Montana Archives - ��ϳԹ�� News

Montana Moves Ahead With Doula Pay but Warns Medicaid Cuts Still May Come

Katheryn Houghton — Wed, 22 Apr 2026 09:00:00 +0000

Montana officials said they are moving forward with plans to allow Medicaid to pay doulas, reversing a previous statement that budget problems had prompted them to pause the effort to reimburse the birth workers.

But officials warned that all optional Medicaid services are still under review as the state health department looks for cuts to offset a shortfall driven by higher-than-expected Medicaid costs.

Jon Ebelt, a spokesperson with the Montana Department of Public Health and Human Services, said the agency is preparing a request to the federal government to add doula care to the state’s Medicaid program. It would cost the state about $118,000 in its first year to provide doula Medicaid reimbursements, according to .

His April 15 comments came three weeks after department officials told ��ϳԹ�� News that the state budget deficit had put those plans on hold. Ebelt denied that a final decision had been made in March to scrap the doula Medicaid payments, which state lawmakers approved in a bill last year. The coverage is “now proceeding as planned,” he said.

“At the time of your initial inquiry, we were still in the process of analyzing the appropriation,” Ebelt said.

Federal health officials must approve any amendments to the state’s Medicaid program before payments can begin. reimburse doulas through Medicaid.

Doulas are trained, nonmedical workers who support people through pregnancy and after they give birth. The care they provide is in health complications, which has prompted more states to cover doula services in recent years.

Montana lawmakers who supported expanding Medicaid to cover doula care in 2025 cited scarce maternity services, especially in rural and Indigenous communities. But this year, the state has a Medicaid budget deficit of more than and is expecting a similar shortfall next year. Plus, federal policy changes slated to take effect later this year are expected to increase costs.

“ There’s a need and a desire for doula services, but a lot of people can’t afford it,” said Sheri Walker, a Helena-based doula and president of the . “So that means many of us have other jobs that we have to juggle.”

Walker is a part-time labor and delivery nurse outside of her doula work.

On March 25, health department spokesperson Holly Matkin said in an email to ��ϳԹ�� News that the agency “will not be moving forward with the implementation of doula services in the Montana Medicaid benefit package at this time.” She had added that it was unclear whether state law gives the department the authority to authorize coverage during the budget shortfall.

State Sen. , a Democrat who sponsored last year’s bipartisan doula reimbursement bill, said she didn’t know about the department’s plans until she saw ��ϳԹ�� News’ reporting. Neumann said she and groups that had backed the legislation began calling health officials, making the case for doula services as a low-cost way to provide critical care.

After about a week, Neumann said, state officials told her the agency was moving ahead with doula services after all.

“They were on the chopping block,” Neumann said. “This is a story of how important it is for all Montanans to pay attention and stay connected to what’s happening.”

Ebelt did not clarify what led the department to change its position. However, he warned that optional Medicaid services, such as doula services, may still be cut.

“All optional services, including this service, are being reviewed,” Ebelt said, referring to doula care. He did not respond to a follow-up query as to whether the department might still decide to postpone the program following federal approval.

are types of care that states choose to cover through their Medicaid programs but aren’t required by federal law. That can include covering eyeglasses, prescription drugs, and prosthetics, and more specialized care such as physical therapy, or inpatient psychiatric services for people under 21.

Those services may not sound optional, said , who studies Medicaid financing at KFF, a health information nonprofit that includes ��ϳԹ�� News. But she said they’re one of the few avenues states have to make adjustments when budgets get tight.

Congressional Republicans’ One Big Beautiful Bill Act, the spending measure President Donald Trump signed into law last July, is expected to put more states in a budget crunch as its provisions start to take effect by the end of the year. The federal government has estimated that the law will reduce federal Medicaid spending by nearly $1 trillion over 10 years. The law also left states with a higher share of the costs to provide food assistance.

Williams said many states expanded services in recent years by boosting optional Medicaid benefits and provider pay.

“We could see them walk those back,” Williams said.

Montana’s financial problems preceded federal changes. Last year, state lawmakers cut some of the health department’s funding and underestimated Medicaid use. The state also overestimated what the federal government would pay toward Montana’s Medicaid costs.

Health officials must outline a plan to cut costs before the state’s 2027 budget year begins on July 1. Simultaneously, the agency is trying to hire more staffers to begin vetting whether Medicaid enrollees meet or are exempt from new work requirements that also go in place July 1. The new rules, mandated through long-delayed state legislation and the federal spending law, will have a three-month grace period.

Stephanie Morton, executive director of , said she’s grateful the state is back on track to pay for doula services through Medicaid. But she said she’s worried about potential health care cuts to come.

“We know that doulas are a critical piece of that infrastructure, but standing alone and losing other sources of care really isn’t optimal,” Morton said. “These are not robust systems as it stands.”

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

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Journalists Talk Hot Health Topics: Urgent Care Clinics Performing Abortions and Doulas’ Pay

Sat, 18 Apr 2026 09:00:00 +0000

��ϳԹ�� News Michigan correspondent Kate Wells discussed urgent care clinics offering abortions on Apple News Today on April 15.

Read Wells’ “Urgent Care Clinics Move To Fill Abortion Care Gaps in Rural Areas.”

��ϳԹ�� News Montana correspondent Katheryn Houghton discussed doula Medicaid reimbursements on Montana Public Radio on April 9.

Read Houghton’s “This Northern Cheyenne Doula Was About To Start Getting Paid — Then Medicaid Cuts Hit.”

��ϳԹ�� News contributor Michelle Andrews discussed farm bureau health plans on The Yonder Report on April 8.

Read Andrews’ “Farm Bureau Health Plans Beat the ACA on Prices With an Age-Old Tactic: Rejecting Sick People.”

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States Face Another Challenge With Medicaid Work Rules: Staffing Shortages

Sam Whitehead — Thu, 09 Apr 2026 09:00:00 +0000

Katie Crouch says calling her state’s Medicaid agency to get information about her benefits can feel like a series of dead ends.

“The first time, it’ll ring interminably. Next time, it’ll go to a voicemail that just hangs up on you,” said the 48-year-old, who lives in Delaware. “Sometimes you’ll get a person who says they’re not the right one. They transfer you, and it hangs up. Sometimes, it picks up and there’s just nobody on the line.”

She spent months trying to figure out whether her Medicaid coverage had been renewed. As of late March, she hadn’t been reapproved for the year for the state-federal program, which provides health insurance for people with low incomes and disabilities.

Crouch, who suffered a debilitating brain aneurysm a decade ago, also has Medicare, which covers people who are 65 or older or have disabilities. Medicaid had been paying her monthly Medicare deductibles of $200, but she’d been on the hook for them for the past three months, straining her family’s fixed income, she said.

Crouch’s challenges with Delaware’s Medicaid call center aren’t unique. State Medicaid agencies can struggle to keep enough staff to help people sign up for benefits and field calls from enrollees with questions. A shortage of such workers can keep people from fully using their benefits, health policy researchers said.

Now, congressional Republicans’ One Big Beautiful Bill Act, which President Donald Trump signed into law last summer, will soon demand more from staff at state agencies in places where lawmakers expanded Medicaid to more low-income adults — nearly all states and the District of Columbia.

Under the law, which is expected to reduce Medicaid spending by almost $1 trillion over the next eight years, these staffers will have to not only determine whether millions of enrollees meet the program’s new work requirements but also verify more frequently that they qualify for the program — every six months instead of yearly.

��ϳԹ�� News reached out to agencies that will need to stand up the work rules, and many said they’ll need additional staff.

The mandates will put extra strain on an already-stressed workforce, potentially making it harder for enrollees like Crouch to get basic customer service. And many could lose access to benefits they’re legally entitled to, said consumer advocates and health policy researchers, some of them with direct experience working at state agencies.

States are already “struggling significantly,” said Jennifer Wagner, the director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities and a former associate director of the Illinois Department of Human Services. “There will be significant additional challenges caused by these changes.”

Long Wait Times for Help

Republicans argue the Medicaid changes, which will take effect Jan. 1, 2027, in most states, will encourage enrollees to find jobs. Research on other Medicaid work requirement programs has found little evidence they increase employment.

The Congressional Budget Office would cause more people to lose health coverage by 2034 than any other part of the GOP budget law. It said last year more than 5 million people could be affected.

Many states don’t have the staff to process Medicaid applications or renewals quickly, said consumer advocates and researchers.

The Centers for Medicare & Medicaid Services tracks whether states can handle the most common type of benefit application within a 45-day window.

In December, about 30% of all Medicaid and Children’s Health Insurance Program, or CHIP, applications in Washington, D.C., and Georgia to process. More than a quarter took that long in Wyoming. In Maine, 1 in 5 applications missed that deadline.

CMS began publicly sharing state Medicaid call center data in 2023, revealing a taxed system, researchers and consumer advocates said.

In Hawaii, people waited on the phone for more than three hours in December. They waited for nearly an hour in Oklahoma, and more than an hour in Nevada.

In 2023, state Medicaid agencies began making sure enrollees who were protected from being dropped from the program during the covid pandemic still qualified for coverage. That Medicaid unwinding process didn’t go well in many states, and lost their benefits.

Health policy researchers and consumer advocates say rolling out the new Medicaid rules will be a bigger challenge. The Medicaid work rules will require extensive IT system changes and training for workers verifying eligibility on a tight timeline.

“It is a much larger scale of administrative complexity,” said Sophia Tripoli, senior director of policy at Families USA, a health care consumer advocacy organization.

After months of trying to get someone on the phone, Crouch said, she finally got answers to questions about her Medicaid benefits after writing to the office of U.S. Rep. Sarah McBride (D-Del.). McBride’s office contacted the state’s Medicaid agency, which eventually called with an update, Crouch said.

Crouch didn’t qualify for Medicaid after all. She said that had never come up in two years of interactions with the state.

“It makes absolutely no sense” that the state never realized she shouldn’t have been on the program, Crouch said.

Delaware’s Medicaid agency didn’t respond to requests for comment on Crouch’s situation.

States Short-Staffed for Medicaid

Some states told ��ϳԹ�� News in late March that they’ll need more staff to roll out the work rules effectively.

Idaho said it has 40 eligibility worker vacancies. New York estimated it will need 80 new employees to handle the additional administrative work, at a cost of $6.2 million. Pennsylvania said it has nearly 400 open positions in county human services offices in the state. Indiana’s Medicaid agency has 94 open positions. Maine wants to hire 90 additional staffers, and Massachusetts wants to hire 70 more.

As of early March, Montana had filled 39 of 59 positions state officials projected it would need. The state still plans to roll out the rules early, starting July 1, despite its long struggle with system backlogs that applicants said have delayed benefits.

Missouri’s social services agency has been cutting staff and has 1,000 fewer front-line workers than it did roughly a decade ago — with more than double the number of enrollees in Medicaid and the Supplemental Nutrition Assistance Program, or SNAP, according to comments Jessica Bax, the agency director, made in November.

“The department thought that there would be a gain in efficiency due to eligibility system upgrades,” Bax said. “Many of those did not come to fruition.”

States could have a hard time finding people interested in taking those jobs, which require months-long training, can be emotionally challenging, and generally offer low pay, said Tricia Brooks, a researcher at the Georgetown University Center for Children and Families.

“They get yelled at a lot,” said Brooks, who formerly ran New Hampshire’s Medicaid and CHIP customer service program. “People are frustrated. They’re crying. They’re concerned. They’re losing access to health care, and so sometimes it’s not an easy job to take if it’s hard to help someone.”

States are paying government contractors millions of dollars to help them comply with the new federal law.

Maximus, a government services contractor, provides eligibility support, such as running call centers, in 17 states that expanded Medicaid and interacts with nearly 3 in 5 people enrolled in the program nationally, according to the company.

During a February earnings call, company leadership said Maximus can charge based on the number of transactions it completes for enrollees, independent of how many people are enrolled in a state’s Medicaid program.

Maximus has “no one-size-fits-all approach” to the services it offers or the way it charges for those services, spokesperson Marci Goldstein told ��ϳԹ�� News.

The company, which reported bringing in $1.76 billion in 2025 from the part of its business that includes Medicaid work, expects that revenue to continue to grow, even as people fall off the Medicaid rolls, “because of the additional transactions that will need to take place,” David Mutryn, Maximus’ chief financial officer and treasurer, said during the earnings call.

Losing Medicaid health coverage isn’t just an inconvenience, since many people enrolled in the program probably don’t make enough money to pay for health care on their own and may not qualify for financial help for Affordable Care Act coverage, said Elizabeth Edwards, a senior attorney with the National Health Law Program.

People could be unable to afford medications or get essential care, which could lead to “devastating” health impacts, she said.

“The human stakes of this are people’s lives,” she said.

��ϳԹ�� News correspondents Katheryn Houghton and Samantha Liss contributed to this report.

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This Northern Cheyenne Doula Was About To Start Getting Paid — Then Medicaid Cuts Hit

Katheryn Houghton — Tue, 07 Apr 2026 09:00:00 +0000

LAME DEER, Mont. — Misty Pipe had about an hour before her shift began at the post office. She used that time to check in on a new mom who lives a few miles outside this town at the heart of the Northern Cheyenne Indian Reservation.

A mom of seven, Pipe is a doula on the reservation who supports new and expectant parents. She does that work free, around her day job. That’s because in this town of about 2,000 people, the closest hospital that delivers babies is 100 miles away.

“Women need this help,” Pipe said.

Doulas ready parents for childbirth, support their deliveries, and can be a steady presence in a baby’s first months. their work with lower rates of costly birth and postpartum complications — especially in hard-to-reach places like Lame Deer.

But that help can be scarce. As Pipe put it: “Doula doesn’t pay the bills around here.”

Things were supposed to change this year. Montana was set to join that reimburse doulas through their Medicaid programs to ease gaps in care. Montana lawmakers approved the payments last year, authorizing up to $1,600 per pregnancy. Pipe hoped that money would give her the chance to leave her post office job one day to help more parents.

But the state Department of Public Health and Human Services postponed adding doula services to its Medicaid program in late March, citing a budget shortfall driven in part by higher-than-expected Medicaid costs.

“DPHHS will not be moving forward with the implementation of doula services in the Montana Medicaid benefit package at this time,” department spokesperson Holly Matkin told ��ϳԹ�� News.

The news caught Pipe by surprise — she hadn’t heard any updates in a while, but the state had finalized its licensing rules for doulas in January. Last year, she supported three people through their deliveries. She doesn’t have time for much more. That weighs on her. the people on the Northern Cheyenne Indian Reservation , and the people she helps usually can’t afford to pay a doula.

“I was looking forward to serving more people,” Pipe said. “Now that’s not going to happen anytime soon.”

Doula Misty Pipe holds Grover WolfVoice at her first check-in visit since his birth. Pipe says she’s most concerned about clients’ health after they return home, when postpartum complications can arise. (Katheryn Houghton/��ϳԹ�� News)

Grover, a few weeks old, is held by his father, Torey WolfVoice. Grover’s mom, Britney WolfVoice, says the doula care Pipe provided through the birth of her two youngest children made her feel safe and heard in hospitals for the first time in her life. (Katheryn Houghton/��ϳԹ�� News)

Charlie Brereton, who heads the health department, told state lawmakers in March that the agency projected a $146.3 million shortfall in federal Medicaid funds for this year. Health officials predict another deficit next year as states feel the effects of Republicans’ massive tax-and-spending law, the One Big Beautiful Bill Act. Signed last year, that law is projected to reduce federal Medicaid spending by nearly $1 trillion over 10 years.

Matkin said it’s “unclear” whether the agency can authorize doula coverage this year. The deficit will lead the department to seek supplemental funding from state lawmakers. When an agency makes that kind of request for the first year of the state’s two-year budget cycle, requires it to create a plan to reduce its spending.

Around the country, optional Medicaid services — such as doula support, home health care, and dental work — are at risk of losing funding as states brace for federal Medicaid cuts to hit their bottom lines. Already, lawmakers in Idaho are considering their own reductions to Medicaid to balance the state’s budget. cutting tens of millions of dollars in services for people with disabilities.

In Montana, doula services are unlikely to be the only Medicaid cutbacks announced. “All options are on the table,” Brereton told lawmakers in March.

Stephanie Morton, executive director of Healthy Mothers, Healthy Babies-The Montana Coalition, said more than half of Montana’s counties are designated as maternity care deserts.

“Budget cuts will continue to diminish the limited services families rely upon in these counties,” said Morton, whose nonprofit had advocated for doula Medicaid reimbursement. “This decision feels like the first of many rollbacks and cuts Montanans will face.”

Laboring Alone

At the check-in just outside town, Pipe handed a waking newborn to his mother and unwrapped a new swaddle for the child. This would have to be a quick visit — she was already late for work.

The mother, Britney WolfVoice, held her newborn son as her three young daughters stood close by. Pipe has been with WolfVoice and her husband for the birth of their newborn son and youngest daughter.

She helped them create delivery plans. For the birth of WolfVoice’s youngest daughter a few years ago, Pipe brought cedar oil, a sacred plant used for prayer, and calmed WolfVoice through her contractions. For the recent birth of her son, when hospital backlogs delayed WolfVoice’s induction, Pipe encouraged her to advocate for an earlier appointment by routinely calling the hospital. Doctors had recommended the procedure to avoid complications.

“Misty is one person who I can count on to be my voice,” WolfVoice said.

If someone needs a ride to a doctor’s appointment, Pipe takes time off work to drive them. If a client goes into labor when Pipe’s at the post office, she texts two other free doulas she knows of on the reservation to see if they have time to help until her shift ends. But they also have day jobs.

Pipe herself has ridden that 100-mile stretch between home and the hospital in labor and in the back of an ambulance. Twice, she gave birth in emergency rooms along the way. In one of her pregnancies, she miscarried at home and couldn’t get a doctor appointment for days.

The long distance to receive care often meant her husband had to stay behind to tend to their other children at home.

“I labored alone so many times,” Pipe said. “I just want to make sure no one’s alone.”

A section of U.S. Route 212 leads to and from Lame Deer, a town in southeastern Montana that is roughly 100 miles from the closest hospital that delivers babies. Nationwide, over 35% of counties don’t have a single birthing facility or obstetric clinician, according to a 2024 report from the March of Dimes. (Katheryn Houghton/��ϳԹ�� News)

Rural maternity care deserts are a , especially as labor and delivery units continue to shutter. In many tribal communities, a lack of care coincides with long-standing inequities caused by centuries of .

Predominantly Indigenous communities face the longest distances to obstetric facilities compared with all other racial and ethnic groups, according to a 2024 report from the March of Dimes. That’s part of the reason Indigenous women are far more likely to get sick from pregnancy and as white women.

Indigenous patients are supposed to be guaranteed access to health care through the federal Indian Health Service. But the chronically underfunded agency has severe gaps. A small fraction of its hospitals and clinics offer labor and delivery. As of 2024, only seven states had either an IHS or tribal birth facility, . To help fill in those shortfalls, Medicaid is the for many Native Americans, according to KFF.

Even where care exists, Native women can experience a distrust of health systems, according to Pipe and other health workers. The U.S. government has a long history of removing children from tribal homes and forcing Native American women to undergo sterilization.

of the Pacific Institute for Research and Evaluation’s Southwest center has studied premature deaths among Native Americans. A member of the Fort Sill-Chiricahua-Warm Springs-Apache Tribe, Haozous said data on maternal health disparities in pregnancy and postpartum often misses a key point.

“It’s not that women are just not taking care of themselves,” Haozous said. “The system is set up for them to not have access to care.”

Pipe sits behind her client, Britney WolfVoice, and WolfVoice’s youngest daughter, Ellie WolfVoice. (Katheryn Houghton/��ϳԹ�� News)

On top of funding cuts, the One Big Beautiful Bill Act will add more frequent eligibility checks and work requirements to access Medicaid. Those changes, when they take effect later this year and next, will lead an estimated 5.3 million people to lose their coverage by 2034.

Native Americans are exempt from some of the law’s new rules, such as the work requirements. Even so, tribal patients can get tangled in administrative hurdles. That includes struggling to enroll in the first place or to prove their tribal status. A full-time college student, WolfVoice said that when she got pregnant, it took about six months to enroll in the state’s Medicaid program.

Despite Montana’s long struggle with a backlogged Medicaid system, state officials aim to implement work requirements this summer, well before the federal deadline.

‘Moccasins on the Ground’

As Pipe pulled into her driveway one day after a full shift at the post office, her kids ran to her. She was also greeted by Felicia Blindman, a 63-year-old public health nurse who used to work for the tribe. The two sat in lawn chairs into the night and brainstormed ways to connect more women to services — such as free prenatal classes.

Pipe’s four youngest children played around them. Her 14-year-old daughter is already certified as an Indigenous doula. Her 8-year-old daughter has begun helping Pipe pick up prescriptions for moms without a car who live out of town. Pipe hopes one day they could do that work full-time, if they want to.

Because of the lost Medicaid payment, Pipe said, she will continue to balance her job with her birth work, even if it means persuading more people to become doulas, such as family and respected community members, to cover more ground.

“It’s not going to stop me from training more birth workers, more young people, more aunties,” Pipe said. “For now, I guess it’s more about grassroots, moccasins on the ground, helping each other.”

She said that means telling pregnant people who walk into the post office she’s there to help if they need support. At least, as long as she’s not at her day job.

Pipe kisses the top of Grover’s head as his father, Torey, scrolls through photos of the baby boy’s namesake grandfather. (Katheryn Houghton/��ϳԹ�� News)

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Give and Take: Federal Rural Health Funding Could Trigger Service Cuts

Aaron Bolton, MTPR — Fri, 27 Mar 2026 09:00:00 +0000

BIG SANDY, Mont. — The emergency department at Big Sandy Medical Center is one room with a single curtain between two beds.

It’s one of the many parts of the 25-bed rural hospital that need updating, former CEO Ron Wiens said.

He said the hospital, an essential service in its namesake town of nearly 800 residents in the state’s sprawling north-central high plains, needs at least $1 million for deferred maintenance, including a failing HVAC system. But the facility has struggled to make payroll each month and can’t afford to make all the fixes, Wiens said.

Built by farmers and ranchers in 1965, Big Sandy Medical Center began with nine beds. Today, a similar community effort — donations and grants to plug financial holes each year — keeps it afloat.

Wiens, who recently left his position at the hospital, said he wishes Big Sandy could get funding from Montana’s share of the $50 billion federal Rural Health Transformation Program to renovate the hospital and direct payments to help secure its future. The state received more than $233 million in its first-year award.

But the hospital may not get the kind of help he sought.

That’s because the five-year program focuses on new, creative ways to improve access to rural health care, not on directly funding services and renovations. And Montana is one of at least 10 states whose leaders say projects launched under the federal program could lead rural hospitals to cut services so they can continue to afford to offer emergency and other essential care.

Ron Wiens, former CEO of Big Sandy Medical Center, worries Montana’s plan for its Rural Health Transformation Program funding will lead to cuts at such facilities. Part of the state’s plan for the money says it will pay rural hospitals for “right-sizing” certain inpatient services. (Aaron Bolton/MTPR)

Congressional Republicans created the fund as a last-minute sweetener to their One Big Beautiful Bill Act, signed into law last summer. The funding was intended to offset disproportionate fallout anticipated in rural communities from the law, which is expected to slash Medicaid spending .

includes programs to make it easier for rural residents to get medical care and live a healthy lifestyle. For example, it says funding can be used to start community gardens, train paramedics to make home visits, open school-based clinics, or bring mobile clinics to rural areas.

rural Montana hospitals can receive payments for implementing recommendations, “including right-sizing select inpatient services” to match demand. In some cases, it says, right-sizing might mean “downsizing.” The state says hospitals will have input and recommendations will be specific to each facility.

“That’s what has all the hospitals on pins and needles, words like restructuring, reducing inpatient beds. Everybody is going, ‘What is this going to look like?’” Wiens said.

The Montana Department of Public Health and Human Services declined to answer questions about how it will carry out its right-sizing efforts.

A Lifeline of Care

Big Sandy cattle rancher Shane Chauvet doesn’t want any services cut.

He credits Big Sandy Medical Center with saving his life after a flying piece of metal nearly cut off his arm during a windstorm a few years back.

“I looked over, saw it coming, and whack!” Chauvet recalled.

His wife drove him to the hospital, where they frantically pounded on the ER door while Chauvet’s blood pooled on the ground.

Because of the storm, staffers worked on Chauvet with no power and no ability to summon a helicopter. He was then taken by ambulance 80 miles through intense rain and hail to a larger hospital.

Chauvet understands the state’s plan doesn’t call for eliminating emergency care, but he worries that reducing other services would set off a downward spiral for the hospital and his town.

Erica and Shane Chauvet’s ranch overlooks the small town of Big Sandy, Montana. Shane Chauvet credits the local hospital with saving his life after an accident. He says he used to think of the hospital as a luxury for such a small town but now considers the facility essential to the community. (Aaron Bolton/MTPR)

In Oklahoma, realigning clinical services could mean “shutting down service lines,” to the federal program. And in Wyoming, any facility that receives funding must agree to “reduce unprofitable, duplicative or nonessential service lines,” .

Monique McBride, business operations administrator at the Wyoming Department of Health, said the department interprets right-sizing as helping rural hospitals provide essential services — such as emergency departments, ambulance services, and labor and delivery units — while maintaining long-term, financial stability.

“This might involve limiting some elective procedures that could be done at lower cost in higher-volume facilities. The main distinction here is time-sensitive emergencies vs. ‘shoppable’ services,” she said.

A New Lease on Life?

Seven of the 10 states — Nebraska, North Dakota, Tennessee, Kansas, Nevada, South Carolina, and Washington — where rural hospital service cuts are on the table say they’ll help pay for hospitals to convert to Rural Emergency Hospitals. The recently created federal designation requires hospitals to halt inpatient services and offers enhanced payments to help them maintain emergency and outpatient care.

At least 15 additional states wrote that they’ll use the federal funding to right-size, evaluate, or adjust services — which could mean adding or taking away services, or transitioning them to a telehealth or outpatient setting.

Brock Slabach, chief operations officer of the National Rural Health Association, said, “There’s a proper concern from rural hospital administrators that this funding is not going to where it was intended.”

He said cutting services that lose money could backfire in the long run. For example, he said, halting labor and delivery care might drive more people out of small towns, further reducing hospitals’ patient numbers and revenue.

The type of hospital services that states will assess matters, said Tony Shih, a senior adviser at the Commonwealth Fund, a nonprofit focused on making health care more equitable.

“If the end result is that high-margin services are taken away from local hospitals with nothing given back in return, it can be financially harmful,” he said.

Shih noted that states’ plans to add more outpatient care could prove beneficial for patients. It’ll take time to know which states help stabilize rural hospitals, he said.

Rural hospital leaders say they know which changes would keep their facilities open and that states shouldn’t suggest or mandate service cuts and other changes on their behalf.

Big Sandy, in north-central Montana and home to nearly 800 people, is an isolated farming and ranching community about 80 miles from the nearest major town. (Aaron Bolton/MTPR)

Josh Hannes, who oversees rural health policy at the Colorado Hospital Association, said “top-down” directives won’t work.

He said the association’s members believe they can find efficiencies and are eager to collaborate. But “a state agency shouldn’t be making those determinations,” he said.

Hannes said members are worried Colorado’s plan to classify rural health facilities as a “hub, spoke, or telehealth node” will compel service reductions. The classification will help determine “which services are sustainable locally and which are best provided regionally or through telehealth,” .

Spokespeople for the Colorado and Oklahoma health departments said no facility will be forced to end services. But Oklahoma spokesperson Rachel Klein said some facilities might choose to do so as part of a broader effort to make sure they’re meeting community needs while remaining financially stable.

“A hospital might shift certain services to a nearby regional provider with higher patient volume and specialized staff while expanding other local services,” such as primary, outpatient, or community-based care, she said.

Wiens and Darrell Messersmith, CEO of Dahl Memorial Hospital in the southeastern Montana town of Ekalaka, said they worry the only way hospitals will get their share of funding is to cut services or become Rural Emergency Hospitals that don’t offer inpatient services.

“I would hate to see things shift toward a pack-and-ship facility,” Messersmith said. “Right now, we function quite well as an inpatient facility.”

Not all Montana health leaders are worried.

Ed Buttrey, president and CEO of the Montana Hospital Association, said he thinks his state’s plan could help rural hospitals become financially sustainable and survive Medicaid cuts. Buttrey is also a Republican state lawmaker.

Chauvet, the Big Sandy rancher, said his perspective on whether remote towns like his should have a hospital is forever changed because of his accident.

“I always would say, ‘Oh, they’re nice to have,’ but now I look at the hospital and say, ‘That’s essential to our community,’” he said.

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Lawmakers Seek To Protect Crisis Pregnancy Centers as Abortion Clinic Numbers Shrink

Jazmin Orozco Rodriguez — Thu, 19 Mar 2026 09:00:00 +0000

Conservative lawmakers in multiple states are pushing legislation drafted by an anti-abortion advocacy group to increase protections for crisis pregnancy centers, organizations that provide some health-related services but also work to dissuade women from having abortions.

The legislation would prohibit state and local governments from requiring crisis pregnancy centers to perform abortions, provide referrals for abortion services, or inform patients about such services or contraception options. It also would allow crisis pregnancy centers to sue the violating government entity.

Wyoming lawmakers of the Center Autonomy and Rights of Expression Act, or , on March 4. Other versions have advanced in and this year. One was in 2025. The CARE Act is “model legislation” created by the , an anti-abortion, conservative Christian legal advocacy group.

A similar proposal, the , was introduced in Congress last year but hasn’t moved out of the House Energy and Commerce Committee.

The Wyoming bill says that pregnancy centers, many of which are affiliated with religious organizations, need legal protection after facing “unprecedented attacks” following the Supreme Court’s overturning of Roe v. Wade. It says that several state legislatures have introduced bills that . Opponents of these centers say they falsely present themselves to consumers as medical clinics, though they are not subject to state and federal laws that protect patients in medical facilities.

“Across the country, government officials are increasingly, increasingly targeting pregnancy care centers,” Valerie Berry, executive director of the in Cheyenne, said at a February legislative hearing on the Wyoming bill. “This legislation is not about creating division. It’s about protecting constitutional freedoms, freedom of speech, and freedom of conscience.”

Wyoming state , a Republican, expressed concern at the hearing about granting protections to pregnancy centers that other private businesses do not have.

“They have protections in place,” he said. “My issue with this is giving extra special protections.”

In 2022, Wellspring Health Access, the only clinic in Wyoming that provides abortions, in an arson attack.

“We are the ones providing the accurate information on reproductive health care, and we suffer the consequences for that,” Julie Burkhart, the president and founder of Wellspring Health Access, told ��ϳԹ�� News.

, a professor at the University of California-Davis School of Law, said the proposed legislation would insulate crisis pregnancy centers from having to meet the standards that medical organizations face. It would blur the line between advocacy and medical practice, she said. And such legislation provides Republicans with a potentially useful campaign message ahead of midterm elections.

“The GOP needs a messaging strategy as for how it cares about women even if it bans abortion and even if it doesn’t want to commit state resources to helping people before and after pregnancy,” Ziegler said. “The strategy is to outsource that to pregnancy counseling centers, which of course increases the incentive to protect them.”

Model Legislation

The Alliance Defending Freedom is the same group that , the 1973 court ruling that protected the right to abortion nationwide. The group drafted model legislation to establish a 15-week abortion ban that was the basis of a 2018 Mississippi law. That led to the Dobbs v. Jackson Women’s Health Organization Supreme Court case that overturned Roe.

The alliance said its attorneys were unavailable to comment on the organization’s strategy for the CARE Act. In for the bill, the group said federal, state, and local efforts are targeting pregnancy care centers in a “clear attempt to undermine and impede” their work and shut them down.

In recent years, have been targeted with vandalism and threats.

But the attacks the model legislation primarily aims to address are the legal and regulatory efforts by some states seeking more oversight of the crisis pregnancy centers, including a California law requiring centers to clearly inform patients about their services. That law was overturned when the Supreme Court ruled in favor of crisis pregnancy centers’ argument that it violated their First Amendment rights.

The Supreme Court is that will decide whether states can subpoena the organizations for donor and internal information.

It’s unlikely that crisis pregnancy centers would face such regulatory measures in the conservative states where the legislation is under consideration. One Wyoming lawmaker acknowledged that in the February committee hearing.

Differing Services

During that hearing, state , a Republican who heads the committee sponsoring the bill, presented the measure as “so important, especially with our maternity desert,” referring to a lack of access to maternity health care services.

Some crisis pregnancy centers may have a few licensed clinicians, but many do not. Many offer free resources, such as diapers, baby clothing, and other items, sometimes in exchange for participation in counseling or parenting classes.

Planned Parenthood clinics, by contrast, provide a range of health services, such as testing and treatment for sexually transmitted infections, primary care, and screenings for cervical cancer. They also are regulated as medically licensed organizations.

Since Roe was overturned, the abortion rights movement has faced significant challenges. Congressional Republicans’ One Big Beautiful Bill Act, which President Donald Trump signed into law last summer, to abortion providers. The move contributed to Planned Parenthood closing last year.

As of 2024, operated nationwide, according to a map created by researchers at the University of Georgia, compared with providing abortions at the end of 2025.

a research organization affiliated with the anti-abortion nonprofit SBA Pro-Life America, has suggested that pregnancy centers could help fill the gap left by the Planned Parenthood closures.

Ziegler said that would leave patients vulnerable to medical risks.

Centers’ Growing Power

Previous efforts in , Colorado, and Vermont to regulate crisis pregnancy centers arose from concerns over allegations of and questions about .

In 2024, in five states to investigate whether centers were misleading patients into believing that their personal information was protected under the Health Insurance Portability and Accountability Act, known as HIPAA, and to find out how the centers were using patients’ information.

Courts, including the Supreme Court, have regularly that argue the attempts at regulation are violations of their First Amendment rights to free speech and religious expression.

Crisis pregnancy centers also have seen a flood of funding since Roe was overturned.

At least , including crisis pregnancy centers, according to the Lozier Institute.

Six states distribute a portion of their federal Temporary Assistance for Needy Families funding — cash payments meant for low-income families with children — to crisis pregnancy centers. Texas, Florida, Tennessee, and Oklahoma have provided tens of millions of dollars for the organizations.

One analysis found that crisis pregnancy centers also received from 2017 to 2023, including from the 2020 relief package signed into law during Trump’s first term amid the covid pandemic.

Despite the challenges clinics that provide abortions face, Burkhart, the head of the Wellspring facility in Wyoming, said it’s important to continue offering access to people who need it. She’s helped open clinics in rural parts of other conservative states and said those clinics continue to see people walking through their doors.

“That proves to me, regardless of your religion, political party, there are times in people’s lives that people need access to qualified reproductive health care,” she said. “That includes abortion.”

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Oz Says California’s Not Fighting Health Care Fraud, but Data Shows It’s Part of a Larger Battle

Don Thompson — Thu, 19 Mar 2026 09:00:00 +0000

SACRAMENTO, Calif. — For weeks, Mehmet Oz has been waging a public feud with California leaders over health care fraud, accusing the blue state of failing to adequately combat such abuse.

Oz, who heads the U.S. Centers for Medicare & Medicaid Services, there was approximately $3.5 billion of fraud in the hospice and home health care industry in Los Angeles County alone. “This administration under President [Donald] Trump is not going to tolerate taxpayer dollars being stolen because people aren’t paying attention anymore. We’re focused on this,” . He claimed the fraud was largely orchestrated by the “Russian, Armenian mafia” and said that most of the money spent on home and community-based services across California “might be fraudulent.”

However, CMS clarified that not all billing activities referenced by Oz were presumed to be improper. And a review of the most recent available data shows that there are hotbeds of health care fraud across the country and across practice areas, most of them allegedly perpetrated by health insurers and other domestic actors, and that California outperforms most other states in recovering fraud dollars.

As the temperature heats up in the conflict between the Trump administration and California, a handful of Republican state lawmakers have entered the fray, accusing Gov. Gavin Newsom in of allowing “rampant fraud.” Democratic state officials insist they aggressively combat fraud, and Newsom has filed a against Oz, calling language in the allegations “baseless and racially charged.”

“The Trump Administration is attempting to take the issue of fraud — a very real, and national issue — and weaponize it against Democratic states,” California Attorney General Rob Bonta said in an early February statement.

Oz said that he would halt “hundreds of millions of dollars” in payments to California if he didn’t get satisfactory answers from state officials. He and Vice President JD Vance announced in late February that they would delay about $260 million in Medicaid payments , another Democratic-led state, over fraud allegations there, and the state is now suing.

Oz has also launched social media campaigns alleging high-dollar public benefit fraud in Democratic-led Maine and New York. On March 17, he added a Republican-led state to his target list: Florida.

Georgetown University professor Andy Schneider, who served as a senior adviser primarily on Medicaid integrity issues during the Obama administration, said fraud has always been an issue across states, dating back decades. About $3.4 billion in Medicare and Medicaid fraud across the country was , according to the most recent report available. Insurers have paid the highest settlements in alleged health care fraud schemes.

“Bad actors trying to steal public health care funds have been around for a long time,” Schneider said.

How California Stacks Up

The federal government is responsible for Medicare, which primarily benefits older people, while Medicaid, which primarily serves people with lower incomes, is a joint federal-state program. Melissa Rumley, a spokesperson for the Department of Health and Human Services’ Office of Inspector General, said the office could not make state-by-state data on Medicare fraud available because the federal probes often cross jurisdictions.

States file annual reports on actions by Medicaid anti-fraud units that are jointly funded with the federal government and run by state attorneys general. They investigate fraud as well as abuse and neglect of Medicaid patients.

These reports provide a sense of the scale of Medicaid fraud across states. In fiscal 2024, states recovered , compared with $949 billion in total Medicaid spending, according to from the HHS Office of Inspector General. California recouped an outsize share, recovering more than 50% of all the criminal recoveries made by the anti-fraud units nationwide in fiscal 2024 even though the state made up only about 17% of enrollment.

California ranked fourth in the U.S. in 2024 in dollars recovered per Medicaid enrollee across civil and criminal investigations, behind the District of Columbia, Montana, and Delaware. It led all the most populous states, followed in order by Texas, Florida, and New York. (California and federal officials noted that state recovery data varies significantly year to year, often because of the length of investigations.)

Vulnerability of Hospice Care

One aspect of health care fraud that has been at the center of Oz’s attack on California is hospice fraud, which has plagued Republican and Democratic administrations.

The use of hospice, intended to provide care to patients expected to die within six months, increased by over 8% from fiscal 2020 to 2024, to about 1.84 million Medicare beneficiaries, significantly.

To combat fraud, the Biden administration in 2023 of hospices in California, Arizona, Nevada, and Texas. The Trump administration Ohio and Georgia.

CMS spokesperson Chris Krepich did not say specifically what criteria were used to choose which states to monitor, only that the decision was based on “activity typically indicative of hospice-related fraud.” As of June, the agency had revoked the Medicare enrollment of 122 hospices in the original four states, but Krepich said a breakdown by state was not available.

While Oz stated there was some $3.5 billion of fraud in the hospice and home health care industry in Los Angeles County alone, his agency clarified that the number is for overall Medicare billing related to hospice and home health services. Krepich said that “not all billing activity referenced in the remarks is presumed to be improper” and added that the agency could not identify the amount of fraudulent activity until an “evidence-based” investigation was completed.

That’s not to say there is no truth to allegations of hospice fraud.

A published in 2022 found “numerous indicators” of large-scale fraud in Los Angeles County, and a highlighted nearly 500 hospices within a 3-mile radius, including 89 companies registered to a single building in Van Nuys. that “hospice fraud has become an epidemic in California.” He noted that state officials have been aggressively combating it for years, including with .

In January, the state in Monterey County with hospice fraud. That follows hospice scam cases in and .

However, California public health officials are overdue in adopting that were supposed to be . The state’s Department of Public Health is currently revising the regulations, according to spokesperson Mark Smith.

In the interim, the state has revoked the licenses of more than 280 hospices over the past two years and is evaluating an additional 300 hospices, . California had licensed hospice agencies as of 2022, according to the state audit.

Civil Rights Complaint

Meanwhile, Newsom is pushing back on Oz. The governor filed his discrimination complaint with the at HHS, which oversees CMS. The office said it will first decide whether it has the authority to investigate, then, if so, will gather information through interviews and documents. However, the process seems designed to aid individuals who have lost a job to discrimination, or to correct a specific policy, and it is unclear whether there could be any real-world consequences.

The governor wants the agency to address “systematic bias from their leadership,” said Newsom spokesperson Marissa Saldivar.

Krepich said CMS “does not target communities, ethnic groups, or states” and bases its decisions on “confirmed investigative findings.” The allegations of organized fraud refer to “documented criminal cases,” Krepich said, providing a link to in which California residents were convicted of using the identities of foreign nationals to steal almost $16 million from Medicare.

It’s unclear what cases Oz was referring to when he spoke of the Russian and Armenian mafia.

Ciaran McEvoy, a spokesperson for the U.S. attorney’s office for the Central District of California, which includes Los Angeles County, said it doesn’t track whether hospice fraud defendants are alleged to be foreign nationals, but he pointed to the office’s online prosecution announcements. None alleged involvement by foreign influences or organized crime.

The state audit references by the U.S. Justice Department under President Barack Obama that an “Armenian-American organized crime enterprise” was behind a nationwide health care scam.

Federal officials at the time described an “international organized crime enterprise” based in Los Angeles and New York but with roots in Russia and Armenia. The scheme involved billing for unneeded medical treatments, not hospice fraud.

A revealed fraud schemes in which hospice operators recruited patients who were not actually terminally ill, then paid kickbacks to doctors who falsely certified these patients as dying so the hospices could bill Medicare. There was no mention of foreign involvement.

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The NIH Workforce Is Its Smallest in Decades. Here’s the Work Left Behind.

Rachana Pradhan — Fri, 06 Mar 2026 19:30:00 +0000

The National Institutes of Health has lost thousands of workers since President Donald Trump began his second term.

Among them: scientists who pioneered cancer treatments, researched tick-borne diseases, or worked to prevent tobacco use.

We spoke to a half dozen scientists who said they left the agency because of the tumult of 2025 and talked about the work they left behind. They say the exodus from the world’s largest public funder of biomedical research will harm the nation’s ability to respond to illness.

“People are going to get hurt,” said Sylvia Chou, a scientist who worked at the National Cancer Institute in Rockville, Maryland, for over 15 years before she left in January. “There’s going to be a lot more health challenges and even deaths, because we need science in order to help people get healthy.”

The NIH consists of 27 institutes and centers, each with a different focus. Major research areas include cancer; infectious diseases; aging-related diseases such as Alzheimer’s; heart, lung, and blood diseases; and general medicine.

Over decades, the value of the NIH may be the one thing everyone in Washington has agreed on. Lawmakers have routinely boosted its funding — even for this fiscal year, in defiance of the White House, which had proposed cutting the agency’s funding by 40%.

Our reporting showed that, nonetheless, the Trump administration’s actions to curb certain research and push out scientists perceived as disloyal are having far-reaching repercussions. The NIH workforce stands at about 17,100 people — its lowest level in at least two decades.

Scientists across specializations outlined challenges that made them decide to leave. They included delays in accessing research equipment and supplies, the termination of funds for topics the Trump administration deemed off-limits, and delayed or denied travel authorizations.

Even research aligned with the Trump administration’s stated priorities has suffered, they said. They questioned whether the NIH could continue to fulfill its mission to “enhance health, lengthen life, and reduce illness.”

“It’s clear when someone comes out with a drug and now you’ve just cured a disease. But you never know which ones could have been cured,” said Daniel Dulebohn, a researcher who spent nearly two decades at Rocky Mountain Laboratories in Hamilton, Montana. “We don’t know what we’ve lost.”

Dulebohn left the NIH’s infectious disease and allergy institute in September and is considering leaving the scientific field altogether.

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Six Federal Scientists Run Out by Trump Talk About the Work Left Undone

Rachana Pradhan — Fri, 06 Mar 2026 10:00:00 +0000

Marc Ernstoff, a physician who has pioneered immunotherapy research and treatments for cancer patients, said his work as a federal scientist proved untenable under the Trump administration.

Philip Stewart, a Rocky Mountain Laboratories researcher focused on tick-borne diseases, said he retired two years earlier than planned because of hurdles that made it too challenging to do his job well.

Alexa Romberg, an addiction prevention scientist focused on tobacco, said she “lost a great deal” of the research she oversaw when federal grants vanished.

“If one is thinking about the ‘Make America Healthy Again’ agenda and the prevention of chronic disease,” Romberg said, “tobacco use is the No. 1 contributor to early morbidity and mortality that we can prevent.”

The National Institutes of Health is the largest public funder of biomedical research in the world, with a to “enhance health, lengthen life, and reduce illness.”

Over decades, the value of the NIH may be the one thing everyone in Washington has agreed on. Lawmakers have routinely boosted its funding.

“I’m so pleased to be associated with NIH,” former Sen. Roy Blunt, a Missouri Republican and one of the NIH’s biggest champions in Congress, shortly before he retired.

But in President Donald Trump’s second term, the NIH has seen an exodus of scientists like Ernstoff, Stewart, and Romberg. Federal data shows the NIH lost about 4,400 people — more than 20% of its workforce. Scientists say the departures harm the U.S.’ ability to respond to disease outbreaks, develop treatments for chronic illnesses, and confront the nation’s most pressing public health problems.

Why They’re Leaving

��ϳԹ�� News interviewed a half dozen scientists who said they quit their jobs years before they’d planned to because of the tumult of 2025.

Only a few years ago, the NIH workforce was steadily growing, from roughly 17,700 employees in fiscal year 2019 to around 21,100 in fiscal 2024, federal data shows. Under Trump, those gains have been slashed.

The Trump administration enacted a campaign to purge government workers perceived as disloyal to the president. People were fired or encouraged to leave. Officials instituted a months-long freeze on hiring.

The NIH workforce has plummeted to about 17,100 people — its lowest level in at least two decades. Most who left weren’t fired. Roughly 4 in 5 either retired, quit, had appointments that expired, or transferred to a different job, according to federal data.

Physician Marc Ernstoff joined the National Cancer Institute in 2020 to shepherd research on how the immune system responds to cancer, to advance the development of drugs that help patients live longer. Ernstoff said he left his job in October because, under President Donald Trump, the National Institutes of Health had turned into a “hostile work environment” and he was denied permission to work remotely. “I was not ready at all to retire,” Ernstoff says. (Rob Strong for ��ϳԹ�� News)

Scientists watched with dread as their colleagues were forced to terminate research funds for topics the Trump administration deemed off-limits. Across NIH labs, routine work stalled. They said they faced major delays in accessing equipment and supplies. Travel authorizations were slowed or denied.

Agency staff were instructed not to communicate with anyone outside the agency. When they could talk again, they were subject to greater constraints on what they could present to the public.

And under the administration’s agenda to eliminate “diversity, equity, and inclusion,” references to minorities or health equity were purged from NIH-funded research. Initiatives to protect Americans’ health were gutted. Among them: support for early-career scientists, ways to prevent harm from HIV or substance use, and efforts to study how different populations’ immune systems respond to disease.

, Chou and Romberg were among a group of NIH scientists who said they resigned in protest of an administration “that treats science not as a process for building knowledge, but as a means to advance its political agenda.”

Alexa Romberg says she thought she would spend the rest of her career at the NIH before the Trump administration made it untenable. “It took a long time to really decide to give up on that, and that that wouldn’t be the future for me,” she says. (Eric Harkleroad/��ϳԹ�� News)

A ‘Fundamental Destruction’

Health and Human Services spokesperson Emily Hilliard said in a statement that the agency had shifted to focus on evidence-based research over “ideological agendas.” She said the NIH is still recruiting “the best and brightest” and advancing high-quality science to “deliver breakthroughs for the American people.” The federal health department oversees NIH.

“A major reset was overdue. HHS has taken action to streamline operations, reduce redundancies, and return to pre-pandemic employment levels,” Hilliard said.

Many scientists, however, question whether the NIH can still fulfill its public mission.

“There’s been a fundamental destruction,” said Daniel Dulebohn, a researcher who spent nearly two decades at Rocky Mountain Laboratories in Hamilton, Montana. It’s going to “take a very, very long time to rebuild.”

Dulebohn left the NIH’s infectious disease and allergy institute in September.

He analyzed how molecules and proteins interact in diseases, such as Lyme disease, HIV, and Alzheimer’s — information that’s key for new treatments. Dulebohn was a resource for scientists when they hit walls trying to understand, for example, if molecules could prevent infection or react to a treatment.

Now he and his wife are living off savings in Mexico with their three young kids. Dulebohn’s thinking about what’s next. One option: real estate.

The expert in biochemical analysis operated equipment few others know how to use. His exit further depletes resources in the specialty.

“It’s clear when someone comes out with a drug and now you’ve just cured a disease. But you never know which ones could have been cured,” Dulebohn said. “We don’t know what we’ve lost.”

Laura Stark, a Vanderbilt University associate professor who specializes in the history of medicine and science, said wiping out NIH staff will propel a shift toward private-industry research, with its profit motives, “as opposed to actually helping American health.”

“We just don’t have people who are now able to pursue research for the public good,” Stark said.

From Support to Scrutiny

Stark said the seeds of the present-day NIH were planted during World War II when the U.S. government spearheaded an effort to mass-produce the antibiotic penicillin to save soldiers from infections.

The agency has played a central role in lifesaving discoveries and treatments — including for heart disease, cancer, diabetes, and genetic diseases such as cystic fibrosis.

With bipartisan backing from Congress, the NIH budget has grown significantly over time, sitting at $48.7 billion for fiscal 2026. The NIH allocates roughly 11% of its budget for agency scientists. About 80% is awarded to universities and other institutions.

The money may be there, but the people who get it out the door are not, scientists said.

Jennifer Troyer left the National Human Genome Research Institute in Bethesda, Maryland, on Dec. 31, after working in various positions at the NIH for about 25 years. The division she led reviews research and oversees grants to organizations studying the human genome — or a person’s complete set of genes — and how it can be used to benefit health.

Last year, she said, her division lost about two-thirds of its staff. “There really are not enough people there right now to actually get the work done,” Troyer said. “It’s extreme harm.”

She decided to quit the day Trump issued an in August that prohibited the use of grants to “fund, promote, encourage, subsidize, or facilitate” what it described as “anti-American values.” It also allowed political appointees to review all funding decisions.

“I wasn’t going to operate a division under those orders,” Troyer said. She hasn’t figured out her next career steps.

Jennifer Troyer left her job at the National Human Genome Research Institute in December, after working at the NIH as a contractor or civil servant for more than two decades. (Eric Harkleroad/��ϳԹ�� News)

‘Enough Is Enough’

Research aligned with the administration’s stated priorities has suffered.

HHS Secretary Robert F. Kennedy Jr. has called the diagnosis and treatment of Lyme disease — a tick-borne infection that can cause debilitating lifelong symptoms — . In December, Kennedy said the government had long dismissed patients burdened with a disease that in the U.S. are diagnosed with annually.

That same month, Stewart, who had dedicated his career to ticks and Lyme disease as a federal scientist, retired early. He’d worked for the government for 27 years. Stewart said workforce cuts and travel delays stalled his efforts to confirm how far Lyme-carrying ticks had spread — information that could help doctors recognize symptoms sooner.

Philip Stewart says the Trump administration had created too many hurdles over the past year for him to do his job well. (Katheryn Houghton/��ϳԹ�� News)

Stewart was a lead scientist on research published last year , or deer tick, in Montana. It was the first time the tick best known for transmitting Lyme disease had been confirmed in the state. He wanted to determine if the discovery was a fluke or an indicator that the species was gaining ground.

“The advice we’ve been getting is, ‘Put your head down below the trench line. Don’t look. Don’t peek over and risk getting shot,’” Stewart said. “At what point do you finally say, ‘Enough is enough’ and ‘We’re not being effective anymore’?”

Scientists said those early in their careers are looking abroad for jobs and training. People who want to stay in the U.S. are running into problems getting hired because of cuts to research grants and uncertainty about funding.

Collectively, people studying diseases warn the U.S. could lose its long-held position as the global leader in biomedical research, with devastating impact.

Stanley Perlman, a University of Iowa virologist who studies pediatric infectious diseases, said that title earned the nation more than prestige; it drew top scientists from the world over to the U.S. to study diseases that particularly affect people here.

There’s no guarantee halted research will be picked up elsewhere, whether by private industry or other countries. If others are doing that work, Americans could face delays in seeing benefits, he said.

“If you don’t have access to how the work was done,” Perlman said, “it’s harder to reproduce and adapt it for your country.”

��ϳԹ�� News data editor Holly K. Hacker contributed to this report.

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The People — And Research — Lost in the NIH Exodus

Rachana Pradhan — Fri, 06 Mar 2026 10:00:00 +0000

‘No Longer Based on Facts or Truth’

Sylvia Chou, 51, Maryland

Program director, National Cancer Institute

(Eric Harkleroad/��ϳԹ�� News)

Sylvia Chou specializes in communication between patients and their health care providers, and social media’s role in public health. She joined the federal government in 2007 as a fellow and became a civil servant in 2010.

She left her National Cancer Institute job in January, she said, because the “work is no longer based on facts or truth.”

After President Donald Trump returned to office, Chou said, health communication scientists like her were falsely accused of “essentially doing propaganda work.” The administration’s “anti-DEI hysteria,” she said, referring to diversity, equity, and inclusion, meant research funded by the National Institutes of Health was flagged and scrubbed of references to “equity, vulnerable, underserved, poor, even communities of color, minorities.”

She said the agency’s climate in 2025 brought to mind her childhood in Taiwan, when the island was still ruled by an authoritarian regime.

“I could see the difference between a time when, you know, we have a choral competition and we have to sing the same songs to revere the leader of the country, to suddenly they say you can sing any song you want,” Chou said. “I came to this country in part because there was so much opportunity to think freely.”

“To see us going backwards,” she added, “it just made me feel like I have limited time on this earth and I cannot participate anymore inside the system.”

‘One Hurdle After Another’

Philip Stewart, 60, Montana

Staff scientist, National Institute of Allergy and Infectious Diseases

(Katheryn Houghton/��ϳԹ�� News)

Philip Stewart’s work was about understanding the pathogens ticks carry that make people and animals sick.

That often started with walks through tall grass searching for the arachnids. He analyzed them back at Rocky Mountain Laboratories.

When Trump entered office in 2025, Stewart experienced repeated disruptions to his work.

“It’s been one hurdle after another. Just when you’ve gotten over one and you think it’s finally behind you, another hurdle pops up,” Stewart said. “I don’t see that changing.”

NIH workers responsible for buying laboratory supplies were fired. As a result, Stewart said, he faced delays in getting the basics, including materials used to identify tick species.

Travel bans in early 2025 threatened his fieldwork. When those bans lifted, Stewart said, for the first time in his career he needed a presidential appointee’s approval to travel. Amid last year’s government shutdown, Stewart missed his only opportunity in the year to collect ticks from deer at hunting stations — his best chance to see if deer ticks had become established in Montana.

The review process for scientists to share their research became more burdensome.

He said scientists have debated whether they should try to stay and work within the system, adding that, if everyone leaves, “no cures get found.”

“If I saw a way to stay on and be useful and perhaps to protest, then I think I would’ve stayed,” Stewart said. “But I don’t see any of those alternatives.”

‘Losing a Lot of Expertise’

Alexa Romberg, 48, Maryland

Deputy branch chief, National Institute on Drug Abuse

(Eric Harkleroad/��ϳԹ�� News)

Alexa Romberg is a scientist who specializes in preventing the use of and addiction to tobacco, electronic cigarettes, and cannabis. The harms that stem from substance use or addiction don’t affect all Americans equally, she said.

Romberg left her “dream job” at the National Institute on Drug Abuse in December, she said, because Trump policies had compromised the research she helped oversee. Among other things, Romberg said, grants were terminated under an initiative she led to reduce health disparities among racial and ethnic minorities related to substance use. Pending applications were also pulled, she said, adding, “I couldn’t be effective from the inside in actively really preserving the science.”

Romberg said her work was undone even though it was consistent with “what the NIH leadership is saying that they want.” In August, NIH Director Jay Bhattacharya on priorities that included “solution-oriented approaches in health disparities research.”

Before the upheaval throughout 2025, she thought she would work at NIDA for the rest of her career.

“We’re losing a lot of expertise,” Romberg said. “Both scientific,” she added, and “institutional knowledge.”

Research ‘for the Benefit of Our Society’

Marc Ernstoff, 73, Maryland and Vermont

Branch chief, National Cancer Institute

(Rob Strong for ��ϳԹ�� News)

Marc Ernstoff spent most of his career in academia before joining the National Cancer Institute in 2020. He led a team of scientists who oversaw grants for research into how the immune system responds to cancer, with the goal of developing drugs that extend patients’ lives.

“I felt that it was important for me to help define a national agenda in immuno-oncology and to give back to a country that I love by working as a civil servant,” Ernstoff said.

Under Trump, the NIH became a “hostile work environment.” Projects with “no weaknesses” were denied funding. Ernstoff left because of those challenges and because he was denied permission to work remotely. He now has a part-time position at Dartmouth Health in New Hampshire.

Leveraging a person’s immune system to fight off cancer is “just the beginning of the story,” Ernstoff said. Understanding how the immune system works — and the environmental and other factors that affect it — all “goes into developing better therapeutics for patients.”

“In my opinion, the government has a responsibility to support this kind of research for the benefit of our society,” he said.

Eyeing Less Stress, Better Pay

Daniel Dulebohn, 45, Montana

Staff scientist, National Institute of Allergy and Infectious Diseases

(Angela Saporita)

At Rocky Mountain Laboratories, Daniel Dulebohn studied how molecules come together in infections and diseases. He helped agency researchers across the nation get insight needed for new discoveries and treatments.

Dulebohn said he worked for the government because he knew his research wouldn’t be steered by the pressure to make money. He had planned to stay indefinitely.

“You’re trying to cure a disease or understand something fundamental about biology,” Dulebohn said.

But then his work began to feel insecure, especially as as inept, corrupt, and partisan.

“Reading the news and hearing people discuss the validity of vaccines,” he said, made him think, “Do we need iron lungs again, or people in wheelchairs, to say, ‘Huh, maybe vaccines are a good idea’? I mean, I don’t know; for me, it was just too much.”

He added federal researchers typically have other options for jobs with bigger paychecks.

Dulebohn left his job in September. He’s taking a year off to think about next options with his wife and their three young kids. Dulebohn said he’s considering going into real estate full-time, which until recently was a weekend hobby.

“It’s a lot less stress,” he said. “Pay is better.”

‘Susceptible to Political Decision-Making’

Jennifer Troyer, 57, Maryland

Division director, National Human Genome Research Institute

(Eric Harkleroad/��ϳԹ�� News)

Jennifer Troyer’s work for the NIH most recently involved reviewing research and overseeing funding awarded to institutions for genomics research. Genomics studies all of a person’s genes to better understand health and disease risk.

She called it quits at the end of December, more than two decades after she arrived. She left for one reason, she said: “The way that the NIH is making the agreement to fund science is now susceptible to political decision-making in a way that it was not before.”

“NIH is looking at not the value of the science but whether the science falls within particular political or socially-acceptable-to-this-administration constructs,” she said. “Not whether it’s valuable for human health but whether it might offend somebody.”

For example, she saw HHS move to to Harvard after alleging that it had shown “deliberate indifference” to antisemitism on campus. Early-career investigators from minority backgrounds lost their research dollars because the money was awarded under programs to make the science workforce more diverse.

The loss of staff means the NIH has “lost so much of that institutional knowledge and leadership, which is not something that is easy or can be learned overnight,” she said.

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