This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

On that rainy Friday afternoon, hundreds of such mourners gathered to honor the man who went to the police department for help and didn’t come back.

“Stay woke. Stay guarded,” his daughter Lania Gilmore told the church full of mourners in this city of fewer than 16,000 with a long, troubled history of racial violence. “Be there for your family and love on one another.”

Her father, a 44-year-old Sikeston resident, died in police custody on June 10. During a quick, physical altercation involving seven Sikeston police officers, he was shocked with a Taser and put into hobble restraints, which allow officers to hogtie a person’s feet and hands, according to a through a public records request. Two autopsies were performed, but they — and Gilmore’s cause of death — had not been released as of mid-July while the result of a toxicology report remained pending.

Gilmore had approached an officer in the parking lot of the police station, according to the report, speaking words the officer said he could not understand. Lania Gilmore said that her dad, who had mental health issues, had asked her to call the police department and that he ran there seeking help.

“I kind of trusted the fact that he was OK because he was at the police station,” she told ºÚÁϳԹÏÍø News.

At his funeral, hardly anyone spoke of the police — and, at the family’s request, the funeral home declined to ask police to provide traffic assistance as they usually would. A preacher did his best to comfort Gilmore’s family. “Sometimes we need not talk,” the Rev. Tommy Robinson Jr. told the crowd. “We just need to listen.”

But after years of expressing concerns of racial bias within the city’s police department, some Black Sikeston residents wonder if anyone is listening at all anymore. They want justice even as the national reckoning over police brutality has faded from public view.

“We need the police. We just need them to do their jobs correctly and leave Black people alone,” said Mark Wiggins, president of Sikeston’s NAACP branch. “They know it. We know it. The truth of the matter is there’s a lot of unwarranted cop killings of Black men in America.”

But despite worldwide protests in 2020 in the wake of high-profile police-involved killings of Black people, the public paid little attention when a prestigious group released a report last year about deaths in custody, said Roger Mitchell Jr., a forensic pathologist finishing his term as president of the , which represents African American physicians. The urged Congress to require states to collect and report data on all in-custody deaths, a problem that Mitchell said disproportionately affects Black men.

“We are in an anti-diversity environment,” Mitchell said. “We’re in a war.”

Upon returning to the White House last year, President Donald Trump that targeted diversity, equity, and inclusion programs. As a result of that and other measures, funding for racial equity has dwindled, researchers who once studied violence as a public health issue have redirected their work to less politically charged topics, and a growing fear of professional and political retaliation has made it increasingly difficult to sustain the momentum.

Kevin Myles, a civil rights leader based in Georgia who has trained tens of thousands of activists around the country, said he saw a shift in priorities around racial equity before Trump was reelected. Since then, it has escalated, he said, and he has lost at least half his funding for his work on equity, child welfare, and mass incarceration.

“I don’t think we really were prepared. It’s not that we didn’t take it seriously. I don’t think we were psychologically prepared for what this means,” Myles said. “Everything we have done before now was practice. The game has just started.”

Sikeston, located in the rural area of southeastern Missouri known as the Bootheel, has a history of racial violence, including the brutal lynching of a Black man named Cleo Wright in 1942. Another Black man, Undraus Nabors, was found dead in a grain silo months after heading out to pick up his white girlfriend in 1999. In April 2020, less than a month before George Floyd’s murder in Minneapolis, an unarmed Black man, Denzel Taylor, was shot at least 18 times by Sikeston police officers. The city was the subject of the 2024 “Silence in Sikeston” documentary film and podcast by ºÚÁϳԹÏÍø News, Retro Report, and WORLD.

Silence in Sikeston

Watch: New Documentary Film Explores a Lynching and a Police Killing 78 Years Apart

The “Silence in Sikeston” documentary film explores how the nation’s first federally investigated lynching and a police killing 78 years apart haunt the same rural Missouri community. The film from ºÚÁϳԹÏÍø News and Retro Report explores the lasting impact of such trauma — and what it means to speak out about it.

Larry McClellon, a longtime Sikeston resident who founded a civil rights group called And Justice for All, has expressed concerns about the integrity of his city’s police department for decades. He’s also convinced that being vocal about racism in Sikeston comes with a price.

“It’s a dark side of Sikeston that a lot of people do not know and don’t prefer to know,” McClellon told ºÚÁϳԹÏÍø News in 2021 after police fatally shot Denzel Taylor. “But I’ve walked the streets.”

He believes someone burned down the headquarters of And Justice for All in 2019. A said the fire was “suspicious in nature.” The electricity in his building wasn’t on when flames erupted, he said, so he wasn’t satisfied when an investigator called it an electrical fire. He asked the department to take another look. No one was charged.

James McMillen, the city’s police chief, told ºÚÁϳԹÏÍø News in 2021 that he had plans to improve policing before Taylor died. At the time, McMillen, who is white, said he and his department had “a poor relationship” with Black residents in the city. He started some community meetings after Taylor’s death, but he said in 2024 that people had stopped showing up.

“We have tried,” the chief said during a this month. “But, as my daddy would say, a relationship is a two-way street. And so I don’t know what else I can do.”

During the meeting, Lania Gilmore pleaded with the city to release more information about her father’s case. Other residents wanted to know why the officers involved were not placed on administrative leave immediately after Gilmore died.

“It depends on the circumstances. It does,” McMillen told them. “You’re assuming a certain set of details that you don’t know.”

Another resident asked the city about training for officers. McMillen said his officers are trained. Nationwide, many communities have to assist people in crisis.

“Chief does not want anybody to be mistreated at all. Period,” Sikeston Mayor Greg Turnbow, who is white, said at the meeting. “And I guarantee you, I put my life in his hands. I’d do it today.”

McMillen declined to comment on ºÚÁϳԹÏÍø News’ questions about Gilmore’s case and the community’s concerns about the department. The Missouri State Highway Patrol investigated the death and planned to refer the results to the Cape Girardeau County prosecuting attorney, Sgt. Bradley Germann said.

The day Gilmore died, his daughter said, he had been anxious and was looking for a “safe space.” So, she said, he had spent much of the day watching her braid hair at the salon where she works, then he went with her to her eyelash extension appointment. Lania Gilmore said he was still feeling undone, but she needed some space, so he asked her to call the police instead. She said she did, then she watched him run toward the police station.

The rest unfolded within 30 minutes, according to the police report and . The police report said that, amid an ensuing scuffle, Gilmore bit one officer’s hand — “but did not break the skin.”

After the police stunned and restrained Gilmore, a paramedic gave him a sedative, and the emergency medical services took him to a hospital, according to the police report. The report listed five victims — all police — and accused Gilmore of third-degree assault and resisting arrest.

Lania Gilmore said police told her that her father overdosed. But she said she doesn’t understand how that would have been possible, given the short time between when he left her and an ambulance was called.

The city’s police force knew Gilmore had mental health issues, his daughter said. Police officers in a neighboring community “excessively tased” and beat him in 2020, . He received a $65,000 settlement five years later, and she said that experience left a mark.

After Gilmore died, Louis Houston, a longtime Sikeston resident, said he decided to move 30 minutes outside the city to a neighboring community, where he feels safer. He said hearing about other Black Sikeston residents being harassed by the police department had started to affect his mental health.

“I got on away from here,” said Houston, who returned to Sikeston for the funeral.

Houston’s already thinking about the conversations he will have with his young children about how to respond if they ever interact with a police officer. He has a script in mind.

“Be careful,” Houston plans to tell them. “They can help you, but they also can kill you.”

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Related Article

No One Wants To Talk About Racial Trauma. Why My Family Broke Our Silence.

Every family has secrets. I spent the past few years reporting about racial violence in Sikeston, Missouri. Interviewing Black families there helped me uncover my family’s traumatic past, too.

By Cara Anthony Sept. 13, 2024

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

In June, Vincent Munster, an infectious disease researcher at the National Institutes of Health, was charged with bringing biological specimens into the U.S. without proper documents. Weeks later, Sen. Rand Paul (R-Ky.) ordered Anthony Fauci, Munster’s former boss, to appear before a Senate committee, alleging that he’d lied to Congress about the covid-19 pandemic’s origins. This spring, the FBI detained a former aide to Fauci, and federal officials banned a virus researcher in North Carolina from receiving federal funding.

In each case, senior U.S. officials and members of Congress have leaned into unproven theories that arrogant scientists damaged rather than protected public health by recklessly experimenting with covid and other killer viruses, including in China.

Conservative groups and social influencers have amplified that view through a whirlwind of covid conspiracy theories, bioterrorism fearmongering, and anti-immigration sentiment. The recent charges stirred long-held mistrust of the high-security Rocky Mountain Laboratories, where Munster works, among residents of this blue-collar mountain town in Montana built on logging.

A dozen scientists interviewed for this article said that any crimes or errors committed by Munster, who was transporting vials of inactivated mpox for research purposes, seemed to be over paperwork and posed no threat to the public. Nonetheless, some colleagues in Montana said, the alleged improprieties needlessly bat a hornet’s nest.

“This just gives ammunition to the people that are trying to stop this valuable research,” said Kim Hasenkrug, a scientist emeritus at the NIH who worked at Rocky Mountain Labs for 31 years. “Even people who have trusted us in the past, this sows seeds of distrust. How could it not?”

Cuts to U.S. foreign aid and research funding have left tens of millions of dollars in gaps in the fight against spreading Ebola and mpox outbreaks, scientists told ºÚÁϳԹÏÍø News. “When the next pandemic comes around and we need vaccines to protect ourselves, the chances are that China will develop them before we do,” said Kristian Andersen, an evolutionary biologist at Scripps Research. Andersen co-authored studies that stoked the ire of proponents of the theory that a lab leak started the covid pandemic.

Emily Hilliard, a spokesperson for the Department of Health and Human Services, which includes the NIH, said the federal government “remains fully equipped to protect Americans and respond to emerging public health threats.” She said the Centers for Disease Control and Prevention had deployed experts domestically and internationally to respond to Ebola.

Scientists like Munster are indispensable for figuring out the source of pandemic viruses, whether bats, pigs, rats, or some other animal, Andersen said. Munster “is the person who goes out to Africa to get samples of bad viruses from people,” said Stanley Perlman, a virologist at the University of Iowa and a longtime member of the FDA’s vaccine advisory panel. “He’s done lots of things that needed to be done, and he does them well.”

Authorities arrested Munster and Claude Kwe, a research fellow at Rocky Mountain Labs, June 2 on charges of conspiracy to smuggle mpox into the United States and lying to border agents. They had been stopped Jan. 25 at the Detroit airport after returning from the Republic of Congo.

The announcing the charges said FBI testing had confirmed the viruses were inactivated — Munster helped — but that the scientists jeopardized Americans’ safety.

“These NIH experts apparently broke our laws by smuggling viral pathogens on a packed commercial airplane from an outbreak in the Republic of Congo. Let that sink in,” said Jerome Gorgon, U.S. attorney for the Eastern District of Michigan.

The says Munster and Kwe falsely told customs agents the mpox specimens they brought back were for diagnostic use. Yet several scientists told ºÚÁϳԹÏÍø News that the specimens most likely were indeed for use in developing mpox diagnostic tests.

The complaint also states that the scientists lacked the appropriate documents. requires researchers to register and certify inactivated viruses.

“He is presumed innocent and we will have to await future proceedings before commenting,” Kwe’s federal community defender, Benton Martin, said of his client.

In Montana, Marshall Bloom, an associate director at Rocky Mountain Labs, told the Ravalli County Board of Health in a July meeting that the scientists have been suspended and aren’t allowed on campus amid an internal NIH investigation. “These are not trivial accusations,” Bloom said.

It is not illegal or unheard of to take an inactivated virus on a plane. If the samples were inactive, “the risk is zero,” said Daniel Jernigan, who worked for 26 years at the CDC and led its National Center for Emerging and Zoonotic Infectious Diseases until retiring last August.

“But you have to have the documentation available,” he added.

Jernigan recalled reprimands issued for this sort of lapse but knew of no arrests.

“In this climate,” Perlman said, “you’d want to make sure you talk to people at your institution to make sure any i’s are dotted and t’s are crossed.”

Munster’s attorney didn’t respond to multiple interview requests.

Skeptical Neighbors

Conservative politicians and others skeptical of the nation’s covid response have had Munster and Rocky Mountain Labs on their radar for years.

The facility is in Hamilton, a town of 5,000 in rural Ravalli County, which gave President Donald Trump 69% of its vote in 2024. The lab got its start with studies of Rocky Mountain spotted fever in the 1900s, when ranchers and cattle were dying from the then-unknown disease.

Today it is a Biosafety Level 4 facility, one of only several dozen labs in the world to employ the highest level of safety controls that enable scientists to study the deadliest pathogens.

Munster and his laboratory of viral ecology are known as the “go-to group for highly dangerous viruses” such as Middle East respiratory syndrome, Nipah, Ebola, and bird flu, said zoologist Peter Daszak, whose work has also been targeted in recent years. Munster “goes into red zones,” gets samples from sick people, and makes diagnostic tests that help assess an outbreak and how to stop it, Daszak said.

Munster and his colleagues contributed to studies of , , and — work that put the lab in the crosshairs of people warning about the dangers of biomedical research.

In April, the White Coat Waste Project, a self-described government watchdog group to stop tax-funded animal testing, paid for billboards across seven cities with NIH-funded labs, including Hamilton.

The next month, about the investigation into Munster, citing an anonymous letter. That caught the attention of Laura Loomer, a far-right activist known as a loyalty enforcer for Trump who has the president’s ear. She posted about it to her 1.9 million followers on the social platform X.

“Fauci Holdovers at @NIH and @HHSGov are about to unleash Ebola in America,” Loomer posted on May 17, asking why Munster, who is Dutch, and Kwe, from Cameroon, weren’t imprisoned or deported.

Little more than a week later, Montana Republican U.S. Sen. Tim Sheehy sent a letter to HHS calling for an investigation, saying the alleged improper behavior by the scientists could threaten national security.

Munster and Kwe were charged days later. U.S. Rep. Paul Gosar, an Arizona Republican, in mid-July as a reason to close the Hamilton facility, part of his ongoing “Fauci-era programs.”

The arrests added to local apprehensions about the facility.

 “You can’t pick and choose which rules you follow when you’re dealing with this stuff,” County Commissioner Jeff Burrows said at a June meeting. “And I know he’s innocent until proven guilty, but for God’s sakes, this is a big deal.”

The Ongoing Push To Blame Fauci

About two weeks after the charges, departing Director of National Intelligence Tulsi Gabbard released declassified documents that she said proved Fauci had lied to Congress about NIH-funded research at the Wuhan Institute of Virology, the lab that, in her words, “sparked covid.” The documents, however, provide no new evidence that the lab launched the covid virus. Most, though not all, virus experts think the best evidence indicates the virus jumped from bats to other animals, and then to humans at a Wuhan market.

of the lab-leak theory have issued fresh calls to punish Fauci, 85, and scientists his institute funded. Fauci declined to comment for this article.

Shortly after Gabbard’s report, Paul, who chairs the Senate Homeland Security and Governmental Affairs Committee, subpoenaed Fauci to testify before the committee.

Fauci “was Dr. Frankenstein of the modern era” and “has the blood of millions of people on his hands,” Peter Navarro, a senior adviser to Trump, on June 25. “You idiot! … You need to come clean, Fauci.”

The administration’s mistrust of the federal bureaucracy and the scientific work it has funded has led to broad cuts and staffing losses, including in .

A May 2025 suspended research on many risky viruses, and HHS later halted an $82 million, that funded research into emerging viruses by 10 labs across the world. In late May this year, the White House that would give political appointees sweeping power over all federally funded science.

Prominent covid experts and scientists close to Fauci have been called before congressional committees, barred from receiving government grants, or arrested.

In April, heavily armed FBI agents of David Morens, Fauci’s 78-year-old former aide. They forced him to strip to his underwear and drove him in handcuffs 40 miles to a federal courthouse, where he was briefly jailed, according to Science magazine. Morens’ case is pending.

In May, HHS told Ralph Baric, a University of North Carolina coronavirus expert, that it was halting his federal funding because of a “pattern of deception” in his communications with the NIH. .

In some ways, the arrests of Munster and Kwe felt unsurprising, said Philip Stewart, a recently retired Rocky Mountain Labs researcher focused on tick-borne diseases.

“There is an anti-science movement,” Stewart said. “We are targets, and if it hadn’t been Vincent, it would have been someone else.”

Most Americans believe in the lab-leak theory, according to surveys, and several U.S. intelligence agencies lean in that direction. That makes targeting scientists who do that kind of work politically expedient, said Daszak, whose NIH-funded nonprofit worked with Chinese virologists in Wuhan and has been under scrutiny since April 2020, when Trump his funding ended.

Animal viruses jump to humans in the wild a year, usually producing negligible infections, occasionally sparking an outbreak. The Ebola virus causing the current African epidemic may have originated in bats, which seem to carry it without getting sick.

Doctors on the ground in the Democratic Republic of Congo lacked diagnostic tests . Munster, who has extensively researched Ebola, was locked out of his lab soon after the January detention.

“While we sit around removing pandemic preparedness grants, arresting scientists, locking them up in some cases,” Daszak said, “viruses are out there evolving.”

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

In February, Hawai‘i’s parole board granted the now-52-year-old compassionate release, which allows prisoners to receive early probation to seek .

But without a long-term care facility willing to accept him, Alameda has not been able to leave.

As of June, at least three other prisoners granted release to tend to their medical needs were living indefinitely in the infirmary after long-term care facilities were unwilling to accept them, primarily because of their criminal backgrounds, the state parole authority said.

“This is a challenge across the country,” said Molly Crane, an attorney for FAMM, which advocates for .

Every state allows for prisoners, though HawaiÊ»i is the only one without a specific law, relying instead on an internal policy. The prisoners who typically qualify for compassionate release can’t care for themselves or have terminal illnesses and may need an assisted living center, a nursing home, or hospice.

But many long-term care facilities nationwide decline to take such prisoners, leaving them incarcerated for months — or years — after they were granted release.

In , a study found that rejections from nursing homes soared after they were told that a patient was coming from prison. , prisoners with extensive medical needs stayed an average of 200 days after being granted parole, because of denials from long-term care centers. And in , prisoners granted parole sued the state when they couldn’t get placed in nursing homes.

President Donald Trump’s signature One Big Beautiful Bill Act further strains long-term care providers’ ability to take people from incarceration. Prisoners don’t qualify for Medicaid, so parolees after they’re granted the release. The law, enacted last summer, reduces the window in which facilities can get reimbursed from three months to before they apply. That means facilities risk not getting paid for new Medicaid patients whose applications are not submitted within the reduced timeframe.

The Centers for Medicare & Medicaid Services “encourages providers and beneficiaries to prioritize timely application submission to maximize coverage,” CMS spokesperson Timothy Foster said.

‘Risk Is Just Too High’

Most nursing homes nationwide already have a waiting list for new residents, according to a by the American Health Care Association and the National Center for Assisted Living. Those waitlists are another hurdle to getting prisoners placed, said Bob Merce, a former attorney who advocates for prisoners’ compassionate release.

“We tell the nursing homes that most of the people who we are talking about cannot hurt somebody,” Merce said.

Some of the prisoners staying at the Halawa infirmary in June couldn’t walk or dress themselves. One man couldn’t recall what his illness was. Another with brain cancer couldn’t coherently respond to questions.

Sean Sanada, the OÊ»ahu Region CEO with the HawaiÊ»i Health Systems Corp., oversees the region’s two state-funded long-term care facilities, Leahi Hospital and Maluhia. Sanada said that the health system has reviewed dozens of compassionate release referrals but has never accepted any of them.

Sanada said the facilities don’t discriminate based on where the resident comes from. His main concerns, he said, were his staff’s safety and the lack of resources to adequately care for the patient.

“The risk is just too high in most of those instances,” Sanada said.

Violent incidents in long-term care facilities have been well documented. A observing 14 assisted living facilities found that in just one month, 15% of residents experienced resident-to-resident aggression.

When long-term care facilities refuse to accept prisoners who have been granted compassionate release, it leaves state taxpayers footing a larger bill. The annual cost to incarcerate an individual in Hawai‘i with complex needs is up to eight times the $112,505 average of housing one person in prison, according to FAMM. In comparison, the average Medicaid reimbursement for a long-term care patient at a Hawaiʻi Health Systems Corp. facility is about .

Four states — Connecticut, Georgia, Massachusetts, and Vermont — contract with nursing facilities to take prisoners who are granted compassionate release, according to FAMM.

The iCare Health Network’s MissionCare Health, which operates nursing homes for people coming out of prison, secured contracts in three of those states. David Skoczulek, iCare’s vice president of business development and communication, estimated that its rates are $100 to $350 a day more per patient than the average nursing home rates in the states where they operate.

In Hawaiʻi, the correctional department determines recommendations to send to the parole board, which decides whether to grant the release. Prisoners who are granted the early probation can be released to family members who commit to caring for them or to a long-term care facility.

Corey Reincke, head of the HawaiÊ»i Paroling Authority, said that in his 24-year career he couldn’t recall getting anyone placed into a long-term care facility without family intervening, for instance by contacting facilities themselves.

“Parole has to find a facility that can meet their medical needs and is also willing to take them,” Reincke said. “That’s where we’re hitting the roadblocks.”

For one parolee, Reincke called more than 100 care homes, he said, but they all declined to accept the patient, over safety concerns. According to a 2024 state report, while HawaiÊ»i’s long-term care facilities use about workforce strains make it difficult to maintain even those levels.

HawaiÊ»i Prisoners’ Refuge: Family

Last year, 69-year-old Paul Kupihea died at a hospital five days after the state granted him compassionate release to his family. He died before he could get on a flight to his home island.

In July 2025, Lahela Kruse, the mother of Kupihea’s child, received a call from a Honolulu hospital informing her that his condition had become severe. By then he had been diagnosed with an incurable form of cancer and had been in and out of the hospital while still in custody.

Kruse and their daughter flew to Oʻahu to see him and were shocked when they saw how sick he was. Their daughter agreed to take him into her home in Hilo, on Hawaiʻi Island, despite not having a relationship with him for most of her life.

“She knew he was sick,” Kruse said. “I told her that, but she didn’t know the severity of it. I didn’t truly know.”

Her daughter’s willingness to take him prompted his compassionate release. But Kruse said the notification about Kupihea’s illness came too late.

FAMM’s Crane has been working on expanding compassionate release laws in states to allow for more prisoners to qualify and strengthen transparency in the process. HawaiÊ»i lawmakers have tried for years to pass bills on compassionate release, but none has succeeded.

Crane said without a law that outlines a formal process and who qualifies, even family support isn’t enough. Prisoners can still face life-threatening delays, she said.

“The absence of a compassionate release statute means that people who need compassionate release languish and even die in prison,” Crane said.

In Alameda’s cell, two beds stood about 3 feet apart, with a seatless metal toilet in the corner and a window looking out on a concrete wall. The smell of bleach permeated the room. Alameda said he hoped to see his daughter soon. She recently turned 5.

“I made some mistakes in my life,” said Alameda, who has been incarcerated since 2024 for drug possession, driving a stolen vehicle, and jumping bail. “I tried when my daughter was born, but I know I’ll change, because she needs me out of here.”

Merce, the former attorney, is still trying to find a place for Alameda, who committed no violent crimes. Merce became aware of prisoners’ struggles through his work as a trial lawyer. He said he has helped about 15 prisoners leave HawaiÊ»i correctional facilities for medical treatment.

He said he’s seen cases in which people have waited years to get out.

“The ones that stick with me, though,” Merce said, “are the ones that I never found placements for.”

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

“It was just too perfect,” said her mother, Shenelle Ball-Green, of those calm, hot weeks.

Then, early on July 5, four days shy of her scheduled cesarean section, Ball-Stribling began experiencing complications from preeclampsia, a potentially life-threatening blood pressure disorder. Speeding up to 110 mph, her husband drove her to the nearest hospital 25 miles away from their home in Belzoni, a Mississippi Delta town of about 1,900 people.

Minutes before reaching the facility, Ball-Stribling suffered a seizure in the passenger seat. Her husband pulled her from the car and performed CPR on the side of the road. It was too late. She and the couple’s unborn daughter, Harper, died on the side of U.S. Route 49.

The tragedy might have had a different outcome if the hospital in Belzoni, a five-minute drive from Ball-Stribling’s home, hadn’t closed 13 years ago. Today, Humphreys County has no hospital, no emergency room, no urgent care clinic, and no county health department. It is one of more than in the U.S. that have fully closed since 2005.

In Belzoni, self-proclaimed “The Heart of the Delta,” and its surrounding area, communities are close-knit, and Harmony’s story is well known. Now, her death has galvanized local and state leaders determined to bring a hospital back to the county that has suffered without one.

“It was a tremendous eye-opener for this community,” said state Rep. Timaka James-Jones, a Democrat who represents the district that includes Belzoni and is Ball-Stribling’s aunt. “It brought to light how we are so without.”

Poverty often shapes the health disparities Humphreys County residents experience. Approximately under age 65 lack health insurance coverage, compared with about 1 in 11 people nationwide. Humphreys County also has the of any Mississippi county, reflecting the economic challenges many residents face. These disparities are evident in the county’s infant mortality rate, which is at roughly 15 deaths for every 1,000 births.

James-Jones has watched these circumstances influence the lives — and deaths — of her loved ones. She said she wants to see a hospital reestablished before her four-year term is up in early 2028.

But that may be easier said than done. In Belzoni, local leaders hoping to restore healthcare services face a tangled web of policy challenges that are especially demanding for a small town with limited resources. Its story reflects what many : Once a rural community loses a hospital, bringing it back can be nearly impossible.

Humphreys County’s Healthcare Losses

Humphreys County Memorial Hospital opened in Belzoni in 1951 as part of a nationwide hospital building boom fueled by a Truman-era law called the Hill-Burton Act. The legislation provided billions of dollars in grants and loans to build and modernize healthcare facilities. At the time, had no hospital. When the building boom began to subside by 1970, in Mississippi had at least one hospital.

But by the 2000s, many rural hospitals in the U.S. confronted financial difficulties. Low patient volumes, an increase in outpatient care, and meager revenues left many on precarious footing. Many had high rates of uninsured patients or those covered through government programs such as Medicaid, which typically reimburse providers at lower rates than commercial insurers.

Humphreys County’s hospital was among those struggling facilities. It was burdened with , and county officials sold it in 2008 to a private company. It was renamed the Patients’ Choice Medical Center. The hospital shut down five years later after Ray Shoemaker, the company’s CEO, was convicted on healthcare fraud charges related to another hospital he owned.

“I do hope they reopen,” Shoemaker wrote in a recent text message to Mississippi Today. “The community needs a hospital.” He said he stepped down from the company before going to prison in 2012.

In 2017, the University of Mississippi Medical Center partnered with the county supervisors and U.S. Rep. Bennie Thompson, a Democrat whose district includes Humphreys County, to secure a from the U.S. Department of Agriculture to open an after-hours acute care clinic in Belzoni. The clinic shut down in 2020, and UMMC officials declined to say why.

G.A. Carmichael Family Health Center, a Canton-based federally qualified health center with five other locations in Mississippi, took it over but did not maintain the extended hours, again leaving Humphreys County residents without after-hours care. Other public health services in the county have closed outright. Three years ago, the county’s health department stopped providing clinical services, said Greg Flynn, a spokesperson for the Mississippi State Department of Health. The county department closed entirely last year, citing staffing shortages and low patient volumes.

In the years since the hospital closed, the county has lost a fourth of its population, falling to 7,000 people, . James-Jones said she does not believe the community can experience growth until healthcare services are reestablished.

“I don’t know how I can see us growing any other way,” she said.

‘Something’s Way Better Than Nothing’

Months after losing her daughter and unborn granddaughter, Ball-Green climbed the steps of the stately, tan, brick Humphreys County Courthouse to attend a crowded Board of Supervisors meeting.

She stood at the dais and urged the supervisors to reestablish emergency healthcare services in the county to protect other residents from the fates of her loved ones.

“I wanted to let them know at any given moment that could be your child, your mother,” she said. “We’re a small town. Everyone knows everyone.”

She remembered the disappointment she felt when the supervisors told her there was nothing they could do. But when the board’s makeup changed after the 2023 elections, she said, she saw these attitudes shift.

Among the newly elected officials was Reggie Pinkston, who is now the president of the board and previously worked as an EMT when the hospital was open. His own family has suffered the consequences of limited healthcare access. A cousin living in Louise, a town about 20 miles south of Belzoni in the county, had a stroke in 2021 and waited an hour for an ambulance to arrive. She died two days later.

Pinkston said witnessing residents’ delays in care has made expanding access to healthcare services one of his priorities.

“We’re losing too many people in our county because of lack of healthcare,” Pinkston said.

The board enlisted several consultants to develop a strategy for expanding healthcare access and identifying funding sources to support these efforts. In late 2025, Thompson secured for Humphreys County through the congressional Community Project Funding process, which allows lawmakers to request federal support for specific projects.

The funds will be used to expand services at G.A. Carmichael’s Belzoni location in a county-owned building on U.S. Route 49, Pinkston said. Expansion plans include extending its hours of operation overnight to 5 a.m., purchasing equipment, and a possible renovation of the facility. It could begin its expanded operations by September, said James Coleman Jr., the health center’s CEO.

Establishing an after-hours urgent care clinic is a starting point toward reestablishing emergency care services or a hospital, James-Jones said.

“Something’s way better than nothing,” she said.

‘Not for the Faint of Heart’

Despite that encouraging first step, Humphreys County faces steep obstacles to opening a hospital.

At the University of North Carolina-Chapel Hill, George Pink is a senior research fellow at the Cecil G. Sheps Center for Health Services Research and tracks rural hospital closures across the U.S. He said he’s aware of only a few communities that have successfully reopened a hospital after it closed.

“I can count that on one hand,” said Pink, who knows of roughly five such examples.

Communities face significant hurdles to reestablishing a hospital, including securing financing for construction or renovation, recruiting qualified staff, and covering substantial operating expenses during the licensing process before the facility can treat patients and generate revenue, said Brock Slabach, the National Rural Health Association’s chief operations officer and a former rural hospital administrator in southwestern Mississippi.

“Reopening a hospital is not for the faint of heart,” Slabach said. “Once they close, it’s very difficult to reopen them.”

To finance a potential hospital project in Humphreys County, local and state leaders said they plan to seek funding through the Rural Health Transformation Program, a federal initiative that will distribute $50 billion to states over five years. The federal government allocated Mississippi in December for the program’s first year.

The program is meant to offset budget cuts passed into law last summer that could harm rural hospitals. Republicans’ One Big Beautiful Bill Act Medicaid spending by $911 billion over 10 years and increase the number of uninsured people by 10 million, according to Congressional Budget Office estimates. Mississippi hospitals are beginning in 2029, according to Cindy Bradshaw, executive director of the Mississippi Division of Medicaid.

But , the program’s funding cannot be used for construction or major building expansions. Officials said the county will instead consider applying for funds through the program to support the recruitment of healthcare professionals.

The federal Rural Emergency Hospital designation is another way rural communities can keep emergency and outpatient services. Hospitals in that program receive over $3 million annually from the federal government and a higher Medicare reimbursement rate, but they .

Research by Pink’s team shows that many hospitals that converted to the model, which was established in 2023, saw an .

But there’s a catch. To receive the designation, a hospital must have been open in 2020, making Humphreys County ineligible. Mississippi’s junior U.S. senator, Republican Cindy Hyde-Smith, introduced legislation in 2024 to to 2014, a threshold that would have still excluded Humphreys County.

James-Jones said county leaders have urged Hyde-Smith to amend the proposed legislation so Humphreys County could qualify. Hyde-Smith did not respond to a request for comment for this article.

For county leaders, the path to widening healthcare access means navigating a thicket of state and federal policies, funding streams, and regulatory hurdles.

Some recent state-level policy changes have created opportunities for healthcare expansion in Humphreys County. In March, Republican Gov. Tate Reeves exempting Humphreys County from Mississippi’s certificate of need requirements, which are meant to prevent unnecessary healthcare expansions.

The exemption could make the county more attractive to prospective healthcare providers. But the financial challenges that contributed to the closure of Patients’ Choice Medical Center in 2013 remain, and Mississippi lawmakers have continued to reject Medicaid expansion, limiting a potential source of reimbursement for rural hospitals and clinics.

Industry officials expect hospitals’ financial pressures to intensify as Medicaid funding cuts take effect. The latest challenge is predicting how these cuts will affect the bottom lines of these facilities and whether additional cuts will come in the future, said Richard Roberson, president and CEO of the Mississippi Hospital Association.

“If someone’s trying to run a business, they’ve got to be able to know what those numbers look like,” Roberson said. “And it’s really hard to try to project that out right now.”

‘Now I Understand’

For Ball-Green, giving in to these obstacles would be a disservice to the Humphreys County residents who face health emergencies similar to the one her daughter experienced.

It has been five years since the funeral, but Ball-Green remembers it clearly. The day was stormy, but attendees brightened the gathering by wearing yellow, Ball-Stribling’s favorite color.

As friends and family gathered to pay their respects, her mother thought back on a relative’s funeral four months earlier. At that service, Ball-Stribling sang the gospel classic You Are My Strength to a roomful of mourners.

“She was singing, and she looked at me,” Ball-Green said, describing a peaceful but eerie expression on her daughter’s face in that moment — a sign of something to come, though she didn’t yet know what. “She turned around, and it was just that look, you know?”

Months later, as she sat at her daughter’s funeral, she began to interpret the foreboding glance differently. She came to believe it was a sign that Ball-Stribling’s gift for helping others by sharing her story would not end with her death.

That purpose had taken shape years earlier in her work as a teacher and continued as she shared about her fertility struggles and IVF journey in the final months of her life. Ball-Green said the community became deeply invested in her and Harper’s story.

In the years since, this gift has endured, she said. Ball-Stribling’s story has continued to resonate throughout Humphreys County, serving as a reminder of what residents stand to lose if they do not reopen the hospital.

“I think back on when she looked back at me,” Ball-Green said. “Now I understand.”

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California lawmakers an expired law that would require the state to identify companies that employ 100 or more people and have employees enrolled in Medi-Cal, the state’s Medicaid program. Nevada has had a similar law in place since 2017, though a proposal for one in Oregon stalled when its legislative session ended in March.

The California bill author, Democratic state Sen. Lola Smallwood-Cuevas, said she is deeply troubled by what is going to happen when work requirements kick in. According to the state, out of more than on Medi-Cal will be subject to the rule.

“We think this is a bill that’s about fairness,” Smallwood-Cuevas said. “It’s a basic principle that taxpayers deserve transparency about which large employers are shifting their healthcare costs onto the public.”

Large employers that regularly top Nevada’s list, such as Walmart and Amazon, have said that the state included part-time and seasonal workers in their counts and that their full-time hourly employees to qualify for Medicaid.

Walmart spokesperson Katrina Proffitt said that the company offers affordable medical coverage to most employees, including eligible part-time workers, and that most of its plans include no-cost virtual care options.

“Healthcare affordability and access to quality care remain real barriers for many Americans, and Walmart continues to be committed to being part of the solution,” Proffitt said.

The push to name and shame companies reflects dueling narratives about the biggest abusers of the joint state-federal Medicaid program, which reached nearly in government spending in 2024. The Trump administration, led by Centers for Medicare & Medicaid Services Administrator Mehmet Oz, has called out blue states for not doing enough to fight insurer fraud and abuse. State Democratic leaders, meanwhile, are pushing back by calling attention to big employers that don’t offer affordable health benefits, which leaves taxpayers subsidizing healthcare costs for the low-wage workforce.

Some states have considered financial penalties. Democratic New Jersey Gov. Mikie Sherrill signed a bill in June that have at least 50 Medicaid-enrolled employees. Companies with 50 to 249 workers on Medicaid per person, and those with at least 500 will pay $725.

Bills that would have penalized companies with workers enrolled in Medicaid failed in this year.

In Sacramento, California, Democrats want to figure out a way to make large businesses pay for their employees’ health coverage. State lawmakers struck a deal with Democratic Gov. Gavin Newsom, who is contemplating a presidential bid as he wraps up his final year in the governor’s office, to explore tax options. Any tax hike would be up to the new governor.

States face of dollars under HR 1, the GOP tax-and-spending law known as the One Big Beautiful Bill Act, notably through that requires nondisabled Medicaid enrollees ages 19 to 64 in most states to prove they are working, volunteering, or going to school at least 80 hours a month to keep their coverage.

Yet federal work requirements are projected to increase the number of uninsured people nationwide by more than 5 million by 2034, according to the . Nebraska and Montana have begun enforcing the rule.

One health policy researcher said employer Medicaid reports highlight the lack of affordable healthcare options available to low-wage workers. More than half of adults enrolled in Medicaid who don’t have dependent children already meet the 80-hour-a-month requirement or face challenges that would likely qualify them for an exemption, .

“There’s a whole set of people who are working — they may not satisfy the work requirement provisions, they may not get the exemption that they’re qualified for, and they don’t have access to that employer-sponsored insurance either,” said Edwin Park, a research professor at the Center for Children and Families at Georgetown University.

Employers Push Back

While employer lists haven’t succeeded in bringing down Medicaid costs, supporters say measuring the burden can be the first step and help lawmakers make the case for further action.

In Nevada, Amazon has employed more Medicaid enrollees than any other company since 2020, according to the state’s report . For state fiscal year 2025, Walmart, the Clark County School District, the state government, and Tesla rounded out the top five.

Employers that the reports are misleading because they have included part-time and seasonal employees. The state’s includes only full-time employees, plus those who could not be confirmed as either full- or part-time employees.

That came to 4,914 Amazon employees and 3,503 Walmart workers in Nevada on Medicaid in 2025.

There are no penalties for companies on the list.

Amazon said it pays its workers more than double the $7.25-an-hour federal minimum wage and noted that Medicaid eligibility is based on household income and size rather than an individual’s wage. That means two employees who earn the same pay may have different eligibility depending on whether they have children or live with parents.

“Pointing fingers at Amazon over Medicaid is a red herring,” said spokesperson Alisa Carroll. “What really needs to happen is a significant and large increase in the federal minimum wage — that would be a big boost for American families.”

Nevada Medicaid spent nearly $950 million on healthcare for more than 133,000 full-time employees and more than 140,000 of their dependents. While the total amount spent dipped in fiscal year 2025, the average cost per member per year increased by nearly 17%.

Yvanna Cancela, a former Nevada lawmaker who sponsored the legislation on Medicaid work reports, said the annual reports force an important conversation “about whether or not this is the kind of economy we want and whether or not it is right or just that people who work full-time don’t make enough to have health insurance.”

A Fraying Safety Net

Health researchers say that uninsured people delay or skip and that their children may end up losing coverage, too.

One analysis found that more than were enrolled in Medicaid and the Children’s Health Insurance Program this April than in January 2025. California is among the states with the among children.

The loss in healthcare coverage among residents will be compounded by the loss of public food assistance benefits, Smallwood-Cuevas said. is pending in the legislature.

She compared Medi-Cal to a trampoline that has become a “very tattered kind of fishnet” overwhelmed by people falling into it. President Donald Trump’s spending-and-tax law pulls and rips at the safety net, she said.

When people lose food assistance and health benefits, they must choose between paying for medicine and paying for rent, Smallwood-Cuevas said.

“We’re going to see more people in their cars, more people on the street, and a lot more people in the emergency room,” she said. “That is dangerous for all of California.”

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It’s a heightened concern for the estimated who are U.S. citizens or legal permanent residents, as new work requirements kick in for the federal-state healthcare program that serves low-income and disabled Americans.

Starting next year in most states, many adults enrolled in Medicaid will have to prove they work, are enrolled in college or vocational courses, volunteer, or do unpaid work for at least .

Advocates say this could pose a significant challenge to Medicaid-eligible farmworkers, who frequently work more than 80 hours a month during harvest season but less in other months. What’s more, outside the harvest season, many workers take on informal jobs in construction, landscaping, or home repair for which they don’t receive formal paychecks that would prove their continuing Medicaid eligibility. Still, they can establish eligibility if they prove their average monthly income over six months is equivalent to at least 80 hours of work at the federal minimum wage.

“Having a work requirement — having to create more paperwork and more proof — is certainly extremely challenging for farmworkers and others who are low-income and who may especially have seasonal jobs, not year-round, and do have periods” when there is no work available, said Alexis Guild, vice president of strategy and programs at .

New Requirements, Additional Hurdles

Agriculture is a , and Americans to put food on their tables. Nearly 60% of those workers are U.S. citizens or green-card holders, according to the . The remaining 40% lack legal status or are otherwise ineligible for Medicaid.

Even among farmworkers with citizenship or legal status, the uninsured rate is three times that of the general population, and most farmworkers with insurance are Medicaid beneficiaries, although participation rates vary by state. According to a , 71%-79% of eligible farmworker households report participation in Medicaid.

The new Medicaid work requirements were a key provision of the One Big Beautiful Bill Act signed last July by President Donald Trump. Under the federal law, and the District of Columbia must implement the requirements by Jan. 1. A few states have the work rule early.

The 80-hour rule applies in states that expanded Medicaid, a process that began in 2014 and was tied to the Affordable Care Act. Following the initial expansions, agricultural workers with legal documentation became to have health insurance, according to a 2021 article in the American Journal of Agricultural Economics.

Immigration Anxieties

The work requirements are the latest in a long list of obstacles placed between workers and the healthcare they’re legally entitled to, Guild said. “Medicaid certainly helps because it alleviates the cost issue,” she said. “But there are still other barriers, such as transportation, taking sick leave, and finding time to visit a health center. All these factors can prevent them from actually receiving medical care.”

For farmworkers with green cards and naturalized U.S. citizens, there is another source of stress: the fear that signing up for Medicaid could put personal information in the hands of immigration authorities.

That’s what worries Luis, a 45-year-old green-card holder and Medicaid recipient who dreams of becoming a U.S. citizen. Luis — who asked to be identified by only his middle name — lives with his wife and daughter in North Carolina, where he has worked in agriculture for nearly a decade.

Speaking in Spanish, he said that when he learned about the work requirements, he knew it would be challenging for him to prove that he works 80 hours a month. “I only work on farms for six or seven months; the rest of the year I work in whatever I can find,” he said.

Republicans in Congress argue that work requirements will reduce federal healthcare spending, encourage nondisabled adults to , and preserve safety net resources for the most vulnerable populations.

Among Hispanic adults enrolled in Medicaid, 67% are already working, according to a 2025 .

The Centers for Medicare & Medicaid Services did not respond to requests for comment for this article. But in June, when its “nationwide framework” to implement the Medicaid work requirements, Administrator Mehmet Oz said it would help beneficiaries “build skills and independence through work, education, job training, or community service, creating new opportunities for themselves and their families.” Federal officials say the new requirements “could reduce poverty by as much as 2.9 million people.”

Chronic Illness

Agricultural work is one of the nation’s , and it is associated with and , including respiratory conditions. A found that 37% of male farmworkers and 47% of female farmworkers in the state had at least one chronic health condition. The new work requirements present one more barrier for those seeking care, advocates said.

“People skip checkups and screenings, and conditions that could be caught early and treated cost-effectively” aren’t, said Adriana Cadena, executive director of .

Emergency rooms often become the “natural” place to go for healthcare, Cadena added. “This drives up waiting times and costs for all of us. … And when people are sick enough that they miss work, it starts a vicious cycle of lost productivity and family economic instability that again threatens all of us.”

A Loss for Families and Children

The new federal rules also require beneficiaries to verify their eligibility at least twice a year, twice as often as previously, creating another potential obstacle.

“Letters can easily be missed, and forms may go unfilled. If people get caught up in the paperwork, they could lose coverage,” said , an assistant vice president at , a nonprofit that promotes an equitable healthcare system.

For farmworkers who travel from state to state, the process can be especially difficult.

“You have to find the time to transfer your coverage and probably find a person or organization that can help you — and that can be really hard when you’re constantly moving,” Cadena said.

The situation highlights the difficulties of navigating a complex system for individuals and families already struggling to make ends meet.

“The result,” Cadena said, “could be the loss of coverage not only for workers, but also for their families and children.”

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So he didn’t know he had a bill to pay. After he and Tix returned home to Minnesota in April, they got a letter from Wellcare, the insurer that provided his drug plan, saying his coverage had been terminated after three months of unpaid premiums totaling $28.80. Under Medicare’s rules, he can’t enroll in a plan again until the fall, for coverage beginning in 2027.

Pare takes Xarelto, a blood thinner that reduces his risk of strokes, blood clots, and pulmonary embolism. “He could bleed to death without it,” Tix said. A 90-day supply of the drug costs about $1,800 using a coupon from GoodRx, a discount drug website, she said.

Pare is among tens of thousands of Medicare beneficiaries who were on Wellcare’s Value Script drug plan who will likely go without prescription drug coverage for the rest of the year because they didn’t pay premiums for three months.

Next year, thousands more people in 32 states and Washington, D.C., who are enrolled in zero-premium drug plans from Wellcare and other insurance companies may find themselves in the same situation if their premiums go up and they don’t realize it, according to a ºÚÁϳԹÏÍø News analysis of drug plan data. Premiums and other changes for 2027 will be unveiled in September.

Going without medication can be life-threatening, especially for Medicare beneficiaries. take one or more prescription drugs, according to the Centers for Disease Control and Prevention. Almost half live with four or more chronic health conditions that can cause functional or cognitive impairments.

Congress added prescription drug coverage to Medicare in 2003. But the coverage is administered by commercial insurance companies, which compete fiercely with one another for the business of about enrolled in drug plans.

Zero-dollar or very low monthly premiums have helped make Wellcare’s Value Script the bestselling stand-alone prescription drug plan in Medicare, with nearly 6 million customers across the U.S., according to government data. But in 26 states and Washington, D.C., some Value Script members who didn’t have to pay a premium last year were caught off guard by increases in 2026.

After a two-month grace period — which Wellcare extended to three — Medicare drug plans can drop customers who don’t pay their premiums, no matter how small the amount. Some members who lost their coverage in Nevada, for example, owed as little as $8.10 for three months, according to a ºÚÁϳԹÏÍø News analysis of Medicare drug plan data.

Wellcare terminated coverage for about 140,000 Value Script beneficiaries in April, according to a person with knowledge of the matter who was not authorized to speak publicly about it and feared reprisals at work for doing so. About 40,000 of the people who were dropped may be able to enroll in new coverage immediately because they have low incomes and receive financial assistance through a program Medicare calls “.”

Multiple state officials said they had heard the same disenrollment figures, including Nevada’s insurance commissioner, Ned Gaines, who chairs the National Association of Insurance Commissioners’ senior issues task force; Rebecca Gouty, director of the State Health Insurance Assistance Program in West Virginia; and Tim Smolen, director of Washington state’s Statewide Health Insurance Benefits Advisors. The West Virginia and Washington initiatives are part of the federally funded , or SHIP, which provides free, unbiased help navigating Medicare.

Surprise Bills

The Centers for Medicare & Medicaid Services, which oversees Medicare drug plans, declined to provide the number of Value Script members who lost coverage due to unpaid premiums. “The agency does not publicly provide plan-specific disenrollment figures or state-level breakdowns related to the non-payment of premiums,” Christopher Krepich, a spokesperson, said in a written statement to ºÚÁϳԹÏÍø News.

Centene Corp., Wellcare’s parent company, also declined to provide disenrollment numbers.

“We recognize how disruptive a loss of coverage can be and are committed to helping members understand their options,” said Sarah Baiocchi, senior vice president for specialty and prescription drug plans at Centene. She acknowledged that “some members in our Value Script plan experienced a premium for the first time, or for the first time in several years.”

Baiocchi said all Value Script members received a CMS-required annual notice of changes in September, before the premium increases took effect.

A sent to members in two states and Washington, D.C., is 21 pages long. The new premium is mentioned on pages 3 and 8, along with changes to out-of-pocket costs and how to find updates on covered drugs and network pharmacies.

The company also informed members about 2026 premium changes through phone calls, text messages, regular mail, or email, Baiocchi said.

People who are dropped are not able to reenroll or join another drug plan until the start of the open enrollment period this fall for coverage beginning Jan. 1, unless they qualify for an exception, Krepich said. And because they will have gone without coverage for at least 63 days, they could be hit with a permanent that increases every year for the rest of their lives.

“Medicare should be doing something about this so that we can go ahead and get coverage now,” said Wayne Bennett, 74, who lives in Durham, North Carolina.

In May, he found out that Wellcare had canceled his Value Script plan because he hadn’t paid his $3.60 monthly premiums. He takes nine prescription drugs to treat his blood pressure, glaucoma, chronic obstructive pulmonary disease, and other health problems. He filled most of his prescriptions — including several at no cost — before he lost coverage. He doesn’t know what he’ll have to pay when his supply runs out.

Gouty, the West Virginia program head, said many Medicare beneficiaries arrange for their monthly drug plan premium to be automatically deducted from their Social Security benefits, and that many likely thought that choice remained in place until they changed it.

“They didn’t realize that when the plan was a zero premium in 2025, that stopped the Social Security premium deduction and they would have had to reelect it for 2026,” Gouty said.

In other words, even if they mistakenly thought the premium was still zero, Medicare beneficiaries would have needed to somehow allow Social Security to make deductions — something the agency doesn’t do — or set up a payment plan through their bank or credit card in case payment was necessary.

“That sounds goofy,” Tix said.

Centene’s Baiocchi blamed the Social Security Administration for the problem: “We believe this was a key driver of non-payment disenrollments and subsequent complaints.”

Spokespeople for the agency referred questions about the matter to CMS.

Krepich said legal requirements for drug plan enrollment and disenrollment limit what CMS can do to help beneficiaries who lose coverage for not paying their premiums.

‘Pretty Upset’

Now that Pare has no prescription drug coverage, his doctor replaced his blood thinner medication with a much less expensive drug that should be just as effective. Pare paid $111 for four other medications that used to be free under his Value Script plan. He hasn’t had to refill four more prescriptions yet and doesn’t know what they will cost, Tix said.

If Wellcare members knew about the premium increases, they could have set up direct billing or an automatic payment plan early this year before the payment grace period ended April 1. But they would have been able to fill prescriptions during the grace period, so if they didn’t see Wellcare’s notices, they likely assumed there was no problem with their coverage.

Bennett, the North Carolina man, said Wellcare used to send him text messages with health tips and reminders when it was time to pick up a prescription. He didn’t know his premium had increased from $0 to $3.60 until it was too late.

“I was pretty upset,” he said, when he called the company. “The premium wasn’t that much, and I was ready to pay it right off the bat. I had my credit card out ready to make the payment.”

The customer service representative wouldn’t let him pay because his coverage had been canceled, Bennett said.

Hoping to restore it, Bennett called , a Durham nonprofit that advises Medicare beneficiaries and is one of more than 2,200 SHIP sites across the country. He was told he must wait until January to restart his drug coverage, said the group’s executive director, Gina Upchurch.

He doesn’t qualify for the “Extra Help” low-income subsidy or meet other CMS criteria for a , which would allow him to change drug plans during the year. CMS typically allows midyear switches for beneficiaries who, for example, move out of their plan’s service area, experience a natural disaster, or get help paying for drugs from a .

Senior PharmAssist was able to help one of its participants join another drug plan after she lost Value Script coverage because she is in North Carolina’s pharmacy assistance program for people with HIV/AIDS and has limited income, Upchurch said.

A further exception allows any Medicare beneficiary to enroll at any time in a drug plan that has earned five stars, the top grade in Medicare’s performance ratings. However, there are no five-star Medicare drug plans available to the general public. Only two insurers offer five-star plans, and only for retirees from certain employers. Their combined enrollment is about 8,700 as of June 1, according to the insurers.

But Upchurch, with more than two decades of Medicare expertise, doesn’t blame beneficiaries for not paying attention or for assuming Wellcare’s messages were bogus. Older adults are particularly vulnerable to identity theft and other scams and are often advised to ignore junk mail and calls from telemarketers.

Since Value Script members such as Bennett continued to get their prescriptions filled during the payment grace period, “why wouldn’t they think this was a scam?” Upchurch asked. “They are constantly bombarded by people selling them something that’s illegitimate or trying to scam them.”

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Cohen is a 38-year-old Las Vegas resident with autism and has dual enrollment in Medicaid and Medicare. He said he’s very concerned that he could lose his Medicaid coverage once work requirements and more frequent eligibility checks take effect in January, under congressional Republicans’ One Big Beautiful Bill Act.

“When you’re going to some providers, notably mental health, once a month, or in the case of one provider, a couple of times a week, those copays quickly add up,” Cohen said.

Republican Gov. Joe Lombardo is running for reelection against Democratic state Attorney General Aaron Ford in one of to be decided in November. Lombardo has , but healthcare policy changes made by the Trump administration are working against him with voters like Cohen in the swing state.

Those changes include Medicaid funding cuts that are expected to strain state budgets, along with new work requirement and eligibility rules for Medicaid and the Supplemental Nutrition Assistance Program, which provides food assistance for low-income families. The changes are expected to increase the number of people without health insurance nationwide by an estimated and decrease the number of people who receive SNAP by from 2025 to 2034.

People across the U.S. have also been feeling the pinch of rising health insurance premiums since Congress allowed enhanced Affordable Care Act subsidies to expire at the end of last year. Many who purchase health plans on the ACA marketplace have chosen less expensive plans with less coverage or are going without insurance altogether.

These changes will have a significant impact in Nevada, where tourism, hospitality, and gaming are cornerstones of the state’s economy. Nearly are self-employed, independent contractors, or freelancers without employer-sponsored health insurance benefits. Many purchase insurance through the state’s ACA health exchange, in enrollment this year after a record 110,000 people signed up for 2025.

Even before the federal changes, Nevada’s 11.4% uninsurance rate was already the , according to data from 2024. A in May that an estimated 70,000 Nevadans could lose their Medicaid coverage under the new rules. Around in the state lost access to SNAP in May.

“This is going to come down to an affordability election, and that’s going to hurt the Republicans,” said , a professor in the political science department at the University of Nevada-Las Vegas.

In a national this year, two-thirds of respondents said they were worried about affording healthcare, more than said the same about food and groceries, housing, or gas. And more than half said their healthcare costs had increased in the past year. KFF is a health information nonprofit that includes ºÚÁϳԹÏÍø News.

While most respondents said that healthcare costs will influence whom they vote for in November, the issue was more pressing among Democrats and independents.

Competitive gubernatorial races are also underway in Arizona, Georgia, Iowa, Michigan, and Wisconsin, with all those races .

The Democratic Party has the edge on healthcare issues over Republicans, but about 3 in 10 voters reported that they don’t trust either party, noted Liz Hamel, a senior vice president and the director of public opinion and survey research at KFF.

“It’s not an overwhelming advantage,” she said.

Not Your Textbook Republican Governor

Lombardo’s campaign his support for a children’s hospital set to be built in Las Vegas; his consolidation of the state’s Medicaid program, ACA marketplace, and public employee benefits program into a single agency; and the expansion of the number of community behavioral health centers in the state during his term.

Before running for governor and unseating Democrat Steve Sisolak in 2022, Lombardo served eight years as sheriff in Nevada’s Clark County. Before that he spent with the Las Vegas Metropolitan Police Department.

Lombardo has taken healthcare stances in his first term that diverge from the typical Republican playbook. For example, that he would oppose a national abortion ban, and in 2023 he prohibiting state agencies from cooperating with other states seeking to prosecute people for traveling to Nevada to get an abortion.

The governor also signed bills into law in 2023 that from engaging in gender discrimination and to ensure greater protections for transgender and nonbinary people, including setting standards for medical care and mental health treatment.

More recently, Lombardo has taken actions more aligned with the Make America Great Again movement. In 2025, he that would have created protections for clinicians who provide gender-affirming care. This year, he to ban transgender athletes from girls’ and women’s sports.

Lombardo’s campaign declined to make the governor available for an interview for this report. In a with Jon Ralston, CEO of the nonprofit news outlet The Nevada Independent, Lombardo said he was surprised during his first term as governor by how “complicated” and “encompassing” healthcare is, and by the “cost of it.”

“Government seems to complicate some of those bigger processes more often than not,” Lombardo said, “but in this case, they’re instrumental in the success or failure of healthcare and how people suffer as a result of bad decisions.”

His opponent, Ford, began his political career as a Nevada state senator and became the state’s first Black attorney general in 2019.

Ford has talked about how he raised his eldest son on his own while attending Texas A&M University. He said he relied on public benefits such as Section 8 housing, Medicaid, food stamps, and the Women, Infants and Children program to provide for them.

He said because of those experiences, his thoughts go to the Nevadans expected to lose Medicaid coverage whenever he hears a reference to the “Big Beautiful Bill.”

“It hits me differently,” Ford said.

His campaign’s calls for lowering prescription drug costs, boosting awareness of the state’s public-option health plans that debuted this year, and canceling medical debt.

A Referendum on Trump?

Most voters who responded to KFF’s poll said they have little or no confidence in how the Trump administration is addressing the cost of living.

“It seems like, if anything, the Trump administration’s approach is not going to help Republicans in the midterms,” Hamel said. But, she added, “November is many months away. A lot of things could change.”

Lombardo appears to be distancing himself from the president amid soaring gas prices and broader affordability issues.

When Trump visited Las Vegas in April, Lombardo didn’t attend the event. The governor later that he would be meeting with the president during his visit, but they spoke only by phone. Damore said he doesn’t think it was an accident that Lombardo didn’t appear with the president publicly.

“Lombardo has done a nice job trying to thread the needle between himself and Trump,” he said.

But Ford has an easier road ahead when it comes to campaigning for healthcare issues, Damore said.

“He just kind of has to say, ‘I’ll do better,’ and point the finger at Trump and say, ‘Where is Lombardo fighting this kind of stuff?’” Damore said. “That’s a pretty easy campaign for him.”

Partisan Nevada voters are nearly evenly split between the two parties, but the majority are registered as nonpartisans, probably because the state’s makes “nonpartisan” the default option for residents who register at the Department of Motor Vehicles. As of last year, voters can no longer choose a party at the DMV, instead needing to fill out paperwork their county election office mails after they register.

Clark County, home to Las Vegas and of , leans Democratic. The next-largest county by population is Washoe County, which is home to Reno and is the in the state. The rest of the state is rural and consistently votes Republican.

But voters in Nevada are fatigued, Damore said, after years of inflation and rising costs since the covid pandemic.

“People are just kind of surly,” he said. “They keep kind of ping-ponging back and forth between the parties. It doesn’t seem to change much.”

Cohen, the Las Vegas voter, is a registered nonpartisan. He said he plans to vote for Ford because he is the candidate who seems most willing to work to protect Medicaid enrollees.

“Sometimes the only way to get something done, to protect it, is to sue,” Cohen said. “I think he’ll bring that background.”

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If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”

QUINCY, Calif. — When Taletha Washburn and the staff at Plumas Charter School first heard that California wanted to help schools treat more kids struggling with mental health, it felt like a well-timed remedy for a rural community where families struggle to find care.

Getting the program funding up and running, however, has proved difficult.

Employees spent two years “spinning our wheels,” attending state-led webinars, filling out countless forms, and researching electronic health record systems to prepare, said Washburn, the school’s executive director. When they reached out for assistance, she said, they waited months for a state response.

The school received its first reimbursement check in April. Washburn said the school has been reimbursed $8,000 and has at least $12,000 in outstanding claims. For a program Washburn had thought could be a game changer in her small rural town, it’s been a disappointing bust.

Plumas Charter is among roughly 1,000 public schools, community colleges, and universities that participate in Gov. Gavin Newsom’s first-in-the-nation initiative requiring that health insurance companies reimburse them for on-campus behavioral healthcare. California schools have been adding counselors, therapists, and psychiatrists to provide services where young people spend most of their time, making mental health treatment more accessible to kids whose families might have spent months waiting to see private therapists.

Five years after the program’s launch, Washburn and other California school officials say they have encountered a rollout fraught with inadequate guidance from the state, an incomplete billing infrastructure, a lack of standardized forms, and persistent delays signing up and getting paid. More than half of California’s school systems and colleges don’t participate in the billing program. Of those that do, fewer than one-fifth as of June 1, according to the latest state data.

The program hasn’t come close to bringing in the half-billion dollars in promised revenue to cover the salaries of thousands of counselors, therapists, and wellness coaches, many of whom school districts hired with a deluge of federal covid pandemic funding. As a result, schools across California have issued amid local budget cuts.

“One of the things that makes people hate government is when we make a promise and then we struggle to keep that promise because we can’t get the administrative part of it up and running,” said state lawmaker Dawn Addis, a former special education teacher and Democrat who has criticized the program’s slow implementation.

Newsom’s office declined to make the governor available for an interview for this article. At a May press conference to release his final state budget proposal, the Democratic governor pointed to the “unprecedented” initiative, saying “no other state in the nation has done more.”

“We have a lot more work to do to deal with the crisis of our time,” Newsom said. “Making investments in wellness, not just physical health, but mental health for our kids, is a good investment.”

He did not answer when asked whether he considered the program a success.

Tom Insel, the former head of the National Institute of Mental Health, who has advised Newsom, said the rocky rollout, in many ways, reflects the groundbreaking nature of what California is trying to do. Still, given the level of investment so far, he too had expected clearer evidence of dramatic improvement.

“What we struggle with in California is: We spend the money, but we don’t always see the outcomes. It’s sobering to realize, especially as an advocate, that you could actually get the programs, get the money, get everything that you want from the policy side, but the execution just isn’t there.”

A First-in-the-Nation Plan?

In 2021, 1 in 10 high school students nationwide said they’d attempted suicide, by then the second-leading cause of death for young people ages 10 to 24.

In response, Newsom announced a “Master Plan for Kids’ Mental Health,” promising an overhaul of California’s behavioral health system that he said would be transformative. National mental health experts said Newsom’s initiative was the most ambitious attempt of any state to tackle a youth mental health crisis that had metastasized during the pandemic.

The state funneled $730 million in one-time funding into workforce efforts, such as campaigns to recruit mental health workers and programs to repay student loans. An additional $220 million has gone to facilitate partnerships between local governments and school officials, and $381 million was distributed in grants to schools and community groups for facilities or services, according to an analysis of program funding by ºÚÁϳԹÏÍø News.

The state has spent roughly $532 million to date on digital apps designed to connect families with counseling and provide a consultation service for primary care physicians handling behavioral health issues outside their expertise, while an additional $232 million has gone toward state operations and program evaluations.

And the state has added 1,855 school counselors since 2021, according to statistics from the American School Counselor Association, which in recent years has integrated mental health into professional standards. That’s well below the 10,000 Newsom had pledged by the end of this year as part of his initiative.

The of Newsom’s Children and Youth Behavioral Health Initiative focused on schools and was designed to increase behavioral health services on campus — at no cost to families. Schools would be able to bill health insurers, who would be required to reimburse them.

Some $1.3 billion — nearly a third of the total investment — has gone toward setting up campus wellness centers, new billing infrastructure, and beefing up school-based mental health support in other ways.

Filing claims became an administrative nightmare for schools unfamiliar with the complex world of medical billing.

In February 2025, when the Fresno County Office of Education launched its medical billing, it felt “like building the plane while flying it,” Trina Frazier, assistant superintendent of student services, told lawmakers in a public hearing a couple of months later. The delays were so acute that lawmakers last year authorized $20 million in grants to Fresno and 170 other school systems so they wouldn’t have to lay off newly hired mental health staffers while waiting for reimbursements.

Anaheim Elementary School District in Orange County, which state officials called a “champion” of the program, has recouped more than $1.1 million since its 23 campuses began billing student insurance in February 2025, said program specialist Shirley Diaz.

Still, that accounts for less than 30% of the behavioral health services the district has provided to students over that time. It’s not just the complexity of medical billing that has hampered the claims process. Parents have also been reluctant to provide health insurance information in the largely Latino district, where residents have been fearful of immigration raids carried out by the Trump administration.

To help administer claims across California, the state signed a $65 million contract with Carelon Behavioral Health, a service , one of the nation’s largest health insurers. But schools have struggled to get claims cleared, and many have spent hundreds of thousands of dollars to troubleshoot and bill claims.

As of June 1, the Boston-based administrator has approved about 232,100 claims totaling more than $11.3 million to 186 school districts and educational agencies, according to the Department of Health Care Services.

That’s a small fraction of the thousands of entities the state had hoped would participate and far from the $500 million a year state officials told schools the program could eventually provide for school-based mental health services.

“We probably were given the impression that this was going to happen more quickly and now there’s this reality of a kind of slow growth,” said Amy Blackshaw, behavioral health project director for the California School-Based Health Alliance.

Carelon contract manager Christina Kim declined to comment to ºÚÁϳԹÏÍø News and referred questions to the state. Autumn Boylan, deputy director of the Office of Strategic Partnerships at DHCS, said staff members incorporated early feedback from school districts and extended claim deadlines, loosened onboarding requirements, and hosted webinars and office hours. But changes of this magnitude, she said, take time.

“We’re trying to help the school districts increase their scale,” Boylan told lawmakers at a May 4 hearing. “It’s not a problem of claims being submitted and not paid. It’s a problem of claims not yet being submitted for payment.”

Boylan noted the volume of reimbursements has increased exponentially since the first claims were filed in November 2024.

Meanwhile, children and youths continue to struggle and have trouble accessing care. In 2024, nearly ages 12-17, for example, reported delaying or skipping mental healthcare because they couldn’t get an appointment, while 1 in 4 teens said they did so because of cost, up from roughly 6.5% the previous year, according to data from the California Health Interview Survey.

The share of young adults 18-24 who reported ever seriously considering suicide has stabilized but remains higher than pre-pandemic, according to the annual survey, conducted by the UCLA Center for Health Policy Research.

And while the suicide rate among Californians ages 12-25 has dropped from its high in 2021, this mirrors national trends, and state rates for female and Black youths increased from 2023 to 2024. “We have to have high expectations that when we invest in the magnitude of billions as this program did, we would have results to show,” said Assembly member David Alvarez, a Democrat in San Diego.

Other states have taken note of California’s implementation difficulties, some adopting a few strategies rather than the dozens California chose to roll out at once, said Sharon Hoover, formerly the co-director of the National Center for School Mental Health at the University of Maryland. Illinois, for instance, has focused on universal mental health screenings for schoolchildren while Colorado has expanded coverage of some behavioral health services for youths who lack a formal diagnosis.

“It’s always hard to be first, and someone has to be brave enough and hopeful enough to take that leap,” Hoover said.

Launching its reimbursement program before billing infrastructure was in place, Hoover said, created momentum but also posed challenges to school districts and providers. Still, she added, Newsom’s focus on prevention and early intervention became one of the biggest national policy shifts in years.

“We’re going to look back on this thinking it was one of the most progressive actions in the history of public systems,” said Alex Briscoe, a principal at the nonprofit Public Works Alliance who has pushed for system reform in kids’ mental health. “We spent a significant amount of money preparing for it. I just don’t think we did that very well or strategically.”

Rural Schools Struggle Most

Students at Plumas Charter School had endured a relentless wave of trauma by fall 2021. Wildfires, covid shutdowns, and, weeks into the school year, a car accident that killed a classmate and left two others severely injured. Teachers saw signs of depression, anxiety, and frequent outbursts among their K-12 students. Nine kids that year reported considering suicide, an all-time high.

So, the school hired a full-time therapist and wellness coach with temporary federal funds.

Senior Will Coelho wasn’t there for any of it, but by the time he arrived in the remote California logging town of Quincy a year later, he’d been through plenty of his own loss.

Days before the pandemic lockdowns, a friend had died in a . Isolated at home, Coelho struggled to process his grief, he said. That year, his stepfather became increasingly violent and, after a bitter, years-long custody fight, Coelho left the Central Valley to move in with his dad in the remote town in Northern California, just weeks before starting high school.

One day, he found himself chatting with a faculty adviser, the new kid half-joking about therapy. At her suggestion, Coelho started seeing the school therapist weekly, on campus and free of charge.

“It has had a large impact on the way I process emotions and my outlook on life,” he said.

Behind the scenes, school officials struggled with how they would continue to cover the therapist’s salary.

Twice, the state rejected the school’s application to the state’s landmark billing program, telling school officials they hadn’t met all the requirements, such as having sufficient systems to bill private insurers and collect student insurance information.

When school staffers flagged difficulties filing claims online, Washburn added, state officials suggested they submit paper claims instead.

The experience has soured Washburn and her staff on the program, which she said doesn’t work for small rural districts like hers where the human resources director is also the office business manager, and the faculty member who manages discipline also teaches PE.

DHCS spokesperson Tony Cava said that many charter schools are small and wouldn’t be expected to participate. While charter schools make up about half of eligible entities, Cava said, they serve only 12% of California’s students.

Lawmakers who represent small, rural districts have argued the program should be able to serve all kids. Early this year, Addis proposed legislation that would give intensive technical help to school officials who need it.

Even if it passes, it may be too late to help Plumas Charter. Washburn is unsure her school will reap enough revenue to pay for their therapist. “In theory, this should be a good program,” Washburn said. “We’re too small, and our funds are too limited to just keep waiting.”

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