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.”

GET THE MORNING HEADLINES.

SUBSCRIBE

Reading Time: < 1 minute

Doula services aren’t covered by Wisconsin Medicaid – known as BadgerCare – as of April 2026.

Doulas provide emotional support and education around childbirth. Unlike midwives (which are covered), they don’t perform medical tasks.

A Wisconsin Department of Health Services spokesperson confirmed doulas aren’t covered as a stand-alone benefit for Medicaid recipients. 

State law requires the health department to get legislative approval before making changes to Medicaid. Doula coverage has been proposed by Gov. Tony Evers and Democratic lawmakers but has not come to pass.

According to the National Health Law Program, 26 states and Washington, D.C., are actively reimbursing for Medicaid coverage of doula care. Seven more are in the process of doing so.

A 2024 study from the American Journal of Public Health found Medicaid recipients with doulas had a 47% lower risk of cesarean delivery and a 29% lower risk of preterm birth than those without.

This fact brief is responsive to conversations such as this one.

Sources

• DONA International: What is a doula?
• Harvard Medical School: What does a doula do?
• Wisconsin Department of Health Services: Email with Elizabeth Goodsitt, communications specialist
• Wisconsin Legislature: 2017 Wisconsin Act 370
• Department of Administration: State of Wisconsin Executive Budget, February 2025
• Wisconsin Legislature: 2025 Assembly Bill 1085
• National Health Law Program: Doula Medicaid Project
• American Journal of Public Health: Role of Doulas in Improving Maternal Health and Health Equity Among Medicaid Enrollees, 2014‒2023

Are doula services covered under Wisconsin Medicaid? is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

States are paying contractors such as Deloitte, Accenture, and Optum millions of dollars to help them comply with the One Big Beautiful Bill Act — a law that will strip safety-net health and food benefits from millions.

State governments rely on such companies to design and operate computer systems that assess whether low-income people qualify for Medicaid or food aid through the Supplemental Nutrition Assistance Program, commonly referred to as food stamps. Those state systems have a history of errors that can cut off benefits to eligible people, a KFF Health News investigation showed.

These benefits, provided to the poorest Americans, can mean the difference between someone obtaining medical care and having enough to eat — or going without.

States are now racing to update their eligibility systems to adhere to President Donald Trump’s sweeping tax and domestic spending law. The changes will add red tape and restrictions. They are coming at a steep price — both in the cost to taxpayers and coverage losses — according to state documents obtained by KFF Health News and interviews.

The documents show government agencies will spend millions to save considerably more by removing people from health benefits. While states sign eligibility system contracts with companies and work with them to manage updates, the federal government foots most of the bill.

The law’s Medicaid policies will cause 7.5 million people to become uninsured by 2034, according to the nonpartisan Congressional Budget Office. Roughly 2.4 million people will lose access to monthly cash assistance for food, including those with children.

In five states alone, company estimates developed for state officials and reviewed by KFF Health News show that changes will cost at least $45.6 million combined.

“This is a pretty big payday,” said Adrianna McIntyre, an assistant professor of health policy and politics at Harvard’s T.H. Chan School of Public Health.

The law, which grants tax breaks to the nation’s wealthiest people, requires most states to tie Medicaid coverage for some adults to having a job, and imposes other restrictions that will make it harder for people with low incomes to stay enrolled. SNAP restrictions began to take effect in 2025. Major Medicaid provisions begin later this year.

Documents prepared by consulting company Deloitte estimate that a pair of computer system changes for Medicaid work requirements in Wisconsin will cost nearly $6 million. Two other changes related to the state’s SNAP program will cost an additional $4.2 million, according to the documents, which Deloitte drafted for the Wisconsin Department of Health Services.

In Iowa, changes to its Medicaid system are expected to cost at least $20 million, according to an estimate prepared by Accenture, a consulting company that operates the state’s eligibility system.

Optum — which operates the platform Vermont residents use for Medicaid and marketplace health plans under the Affordable Care Act — estimated that it could cost roughly $1.8 million to evaluate and incorporate new health coverage restrictions.

Initial changes in Kentucky, which has had a contract with Deloitte since 2012, have cost the state $1.6 million. And in Illinois, Deloitte estimated modifications will cost at least $12 million.

A historic mandate

For six decades after President Lyndon Johnson created the government insurance program in 1965, Congress had never mandated that Medicaid enrollees have a job, volunteer, or go to school.

That will change next year. The tax and spending law enacted by Trump and congressional Republicans requires millions of Medicaid enrollees in 42 states and the District of Columbia to prove they’re working or participating in a similar activity for 80 hours a month, unless they qualify for an exemption. The CBO projected, based on an early version of the bill, that 18.5 million adults would be subject to the new rules — nearly half of those enrolled.

Vermont Medicaid officials expect it will cost $5 million in fiscal 2027 to implement changes in response to the federal law, said Adaline Strumolo, deputy commissioner of the Department of Vermont Health Access. About $1.8 million is for Optum to make eligibility system adjustments. Optum is a subsidiary of UnitedHealth Group.

The One Big Beautiful Bill Act will subject nearly 55,000 Vermont Medicaid recipients to work requirements — about a third of the state’s enrollees.

The law forced the state “to essentially drop everything else we were doing,” Strumolo said in an interview. “This is a big, big lift.”

Optum’s contract with the state was worth $125.6 million as of October.

Nearly two-thirds of adult Medicaid enrollees nationally are already working, according to KFF. Advocacy groups for Medicaid recipients say work requirements will nonetheless cause significant coverage losses. Enrollees will face added red tape to prove they’re complying. And eligibility systems already prone to error will have to account for employment, job-related activities, and any exemptions.

An estimated 5.3 million enrollees will become uninsured by 2034 due to work requirements, the CBO reported.

In Wisconsin, state officials estimate roughly 63,000 adults could lose coverage after work requirements take effect. Not covering those people would save $532.6 million in Medicaid spending for one year.

Wisconsin’s eligibility system for Medicaid and SNAP — known as CARES — was implemented statewide in 1994, and initially was a transfer system from Florida, according to a 2016 state document.

Deloitte submitted its cost estimates for Medicaid and SNAP changes to the state in September and December. Elizabeth Goodsitt, a spokesperson for the Wisconsin Department of Health Services, declined to answer questions about whether additional changes will be needed, how much it will cost to make all eligibility system changes to comply with the new federal law, and whether the state negotiated prices with Deloitte.

Bobby Peterson, executive director of the public interest law firm ABC for Health, said Wisconsin has invested “very little” to help people navigate the Medicaid eligibility process, which soon will become more difficult.

“But they’re very willing to throw $6 million to their contractors to create the bells and whistles,” Peterson said. “That’s where I feel a sense of frustration.”

New hurdles for vets and homeless people

Medicaid work requirements are only one change required by Trump’s tax law that will make it harder to obtain safety-net benefits.

Starting in October, the law prohibits several immigrant populations from accessing Medicaid and ACA coverage, including people who have been granted asylum, refugees, and certain survivors of domestic violence or human trafficking. Beginning Dec. 31, states must verify eligibility twice a year for millions of adults — doubling state officials’ workload. And the law restricts SNAP benefits by requiring more adult recipients to work and by removing work exemptions for veterans, homeless people, and former foster youth.

Days after Trump signed the bill in July, Kentucky health officials raced to make changes to the state’s integrated eligibility system, which verifies eligibility for Medicaid, SNAP, and other programs. Deloitte operates the system under a five-year contract worth more than $157 million. According to documents obtained by KFF Health News, initial changes costing $1.6 million were labeled a “high priority” and approved on an “emergency” basis, with some of the changes to the nation’s largest food aid program going into effect almost immediately.

Officials with Kentucky’s Cabinet for Health and Family Services declined to answer a detailed list of questions, including how much it will cost to make all the modifications needed.

Deloitte spokesperson Karen Walsh said the company is working with states to implement new requirements but declined to answer questions about cost estimates in several states. “We are delivering the value and investments we committed to,” Walsh said.

In most states, government agencies rely on contractors to build and run the systems that determine eligibility for Medicaid. Many of those states also use such computer systems for SNAP. But the federal government — that is, taxpayers — covers 90% of state costs to develop and implement state Medicaid eligibility systems and pays 75% of ongoing maintenance and operations expenses, according to federal regulations.

“Five, 10 years ago, I’m not sure if you would hear much mention of SNAP from a Medicaid director,” Melisa Byrd, Washington, D.C.’s Medicaid director, said in November at an annual conference of Medicaid officials. “And particularly for those with integrated eligibility systems — as D.C. is —­ I’m learning more about SNAP than I ever thought.”

The federal law was the topic du jour at last year’s gathering in Maryland, held at the Gaylord National Resort and Convention Center, the largest hotel between New Jersey and Florida.

Consulting companies had taken notice. Gainwell, an eligibility contractor and one of the conference’s corporate sponsors, emblazoned its logo on hotel escalators. Companies set up booths with materials promoting how they could help states and handed out snacks and swag.

“Conduent helps agencies work smarter by simplifying operations, cutting costs and driving better outcomes through intelligent automation, analytics, and innovation in fraud prevention,” read one such handout from another contractor. “Together, we can better serve residents at every step of their health journeys.” Conduent holds Medicaid eligibility and enrollment contracts in Mississippi and New Jersey, their Medicaid agencies confirmed to KFF Health News.

In handouts, Deloitte touted its role in “building a new era in state health care” and as “a national leader in Medicaid program and technology transformation, building a strong track record across the federal, state, and commercial health care ecosystem.” KFF Health News found that Deloitte, a global consultancy that generated $70.5 billion in revenue in fiscal 2025, dominates this slice of government business.

“With Medicaid Community Engagement (CE) requirements, states are tasked with adding a new condition of Medicaid eligibility to support state and federal objectives,” added another brochure. “Deloitte offers strategic outreach and responsive support to help states engage communities, lower barriers, and address access to coverage.”

A $20.3 million bill in Iowa

Before Trump signed the One Big Beautiful Bill Act, Iowa lawmakers wanted to impose their own version of work requirements. They would have applied to 183,000 people before any exemptions. The new law would necessitate a change to Iowa’s Medicaid eligibility system, according to documents prepared by Accenture, which operates Iowa’s system through a contract worth more than $60 million.

Adding the ability to verify work status would cost up to $7 million, an Accenture estimate from March 2025 showed. By July, the cost to implement the One Big Beautiful Bill Act’s work requirements and other Medicaid provisions skyrocketed to roughly $20.3 million. Accenture’s analysis said the federal law necessitated additional changes to Iowa’s system. Making employment a condition of Medicaid benefits could cause an estimated 32,000 Iowans to lose coverage, according to a 2025 state document.

Cutting 32,000 people from coverage could save $183 million in one year, a fraction of the $8.9 billion Iowa and the federal government spend on Medicaid in a given year.

In Cedar Rapids, most of Eastern Iowa Health Center’s patients rely on Medicaid, CEO Joe Lock said. He questioned the government’s logic of spending tens of millions of dollars on a policy to remove Iowans from Medicaid.

Most of the health center’s patients live at or below the federal poverty level — currently $33,000 for a family of four.

“There is no benefit to this population,” Lock said.

Danielle Sample, a spokesperson for Iowa’s Department of Health and Human Services, did not answer questions about how much it will cost to implement changes to the state’s separate SNAP eligibility system.

In Illinois, the state’s work this year is largely focused on meeting major provisions of the One Big Beautiful Bill Act. The state estimates that as many as 360,000 residents could lose Medicaid, largely due to the work requirements, said Melissa Kula, a spokesperson for the Illinois Department of Healthcare and Family Services.

Kula confirmed that most of the work detailed in one of Deloitte’s estimates — priced at $12 million — is related to Trump’s law. The estimate also mentions other work. Kula said Deloitte is charging the state a $2 million fixed fee related to work requirements.

The Trump administration has acknowledged that the work is coming at a cost. In January, top officials for the Centers for Medicare & Medicaid Services said government contractors, including Deloitte, Accenture, and Optum, have promised to offer discounts and reduced rates through 2028 to help states incorporate system changes.

“The companies were extremely excited to do this,” said Daniel Brillman, the top CMS Medicaid official. “Everyone’s really focused on getting to work.”

CMS spokesperson Catherine Howden declined to answer questions about the discounts.

Goodsitt, the Wisconsin Medicaid spokesperson, declined to answer questions about whether Deloitte has discounted its rates. Officials with Kentucky’s Cabinet for Health and Family Services did not answer a detailed list of questions, including whether Deloitte extended discounts to make these changes.

It’s unclear what discounts, if any, Deloitte and Accenture have offered to individual states. Walsh, the Deloitte spokesperson, declined to answer detailed questions about the discounts the Trump administration announced this year. Accenture did not respond to repeated requests for comment.

Strumolo, the Vermont health official, said state officials discussed the announcement with Optum “in detail.”

Optum pledged to offer discounts for a specific module related to Medicaid work requirements. That product is unworkable for Vermont because it would mean “moving to a new system when we don’t have to.” When asked about whether the company offered discounts, Strumolo said “not explicitly.”

In a statement, UnitedHealth Group spokesperson Tyler Mason said Optum supports state implementation of new federal requirements “with a range of options to meet their unique cost and policy needs.”

He declined to specify whether Optum discounted Vermont’s rates and how it calculated the costs of doing its work. “Optum is helping mitigate upfront implementation expenses so states can focus on approaches that reduce duplication, accelerate implementation, and manage costs over time — supporting better outcomes for individuals covered by Medicaid,” Mason said.

Strumolo said Optum’s initial changes in Vermont cover items that take effect this year and in 2027 — Medicaid work requirements, checking eligibility every six months, and prohibiting certain immigrants from qualifying for health programs.

“There’s a lot more that could come,” she said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License. 

Reading Time: 2 minutes

Wisconsin has thousands of assisted living providers. Some are small houses; others are more like apartment complexes. Some take Medicaid, while others require residents to pay out of pocket. It’s a lot to sort through, especially when someone needs care fast. 

Searching “assisted living” on Google pulls up several pages of facilities, many listed under a prominent “sponsored results” section.

Mixed in with actual providers are referral companies that promise a way to compare options. Long-term care referral companies don’t typically charge families for their services. Instead, they often receive money from facilities they recommend.

Wisconsin lawmakers in May proposed legislation to make any financial relationships between a referral agency and an assisted living facility clearer. 

Supporters of the bill said disclosure requirements could help families make more informed decisions. Opposing the bill, referral companies argue that they are already transparent and that proposed guardrails would prevent them from helping more families. 

The bill failed to pass before the Assembly adjourned last month. But the debate left me wondering: Where should someone start the search for care?

Aging and disability resource centers

Aging and disability resource centers (ADRCs) can provide objective provider lists for free, alongside information about services and payment options, said Janet Zander, the advocacy and public policy coordinator with the Greater Wisconsin Agency on Aging Resources, Inc. 

The Wisconsin Department of Health Services lists ADRCs by county online. 

ADRCs cannot recommend one facility over another, Zander said. But they can suggest what to look for during a tour. Zander also recommends looking at a facility’s Wisconsin Division of Quality Assurance surveys.

They can also help people identify what kind of care makes the most sense and explore aging at home, said Sara Tribe Clark, the director of the Eldercare Locator, which offers local resources for older adults, people with disabilities and caregivers. 

If you work with a referral agency, ask questions

Tribe Clark recommends asking:

• Do you receive compensation from the providers you recommend?
• Are your referrals limited to certain facilities?
• How do you determine which providers to suggest? What is the criteria for inclusion/exclusion?
• Are there providers in my area that you do not represent?

We want to answer your questions

Getting answers to my own questions is a perk of being a reporter. But I haven’t yet navigated Wisconsin’s aging and disability resources for myself or a loved one. I know I’m missing important questions, so please send me yours, alongside your perspectives.

What has been confusing or frustrating about finding care?

What do you wish you’d known sooner?

What made the process easier?

Even after more than two years reporting on long-term care in Wisconsin, I won’t have all the answers. But I will find experts who do. Email me at acostello@wisconsinwatch.org or call 608-616-5239.

Finding long-term care is hard. Here’s how to start. is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Thousands of low-income people living with HIV could be losing drug coverage as states impose limitations on HIV assistance programs amid constrained budgets — raising alarms over consistent access to lifesaving medications.

Many factors are putting budget constraints on state programs, including federal funding — which has remained flat for years and hasn’t been adjusted for inflation — increased drug costs and rising insurance premiums.

The Ryan White HIV/AIDS Program is the national safety-net program supporting more than 600,000 low-income people living with HIV across the nation. States receive federal grants and drug rebate money — the latter making up the bulk of state program budgets — to, among other things, help pay for medications and support community groups and specific populations, such as women and children.

Congress has kept key drug assistance funding at $900.3 million annually since 2014. New enrollments for state programs jumped 30% from 2022 to 2024, in part because states cut off pandemic-era Medicaid assistance.

As of January, at least 18 states have pulled back their Ryan White AIDS Drug Assistance Programs, known as ADAPs, in some way, according to a March 2 analysis by health research group KFF and a report by the National Alliance of State and Territorial AIDS Directors, which offers consultation for states.

There are roughly 1.2 million people in the United States living with HIV, and about 1 in 4 people get support from a state drug assistance program.

A disproportionate number of HIV/AIDS patients are gay, bisexual and other men who have male-to-male sexual contact, according to the federal Centers for Disease Control and Prevention. LGBTQ+ communities have been targeted in recent years by some federal and state policies, including the rollback of civil rights, shutting down a youth mental health hotline, restricting health care access, and imposing discussion and book bans in public schools.

Florida has introduced the most dramatic restrictions on income eligibility for its HIV drug program — cutting individual eligibility for the program from 400% of the federal poverty level to 130%. That means uninsured and underinsured people up to that 400% poverty line no longer have coverage under the program.

That’s roughly slashing maximum annual income of $63,840 for an individual down to $20,748. The state says the change will prevent a $120 million shortfall.

“(That) creates an immense coverage cliff,” for example, for childless adults not eligible for Medicaid, said Amber Tynan, CEO of Big Bend Cares, a North Florida Ryan White provider. Florida is among the 10 states that haven’t expanded Medicaid eligibility under the Affordable Care Act.

Florida’s department of health didn’t respond to Stateline’s request for comment.

Delaware, Kansas, Pennsylvania and Rhode Island have also reduced income eligibility for their programs, but to a lesser extent, according to KFF. For example, Kansans with HIV/AIDS whose incomes are above 250% of the federal poverty level won’t be eligible for help with Obamacare insurance premiums. That change will affect about 230 people, the National Alliance of State and Territorial AIDS Directors estimates.

In Pennsylvania, about 1,600 people will lose HIV drug assistance coverage as the state imposes income eligibility caps at 350% of the federal poverty level.

“We cannot continue to provide services at a certain level when the funding to do so does not exist,” Neil Ruhland, Pennsylvania Department of Health press secretary, told Stateline in a statement. He pointed to drug costs and enrollment numbers that are “steadily rising while funding remains stagnant.”

Florida also is removing the brand-name drug Biktarvy, which is the only single-tablet HIV medication regimen recommended by national guidelines for those starting treatment and is the most widely prescribed antiretroviral medication nationally. There is no generic form.

The medication is highly effective at reducing a person’s viral load, meaning the virus is undetectable in blood tests and untransmittable to others.

Eighty percent of Floridians with HIV who are in the state’s program use Biktarvy, Tynan said.

“Not having the opportunity to stay on lifesaving treatment is creating quite the panic and crisis for our population,” Tynan said. “For decades we’ve worked to turn HIV from a fatal diagnosis into a manageable chronic condition, and that progress depends on one thing: consistent access to treatment. When that stability is disrupted like it has (been) in Florida, it creates real risk for patients and for public health.”

Other states (Arizona, Michigan, Pennsylvania, Rhode Island, Virginia and Washington, plus the District of Columbia) also are considering limiting which drugs they cover, according to the alliance’s report.

And several other states may impose other limits to their drug assistance program. Health agencies in Hawaii, Idaho, Montana, New Jersey, South Carolina, Virginia and Washington are considering cutting funding for core medication and support services. Others are considering implementing a six-month recertification period, restricting eligibility, putting caps on expenditures, changing covered medications and lowering assistance for insurance premiums.

While no state has implemented a waiting list for drug assistance, three states — Arkansas, Louisiana and New Jersey — are considering one as a future cost-containment measure, according to the national alliance’s report.

Dr. Sabrina Assoumou, an infectious disease physician at Boston Medical Center, said many of her HIV patients are under-resourced and rely on her state’s Ryan White program. She added that she’s relieved Massachusetts’ program hasn’t announced any changes as of February, when the alliance’s report was released, but that she’s worried for patients in the other states.

“We’ve taken HIV from a very serious virus, a deadly virus when it was first discovered in the ’80s, to a very manageable chronic condition because of the medicines,” she said. “It is concerning to see … that we’re sort of moving backwards by not providing that kind of care that’s so much needed, and that’s lifesaving.”

Florida bypassed a rulemaking process when it announced its changes days before open enrollment ended. In late January, the AIDS Healthcare Foundation, a global nonprofit agency, sued the state department of health over the changes. The U.S. Centers for Medicare & Medicaid Services opened a new enrollment period for Floridians losing coverage to enroll in a different marketplace plan.

In late February, Florida issued an emergency rule putting the new eligibility requirements into effect. About 32,000 Floridians get help from the state program in some way — whether it’s through local health departments or the state helping to pay for insurance premiums.

Half of those, around 16,000, will lose coverage entirely — but many others will be affected in other ways, such as losing access to Biktarvy.

“So if you remain in the program, there’s a very high likelihood that you’re still going to be impacted by some of the other changes, like the dropping of the premium assistance, the elimination of Biktarvy from the formulary,” said Tim Horn, director of medication access for the National Alliance of State and Territorial AIDS Directors. “When you take a look at all of these changes in the net, the vast majority of Florida ADAP clients are going to be impacted by this, one way or another.”

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

Editor’s note: This is the first report in an ongoing series.

The patient came in with a belly full of blood, Dr. Leilah Zahedi-Spung recalled. Her pregnancy was ectopic, no longer viable, and could have killed her if left untreated. But when she went to a mobile pregnancy help center offering free care in an RV in St. Louis, she was told the pregnancy could be saved.

By the time she saw Zahedi-Spung days later, her fallopian tube had ruptured.

In North Lauderdale, Florida, Ieshia Scott was pregnant and in the throes of postpartum depression. She thought she’d arrived at an abortion clinic. She told the staff she might hurt herself if she had another baby. They told her God would give her strength.

A woman and her partner in Sheboygan, Wisconsin, went to a pregnancy help center by mistake. When they made it to a Planned Parenthood clinic across the street, the pregnant patient handed Dr. Kristin Lyerly a copy of the sonogram. But the scan was not of her uterus. It was her bladder.

All three patients had gone to crisis pregnancy centers, organizations that advertise free pregnancy tests and ultrasounds but dissuade women from pursuing abortions and contraceptive options. Since the U.S. Supreme Court ended national abortion access in June 2022, the centers have seen an infusion of taxpayer dollars in many Republican-led states. But medical experts have urged lawmakers to reconsider the state support, as the centers can endanger public health by “causing delays in accessing legitimate health care,” according to the American College of Obstetricians and Gynecologists. 

States Newsroom conducted a 50-state investigation examining state and federal budgets, as well as the tax records of these organizations, finding that while the magnitude of public funding for them is growing, oversight is not. 

Twenty-one states funneled nearly a half-billion dollars, or $491 million, of taxpayer money to crisis pregnancy center organizations between fiscal years 2022 and 2025. That figure does not include millions some states diverted from federal programs like Temporary Assistance for Needy Families, and it does not include multimillion-dollar tax credit programs launched after federal protections for abortion rights were overturned. 

Nearly $1.3 billion in local, state or federal government grants were awarded to 1,259 crisis pregnancy centers in total between 2019 and 2024, according to States Newsroom’s analysis of tax records. The actual figure may be higher, as digital records are not comprehensive or entirely up to date.

Yet that largesse hasn’t been matched by corresponding regulation. Oversight of taxpayer funding remains weak, either blocked by legislators or ignored by state agencies. 

The centers are most often faith-based nonprofits that say they provide much-needed support for pregnant clients at no cost. An estimated 2,633 crisis pregnancy centers were operating in the United States as of March 31, 2024, according to research from the University of Georgia. 

John Mize, CEO of Americans United for Life, argues that pregnancy centers are important for people who really don’t want an abortion, and for anyone who regrets their abortion to find support. 

“I am strongly of the opinion that most women that have abortions do it because they don’t feel like they have any other option,” Mize said.

But critics and researchers say the pregnancy centers mislead potential clients about their services or pose as medical clinics despite lacking proper licensure. They sometimes promote treatments like abortion pill reversal, which is unproven and potentially dangerous. 

“Often, patients are lured in by this idea of getting free care,” said Dr. Rachel Jensen, Darney-Landy complex family planning fellow at the American College of Obstetricians and Gynecologists. “It’s free, because it’s often subsidized by taxpayer dollars. Free health care sounds amazing. It should be available to all people. But the problem is, then, that the CPCs are unregulated — and they operate outside of ethical principles and best care practices.”

Firsthand accounts: ‘What’s your plan for this pregnancy?’ Comfort, shame and a missed diagnosis

Indiana state Sen. Shelli Yoder, a Democrat, said access to maternal health care in her state continues to decrease while support for crisis pregnancy centers increases. Indiana boosted its budget for the centers from $250,000 in 2021 to $2 million, then doubled it to $4 million by 2024. The state’s maternal mortality rate is among the worst in the country. 

“It’s not that these centers don’t serve a purpose. But they certainly are not a replacement for maternal health care, and they are not health care centers, and yet our state is using taxpayer money to fund them as if they are,” Yoder said. “And we are sending a message to moms, or to women, that they are health care centers, and they are not.”  

Zahedi-Spung was working an emergency room shift in 2019 at a St. Louis hospital, not too far from the pregnancy center housed in an RV and frequently parked in front of a Planned Parenthood clinic. She said she was horrified to learn the patient with the ruptured ectopic pregnancy had been told at the mobile crisis pregnancy center a few days before that it could be saved. A tubal ectopic pregnancy is never viable.

Today, Zahedi-Spung works in Colorado as a high-risk OB-GYN. But that experience in the ER still haunts her.

“They’re a private organization providing medical care without a medical license, so they are not liable for anything they tell anyone,” she said.

Andrea Trudden, spokesperson for Heartbeat International, one of the largest pregnancy center networks in the U.S., said that as of 2025, more than 75% of Heartbeat affiliates offer medical services and are different from pregnancy resource centers, which offer parenting classes and material aid but not medical services.

“Medical affiliates that provide limited obstetrical ultrasound or other services follow applicable state laws, professional standards, and clinical protocols,” Trudden said in a written statement.

According to a report from the Charlotte Lozier Institute, 37% of 2,775 crisis pregnancy centers provided testing for sexually transmitted infections, and 29% provided STI treatment in 2024. The institute, which is the research arm of one of the largest anti-abortion policy groups, Susan B. Anthony Pro-Life America, found that 81% of surveyed centers provided ultrasound services in 2024. The report notes that 28% of paid center staff have medical licenses, along with 12% of volunteers.

The only option for miles

In North Florida’s largely rural Wakulla County, there are no full-time practicing OB-GYNs. Wakulla Pregnancy Center is in Crawfordville, the county seat of about 4,800 people. Many women in the area lack transportation, said the center’s director, Pam Pilkinton. They have to travel about 20 miles north to Tallahassee for prenatal care.

Run by a local ministry, the center has a blue-and-white sign that advertises “Free Pregnancy Tests.” Inside, a cozy living room furnished with sofas leads to a counseling room and donation space, where moms peruse a range of free baby clothes and supplies. Most of the center’s clients have low incomes, and are on Medicaid or uninsured.

When Florida passed a six-week abortion ban in 2023, legislators simultaneously increased state funding for crisis pregnancy centers by 455% — from $4.5 million to $25 million. The following legislative session, they added another $4.5 million. 

The funds go to the Florida Pregnancy Care Network, which manages contracts with more than 100 crisis pregnancy centers across the state. The organization is required to report the amount and types of services provided and the expenditures to the governor and state legislature once a year. But it is not required to make any noncompliance findings public. 

The public money for centers in Florida doesn’t end there. Wakulla Pregnancy Center received a separate allocation in the 2025 budget of $136,000. According to the funding request, $60,000 is allocated for a building asbestos issue, and $58,000 pays for the salary and benefits of the executive director and client coordinator. The rest is for pregnancy tests, educational materials, ultrasound referrals and other supplies. 

But Pilkinton is clear about one point: The center does not provide medical care in this maternal health care desert. 

“We’re not a medical facility, and that is something that we let everyone know up front,” Pilkinton said. “We provide material support, education, information and peer counseling.”

That doesn’t include practices like referring a patient to an OB-GYN for prenatal care after a positive test, for example, “because we’re not a medical facility,” she said.

Wakulla County’s severe maternal hospitalization rates ranked among the worst in the state in 2023 and 2024.

Like in other states, maternal health care has continued to flounder in Florida — and shortages are likely to worsen. Nearly half of 1,500 OB-GYNs who responded to a state survey say they plan to stop delivering babies within the next two years. 

The money Florida allocated for pregnancy centers might have covered more maternity care across the state, said Democratic state Rep. Anna V. Eskamani.

“We do need to strengthen our safety nets when it comes to supporting new moms,” Eskamani said. “Instead of addressing those gaps and investing in those areas, we continue to dole out millions of dollars to these unregulated and often religiously affiliated anti-abortion centers that are not addressing any of these disparities.”

In previous legislative sessions, Eskamani filed bills to repeal state funding and introduce regulation of existing centers. The bills have yet to receive a hearing, but she and her colleagues have filed them again.

“These not-for-profit organizations run with very little federal or state oversight, and sometimes they don’t even have licensed medical staff on site,” she said. “At this point, it’s a blank check.”

Big checks, little oversight

Much of the state funding for pregnancy centers did not exist before the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision ended federal protections for abortion rights in June 2022. 

Conservative-led states — such as Texas — that already allocated tens of millions to pregnancy centers have doubled or tripled their budgets for pregnancy resource groups since 2022. In Missouri, lawmakers have budgeted nearly $50 million since fiscal year 2022 from the general fund and federal block grant dollars. Texas’ allocation ballooned from $140 million in fiscal years 2024 and 2025 to $180 million in 2026 and 2027. 

In southwest Missouri, Republican state Rep. Christopher Warwick’s support of the centers is a focus of his reelection campaign.

“I think it’s important that we fund organizations that are willing to save life,” he said.

Read more: Federal funding for people in poverty heading to anti-abortion centers instead

Louisiana lawmakers directed $4 million from the state’s general fund to pregnancy centers for 2025, as part of its Pregnancy and Baby Care Initiative. But an audit found the state doled out the maximum amount per center allowed by state law — $100,800 — to most of the groups without requiring them to fully document how they spent it.

Auditors were concerned Louisiana paid the centers more than the cost of the actual services provided.

In Oklahoma, state auditors discovered in 2022 that an anti-abortion nonprofit called Oklahoma Pregnancy Care Network disbursed less than 7% of the $1.6 million it promised to nonprofits under the state’s Choosing Childbirth program. A month and a half before its contract was scheduled to end, the group had served 524 women, less than 6% of the 9,300 Oklahoma women it initially projected it would serve. An administrator with the nonprofit told The Oklahoman she was unaware there were problems.

Despite those findings, state lawmakers later directed nearly $18 million — a quarter of the state health department’s entire budget — toward Choosing Childbirth through November 2027. More than $4 million of it went to the Oklahoma Pregnancy Care Network. The network did not respond to States Newsroom’s requests for comment.

Inner workings

Lyerly, the OB-GYN in Sheboygan, Wisconsin, said the couple with the mislabeled sonogram came into her Planned Parenthood clinic in the early months of 2022. It wasn’t uncommon for patients with appointments at Planned Parenthood to accidentally go to the crisis pregnancy center across the street. This couple sought an abortion, she said, but came in with the ultrasound image of the woman’s bladder rather than her uterus. On top of the mislabeled ultrasound, they felt misled, because they were told the pregnancy was just a few weeks along when it was much more advanced.

“This was a challenging situation for them, was emotional and frustrating and upsetting to them, and it was so unnecessary,” said Lyerly. She stopped providing abortions in Wisconsin later that year when a state law banning the procedure went back into effect after the Dobbs decision.

Many centers are affiliated with umbrella organizations, including Care Net, Heartbeat International (formerly Alternatives to Abortion International) and National Institute of Family and Life Advocates, but often do not disclose that connection on their website. The parent companies provide guidance for operations, including yearly conferences, along with training for limited ultrasounds and other services. Training and funding for many of these centers’ ultrasound programs also come from national religious groups like Focus on the Family and the Knights of Columbus.

Heartbeat International is the largest of the three, with more than 4,000 affiliated service providers across the U.S. and in more than 100 countries, according to Trudden.

Trudden said Heartbeat International offers professional training and practical resources for affiliates, who determine their own governance, leadership and location and must agree to a set of standards also shared by Care Net and the National Institute of Family and Life Advocates. Those standards include practicing honesty and confidentiality with clients and complying with all legal and regulatory requirements. 

Some pregnancy centers are staffed with licensed professionals trained in sonography. The National Institute of Family and Life Advocates says it has trained more than 6,000 health care professionals “in the medical and legal ‘how to’s’ of limited obstetrical ultrasound.” But at its national conference last year, leaders discouraged centers from performing ultrasounds on women who they suspect have ectopic pregnancies to avoid liability. The guidance came in the wake of a lawsuit against a Massachusetts center, in which the plaintiffs alleged that center staff failed to diagnose an ectopic pregnancy that ruptured, prompting emergency surgery. The clinic reached a settlement with the patient. 

Some centers offer more medical services, like prenatal support and testing and treatment for STIs, such as Idaho’s Stanton Healthcare, which is accredited by the Accreditation Association for Ambulatory Health Care and does not receive any public funding. 

“We have caught ectopic pregnancies. … I can think of three in the last eight months off the top of my head,” said Angela Dwyer, Stanton’s director of client services. 

But advocacy groups such as Campaign for Accountability have raised alarms about how many clinics do not have to follow federal health privacy laws, including the Health Insurance Portability and Accountability Act, known as HIPAA.

Clinics that offer free services and do not bill insurance face no penalty for disclosing a client’s information. 

In contrast, Jessica Scharfenberg, CEO of Healthfirst Network in central Wisconsin, said if any of her 10 reproductive health clinics violated HIPAA, they would face steep federal fines and possible jail time for staffers. 

“If my entity broke HIPAA, we would have federal consequences, even though we also have an internal policy for it,” Scharfenberg said. “They have their internal policies. They break HIPAA, there’s no consequences for it.”

The websites of some centers give the appearance of being HIPAA compliant even though they aren’t, States Newsroom has reported. 

The other two main umbrella organizations did not respond to multiple requests for comment by email and phone. 

‘So much help’

In North Lauderdale, Ieshia Scott would stare at her 6-month-old, unable to hold the baby when she cried. Scott, who also had a 10-year-old, felt overwhelmed by a constant cloud of stress and sadness, all while trying to keep up with college classes.

When she found out she was pregnant again, Scott searched for an abortion clinic in the city, and a pregnancy resource center came up in the search results. That 2018 visit would last nearly three hours, during which she fielded dozens of questions about why she wanted an abortion. Scott had suicidal thoughts and was depressed but felt totally unheard. 

“I really was disregarded,” said Scott, now 36. “I was actually saying to her, like — ‘I don’t know, I might hurt myself, I might hurt the baby.’”

The center didn’t refer her to a psychiatrist, therapist or OB-GYN. The staff member instead reminded her of the Ten Commandments.

“I’m literally telling her, I can’t — I can’t do it. And she was like, ‘You can, you can. And there’s so much help.’”

Mental health is a contributing factor in about 23% of the nation’s maternal deaths, reports from the federal Centers for Disease Control and Prevention show.

Scott eventually went to a clinic to get the care she needed. But she worries for women who can’t. 

More than a dozen states passed abortion bans after Dobbs, and efforts continue nationwide to dismantle what access remains. Several states with abortion bans — including Missouri, South Carolina and Texas — have moved to cut Planned Parenthood out of state Medicaid programs as well, after the U.S. Supreme Court ruled last year that excluding the organization did not violate Medicaid’s provision requiring freedom of choice in providers. Florida legislators are also discussing cutting Planned Parenthood out of the state Medicaid program.

In 2025, at least 51 Planned Parenthood locations closed or limited medical services after losing state and federal support. Those communities lost access not only to abortion services but also to other reproductive and primary medical care. Independent clinics such as Maine Family Planning stopped offering primary care services for about 600 patients because of a funding loss of about $1.9 million, even though none of the Medicaid dollars were used for abortion.

‘Government handouts’

Lawmakers are not only opening public coffers to provide direct financial support to pregnancy centers, but they’re also creating tax breaks, drawing on federal sources and shifting funds meant to help low-income families to aid the anti-abortion organizations — with few regulations.

Some legislators have resisted stronger oversight. 

In Missouri, state Rep. Warwick opposed a colleague’s suggestion to require the centers to report how they spend their donations in a tax credit program, saying he wanted to limit bureaucracy. He said in a February 2025 legislative hearing that the tax credit keeps the state from having to “verify what programs work.” 

“I don’t think they’re funded enough to be able to mishandle their money,” he told States Newsroom in December. “At least not the ones I’m familiar with.”

Warwick proposed raising the tax credit for pregnancy center donations from 70% to 100% in 2025, meaning someone donating to a pregnancy center could reduce their state tax bill by the exact amount donated. 

The credits that Missourians redeemed shot up from about $2 million to an average of more than $7 million per year after lawmakers removed a cap on credits in 2021, according to a fiscal note attached to Warwick’s bill. State officials estimated a 100% tax credit just for pregnancy center donations would cost the state more than $10.7 million in the first year.

Missouri also funnels more than $2 million per year in state and federal dollars to pregnancy resource centers and similar organizations through its Alternatives to Abortion program. That’s in addition to what the centers receive from Missouri’s federal Temporary Assistance for Needy Families fund — $10.3 million in this fiscal year.

Although Warwick’s 100% pregnancy center tax credit failed, he plans to try again in this year’s session. “I don’t think it (a 100% tax credit) would significantly hurt the state, especially when we’re talking about protecting life, protecting the birth of children,” he said.

Nebraska Sen. Joni Albrecht, a Republican who also sponsored a six-week abortion ban, said the centers were a valuable investment when she sought to create a $10 million tax credit program that was revised down to $1 million in 2024. 

Of the 13 pregnancy centers approved for tax credits in Nebraska, four provided less than $150,000 in services, according to tax returns, and one had three consecutive state audit reports with findings of deficiencies in controlling and complying with federal grant funding requirements.

In Montana, a state without an abortion ban, Republican Gov. Greg Gianforte found another way to give taxpayer money to pregnancy centers by donating a portion of his annual salary. In 2020, he pledged to give his salary to nonprofit organizations and charities, and has for the past three years included pregnancy centers in that list for a total of more than $60,000.

Idaho state Sen. Ben Adams, a Republican who sponsored a bill to establish a grant fund of $1 million for crisis pregnancy centers in 2025, told States Newsroom he felt it was important to put resources into helping people choose to have a baby. 

“We have, for a very long time, primarily through the federal government, essentially funded abortion through funding for Planned Parenthood and all these different organizations,” Adams said. “We say we’re going to restrict a woman’s access to abortion and that we’re pro-life. Well then, we actually have to be investing in those folks who are choosing life and show them that we mean it when we say we want them to choose life.”

For decades, the Hyde Amendment, a provision Congress has renewed annually, has prohibited the use of federal funding for abortions, except in cases of rape, incest and to save the mother’s life.

Idaho is one of a few states with an abortion ban that isn’t providing government support for crisis pregnancy centers. Adams’ bill failed by one vote in committee and faced opposition from many constituents, including a former board chairman of a crisis pregnancy center in Idaho who said subsidizing nonprofit entities with taxpayer dollars is not the proper role of government.

“Providing taxpayer funds on either side of this moral question is inappropriate,” said John Crowder in his testimony to the legislative committee, prefacing his comments by saying he is a Christian who believes life begins at conception. “Such decisions to lend financial support should be left to churches and individuals, not the government.”

Based on his knowledge of the finances of that center, Crowder said, it was clear they could meet the goals of their mission with the donations they received and “without government handouts.” 

Stateline reporter Amanda Watford contributed to this report. 

This story is part of a reporting fellowship sponsored by the Association of Health Care Journalists and supported by the Commonwealth Fund.

States Newsroom’s investigation is ongoing. If you have had an experience with a crisis pregnancy center, please get in touch at cpcproject@statesnewsroom.com.

METHODOLOGY: To identify government grant funding received by nonprofit crisis pregnancy centers (CPCs), a team of States Newsroom reporters used multiple data sources. Reporters reviewed state and federal budgets and legislation to identify public funding allocated to CPCs between 2019 and 2025, with a particular focus on the period following the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision in June 2022, as well as in prior years, as applicable. The team did not include federal funding from sources such as Temporary Assistance for Needy Families in the nationwide analysis, and state tax credit programs were also excluded.

Data reporter Amanda Watford cleaned and analyzed a publicly available dataset of CPCs originally collected by the nonprofit advocacy group Reproductive Health and Freedom Watch. Organizations that appeared to be permanently closed or did not report enough revenue to file a full IRS Form 990 were removed from the States Newsroom analysis. Watford extracted filings from ProPublica’s Nonprofit Explorer for about 2,000 organizations, covering 2019 to 2025. Government grant totals were only available for 217 organizations for 2023 and 2024 due to data infrastructure limitations. A separate analysis using the GivingTuesday 990 database captured basic financial and government grant data for 1,243 organizations between 2019 and 2023. Watford combined the 2019-2023 GivingTuesday data and 2023-2024 ProPublica data. The total amount of government funding provided to CPCs was calculated for each year, yielding a grand total of nearly $1.3 billion across 1,259 CPCs between 2019 and 2024.

This analysis is not comprehensive. Some IRS Form 990 filings were unavailable digitally, and some organizations did not report any government grant funding, so grant funding reported outside the available electronic filings was not fully captured. Financial information available through IRS Form 990 filings is self-reported by organizations to the IRS and is not independently audited. Additionally, there is a lag between when organizations are expected to file returns and when filings are publicly available. Due to these factors, the States Newsroom  findings likely undercount the total amount of public, government funding directed to CPCs. An estimated 2,633 CPCs were operating in the United States in 2024, according to research from the University of Georgia.

On Friday, lawmakers in the Wisconsin Assembly voted in favor of a bill seeking Medicaid coverage for people in Wisconsin prisons and jails. Supporters hope it will help recently incarcerated people avoid addiction and overdoses. 

Rep. Shelia Stubbs (D-Madison) said her experience working for the Wisconsin Department of Corrections has given her firsthand knowledge about the impact AB 604 will have. She said it will improve access to treatment and case management and ease the financial burden on justice-involved Wisconsinites. 

The bill would give incarcerated people a greater chance of maintaining sobriety and preventing overdose after release from prison, Stubbs said. After a Minnesota study about the causes of death of recently incarcerated people, researcher Tyler Winkelman said that “substance use is clearly the main driver of death after release from both jail and prison.”

Medicaid is prohibited from paying for services provided during incarceration, barring some exceptions involving inpatient services or an eligible juvenile under 21 years old. The National Association of Counties published a toolkit critical of the “inmate exclusion policy,” arguing in part that it unfairly revokes federal health benefits from people who are being detained prior to trial and have not been found guilty.  

The bill would pursue a path offered by the federal government that allows for a partial waiver of the policy. 

The proposal directs the Department of Health Services to request a waiver to conduct a demonstration project; 19 states have approved waivers and nine states including Washington D.C. have pending waivers, as of November 21. 

A waiver would allow for prerelease health care coverage under the Medical Assistance program, which provides health services to people with limited finances, for up to 90 days before release of an eligible incarcerated person. Coverage would be provided for case management services, medication-assisted treatment for all types of substance use disorders and a 30-day supply of prescription medications. 

The bill garnered support from lawmakers from both parties and from WISDOM and EX-Incarcerated People Organizing, groups that advocate for incarcerated people. 

The Assembly’s vote to seek the coverage for incarcerated people comes on the heels of its vote to accept a federal expansion of Medicaid coverage for women for one year after they give birth. 

For the waiver, if the state seeks federal Medicaid coverage for services that are currently funded with state or local dollars, the state has to reinvest any savings in state or local funds. Savings would be invested in programs to increase access to or improve the quality of health care for incarcerated people. 

In the Department of Corrections fiscal estimate, the DOC said that in fiscal year 2025, the agency spent $500,000 on the 30-day medication supply dispensed for incarcerated people pre-release, $300,000 on pre-release medication assisted treatment medications and $3.9 million on the Opening Avenues to Reentry Success (OARS) program. The OARS program supports the transition from prison to the community of incarcerated people living with a severe and persistent mental illness who are at medium-to-high risk of reoffending. 

The agency estimated it may have over $750,000 in potential cost savings if the waiver is approved and implemented. 

Because not all incarcerated people will qualify, the estimate assumes that half of the medication supply and medication assisted treatment medications costs will be reimbursed, as well as 10% of the OARS program costs. There may be other costs DOC can have reimbursed.

AB 604 would require the Department of Health Services to submit the waiver request no later than Jan. 1, 2027. 

The bill now goes to the state Senate. Supporters of the bill include the Wisconsin Medical Society, the National Alliance on Mental Illness Wisconsin, the Medical College of Wisconsin and the Wisconsin Counties Association. 

GET THE MORNING HEADLINES.

SUBSCRIBE

Before Assembly Speaker Robin Vos (R-Rochester) announced his retirement Thursday, it was obvious something had changed. The longest serving speaker in Wisconsin history, known for keeping Assembly Republicans on a tight leash, slipped out of a caucus meeting late Wednesday night. Capitol reporter Baylor Spears tracked him down at a fundraiser at the Madison Club, where, she reported, Vos told her his caucus was meeting without him. Later that evening, Assembly Republicans announced that Vos had suddenly dropped his yearslong opposition to letting Wisconsin expand postpartum Medicaid coverage for new mothers for one year. Vos’ last-minute change of heart allowed eight Republicans facing competitive reelection races to hold a late-night press conference proclaiming the news that they planned to pass postpartum coverage, along with another measure extending life-saving breast-cancer screenings that Vos was suddenly permitting to come up for a vote. Vos himself didn’t bother to attend. 

With both Vos and Gov. Tony Evers retiring, the two most powerful politicians in the state — and the often dysfunctional dynamic between them — are going away. It’s the end of an era characterized by toxic partisanship, although probably not the last we’ll see of divided government in our 50/50 state. 

Still, as Vos relaxes his grip, Wisconsin Republicans are starting to wrap their heads around the new reality that they no longer hold complete control over what was once, effectively, a one-party state. 

New, fairer voting maps have already eroded gerrymandered GOP supermajorities in the Legislature that previously endured even when Democrats won every statewide race. In the upcoming November elections, the new maps will, for the first time, take full effect.

The creation of more competitive districts has not immediately ushered in an atmosphere of productive bipartisanship in the Capitol. But it did cause enough of a thaw that Wisconsin could finally join the other 48 states that have already expanded postpartum Medicaid. Republicans running in newly competitive districts can campaign on this bit of belated progress. Two cheers for Wisconsin! We’re 49th!

At the Vos-less press conference Wednesday night, Republicans gave emotional testimony about “the women who need this protection.” They thanked the speaker for finally listening to their pleas. Then, instead of reaching across the aisle, they delivered a scorching rebuke to Democrats who had been pushing for months for a vote on both of the women’s health bills they were celebrating. When the bills were not scheduled, Democrats vowed to bring them up as amendments to other bills, holding up action on the floor and threatening to put their GOP colleagues in the embarrassing position of having to vote down their efforts.

“I’m very angry at what happened today — very angry,” Rep. Patrick Snyder (R-Weston) said. “I talked to my Democratic colleagues and told them that I was close, that it was going to get done, but then they throw this crap at us today. It almost blew it up.”

By speaking up, Democrats nearly ruined Republicans’ efforts to gain support within their own caucus, according to Snyder. That analysis caused Democratic Minority Leader Greta Neubauer to roll her eyes. “It seems that the bills are going to the floor after years of Rep. Pat Snyder telling us that these bills were going to be passed and them not being passed, so it does seem like our actions made a difference today,” Neubauer said. 

Partisan habits die hard. For much of the most recent legislative session, Republicans formed a Sorehead Caucus whose sole aims were rehashing grievances about their loss of power and trying in vain to recreate the dominance they enjoyed when they controlled every branch of government. 

Back in 2018, when Evers won the first time, breaking the GOP stranglehold by beating former Republican Gov. Scott Walker, Republicans held a lame duck session to claw back the incoming governor’s powers. Eight years later, as Evers is about to leave office at the end of his second term, they’re still at it. Motivated by spite over Evers’ line-item veto extending their modest, two-year increase in school revenue limits for the next 400 years, they have insisted on starving school districts of state funds, punishing not only Wisconsin schoolchildren but also the property taxpayers who, in the absence of state funding, are forced to pick up the tab. 

In a similarly spiteful vein, Republicans just killed off the popular, bipartisan Knowles Nelson stewardship program, setting up the 36-year-old land conservation effort to die this summer. Over and over in hearings on whether to renew the program or drastically cut it back, Republicans cited a state Supreme Court decision that held they cannot anonymously veto individual conservation projects. GOP legislators said the decision — written by the most conservative justice on the Wisconsin Supreme Court — left them no option but to gut the program just to show who’s boss. 

As Henry Redman reports, a handful of conservation-minded Republicans could have joined forces with Democrats to save the program, but Republican bill authors insisted on negotiating only within their own caucus, ignoring Democratic efforts to make a deal and instead trying to please the program’s far-right enemies by making deeper and deeper cuts before finally giving up and letting the program lapse.

This style of governing — a hangover from the Walker era — might satisfy certain politicians’ hunger for power, but it’s ill-suited to getting anything productive done for the people who live in the state.

Let’s hope Vos’ departure marks the end of the petty partisanship that has blocked progress in Wisconsin for far too long.

GET THE MORNING HEADLINES.

SUBSCRIBE

Roger Williams Medical Center in Providence, R.I. A new study shows that women with breast cancer living in Rhode Island and other states that expanded Medicaid eligibility were less likely to die from the disease. (Photo by Michael Salerno/Rhode Island Current)

Women with breast cancer living in states that expanded Medicaid eligibility were less likely to die from the disease — but not everyone benefited equally, according to a recent study published in the medical journal JAMA Network Open.

Researchers from Howard University, the University of Alabama, Henry Ford Hospital in Michigan, and others looked at data from about 1.6 million women ages 40 to 64 who were diagnosed with breast cancer between 2006 and 2021.

They compared survival rates among women living in states that expanded Medicaid eligibility under the Affordable Care Act, commonly known as Obamacare, with the rates in states that did not expand. About 58% of the women lived in expansion states, and roughly 42% lived in nonexpansion states. States began expanding Medicaid in 2014.

The researchers found that Medicaid expansion was associated with lower overall mortality — no matter the disease stage, race or ethnicity, or neighborhood income of the women. Women in expansion states whose cancer had spread to other organs — the most advanced stage of disease — saw the most significant decline in deaths.

Among racial and ethnic groups, the largest relative gains were among Hispanic women — they were 19% less likely to die if they lived in an expansion state. There were smaller gains among non-Hispanic Black women and residents of low-income areas. The smallest difference was among white women.

Hispanic women’s large gains could be due to many previously lacking insurance, said Dr. Oluwasegun Akinyemi, senior research fellow at the Howard University College of Medicine’s Clive O. Callender Outcomes Research Center and a coauthor of the study.

Black women have higher breast cancer death rates compared to white women, even though there are fewer cases among them, partly because they are often diagnosed with the disease at a later stage.

Overall, Black women with breast cancer benefitted less from Medicaid expansion than other groups because they are disproportionately located in the South, where most states have not expanded, Akinyemi noted. The expansion holdout states include Alabama, Florida, Georgia, Mississippi, South Carolina, Tennessee and Texas.

The remaining three nonexpansion states are Kansas, Wisconsin and Wyoming.

The researchers also compared mortality rates in low- and high-income neighborhoods. Women living in the highest-income neighborhoods, as well as those who received immunotherapy treatment, had lower mortality rates. Akinyemi said that result suggests that coverage leads to greater access to treatment.

In July, President Donald Trump signed a broad tax and spending bill  that will cut federal Medicaid funding by more than $900 billion over the next decade. As a result, about 15 million people may lose Medicaid coverage, according to estimates by the Center on Budget and Policy Priorities.

Editor’s Note: Because of inaccurate information provided to Stateline, an earlier version of this story misstated the position of Dr. Oluwasegun Akinyemi. Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

Reading Time: 6 minutes

Click here to read highlights from the story

• Federal immigration officials could gain access to sensitive Medicaid data — but not yet. A judge has temporarily limited what information the Department of Homeland Security can access in states, like Wisconsin, that are suing to block a data-sharing agreement. 

• Advocates warn the data-sharing risks chilling health care access — potentially even discouraging some from enrolling in programs for which they’re eligible. 

• Undocumented immigrants are categorically ineligible for full Medicaid, but two narrower options exist. In Wisconsin, emergency care and prenatal coverage are available regardless of immigration status, covering about 3,200 people as of late 2025.

• State Republicans unsuccessfully sought to ban any public funding for health care for people without legal immigration status, citing rising Medicaid costs. Gov. Tony Evers vetoed the proposal, arguing it would create confusion and solve problems that don’t exist.

Can federal immigration officials access personal data on every Wisconsinite enrolled in Medicaid? 

Not for now, but the question is winding its way through federal courts.  

The U.S. Department of Health and Human Services last summer signed an agreement with the Department of Homeland Security to give immigration enforcement officers broad access to Medicaid data, which includes names, addresses, claim information and banking details. Trump administration officials claim the agreement is needed “to ensure that Medicaid benefits are reserved for individuals who are lawfully entitled to receive them.”

Wisconsin joined 21 other states in a lawsuit challenging the agreement last year. 

“Millions of individuals’ health information was transferred without their consent,” the lawsuit argues. “In doing so, the Trump administration silently destroyed longstanding guardrails that protected the public’s sensitive health data.” 

In December, a federal judge in California ordered that, in states involved in the lawsuit, DHS can only access the names and contact information of undocumented immigrants in states involved in the lawsuit. 

But patient advocates say it’s unclear how the agency could separate the records of undocumented immigrants from those of immigrants with legal status.

“The sharing of data is dangerous for all of us at the end of the day,” said Esther Reyes, movement-building director with the national advocacy group Protecting Immigrant Families. 

How does immigration status affect eligibility for Medicaid and other health programs? 

Federal law bars undocumented immigrants and many other recent immigrants from receiving full-benefits Medicaid coverage. Most legal permanent residents and new arrivals with legal status become eligible for full Medicaid coverage only after five years in the U.S. A list of exceptions to that rule shrank last year when President Trump signed his trademark “big beautiful bill” into law. 

But the White House claims many undocumented immigrants still access Medicaid benefits, largely citing state-funded health care programs — including a now-shuttered program in Illinois — that provided coverage for undocumented adults. While those programs must operate without federal dollars to avoid running afoul of federal law, the Trump administration argues a tax “loophole”, which it moved to close last week, made them possible.

Medicaid rules make one exception for immigrants ineligible for full coverage: Under federal law, hospitals must provide emergency care for any uninsured patient. Emergency Medicaid coverage can reimburse hospitals for those costs, meaning people of any legal status can receive temporary coverage in dire circumstances — though receiving that emergency coverage is not guaranteed.

“Emergency Medicaid is exclusively available when you go to the emergency room if you don’t qualify for Medicaid because of your immigration status, and it covers services that states by law are required to cover — life or death situations,” Reyes said.

Absent that reimbursement, hospitals may distribute the costs of emergency care for people without insurance across other patients. 

Some states also rely on the federal Children’s Health Insurance Program, which is separate from Medicaid, to cover prenatal care for pregnant patients regardless of immigration status. 

How do those programs work in Wisconsin, and how much do they cost?

In Wisconsin, those two options are called Medicaid Emergency Services and BadgerCare Plus Prenatal, respectively. The prenatal program is open both to immigrants ineligible for other coverage and to pregnant inmates in Wisconsin’s prisons and jails.

Immigrant patients can receive emergency services coverage until their “condition is no longer considered an emergency,” according to state guidelines. Patients enrolled in the prenatal plan remain covered through their pregnancy, though many then become eligible for two months of emergency care coverage.

Roughly 3,200 people were enrolled in the two programs combined in October 2025, according to Wisconsin’s Department of Health Services’ data. That marked the programs’ lowest monthly enrollment since the start of the COVID-19 pandemic.

The state paused reviews of Medicaid recipients’ eligibility during the pandemic, allowing some enrollees in the emergency services and prenatal programs to remain insured beyond the standard cutoff, but enrollment plummeted after Wisconsin DHS resumed reviews in June 2023 in a process often called the “unwinding.”

Not all patients enrolled in the programs are undocumented, and Wisconsin DHS records do not break down enrollment by legal status.

Spending on the two programs dipped from about $60 million in fiscal year 2024 to about $57 million in 2025 — less than 0.4% of the state’s overall medical assistance spending that year.

Why did Wisconsin Republicans try to block state-funded health care for undocumented immigrants last year?

The Republican-controlled Legislature voted last year to bar Wisconsin agencies and local governments from funding any form of health services for undocumented immigrants. 

Rep. Alex Dallman, R-Markesan, one of the bill’s co-sponsors, pointed to Illinois’ expansion of health coverage to some undocumented adults as reason for Wisconsin to preemptively block any similar expansion; the Illinois program’s costs consistently exceeded projections, prompting the state to end the program last year.

“We’re in such a deficit on Medicaid already that it’s hard to keep up as it is,” he told Wisconsin Watch. Wisconsin is on track to overspend its Medicaid budget by $213 million by the end of the current budget cycle, state DHS Secretary-designee Kirsten Johnson wrote in a letter to state lawmakers at the end of December.

Dallman noted that the bill made an exception for health care spending required under federal law. “If they go to the emergency room, they are still going to get emergency care,” he said. As he understood it, Dallman said, that language in the bill would have shielded emergency Medicaid.

But opponents say it isn’t clear that Wisconsin’s emergency services program would have been left untouched. Some also argue that the proposal could also require immigration status checks to access any form of subsidized health care, spanning far beyond hospitals alone.

“If a child is at school and they’re sick… does the school nurse need to figure out how to verify their status before they provide health care?” asked William Parke-Sutherland, government affairs director of Kids Forward, which advocates for low-income and minority families.  

“It would have affected health care services for people if they are in need of emergency services like EMTs,” he added. “We have a primarily county-based crisis mental health system — I think that this would have applied to those as well.”

Gov. Tony Evers vetoed the bill in December, arguing that it sought to solve problems that “do not exist.” 

Could sharing Medicaid data deter patients from seeking health care?

Health outreach workers warn that giving federal immigration officials access to even some Medicaid patient data could discourage people from enrolling in programs for which they are eligible — including U.S. citizens.

The database shared with immigration authorities, called the Transformed Medicaid Statistical Information System, doesn’t clearly distinguish between undocumented immigrants and immigrants with legal status who are ineligible for full-coverage Medicaid for various reasons.

In December, U.S. District Court Judge Vince Chhabria of northern California ruled that immigration authorities may access data only on undocumented immigrants — and only if it can be separated from data on citizens and eligible immigrants. 

It’s still unclear whether officials can do that.

Regardless, the data-sharing agreement alone is enough to make many immigrants — and some citizens with immigrant family members — “think twice about whether they actually access programs like Medicaid,” Reyes said.

But health care navigators say skipping coverage can be far riskier than the potential for their address to land in the hands of immigration enforcement officers.

“You’re protecting the life of your child — and yours” by enrolling in the prenatal program, said Francisco Guerrero, a health coverage navigator with the Wisconsin Institute for Public Policy and Service.

For now, advocates are urging people to be cautious when deciding whether to drop their coverage. If people are already enrolled in the emergency or prenatal programs and haven’t changed their address, leaving the program won’t wipe their information from the database, Reyes said. U.S. citizens don’t have to disclose the immigration status of anyone in their household, she added, and immigrant parents enrolling U.S.-born children do not need to share their own legal status.

“We want people to make informed decisions and understand the risks,” Reyes said. “We understand, though, that it’s really critical to get the care that you need for yourself and for your children.”

Can immigration officials access your Medicaid data? What it means for Wisconsin patients is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

A Planned Parenthood clinic in Salt Lake City on Wednesday, July 31, 2024. (Photo by McKenzie Romero/Utah News Dispatch)

WASHINGTON — A federal judge on Monday closed the lawsuit Planned Parenthood filed last summer after Republicans’ “big, beautiful” law blocked Medicaid patients from visiting its clinics for any health care appointments for one year. 

Planned Parenthood filed notice with the court Friday that it had dismissed “without prejudice all claims against” the Trump administration in the case. Massachusetts District Court Judge Indira Talwani issued an electronic order Monday closing the case “Pursuant to Plaintiffs’ Notice of Voluntary Dismissal without Prejudice.”

The law prevents people on Medicaid from being seen at Planned Parenthood facilities through early July, when the one-year period would expire.

Planned Parenthood Federation of America President and CEO Alexis McGill Johnson wrote in a statement released last week that President Donald Trump “and his allies in Congress have weaponized the federal government to target Planned Parenthood at the expense of patients —  stripping people of the care they rely on. 

“Through every attack, Planned Parenthood has never lost sight of its focus: ensuring patients can get the care they need from the provider they trust. That will never change. Care continues, as does our commitment to fighting for everyone’s freedom to make their own decisions about their bodies, lives, and futures.”

The Department of Justice did not immediately respond to a request for comment from States Newsroom. 

Talwani originally ruled for Planned Parenthood in the case, temporarily blocking the defunding provision from taking effect. But an appeals court later overturned that decision, allowing the Trump administration to legally withhold Medicaid funding from going to Planned Parenthood. 

Talwani was nominated by former President Barack Obama.

The provision in Republicans’ “big, beautiful” law that blocks all Medicaid funding from going to Planned Parenthood was originally slated to last for a decade, but the final version covered one year. 

Federal law for decades has barred spending from covering abortions with limited exceptions for rape, incest, or the woman’s life. 

So the new language prevented Medicaid patients from scheduling appointments at Planned Parenthood for other types of health care, like annual physicals, cancer screenings, or birth control appointments. 

Shireen Ghorbani, president and CEO of Planned Parenthood Association of Utah, which filed the lawsuit along with Planned Parenthood League of Massachusetts and Planned Parenthood Federation of America, wrote in a statement that its health care providers would “continue to see patients and deliver on our mission to provide high-quality care and education to everyone who needs it, no matter where they live or how much money they make.” 

A Planned Parenthood spokesperson, who did not want to comment on the record, said that certain clinics may choose to cover the cost of treating Medicaid patients, even though the clinic will not receive reimbursement from the federal government under the law. 

Angela Vasquez-Giroux, vice president of communications at Planned Parenthood Federation of America, wrote in a statement that the organization’s “health centers initially shielded the overwhelming majority of patients who rely on Medicaid from the harm of this cruel law. Unfortunately, the consequences for patients will worsen considerably over time as health centers close, costs rise, and access to their trusted provider is pushed further out of reach.”

Our first issue of 2026 brings the focus back to transportation of students with special needs and disabilities. Learn more about leveraging camera technology for student safety and driver training, Medicaid reimbursement management, the considerations of using non-yellow school bus vehicles for student transportation and the details on new securement technology for students with disabilities and how to train staff to use it correctly. Also read articles on targeting sexual assault onboard school buses and the multi-faceted approach needed to build and retain student transportation teams that are prepared for the wide variety of student needs.

Find more information about our upcoming 2026 conferences in the magazine as well as a recap of the 2025 TSD Conference!

Read the full January 2026 issue.

Features

Navigating the Complexities
The arduous task of tracking students and routes for Medicaid reimbursement can be off-putting. However, software companies are highlighting the benefits of how technology can help with documenting and reporting.

Smaller Options
Switching to alternative transportation vehicles like vans and SUVs for students with disabilities is beneficial in some circumstances, but at what cost?

Secure & Ensure
As securement devices for students with disabilities become more specialized, ensuring transportation staff are trained in securing them properly inside the school bus is a top safety element.

Special Reports

Eagle Eye on Student Transportation Safety
Leveraging camera technology can offer a host of safety solutions, from identifying student behavior issues to detailing driver performance behind the wheel.

Feedback
Online
Ad Index

Editor’s Take by Ryan Gray
Driving Change in 2026

Thought Leader by Linda Bluth
Sexual Assault on School Transportation Vehicles: A Call for Action

Publisher’s Corner by Tony Corpin
Innovative Staffing & Retention

The post January 2026 appeared first on School Transportation News.

Reading Time: < 1 minute

Unauthorized immigrants are not eligible for federally or state-funded health coverage in Wisconsin. 

That includes Medicaid, Medicare and the Children’s Health Insurance Program (CHIP), and coverage purchased through the Affordable Care Act (Obamacare) marketplaces.

Unauthorized immigrants also are not eligible for Wisconsin Medicaid or BadgerCare Plus.

Fourteen states, including Illinois and Minnesota, use state Medicaid funds to cover unauthorized immigrants, but Wisconsin does not.

Democratic Gov. Tony Evers on Dec. 5 vetoed a Republican-backed bill that would have banned public money from going toward health care coverage for unauthorized immigrants.

Republicans said the bill was meant to be pre-emptive.

On Dec. 10, Republican U.S. Rep. Tom Tiffany, who is running for governor in 2026, incorrectly said Evers’ veto allowed unauthorized immigrants “to continue to get taxpayer-funded health care.”

When Evers vetoed the bill he criticized it for “trying to push polarizing political rhetoric.”

This fact brief is responsive to conversations such as this one.

Sources

• Wisconsin Watch Do tens of millions of unauthorized immigrants receive federal health benefits?
• Wisconsin Health Services Department Medicaid: Health Care Coverage for Noncitizens
• Wisconsin Watch Are unauthorized immigrants eligible for federal Medicaid coverage?
• WPR Evers vetoes bill to block Medicaid funds from undocumented residents
• Wisconsin Legislature Assembly Bill 308
• Rep. Alex Dallman Testimony in Favor of Assembly Bill 308
• Gov. Tony Evers Veto message
• Wisconsin Watch Here are 8 claims related to health care and immigration … and the facts

Did Wisconsin Gov. Tony Evers allow unauthorized immigrants to get taxpayer-funded health care? is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.