Charlotte Cravins’ son Landry turned 2 in January. He’s a smiley little boy who loves singing “Itsy Bitsy Spider” and recently got his first pair of glasses.

Landry was born with Down syndrome and has impaired vision. He receives publicly funded therapies that have helped him learn to crawl, to pull himself up to stand, and to use American Sign Language.

Landry lives with his parents and sister in Baton Rouge, Louisiana, one of the eight states whose attorney general has chosen to remain in a lawsuit challenging a federal rule that protects accommodations for people with disabilities. States are asking a federal court in Texas to declare unconstitutional a part of federal law that requires states to provide services to disabled people in their communities, rather than in institutions, when appropriate.

Cravins, an attorney, has followed the case with increasing concern. If the states succeed, that could strip disabled people like her son of the right to publicly funded services that allow them to live in their own homes and neighborhoods, and instead push them into institutions such as state hospitals and nursing homes.

“Landry is a part of our family, a part of the community,” she said, “and to present his involvement in our family and in our community as a burden is unconscionable.”

The lawsuit is unusual. It began in 2024 with 17 Republican-led states suing the Biden administration over its inclusion of gender dysphoria as a protected disability under a portion of federal law known as Section 504. The states also challenged the constitutionality of Section 504 itself.

But the suit has since morphed into something different.

After President Donald Trump was reelected and his administration made clear it would not enforce the Biden rule protecting gender dysphoria, eight states pulled out of the lawsuit. Their attorneys general scrambled to distance themselves from it, amid a swift backlash from the disability community that warned the suit imperiled federal protections for all people with disabilities.

But in a surprising move, nine states chose to stick with the lawsuit anyway, and in January amended their complaint.

They’re now asking the court to strike down a part of Section 504 that requires states to provide disabled people with services in their communities whenever possible, rather than in institutions such as state hospitals and nursing homes.

It’s a maneuver that has shocked many in the disability rights community. Those who spoke with Stateline said they have not received answers from public officials about why the states are still pursuing the lawsuit after the Trump administration removed federal protections for gender dysphoria.

The Republican attorneys general from the states involved either did not respond to Stateline’s requests for comment or referred Stateline to Texas Attorney General Ken Paxton, who is leading the lawsuit. Paxton did not respond to Stateline’s request for comment.

Last week, a few days after Stateline reached out, Indiana dropped out of the lawsuit, leaving eight states remaining.

Indiana Attorney General Todd Rokita, a Republican, said he remains concerned about “federal overreach into traditional state matters” but felt that Trump’s move in December to officially exclude gender dysphoria from Section 504 protections meant the lawsuit’s core objective had been reached.

“Our goal in this lawsuit was to remove President Biden’s ridiculous addition of gender dysphoria as a disability, which risked jeopardizing services for those who truly need them most,” Rokita said in a statement. He noted he has a child with a disability; his son has Angelman syndrome, which causes developmental delays.

But eight other states are pushing forward with the lawsuit: Alaska, Florida, Kansas, Louisiana, Missouri, Montana, South Dakota and Texas.

Cravins, Landry’s mom, said she feels misled by Louisiana Republican Attorney General Liz Murrill, because Murrill initially framed the case as being about the inclusion of gender dysphoria and has not responded to questions about why her state remains involved after that’s no longer an issue.

“Other states left the lawsuit. Louisiana didn’t. Why?” Cravins asked. She said she’s written an open letter to Murrill about the case, with no response. “At this point, it seems that her issue is people with disabilities living in the community.”

States say in their revised complaint that updates to Section 504 unfairly restrict how they’re able to spend money and prevent them from deciding how best to care for their own residents. They say their budgets, strained by rising costs and workforce shortages, can’t always accommodate expensive service changes required by the law, and that with smaller Medicaid budgets they’re having to make hard choices. Removing the law’s “integration mandate” would give them more flexibility.

Disability rights advocates respond that if the court strikes down the integration rule, it will be harder for people with disabilities to get services in their communities. States won’t be required to provide those as a condition of receiving federal money.

And they worry the states’ efforts signal a return to darker times, when disabled people were hidden away, warehoused in institutions and far from family and friends.

“The reality is, the world was not built with us in mind, and there are people who would rather us not be here,” said Kaleigh Brendle, an advocate and college student who launched a nonprofit to push back against efforts to defang Section 504. “Us existing in the world makes people uncomfortable, with our braces, our canes, our wheelchairs, our differences.”

Nonpartisan, until recently

For decades, disability issues were largely nonpartisan. The two most consequential landmark federal disability rights laws were signed by Republican presidents: Richard Nixon signed the Rehabilitation Act — which includes Section 504 — in 1973; George H.W. Bush signed the Americans with Disabilities Act in 1990.

The requirement that states provide services for disabled people in their communities comes from the landmark 1999 Olmstead v. L.C. ruling by the U.S. Supreme Court. Advocates hailed that decision as a civil rights victory that has helped shift disability care from institutional “warehousing” to integrating disabled people into the fabric of their communities.

“Now the states’ lawsuit seeks to upend all of that,” said M. Geron Gadd, a senior attorney with the National Health Law Program who focuses on disability rights cases.

Gadd said that as a litigator, she’s seen states shift how they fight disability-related cases: Instead of disputing how laws apply in specific situations, states are increasingly challenging the thrust of the laws themselves.

“States seem to be much more offended by having to conform their programs and services to basic requirements of disability law,” said Gadd. And, she added, “it seems to have become politicized in ways that it had not been for decades.”

State efforts have echoed those at the federal level.

The Trump administration has been pushing a rule change that would penalize disabled adults who live with their families and deduct the value of their bedroom from the amount they receive in federal benefits. Last year, Trump administration officials abandoned a proposal to cut disability benefits for older workers after news reports and public outcry. The efforts have been made in the name of government efficiency and reducing red tape, particularly in safety-net programs.

And in April, the U.S. Department of Justice delayed a Biden-era deadline — based on the Americans with Disabilities Act — for state and local governments to update their web content to make it accessible for people with disabilities.

Disability rights advocates say the conservative-led states and the U.S. Department of Health and Human Services they are suing feel like two sides of the same coin, with disabled people and their families caught in the middle of the case, without a champion.

‘Something to fight back’

When Kaleigh Brendle was 17, she joined four other vision-impaired high school students in challenging a decision by the College Board — which administers Advanced Placement tests — to replace hard-copy Braille exams with a digital format during the COVID-19 pandemic.

They were successful. Brendle’s experience then, as well as her experiences pushing to get the accommodations she needed in school, drove her to advocate for disability rights nationally.

She named her new advocacy nonprofit Judy’s League, for Judy Heumann, a legendary disability rights activist known as the “Mother of the Disability Rights Movement.” Brendle likes to quote Heumann, who often said that disability can happen to anyone at any time.

Families and students with disabilities also worry the Republican states’ lawsuit could erode Section 504 protections for students if states were no longer required to provide services in public schools and could instead direct students to institutions.

As a student, Brendle received services locally that helped her learn to use a cane, to read Braille and to use accessible technology needed to complete school coursework.

At times she had to push for the accommodations she needed.

“But at least 504 gives you a leg to stand on,” she said. “It gives you something to fight back with.”

Similarly, Cravins worries her son Landry could have a hard time receiving services at his local school when he’s old enough to attend, even though he would be able to go to school with his peers with the right supports.

National disability rights groups — including the National Federation of the Blind, the National Down Syndrome Society and the Disability Rights Education and Defense Fund — have continued urging the public to speak out about the possible loss of rights.

“It feels like it’s up to us as individuals to try and convince these people in these positions of power to stop attacking us,” Brendle said.

Cascading effects

On Monday, the states asked the judge to decide the lawsuit without a trial. Over the next few months, the states and feds will file briefs with the court. Disability community groups and allies will have the chance to file briefs as well.

If the states prevail, it’s hard to say what the cascading legal impacts could be. A win could trigger further litigation. Other courts might interpret the law differently.

A number of state laws, programs and other efforts have been built on the integration mandate and could be affected as well, said Mike Oxford, a retired director of an independent living center in Topeka, Kansas, who has been a longtime disability rights advocate.

“I’ve seen people with significant disabilities become great lawyers, academics, corporate leaders, on and on,” he said. “That would not have happened” without the integration mandate.

Oxford said he has not gotten a response from Kansas Republican Attorney General Kris Kobach when he asked about the case. He doesn’t think that the attorneys general remaining in the case believe it’s still about gender dysphoria.

“It’s just totally ridiculous,” he said. “They’re lawyers. They signed the new complaint. They know what it does and doesn’t say.”

If the court strikes down the integration mandate, that doesn’t mean the entire law is invalidated or in-community services automatically cease.

But it does mean that if a family were denied services outside of an institution, they’d likely have to pursue litigation each time to fight the decision, Cravins said.

“I think it’s important for the average citizen to realize that laws only work when there is enforcement behind them,” she said.

Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.

A Milwaukee provider of personal care services has been charged with bilking Wisconsin’s Medicaid program of almost $2.2 million, the state Department of Justice announced Wednesday.

Debbie Long, 44, was charged with billing Medicaid for services that didn’t take place, according to the criminal complaint filed Tuesday.

The complaint also charges Long inflated the size of the payroll and workforce at her home health business to obtain a $219,072 loan under the Paycheck Protection Program enacted to help businesses that had to temporarily shut down early in the COVID-19 pandemic.

In addition, the complaint alleges she purchased businesses and a luxury car with proceeds, using a series of shell companies to conceal where some of the funds came from.

Long’s business, Pinnacle Home Health Care LLC, submitted reimbursement claims for services purportedly provided to Medicaid members between March 2017 and August 2022, according to the complaint. DOJ investigators reviewing those submissions found at least $2.1 million in Medicaid reimbursements to Pinnacle for services that weren’t performed, the complaint charges.

The complaint says the allegedly fraudulent billings included “impossible or improbable hours of service,” such as a personal care worker who reportedly worked more than 12 hours on a single day for one Medicaid member.

There were also reimbursements for services that were never provided, according to the complaint, for services that were more than workers provided, for services in which the Medicaid member’s need was “misrepresented,” and for services when the Medicaid member was in the hospital or incarcerated — situations in which members weren’t eligible for Medicaid reimbursement.

The investigation included interviews with Medicaid recipients as well as personal care workers employed by the business who helped investigators uncover some of the allegedly false information provided, according to the complaint.

Long is charged with five felony counts: theft by false representation greater than $10,000, fraud against a financial institution greater than $100,000, wire fraud against a financial institution, and two counts of money laundering greater than $100,000.

Court records reviewed Wednesday did not list an attorney for Long.

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WASHINGTON — Voters, including those within the Make America Healthy Again movement, say the rising cost of healthcare is a significant concern that will have an impact on whom they support in November’s midterm elections, according to a poll released Wednesday by KFF. 

Sixty-one percent of respondents to the survey, which asked how important several health-related issues were, said the price of healthcare will have a major impact on which party they support as control of Congress hangs in the balance.

Among MAHA voters, who are predominantly Republicans but also include independents and some Democrats, 42% said cost is their top issue heading into the elections. 

“While the issue of health costs is more salient for Democratic voters than for Republicans, larger shares across partisans say health costs will have a major impact on their voting decisions than say the same about vaccine policy or food safety,” the survey said. 

Seventy-two percent of Democrats, 63% of independents and 47% of Republicans said the cost of healthcare will have a major impact on which party’s candidate they vote for. 

Vaccine policy came in next, with 57% of Democrats, 46% of independents and 32% of Republicans surveyed saying it will have a major impact on their choice. 

Issues related to food safety came in third after 43% of Democrats, 40% of independents and 38% of Republicans responded that it will have a major impact on their choice of candidate.  

MAHA issues 

For MAHA voters, twice as many listed health costs as their first priority than the next issue: restricting the use of certain chemical additives in food, which was a key concern for 21%.

Ten percent were interested in politicians who will reevaluate vaccine approvals, 8% want lawmakers to limit corporate interest in food and 8% want Congress to limit the use of pesticides in agriculture. Eleven percent said none of those or had no answer. 

The survey showed that a significant majority of Americans across the political spectrum believe the government hasn’t done enough to address chemical additives in food or pesticide use in agriculture, two core demands of MAHA supporters.  

“The public perception that there is not enough regulation may be rooted in broader skepticism toward the industries themselves,” the survey said. “Most U.S. adults do not trust pharmaceutical companies, food and beverage companies, or agricultural companies to act in the public’s best interest.”

Doctors and healthcare providers were the most trusted source of information at 70%, followed by agriculture companies at 40%, food and beverage companies at 25% and pharmaceutical companies at 21%. 

Seventy-five percent of those polled said the government hasn’t done enough to regulate chemicals in food, while 65% said it should do more to regulate pesticides in agriculture. 

The poll of 1,343 U.S. adults took place from April 14 to April 19. It has a margin of error of 3 percentage points for the full sample and 6 percentage points for MAHA supporters.

The U.S. Supreme Court issued a temporary stay on an appeals court ruling from Friday that was blocking remote access to an abortion drug, restoring access until at least May 11.

The administrative stay, issued by Justice Samuel Alito, pauses Friday’s decision by the 5th Circuit Court of Appeals. That ruling blocked a 2023 rule adopted by the U.S. Food and Drug Administration allowing mifepristone, one of two drugs used to terminate a pregnancy before 10 weeks and to treat miscarriages, to be prescribed without an in-person visit with a health care provider and also allowed it to be mailed to recipients in states with abortion bans.

“The administrative stay is temporary, and I am confident life and law will win in the end,” said Louisiana Republican Attorney General Liz Murrill in a statement. 

Thirteen states have near-total abortion bans, including Louisiana. Murrill sued the FDA in October, saying the rule undermines the state’s laws and causes financial harm because the state paid $92,000 in Medicaid bills for two women who needed emergency care in 2025 from complications related to mifepristone. 

In the years since the 2022 U.S. Supreme Court decision allowing states to regulate abortion access, telehealth prescriptions of abortion medication have become increasingly popular, with more than 27% of all abortions provided that way in 2025, according to data from the Society of Family Planning.

“While this is a positive short-term development, no one can rest easy when our ability to get this safe, effective medication for abortion and miscarriage care still hangs in the balance,” said Julia Kaye, senior staff attorney for the Reproductive Freedom Project at the American Civil Liberties Union, in a statement. “The Supreme Court needs to put an end to this baseless attack on our reproductive freedom, once and for all.”

The case could follow a similar pattern to one that played out in 2023, after U.S. District Court Judge Matthew Kacsmaryk of Texas issued a ruling that would have revoked access to the abortion drug mifepristone altogether. 

The U.S. Supreme Court intervened shortly after that ruling and kept mifepristone available while the case proceeded in the 5th Circuit appeals court, which eventually decided that more restrictions were warranted, but not pulling the drug’s approval. The Supreme Court officially took the case several months later, and unanimously ruled in June 2024 that the plaintiffs suing the FDA did not have standing, keeping access to mifepristone intact.

Responses from the attorneys in the latest case are expected to be filed with the Supreme Court by Thursday, according to Alito’s order.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

In the contest for the Democratic nomination for governor, “affordability” might be the most frequently used campaign watchword. Side-by-side with it is another word: Healthcare.

Healthcare “is one of the most broken systems in the whole of government,” says former Lt. Gov. Mandela Barnes. It’s “working as it was designed to,” says state Rep. Francesca Hong — in what is decidedly not a compliment to the system.

Among voters, it is “a top issue if not the top issue,” says Milwaukee County Executive David Crowley. Former Wisconsin Economic Development Corp. CEO Missy Hughes calls healthcare one of the “foundational pieces of our economy” — but one that is under strain and not working well.

For Lt. Gov. Sara Rodriguez, it’s “a complicated system” in which she made a career as an  emergency room nurse, a CDC infectious disease officer and finally a health system executive — “which means that I know the levers that we can pull to try to reduce costs across the state of Wisconsin.”

Former Department of Administration Secretary Joel Brennan considers healthcare a leading Wisconsin asset, innovator and employer, but one that’s been hobbled by “the healthcare management that we are allowing to go on in this county — and it’s not helping.”

State Sen. Kelda Roys describes the healthcare system  as imbued with “the worst aspects of capitalism in that we’ve injected profits before patients at every step, but none of the benefits of capitalism — there’s no free market, there’s no real competition.”

Those remarks come from three forums in April at which the seven leading Democratic hopefuls fielded questions about their healthcare policies and priorities.

Four of them — Rodriguez, Barnes, Roys and Hong — took part in a forum hosted by HealthWatch Wisconsin that focused entirely on healthcare issues. (All seven were invited, according to HealthWatch, which is affiliated with the nonprofit public interest law firm ABC for Health).

All seven joined a Wisconsin Health News event focused entirely on healthcare as well as a Wisconsin Citizen Action online forum, where healthcare led off a discussion that covered a cross-section of other issues as well.

Many of the Democratic Party rivals’ policies and priorities overlap. They all agree that healthcare costs and access are among the most important priorities for the state.

All of them say they favor a public option for health insurance — a plan that would be available for people to purchase health coverage on the Affordable Care Act health insurance marketplace if they don’t have coverage through work and their incomes are too high to qualify them for Medicaid.

All but one of the seven propose to expand Medicaid, referred to as BadgerCare in Wisconsin, under the Affordable Care Act. Expansion would open the health insurance plan for low-income Wisconsinites with incomes above the current limit (100% of the federal poverty guideline) up to 138% of the guideline.

Roys is the exception, arguing that Medicaid expansion is no longer feasible in Wisconsin because of federal changes enacted after President Donald Trump took office.

Instead, Roys proposes a public option that would allow the public to buy into the state health insurance plan for public employees. Brennan also proposes using the public employees’ plan as a public option, but he favors Medicaid expansion as well.

Four of the other five Democrats would tie the public option to Medicaid expansion, making it possible for people whose incomes don’t qualify them for BadgerCare to pay a monthly health insurance premium for BadgerCare coverage. Rodriguez proposes a public option plan called “BadgerChoice,” which would be a state-based insurance plan but would not be connected to BadgerCare, according to her campaign. 

Four years after the U.S. Supreme Court overturned a national right to abortion, all seven Democrats have vowed to protect reproductive healthcare and to firmly back abortion rights in Wisconsin.

All of them speak of the importance of ensuring that mental health is treated on a par with physical health. And all of them at least nod to the need to improve healthcare access in rural Wisconsin.

At the same time, each candidate’s proposals differ, sometimes in fine details, sometimes in broad priorities, and sometimes mostly rhetorically.

Federal relations

Another point of general agreement is on the need for stronger support for public health measures. All of the Democratic candidates have criticized the Trump administration and Health and Human Services Secretary Robert F. Kennedy Jr. for undermining longstanding support for vaccination against communicable diseases.

But they take different directions in their expectations for federal-state relations in healthcare. Roys, for example, writes off federal assistance during the current administration, which is why she considers expanding Medicaid a dead issue for now. Crowley’s Medicaid expansion proposal explicitly refers to federal matching funds to cover some of the costs.

None have laid out the level of detail that will be required for turning their ideas into legislation or incorporating them into the next state budget.

This report has been updated to clarify that the “BadgerChoice” proposal from Sara Rodriguez is not connected with Medicaid Expansion. 

In the gallery below, click on the caption of each candidate’s picture to read a summary of what that candidate has said and published about their approach to healthcare policy and links to relevant pages on the candidate’s campaign website. 

Massachusetts and Rhode Island are considering dropping GLP-1 drugs for obesity treatment from their Medicaid programs, continuing a trend of states that have stopped coverage of these expensive medications. 

Thirteen state Medicaid programs are covering GLP-1 drugs for the treatment of obesity this year, down from 16 last year. 

Medicaid programs in California, New Hampshire, Pennsylvania and South Carolina have eliminated coverage of the drugs for weight loss, because the expense strained state budgets. 

In Massachusetts, the governor’s proposed fiscal 2028 budget would not fund the state’s Medicaid program, MassHealth, to cover GLP-1 medications for weight loss alone, though the state would continue covering the drugs for diabetes and other conditions. The legislature is still debating the state budget. 

Rhode Island’s governor also has proposed removing GLP-1 coverage from the state’s Medicaid program for weight loss treatment. 

North Carolina reinstated such coverage in mid-December after having dropped it in October. 

Medicaid programs in Delaware, Kansas, Michigan, Minnesota, Mississippi, Missouri, Tennessee, Utah, Virginia and Wisconsin also cover the drugs for obesity treatment, according to KFF, a health policy research group. 

But some states, such as Michigan, have restricted eligibility for these medications to morbidly obesity patients rather than those who are overweight or obese. The move is expected to save the state an estimated $240 million. 

Meanwhile, lawmakers in Louisiana are debating whether to allow Medicaid to cover GLP-1s for obesity treatment if enrollees have another chronic condition, or comorbidity, such as prediabetes, hypertension or cardiovascular disease.  

The medications generally have been too expensive for people without insurance. In February, one of the largest producers of these drugs, Novo Nordisk, announced it would reduce their list prices to $675 per month in 2027. 

Gross spending on Medicaid prescriptions for GLP-1s — for diabetes as well as for weight loss — has increased from around $1 billion in 2019 to almost $9 billion in 2024 as demand for these drugs has risen, according to KFF. 

At the same time almost 40% of adults and a quarter of children with Medicaid have obesity and may benefit from having access to the drugs, according to KFF. 

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

One of the main methods of obtaining abortion medication for those living in states with bans is now blocked nationwide, after a federal appeals court decision issued Friday afternoon.

The 5th Circuit Court of Appeals blocked a U.S. Food and Drug Administration rule from 2023 that allowed mifepristone, one of two drugs used to terminate a pregnancy before 10 weeks and to treat miscarriages, to be dispensed without an in-person visit with a health provider. 

In the years since, states with abortion access have increased their telemedicine offerings to prescribe the medication remotely and send it through the mail. Many of those states also enacted shield laws to prevent officials from states with abortion bans from prosecuting or investigating their providers — meaning many patients have been able to receive the medication across state lines.

Louisiana judge preserves telehealth abortion access provision for now, puts case on hold

The block will remain in effect as the lower court case proceeds, but the FDA could file an emergency appeal to the U.S. Supreme Court in the coming weeks.

More than 27% of all abortions were provided through telehealth appointments in the first six months of 2025, according to the Society of Family Planning, a research and advocacy group that publishes a report called #WeCount. Nearly 15,000 abortions per month were provided under shield laws during that same time frame, according to the report.

Louisiana Republican Attorney General Liz Murrill sued the FDA in October, seeking to strike down the 2023 provision, and the lower court declined to do so in early April. U.S. District Judge David C. Joseph said then that the stay was premature while the FDA completed a safety review of mifepristone, but allowed state officials the opportunity to re-file the motion after that review was complete. The state appealed that decision to the 5th Circuit.

“Every abortion facilitated by FDA’s action cancels Louisiana’s ban on medical abortions and undermines its policy that ‘every unborn child is human being from the moment of conception and is, therefore, a legal person,’” Friday’s decision said.

There were no dissenting opinions among Judge Leslie Southwick, an appointee of former Republican President George H.W. Bush, and Judges Stuart Kyle Duncan and Kurt D. Engelhardt, both appointees of Republican President Donald Trump.

Without access to telemedicine and the opportunity to receive the medication through the mail, people in 13 states with near-total abortion bans may have to travel to another state to get an abortion.

There is a misoprostol-only abortion pill protocol that some providers can use, but it is slightly less effective and requires a higher dosage, which can increase side effects.

“Reinstating in-person dispensing requirements would force people to travel farther, take more time off work, and absorb costs that are simply too high. For people living in states already hostile to abortion access, many of which are home to Black women and families, this is not health care,” said Regina Davis-Moss, CEO of advocacy group In Our Own Voice: National Black Women’s Reproductive Justice Agenda, in a statement. 

Murrill said in a statement on Friday that former Democratic President Joe Biden’s administration facilitated “illegal mail-order abortion pills.”

Nearly 1 in 4 people seeking abortions out of state chose Illinois. Here’s why.

“Today, that nightmare is over, thanks to the hard work of my office and our friends at Alliance Defending Freedom. I look forward to continuing to defend women and babies as this case continues,” Murrill said, crediting the advocacy legal organization that helped in the case.

The court also found Friday that the 2023 rule injures Louisiana by causing it to spend Medicaid funds for emergency care for women harmed by using the drug. The state identified $92,000 paid by Medicaid for two women who needed emergency care in 2025 from complications “caused by out-of-state mifepristone.”

Numerous studies have shown mifepristone is safe to use, with very low complication rates. A combined review of 10 years’ worth of studies between 2005 and 2015 found that severe outcomes requiring blood transfusion and hospitalization occurred in less than 1% of cases.

“We are alarmed by this court’s decision to ignore the FDA’s rigorous science and decades of safe use of mifepristone in a case pursued by extremist abortion opponents. We are reviewing the court’s order in detail,” said Evan Masingill, CEO of GenBioPro, one of the main manufacturers of mifepristone, in a statement. “We remain committed to taking any actions necessary to make mifepristone available and accessible to as many people as possible in the country, regardless of anti-abortion special interests trying to undermine patients’ access.”

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

WASHINGTON — State officials say they need more information from the Trump administration before they can fully implement new requirements for Medicaid, according to a survey released Thursday by KFF and the Georgetown University Center for Children and Families.

Republicans’ “big, beautiful” law made several changes to the state-federal health program for lower income people and some people with disabilities, including that enrollees between the ages of 19 and 65 work, participate in community service, or attend an education program for at least 80 hours a month.

The survey of Medicaid program officials from 43 states showed the people tasked with implementing the law have questions about how exactly they should determine if someone meets the new requirements or is exempt. 

“In addition to how to define medical frailty, states wanted additional direction in many areas including what qualifies as community service, how to calculate half-time school attendance, and what is considered a ‘significant relationship’ to qualify for the caregiver exemption,” the report states. “They also indicated they need guidance about what sources can be used for verification, whether self-attestation will be allowed if other sources are not available, and how long verification of exemptions remain valid.”

The law includes several additional carve-outs, including for Medicaid enrollees who are pregnant, have dependent children, are tribal community members or are in the foster care system, and for individuals released from incarceration in the last 90 days, among others.

The vast majority of state officials surveyed said they would implement the new requirement for work, education, or community service at the start of next year.

There are, however, a few states moving forward earlier. 

Nebraska plans to begin May 1, Montana on July 1 and Iowa officials said they will begin this year, though they haven’t provided a date, KFF said. Arkansas has planned a “soft launch” for July but won’t actually remove anyone from Medicaid for not meeting the new requirements until next year, according to the report.

Hardship exemptions

The KFF-Georgetown survey says that nearly all states will allow hardship exemptions for people in counties with higher unemployment; those who recently experienced a natural disaster; those who have been admitted to a hospital or nursing facility; or those who need to travel outside their community for medical care.

Indiana and Iowa are the only two states so far that don’t intend to allow any hardship exceptions from the requirement that Medicaid enrollees work, attend community service, or enroll in an education program, the report said. 

“Oklahoma is not adopting the exceptions for residents of counties with high unemployment or with a declared natural disaster while Missouri is not adopting the exception for residents of counties with high unemployment,” the report says. “New York is not planning to adopt the exception for individuals traveling outside their community for medical care. Twelve states had not made a decision.”

Look-back periods vary

Thirty-six states will look back one month when someone applies for Medicaid to determine whether they’re working, participating in community service, or enrolled in an education program. Indiana and Idaho will look back at the last three months before the person applied to determine whether they meet the new requirement. 

Thirty-four states will look back one month during the renewal process, which must happen at least every six months under the law. 

“Indiana and New Hampshire will check quarterly and at renewal to verify that enrollees meet the requirements every month between renewals,” according to the report. “Arkansas will also look back three months at renewal but is not planning quarterly checks. States that had not made a decision at the time of the survey included five states for application, six states for renewal, and seven states for more frequent checks.”

Three years after a miscarriage that caused a severe, nearly septic infection because a Tennessee hospital denied her an abortion, Katy Dulong was looking forward to telling her story in a trial that was scheduled to begin Monday.

But this week, the state appealed to a higher court based on a new law passed by the legislature in March, and the court put the trial on hold indefinitely. It will now be months before the lower court can proceed.

Dulong had complications that led to a miscarriage in November 2022 at 16 weeks of pregnancy, long before fetal viability. Under the state’s abortion ban, which had only been in place for a few months, the hospital sent her home to miscarry on her own. When that didn’t happen, severe infection started to set in 10 days later, when she was able to get doctors to agree to help. The experience left her with post-traumatic stress disorder.

Tennessee bill expands attorney general rights to appeal case rulings

The delay in the legal case feels like the state trying to silence her and the other plaintiffs, she said.

“It’s shocking to me that there’s anyone in this world that would have such opposing views to think that our voices don’t matter,” Dulong said in an interview. “How are they taking away our voice right now?”

In a motion to dismiss in February, the state argued it couldn’t be sued by the plaintiffs under a term called sovereign immunity, and in April, the Tennessee Legislature passed a law making it harder to sue the state on the constitutionality of a state or government action. Legislators passed another bill allowing the state to automatically appeal a decision related to sovereign immunity.

Nicolas Kabat, a staff attorney at the Center for Reproductive Rights who has been working on the case with the plaintiffs, said the state has tried to have the case dismissed four times without success, and said this is just the latest move to delay the trial. But he said the latest laws passed by the legislature allowing automatic appeals in the middle of a case, on the eve of a trial, make the situation unique.   

“There is nothing unusual about appealing an appealable order,” said Phil Buehler, press secretary for Tennessee Republican Attorney General Jonathan Skrmetti, in an email Thursday.

Similar lawsuits are ongoing or have already been resolved in several states with bans, including Texas and Idaho, where state residents have challenged the law based on their personal experiences. Plaintiffs in Idaho won their case in April 2025, when a judge said the near-total abortion ban does not mean a pregnant patient’s death has to be imminent or “assured” to perform an abortion. Complaints are also pending related to Texas hospitals allegedly not complying with federal law mandating emergency room treatment for a patient who needs an abortion as stabilizing care.

Women with serious pregnancy complications sue over state abortion bans

Allie Phillips, the lead plaintiff in Tennessee, joined several other women to sue the state in September 2023, alleging that the abortion ban put their health and lives in jeopardy when they were pregnant. They asked the state to clarify the law so that health is considered in an abortion decision, not just an immediate threat to a pregnant patient’s life. The way the law is written, attorneys argue, is too vague to allow for those exceptions.

Phillips and Nicole Blackmon, another plaintiff, had fetuses with anomalies related to the development of vital organs. Blackmon couldn’t afford to travel out of the state for an abortion, and eventually had to stop working because the pregnancy was affecting her health. She delivered a stillborn baby in her seventh month of pregnancy. Phillips raised enough money to seek an abortion in New York, only to find when she got there that the fetus had already died.

After the court granted a temporary block on the law as it relates to pregnancy complications, the state passed several laws that affected the case. The first bill, meant to clarify the state’s health exception for an abortion, was enacted in April 2025 but didn’t solve the issue, Kabat said. The language still wasn’t clear enough, and the court agreed and allowed the suit to continue.

Kabat said the legal team will continue its effort to clarify Tennessee’s laws so that stories like Dulong’s don’t happen to others.

“No matter how long this takes, we’re going to get the trial, we’re going to get these stories heard and we’re going to seek accountability from the state,” Kabat said.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org. 

This report was updated at 1:35 p.m. 4/23/2026.

Employees of two Wisconsin clinics operated by Rogers Behavioral Health voted by large majorities in favor of union representation Wednesday after more than two months in which the mental health nonprofit had campaigned heavily against the union.

In West Allis, employees voted 53-4 in favor of joining the National Union of Healthcare Workers. In Madison, the vote to join the union was 26-4. The votes were supervised by National Labor Relations Board officials at both clinics.

Employees at the two clinics “are ready to negotiate contracts that would provide better pay, protections to ensure safe staffing levels and more time to care for individual patients, as Rogers workers secured in California after joining NUHW,” the union stated in a press release Thursday.

The union represents Rogers employees at three facilities in California, where contracts have been negotiated, and one in Philadelphia, Pennsylvania, where contract negotiations are underway. “While contract negotiations are still ongoing in Philadelphia, the contracts Rogers agreed to for workers based in the Bay Area, Los Angeles and San Diego are among the best in the industry,”  the union statement said. “They include strong raises, limits on caseloads, and guarantees that no jobs will be lost to new technologies, including artificial intelligence.”

Rogers, based in Oconomowoc, said in a statement released Thursday, “We acknowledge the union election outcomes in Madison and West Allis Lincoln Center. We are evaluating our next steps in support of our system of care. We are committed to our patients, our people, and the integrated care that has made Rogers a trusted provider across Wisconsin since 1907.”

The union said in its press release that during the West Allis election Wednesday, Rogers management “prohibited NUHW’s representative from entering the facility and then suspended a worker who had agreed to serve as the union’s observer.”

Federal labor law procedures call for representatives from management as well as the union to observe the vote count. The absence of a union observer “could have resulted in the ballots being impounded and not immediately counted,” the union press release stated.

A second Rogers employee volunteered to serve as the union observer for the count “over the objections of Rogers’ representatives,” the NUHW stated, adding that Rogers did not attempt to stop ballots from being counted at the Madison clinic.

The workers involved were among three employees fired shortly after workers announced their petition for a union. The union has filed unfair labor practice charges over the terminations, claiming that the three were fired in retaliation for their support for unionization, which is illegal under federal law.

Rogers has declined to explain the firings, citing employment confidentiality, but said that it has not violated any laws.

Rogers Behavioral Health issued a follow-up statement Thursday about the voting conflict in West Allis. According to the statement, “individuals who are no longer employeed by Rogers had illegally entered the facility,” and Rogers contacted local police.

The next step will be for the National Labor Relations Board to certify the results. But a federal lawsuit challenging the agency is still pending. In addition, Rogers said in public statements as well as in communications to the workers before the vote that the company would not begin bargaining with the union until all its appeals have been exhausted. 

The nonprofit campaigned actively against unionization, telling employees that a union would not have been in the interests of the staff, the patients or the organization. In a final letter distributed on Monday, Rogers urged employees to vote no and made statements that the organization had made mistakes and wanted to be given another chance to improve relationships with the staff without a union.

Union supporters welcomed the outcome of Wednesday’s votes.

“We are thrilled with the overwhelming victory,” said Stephani Lohman, a nurse practitioner who was among those active in the union organizing campaign and was one of the three fired employees. “Over the last few weeks Rogers has shown us exactly why we need a union by running an aggressive anti-worker campaign, trying everything in their toolbox to intimidate and demoralize us, but it failed spectacularly because it was so cruel and wicked that it drove everyone to support the union.”

According to union supporters, the union campaign began late last year after changes at Rogers that included clinicians being reclassified from salaried to hourly, which resulted in schedule changes that increased patient volumes for staff members and reduced individual patient care. The organization increased caseload caps, “forcing caregivers to be responsible for far more patients than previously,” the NUHW said in its statement.

This report has been updated with additional information and comments Thursday from both the National Union of Healthcare Workers and from Rogers Behavioral Health. 

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A federal judge in Milwaukee rejected a bid from Rogers Behavioral Health Tuesday to block a pair of union elections scheduled for Wednesday at Rogers mental health clinics in West Allis and Madison.

The decision sets the stage for votes to go forward at both clinics. About 35 employees at Rogers’ Madison clinic and about 68 at the West Allis clinic will vote Wednesday on whether to be represented by the National Union of Healthcare Workers.

Rogers, based in Oconomowoc, had argued that the union election should cover all 13 Rogers facilities in Wisconsin — not just the two where employees had actively organized. But in a direction of election issued April 14, the NLRB regional director whose jurisdiction includes Wisconsin said those two clinics alone were each appropriate bargaining units.

On Monday, Rogers lawyers filed a lawsuit to block both elections. U.S. District Judge Lynn Adelman denied the mental health nonprofit’s petition for a temporary restraining order Tuesday after an online hearing that ran a little more than 40 minutes.

“I don’t think that they’ve established unconstitutional irreparable harm,” Adelman said of Rogers’ lawyers.

The Rogers lawsuit echoed a recent line of legal challenges that have sought to unravel the National Labor Relations Board — the 91-year-old agency created under President Franklin Delano Roosevelt as part of his administration’s New Deal to secure rights for workers and help the U.S. recover from the Great Depression.

One of Rogers’ lawyers, Aron Karabel, argued that the members of the NLRB itself as well as the regional director who issued the union election order are unconstitutional because they aren’t subject to dismissal by the president, violating the separation of powers in the U.S. Constitution.

Similar arguments have been made by other businesses, including Amazon and SpaceX, but the U.S. Supreme Court has not endorsed the claim.

Karabel’s colleague, Hannah Fitzgerald, argued that under Wisconsin law, the NLRB regional director had engaged in “tortious interference” with existing employment contracts for some of the Rogers employees who would be included in the union election bargaining unit. For that reason as well as other reasons, the election could cause “irreparable harm” to Rogers, Fitzgerald asserted.

Representing the NLRB, lawyer Craig Ewasiuk said that a Supreme Court ruling 82 years ago established that individual contracts “may not be availed of or to defeat or delay the procedures prescribed by the National Labor Relations Act” to further collective bargaining.

“The Supreme Court has spoken unambiguously on this question, and you simply can’t bring tortious interference acts against the NLRB for running elections,” Ewasiuk said.

Karabel argued that Rogers’ case was not about collective bargaining — which would prevent the federal court from acting until after final action by the NLRB — and for that reason, the court was an immediately appropriate venue.

The NLRB lawyer rejected that argument. ‘’The employer is essentially trying to stop the board’s proceedings from resolving this underlying labor dispute,” Ewasiuk said.

Staunch resistance to the union

Rogers Behavioral Health has mental health clinics and hospitals in 10 states. Employees are already represented by the National Union of Healthcare Workers at four clinics — three in California and one in Philadelphia, Pa. — and at three of those, the union was recognized voluntarily.

But in its home state of Wisconsin, Rogers has taken a much different posture.

Three employees were fired shortly after the union campaigns went public, according to the union, and the NUHW has filed unfair labor practice charges claiming the firings were illegal retaliation for union support.

Rogers has declined to discuss the firings as confidential personnel decisions but has stated they were not in violation of any laws.

From when employees first notified Rogers management of their desire for union representation, however, Rogers has posted notices and issued statements declaring that the mental health nonprofit doesn’t want  union representation for the West Allis and Madison employees.

“Many of your colleagues, your leaders, and I strongly believe that this union is not in the best interests of you, your family or our patients,” said one notice, stating it was from clinic leaders but without a name attached, that was shared with the Wisconsin Examiner. “We believe you should vote no and allow our team the opportunity for positive and direct collaborations.”

In March, Rogers’ executive director of marketing and communications, Maureen Remmel, responded to a question from the Examiner about the difference between Rogers’ responses at its California and Pennsylvania clinics and its handling of the union campaigns in Wisconsin

“While we work in good faith with the NUHW in California and Pennsylvania, our integrated system in Wisconsin is different,” Remmel said in an email message  March 17. “A direct relationship with our Wisconsin team members best serves employees, patients, and the company.”

At an NLRB hearing in February to establish the appropriate bargaining units for the Wisconsin clinics, Rogers’ lawyer argued that flexibility across multiple facilities was important and necessitated allowing all 13 Wisconsin locations to vote on union membership.

A statement attributed to the organization as a whole that Remmel sent April 16, after the election order was issued, asserted, “A union is not right for Rogers Behavioral Health in Wisconsin because it jeopardizes our ability to work together to solve problems quickly and flexibly.”

Jennifer Hadsall, the NLRB regional director, wrote in her analysis that there was little evidence of “functional integration” across the system to overcome the presumption that the two facilities where employees had organized were by themselves appropriate bargaining units.

Hadsall also rejected Rogers’ argument that certain employees were supervisors and therefore not eligible to be part of their facility’s bargaining unit.

Professional consultants

Starting in early February, Rogers has hired consultants to assist in managing its response to the union campaigns, according to LaborLab, a nonprofit based in Helena, Montana. LaborLab monitors the industry of consultants who advise and assist employers in responding to union drives.

Under the federal Labor-Management Reporting and Disclosure Act, employers and the consultants they hire to persuade employees “directly or indirectly” about unionizing must regularly file reports with the federal government. Employers file LM-10 reports and consultants file LM-20 reports as well as LM-21 annual financial reports.

While advocates for greater disclosure complain that those reports are often late or incomplete, they offer some information about those businesses.

LaborLab has identified three consultants working for Rogers since early February, when pro-union employees in Madison and West Allis petitioned for voluntary recognition. Two were identified through their LM-20 reports and one was named by union supporters during a radio interview with WORT-FM, the listener-sponsored community radio station in Madison.

LaborLab has estimated the consultants’ fees total about $50,000 a week, or more than $325,000 through April 1. Those don’t include the cost of attorneys representing the business on legal matters connected with the union campaign or “internal costs” that LaborLab’s calculations impute to employees assigned to directly address the union organizing effort.

“It’s hard to be precise because there are a lot of variables in these campaigns,” said Teke Wiggin, LaborLab’s strategic coordinator. “But we think that workers should have some general sense of how much is being invested in these campaigns.”

Wiggin said in an interview that some consultants interact only with corporate managers and executives, while others hold meetings with employees themselves, an action that requires disclosure in federal reports.

“They take arguments that have been crafted by industrial psychologists to sow as much fear and doubt about the value of unionization as possible,” Wiggin said.

In a letter sent to Rogers Feb. 25, 20 local and state elected officials criticized the organization for having “hired union busters” and urged the organization’s CEO to “immediately stop wasting patient care dollars on union busters paid to try to intimidate workers from organizing.”

Rogers did not respond to a question from the Examiner about its use of consultants in the organizing campaign.

In a response to the elected officials that was signed by “Rogers Behavioral Health,” the organization said it has “retained consultants to better understand and address the concerns shared by our employees and to raise awareness about their rights and the election process.”

Messages to employees

In a media statement April 16 after the election was scheduled, Rogers reiterated the organization’s position that a union was not the right choice for its employees and its intention to appeal the regional director’s finding after the election.

The day before, Rogers management emailed employees with a similar message, stating, “We are disappointed and disagree with this decision and are appealing to the full NLRB in Washington, D.C.”

The final line of the message was, “Regardless of the election outcome, bargaining will not start with the union until all appeals have been exhausted.”

The Wisconsin Examiner was provided screenshots of the message.

Employees involved in the union campaigns said that shortly after it landed in their inboxes, that message was remotely deleted, possibly because it was recalled.

On Monday, Rogers distributed another letter at both the West Allis and Madison locations that took up about a page and a half.

“We want to be direct with you today: change is coming to Rogers,” states the letter, photos of which were shared with the Examiner. “You will see it. We are working on it. That is why we are asking you to vote no on Wednesday and allow leadership 12 months to demonstrate to you, your colleagues, patients and families our commitment to making Rogers better than ever.”

Under federal labor law, if a majority of employees vote against a union in a representation election, the employees must wait at least 12 months before seeking a union again.

The members of Rogers’ leadership team “have heard you,” the letter states. “We know that there are things we can do and must do better.”

The letter’s final paragraphs reiterated both the vow to improve relations and a plea to vote against the union.

“The leadership team is committed to doing better. Today we are asking you to please give us 12 months. Vote ‘no’ in the upcoming election and give us a chance to show our commitment in action. If we do not come through for you, the law gives you the right to hold another election. Rogers will honor your choice in that election.

“Please vote ‘no’ on April 22. Vote to hold Rogers leadership accountable.”

Federal court records show Rogers filed its lawsuit to block the vote the same day that employees received that letter.

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Elected leaders and public health officials in Milwaukee gathered at the Marcia P. Coggs Center for Health & Human Services building to announce that opioid overdose deaths in Wisconsin’s most populous county have declined for the fourth straight year in a row. 

According to data provided through the county’s overdose dashboard, there has been a 17.7% decrease in fatal overdoses and a 22.7% decrease in fatal opioid overdoses since 2024. There has been a 42.6% decline since 2022 in all forms of overdose death, with a 54.6% decline in opioid-related overdose deaths specifically.

Milwaukee County Executive David Crowley praised the use of opioid settlement funds to expand  treatment and harm reduction strategies. The funds originate from lawsuits against the producers and distributors of pain killers that triggered the opioid crisis. The nationwide epidemic of addiction and overdoses is also tied to the powerful synthetic opioid fentanyl which began spreading in  the mid-2010s, causing deaths on an unseen scale.

“As we acknowledge the progress we have made, we must also remember those we have lost,” said Crowley. “Their lives matter, and their stories remind us why this work is so critical. I am committed to continuing this work until every person in Milwaukee County has access to the care, support and second chances they deserve.” 

The latest data shows that 387 people in Milwaukee County still lost their lives to an overdose last year. “These are our neighbors, these are our loved ones, these are our family members,” said Crowley, “people who we care about that live in our own communities.” At a press conference Tuesday, Crowley said he has seen family and neighbors struggle with addiction as he grew up. “And I saw firsthand the barriers that they faced when trying to access treatment, but also continue to take those steps towards healing,” said Crowley. “Healing is a lifelong journey. So to me these aren’t just numbers on a dashboard. They’re people, and even one overdose death is one too many.” 

Milwaukee County will receive $111 million over the next 18 years through the opioid settlements. This represents the largest amount recovered by a local government in Wisconsin history, a county press release states. 

“Three years ago, we were losing a life to opioid overdose every 16 hours,” said Chief Health Policy Advisor Dr. Ben Weston, praising the sharp decline in deaths since then.

Weston recalled an April weekend three years ago when there were 16 overdose deaths in Milwaukee County. The scale of the epidemic was “unimaginable” Weston said, and it forced emergency management staff, firefighters, police and community members  to “say enough,” said Weston. 

Over the  last several years Milwaukee County adopted multiple harm reduction strategies. Narcan — the nasal spray used to revive someone from an opioid overdose — has been distributed in vast quantities to emergency responders and average citizens. There are also 27 free-to-use harm reduction vending machines around the county providing narcan, fentanyl testing strips and even gun locks. 

The vending machines were launched through a Department of Health and Human Services program called Harm Reduction MKE. Another program called Pull Up & Pick Up offers residents the opportunity to order free supplies and pick them up at the Coakley Brothers building (400 S. 5th St) on the third Friday every month. Vivent Health Depot has also partnered with Milwaukee County to provide free harm reduction supplies delivered right to people’s homes. 

“We’ve expanded community paramedicine programs and peer support to close the gaps in care and reach people who might never otherwise have entered into the system,” said Weston. “And we’ve partnered with the state using real-time overdose data and predictive learning and modeling to better understand who is at highest risk, and be able to intervene early.” 

Treatment centers have also worked to overcome zoning restrictions and stigma to open in new parts of Milwaukee. Treatment access has also been expanded for people both entering and leaving incarceration, a particularly dangerous time when people are more likely to overdose, Weston said. 

“At the Medical Examiner’s Office, we see firsthand the human toll of this crisis, and while the data shows progress, it also reminds us that this work is far from over,” said Dr. Wieslawa Tlomak, Chief Medical Examiner of Milwaukee County. ”

Tlomak said that it should concern everyone that every third or fourth death in Milwaukee County is due to drug overdose. She noted that usually overdose deaths are caused by multiple drugs. While Narcan can reverse an opioid overdose from fentanyl, there is no equivalent medication to reverse the effects of stimulants like cocaine or meth. “In other words, the landscape of overdose deaths has changed,” said Tlomak. “It is more complex, more unpredictable, and more difficult to treat.”

Tlomak said that of the 387 people who died of fatal drug overdoses last year, 263 involved opioids. 

Jeremey Triblett, Prevention Integration Manager at the Department of Health and Human Services, highlighted the importance of new campaigns in Milwaukee to continue to reduce overdose deaths. One program, dubbed “Better Ways To Cope,” provides residents with strategies to deal with life problems. 

On June 12, recognized as National Harm Reduction Day, the Department of Health and Human Services is inviting residents to participate in the 1,000 Doors Challenge, a neighborhood canvassing project aimed at spreading information and supplies to the people who need it. 

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Two right-wing organizations are taking aim at the ban on conversion therapy in Wisconsin’s professional code for social workers, citing a recent U.S. Supreme Court ruling.

But the head of a group that fought for the ban says professional standards are the central issue — and aren’t subject to free speech claims. 

In a joint letter Wisconsin Family Action and the Wisconsin Institute for Law & Liberty are demanding that Wisconsin repeal the ban. Conversion therapy is a widely discredited practice purporting to change sexual orientation or gender identity.

The Wisconsin Marriage and Family Therapy, Professional Counseling, and Social Work Examining Board included the ban in its updated professional code published in April 2024.

The code declares that it is “unprofessional conduct” for practitioners to use or promote “any intervention or method that has the purpose of attempting to change a person’s sexual orientation or gender identity, including attempting to change behaviors or expressions of self or to reduce sexual or romantic attractions or feelings toward individuals of the same gender.”

WILL has been at the center of many conflicts over trans-inclusive policies and gender identity. Wisconsin Family Action has also lobbied against including gender identity in state civil rights protections.

Their letter seeking the conversion therapy ban’s repeal cites a U.S. Supreme Court ruling March 31 in a lawsuit that challenges Colorado’s law banning conversion therapy on First Amendment grounds.

The high court ruling didn’t throw out the Colorado law directly. Instead, it instructed the federal court hearing the Colorado lawsuit to subject that law to “strict scrutiny” on First Amendment grounds because it seeks to “regulate speech based on viewpoint.”

The WILL-Wisconsin Family Action letter, first reported by Wisconsin Health News, was sent April 14 to Gov. Tony Evers, the Department of Safety and Professional Services and the chair of the social work examining board. 

The letter demands that the board stop enforcing the ban and start the process of repealing it. WILL represents a Christian counselor in a pending federal lawsuit to block a La Crosse city ordinance that bans conversion therapy.

Marc Herstand, executive director for the National Association of Social Workers’ Wisconsin chapter, said the U.S. Supreme Court ruling isn’t relevant to the Wisconsin rule.

“I don’t think it applies because we have a rule, and according to state statute, professional boards can create their own ethical standards,” Herstand told the Wisconsin Examiner. That is supported by both the general law that applies to the state’s licensing boards as well as specific provisions authorizing the social worker board, he said.

Herstand said rules against conversion therapy are to prevent harm. He compared the practice to an electrician’s bad advice that leads to a homeowner’s fatal electric shock or a health provider whose bad advice leads a patient with diabetes to lose a limb to nerve damage or the loss of circulation.

“That’s not free speech — that’s unprofessional conduct,” Herstand said. The electrician or health professional “would be held accountable by the [relevant professional] board. Conversion therapy is exactly the same thing.”

Republican lawmakers repeatedly blocked several previous attempts to update Wisconsin’s social work standards. In April 2024, after the Legislature’s session ended, the social work examining board updated its professional standards to restore the conversion therapy ban.

Then, in a landmark state Supreme Court ruling in July 2025, Chief Justice Jill Karofsky wrote that the statutes that state legislators had used to review and suspend administrative rules violated the Wisconsin Constitution. The examining board “exercised its statutory authority” when it revised its rules to ban conversion therapy, Karofsky wrote in the 4-3 decision.

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Employees of two Wisconsin mental health clinics, both part of a national mental health nonprofit based in Oconomowoc, will vote next week on whether to join a union after what has become a highly contested campaign.

Almost two months after a four-day National Labor Relations Board hearing, the NLRB’s Minneapolis-based regional director this week ordered the elections at the clinics, operated by Rogers Behavioral Health in West Allis and Madison.

In the April 14 order, Regional Director Jennifer A. Hadsall rejected Rogers’ position that the election should include all 13 Wisconsin Rogers locations. Hadsall instead directed elections at the West Allis and Madison clinics, where a majority of employees had signed up with the National Union of Healthcare Workers, according to the union.

Union supporters at the Wisconsin clinics have said they decided to seek union representation in response to increased caseloads, changes in how employee productivity was measured and a reduction in individual time that therapists and other providers could spend with patients.

“All of the changes were about increasing the number of patients that were coming into the building,” Stephani Lohman, a nurse practitioner, told the Wisconsin Examiner earlier this year. “It did not seem to have a cohesive plan and no plan would be communicated.”

The NUHW is based in California. After employees at a Rogers clinic in Walnut Creek, California, organized in 2023 and elected the union to represent them in 2023, they negotiated their first contract in 2024.

Employees at two other California clinics and at a clinic in Philadelphia also joined the union, which those three clinics voluntarily recognized.

Union supporters at the West Allis and Madison clinics each sought voluntary recognition of the union after organizing over the past year.

In Wisconsin, however, Rogers declined voluntary recognition, and the employees then filed petitions with the NLRB for union elections.

Lohman worked at the West Allis clinic, known as Lincoln Center, and was among those active in organizing the union. She said she and two other employees were fired after submitting the petition to be recognized. The union has filed unfair labor practice charges claiming that the three firings were in retaliation for union organizing, which is against the law.

In response to an inquiry in March about the firings, Maureen Remmel, Rogers’ executive director for marketing and communications, told the Wisconsin Examiner via email, “We do not comment on confidential personnel matters and have acted in compliance with applicable law.”

Hadsall held a hearing that took place Feb. 23 through Feb. 27 at the NLRB’s office in Milwaukee, where Rogers’ lawyers argued for a bargaining unit of 1,383 employees encompassing all Rogers locations in Wisconsin — three hospitals in the Milwaukee area and 10 outpatient clinics around the state.

Rogers had “a heavy burden” to overcome the presumption that a single facility is an appropriate bargaining unit, Hadsall wrote in her order this week, and she found that management had  failed to do so.

The evidence in how Rogers is organized and supervises its employees was insufficient to overcome a general presumption in U.S. labor law — that a union bargaining unit representing a single health care facility in a larger network or organization is considered appropriate.

Evidence in the case showed that neither of the two clinics had “lost their separate identity such that a single-facility union would be inappropriate,” Hadsall wrote.

Union elections for about 68 employees at the West Allis Lincoln Center clinic and about 35 at the Madison clinic are scheduled for Wednesday, April 22.

For employees at both clinics who have been seeking union representation, the decision was welcome news.

“I’m thrilled and beyond thrilled,” said Erin Quinlan, a behavioral health specialist at the Madison clinic. “It really just vindicated how firm our stance is and how confident we feel about organizing a union and doing so for the Madison clinic.”

Lohman said she and other West Allis employees who have been seeking union representation were pleased as well.

“I’ve just been feeling really overjoyed,” Lohman said Thursday. She and the other fired employees will be able to vote in the West Allis union election, she said.

Rogers Behavioral Health has announced the organization will appeal the order to the full NLRB in Washington, but that will not forestall next week’s voting.

“We are disappointed with the NLRB regional office’s decision to allow separate bargaining units given that Rogers Behavioral Health operates as one unified system across Wisconsin,”  Rogers said in a statement, which Remmel delivered via email. The statement asserted that patients “can move seamlessly between different levels of care, supported by providers who collaborate across locations.”

In her order, however, Hadsall found that there was not sufficient evidence of “functional integration” across the system to overcome the presumption that a single facility is appropriate for a bargaining unit.

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WASHINGTON — President Donald Trump on Thursday said he will nominate Erica Schwartz, who served in the president’s first administration, to lead the Centers for Disease Control and Prevention, a seat left vacant for months after his last director said she was ousted in a rift over childhood vaccines.

Trump announced his new pick on his social media platform, Truth Social, touting Schwartz’s career as a medical doctor with the U.S. armed forces.

“She is a STAR!” he wrote.

Schwartz was a deputy surgeon general during Trump’s first term, and previously served as the director of health, safety and work life while a rear admiral in the U.S. Coast Guard.

Trump’s previous CDC director, Susan Monarez, told U.S. senators under oath in September that Health and Human Services Secretary Robert F. Kennedy Jr. fired her for not agreeing to pre-approve changes to the childhood vaccine schedule, and for refusing to fire agency scientists without cause. 

Monarez held the position for just 29 days before she was ousted. She was confirmed by the U.S. Senate on a party-line vote in July.

The president also announced nominations of several other health officials to fill open spots at the CDC.

“I am also pleased to announce the appointment of Sean Slovenski as the CDC Deputy Director and Chief Operating Officer, Dr. Jennifer Shuford, MD, MPH, as the CDC Deputy Director and Chief Medical Officer, and Dr. Sara Brenner, MD, MPH, as Senior Counselor for Public Health to Secretary Robert F. Kennedy, Jr.,” Trump wrote.

“These Highly Respected Doctors of Medicine have the knowledge, experience, and TOP degrees to restore the GOLD STANDARD OF SCIENCE at the CDC, which was an absolute disaster focused on ‘mandates’ under Sleepy Joe,” he added.

The CDC’s vaccine advisory committee adjusted recommendations for childhood vaccines in September, withdrawing the agency’s recommendation that children receive the COVID-19 vaccine.

WASHINGTON — Health and Human Services Secretary Robert F. Kennedy, Jr. testified before Congress on Thursday that he’s not pleased with how spending cuts to programs that help lower-income Americans afford food will affect his efforts to bolster healthy eating habits. 

“Am I happy about the cuts? No, I’m not happy about the cuts,” Kennedy said during a lengthy hearing in front of the House Ways and Means Committee, one of several congressional panels he’ll testify before in the days ahead. 

Kennedy added that President Donald Trump and White House budget director Russ Vought also didn’t truly want to propose funding cuts to the Special Supplemental Nutrition Program for Women, Infants, and Children, often called WIC, and the Supplemental Nutrition Assistance Program, or SNAP. 

“Nobody wants to make the cuts. Russ Vought doesn’t want to make the cuts. President Trump doesn’t,” he said. “But we got a $39 trillion debt.”

Wisconsin Democratic Rep. Gwen Moore, who asked the questions, then referenced comments Kennedy made earlier in the hearing about Froot Loops, when he said it “isn’t even a food. It’s just poison.”

Moore noted the cereal is “a lot cheaper than good, healthy food.”

Froot Loops includes a corn flour blend, sugar, wheat flour, whole grain oat flour, modified food starch and other ingredients. 

Trump advocates reductions for HHS

The Trump administration’s budget request for the fiscal year set to begin on Oct. 1 proposes Congress increase defense spending by more than half a trillion dollars, accounting for a 43% boost, and that lawmakers cut domestic spending by 10%. 

It suggested Congress reduce spending at HHS by $15.8 billion, or 12.5%, to $111.1 billion, though lawmakers largely rejected proposed spending cuts to the department during last year’s government funding process. 

Vought testified earlier this week that the administration expects to ask Congress for additional defense spending for the war in Iran, though he said he couldn’t give lawmakers a ballpark estimate for how much that will add to the current request for $1.5 trillion in defense funding. 

Lawmakers questioned Kennedy about dozens of other issues throughout the hearing, including how he’s spoken about vaccines since being confirmed HHS secretary, the rise in measles cases throughout the country and comments Kennedy and Trump made about the possible causes of autism. 

Utah Republican Rep. Blake Moore, after sharing that his 10-year-old is on the autism spectrum, said he was “underwhelmed” by what the administration has released so far about possible causes. 

He also said that his wife was hurt by claims from Trump and Kennedy that women who take Tylenol when pregnant could increase the risk their children are later diagnosed with autism. 

“We don’t even know if she took Tylenol during her pregnancy, but that was a hurtful moment for her,” Blake Moore said. “And I just want to encourage the administration and your team to keep at it. And I think there’s more we can do here with low expectations.”

Medical experts say that decades of research shows autism is the result of a combination of genetic and environmental factors.  

Measles death

California Democratic Rep. Linda T. Sánchez questioned Kennedy about comments he made during his Senate confirmation hearing on vaccines, arguing that he hasn’t stuck to the commitments he made during that process. 

She then asked him if the measles vaccine could have prevented a boy from dying of the disease in Texas. 

“It’s possible, certainly,” Kennedy said. 

But, he repeatedly declined to answer a question from Sánchez about whether Trump approved the Centers for Disease Control and Prevention’s decision to remove a messaging campaign to encourage vaccination, even as she asked it several times. 

Sánchez then displayed a poster showing a photograph of Kennedy and Kid Rock to illustrate her discontent with his work so far as HHS Secretary. 

“Now, one thing that I find incredible is that you suspended this pro-vaccine messaging campaign. But somehow you’re spending taxpayer dollars to drink milk shirtless in a hot tub with Kid Rock,” she said. “And somehow you think that’s a better public health message than informing the public about the importance of vaccines.”

Day care, Medicaid, Black maternal health

Illinois Democratic Rep. Danny K. Davis pressed Kennedy about whether he agrees with a statement Trump made earlier this month when the president said, “We can’t take care of day care. It’s not possible for us to take care of day care. Medicaid, Medicare, all of these individual things. They can do it on a state basis. You can’t do it on a federal. We have to take care of one thing, military protection.” 

Kennedy responded that he was “told to make a 12% cut across our department” because the national debt, which has accumulated over decades, has reached $39 trillion. 

“We’re now having to tighten our belt,” Kennedy said. 

Davis also questioned Kennedy on funding and initiatives to reduce Black maternal mortality, saying “the Trump administration is undermining Black maternal health from all sides.”

“The GOP slashed over a trillion dollars from Medicaid, which pays for over 40% of births in the United States. President Trump just proposed cutting maternal and child health programs by over $800 million,” he said. “DOGE canceled funds for several research projects that could save countless Black mothers, like the Morehouse School of Medicine research on improving the health of Black pregnant and postpartum women.”

Kennedy responded by arguing that he and others in the Trump administration are “doing more to advance maternal health than any other administration in history.”

“There was tremendous duplication in the departments. We had 42 different maternal health services in our department,” Kennedy said. “And we cut some of those and consolidated them. Right now, we are investing huge amounts of money in maternal health.”

At Family Planning Associates in Chicago, in the office where staff take phone calls from potential abortion patients, a U.S. map colored in with red and green dry-erase markers notes the latest status of abortion access in every state. The map can change at any time.

In the center of the map’s biggest sea of red is Illinois, outlined in green — showing it’s a state with strong abortion access — surrounded by several states that ban or severely restrict abortion. Illinois is the destination for nearly 1 in 4 people traveling to another state for abortion care, according to a report from the Guttmacher Institute, an advocacy and research organization that supports abortion access and tracks data nationwide.

“Illinois really became kind of a haven state for the Midwest and much of the South immediately post-Dobbs,” said Megan Jeyifo, executive director of the Chicago Abortion Fund, which provides logistical and financial support to people who need abortions.

The state’s geography explains part of its popularity; in five of the six border states, abortion is either banned or largely inaccessible. But Illinois also is among the states that have put in place new policies — along with millions of dollars — to welcome patients who aren’t their residents. Advocates and providers say other safe-haven states should replicate the investments.

That’s happened most recently in Maine and Washington state, where governors approved funding to support family planning and abortion care, including for out-of-state patients.

Since the U.S. Supreme Court’s 2022 Dobbs v. Jackson Women’s Health Organization decision that overturned the constitutional right to abortion and allowed states to regulate the procedure, 13 states have implemented near-total abortion bans, and seven others have bans after six to 12 weeks. Although about one-quarter of people who need an abortion now obtain medication by telemedicine, many who live in states with bans still have to travel elsewhere for various reasons, including fear of prosecution.

Guttmacher’s data showed that fewer people traveled for care in the past two years than the peak of 170,000 who traveled in 2023, the year after Dobbs.

That number fell to about 155,000 in 2024, including 35,000 who went to Illinois, the data showed. Last year, an estimated 142,000 abortion patients traveled out of state, with a fairly consistent number, about 32,000, going to Illinois.

The next-highest destination after Illinois was North Carolina, followed by New Mexico and Kansas.

Guttmacher and other advocates attribute part of that decrease in the national numbers to wider availability of telehealth access to abortion medication that can be mailed to patients in other states. There were an estimated 1.1 million abortions across the United States in 2025, about the same amount as 2024 but the highest number since 2009, according to Guttmacher.

Shield laws protect health care providers in many states, including California, Illinois and New York. Those laws have prevented Republican attorneys general in other states, such as Texas and Louisiana, from trying to punish providers who prescribe the drugs.

Louisiana has unsuccessfully tried to charge and extradite doctors from California and New York, and is also suing the federal government to remove the provision that allows abortion medication to be prescribed by telehealth. A federal judge put the case on hold for now as the U.S. Food and Drug Administration completes a safety review.

Policy changes in Illinois

Illinois’ “haven” status is derided by anti-abortion groups, who call the state’s policies extreme.

“The abortion industry in Illinois is the wild west, which is clear by these numbers,” said Mary Kate Zander, president and CEO of Illinois Right to Life, to the Chicago Sun-Times, speaking about the Guttmacher report.

One state changing its laws to restrict abortion access can lead to a significant influx of patients traveling to clinics in other states. Dr. Allison Cowett, chief medical and advocacy officer for Family Planning Associates, said when six-week abortion bans went into effect in Florida and Georgia in May and October of 2024, respectively, many more patients from the South started coming to Chicago.

“Within the first few months after Dobbs, we had more than 1 in 3 patients coming from outside Illinois, and that has maintained for those three, almost four years,” Cowett said.

Illinois also borders Indiana, which has a near-total abortion ban in place. Cowett said Indiana residents were the largest percentage of out-of-state abortion patients at her clinic before 2022, and it has stayed that way.

Restricting, cutting Medicaid funding shifts more reproductive health care to telemedicine

Jeyifo said when she started as a volunteer with the Chicago Abortion Fund in 2016, the organization couldn’t financially support large numbers of out-of-state patients because Illinois didn’t invest in access the way it does now. The biggest change came in 2018, when Illinois allowed its state Medicaid program to cover abortion procedures.

“We would not have been able to expand our support outside of Illinois residents without that coverage,” Jeyifo said.

Nineteen other states allow their Medicaid program to cover abortion procedures, according to KFF, a health policy research group.

In 2023, Democratic lawmakers in Illinois allocated $10 million from the state health department to establish the Complex Abortion Regional Line for Access, known as CARLA, a hotline for the Chicago Abortion Fund and four area hospitals to help coordinate care. Jeyifo said more than 1,000 people have received assistance through that hotline in the years since.

The state has also helped fill in lost Medicaid funding after Congress passed a provision blocking federal Medicaid payments to certain abortion providers, mainly targeting Planned Parenthood, and it has helped pay for training and other programs that help connect people with care.

In January, the state launched a new partnership with the Chicago-based Michael Reese Health Trust to establish the Prairie State Access Fund, which will provide aid to out-of-state patients in need of reproductive and gender-affirming health care.

“(Illinois) is this model for other receiving states around the country to take up and learn about, because the proximity on a map is important, but the resources that are available once you get to a place are so much more important,” Jeyifo said.

Finding nearby states

The Guttmacher report showed 62,000 of the 142,000 people who traveled came from states with near-total bans, more than double the number who traveled from those states before 2022. But it has declined over the past year, down from 74,000 who traveled from those states in 2024.

The next-highest state for travelers, North Carolina, is relatively close to Georgia and Florida. The number of out-of-state travelers has remained steady there since 2024, even though North Carolina has a 12-week ban and a three-day waiting period for abortions.

In New Mexico and Kansas, about two-thirds of all abortions provided were for people traveling from outside the state, but those numbers are going down. New Mexico is often a destination for people from Texas, and Kansas borders Oklahoma, two states with strict bans. Kansas also borders Missouri; voters in 2024 passed a constitutional amendment legalizing abortion, but access has not returned, and lawmakers are trying to reverse the amendment in this year’s midterm elections.

Family Planning Associates is one of the largest independent abortion clinics in Illinois. It expanded its staff — including doctors, nurses and front desk workers — during the first year after Dobbs from about 40 people to more than 70 to handle the new patient volume, Cowett said. The clinic also expanded its physical space by about two-thirds.

Many of those who come from the South have never left their home state, Cowett said, and it can be overwhelming for them to come to a big city during an already emotional event. The abortion fund and others help supply a closet in the clinic that is stocked with toiletries, basic clothing, shoes and other items to assemble care packages for patients.

The state has also provided security infrastructure grants to nonprofits to protect against potential attacks, such as a clinic firebombing in Peoria, Illinois, in 2023, two days after Democratic Gov. JB Pritzker signed abortion protections into law. No one was in the building at the time.

Such aid was especially important for the Choices: Center for Reproductive Health clinic in Carbondale, a city at the southern tip of Illinois and the intersection of neighboring states with strong anti-abortion laws: Arkansas, Kentucky and Tennessee.

It’s a much shorter drive to Carbondale for people in those states than it is to Chicago, said Jennifer Pepper, Choices president and CEO, and it’s a more familiar, smaller area.

The state grant allowed them to harden the physical security of the clinic in Carbondale, Pepper said, which is something they haven’t been able to do for their sister location in Memphis, Tennessee. That clinic provides birth control, wellness exams and midwifery services, but receives no state support.

“We’ve never had state support in all of our 52 years in Tennessee,” Pepper said.

State assistance

Other states with Democratic leadership and protective abortion laws are starting to approve more funding to support reproductive health care.

Maine Gov. Janet Mills signed a budget bill Friday that includes funding for lost Medicaid reimbursements and creates an ongoing $5 million annual appropriation for family planning services. Washington Gov. Bob Ferguson signed a law in late March establishing a new revenue source for abortion care by implementing a tax on health insurance companies that is expected to generate about $10 million in the first year and about $2 million in each subsequent year.

Jeyifo, of the Chicago Abortion Fund, said she hopes to see more of those efforts in other states with laws that are supportive of reproductive health care, including ones with Democratic leadership that could be doing more to expand clinic availability and rescind waiting periods, such as the 24-hour waiting requirement that still exists in Wisconsin before a patient can get an abortion.

“So many states in our region could be doing more just for their own residents, let alone people traveling,” Jeyifo said.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

Some anti-abortion state lawmakers are pushing to revise the definition of “abortion” so abortion bans don’t apply to cases in which the death of an “unborn child” is the result of medical care provided to the pregnant woman.

In the four years since the U.S. Supreme Court allowed states to ban abortion, stories continue to emerge of women with doomed pregnancies who developed life-threatening infections, had to travel to another state, or even died because doctors were afraid to provide what was once considered standard pregnancy-loss care.

Thirteen states have abortion bans, and all of them include a medical exception that allows abortions to protect the life of the pregnant woman. Some, but not all, of the bans also have exceptions to protect the health of the woman.

But patients and providers have argued in lawsuits challenging the bans that such exceptions are too ill defined to give doctors and hospitals the confidence to provide timely care. As a result, they say, providers end up denying care until the woman’s condition deteriorates to a point where the exceptions definitely apply, jeopardizing her health and future fertility.

Last year, states including Texas, Kentucky and Tennessee enacted laws designed to provide additional clarity. Confusion persists in those states and others, however, and research has linked abortion restrictions to higher rates of maternal death and injury.

The latest measures, crafted and promoted by national anti-abortion groups, would redefine “abortion” as the intentional ending of the life of the “unborn child.” Supporters say they would clear the way for doctors to manage miscarriages, ectopic pregnancies and other pregnancy-related emergencies.

“No one wants a physician to hesitate or pause and further endanger the life of the mother,” said Ingrid Duran, director of state legislation for the National Right to Life Committee, which has advocated for all of the measures, in a written statement. “This is why providing clearer language in defining terms can be beneficial.”

But reproductive rights advocates and many OB-GYNs say the real purpose of the bills is to fortify abortion bans that are broadly unpopular, even in states with full bans, and under legal challenge in multiple states. They argue the new measures are still too vague because they hang on the intentions of individual physicians, and many of the same procedures and medicines used in abortions are used to treat miscarriages.

They also say the language in the bills could grant embryos legal rights, thereby making some fertility treatments illegal.

“If you’re trying to define what is and is not an abortion, and you’re creating really specific, narrow guidelines, it could really unintentionally classify some pregnancy-related procedures as abortion care, and therefore within the law not medically necessary,” said Elias Schmidt, state legislative counsel for the Center for Reproductive Rights, an advocacy group.

South Dakota is first

In March, South Dakota became the first state to enact such a law. Its measure states that the state’s abortion ban only applies to “the intentional termination of the life of a human being in the uterus,” and not to medical treatment that results in “the accidental or unintentional death of the unborn child,” treatment to resolve a miscarriage or ectopic pregnancy, “the removal from the uterus of a deceased unborn child,” or a medical procedure that aims to save the fetus.

To the concern of fertility-treatment advocates, the law also defines “human being” as “an individual living member of the species of Homo sapiens, including the unborn human being during the entire embryonic and fetal ages from fertilization to full gestation.”

A similar bill introduced in Missouri defines abortion as “the act of using or prescribing any instrument, device, medicine, drug, or any other means or substance with the intent to destroy the life of an embryo or fetus in his or her mother’s womb.” It explicitly exempts miscarriage management and treatment for ectopic pregnancies from the definition.

And a bill in Utah, where abortion is still legal up to 18 weeks’ gestation, would regulate how an abortion procedure is recorded in a patient’s chart, distinguishing between an elective abortion and a medically indicated abortion. It defines the latter as an abortion “to remove a deceased fetus,” resolve an ectopic pregnancy, or to avert the death or “serious physical risk of substantial impairment of a major bodily function of a woman.”

Wisconsin’s legislature recently voted not to advance a similar bill this past legislative session.

Blame for the confusion

Anti-abortion groups blame doctors and abortion-rights advocates for creating the confusion around the medical exceptions in abortion bans, insisting it is clear what is a medically indicated abortion and what is purely elective.

“The fact that we’re in a place now that states actually have to define (abortion) is a result of my field, particularly (the American College of Obstetricians and Gynecologists) not clarifying it,” said Dr. Susan Bane, vice chair of the board of the American Association of Pro-Life Obstetricians and Gynecologists, which is made up of about 7,500 physicians and other medical professionals who oppose abortion.

The organization has launched a medical education and messaging campaign arguing that abortion bans do not prevent necessary health care.

According to Bane, the main difference between an induced abortion and medically indicated termination is that in the first case, “you want a dead baby at the end of whatever you do.”

The author of the South Dakota law, Republican state Rep. Leslie Heinemann, said he sponsored the measure to quell some of the criticism that the medical exceptions in his state’s ban were ill defined. He admitted he underestimated how difficult it would be to codify in law when care for a miscarriage is necessary.

“Even the medical community had trouble with helping define some of the issues,” he said.

The version of the bill that became law names only a few conditions and leaves the rest up to the discretion of physicians, who must exercise “appropriate and reasonable medical judgment that performance of an abortion is necessary to preserve the life of the pregnant female” to avoid felony charges.

Heinemann insisted his measure would not restrict fertility treatments or birth control. But reproductive health and legal experts say that by defining the beginning of human life as “the entire embryonic and fetal ages from fertilization to full gestation,” it could have that effect.

“Embedding personhood language into state laws does really bring up concern around contraceptive access and IVF access,” said Kimya Forouzan, principal state policy adviser for the Guttmacher Institute, a think tank that supports abortion rights.

“As personhood provisions grow in the state code, it brings up the question: At what point are we granting the legal rights of a person and placing those rights above the individual themselves?”

Dr. Amy Kelley, an OB-GYN in Sioux Falls, South Dakota, who was the chair of the South Dakota chapter of the American College of Obstetricians and Gynecologists from 2023 to 2025, said lawmakers ignored her and other doctors’ concerns that the amended abortion ban is still too vague.

“The whole point of medicine is to prevent people from becoming on the brink of death, right? So are they expecting us to wait until that?” Kelley said. “It’s still not very clear, and the definition for miscarriage and ectopic is also not the one we wanted. It’s just not helpful.”

Kelley said that since her state enacted an abortion ban, she often waits longer to terminate a pregnancy for medical reasons, and will sometimes send patients out of state for care. She noted that the new law doesn’t explain what level of risk to the pregnant woman justifies terminating a pregnancy.

“They want to say elective abortions are not allowed. But what do they consider elective?” she said. “Let’s say they have a heart condition and their risk of dying in pregnancy is 40%. Is that an elective abortion because their risk is not 100%?”

Stateline reporter Sofia Resnick can be reached at sresnick@stateline.org

In the eight states that expanded Medicaid after 2018, the number of people receiving prescriptions for the opioid addiction treatment medication buprenorphine increased dramatically, according to a paper that researchers will present next month.

The states that expanded Medicaid before that period also saw gains, but they were generally smaller. That’s because other changes, aside from Medicaid expansion, made buprenorphine easier to get after 2018.

The researchers found that among all patients — those covered by Medicaid, other insurers and the uninsured — the number of buprenorphine prescriptions increased in the eight most recent Medicaid expansion states (Idaho, Maine, Missouri, North Carolina, Oklahoma, South Dakota, Utah and Virginia) by more than 21% between 2019 and 2023. Maine, Oklahoma and Virginia saw the most dramatic increases.

Among the states that expanded Medicaid in 2018 or before, Kentucky, Vermont and West Virginia experienced the largest boosts. The study, published in February in JAMA Network Open, was conducted by researchers from Rutgers University and Indiana University, based on pharmacy claims data from retailers across the country.

Stephen Crystal, director of the Center for Health Services Research at Rutgers University and one of the authors, explained that buprenorphine became more accessible after 2018 as the federal government loosened various prescribing rules, including allowing prescribing via telehealth.

“Longer-term tracking shows that expansion, whether early or later, provides essential financial access and supports the growth of a provider network that improves population-level treatment rates,” Crystal told Stateline.

Experts warn that looming Medicaid cuts could cut off buprenorphine access to thousands of patients. The broad tax and spending law President Donald Trump signed last summer is projected to cut federal Medicaid spending by an estimated $886.8 billion over the next decade, largely because new work requirements will push people off the rolls, according to estimates by the Congressional Budget Office. CBO estimates that it could increase the number of people without health insurance by 7.5 million in 2034.

Opioid overdose deaths in the U.S. peaked during the COVID-19 pandemic, reaching a high of 81,806 deaths in 2022. They’ve fallen sharply since then, to 79,358 in 2023 and 54,045 in 2024.

Medicaid is  the largest payer of opioid use disorder treatment, and in 2023 it covered nearly half of all non-elderly adults in the U.S. with opioid use disorder in 2023, said Robin Rudowitz, a senior vice president at KFF, a health policy research group.

“Having health insurance is the main way for people to have consistent access to health care services, and also particularly for Medicaid, as most people are low income, and it provides protections against financial burdens,” Rudowitz said.

“And for (opioid use disorder) specifically, research shows that when people discontinue treatment, mortality risk increases. And for discontinuation of Medicaid, specifically, when coverage lapses, mortality rate increases.”

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

Under a bill signed Wednesday by Gov. Tony Evers, Wisconsin will seek health care coverage from the federal government for certain services for incarcerated people. 

A statement from Evers’ office said that AB 604 — now Wisconsin Act 233 — aims to improve health outcomes and reduce disruptions in care and rates of people committing new crimes. 

As people with substance use disorders return to the community from jail or prison, they are especially vulnerable to dying from an overdose. Supporters of the new law hope it will aid them.

A federal “inmate exclusion policy” limits incarcerated people’s ability to use Medicaid, but under the new law the state will apply for a waiver, taking advantage of an exception outlined by the federal government. 

The Wisconsin Department of Health Services will submit a request for a waiver to conduct a demonstration project to provide incarcerated people with health care coverage for certain services for up to 90 days before release. 

The department will request coverage for case management services, medication-assisted treatment for all types of substance use disorders and a 30-day supply of prescription medications. If the waiver is approved, incarcerated people would have to be otherwise eligible for coverage under the Medical Assistance program in order to qualify. 

As of Nov. 21, 19 states have approved waivers and nine states including Washington D.C. have pending waivers. 

The Wisconsin Department of Health Services must submit the waiver request by Jan. 1, 2027. The department told the Examiner in November that it needed the authority that the bill would provide before it starts work on putting together the details of the waiver. 

‘The care they need to live’

Rep. Shelia Stubbs (D-Madison), one of the lawmakers who introduced AB 604, said in a statement Wednesday that the bill gives incarcerated people “a greater chance of maintaining sobriety, preventing overdose, and remaining healthy after they rejoin the community.” 

The criminal justice advocacy organization WISDOM was among groups that expressed support for the bill. Tom Denk, the co-president of one of WISDOM’s affiliates, said in an emailed statement that this law is very personal to him and called it “a step forward.”

Denk, who was released from prison to extended supervision in 2022, said he’s had friends in and out of facilities and had too many die because of a lack of services. 

He said that “my own struggles, the trauma, and the deaths of some of my best friends are what motivated me to get involved in advocating for a better system.”

“Medications, and access to medical care, will literally save lives,” Denk said. “Too many people don’t have either, when they’ve left facilities.” 

Denk also emailed the Examiner a statement signed by Bev Kelley-Miller, who wrote that she lost her 22-year-old daughter, Megan Kelley, to a preventable heroin overdose. Kelley-Miller wrote that her daughter had an ankle bracelet “but that didn’t stop her from using.” 

Kelley-Miller, who expressed support for AB 604, wrote that substance use disorder is a medical condition and that using substances is not a choice once you are addicted. 

“I wish Megan was still here,” Kelley-Miller wrote. “Since she’s not, I advocate for others to receive the care they need to live.”

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