Nearly 100 community-based organizations have lost their federal HIV-prevention grants this week as the Trump administration redirects dollars to state and local health departments.

The funding change represents a departure from the decades-old national HIV prevention strategy favored by most public health organizations.

President Donald Trump launched the Ending the HIV/AIDS Epidemic Initiative during his first term in office. Since 2021, the program has disbursed a total of nearly $240 million to 96 community-based organizations in 31 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands.

Those groups have used the money to pay for testing and pre-exposure prophylaxis (PrEP), a medication that people at high risk for HIV can take for protection during sex or injection drug use. Preventing new HIV infections and preserving access to treatment for those who have HIV helps prevent further transmission of the virus.

By prioritizing areas with the highest number of HIV diagnoses, the initiative sought to reduce HIV incidence by 75% in five years and by 90% by 2030. It continued under the Biden administration.

But now the Trump administration has shifted course.

Instead of granting money directly to community-based organizations, the administration is offering one-time grants to state and local health departments. It is encouraging the jurisdictions with the most HIV diagnoses to funnel at least 25% of the money to community groups, but there is no requirement that they do so. Health departments in areas with fewer diagnoses are being encouraged to send 10% of their money to community groups.

The state and local health agencies are required to spend whatever dollars they don’t pass on to community groups on HIV surveillance and PrEP access.

When the federal Centers for Disease Control and Prevention announced the availability of the original grants in 2020, it noted that since the late 1980s, it had partnered with community-based organizations to fight the spread of HIV because of “their accessibility, history and credibility in the community,” especially among Black and Hispanic people, gay and bisexual men and people who inject drugs.

“CDC has done this for a very long time, specifically because they know that community-based organizations are important players in the community,” said Lindsey Dawson, associate director for HIV policy at KFF, a nonprofit health research group.

“They’re a voice in the community that people trust, and these programs really are able to reach people who are at greatest vulnerability to HIV in a way that the state or federal or local government (would) not be able to do.”

When asked for an explanation of the change, the U.S. Department of Health and Human Services referred Stateline to the Office of Management and Budget. Neither OMB nor the White House press office responded to multiple requests for comment.

The National Alliance of State and Territorial AIDS Directors told Stateline that under the new grant program, the federal government will disburse approximately $90 million to state health departments through May 2027. Though that amount is nearly twice as much as the roughly $48 million per year that was handed out under the old grant program, community-based organizations are going to see less money, public health experts say.

In August, KFF estimated that overall, community-based organizations would need about 35% of the new money to match what they were getting before. The National Alliance of State and Territorial AIDS Directors estimates that percentage to be closer to 50%.

In Texas, health officials said the state plans to send about 23%, or about $1.2 million, of its $5.24 million grant to community-based organizations.

Jeffrey Campbell, chief executive officer of Allies in Hope — formerly called AIDS Foundation Houston — told Stateline that he expects his federal funding to be cut by $441,000, which could force him to lay off at least three staff members.

Under the old grant structure, half of all funding had been channeled to organizations in the South, which accounts for more than half of the nation’s HIV diagnoses.

But already, one organization in that region has announced it will have to shut down as a result of the funding change: PowerHouse Charlotte in North Carolina announced in August that it will close. For 16 years, that  organization has provided  free HIV and STD screenings, prevention services and community resources geared toward gay Black men.

In at least two states, Minnesota and Oregon, state health agencies wouldn’t be able to match the amount of money their community-based organizations were getting under the old system even if they gave 100% of their state grants to those groups, according to KFF.

“These community-based organizations are on the ground doing the work with the populations that need it,” said Carl Schmid, executive director at the HIV+Hepatitis Policy Institute, a public health nonprofit that tracks policies related to HIV prevention.

“Some states may have relationships with some of the existing grantees and may be fine, but others, they may not. And so there’s definitely going to be a lapse of funding.”

Emily Schreiber, senior director of policy at the National Alliance of State and Territorial AIDS Directors, said that under the new rules, states don’t have much time to establish new contracts with community-based organizations.

“(States) are trying to turn around things as fast as possible. But simply there (was) not enough time to get that funding through the contracting process and all of that by September 30th, which was really unfortunate,” she said.

“It’s not easy for a health department to create a whole new contracting process overnight. Even in the best-case scenario, this is not a perfect solution.”

Many health departments take between 45 and 90 days to scale new contracts and grants, said Toni Young, executive director and founder of Community Education Group, a nonprofit offering HIV community engagement, testing and outreach across rural West Virginia and the broader Appalachian region.

“We don’t have an infrastructure in many rural communities to address HIV,” she said.

Another challenge for community-based organizations is that because they won’t be getting money directly from the federal government, they will no longer be eligible for discounted drugs under the federal 340B program.

“When you took away this grant, you also took away their 340B status, which is the reason some have had to potentially close or at least stop this entire side of operations,” said Maximillian Boykin, manager of the Save HIV Funding Campaign.

“It leaves a lot of these places very fragile.”

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

Medicaid enrollees from five states and leading medical organizations filed a lawsuit Friday challenging new Medicaid work requirements.

The broad tax and spending law that President Donald Trump signed last summer, known as the One Big Beautiful Bill Act, established work, school or community service requirements for low-income adults who receive Medicaid under expansion provisions and waiver programs across 44 states. The law exempts people who are medically frail from work requirements, but the lawsuit argues a new administration rule severely restricts who qualifies.

Plaintiffs in the lawsuit filed in the U.S. District Court for the District of Maryland include Medicaid enrollees from five states — Kentucky, Illinois, Indiana, Missouri and North Carolina. 

They also include the American College of Physicians, the American Academy of Pediatrics, the Society for Adolescent Health and Medicine, Doctors for America, the New Hampshire Medical Society, the New Hampshire Chapter of the American Academy of Pediatrics and the city of Columbus. The National Health Law Program and the Democracy Forward Foundation are representing the plaintiffs.

“Creating barriers to healthcare coverage for the most vulnerable needlessly puts people’s lives at risk and inevitably drives up the cost of care for everyone,” Columbus City Attorney Zach Klein said in a news release. “These are folks who should be focused on getting the help and care they desperately need, not overcoming even more obstacles.”

The federal government in June issued a rule that specifies “medical frailty” exemptions from the work requirements. Those include people who are blind or disabled, or have any physical or developmental disability that interferes with daily living; people with substance use disorders or disabling mental disorders; or those with “serious or complex” medical conditions. People who fall in these categories still must prove that their conditions hinder their ability to work or participate in community engagement.

Republicans argue that work requirements would push people into the workforce and allow them to come off government aid. Research shows the majority of Medicaid recipients already work or are in school.

The plaintiffs argue that the new designations are narrow and that work or exemption verification processes will create red tape that threatens Medicaid coverage for people with serious or chronic health conditions. Those who could be harmed under the new rule include people with cancer, diabetes, HIV, substance use disorders and other behavioral health conditions, the lawsuit argues. 

Individuals represented in the lawsuit have health conditions ranging from autism spectrum disorder, obsessive compulsive disorder, bipolar disorder, severe vision impairments, HIV and narcolepsy.

Work requirements will be costly for cities and localities that provide public health and emergency care services, the plaintiffs argue, as many people may lose coverage.

“When they (cities and localities) provide services for residents who lose their Medicaid coverage, they do so without compensation,” the lawsuit reads.

Medical groups are concerned the reporting burdens will cause interruptions in care and coverage for low-income, vulnerable adults.

“We should not and must not be implementing policies that place this already vulnerable population at increased risk of interrupted treatment, disrupted coverage, or losing healthcare access altogether,” said Dr. Jan K. Carney, president of the American College of Physicians.

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

Four in 10 pediatricians reported kids in immigrant families are avoiding coming in for healthcare out of concerns around immigration status, according to a new survey published Tuesday.

More than 1,600 pediatricians responded between April and June to the survey by American Academy of Pediatrics researchers.

In the survey, pediatricians were asked whether over the past year, their patients or the families they care for avoided seeking medical care for their child due to concerns around the immigration status of a household member. They were also asked the same about sending kids to school and about applying for safety net programs such as Medicaid, the Children’s Health Insurance Program or food stamps. 

On average, pediatricians reported that about a quarter of their patients are in immigrant families. Forty percent of pediatricians reported those families avoided seeking medical care for their child out of concern for the patient or family’s immigration status. 

Thirty-one percent of the surveyed physicians reported immigrant families avoided applying for government programs. Just over a fifth reported that families had avoided sending their child to school.

The American Academy of Pediatrics said the findings are likely an undercount and that more children are likely going without care.

Stateline reported this month that many clinicians are seeing more advanced illnesses among kids of immigrants, as well as skipped preventive care and forgone surgeries amid immigration status fears.

In the survey, answers varied across different service areas and subspecialities. For example, nearly 45% of pediatricians with subspecialities and almost half — 48% — of urban, inner city pediatricians said families retreated from seeking medical care for their child, versus 32% of rural pediatricians surveyed.

In January of last year, the Trump administration rescinded Biden- and Obama-era restrictions on places where immigration agents generally could not arrest people, such as hospitals, clinics and schools. 

In 2024, a quarter of children nationwide were in immigrant families with one or both parents born in another country, with the percentages varying by state, the researchers noted.

Healthcare professionals have also raised concerns about a new federal policy that goes into effect Friday. It broadens the discretion of immigration officers reviewing applications for green cards, certain visas or admissions into the U.S., allowing officers to consider enrollment in public benefits — such as housing and food assistance, Medicaid and the Children’s Health Insurance Program — as a “public charge,” which is grounds for inadmissibility under federal law. 

“Pediatricians have long spoken out against changes to the public charge policy because we know that it leaves families fearful of accessing programs and services that are critical for their health and well-being,” Dr. Sural Shah, chair of the academy’s Council on Immigrant Child and Family Health, said during a news conference on the policy last week.

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

States, cities and counties filed a pair of lawsuits Monday challenging new federal rules that will allow immigrants’ use of safety net resources to be taken into account for green cards and other applications to stay in or enter the country.

The new federal policy goes into effect Friday and broadens the discretion of immigration officers reviewing applications for green cards, certain visas or admissions into the U.S., allowing officers to consider enrollment in public benefits, such as housing and food assistance, Medicaid and the Children’s Health Insurance Program, as something called “public charge.” 

When officers determine a person could become dependent on government benefits, that “public charge” is a ground for inadmissibility under federal law. Such non-cash benefits were previously restricted from public charge consideration under the Biden administration. 

The Trump administration rescinded that 2022 policy, arguing that it is protecting taxpayer dollars and expects immigrants to be self-sufficient.

Both lawsuits were filed against the U.S. Department of Homeland Security and the U.S. Citizenship and Immigration Services in the U.S. District Court for the Southern District of New York. 

Many mixed-status households are expected to forgo benefits and disenroll from programs, causing U.S. citizen dependents, including children, to lose care and benefits for which they’re legally entitled to receive, experts and state officials say.

In their lawsuit, 22 states and the District of Columbia pointed to DHS estimates that say states nationwide may lose roughly $4.05 billion in annual federal transfer payments for Medicaid and CHIP programs alone. Of that nationwide total, the plaintiffs may stand to lose about $2.2 billion in reduced federal payments. 

The states include Colorado, Connecticut, California, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington and Wisconsin.

Due to disenrollments, states nationwide could lose about $1 billion in the Supplemental Nutrition Assistance Program (SNAP). Of that, the plaintiff states could lose $575 million in reduced federal payments.

The states argue that the new rules contain many ambiguities and will cause the states to“ultimately be forced to fill the breach” by funding gaps out of their own budgets, leading to “staggering” costs.

Along with losing federal funding due to disenrollments from state programs, public agencies will face administrative costs, the states argue, and as households forgo enrolling in benefits, such as preventative healthcare and nutritional assistance, including school lunches, public health will suffer, leading to an increase in disease prevalence and driving up the costs of medical care, they argue.

In a separate lawsuit, a coalition of cities and counties — New York City; Chicago; San Francisco; Santa Clara County, California; Seattle and King County, Washington — say the new rule is unlawful in reversing “longstanding limits on public charge determinations.” Roughly 1.3 million people, including 600,000 children, could lose care and coverage in those places, the suit argues.

New York City, which led the cities’ lawsuit, estimates it would see 6,000 fewer annual primary care visits. 

“The new public charge rule seeks to push immigrant families away from the programs that have kept people fed and healthy for decades,” New York City Mayor Zohran Kwame Mamdani said in a news release. “New Yorkers will be afraid to see a doctor or ask for help they are legally entitled to. That fear will not stop at the families that the federal government is targeting. Families who remain fully eligible for benefits will feel a chilling effect and all New Yorkers will pay for it.”

The coalition also argues that children would be forced to withdraw from free or low-cost education programs. It notes that about 19% of Seattle residents and 26% of King County residents rely on such programs.

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

New rules going into effect next week allow immigrants’ enrollment in safety net resources to be taken into account for lawful immigration status applications, the latest in the Trump administration’s immigration overhaul.

The rules will have wide implications for mixed-status households, as people without lawful status may forgo enrollment in public benefits for their U.S. citizen kids and other dependents out of fear. 

The new U.S. Citizenship and Immigration Services (USCIS) guidance goes into effect Sept. 18 and affects people applying for a green card, certain visas or admission into the United States. It rescinds the Biden administration’s 2022 public charge regulations, which restricted immigration officers from considering immigrants’ use of non-cash public benefits, including many benefits for low-income families such as Medicaid, housing programs and food stamps.

When an immigration officer determines a person could become dependent on government benefits, that “public charge” is a ground for inadmissibility under federal law.

Trump’s new policy broadens immigration officers’ discretion, allowing them to consider enrollment in non-cash public benefits as public charge. That includes Medicaid, Children’s Health Insurance Program (CHIP) and the Supplemental Nutrition Assistance Program, the country’s largest food assistance program.

Those subject to public charge consideration are immigrants seeking adjustment of immigration status to lawful permanent residency, and includes those who are spouses, siblings, parents and children of U.S. citizens; widowers and widows; foreign medical school graduates; U.S. armed forces personnel; certain workers such as those with advanced degrees, and others.

USCIS specifies certain immigrant groups and classifications that are not subject to public charge. Those include asylees, refugees, Afghani and Iraqi interpreters or such nationals who worked for the U.S. government, people seeking temporary protected status, human trafficking victims, self-petitioners under the Violence Against Women Act, Indigenous people born in Canada who aren’t U.S. citizens, among other groups.

Health research group KFF this summer estimated that between 1.4 million and 4.1 million Medicaid and CHIP enrollees living in a household with a noncitizen could disenroll due to the public charge rule or another immigration-related fear.

Last November, the U.S. Department of Homeland Security acknowledged this, saying that the rule would affect U.S. citizens in mixed-status households. The agency said that federal and state spending could be reduced by almost $9 billion annually “due to disenrollment or forgone enrollment in public benefits programs by members of households that include aliens who may be receiving public benefits.”

It also acknowledged “downstream and upstream” effects for states and their economies.

“For example, the rule might result in reduced revenues for healthcare providers, such as hospitals and nonprofits, participating in Medicaid, companies that manufacture medical supplies or pharmaceuticals, grocery retailers participating in SNAP, agricultural producers who grow foods that are eligible for purchase using SNAP benefits, or landlords participating in federally funded housing programs,” the agency wrote in its proposed guidance.

Previous studies found that under the first Trump administration’s public charge rules, families were less likely to apply for food assistance or seek healthcare, a point emphasized by the American Academy of Pediatrics this week.

“When a child is hungry, it can affect every aspect of their development and lead to chronic conditions like heart disease and diabetes, even into adulthood,” said Dr. Sural Shah, chair of the American Academy of Pediatrics’ Council on Immigrant Child and Family Health, during a news conference Thursday.

“Without accessing WIC, babies and young children will miss out on critical nutrition supports that are important for brain development in the first 1,000 days of life. Medicaid and CHIP are lifeline programs.”

In an executive order he signed a month after his inauguration, President Donald Trump wrote that his administration would “uphold the rule of law, defend against the waste of hard-earned taxpayer resources, and protect benefits for American citizens in need, including individuals with disabilities and veterans.” 

Health clinicians say immigration activity has been leading to fear and isolation among families, causing delayed care and illnesses to advance among children. They also say those with disabilities and complex needs will be among those hit hardest.

The Autism Self Advocacy Network, for example, said immigrants with disabilities will be disproportionately affected, as they tend to use public benefits more than other immigrants. 

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

In Minnesota, an elementary schooler has gone without surgery to treat a rare, life-threatening neck infection that isn’t responding to antibiotics.

Another young child can’t use their hearing aids because the family ran out of batteries and hasn’t come to get replacements.

Yet another child’s cochlear implant surgery was delayed by several months. 

These patients’ families, all immigrants, have been afraid of showing up to the hospital after immigration officers flooded their communities in recent months, said their doctor, pediatric otolaryngologist Asitha Jayawardena, a head and neck surgeon at Children’s Minnesota. 

Clinicians like Jayawardena say immigration arrests and detentions are taking a particularly acute toll on children’s health as families isolate at home. He’s seen some cases — such as the child with the neck infection — worsen because fearful parents aren’t coming in. 

“Without a doubt, it oscillates between being infuriating and absolutely disheartening,” Jayawardena said about the chilling effect. 

As the Trump administration’s immigration enforcement leads to sweeping arrests, healthcare workers say those actions have hit children hard — including children who are U.S. citizens and those in families without arrests.

Many healthcare providers report that since January 2025, they’ve seen a surge in missed pediatric appointments, delayed preventive care, and sick or injured kids going without treatment. Immigration and Customs Enforcement arrests have continued to climb — with a record 51,000 arrests in July — and experts predict continued unhealthy outcomes among children, causing collateral damage that could extend for years. 

Healthcare workers told Stateline that in addition to the physical healthcare fallout, they’ve also seen a significant increase in depression, anxiety and post-trauma symptoms among their pediatric patients. 

Delayed healthcare has critical consequences for young kids. For example, hearing loss, such as that experienced by Jayawardena’s patients, can hinder crucial development including speech, language and social skills. Along with missing health milestones and getting needed healthcare, kids are grappling with the long-term trauma of losing a parent.

“Community-wide trauma that is being inflicted is having a really important impact on families and children in particular. There are children that are losing their guardians. There are families that are losing their breadwinners,” said Amy Liebman, chief program officer of the Migrant Clinicians Network, a nationwide organization of healthcare workers serving migrant families.

“That certainly is going to ultimately impact their health and then their ability to access care,” she said.

The Trump administration also has introduced rules that allow federal agencies to take into account a family’s use of public benefits when reviewing applications for lawful immigration status. Dr. Gabriela Maradiaga Panayotti, a pediatrician in Durham, North Carolina, pointed to studies showing that such policies lead to a decrease in healthcare use, including among U.S. citizen children.

One of her patients, a U.S. citizen on Medicaid, had stopped a medication for ADHD that had helped him achieve better grades at school. His parents feared being targeted through Medicaid paperwork, so they didn’t refill his prescription. The child’s grades began to drop again.

“They didn’t want to be labeled as utilizing resources,” Maradiaga Panayotti said. “I hurt for him, especially because he’s at this tender preteen age where self-confidence and performance at school can really either build on and set a good foundation for success in high school, or can drop.”

Millions of children

Researchers at the Brookings Institution, a public policy research nonprofit, estimate that since Jan. 20 of last year, the day President Donald Trump was sworn in, and through early April of this year, over 146,000 U.S. citizen children have had a parent detained.

But many more are living with that fear. 

The Pew Research Center estimates 4.6 million U.S.-born children lived with an unauthorized immigrant parent in 2023, and roughly 2.5 million children could face the detention of both household parents, according to a Brookings analysis. 

But the trend cuts across immigration status — including those born to refugees, DACA recipients, asylees and people with temporary protected status. Across the nation, about a fourth of children are born to immigrant families, according to the Migrant Policy Institute.  

Increased ICE activity has included arrests at hospitals, and the agency has also made unprecedented efforts to obtain private health data, including Medicaid patient records, to extract addresses and immigration statuses — another major source of fear for families.

Jayawardena and his colleagues published a study in the American Academy of Pediatrics medical journal in August measuring whether pediatric outpatient care visits were disrupted during and after the large-scale immigration raids of Operation Metro Surge in Minneapolis, when the Trump administration deployed 3,000 agents, heavily targeting Somali and South Asian communities. 

The research team found that the rate of missed appointments among Hispanic or Latino children increased by over 50% during Metro Surge compared to the same time period — the first week of December to second week of February — in the prior two years.

Missed appointments increased by 80% among Spanish-speaking families and 53% among families needing language interpretation services. 

“The barrier is not necessarily lack of access, but more the fear and the isolation, and so the enforcement is having this chilling effect on immigrant families who, even though they may need these critical services, may be avoiding the hospital, the counseling, the victim services, and other essential care,” said Jasiel Fernandez, vice president of psychosocial supports at the global pro bono nonprofit KIND, or Kids in Need of Defense. “We see that happening over and over.”

The Migrant Clinicians Network, along with Physicians For Human Rights, surveyed nearly 700 healthcare workers across 30 states between March and August of last year, amid spikes in immigration activity. Most of the surveyed professionals — 84% — reported significant or moderate drops in pediatric patient visits since Trump’s January 2025 executive orders on immigration.

Kids also were spending less time outdoors, which affects overall health, and saw delayed diagnoses of their conditions. About 27% of clinicians said patients feared enrolling in benefits for their children, and couldn’t afford doctor visits. Preventive care, such as vaccinations, as well as chronic disease management and mental health care were the most affected, healthcare workers reported. 

And in both the survey and through interviews with Stateline, clinicians have reported seeing kids show up to emergency departments alone.

In Missouri, one pediatric emergency medicine physician, who spoke with Stateline on the condition of anonymity because he feared retaliation against his hospital, recalled an 11-year-old child who had been attacked by a dog, his legs riddled in bites. He came to the hospital with only his teenage sister.  

“He told us that (his parents) were scared to come in because ICE might be at the hospital,” the physician recalled. 

Others aren’t showing up to care at all. “Kids like these are so vulnerable that they kind of could fall through the cracks,” he added. “We see the downstream effects of policy changes, and we try to address all these needs. But when kids are coming in, they’re super sick.” 

Missed care, advanced illness

Some clinicians told Stateline that by the time some children reach their clinics, their health conditions have advanced to a more difficult stage. 

One North Carolina pediatrician has seen kids with asthma miss inhaler prescriptions, leading to more asthma attacks. In another case, a large family of refugee children came in covered in splotchy, itchy rashes — scabies. The family had been sharing two bedrooms. Afraid, they had postponed care for four weeks. 

“All of these children, totally ridden throughout their bodies, and it’s so uncomfortable. You can’t sleep because it’s horribly itchy,” said the pediatrician, who spoke to Stateline on the condition of anonymity, fearing retaliation since her clinic receives federal funding. 

“We’re creating tremendous problems for our community that will probably come back to bite us, because now these kids are going around with untreated medical conditions that are only going to get worse,” she said. “It’s a time when they need even more support than before, and our administration just isn’t really allowing that.”

She and others said they’re also noticing worsening depression among their patients.

“They’re spiraling out, and they’re not getting any support because they can’t come in and get care,” said the North Carolina pediatrician. She recalled one teenager telling her that they couldn’t sleep at night. “ ‘I’m sobbing and crying, terrified that my parents will be taken away,’ ” she recalled the teen telling her.

Elsewhere, one of KIND’s clients in California, a preteen sexual assault victim, has gone weeks without mental health care.

“The child’s sponsor, who is undocumented, is very afraid to take the young person to mental health appointments or any other kind of follow-up service,” Fernandez said. “Choosing basically to forgo that for the time being.”

In Texas, which has the most immigrant detainees of any state, a 14-year-old’s primary caregiver was detained. The teen has been suffering suicidal ideation.

“That young person is unable to access services,” Fernandez said. “Even if we think that a teenager has a certain level of agency to do certain things, when the caregiver is removed abruptly … the sponsor is not able to support, is not able to meet significant needs and monitoring for that young person.”

Fernandez said KIND has been offering Uber and Lyft rides to field offices because clients are afraid to drive to appointments to receive healthcare.

In southeast Florida’s Indian River County, Heather Miranda is CEO of Treasure Coast Community Health, which runs multiple clinics serving nearby communities of agricultural workers. Clinic staff in the northern area of the county, where Miranda said most immigration enforcement activity has been concentrated, told her they’ve seen a significant decrease of kids coming in — nearly 500 pediatric no-shows since February, 16% of all appointments. 

“They’ve seen kids not coming in for sick visits,” Miranda said. “Not coming in for their well-child or their vaccines. … It’s just been, overall, a decrease in preventative care, which is really, really important.”

Back in Minneapolis, Jayawardena said that even months after Operation Metro Surge, fear among his patient families remains “a persistent problem.”

“I want to help take care of these children, and the families want to get taken care of, as does my entire hospital system — and we cannot get them just physically into the hospital for things that are necessary,” he said.

“It’s just very disheartening knowing that there’s something I can do, but I am prohibited from doing it because families don’t feel safe.”

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

LGBTQ+ adults are more likely than other adults to miss healthcare appointments due to cost or other reasons — with a third reporting their health worsened as a result, according to a new survey by health policy research group KFF.

Among the 2,640 LGBTQ+ adults surveyed, those who are transgender, younger than 30 and those with lower incomes or without insurance were most likely to miss or forgo care due to cost. Over three-quarters of uninsured LGBTQ+ adults reported missing needed healthcare, according to the survey.

Overall, 6 in 10 of the adults surveyed reported missing needed healthcare in the past year due to cost, being unable to find a provider with available appointments or other reasons, compared with 38% of non-LGBTQ+ adults. Transgender adults, who made up 9% of those surveyed, were the most likely to report missing care.

Along with being more likely to postpone or skip needed care, 22% of LGBTQ+ adults reported forgoing prescription medications due to cost, compared with 12% of non-LGBTQ+ adults. Almost a third — 30% — also reported struggling to pay medical bills, compared with about a fifth of other adults.

Three in 10 LGBTQ+ adults say their health got worse because they skipped or delayed care, nearly twice the share of non-LGBTQ+ adults. This was more common among LGBTQ+ women than men — 63% of women compared with 46% of men.

Among transgender adults, nearly half — 45% — said their health worsened.

Insurance denials were also more likely. Thirty-two percent of insured LGTBQ+ adults reported denials by insurance companies, compared with just over a fifth of non-LGTBQ+ adults. Denials or delays in care, prescriptions or treatments were also more pronounced among trans adults as well as those covered by Medicaid or a self-purchased insurance plan.

The survey also looked at care among different age groups. While younger adults in general are more likely to forgo care, LGBTQ+ people had an especially high rate in the survey. LGBTQ+ adults under age 30 were 20 percentage points more likely to report forgoing care than non-LGBTQ+ adults of the same age group, according to the report. Those gaps narrow when it comes to adults over age 65, which could be because of Medicare eligibility, the researchers wrote.

The report noted that LGBTQ+ people are, in general, younger than the overall U.S. population. They are also more likely to have lower incomes, and somewhat more likely to lack insurance coverage, the authors wrote. The survey findings might reflect those  disparities, rather than LGBTQ+ identity, “though those factors are certainly intertwined,” they noted.

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.