The Trump administration has issued final rules on how states should ensure that millions of Medicaid enrollees prove they’re working or completing other activities, such as job training, volunteering, or being enrolled in an educational program.

The Centers for Medicare & Medicaid Services released the rules on June 1. That deadline was set last year in the GOP tax-and-spending law known as the One Big Beautiful Bill Act, which established a work requirement for certain people enrolled in Medicaid, the state-federal health insurance program for people with low incomes or disabilities.

Medicaid agencies are scrambling to rework IT systems and make sure they have staff to effectively enforce the rules, while also keeping enrollees from losing coverage for administrative reasons, such as difficulty navigating state eligibility portals.

The newly announced regulations offer a clearer picture of what roughly 18.5 million Medicaid enrollees will have to do to prove they qualify for benefits.
Jim Torres, who helps people enroll in health coverage at the Samuel U. Rodgers Health Center in Kansas City, Missouri, said a “very small percentage” of his clients have heard of the changes coming to Medicaid.

“These folks have very busy lives. They’re doing the best they can to get by,” he said. “It’s just not a top-of-mind thing for most of them.”
Health policy researchers and consumer advocates said enrollees should keep a few things in mind as the Jan. 1, 2027, rollout approaches in most states.

1. The Work Rules Won’t Apply to Everyone.

The new rules will apply to people covered through what’s known as Medicaid expansion. Since 2014, more than 40 states and the District of Columbia have decided to allow more people into their Medicaid programs, generally low-income adults without dependents. Georgia and Wisconsin offer coverage to some people in this group, so they’ll be subject to the rules.

Children and pregnant people, as well as individuals with disabilities who receive Social Security payments — all groups that already qualify for Medicaid — won’t be subject to the rules. Nor will people determined to be “medically frail,” or too sick to work.

People subject to the work rules are “crowding out” people in the Medicaid program who are “truly in need,” CMS Director Mehmet Oz claimed during a June 1 press call. “Work requirements are going to turn this around, we hope.”

The rules are set to take effect in most places in January. Nebraska started enforcing them in May. Montana plans to start in July but won’t kick people off until October. Arkansas will do a “soft” launch in July — it will start enforcing the rules but with no penalties until next year.

2. States Will Take Your Word That You’re Too Sick To Work. For Now.

Federal officials have stressed that states should make the process of reporting hours and requesting exemptions as simple as possible for Medicaid enrollees by creating automated systems and using existing data sources, such as unemployment and education records.

If states cannot determine you’re performing 80 hours of qualifying activities a month using those data sources, you may be allowed to “self-attest” to that in 2027, health policy researchers said.

People will also be allowed to “self-attest” that they are too sick to work in 2027, and do so one time in 2028. Then states will start asking for proof, if they can’t find it through available data.

But after the initial rollout, the burden of proof is likely to still fall on many enrollees, said researchers and consumer advocates.

People may need to dig up pay stubs, medical records, and doctors’ notes and submit them for state review, said Morgan Henderson, who has studied Medicaid work programs in Georgia and Arkansas at The Hilltop Institute, a research center at the University of Maryland-Baltimore County.

“The higher this manual reporting burden, the less people are going to do it,” he said. “That means that we’re going to see coverage drop-offs.”

3. The Rules Are Tougher Than Expected for People Too Sick To Work.

One of CMS’ primary goals has been to “protect vulnerable populations” through “strong exemptions to make sure people who can’t reasonably be expected to work are not subject to the requirements,” Dan Brillman, a deputy administrator at the agency, said during the June 1 press call.
Consumer and patient advocates, however, said the final rules’ exemptions are more restrictive than expected. Enrollees will eventually have to provide documentation, such as a statement from a medical professional, to prove that a health condition keeps them from working. And each individual state will have to determine the severity of beneficiaries’ medical conditions.

“Someone could be medically frail in Nebraska but not medically frail in Delaware,” said Carolyn Sheridan, associate director of state policy for the National Organization for Rare Disorders, which lobbies for patients with rare diseases. She said her group had hoped the rules would offer a standardized definition of who counted as medically frail and not leave the decision up to states.

Trump administration officials have publicly crusaded against fraud in government health programs, such as Medicaid, and states could face financial penalties for incorrectly granting people exemptions from the work rules, said Jennifer Tolbert, who researches Medicaid at KFF, a health information nonprofit that includes KFF Health News.

“States may be more cautious,” she said. “That will likely lead to people losing coverage who may still be eligible.”

4. Only Certain Qualifying Activities Count.

Enrollees can satisfy the rules by working 80 hours a month. They can also be enrolled in college courses, volunteer through a community organization, or do “in-kind” work that doesn’t result in pay.

The rules set out, in detail, how many academic credit hours translate to 80 hours a month — students need to be enrolled in six credit hours per semester to meet the “half-time” requirement. An unpaid internship can count toward the 80 hours.

People can also prove they’re volunteering with “a document from a community service organization.”

Consumer advocates say it might be hard for people to obtain proof they’re performing these kinds of informal activities. But supporters of the rules say volunteerism can already be tracked.

“If you run into trouble with the law and the judge says, ‘Hey, you need some volunteering and community service to serve your time,’ there are already ways that we verify that,” said Niklas Kleinworth, who works on state health policy for the conservative Paragon Institute.

5. You Have Time To Prepare.

Make sure your state Medicaid agency has your current mailing address and keep your eye on your mailbox, said researchers and consumer advocates. State Medicaid agencies must inform you in two ways if you’ll be subject to the rules — by either regular mail or email, and by one other form of communication, such as a text or phone call or by posting a notice online.

“The important stuff comes by mail,” Henderson said.

And check in with your state Medicaid agency, said researchers and advocates. Some states, including Arkansas, California, and Wisconsin, have already posted information about the work rules on their websites. If you can’t find what you’re looking for there, visit or call a local office. A caseworker should be able to tell you whether you’ll be subject to the rules.

“Get ahead of this,” said Joan Alker, who is executive director of the Georgetown University Center for Children and Families and studies Medicaid. “So that you don’t end up going to the pharmacy one day and they say ‘Oh, you’re not insured anymore’ when you’re trying to get your prescriptions refilled.”
KFF Health News correspondent Samantha Liss and senior correspondent Rachana Pradhan contributed to this report.

Have you tried to prove your eligibility for Medicaid under new rules that require people to show they are working, going to school, or participating in another qualifying activity? Click here to contact KFF Health News.

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 — the independent source for health policy research, polling, and journalism.

Forty-six percent of U.S. adults — regardless of insurance type — reported struggling to afford healthcare last year, according to a report released Wednesday by the Urban Institute, a nonprofit research think tank.

The report analyzed findings from a December 2025 survey of 10,000 working-age adults across the nation. Funded by the Robert Wood Johnson Foundation, the research comes at a time of U.S. cost-of-living concerns and economic woes. 

Uninsured adults were most likely — 60% — to report at least one affordability problem.

Researchers defined affordability challenges as: trouble paying family medical bills in the past year, a family member not getting healthcare they needed due to costs, or the family having medical debt at the time of the survey. 

Almost 40% of adults with private employer coverage, roughly 54% of those with Marketplace or plans, and 57% of adults with Medicaid reported having problems affording medical care.

More than a third — about 35% — of all surveyed adults said a family member had unmet healthcare needs because of costs.

The survey also found disparities in care affordability.

Adults with disabilities, for example, were more likely to have trouble affording healthcare for their families at almost 69% of those surveyed, compared with 40% of adults without disabilities. And the majority of Black and Hispanic adults reported struggling to afford care, compared with about 42% of white adults and 28% of Asian adults.

Health conditions also coincided with affordability troubles: More than 7 in 10 people who suffered strokes reported problems affording care for their families, followed by 70% of those with COPD, chronic bronchitis or emphysema, and about 64% of those with cancer and heart disease.

Half of adults living in the South — a region home to several states that haven’t expanded Medicaid eligibility — and those in rural areas of the country also reported affordability challenges, in contrast with roughly 45% of adults in urban areas.

Survey results also showed about 1 in 5 adults with private health insurance coverage reported large increases in insurance premiums — but adults with individual Marketplace plans were nearly twice as likely to report large premium increases as those with employer coverage. 

According to health policy research organization KFF, the average Marketplace deductible surged by about $1,000 per person this year, as more enrollees shift to higher-deductible plans after enhanced subsidies expired.

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

Nearly 200 residents at the St. Joseph’s Center nursing home in the affluent Connecticut suburb of Trumbull were evacuated last year after Legionella bacteria was found in the facility’s water system. Two months later, they were evacuated again over critical failures in the building’s fire safety systems.

Three years earlier, residents at another Connecticut nursing home, the Quinnipiac Valley Center, were relocated after two resident deaths triggered a state health investigation.

The nursing homes were both owned by private equity-backed Genesis HealthCare, among the largest skilled nursing operators in the nation. It’s already faced lawsuits or investigations in California, Georgia, Massachusetts, Missouri, Nevada and Vermont over allegations of patient neglect and abuse.

This year, Connecticut enacted what may be the strongest law in the country addressing transparency and accountability for private equity-owned nursing homes.

It is the latest in a string of states stepping into a regulatory vacuum created by limited federal laws and a presidential administration that’s proven friendly to private equity while showing little appetite for scrutinizing private equity’s role in the healthcare industry.

Private equity’s foray into healthcare over the past several years, particularly into hospital ownership, has drawn public outrage and legislative scrutiny.

It’s all happening as states are staring down steep federal cuts to Medicaid, the public health insurance for people with low incomes that is also the primary payer for long-term nursing home stays. Those cuts, experts fear, could ultimately direct more older Americans into nursing home care.

Last year, at least seven states (California, Indiana, Massachusetts, Maine, New Mexico, Oregon and Washington) passed legislation putting more guardrails around private equity’s involvement in healthcare.

Virginia is still considering a bill to curb predatory property financing practices that have been used by private equity in nursing homes.

Illinois lawmakers sent two measures to Democratic Gov. JB Pritzker that aim to strengthen oversight and transparency requirements of healthcare mergers or acquisitions, and place new restrictions on private equity ownership of disability service providers. The first bill was Democratic-sponsored, while the second had both Democratic and Republican sponsors.

Democratic Gov. Ned Lamont signed Connecticut’s measure last week. The new law requires nursing homes that are owned by private equity to disclose their financial dealings with the state and bans private equity from controlling day-to-day care decisions about nursing home residents. Lamont also signed a related bill to curb private equity’s influence over hospitals in the wake of financial moves by equity-owned health groups in his state that led to hospital closures.

Genesis HealthCare declined an interview with Stateline, but provided a statement saying it “remains focused on supporting our affiliated centers in delivering high-quality care to patients and residents.”

The nursing home industry argues that private equity controls a relatively small share of the nation’s facilities, and that reported problems have been the result of a few bad actors. The federal government estimated that about 5% of Medicare-enrolled nursing homes nationwide had private equity owners in 2022, but admitted that some nursing homes don’t always list all of their owners in the federal database. Some researchers have pegged the real share as high as 13%.

“Focusing on private equity in long term care has become a distraction from the real issues that impact the majority of providers, like chronic Medicaid underfunding and a growing caregiver shortage,” said John Kane, a senior vice president at the industry group American Health Care Association/National Center for Assisted Living, in a statement to Stateline.

“If we truly want to improve care throughout the health care system, we need policymakers to find a proper balance of oversight while still encouraging more investments.”

But a growing number of states are moving to regulate investment companies that draw heavily on Medicaid and Medicare dollars.

“The big question about private equity is not whether profit belongs in the nursing home; it’s whether public dollars meant for care are being converted into financial returns (for investors) without enough accountability,” said Gregory Orewa, an assistant professor at the University of Texas at San Antonio whose research has focused on private equity ownership in U.S. healthcare.

“Nursing homes exist to care for the most vulnerable who cannot care for themselves,” he said, “so we should be holding private equity or anybody to high standards on providing quality care.”

Quality and profits

Private equity firms use pooled investments from pension funds, sovereign wealth funds, endowments and wealthy individuals to buy a controlling stake in a company. Then they try to maximize the company’s value before selling it at a profit, usually within a few years.

Nursing homes and other long-term care facilities are attractive to investors because demand is always there; the share of Americans 65 and older has been steadily rising and is expected to continue.

Nursing home care is heavily subsidized by the government through Medicaid and to a lesser extent Medicare, the public insurance program for adults over 65 and some people with disabilities, offering investors a predictable revenue stream.

And it’s an industry where investors can scoop up struggling independent facilities and improve their margins through corporate consolidations, streamlining management, adjusting staffing or capitalizing on valuable real estate owned by the nursing homes.

Private equity’s defenders say it provides nursing homes with much-needed capital, disciplined management and operational improvements that help facilities scale up their services.

But the private equity model’s primary goal in any sector is to generate returns for shareholders, usually within a few years.

Critics say that priority conflicts with the kind of long-term investment that’s needed to provide quality healthcare, such as paying enough to hire sufficient staff or upgrading facilities.

“One of the biggest misunderstandings is that private equity ownership is only bad,” said Orewa, of the University of Texas at San Antonio. “The issue is more structural. Nursing homes operate on very thin margins, they depend heavily on public dollars and they care for the most vulnerable people who can’t easily exit when nursing home quality declines.”

Nursing home residents aren’t like other healthcare consumers. They may lack financial literacy, or their decision-making may be impaired by cognitive decline, which could lead to them making choices not in their best interests, researchers have noted. They’re a captive audience, often choosing a facility that’s nearby or near family, rather than shopping around for the best option.

Research on how private equity ownership affects nursing homes has found few positive effects. One large 2023 study found it increases a nursing home’s death rate by 11%. Private equity-owned facilities tended to maintain care quality for sicker patients by adding registered nurses, but researchers found those gains were offset by staffing cuts to the frontline nursing assistants who handle most of the hands-on care. Other studies have linked private equity involvement to increases in emergency room visits and rising Medicare costs.

Orewa and his colleagues published a comprehensive review last year of a dozen major studies, linking private equity ownership to a higher number of deficiencies in nursing homes, increased hospitalization rates and higher mortality. They also found that private equity-owned facilities bill Medicare more than other nursing homes.

Facilities’ financial outlooks initially improved after a private equity buyout, Orewa said, but they later faced long-term challenges. The financial maneuvers that private equity uses to extract more revenue from nursing homes can hurt their stability long term.

Hidden disclosures

All nursing homes that receive federal funding are required to publicly disclose the names of any entities that exercise financial control over them. But companies can use complex methods to mask that ownership, meaning it’s difficult even for experts to find out who really owns a nursing home.

“A lot of nursing homes will not provide that information, and their information may not be audited,” said Michael Fenne, healthcare policy coordinator at the Private Equity Stakeholder Project, a research group that tracks the private equity industry.

For example: The private equity-backed Portopiccolo Group acquired more than 130 nursing homes across 9 states from 2016-2022 and yet didn’t appear in federal data as an owner of those facilities, according to the consumer advocacy nonprofit Public Citizen.

And ownership information matters to consumers looking for a safe place for their loved ones: The Portopiccolo Group’s nursing homes have faced heavy fines. A 2023 study by watchdog group Good Jobs First found Portopiccolo had an average fine per facility of more than $81,000, landing it on a list of parent companies with largest average penalties in the U.S.

Predatory tactics?

Virginia lawmakers are considering a Republican-sponsored bill that would cut funding to nursing homes that pay excessive rents to landlords. If passed, it could become a first-in-the nation effort to directly curb a financial maneuver known as sale-leaseback that state regulators have deemed predatory.

In sale-leaseback arrangements, a private equity-backed firm buys a healthcare company, such as a nursing home chain, and then sells its underlying real estate property to a separate investment trust. This sale generates quick returns for investors but saddles the nursing homes with monthly rent payments they may struggle to make, leaving less money available for patient care.

It’s a tactic that has contributed to healthcare bankruptcies across the nation, including for Genesis HealthCare and for Georgia-based nursing home chain LaVie Care Centers.

Increased need for nursing homes

By 2030, 1 in 5 Americans will be 65 or over, and most older adults say they would prefer to remain living in their homes for as long as possible.

For many, that’s possible because of services — such as home health aides or visiting nurses — that are funded through Medicaid.

But elder care experts worry those services will be the first on the chopping block for cash-strapped states facing $665 billion in Medicaid cuts over the next decade from President Donald Trump’s One Big Beautiful Bill Act. This is because federal law requires state Medicaid programs to cover nursing home care, but home-based services are optional.

Most people who receive those home-based Medicaid services need the kind of care that would land them in a nursing home without such services, said Jason Resendez, president and CEO of the advocacy group National Alliance for Caregiving.

“When we take those benefits away, it doesn’t take away the need for that care,” he said. One of the impacts of cuts to home-based services “will certainly be more folks forced to make the hard choice of going into more institutional-based care.”

And cuts to Medicaid could financially weaken smaller, independent or safety-net nursing homes that serve lower-income patients who heavily rely on Medicaid.

“Those distressed facilities may become cheaper acquisition targets for private equity,” Orewa said. “That creates an opportunity for investors with capital to buy at a discount.”

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

The state health department has launched a new webpage to explain the federal work requirement for some Medicaid recipients that will take effect in 2027.

The Wisconsin Department of Health Services is still reviewing the federal rule, released on June 1, governing how states are to implement the work requirements, a spokesperson said. Medicaid is known as BadgerCare in Wisconsin.

On June 5, DHS posted a Federal Medicaid Work Requirement webpage with general information about the requirement, including when it takes effect, how participants in Medicaid might meet the requirement, and reasons people might be exempt from meeting it.

The DHS work requirement page also includes a screening tool that people can use to advise them whether they might have to meet the new requirement.

The screener is intended only as information, according to DHS. It is not an application form and the result it provides is not an official decision about coverage for the person completing the form.

A disclaimer on the first page of the screening form states, “No matter what the results of this tool say, you should still watch your mail for letters, read them, and follow all directions. If we ask you to send information or documents, it is important that you do so right away. If you don’t, you could lose your health care coverage.”

The tax and spending megabill HR 1, passed by congressional Republicans and signed on July 4, 2025, by President Donald Trump, added the work requirement for Medicaid participants who gained healthcare coverage through Medicaid expansion under the 2010 Affordable Care Act.

While Wisconsin did not adopt the full ACA expansion, the state added childless adults whose incomes are at or below the federal poverty guideline to its Medicaid program. About 190,000 childless adults in Wisconsin were covered by BadgerCare in April, according to DHS.

“If you could be affected by the federal work requirement, we’ll send you a letter in August or September to explain what you need to know and what will happen next,” the webpage states.

Under the federal requirement, childless adults ages 19 to 64 must report at least 80 hours of work or volunteer service in a month, or enrollment in education or a workplace training program, to qualify for Medicaid.

The requirement also provides for exemptions due to certain health conditions or other factors.

After the federal government issued its work requirement implementation rule June 1, advocates said it imposed stringent terms that will make it more difficult for people to remain covered by Medicaid, even if they fully qualify.

In an analysis published Tuesday at the Substack newsletter “Can We Still Govern?” Chloe East of the University of Colorado and Adrianna McIntyre of Harvard University wrote that research showed work requirements imposed in Arkansas in 2018 during the first Trump administration “had no positive effect on employment and made participants worse off.”

The paper was written in response to a new federal report from the Trump administration asserting that work requirements would “incentivize employment” and “reduce poverty.”

East and McIntyre wrote that the report’s assumptions were not supported by research literature on work requirements for Medicaid and federal nutrition aid programs (SNAP).

“One consistent finding across dozens of papers on work requirements is that they reduce program participation among vulnerable individuals and households,” East and McIntyre wrote.

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When her son was a teenager, Connecticut mom Amy Wadsworth said, he was the type of kid parents rarely worry about.

He played sports, cared about his health and stayed away from drugs. In 2018, when he left West Hartford to start his freshman year at American University in Washington, D.C., she expected his biggest challenge would be adjusting to college life.

Instead, she said, he began using cannabis to cope with social anxiety and as a sleep aid.

Within months, Wadsworth’s son was calling home in the middle of the night, terrified and disoriented.

Over the next several years, his behavior became increasingly erratic, he had psychotic episodes and he was eventually diagnosed with severe cannabis use disorder. That’s when a person’s marijuana use becomes difficult to control and begins interfering with daily life.

Now 25, Wadsworth’s son has spent much of the past several years cycling through hospitals and treatment programs across the country.

“It’s definitely changed the trajectory of his life,” Wadsworth said. “It did nothing but harm him, literally harm every facet of his life — every facet, physical, mental, everything.”

States have spent the past several decades debating whether to legalize cannabis. Now, they are debating how intoxicating legal products should be.

A growing body of research suggests that frequent use of high-THC cannabis increases the risk of cannabis use disorder, psychosis and other mental health problems for users, particularly adolescents and young adults. In response, lawmakers in some states this year have moved to impose stricter potency caps, while others have scaled back or rejected such measures amid industry opposition and uncertainty over research findings.

While cannabis flower once commonly contained THC levels in the single digits, many products sold legally today contain 15% to 20% THC or more. Concentrates — such as waxes, oils and shatter — can exceed 80%.

About 15% of Americans ages 12 and older reported using marijuana in the past month in 2024, according to the Substance Abuse and Mental Health Services Administration. And about 3 in 10 people who use cannabis have cannabis use disorder, according to the federal Centers for Disease Control and Prevention.

Some public health researchers and addiction specialists argue that public perceptions of marijuana have not kept pace with the growing availability of high potency products. They say broader legalization efforts — including the federal government’s recent move to reclassify medical marijuana as a less restrictive drug under the Controlled Substances Act — may reinforce the belief that cannabis is harmless.

“Moving cannabis from Schedule I to Schedule III doesn’t help me save lives by decreasing the perception of that risk,” said Dr. Alta DeRoo, the chief medical officer of the Hazelden Betty Ford Foundation, one of the largest nonprofit treatment providers for addiction and mental health. DeRoo also is a board-certified addiction medicine physician and OB-GYN.

Some state efforts to impose potency limits have been stalled by resistance from the cannabis industry and questions about how far governments should go in regulating a legal product.

In Connecticut, lawmakers this year reinstated a 35% THC cap on flower just weeks after voting to eliminate it. Lawmakers from both sides of the aisle said they were concerned about the potential public health effects of increasingly potent marijuana products.

At the same time, the legislation moved forward with other cannabis market expansions. Lawmakers removed a 70% THC cap on concentrates, increased the amount of THC allowed in certain cannabis-infused beverages and expanded the market to include products such as topicals, tablets and capsules.

Proposals to cap THC potency have surfaced in statehouses across the country for years. This year, lawmakers in California, Georgia, Mississippi, Oklahoma, Oregon and South Dakota introduced similar measures, though most did not advance.

Georgia Republican Gov. Brian Kemp signed a law in May that removes the state’s previous 5% THC potency cap starting July 1. The new law will also add a 12,000 mg possession limit for registered medical cannabis patients and allow patients over 21 to vaporize medical marijuana.

‘A perennial debate’

Lawmakers across the country have proposed a range of measures aimed at limiting the potency of cannabis products.

In Washington state, Democratic state Rep. Lauren Davis has spent years trying to place guardrails on high-potency cannabis products. Since 2020, she has introduced at least five bills that would have capped THC levels in concentrates or imposed safeguards, including age restrictions, warning labels and a higher tax rate on products with elevated THC levels.

Most of those measures were thwarted by opposition from the cannabis industry, Davis told Stateline.

Industry groups and cannabis businesses argued that Washington’s existing regulations already protected consumers and kept cannabis away from minors. Opponents also warned that limiting high-THC products would drive consumers to the illicit market, hurting legal businesses and exposing users to unregulated, possibly contaminated products.

“(The industry) then went on to basically rain down all fire and brimstone and crush every bill that I’ve ever attempted in this area,” Davis said.

The only proposal to become law was a 2024 measure that requires retailers to warn customers about the association between high-potency THC products and psychotic disorders.

Washington state does not currently impose THC caps on flower or concentrates, but it does set limits on edibles and beverages.

Nearly all states have some form of medical-only or hybrid medical and recreational cannabis program, but just eight states, Connecticut, Mississippi, Montana, Nevada, New Mexico, Oregon, Rhode Island and Vermont, have potency caps on some products, including flower, according to the National Conference of State Legislatures. Potency limits on edibles are far more common.

“This is a perennial debate that comes up in Vermont and elsewhere around higher potency products,” said James Pepper, who chairs the Vermont Cannabis Control Board, the agency that regulates the state’s market.

“I feel like the concerns are certainly real,” he added.

In Oklahoma, a recent incident in which a 4-year-old boy was hospitalized and remained unconscious for more than a day after his parents said he ingested a 1,000 mg edible found at a playground has added to growing debate over high-potency cannabis products in the state.

“We know that some of our medical patients truly do need higher potency products, but do we really need a 2,000 milligram gummy available for anyone with a patient license to purchase in an Oklahoma dispensary?” said Adria Berry, the executive director of the Oklahoma Medical Marijuana Authority, which oversees the state’s medical market.

Oklahoma Republican Gov. Kevin Stitt also signed a measure into law last month that will take effect in November, adding stricter packaging and labeling requirements, including restrictions intended to prevent products from resembling candy or appealing to children.

While some industry experts acknowledge the potential harms, they say the focus should be on consumer education and clear information about potency and effects, rather than new restrictions.

An official with Trulieve, a cannabis company that operates dispensaries in eight states, told Stateline that its products are independently tested and that potency information is available for customers to review and ask questions about, including a product’s effects.

“We believe that that piece of information is critical for a consumer to make an educated decision on what type and what potency of product they are looking to consume,” said Lauren Niehaus, Trulieve’s executive director of government relations.

Some advocacy and trade groups, such as the National Cannabis Industry Association and the National Organization for the Reform of Marijuana Laws (NORML), argue that policymakers should steer consumers into tightly regulated legal markets rather than imposing blanket THC caps that could push some users back to illicit sellers. They say that accurate labeling, child-resistant packaging and public education campaigns are the best strategies to protect public health and prevent youth access.

“It’s undoubtedly safer and better for public health outcomes to regulate these products,” said Adam Rosenberg, who chairs the board of the National Cannabis Industry Association.

Paul Armentano, NORML’s deputy director, said potency caps oversimplify the risks of cannabis products and fail to account for how consumers actually use them. Consumers view ultra-potent products as a novelty, he said, and ultimately gravitate toward lower-potency options.

“When you look at state-tracked sales in legal states, cannabis flower or botanical cannabis still outsells every other product, and I would dare say it’s because that is the most moderate to low potency product available on the shelf, and that’s what most people want,” Armentano said.

Armentano also argued that some of the strongest calls for THC limits come from opponents of legalization, who see potency restrictions as a way to gradually roll back access to legal cannabis.

What the research says

A study published earlier this year in JAMA Health Forum found that adolescents who use cannabis, including products with higher potencies, had a significantly increased risk of developing psychotic and bipolar disorders, along with higher risks of depression and anxiety. The research followed about 463,000 adolescents in Northern California between ages 13 and 17 and tracked outcomes into early adulthood. The study did not, however examine whether the use of higher-potency products is more likely to cause psychotic and bipolar disorders.

But other research has linked frequent use of high-potency cannabis to a greater risk of psychosis and psychotic disorders, particularly among heavy users. Several studies have found a dose-response relationship, meaning the risk tends to rise as THC concentration and frequency of use increase. Experts caution, however, that many studies cannot definitively prove that cannabis causes psychosis and that individual risk varies widely.

Other research suggests the risk of developing psychosis may be higher for adolescents and young adults, whose brains are still developing, as well as people with existing mental health conditions or a family history of psychotic disorders.

“I’ve seen patients come through our facilities where they haven’t done any other drugs other than just high-potency marijuana, and their psychosis is remarkable,” said DeRoo, of the Hazelden Betty Ford Foundation. “They don’t have a grasp of reality. They come in seeing things, they come in believing things, alternate realities.”

John Puls, a psychotherapist and addiction specialist in Florida, has seen similar patterns in his practice at Full Life Comprehensive Care, particularly among adolescents and young adults using high-potency products.

He said families often don’t believe cannabis alone could be driving such dramatic changes. Beyond psychosis, he added, cannabis can chip away at more ordinary parts of life: Motivation drops, executive functioning suffers, patients miss appointments or forget obligations, and short‑term memory and relationships start to fray.

Some medical and industry experts say that cannabis can provide meaningful relief for some people, including those undergoing cancer treatment or who have chronic pain. But there is very little consensus on appropriate medical uses, dosing and long-term effects, particularly as products vary widely in potency.

“If there’s no standardized testing of products, or if there’s no enforcement of potency limits, then we might be putting people at more risk,” said Dr. Smita Das, an adult addiction psychiatrist and a clinical professor at Stanford University School of Medicine.

Stateline reporter Amanda Watford can be reached at awatford@stateline.org.

Carrie Frail was in the process of leaving an abusive relationship when she discovered she was pregnant. Her partner told her he could hit her in the stomach until she had a miscarriage, and it would save some money.

“I firmly believe he would have killed me at some point, whether accidentally or intentionally,” Frail said.

She had a medication abortion at a Planned Parenthood clinic in St. Louis, Missouri, in 2008 while serving in the U.S. Air Force. She was relieved to have the option of using medication instead of a procedure, and it let her take less time off work. It wasn’t an easy decision, she said, but she knew if she hadn’t done it, she never would have been able to get away from that partner.

“I was too wrapped up mentally and emotionally in my life with him that … I needed to be able to leave without giving him a phone number or letting him know where I was,” Frail said. “I still believe that an abortion saved my life.”

Access to telehealth prescriptions of mifepristone, one of two drugs used to terminate a pregnancy in the first trimester or to treat miscarriages, is threatened by an ongoing lawsuit in Louisiana. That state government has sued the U.S. Food and Drug Administration, trying to strike down the agency’s 2023 rule allowing the medication to be dispensed without an in-person visit.

Researchers, advocates and survivors of domestic violence say it’s vital to keep telehealth access available for people in abusive relationships who need discreet abortion options. The Louisiana lawsuit, however, argues in part that mifepristone has been weaponized against pregnant women in abusive relationships and shouldn’t be available by telehealth.

The 5th U.S. Circuit Court of Appeals temporarily blocked the FDA’s 2023 rule in early May, making in-person visits required for mifepristone prescriptions for two days before the U.S. Supreme Court paused that decision on emergency appeal. The court, with the exceptions of Justices Samuel Alito and Clarence Thomas, decided to keep the rule in place while the appeals case proceeds. But the rule could still be struck down again later, and the full case may end up in front of the Supreme Court.

Data from the federal Centers for Disease Control and Prevention’s National Intimate Partner and Sexual Violence Survey from 2023-24 showed about 34% of women and 17% of men experienced physical or sexual violence or stalking by an intimate partner. Those figures could be higher because of hesitance to report incidents of abuse. States with high rates of violence include many with near-total abortion bans, including Arkansas, Indiana, Oklahoma, Tennessee and West Virginia — meaning residents who are victims of reproductive coercion have less access to abortion medication.

Pregnancy is a time of heightened risk in a relationship with domestic abuse, according to research, and intimate partner violence is a leading non-obstetric related cause of death among pregnant and postpartum women. Those risks are highest among Black and Indigenous people in the United States.

Reproductive coercion 

The lawsuit over mifepristone access includes Louisiana resident Rosalie Markezich as a plaintiff, who says the availability of the drug without an in-clinic visit allowed her boyfriend to order the pills in 2023 and pressure her to take them. In her written statement in the case, Markezich said the pressure caused ongoing trauma, and that if she’d had to see a doctor beforehand, she could have told the provider she didn’t want an abortion and the pills would never have been prescribed.

Anti-abortion groups, including Susan B. Anthony Pro-Life America and Family Research Council, submitted amicus briefs to the U.S. Supreme Court about the type of coercion Markezich said she experienced. The telehealth option prevents in-person screenings for coercion, Susan B. Anthony Pro-Life America said, and the in-person requirement provided “a line of defense” against reproductive coercion. Family Research Council also argued that because the FDA’s initial approval of the telehealth provision did not include a thorough study of how it could be used for coercion, it should be struck down.

Liz Tobin-Tyler, professor of health services, policy and practice at the Brown University School of Public Health, said people in abusive relationships very commonly experience what researchers call reproductive coercion. According to the American College of Obstetricians and Gynecologists, that includes situations in which a partner tries to control when and how pregnancy occurs, either by intentionally causing a pregnancy or forcing someone to end it, as with Markezich.

Coercion can also occur when a partner interferes with contraceptive methods, such as trying to force the use of a certain method or intentionally failing to use contraception. Tobin-Tyler said sometimes the abusive partner attends medical appointments to try to influence decisions related to birth control and other medical care discussions.

“It all comes back to that aspect of control,” she said.

Robin Turner, Montana director at gender equity organization Legal Voice, said what happened to Markezich was terrible, but that Louisiana could prosecute Markezich’s partner under existing laws, including harm induced by drugs. She said reinstating the in-person requirement for mifepristone would harm many other people because it would apply nationwide.

“It’s not a reasonable or proportional way to address what happened to the client,” Turner said. “We have to take what happened to the plaintiff seriously — and understand that taking that (access) away is not effective.”

Turner co-authored a brief for Legal Voice submitted to the U.S. Supreme Court during the emergency appeal proceedings that centered on the importance of access to mifepristone for people in relationships marked by domestic violence.

“A lot of what being in these relationships is about is your world getting smaller, and we don’t want our systems to imitate the dynamics of abuse. But that’s what happens when the government takes away the access to the healthcare that they need,” Turner told Stateline.

Safety planning for hotline callers

Kaelah Oberdorf, 24, said she was on birth control when she discovered she was pregnant in 2023 in upstate New York.

She was in an emotionally abusive relationship, struggling financially and still recovering from the postpartum depression she experienced after having her first child when she was 20, despite thinking that she couldn’t get pregnant because of a medical condition. The depression was so severe she had to be hospitalized. She decided that ending the pregnancy was the right thing to do for her mental health and the daughter she already had.

“I didn’t want to be tied to him for life, I didn’t want my daughter, or any of my children, to be tied to him for life,” said Oberdorf, who now lives in Georgia. “I already had a living child who did not need to be kept in that situation, and if I’d had another one, even if I left him, I mentally would not have been able to handle it.”

Research also shows that pregnant and postpartum women in rural areas experience higher rates of intimate partner violence, possibly because they’re farther from in-person medical care, which could contribute to lower rates of preventive screenings for abuse.

Elizabeth Ling, associate director of legal services at nonprofit hotline If/When/How, which offers reproductive legal aid, estimated the hotline receives between five and 10 calls a week from people who talk about experiencing intimate partner violence, whether it’s physical, emotional or some form of coercion. She said callers in rural communities are some of those who need access to medication abortion by telehealth and via mail because they are often the furthest away from a clinic and can’t travel because a partner is actively watching their movements.

If/When/How talks callers through their legal options and counsels them about legal risks, which Ling said is a top concern for people in abusive relationships. It’s common for them to be fearful of their partner reporting them for having an abortion, which can bring unwanted attention from police and investigations even if it doesn’t result in charges.

The hotline also helps people make a safety plan for receiving abortion medication, talking through steps such as where medication will be mailed, who has access to that mailbox and how to navigate a situation with a partner tracking their movements.

“Abortion pills really are a lifeline for those who call and share their experiences with us,” Ling said.

Frail, who still lives in Missouri, now has a daughter and a son who are in their 20s. She has left many voicemail messages recently for Republican U.S. Sens. Josh Hawley and Eric Schmitt, who have advocated for the withdrawal of FDA approval for mifepristone and called for federal investigations into drug manufacturers. In her messages, she says that being able to choose when she had her children made her a better parent.

“I know if I had not had an abortion, I would not have ever been able to get away from that abusive partner,” Frail said.

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

The Society for Maternal-Fetal Medicine published new clinical guidance this week affirming that acetaminophen, better known by its brand Tylenol, should be the “first-line” defense against pain and fever during pregnancy. 

The directive contradicts the Trump administration’s notice to physicians last year cautioning against the use of the primary pain reliever recommended for pregnant women, following the president’s unsupported claims that the medication could lead to autism in children.

The national professional association for maternal-fetal medicine specialists, clinicians and scientists continues to recommend acetaminophen as the “first-line medication” to treat pain and fever during pregnancy. The federal government’s statements prompted the organization to review its 2017 guidance finding acetaminophen safe to use during pregnancy. 

Trump ties autism to Tylenol use in pregnancy despite inconclusive scientific evidence

“Although some studies have reported associations between maternal acetaminophen use and adverse neurodevelopmental outcomes in offspring, methodological limitations preclude conclusions about causality, and the biological mechanism for such an effect remains unestablished,” reads the statement, following a comprehensive review of recent and historical scientific literature. 

The organization’s guidance cautions patients to “use the lowest effective dose of acetaminophen for the shortest duration necessary,” while emphasizing that untreated maternal fever carries well-documented risks to the fetus, especially in the first trimester.

At a news conference last September, President Donald Trump said his administration had found acetaminophen use during pregnancy to be a likely contributing environmental cause of autism. 

Health and Human Services Secretary Robert F. Kennedy Jr. has directed the U.S. Food and Drug Administration to shift its research into autism toward potential environmental causes. 

Even though medical experts and the drug manufacturer have said there is no proven link, the FDA immediately said it would initiate a process for a label change for Tylenol and similar products to “reflect evidence suggesting that the use of acetaminophen by pregnant women may be associated with an increased risk of neurological conditions such as autism and ADHD in children.”

The label has not yet changed. But the September news conference has had consequences.  

A month later, Texas’ Republican Attorney General Ken Paxton, who is running for U.S. Senate, sued Johnson and Johnson, alleging the pharmaceutical company failed to warn pregnant consumers about the risk of taking Tylenol.

And a study in The Lancet published in March found that emergency department orders for acetaminophen for pregnant patients fell 10% in the months following Trump’s statement, while there was no change in the acetaminophen orders for comparable women who were not pregnant.

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

Wisconsin healthcare advocates have been worrying for months that new work requirements for some people on Medicaid that will take effect next year will make it harder for people who are eligible to get on, or stay on, the health insurance program.

Those worries increased this week now that the federal government has issued its rules for states to implement the new requirements.

“More people are going to have a harder time complying with the bureaucracy, and they’re going to get caught up in that,” William Parke-Sutherland, government affairs director at Kids Forward, told the Wisconsin Examiner Tuesday. Kids Forward is a Wisconsin research and advocacy organization for children and families of color and facing barriers to opportunity.

Medicaid — known as BadgerCare in Wisconsin — provides health insurance primarily for people with incomes below the federal poverty guideline: $15,960 for one person and $33,000 for a household of four. Medicaid is regulated and partially funded by the federal government, with the states administering the program and sharing responsibility for its costs.

Work requirements were among changes to Medicaid included in HR 1, the tax and spending megabill that congressional Republicans passed a year ago and President Donald Trump signed July 4, 2025. HR 1’s cuts to Medicaid will total more than $900 billion over 10 years, according to KFF, a health policy research and news nonprofit.

The new Medicaid work requirements apply to people who were added to the program as a result of Medicaid expansion under the Affordable Care Act, the federal health insurance law enacted in 2010.

Under the ACA, states were able to get additional federal funds by expanding Medicaid to cover families with incomes up to 138% of the federal poverty guideline — $45,540 for a family of four.

Wisconsin didn’t adopt the full ACA expansion, however. Instead, under former Gov. Scott Walker, the state extended Medicaid healthcare coverage to childless adults with annual incomes up to $15,960, the  federal poverty guideline.  

About 190,000 childless adults in Wisconsin were covered by BadgerCare in April, according to the state Department of Health Services. Nationally at least two-thirds of people under Medicaid expansion are already working, Parke-Sutherland said. 

Starting in 2027 those additional Medicaid recipients must show they are working or engaged in community service at least 80 hours a month, or enrolled in an education program at least part time. The 2025 tax-cut law provided exemptions for people with disabilities or in frail health, as well as for pregnant women and caregivers for other people with disabilities.

The federal rule that the Centers for Medicare & Medicaid Services issued Monday outlines how states must implement those requirements.

“We have been preparing to implement the requirement for almost a year based on limited verbal guidance we received from CMS as well as information we learned by collaborating with other states and learning from their approaches,” Elizabeth Goodsit, spokesperson for the Department of Health Services, said Wednesday.

DHS has spent months developing policies, procedures and system changes to implement the requirement, Goodsit said. “Our goal is to reduce the administrative burden on current and future Medicaid members to meet the new federal red-tape work requirements.”

Healthcare advocates contend that stringent terms in the newly released federal rule will make it more difficult for people to remain covered by Medicaid, even if they fully qualify.

For example, the rule presents “a much more restrictive definition of ‘medically frail’ than what appears to be in the statute of HR 1, and what people had been hearing from CMS,” Parke-Sutherland said.

Advocates said the rule also makes qualifying for an exemption more complicated for people with disabilities.

“We’re looking at how many people with disabilities aren’t going to be qualifying for an exemption and are at risk for losing their healthcare,” said Tamara Jackson, public policy analyst for the Wisconsin Board for People with Developmental Disabilities.

Unpaid family caregivers are supposed to be exempt, but Jackson said the relevant language in the federal rule “is, I think, really confusing and really difficult for unpaid family caregivers [to navigate].”

Jackson said the state will face “a tremendous amount of problem-solving that has to be done in a very short amount of time.” 

It appears the federal rule doesn’t permit states to automatically declare a person exempt from the work requirement on the basis of a particular illness or diagnosis — such as Parkinson’s Disease, multiple sclerosis, HIV-AIDS or cancer.

Many of those conditions are cyclical, with patients alternating between times when symptoms seem mild and times when they’re deeply debilitating, Parke-Sutherland said.

Patients “[are] going to have to prove that they can’t work in order to qualify” for coverage, he said. “That’s a big change, and it’s going to make it harder for individuals and it’s going to make it harder and more costly for the state.”

In a statement issued earlier this week, Lisa Lacasse, president of the American Cancer Society Action Network, said the new restrictions collide with cancer patients’ essential need for health coverage.

“Knowing 1 in 3 children diagnosed with the disease and 1 in 10 people with a history of cancer currently count on Medicaid for their health insurance, this coverage is a matter of life or death for millions of people nationwide,” Lacasse said.

The restrictions in the new federal rule “link the definition of medical frailty to a person’s ability to work,” Lacasse said. The “debilitating side effects of the disease or treatment” complicate the task of fulfilling a work requirement or proving they can’t work, however.

Many cancer patients want to work between rounds of chemotherapy, she said, but instead, they “will have to choose between losing their Medicaid coverage, working the required 80 hours per month, or giving up working altogether to qualify for an exemption.”

Parke-Sutherland said the work requirements alone are expected to cut Medicaid nationwide by $326 billion over 10 years.

“That will not make people healthier and will not make people more likely to work,” he said. “The only way it reduces costs is because people who are currently eligible are not going to be eligible any more, not able to prove they’re working, not able to prove they have a condition [that makes them exempt], or they’re going to get caught up in the bureaucratic red tape of trying to prove those things.”

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The federal government released new guidance this week on how states should roll out the Medicaid work requirements that will affect  healthcare coverage for millions of Americans.

The new interim rule, issued by the federal Centers for Medicare & Medicaid Services, is intended to give states more details on how they’re supposed to verify the work status for about 20 million adults enrolled in Medicaid, the publicly funded health insurance program for people with low incomes.

The new details come as states are staring down the January 1, 2027, deadline to put the new work requirements in place, and have requested more clarity from the feds on how they’re supposed to implement them.

“States are being asked to carry out a complicated federal mandate without clear rules, without enough time, and with the risk that eligible people lose health care because of paperwork problems and system failures,” Oregon Democratic Gov. Tina Kotek said last week in a statement.

Kotek led a six-state coalition of Democratic governors in asking the Trump administration last week to slow the rollout of the new work requirements, calling the timeline unworkable.

Congress built the new work requirements into last year’s so-called One Big Beautiful Bill Act. Under the measure, states that have expanded Medicaid eligibility to more adults under the Affordable Care Act — 40 states plus the District of Columbia and another two that have partially expanded — will have to require those adults to prove they’re working, going to school or serving their communities for at least 80 hours a month to receive Medicaid.

The rules released this week are intended to clarify key parts of the new law, including exemptions for people who are considered “medically frail,” how to reach out to Medicaid beneficiaries, and methods for verifying Medicaid eligibility.

“This rule helps Americans build skills and independence through work, education, job training, or community service, creating new opportunities for themselves and their families,” said Dr. Mehmet Oz, director for the Centers for Medicare & Medicaid Services, in a statement announcing the new guidance.

But critics of work requirements point to evidence that it kicks people off Medicaid who are otherwise entitled to it without meaningfully increasing the share of adults who are working.

For example, Arkansas tried instituting work requirements for Medicaid recipients during Trump’s first term in 2018. By the time a federal judge halted the policy less than a year later, 18,000 adults had already lost coverage and reported problems paying off medical debt, delaying healthcare and delaying medications due to cost. Studies later found that Arkansas’ work requirements didn’t increase employment. And data shows that most adults on Medicaid under age 65 are already working.

Supporters say the new requirements are flexible. They say the feds have created a broad category of “medically frail” people who are exempt from the work requirements, and they’re permitting states to allow people to self-attest that they’re exempt one time before documentation is required.

The new work requirements will apply to about 20 million people who are eligible for Medicaid through expansion, according to estimates from health research organization KFF. These expansion enrollees make up about 30% of all Medicaid enrollees.

A recent analysis from the Urban Institute projects that 3-7 million people could lose coverage because of the new work requirements.

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

Vaccine hesitancy fed by misinformation is causing new surges of measles and whooping cough, while COVID-19 hotspots persist in some states and a new threat looms from an Ebola outbreak in central Africa.  

Nationally there have been 1,983 measles cases this year, nearly the 2,288 total for all of 2025, which in itself was the worst year since 1991, the federal Centers for Disease Control and Prevention reported Friday.  

Halfway through the year, 12 states and the District of Columbia already have more measles cases than they did for a full year in 2025. That’s true for South Carolina and Utah, where cases are already more than double last year, and also for states such as Florida, which has 139 cases so far compared with eight in 2025, and Virginia, which already has 63 compared with six in all of 2025.  

South Carolina, the state with the highest number of cases this year at 669, declared an end in April to an outbreak that was the nation’s largest in 35 years. The outbreak in the northwestern part of the state was centered in Spartanburg County, where religious exemptions to vaccination have spiked.  

The Utah outbreak, which began in the Short Creek area on the Utah/Arizona border, where vaccination rates are low, has generated 484 cases this year and is now slowing, said Dr. Andrew Pavia, a pediatrician and professor at the University of Utah, speaking at a May 26 briefing for the Infectious Diseases Society of America. 

Dozens of measles patients have been hospitalized with serious symptoms such as brain inflammation or pneumonia, he said, and one baby developed life-threatening congenital measles during pregnancy but survived, he said.

The national increases signal that the U.S. will certainly lose the measles elimination status it gained in 2000, Pavia said, in a determination due this fall. 

“Most state public health departments are stretched very, very thin, limiting their ability to contain measles. Anti-vaccine rhetoric has made this all the more difficult,” Pavia said. He referred to $11 billion in federal funding cuts to local public health last year that were delayed by a restraining order when states sued. The case is in settlement negotiations, according to court records. 

The Trump administration cited a “non-existent pandemic that Americans moved on from years ago” in the funding cuts, but COVID-19 is still causing more than 1,000 deaths a month and wastewater surveillance still shows hotspots in the Appalachian region and some other states, including Michigan.

Whooping cough is also on the rise with Ohio and Florida most affected. Deaths last year were at the highest level, 22, since 2010, according to the latest CDC WONDER provisional statistics.  

“The rising number of deaths from whooping cough, including among infants, is a reminder of the vital importance of vaccination,” said Dr. Joshua Sharfstein, a pediatrician and professor at Johns Hopkins Bloomberg School of Public Health in Baltimore who follows whooping cough trends. 

“Families who follow public health guidance on vaccination and other precautions can avoid a needless tragedy,” Sharfstein said. 

Louisiana was accused of unusual delays in reporting a whooping cough outbreak last year that claimed at least two lives. Shortly after the deaths were reported, the state ended promotion of vaccines and vaccination events. At least three babies died in Kentucky last year along with at least one in Oregon. 

Unvaccinated people are like fuel for the wildfire of disease outbreaks, said Pavia, of the University of Utah, in his remarks. 

“Until we can restore faith in vaccines and restore funding for our public health agencies and increase measles vaccine coverage, we have to anticipate that there will be many more outbreaks, and some of these may blow up into very large conflagrations,” Pavia said.

Meanwhile the Trump administration announced a new quarantine center in Kenya opening Friday, May 29, for Americans exposed to the Ebola virus in the Democratic Republic of the Congo. The move was criticized by the Infectious Diseases Society of America in a statement, saying the decision to send exposed Americans to Kenya “raises serious questions about resources, timing and the level of care Americans sent there will receive.”

On Ebola, a May 22 CDC directive prohibited United States entry of non-citizens who had been in the Democratic Republic of the Congo, or nearby Uganda or South Sudan, in the previous 21 days. The disease has killed 224 people in that region, and there are more than 900 suspected cases. 

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.

The U.S. Department of Justice’s recent decision to downgrade the drug classification for medical cannabis will help medical marijuana businesses. Companies will be able to claim some federal tax benefits. New research can start up at state universities.

But the broader divide between federal and state marijuana policy remains largely intact, leaving states to navigate a fragmented and still-evolving cannabis landscape with few clear answers about what comes next.

The unprecedented change in April reclassifying medical marijuana from Schedule I to Schedule III means the federal government is acknowledging an accepted healthcare use for cannabis. Recreational marijuana, however, remains a Schedule I drug under federal policy, even though 24 states and the District of Columbia allow recreational cannabis in various forms, from dried flower to vaping oils to processed gummy candies.

The U.S. Drug Enforcement Administration is set to hold its first hearing at the end of June on the possible de-scheduling of marijuana broadly, which would include recreational or adult-use cannabis.

Until then, some experts say little is expected to change for the more than half of states with medical or recreational marijuana programs.

“This change is sort of catching up to what states are already doing,” said Katharine Neill Harris, a drug policy fellow at Rice University’s Baker Institute for Public Policy. “In some ways the federal government is following the states on this issue.”

States have spent years building regulatory frameworks for medical and recreational marijuana programs — including licensing systems, tax structures, testing requirements and retail oversight.

Following the DEA’s announcement in April that it would reschedule medical cannabis, some state commissions acknowledged the decision but stressed that their laws have not changed and that they are awaiting further federal guidance.

In Nevada, for example, state cannabis officials released a statement noting that the rescheduling change allows medical cannabis licensees to register with the DEA, while also emphasizing that Nevada law still classifies non-medical marijuana as a Schedule I substance.

In mid-May, the California Department of Cannabis Control proposed emergency regulations that would allow businesses holding licenses for both medical and recreational marijuana to obtain separate licenses. The change could position cannabis businesses to take advantage of potential benefits tied to the rescheduling of medical marijuana.

Many of the day-to-day functions of state cannabis programs are expected to remain intact, according to experts.

“Right now, nothing would have to change for states because we don’t know what the federal regulations are going to look like for managing medical cannabis,” said Heather Trela, the director of operations and a fellow at the Rockefeller Institute of Government, a nonpartisan public policy think tank.

“Everyone’s kind of figuring it out right now, and we don’t have all the details, so it’s hard for states,” she said.

State cannabis regulators and officials in several states, including Oklahoma, Vermont and Washington, told Stateline they are waiting for guidance from the DEA and other federal agencies before determining whether businesses will be required to register with the DEA, qualify for federal tax relief or face new compliance requirements, and whether states may need to revise their own cannabis laws.

“None of us really can effectively advise our licensees, which is just incredibly frustrating, especially with a ticking clock,” said James Pepper, the chair of the Vermont Cannabis Control Board, which regulates the state’s medical and adult-use market.

In the coming months, other federal agencies may issue guidance on how rescheduling will affect existing rules, according to policy experts. The U.S. Department of Transportation said in December that drug testing and licensing standards will not change, and TSA rules still prohibit carrying marijuana on flights. Financial guidance from the IRS and the Treasury Department also are still pending.

‘Taxed like a normal business’

But some marijuana policy experts and industry leaders say the federal shift could bring major changes to cannabis business operations and scientific research.

Cannabis businesses have long been blocked from taking certain federal tax deductions because marijuana was classified as a Schedule I substance. Some industry leaders say moving medical cannabis to Schedule III could ease some of those constraints.

“Going forward, we can be treated and taxed like a normal business, which ultimately helps the bottom line and allows us to reinvest more meaningfully in the states where we operate,” said Lauren Niehaus, the executive director of government relations at Trulieve Cannabis Corp., one of the largest cannabis companies in the country. Trulieve, based in Florida, operates dispensaries in eight states.

The tax policy change is a central issue for cannabis operators across the board, from small businesses to large multistate companies, Niehaus said.

Ryan Hunter, the chief revenue officer of Spherex Labs, said rescheduling changes could shift investor and lender attitudes toward the cannabis industry, with some capital partners becoming more willing to invest.

But Hunter said the latest federal change also creates new uncertainty for companies operating in both medical and recreational markets, including Spherex Labs, which operates in Colorado.

“Our business is still very much in wait-and-see mode,” Hunter said. “There are a lot of positive gains here, but really more than anything, a lot more confusion.”

The federal government has effectively created different legal frameworks for the same substance, he added. Medical cannabis is now federally recognized, while recreational marijuana and its consumers remain in conflict with federal law.

The rescheduling change also carries federal registration requirements under the Controlled Substances Act, a law that would require medical cannabis businesses to register with the DEA, pay annual fees, and comply with detailed reporting, inventory and security rules that may overlap or conflict with existing state systems.

Spherex Labs has chosen not to register at this time, Hunter said, opting to wait for further federal guidance.

Earlier this month, the Oklahoma Bureau of Narcotics and Dangerous Drugs Control sent a letter to licensed medical cannabis businesses encouraging them to register with the DEA and warning of possible sanctions, including revocation of their state licenses, for failing to comply with federal requirements.

But the Oklahoma Medical Marijuana Authority, which oversees cannabis licensing and regulation in the state, told Stateline the letter came as a surprise and that it remains unclear whether federal officials actually intend to require DEA registration for medical operators.

Other states could adopt similar federal registration requirements, according to Trela, of the Rockefeller Institute of Government.

Cannabis research

Some researchers and experts say rescheduling marijuana could reduce longstanding barriers to studying its medical use, safety and long-term health effects.

Current research on marijuana’s effects falls short of what is needed to fully understand cannabis as a medical treatment, according to Chad Johnson, an assistant professor of pharmaceutical sciences at the University of Maryland School of Pharmacy. Johnson also is the director of the university’s medical cannabis graduate studies program.

“We really do need those randomized trials to really say that cannabis is effective for treating a particular condition,” Johnson said.

There are still major gaps in cannabis research, he said, including how it is formulated and delivered, such as whether methods beyond smoking, vaping or edibles may be more effective, and how to determine appropriate dosing for specific medical conditions.

Johnson added that rescheduling could allow academic institutions to study products already being sold in their respective states, making research more closely aligned with what consumers are actually using, rather than relying on cannabis sourced through federally authorized suppliers.

Some public health and addiction experts say the federal shift should not be interpreted as a signal that cannabis is risk-free, pointing to ongoing concerns about cannabis use disorders, dependency and effects on mental health.

“It’s going to reduce the public’s perception of risk of cannabis, and right now, I don’t think the public is aware of the high potency that cannabis has,” said Dr. Alta DeRoo, the chief medical officer of the Hazelden Betty Ford Foundation, one of the largest nonprofit treatment providers for addiction and mental health. DeRoo also is a board-certified addiction medicine physician and OB-GYN.

Some opponents of the change also argue it is driven as much by political and economic pressure from the cannabis industry as by evolving science.

“The issue is not research. The issue is money, tax breaks for an industry, and that’s really what the whole effort to relax marijuana laws is about,” said Kevin Sabet, a former drug policy adviser to three presidential administrations and the president and CEO of Smart Approaches to Marijuana, a nonprofit that opposes legalizing marijuana.

What’s next

New federal changes also could face court challenges or be reversed by a future administration, according to some cannabis policy experts.

Last week, the attorneys general of Indiana, Louisiana and Nebraska filed a petition for review in the U.S. Court of Appeals for the District of Columbia Circuit, arguing that the Justice Department’s rescheduling order violates federal administrative law. Louisiana and Nebraska have medical-only cannabis programs, while Indiana does not have a cannabis program at all.

Smart Approaches to Marijuana and the National Drug and Alcohol Screening Association filed a similar lawsuit earlier this month, arguing that the administration exceeded its authority under the Controlled Substances Act.

At the same time, the White House’s latest National Drug Control Strategy document also raised concerns about high-potency marijuana and warned that international cartels and organized crime groups continue to exploit state cannabis legalization laws.

Aside from criminal justice implications, federal restrictions have limited cannabis businesses’ access to banking, investment and long-term planning, even as state markets have expanded into a multibillion-dollar industry.

Banks have largely avoided working with cannabis businesses because marijuana remains broadly illegal under federal law, which exposes financial institutions to potential regulatory penalties and compliance risks even in states where cannabis is legal.

Several bills have been introduced in Congress that would provide protections for banks offering services to cannabis businesses, but no legislation has been adopted.

Stateline reporter Amanda Watford can be reached at awatford@stateline.org.

In the 2024 election, Republican messaging that marginalized transgender Americans and attacked Democrats got widespread attention.

Opinion is divided among political analysts about whether anti-trans messaging contributed to Democratic presidential candidate Kamala Harris’s narrow loss — about 29,000 votes in Wisconsin and about a 1.5% margin nationwide — or was irrelevant. 

A 2023 Marquette University Law School poll found that a majority of respondents favored protecting trans people against workplace discrimination, but 70% also believed athletes should be required to play sports on teams that match the sex they were assigned at birth. 

But whether or not the strategy helped seal Donald Trump’s victory two years ago, Republican candidates in Wisconsin have been leaning into messaging that targets transgender and nonbinary people.

Sen. Melissa Ratcliff (D-Cottage Grove), whose adult son is transgender, sees little reason to “rehash” the 2024 election. “I think it’s always important to make sure that we are advocating for our trans community and for kids and speaking out against hate,” she said. “I think the bigger concern is why a party feels the need to attack our trans kids and use that as an issue to rile up part of their base ultimately.”

Transgender individuals account for less than 1% of the adult Wisconsin population, about 36,000 people, and 3.3% of teenagers between the ages of 13 and 17, fewer than 13,000 people — or 180 per county. The Williams Institute at the University of California Los Angeles Law School calculated those estimates based on survey data the Centers for Disease Control and Prevention (CDC) collected between 2021 and 2023.

The Republican majority in the state Legislature has passed bills that would bar gender-affirming care for young people and ban kids from playing on sports teams that didn’t match the gender they were assigned at birth or their biological sex. Gov. Tony Evers has repeatedly vetoed those measures.

“We’ve seen this in the Legislature, that by somehow going after children and bullying them is something that they see as a winning issue,” Ratcliff said. “It just doesn’t make any sense to me. And that grown adults think it’s OK to bully kids is just gross.”

Meanwhile, with Trump’s inauguration to a second term, federal policy has turned against transgender people and also against a more expansive understanding of gender.

During the Wisconsin Republican convention in Wisconsin Dells on May 16, speakers attacked the transgender population, particularly youth, sounding the alarm about the possibility of trans girls playing high school sports, mocking the use of inclusive language and promoting the  policing of bathrooms. 

Republican nominee for governor Tom Tiffany opened his speech by asking the delegates, “Are you ready for a governor that’s going to protect girls’ sports?”

Sen. Ron Johnson inveighed against “Biological males competing against our little girls in sports. Biological males invading their locker rooms, their showers, their bathrooms.” He as well as former Gov. Scott Walker falsely claimed that minors identified as transgender can be subjected to surgical procedures.

And a May 19 press release by Republican press secretary Zach Bannon falsely claimed that more than 90 lawmakers were “emphasizing their support of sex-change surgeries for minors” in an open letter to two leading Wisconsin hospital systems.

The false claim was repeated three times in the press release, which attacked Democrats in Wisconsin’s 3rd Congressional District who are running in the party’s primary to challenge Republican U.S. Rep. Derrick Van Orden. 

The letter called on the healthcare providers, Children’s Wisconsin in Wauwatosa and UW Health in Madison, to resume gender-affirming care for minors, which both suspended early this year following threats to federal medical dollars from the Trump administration.

That form of care does not include surgery, however. A Children’s Wisconsin spokesperson said medical treatment prior to the suspension of care involved medication, and that Children’s still provides mental health and behavioral care. 

“UW Health does not offer gender-affirming surgery to minors,” said Sara Benzel, a spokesperson for the Madison-based system.

Abigail Swetz, executive director of Fair Wisconsin, a statewide LGBTQ+ advocacy group, said that for the youngest children who have been diagnosed with gender dysphoria — a deep-seated sense that their gender identity doesn’t match their biological sex — the first step is extensive counseling with a therapist.

Gender-affirming care “is also age-appropriate, and this is the part that I think people miss all the time,” Swetz said in a recent interview.  “There are no medical interventions until puberty for gender-affirming care.”

Interventions at puberty can involve medication but not surgery, Swetz said. Those can include hormone treatment to delay puberty and to redirect the body’s development.

“But that is all age-appropriate, and highly individualized, just like all good medical care is with the doctor,” Swetz said. “And always with full consent of parents and guardians. When we are talking about gender-affirming care for trans youth, that’s what we’re talking about. Not what the other side would like to pretend.”

Bannon did not respond to a Wisconsin Examiner email message seeking an explanation for the false statements in his press release.

A federal judge in April blocked the Trump administration from cutting off federal funds to hospitals that provide gender-affirming care. The judge’s order said the Department of Health and Human Services lacked the authority to override professional standards of care or to deny funding to healthcare providers following those standards.

Since then some health providers in other states, including Children’s Minnesota hospital, have resumed providing gender-affirming care for minors.

Both UW Health and Children’s Wisconsin said they sympathized with patients who had been undergoing that care and their families, but that they believe they would remain in legal jeopardy if they resume care involving medication.

Ratcliff said that as someone whose family has gone through the experience of addressing the needs of a transgender child, it was important to her “to make sure that all trans kids and the trans community know that there are people in the Capitol that care about our trans community, that see them, that are fighting for them, and that we can push back again and fight back against all the hateful rhetoric toward our trans community.”

She said she believes Republicans are ramping up  attacks on trans people as a deflection from the economic squeeze voters are feeling.

“We know that everyday costs are going up and they aren’t putting forward policies that actually help everyday lives of Americans or Wisconsinites,” Ratcliff said. “My child being trans is not causing these prices to go up. My child’s healthcare is not causing any difference in people’s lives except for my child’s life.”

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Five Wisconsinites have been reported infected with mpox this year, and state health officials are recommending that people who might be at risk for the illness get vaccinated.

Mpox — previously known as monkeypox — is a viral illness that produces a rash, skin lesions, and fevers, aches or chills.

The virus isn’t common but can be serious, and is spread through intimate, face-to-face contact that includes talking or breathing closely, or through sustained skin-to-skin contact, according to the Wisconsin Department of Health Services. It can also be spread through items that have been contaminated with fluids or sores from someone with mpox.

Since 2022 mpox has been circulating in the U.S. at low levels, according to DHS. For 2026, through May 26, 535 cases of mpox have been confirmed in the U.S, including the five people diagnosed in Wisconsin.  

The risk is low for the general public, DHS reported, but people who may be at higher risk for exposure to mpox should talk to healthcare providers about vaccination. DHS has recommended the mpox vaccine for higher risk people, including men who have had sex with men and who have had more than one sex partner in the last six months. 

Travel and sexual exposure elsewhere in the world are other risk factors, according to DHS. People who are in close contact with someone with mpox, including healthcare workers who are exposed, also are at higher risk.

To prevent mpox infection, DHS has recommended that people learn the symptoms of mpox, watch their own and their partners’ bodies for changes such as rashes or skin lesions, and have “open and honest conversations” with partners about mpox as well as about sexually transmitted infections and HIV, the virus responsible for Acquired Immunodeficiency Syndrome, or AIDS.

“Anyone who thinks they were recently exposed to mpox should contact a health care provider to talk about whether they should get vaccinated,” DHS said in an announcement. “Monitor health for fever, chills, swollen lymph nodes and new, unexplained rashes and contact a health care provider if one occurs. People who become ill should avoid contact with others until receiving health care.”

More information on the virus can be found at the DHS web page for mpox or by contacting https://211wisconsin.communityos.org/.

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More than 800 nurses at a Madison hospital owned by a national nonprofit group will vote in the coming weeks on whether to join a union.

The organizing campaign at St. Mary’s Hospital is one of the largest in recent memory in Wisconsin.

In a statement earlier this month, a spokesperson said the hospital’s parent organization, SSM Health, “respects the right of its employees” to freely choose union representation. Nurses and the Service Employees International Union say the hospital’s management has responded with stiff opposition.

Union supporters are planning a rally Thursday afternoon in front of the hospital, with U.S. Rep. Mark Pocan (D-Black Earth) among the featured speakers.

“There’s a national crisis facing both our healthcare system and the nursing workforce,” Pocan said in a statement issued Tuesday announcing the event. “St. Mary’s nurses are trying to address this crisis right here in our community by having a strong voice for better staffing and retention. SSM should respect their freedom to vote in a fair union election without any pressure campaign.”

The union election, supervised by the National Labor Relations Board, will be the largest such vote in recent memory in Wisconsin. A date for the election hasn’t yet been set, but it could be announced as early as this week.

It comes amid a rising interest in unions among healthcare workers — one that coincides with the growth of increasingly concentrated multistate healthcare networks, including nonprofit organizations.

“We’re seeing more union elections, we’re seeing more petitions for recognition of unions as well,” said Dr. Ahmed Ahmed, a research fellow at Brigham and Women’s Hospital in Boston and Harvard Medical School, in a panel discussion earlier this month conducted by Wisconsin Health News.

With mergers and consolidations, hospitals and health systems have grown larger and larger. Labor costs are their biggest expense, and in trying to trim those costs, they’re increasing caseloads and reducing the time patients have with their providers, Ahmed said. Healthcare workers are turning to unions in search of “one collective voice that is able to govern and be able to bargain for those things.”

Centralized decision-making

Supporters of the St. Mary’s union campaign say that concentration is one of the reasons they’re organizing. Centralized decision-making at the Missouri headquarters of the parent organization have felt to some like a corporate takeover.

“There have been a lot more directives from corporate headquarters in St. Louis,” said Josh Taylor, a nurse in the hospital’s inpatient behavioral health unit.

St. Mary’s was one of several hospitals and healthcare facilities established by nuns from Europe and sponsored by Roman Catholic congregations in the 19th century. The facilities were only loosely connected until 1986 when the corporate structure changed with the creation of SSM Health, according to the SSM Health website.

SSM Health had been sponsored by the Franciscan Sisters of Mary until 2013, when sponsorship shifted to a new corporate entity, SSM Health Ministries, while remaining part of the Roman Catholic church.

SSM Health is headquartered in St. Louis and operates in four states — Wisconsin, Illinois, Missouri and Oklahoma — where it runs 24 hospitals and more than 540 other facilities, including doctor’s offices, outpatient services, home care and hospice programs.

According to SSM’s annual financial statements, SSM Health had $12.7 billion in revenues in 2025 and ended the year with a balance of $484 million in net revenue over expenses.

In 2014 SSM Health began applying its name to all of the healthcare facilities in its network.  It also consolidated its business operations including human resources, finance, strategy and planning and marketing and communications.

With those changes, nurses who are supporting unionizing say that decision-making on day-to-day policies and practices has moved farther away.

“We watched our personalized policies for our hospital disappear,” said Lynette Willsey-Schmidt, a labor and delivery nurse who has worked at St. Mary’s for more than 11 years.

Employee councils called ineffective

Willsey-Schmidt said labor and delivery nurses along with the doctors in the department had developed a series of practices to reduce intervention during births where risks and complications were lower. Those practices were welcomed by patients, she said.

But as SSM Health took charge of policymaking, “we were told we can’t do that anymore,” Willsey-Schmidt said, because those policies didn’t exist elsewhere in the SSM Health system.

Taylor said that while employee councils are supposed to relay feedback from the floor to upper management, they haven’t been effective.

“I’ve been on the unit councils,” he said. “We have tried the normal routes to bring our concerns to the table. We are heard, but nothing is acted on.”

When employees have raised concerns, “We’re told, ‘This is how it is. This is how all the hospitals have to do it,’” Taylor said.

Morgan Espich, an inpatient medical and surgical nurse, said the hospital recently purchased and began requiring nurses to use a new brand of intravenous pumps, different from what they had been using. She and her coworkers had been happy with the previous models, Espich said, and no one explained the reason for the change. “We just had to get new ones that no one asked for,” she recalled.

In addition, the hospital staff has to keep some of the older IV pumps on hand, said Carrie Schrank, an intermediate care trauma nurse, to substitute for the new pumps when they malfunction.

Nurses contend staffing levels have left employees straining to cover all their responsibilities, while nurses have been told to improve productivity.

“Productivity should be about patients’ outcomes,” Willsey-Schmidt said.

Consultants who visited earlier this year recommended ways to reduce staffing, but Schrank said their recommendations didn’t address how acutely ill some patients are.

“The days we’re busy, we go home and wonder, did I do enough?” Espich said.

Hospital stance — respect or intimidation?

SSM Health released a statement earlier this month in response to the Wisconsin Examiner’s submission of specific questions about the union campaign as well as a request for an interview.

“At SSM Health, we work hard to cultivate a supportive and collaborative work environment where every employee is treated with respect and compassion,” said the statement, delivered by Kim Sveum, SSM Health regional director of communications.

“We value our high-quality patient-centered care and place of healing.  We strive to ensure that our team thrives so that they can do their best work in realizing our Mission to provide exceptional patient care.”

The statement concluded, “SSM Health respects the right of its employees to make a free and informed choice as to whether or not they wish to be represented by a union.”

Union organizers say that there have been extensive messages posted on employee bulletin boards disparaging unions and the SEIU and emphasizing employees’ right to decline to sign a union authorization card.

“They have been constantly intimidating staff,” Schrank said.

Employees typically attach their work badges to a retractable line coiled up in a holder called a badge reel that can be clipped to a lapel or pocket. When they made their campaign public, pro-union nurses began using a customized badge reel with an emblem, “St. Mary’s Nurses United.”

Supervisors have ordered employees to remove those badge reels. Espich and other nurses said they have been told that “this is soliciting” against hospital policy, and that nurses who don’t remove the badge reel would be sent home without pay for the day.

“With this union-busting, though, we’re all fired up even more,” Espich said.

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I was delighted to read Wisconsin Watch’s article “Parkour for Seniors? Classes help older Wisconsinites build strength, community — and prevent deadly falls.” At a time when older Americans are facing a serious falls epidemic, we must promote fun ways to build fitness, prevent injury and maintain independence.

According to the U.S. Centers for Disease Control and the Wisconsin Department of Health Services, Wisconsin has the highest rate of deaths from falls in the country. The number of falls that emergency medical services respond to is rapidly growing each year, resulting in 55,000 emergency department visits in 2024 alone. This is bad for older adults who get hurt, first responders and health care providers who are stretched thin and taxpayers who shoulder the burden of hospitalizations and lengthy recoveries.

Unfortunately, many older adults are not getting the preventative care they need to maintain their balance and health. That needs to change. 

The Stopping Addiction and Falls for the Elderly (SAFE) Act, sponsored by U.S. Rep. Carol Miller and U.S. Sen. Jim Justice, both West Virginia Republicans, would address this crisis by allowing Medicare beneficiaries to receive a no-cost falls risk assessment from a physical or occupational therapist as part of their annual wellness visit. 

A growing number of bipartisan co-sponsors — including Democratic Rep. Mark Pocan of Wisconsin — supports this legislation. I urge all of Wisconsin’s congressional delegation to do the same.

Kevin Svoboda is a physical therapist in Greendale and a member of the Alliance for Physical Therapy Quality and Innovation.

Guest opinion: How Congress can reduce deadly falls among older Americans 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.

Budget constraints are forcing liberal-leaning states that spend their own money on healthcare for noncitizens to scale back that aid, as they grapple with federal Medicaid cuts and the expiration of federal subsidies that helped people buy Obamacare plans.

Under federal law, immigrants who are in the country illegally are not eligible for federally funded health coverage.

But as of last month, six states — California, Colorado, Illinois, New York, Oregon and Washington — plus the District of Columbia were spending state dollars to cover some income-eligible noncitizen adults regardless of their immigration status. A total of 14 states plus the district provide state-funded coverage to noncitizen children whether they are here legally or not. And three states — Colorado, New Jersey and Vermont — cover pregnant women regardless of their immigration status.

In addition, 40 states have taken up options in Medicaid and the Children’s Health Insurance Program, known as CHIP, to provide coverage to lawfully present children and/or pregnant women who are not citizens.

But the sweeping tax and spending bill President Donald Trump signed into law last summer cuts federal spending on Medicaid, the joint federal-state health insurance program for low-income people. It also places new eligibility restrictions on lawfully present immigrants, including refugees and asylees, who are enrolled in a variety of government-subsidized health programs, including Medicaid, CHIP, Medicare and plans available on the insurance marketplaces created under the Affordable Care Act, better known as Obamacare.

And Congress at the end of last year failed to renew federal subsidies that helped people buy Obamacare plans.

With less federal money to provide health benefits, at least five states (California, Colorado, Illinois, Minnesota and Washington) plus the District of Columbia have already scaled back or announced plans to scale back state-funded health benefits for immigrants. Other states also may have to pull back as budget pressures continue.

“The federal government shifted much more of the financial burden of providing those services to states. And so states are taking a holistic view at their healthcare budgets and trying to figure out where they can cut,” said Medha Makhlouf, a law professor and the founding director of the Medical-Legal Partnership Clinic at Penn State Dickinson Law, who studies immigrants’ access to healthcare.

“Historically and currently, as we’re seeing, immigrants are going to be the first to be cut, for a variety of reasons. They don’t have political power in the same way citizens do.”

Drishti Pillai, director of immigrant health policy at KFF, a health policy research group, warned that the state cuts, combined with the federal changes, “will likely increase uninsured rates and reduce access to care among immigrants and their children, most of whom are U.S. citizens.

“Over the long-term, these changes could lead to worse health outcomes that could be more complex and expensive to treat,” Pillai said.

But Cooper Smith, director of homeland security and immigration at the America First Policy Institute, a conservative think tank that has worked on policy development with the current Trump administration, said that when budgets tighten, policymakers should prioritize U.S. citizens.

“Taxpayers pay into a system,” Smith said. “I think it’s reasonable to expect that those who have paid into the system should be the primary beneficiaries of public benefit.”

California has traditionally provided some of the most generous benefits. But last June, Democratic Gov. Gavin Newsom signed a state budget that barred immigrants who are here illegally from newly enrolling in the state’s Medicaid program, known as Medi-Cal. In addition, current enrollees between the ages of 19 and 59 will have to pay a new $30 monthly premium beginning in July 2027. And this July, the state will eliminate dental care for noncitizens.

Newsom’s budget plan for next year proposes scaling back Medi-Cal coverage for some immigrants living in the country lawfully, including an estimated 200,000 asylees, refugees, and others with certain immigration statuses.

California Democratic state Sen. María Elena Durazo is pushing legislation this session that would undo the enrollment freeze and restore access to full-scope Medi-Cal coverage for adults living in the U.S. illegally.

“California immigrants are not going to go away,” Durazo said. “We need them. They’re agricultural workers, they’re food workers, they’re construction workers.

“Are we going to not provide the minimal basic healthcare coverage and think that somehow it’s not going to come back to haunt us through emergency rooms and other counties and public hospitals?”

Hannah Orbach-Mandel, a policy analyst at the nonprofit California Budget and Policy Center, said the state should find alternatives to the cuts, such as raising corporate taxes. She said scaling back coverage puts immigrants “in a really vulnerable position that ultimately can result in people dying.”

Colorado made a similar choice.

Using state money, Colorado’s SilverEnhanced Savings program allows immigrants who are here illegally to buy Obamacare plans with zero premiums. But budget constraints prompted the state to lower the enrollment cap for the program to 6,700 from 12,000.

Now the state is poised to downsize another program. Last year, the state launched Cover All Coloradans to provide state-funded health coverage for low-income children and pregnant women who would be eligible for CHIP or Medicaid if not for their immigration status. But a bill the legislature sent last month to Democratic Gov. Jared Polis would scale back some of the benefits available under the program and cap enrollment to help close a roughly $1 billion state budget gap driven in part by ballooning Medicaid costs.

When the law creating the program was enacted in 2022, financial analysts estimated it would cost $14.7 million this fiscal year and cover almost 3,700 children and pregnant women. Instead, the program ended up serving almost 28,000 people at an estimated cost of $104.5 million.

Colorado Republican state Rep. Rick Taggart, a member of the Joint Budget Committee, called the changes to the program “a painful compromise.”

“It’s impossible to separate the human side from the financial side in this area,” Taggart said in a phone interview. “We are talking about children, and we’re talking about pregnant women, and they have very real needs … the children, in most cases, didn’t have anything to do with the decision about immigrating to the U.S. and to Colorado.”

But other Colorado lawmakers said providing services to children who are here illegally ends up depriving the children of legal residents.

“When we come up here compassionately talking about kids, let’s talk about all the kids in our state,” Republican state Rep. Brandi Bradley said during debate on the House floor last month. “There’s plenty of kids whose parents are working a ton of jobs to just keep up with inflation and the price of groceries in the state, while we continue to grow programs like this.”

According to a 2001 court ruling, the New York Constitution bars the state from distinguishing between citizens and legal immigrants in providing Medicaid. Legal immigrants include people who have temporary and humanitarian status or might be here under the Deferred Action for Childhood Arrivals program, known as DACA, and would be income-eligible for Medicaid.

But even New York has had to make changes. Because of federal funding cuts, the state says, it is narrowing the income eligibility rules for its state-run Essential Plan, which provides zero-premium coverage for people who are here legally but do not qualify for Medicaid.

Beginning in July, the program will no longer cover households making between 200% and 250% of the federal poverty level. The change will end coverage for an estimated 450,000 New Yorkers.

“Our priority continues to be protecting coverage for as many New Yorkers as possible and ensuring people have information and assistance during this transition,” said Danielle De Souza, a spokesperson for the New York State Department of Health.

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

A group of more than 60 nonprofits, advocacy organizations and businesses wrote to two Wisconsin health systems Thursday, urging them to resume gender-affirming care for minors that they halted five months ago.

The hospital organizations — UW Health in Madison and Children’s Wisconsin in Wauwatosa — stopped providing hormone medication and puberty-blocking medication to minors with gender dysphoria following Trump administration actions targeting such healthcare.

Thursday’s letter, led by the LGBTQ+ rights groups Fair Wisconsin and GSAFE, cites a federal judge’s ruling in April that threw out the administration’s order blocking gender-affirming care.

“Gender-affirming care is legal in Wisconsin, but it is increasingly more and more difficult to access due to decisions made to pause the provision of this care at your institutions,” states the letter. “These decisions must be reversed and care restarted immediately.”

Thursday’s letter was the second this week to UW Health and Children’s Wisconsin. On Tuesday, more than 90 elected officials from around the state released a letter urging both hospitals to restore the suspended services, “reaffirm [their] commitment to evidence-based care, and rebuild trust with the transgender and gender diverse community.”

“The most important thing for people to understand is that the support for this care is so much broader and deeper than people realize,” Abigail Swetz, executive director of Fair Wisconsin, told the Wisconsin Examiner Thursday. “I hope the leadership of these hospitals are seeing that in this letter and the others that are coming through.”

She said local groups, Madison TRAC and Reproductive Justice Action Milwaukee, are organizing petitions in their communities as well for the general public to sign.

Both hospitals released statements Thursday that acknowledged the concerns of families and their children seeking gender-affirming healthcare, but cited legal risks of providing such care.

“We know this issue matters deeply to many in our community, especially the patients and families we serve,” Children’s Wisconsin said.

“Due to ongoing legal and regulatory uncertainty affecting organizations and providers across the country, we are not currently providing gender-affirming pharmacologic care,” it said. “We recognize the impact this has on patients and families.”

Children’s said it continued to provide related mental and behavioral healthcare.

UW Health said it paused gender-affirming medication therapy for minors “due to ongoing federal actions that threaten health systems that provide this care.”

“While we continue to believe this is evidence-based care, threats from those federal actions are not fully resolved,” UW Health said. “Therefore, the current risk is too great to resume this care. We recognize the challenges faced by impacted patients and families and remain committed to providing patient-centered care and supporting their health and well-being throughout this critical time.”

Gender-affirming care is a response to gender dysphoria, which the American Psychiatric Association has defined as  “psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity.”

Based on survey data collected by the federal Centers for Disease Control and Prevention between 2021 and 2023, the Williams Institute at the University of California at Los Angeles Law School estimated in an August 2025 report that 3% of adolescents ages 13 to 17 and 1% of adults 18 or older identify as transgender or nonbinary.

Swetz said that when health professionals provide gender-affirming healthcare, they do so because it is medically necessary.

“I think it is sometimes seen as something that is not essential, but it absolutely is medically necessary, because we know that when gender dysphoria is treated then the mental health of our trans youth just drastically improves,” she said.

Gender-affirming care is also provided based on what is appropriate for the person’s age, “and always, with the full consent of parents and guardians,” Swetz said.

For a child who hasn’t yet reached puberty, it entails counseling and other forms of behavioral therapy — not medication, she said. At the start of puberty, medication may be used to pause that process, along with hormone treatment, but it’s also “highly individualized,” she added.

“We’re talking about high quality care that is respectful and meets a trans youth exactly where they’re at, in the age appropriateness of the kind of care that will help move them forward in their lives and make it possible for them to live in a body that really feels like home,” Swetz said.

The two hospitals paused their use of gender-affirming care medication after a Dec. 18, 2025 declaration from Health and Human Services Secretary Robert F. Kennedy Jr. that threatened to withhold federal health dollars, such as Medicaid reimbursement, from providers offering gender-affirming healthcare for minors.

Wisconsin was one of 21 states and the District of Columbia that sued to block the federal rule. In late March, a federal judge in Oregon ruled for the states on summary judgment, and in April issued a written order that vacated Kennedy’s declaration.

The judge ruled that the declaration violated the Administrative Procedures Act; that Kennedy and HHS officials lacked the authority to override professional standards for gender-affirming care; and lacked the authority to exclude providers from federal programs for providing gender-affirming care that meets professional standards.

The order also includes an injunction forbidding “any materially similar policy which supersedes or purports to supersede the professionally recognized standards of care for gender-affirming care that exist” in the 21 states and D.C. that filed the lawsuit.

“They’re trying to make sure that the federal government can’t go around and just, like, do something in another name,” Swetz said. “And I think it’s important for people to know that Wisconsin specifically is one of the states.”

This report was updated to correct the organizers of local petitions in Madison and Milwaukee.

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An anti-abortion group last month sued seven Utah fertility clinics, claiming their disposal of embryos as part of the in vitro fertilization process violates the state’s wrongful death law.

The ministry Voice for the Voiceless believes it has a strong case because Utah is one of four states — Alabama, Louisiana and Missouri are the others — that have both a “fetal personhood” law and a civil wrongful death law that, the group contends, might apply to frozen embryos.

Other states offer opportunity for similar lawsuits: At least 10 have either a fetal personhood law — giving a fetus, embryo or fertilized egg the same legal rights as a person who has been born — or a wrongful death statute that might include frozen embryos, according to Pregnancy Justice, a group that tracks the issue and advocates for the rights of pregnant women, including the right to abortion.

“There’s a number of states that have laws like Utah’s that find that a person exists at a certain point, and that is conception,” said Frank Mylar, the attorney representing Voice for the Voiceless. He also represents another plaintiff, an anonymous woman from Ogden, Utah, who alleges in the lawsuit that she underwent an IVF procedure at one of the seven fertility clinics and was not informed that unused embryos would be discarded or about options to put her embryos up for adoption.

“Once that egg is fertilized, it actually at that point becomes a human being that’s entitled to rights,” Mylar said in an interview. “So every state that has that as a law, what we’re doing in this lawsuit would be very much applicable.”

The lawsuit illustrates the divide among many in the anti-abortion movement. Followers of a conservative philosophy known as “pronatalism” believe it’s imperative for Americans to have more babies. They want easier access to IVF, and President Donald Trump campaigned on making IVF more affordable.

So far, he has negotiated steep discounts on three IVF drugs and proposed allowing employers to provide separate health insurance coverage for fertility benefits, including lab tests, medications, genetic testing and IVF.

But the IVF process often involves discarding embryos, creating a conundrum for people who support IVF but believe that life begins at fertilization and oppose abortion. For anti-abortion purists, those embryos are unborn children, so disposing of them is no different from abortion.

The split on the political right drew attention in February 2024, when the Alabama Supreme Court, which consists of nine Republicans, ruled 8-1 that the state’s wrongful death statute applied to embryos. That decision cleared the way for couples to pursue lawsuits if their frozen embryos were destroyed. It temporarily halted IVF at Alabama clinics. It also ignited a national uproar and prompted the Republican-led Alabama legislature to immediately step in to protect IVF providers from legal liability.

But court cases and legislative efforts in multiple states show that the IVF debate is ongoing.

In Indiana and Ohio, courts have weighed whether frozen embryos are people or property in cases involving former partners who disagreed on what to do with their embryos when they separated.

In Kentucky, a judge earlier this month struck down language in the state’s abortion ban defining human life as beginning at conception, handing a victory to a Jewish woman who argued that the ban violated her religious freedom by putting her at risk of prosecution if she pursued IVF. The state has appealed the case.

In Kansas, a proposed bill this year would have made it illegal to destroy a fertilized embryo, though it died in committee. And Tennessee last year became the first state in the South to enact a law explicitly affirming the right to access IVF and birth control.

Kulsoom Ijaz, a senior policy counsel for Pregnancy Justice, predicted that IVF opponents will continue to use fetal personhood language to challenge the fertility procedure. Ijaz said that when fetal personhood language appears in one area of state law, “it inspires legislators to align their laws across the board, with these equal-protection-for-the-unborn bills.”

Then, she said, “courts use these definitions to then make case law in other areas of the law.”

Risa Cromer, an anthropology associate professor at Purdue University who focuses on medicine and reproductive politics, described personhood language as “a threat for broad swaths of reproductive health care needs that remain highly popular, IVF being one of them.”

“Personhood doesn’t explicitly implicate abortion miscarriage management, treatment for ectopic pregnancy, contraception, or IVF. In judicial interpretation, it absolutely is proving to be a threat,” Cromer said.

Utah lawsuit

IVF involves retrieving a woman’s eggs from her body and then fertilizing them with sperm in a laboratory. Any embryos that result can then be either transferred to her uterus or frozen for future use. Unused embryos can also be adopted, but many are discarded. And storing frozen embryos can be costly, from hundreds to thousands of dollars per year.

Louisiana is the only state that bans the destruction of IVF embryos. But fertility clinics have gotten around the 1986 law by shipping unused embryos out of state for storage.

The lawsuit says Voice for the Voiceless is morally opposed to IVF. But it also claims the clinics could perform IVF without discarding embryos by only creating as many embryos as will be implanted into their clients.

Mylar, the attorney, said defendants could change their clinic policies to comply with the state’s wrongful death statute “if they basically said, ‘Our intent is that you have every one of these fertilized eggs, and we’re not going to willingly or negligently or intentionally let them die.’”

Voice for the Voiceless President Kriss Martenson, named as a plaintiff, said in an interview that he does not believe IVF could be practiced without violating the law. He said the lawsuit is a strategic effort to apply fetal personhood language to IVF and to abortion at all stages. The lawsuit says the organization, which it describes as a nonprofit, has legal standing because of its efforts opposing abortion in Utah.

Martenson said he was inspired to file the Utah lawsuit by the 2024 Alabama Supreme Court decision and by the combination of Utah’s fetal personhood and wrongful death laws.

A victory in the lawsuit “could strengthen the legal arguments that the state has a constitutional obligation to protect human life from the moment of fertilization,” Martenson said. “So that’s what I’m showing in Utah, and I think that could affect other states.”

Discarding embryos

Disposal of embryos is common in IVF because for each single fertilization effort, multiple embryos are created to maximize the chance of success. Typically only one or two are transferred to a patient’s uterus, however, to prevent high-risk pregnancies of multiple fetuses. Some embryos are discarded because of chromosomal issues or genetic diseases, discovered during genetic screening in the lab. The Utah lawsuit charges that this is “akin to eugenics.”

Stateline contacted all of the clinics named in the lawsuit, but one declined to comment and the others did not respond in time for publication. The defendants have not yet filed written responses to the lawsuit. The seven clinics are: Conceptions Fertility Center, East Bay Fertility Center, Reproductive Care Center, Utah Center for Reproductive Medicine, Utah Fertility Center, Utah Fertility Specialists and Wellnest Fertility Clinic.

Susan Crockin, an adjunct professor at Georgetown University Law Center who teaches assisted reproductive technology law, said it is standard practice to inform IVF patients about their options around unused embryos. If the lawsuit is successful, Crockin said, it could severely curtail patient choice.

“The one thing that I think gets lost in this debate often is that a number of embryos that are not used for procreation … because they potentially have a genetic anomaly that is incompatible with life,” Crockin said. “So if every IVF embryo is considered a legally recognized person, I don’t understand what these anti-abortion, anti-IVF advocates would have us do with these embryos that will be sitting in cryopreservation tanks, or will not be making a viable human being.”

She added that “conflating every attempt to have a family with ‘every embryo in a freezer deserves to be put into a deserving womb’ feels very dangerous.”

Cromer, of Purdue University, noted that “the vast majority of religious Americans are supportive of access to IVF.” Cromer is a fellow at the Public Religion Research Institute, which found in a 2024 survey that majorities of white evangelical Protestants, Hispanic Protestants and Latter-day Saints both oppose laws that would make IVF illegal and strongly support laws declaring that human life begins at fertilization.

“So, these kinds of lawsuits, while there might be political opportunity for particular jurisdictions, such as the state of Utah, (are) completely out of step with what most Americans — religious Americans — want for themselves, their families and their neighbors,” Cromer said.

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

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More older residents in Milwaukee are facing homelessness, according to findings from a yearlong study funded through a grant from the Advancing a Healthier Wisconsin Endowment, which included Community Advocates Public Policy Institute and the Medical College of Wisconsin. 

Community Advocates is a social service agency that provides a number of services, including those related to housing. 

Researchers examined why older people are at risk for homelessness and what changes need to be made to keep them housed. 

“Older adults used to be stable and now there’s instability,” said Erin Cronn, director of nursing for the City of Milwaukee Health Department. 

The breakdown

The study showed that the majority of Milwaukee’s homeless older adults are Black males between 55 and 65, who have a high school diploma or some college. 

According to Community Advocates Public Policy Institute and the Medical College of Wisconsin, their homelessness was due to a loss of income, family conflict or health challenges. 

Matt Raymond, supportive housing programs director for Community Advocates, said intakes of people 62 and older have doubled and sometimes tripled over the last 10 or so years.  

Raymond said that many of the older adults had never been homeless and that accessibility to resources for them can be difficult. 

“This is many of their first time experiencing homelessness and having to navigate a system that can be complex and nuanced,” Raymond said. 

To help get older adults the housing resources they need, Cronn said, there needs to be a better way of sharing important information. 

“A lot of information is disseminated in electronic ways and there’s a lot of isolation, so word of mouth doesn’t always work,” Cronn said. 

The study also revealed that many older adults would prefer for all services to be in one place and have better transportation and more places to stay.

Understanding the hard truth

Although the study highlighted promising solutions, Emily Kenney, director of strategic initiatives and transformation at the Milwaukee County Department of Health & Human Services, said there’s still no housing system, which is why older adults struggle. 

She believes that homeless shelters, housing programs and landlords should be functioning under one system instead of operating separately. 

“When you think about the criminal justice system, health or behavioral system, those systems work together with you from beginning to end, but not for housing,” she said. 

She said this gap causes a lack in prevention support for older adults and only assists people when they’re already homeless. 

“When I was running a coordinated entry system, what I heard all day was people were on the brink of losing their housing and needing resources, and the only solution was to come into a homeless system first,” Kenney said.

Homelessness and the health care system

Family medicine specialist Dr. William Calawerts said he’s received older patients with high blood pressure, diabetes and other health challenges but can’t help if they don’t have stable housing.

Without a home, older adults can’t take their medicine or attend doctor appointments, which will make them more ill, he said. 

“Their health issues are usually extremely complex and serious, but oftentimes we’re not able to address that adequately in the outpatient setting,” he said. 

Cronn said health can mean different things to homeless older adults compared with health care professionals.

For older adults, it means having safe housing, clipped nails, ability to wash their hands or having clean and dry clothes, but professionals may see health as traditional doctor visits, he said.

“As a practitioner, it’s hard to prioritize health and the folks we’re seeing because their version of what their needs are is different than what we’re seeing,” Cronn said.

Calawerts said when he’s training medical students about homeless patients, he teaches them to take their time, have compassion and treat them beyond their illness.

“We try to tell them that you’re a human first and a physician second,” Calawerts said. “I think we’ve lost the humanism component in a lot of things we do.”

Affordable housing challenges

Kenney raised concerns about housing programs that give out vouchers to help with paying rent but have been a contributing factor to older adult homelessness.

She said developers are using loans to build houses, and the way the loans get paid off is through rent. 

“Developers can’t offer rent at a price people need because the tax credits they get aren’t enough,” Kenney said. “The people who get the vouchers have already entered the homeless system.” 

As a result, Raymond said some older adults have been moving into permanent supportive housing. These programs help homeless individuals get their own long-term place and additional services to help.

Community Advocates refers some of its intakes to Autumn West Safe Haven, an apartment on Milwaukee’s North Side that gives homeless or mentally ill individuals a place to stay short term until they find stability.

According to Community Advocates, 36 individuals who were homeless or mentally ill received services and housing through Autumn West Safe Haven, while 101 individuals who were chronically homeless and living with a disability received immediate help in 2025.

“Over the last few years at Autumn West Safe Haven, we’ve gone into outreach community centers to offer on-site telepsychiatry care to our residents and established a relationship with Advocate Aurora to bring in their mobile clinic on a monthly basis,” Raymond said. 

Hopes for the future

Overall, community leaders want people to know that existing organizations need to make their population broader and do a better job at synthesizing resources, even though it may take time. 

“There’s no reason for Milwaukee not to be at the forefront fighting this nationally,” Kenney said. 

Calawerts also mentioned the resilience of older adults, having heard many success stories of them getting through mental health, homelessness, unemployment and other challenges. 

“Those stories are the ones that give me hope, and with more robust services that are connected in these spaces, we can see more of those successfully,” Calawerts said.

Health care professionals and leaders want change as more older Milwaukee residents become homeless  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.

Pregnant patients experiencing miscarriage who live in states with abortion bans have fewer options for healthcare management, according to a new study published by the Journal of the American Medical Association.

The study, published May 18, found a shift away from managing miscarriages with a two-drug approach that includes mifepristone — which has been the subject of numerous legal battles that are still playing out in federal courts — and toward approaches that include only misoprostol, which has a lower rate of effectiveness.

The states with abortion bans had a nearly 3% increase in expectant management, the study showed, which means a health provider monitors the condition without prescribing any form of treatment to see whether the condition resolves without intervention. The study was conducted by researchers in the Department of Obstetrics and Gynecology at Oregon Health and Science University.

Among those patients who received medication, there was a nearly 14% increase in the use of misoprostol-only regimens, which goes against the American College of Obstetricians and Gynecologists’ recommendation of using a combination of mifepristone and misoprostol as the most preferred method of managing miscarriages. Used together, the medications are the most effective at completing expulsion of pregnancy tissue and reducing side effects such as bleeding and cramping.

The expectant management approach, the study said, could increase the risk of hemorrhage and retained pregnancy tissue, which can cause infection if it is not removed.

The method of treatment for a miscarriage is the same two-drug regimen that is used to terminate a pregnancy before 12 weeks. A group of anti-abortion doctors unsuccessfully tried to revoke the U.S. Food and Drug Administration’s approval of mifepristone altogether in 2023, and government officials in Louisiana are trying to strike down a 2023 rule enacted by the FDA that allows the drug to be prescribed by telehealth and mailed to a patient. That case is ongoing.

Using healthcare claims data, the study included nearly 123,600 commercially insured patients who had a miscarriage before 77 days’ gestation between the beginning of 2018 and the end of September 2024. That time frame includes 53 months of data from the years before the U.S. Supreme Court’s Dobbs decision in June 2022 to allow states to regulate abortion access, and 27 months after at least a dozen states implemented abortion bans.

The states with bans that affect pregnancies at six weeks of gestation or earlier are Alabama, Arkansas, Georgia, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas and West Virginia. They were compared with 18 other states that do not have bans before fetal viability, which is generally considered to be about 24 weeks.

Some of those states with bans have gone further in adding criminal penalties to the use of mifepristone for abortion, which doctors have said affects abortion patients as well. Louisiana classified mifepristone and misoprostol as controlled substances in 2024, which meant providers had to start treating the storage and access to the medication much differently. Patients have tried to fill a prescription for misoprostol at major pharmacies in Louisiana, only to be told it’s unavailable, Louisiana Illuminator reported.

“It’s definitely getting more and more challenging to provide for patients and provide for them adequately,” Dr. Nicole Freehill, an OB-GYN in New Orleans, told Stateline in March. “That criminalization, more than anything, has created so many problems, because so many providers are just afraid to act.”

Mississippi enacted a law in April adding mifepristone and misoprostol to the state’s drug trafficking law, making it a crime punishable by up to 10 years in prison to distribute or intend to distribute the drugs. Lawmakers said the law would help limit the number of people sending the medications through the mail.

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