was passed as part of the One Big Beautiful Bill Act in July, which drastically cut Medicaid spending and will disproportionately impact rural areas. But RHTP can't be used to "bail out" rural hospitals or clinics. KFF News explains, "The money [must] be spent on transformational ideas."

Although CMS isn't sharing application details, some states have been transparent about their applications. According to the article, a health strategy team at Princeton University tasked with tracking state application summaries found "themes including expansion of home-based and mobile services, increased use of technology, and workforce development initiatives . . ."

KFF Health News is collecting state-by-state application materials and adding them to its mapped repository, which will be updated as information arrives. 

Farm-to-prison programs can provide inmates with healthier food, support area farmers and cut some state food costs

Farm-to-prison food can sometimes help states save money.
(Graphic by Adam Dixon, Offrange)

A small but growing number of programs are working to create farm-to-prison pipelines that provide fresher food to inmates while supporting area farmers. "Using nutritious, local ingredients in a prison setting to cook food from scratch is far from the norm," reports Liz Susman Karpfor for Offrange. "A handful of correctional facilities throughout the country are reshaping the unhealthy, tasteless, even toxic diet that has historically been served to people in prison."

In states such as Vermont and Maine where department of corrections are using farm-to-prison and made-from-scratch programs, the objectives are better inmate rehabilitation outcomes, overall inmate health improvements and food cost savings. 

DOC offices that want to begin farm-to-prison initiatives should start by getting support to work through procurement processes. Karpfor explains, "Each state possesses different, often cumbersome, and poorly understood procurement policies."

While some DOC officials may believe farm-to-prison food will be expensive, many times it saves the state money. The Mountain View Correctional Facility in Maine uses flour milled in the Northeast and bakes many of its bread items from scratch. Karpfor reports, "Baking a sub roll in-house costs 5.8 cents, versus 33 cents for one purchased via a state contract."

Kyle Moore, who is the food service manager at the Marble Valley Regional Correctional Facility in Rutland, Vermont, "sometimes purchases seconds or an oversupply at lesser cost," Karpfor writes. "His staff is testing products from Salvation Farms, an enterprise using agricultural surplus to build a resilient food system in Vermont."

Michigan and Oregon have "developed high-quality kitchen and gardening apprenticeships in which participants receive certifications and can sometimes be paid," Karpfor adds. While the list of states using farm-to-prison models is small, over the past five years it has grown "exponentially."

Fund with $50 billion for rural hospitals got off to a rough start; experts predict the money won't be enough

Delays, last-minute changes and a poor rollout have already plagued the newly created $50 billion rural hospital fund GOP lawmakers put together to pass the One Big Beautiful Bill Act. But analysts predict the "money to be spent over five years is less than the estimated $137 billion in cuts to rural health systems over 10 years," reports Aneeta Mathur-Ashton of U.S. News & World Report.

The Rural Health Transformation Program was designed to help rural hospitals weather Medicaid cuts included in the GOP's package and support longer-term cybersecurity and infrastructure improvements hospitals need to stay afloat; however, fund critics say the program is a short-term solution for a long-term problem.

States that receive RHTP grants must use the funds for at least three purposes outlined by the Centers for Medicare & Medicaid Services (CMS), including "promoting care interventions, paying for health care services and expanding the workforce," Mathur-Ashton explains.

As rural hospitals receive funds, they will need to apply them carefully. Alan Morgan, chief executive officer of the National Rural Health Association, "praised the fund as a 'fabulous program that hopefully, if done correctly, can transform rural health going ahead, to a sustainable model,'" Mathur-Ashton writes.

Some Democrats consider the $50 billion to be a slush fund with unclear guidelines that can't undo the harm planned cuts will cause. "The bill gives [CMS] the authority to determine which applications to approve and deny, but does not spell out the criteria it should be using to do so," Mathur-Ashton reports. 

Rural health advocates say they want states to apply for RHTP, but many are pushing to have the $150 billion in Medicaid cuts rescinded. Morgan told U.S. News, "Congress either later this year or next year, is going to have to repeal those cuts for rural hospitals, or you're just going to see hundreds of rural hospitals close. It's non-workable.”

Quick hits: Newspaper sitcom; free child care; inspiring cave cleanup; soybean field discovery; dark sky ruminating

Can a sitcom about journalism capture its 'grit, humanity, and relentless optimism'?

Keeping a local newspaper alive is one thing, but revitalizing one staffed with employees who list texting and tweeting as their most recent writing ventures is an entirely different story. Meet Peacock's new mockumentary, "The Paper," which depicts the life and times of the struggling Toledo Truth Teller newspaper and its quirky staff. "Members of the news community weren’t sure whether to laugh or cry," writes Gretchen A. Peck of E&P Magazine. "For publishers and editors. . . the [show] raises big questions: can a sitcom capture the grit, humanity, and relentless optimism of real journalism?" The trailer is here.

New Mexico will be the first state in the union to offer free child care to all its families, regardless of income. "The state has been working to lower child care care costs since 2019, when it created the Early Childhood Education and Care Department," reports Chabeli Carrazana of The 19th. The new policy rollout in November will allow all families access to the state’s child care assistance program without meeting eligibility criteria and will remove any copay requirements. Families are expected to save an average of $12,000 per child.

Hidden River Cave's kaleidoscope-like Sunset
Dome is a popular tourist attraction.

What was once a heavily polluted cave in Horse Cave, Ky., is now a point of community pride and a tourism draw. "For generations, the cave was all but lost to the town on top of it. Miles of caverns and waterways brimmed with sewage that sent a putrid stench up from the depths and across downtown," reports Hiroko Tabuchi of The New York Times. "The restoration of Hidden River Cave is one of the most remarkable examples of a cave cleanup. . . . Last year, 30,000 people, more than 10 times the town’s population, toured the cave."

Some ranchers prefer the beaverslide for stacking hay.
(Photo by Linda Teahon, Offrange)

No need to purchase fancy machinery to stack hay bales -- a beaverslide is much cheaper and simpler to own. "The haystacking device consists of a wide, sliding fork at the base of a ramp and a cable pulley system rigged to the ramp’s underside," explains Katie Hill for Offrange. "Ranchers use a team of horses or a motorized vehicle to pull one of the cables perpendicular to the beaverslide, which in turn hoists the fork up the ramp, bringing a giant pile of hay up with it. . . .At the top of the ramp, the hay falls to the other side, forming three-story piles that can reach 25 tons in weight."

It hadn't been seen or touched by humans for 2,000 years, but this summer, artifact hunter Ben McGhee unearthed the discovery of a lifetime: "A hoard of 51 Native American blades buried in a Missouri soybean field," writes Chris Bennett of Farm Journal. "Based on the location, and the lack of percussion flakes or hammer stones within immediate proximity, McGhee believes the cache was transported to its present location, close to the water’s edge, for trade access." Native Americans traded the blades, which could be more precisely carved into arrowheads.

Glacier National Park is an International Dark Sky Sanctuary. Visitors can see the Milky Way from St. Mary’s Glacier, pictured here. (Photo by Ray Stinson, National Park Service)

In places where the cover of night is treasured, skies filled with stars, glowing planets and the Earth's solitary moon light the way. For many people, dark skies offer a window into thoughtfulness and mystery. "There is a feeling of possibility, timelessness, and, potentially, of fear, in the night sky," writes Sarah Melotte of The Daily Yonder. Some rural places "claim the preservation of dark skies as a core value. They protect a visitor’s experience of wonder and mystery. . . There are 152 dark sky 'places' in the continental United States." Find dark skies here. 

Emergency departments in some rural areas don't have 24/7 on-site physician coverage

A hospital in Ekalaka, Mont., sits at the intersection of two dirt roads. 
(Photo by Arielle Zionts, KFF Health News) 

Many rural emergency rooms are no longer run by attending physicians, but instead depend on care by nurse practitioners and physician assistants. "A recent study found that in 2022, at least 7.4% of emergency departments across the U.S. did not have an attending physician on-site 24/7," reports Arielle Zionts for KFF Health News. "More than 90% were in low-volume or critical access hospitals — a federal designation for small, rural hospitals."

The 2022 report represents "82% of hospitals that responded to a survey sent to all emergency departments in the country, except those operated by the federal government," Zionts writes. "The study is the first of its kind, so there isn’t proof that such staffing arrangements are increasing, said Carlos Camargo, the lead author and a professor of emergency medicine at Harvard Medical School."

The idea of an emergency department without a doctor on staff remains controversial, and not all states allow it. "Some doctors and their professional associations say physicians’ extensive training leads to better care, and that some hospitals are just trying to save money by not employing them," Zionts explains. Indiana, Virginia, and South Carolina have passed laws that require all their EDs to have a 24/7 physician on-site.

Even when states require their EDs to staff a round-the-clock doctor, that doesn't make finding one easy. "In the Dakotas, more than half of emergency departments were running without 24/7 attending physician staffing," Zionts reports. In response to the regional shortage, Sioux Falls-based Sanford Health launched an emergency medicine residency to help increase its ED physician numbers.

Some rural health advocates say lawmakers need to be sure that employing full-time ED physicians 24/7 is feasible for their region before passing legislation that requires it. Zionts adds, "Camargo said some doctors say that if lawmakers are going to require 24/7 on-site physician coverage in ERs, they need to pay to help hospitals implement it."

States are already seeing their digital equity grants get canceled, and the divide hurts rural communities more

The program designed to erase the digital divide has
disappeared from the NTIA website. (Adobe photo)

Not long ago, rural hubs were burgeoning with plans and dollars directed at leveling the digital divide, but things have changed quickly. "Within days of President Donald Trump announcing on social media that he was ending the federal digital equity grant program, it looks to be consigned to history," reports Chris Teale of Route Fifty. The program's information has disappeared from the National Telecommunications and Information Administration’s website.

States are already seeing their funding cut. Aaron Wheeler, director of Washington state’s broadband office, said last week that "he had received a letter cancelling its $15.9 million grant award," Teale writes. During a press conference with Democratic U.S. Sen. Patty Murray, Wheeler said, “[Losing the funds] undermines our digital equity plan’s goals and perpetuates existing disparities that fall most heavily on our state's rural communities."

Maine had $35 million in grants canceled. The funds were intended "to help the state build digital skills and online safety, especially for rural and low-income residents, veterans and small businesses," Teale reports. "The state said 130,000 people would have been served by the three grants."

The State Educational Technology Directors Association said "at least 20 [states] have seen planning and capacity grant funding pulled by NTIA in light of the president’s order," Teale adds. Murray, "the architect of the Digital Equity Act, said during last week’s press conference that she wants her colleagues to step up, or else legal action could ensue."

Ohio could end tainted public subsides for failed coal plants, but lawmakers add a catch to their new energy plans

The bailed-out coal plants were built in the 1950s.
(Adobe Stock photo)

The Ohio legislature finally overhauled subsidies for two failing coal mines that have cost state taxpayers $400,000 per day since 2019. The hefty charges originated in the state's infamous House Bill 6 energy bill that grew into the "largest corruption scandal in state history," reports Julie Carr Smyth of The Associated Press.

House Bill 15 would rid Ohio consumers of the "legacy generation rider” contained in House Bill 6 for the Ohio Valley Electric Corp. "The Ohio Senate passed its version of the legislation in a rare unanimous vote Wednesday, before sending it back to the Ohio House," Smyth explains. "The bill goes next to Gov. Mike DeWine, whose office said he is reviewing the amended measure."

Beyond ending expensive subsidies, the bill "requires utilities to routinely come in for rate cases and justify how they spend ratepayer-collected money," Smyth reports. It contains a loan program to lower energy costs for public schools and ensures consumers are refunded for incorrect charges.

The subsides' corruption history is one that current Ohio lawmakers have sought to decry and erase. State Rep. Casey Weinstein's commented on the scandal saying: "It was an outrageous misuse of public funds — sending hundreds of thousands of dollars a day to an aging coal plant in Indiana. Putting an end to that is a victory for ratepayers across the state."

Even as lawmakers cheer their success, the state's new energy bills are being met with mixed responses. Cathy Cowan Becker writes in her opinion for the Ohio Capital Journal, "Ohio could finally see the end to some of the worst aspects of 2019’s House Bill 6 — which David Roberts of Vox called 'the worst energy bill of the 21st century.'"

As Becker writes, "That is great news — but it [could] come at a high cost. Instead of bailing out coal and nuclear plants, Ohioans could find themselves living next to large gas plants, pushed through a fast-track approval process without local approval, supplied with gas from fracking our parks."

With little notice and no public debate, lawmakers closed a rural school district with a property tax reform bill

Rep. J.D. Prescott defends his reasons for closing USC
 at a public meeting. (Photo by Eric Weddle, NPR)

School officials and parents were shocked to learn Indiana lawmakers quietly closed their rural school district without public debate. "Tucked into a sweeping property tax reform bill with little public notice, the closing of Union School Corporation came as a surprise to nearly everyone except the lawmaker who wrote it — Rep. J.D. Prescott, a Republican from Union City, Ind.," reports Rachel Fradette of NPR, Indianapolis.

Located in tiny Modoc, Indiana, Union School Corporation educates roughly 7,500 students through its virtual programs, with around 290 students attending class in person. Fradette writes, "Under Indiana’s new property tax reform law, it will be dissolved in 2027 and the area (redistricted) among other school corporations."

At a town meeting just days after the bill passed, residents questioned Prescott about the lack of notice. Prescott told them, "The legal process was followed." Fradette reports, "Prescott told the crowd a combination of factors led him to write the legislation: prior years of discussion about district consolidation; more than half of families who live in the Union boundaries choosing to enroll their children in other districts; and poor academic performance at the virtual schools."

The closure, which was wrapped into Senate Enrolled Act 1, has been signed by Indiana Gov. Mike Braun. And while this isn't the first time Indiana lawmakers have stepped in to help struggling schools, those instances included public notice and debate. Chris Lagoni, executive director of the Indiana Small and Rural Schools Association, "said this is the first time in 50 years a school district has been closed by state mandate," Fradette writes. "District leaders now wonder if the state is applying new academic expectations to justify future closures."

Some school officials believe the district's wealth and number of virtual learners may have pegged it for closure. Superintendent of Union Schools Galen Mast "believes Union was targeted in legislation because their virtual schools attract students from other districts and charter schools," Fradette explains. "In Indiana, state funding follows the student. So if a student leaves. . . there is less funding for the home district to cover academic programs and teacher pay."

Union school officials and supporters plan to legally challenge the closure. Mast told Fradette, “We've been here for 70 years. Our intent is to be here for another 70 years.”

A program to expand broadband services in U.S. faces review; many state and local leaders want it to be 'left alone'

Providing every American with broadband access 
is the BEAD program's goal. (Adobe Stock photo)

After Commerce Secretary Howard Lutnick committed to a 'rigorous review' of the country's $42 billion Broadband Equity, Access and Deployment program, or BEAD, last week, House Republicans lined up at a House subcommittee meeting to complain about the program's failure to provide "internet for all," reports Chris Teale of Route Fifty. Despite those complaints, the program still has solid bipartisan support from those who want BEAD to continue to evolve.

When it comes to congressional calls to scrap the program, state and local leaders have a simple "message for the federal government, Washington, D.C. and Congress: 'Leave it alone; let the states do what they've done,' Missouri State Rep. Louis Riggs, a Republican, told Teale. "'The feds could not do what the states have done. . . . Trying to claw that funding back and stand up a new grant round is the worst idea I've heard in a very long time, and that's saying a lot coming out of D.C.'"

While many Republicans bemoaned the program's red tape and slow roll-outs as failures, others saw opportunities to allow the program to adapt along a learning curve. "In a statement after Lutnick’s announcement, Sen. Shelley Moore Capito, a West Virginia Republican, said she favors 'improving the program,' but does 'not want to see West Virginia wait longer than is necessary or have to redo their proposals and application,'" Teale reports. 

Accurate mapping has slowed BEAD disbursements; however, "there has been more movement in several states as Delaware, Louisiana and Nevada have started making grant awards," Teale explains. "Others are hesitant amid the federal uncertainty, however, including Texas, which paused its digital equity program early this month."

Medicaid cuts could 'close maternity services and shutter struggling facilities' across rural America

When a rural hospital closes, it hurts the entire
community. (Adobe Stock photo)

The massive federal Medicaid cuts currently under consideration "could devastate America’s teetering rural health care system," reports Lauren Weber of The Washington Post. "Rural hospitals across the United States fear [the cuts] could decimate maternity services or shutter already struggling medical facilities in communities that overwhelmingly voted for Donald Trump."

Any significant cuts to federal Medicaid dollars will end in health care sacrifices for rural Americans. "Rural hospital leaders in Arkansas, Colorado, Kansas, Mississippi, Missouri and Texas warned that the enormous cuts congressional Republicans are weighing could further destroy limited health care access in rural America," Weber explains. Regardless of insurance status, the loss of a rural medical treatment center or clinic hurts all rural residents.

Benjamin Anderson, chief executive of Hutchinson Regional Healthcare System, which runs a rural hospital in Kansas, told Weber, “Every nickel matters. It will cripple and close the health-care delivery systems that serve everyone.”

Medicaid may have the reputation as urban population service, but the reality is that "rural children and non-elderly adults are more likely to rely on Medicaid or the Children’s Health Insurance Program than those in metro areas," Weber reports. "Even if rural facilities manage to stay open but are forced to cut Medicaid-heavy services such as nursing homes or obstetrics care, more rural Americans — and Republican voters — will be left to deal with the consequences."

The president has "repeatedly said he will not touch Medicaid," Weber writes, "But he has also endorsed the House’s plan to find ways to cut spending across federal programs, which are expected to come out of the Medicaid program if lawmakers avoid cutting Medicare or Social Security."

Republicans have repeatedly promised Medicaid cuts that will reduce fraud and waste, but those reductions won't come close to the $880 billion in reductions Trump wants. Still, some believe that rural hospitals -- and the jobs they provide small-town economies -- will survive the cuts. Weber adds, "With broad support for rural hospitals, there are likely to be carve-outs to protect them in a Republican reconciliation bill, said Brian Blase, an influential voice in the Medicaid debate." 

The 'right-to-repair' movement continues to gain traction. Its coalition runs a know-your-rights program open to all.

Six states have passed right-to-repair laws.

Whether it's fixing a broken cell phone or a car, many Americans have been fighting for their "right-to-repair" purchased products without industry restrictions, reports Iris Kim of NBC News. Historically, manufacturers of items such as computers, cars and tractors have used copyright law to prevent consumers from seeking repairs outside of the manufacturer's "licensed or company" representatives.

As U.S. consumers became more aware of right-to-repair benefits, including cheaper and quicker repairs, more states have passed laws to "protect consumers’ ability to repair or modify their products instead of having to go through the manufacturer," Kim explains. "As of March, right-to-repair bills had been introduced in all 50 states, and 20 state legislatures are currently debating such bills."

State laws differ on right-to-repair products and allowances. "Some narrowly target automobile manufacturers while others are broad enough to cover all consumer electronics," Kim writes. "Though bipartisan federal legislation for automobile repair stalled last year, it was reintroduced last month."

The U.S. right-to-repair movement has faced staunch corporate resistance because manufacturers have capitalized on repair revenue. Kit Walsh, a director at the nonprofit rights group Electronic Frontier Foundation, told Kim, "Manufacturers will always try to figure out another means of restricting independent repair because it’s a very lucrative market for them."

The Right to Repair Coalition "runs a know-your-rights program where people can check what laws are enforced in their state," Kim reports. "If the manufacturer of a product is not in compliance with the law, consumers can fill out a form that sends a direct complaint to the state attorney general’s office."

Medicaid cuts will hurt rural Americans. If Congress doesn't shrink Medicaid, how can $4.5 trillion in tax cuts be made?

Republican lawmakers had planned to
cut Medicaid to help balance tax cuts.

The health of many rural Americans depends on Medicaid coverage, but that safety net seems to be threatened as Republican lawmakers plan to slash Medicaid spending to pay for President Donald Trump's planned massive tax cuts. Meanwhile, during a recent interview, Trump insisted that Medicaid isn't on the federal budget chopping block, reports Margot Sanger-Katz of The New York Times.

"Trump said Tuesday night on Fox News that he wouldn’t make cuts to Medicaid, the federal-state health insurance program that mostly covers poor Americans," Sanger-Katz writes. "But making substantial cuts to Medicaid is a key part of congressional Republicans’ plan to extend the tax cuts."

Small Towns/Rural Areas include non-metropolitan counties with no urban areas of at least 50,000 residents. (Georgetown University map, from 2022-2023 American Community Survey data)

Medicaid decisions matter for small-town America where in 2023, 40.6% of children were enrolled in Medicaid/CHIP compared to 38.2% in metro areas. Lawmakers' suggested reductions would also hurt rural non-elderly adults covered by Medicaid. Mike Johnson, the House Speaker, "has been hard at work on a major bill that can balance various priorities of Trump and his caucus," Sanger-Katz explains. "The budget Johnson negotiated calls for around $880 billion in cuts to Medicaid. . . . Trump’s comments may make that carefully negotiated package moot."

Over the past four years, Trump repeatedly promised to leave Medicare relatively untouched. "But he has always been more open to changes to Medicaid, which has become the biggest health insurance program in the country," Sanger-Katz reports. Since Trump's first term, the program has grown to cover 72 million Americans, including 7.2 million low-income seniors.

If Republican lawmakers move to shrink Medicaid spending, the fallout won't only impact individuals and families. It will complicate state budgets that are dependent on federal Medicaid dollars. Sanger-Katz adds, "Cuts would put fiscal pressure on Republican governors, not just poor patients who need help paying for their health care."

If Congress leaves Medicare, Medicaid and Social Security spending at their current levels, it's unclear how Johnson can produce a budget that includes Trump's "desire for $4.5 trillion in tax cuts," Sanger-Katz reports. "Hitting the target without Medicaid cuts would mean revising the bill’s language as well as enormous cuts to remaining programs."

Southern states spend millions on new clinics to serve rural residents. It's one way to avoid federal Medicaid expansion.

Clemson Rural Health serves rural Walhalla, S.C.
(Clemson University photo via KFF Health News)

Southern states made rural health a focus, but the sector's trendiness hasn't translated into Medicaid expansion plans. "State lawmakers nationwide are spending millions of dollars to address a rural health care crisis long in the making," reports Lauren Sausser of KFF Health News. For more than a decade most Southern states have refused billions in federal funds that would provide public health insurance coverage to more low-income adults."

Among the 10 states that refused Medicaid expansion, some have developed their own approaches to addressing rural health disparities with state dollars. Clemson Rural Health in South Carolina is a small primary care clinic run by Clemson University that "attempts to fill [rural health care] gaps by providing primary care. . .for uninsured patients free of charge or at reduced rates," Sausser explains. Clemson's clinic receives the largest part of its funding from the state Department of Health and Human Services.

Jonathan Oberlander, a professor and health policy scholar at the University of North Carolina, said "he doesn’t expect to see any of the remaining states rushing to fully expand Medicaid," Sausser writes. "Oberlander said conservative lawmakers often consider projects such as building new rural clinics more politically palatable than expanding Medicaid coverage."

Other southern states have followed suit. "The University of Georgia established a new medical school, partly to send more physicians into underserved and rural areas," Sausser adds. "The Georgia General Assembly kicked in half the cost of a new $100 million building for medical education and research in Athens. . . .The Tennessee General Assembly passed a budget last year that included $81 million for a variety of rural health initiatives." 

States promised opioid settlement spending transparency, but many have already strayed from commitment

When states and local governments anticipated billions in opioid settlement dollars, 12 states committed to 100% spending transparency, "promising annual reports 'specifying the activities and amounts,' they have funded," reports Aneri Pattani of KFF Health News. "But many of those reports remain difficult, if not impossible, for the average person to decipher."

Idaho settlement dollars are an example. The attorney general’s website hosts "more than 90 standardized spending reports from state and local entities. Sounds great. But in reality, it reads like this: 'In fiscal 2023, the city of Chubbuck spent about $39,000 on Section G, Subsection 9.' Cracking that code requires a separate document," Pattani explains. "The Idaho attorney general’s office, which oversees the state’s opioid settlement reports, did not respond to requests for comment."

New Hampshire has a different transparency problem. "The state government controls 85% of the state’s settlement funds and posts reports from grant recipients on its opioid abatement website," Pattani reports. "The reports explain the projects and populations served but lack a key detail: how much money each organization received."

Accessing dollars and cents details means searching through "the opioid abatement advisory commission’s meeting minutes, which date back several years" or other state government meetings and notes.

Graph by Aneri Pattani and Lydia Zuraw, KFF Health News and Christine Minhee, OpioidSettlementTracker.com

Idaho and New Hampshire aren't the only states falling short of their commitment. Other states have zero reporting, even though many residents are asking for the information. Pattani writes, "One of the loudest and most frequent questions from the public has been: Where are the dollars going? Victims of the crisis, along with their advocates and public policy experts, have repeatedly called on governments to transparently report how they’re using these funds, which many consider 'blood money.'"

Of the 12 states that promised spending accountability, seven have "reported 100% of their expenditures in a way that is easy for the public to find and understand," Pattani reports. "There are also states such as Indiana that didn’t originally promise 100% transparency but are now publishing detailed accounts of their expenditures."

Sharing settlement spending information not only helps the public hold state and local officials accountable for their spending choices, but it can also foster hope. Norman Litchfield, the director of addiction medicine at St. Luke’s Health System in Idaho, told Pattani, "A lot of people simply are just not aware that these funds exist and that these funds are currently being utilized in ways that are helping."