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California’s Medicaid Experiment Spends Money to Save Money — And Help the Homeless

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by Angela Hart
Wed, 19 Apr 2023 09:00:00 +0000

SAN DIEGO — Sporting a bright smile and the polished Super Bowl ring he won as a star NFL player in the late 1980s, Craig McEwen doesn’t fit the archetype of someone teetering on the brink of homelessness.

Evicted from his San Diego County apartment last July, McEwen — who endured repeated concussions during his six seasons in the NFL — scoured housing listings for anything he could afford.

Working as a part-time groundskeeper at a golf course for $15 an hour, his frantic search turned up nothing. So, feeling overwhelmed by rents pushing $3,000 a month for a one-bedroom apartment, he made a plan: move into his truck or rent a storage container to live in — an alternative he turned to when he was previously homeless in 2004.

McEwen is hopeful that a massive health care initiative in California offering new, specialized social services will help him get back on his feet. He is one of nearly 145,000 low-income Californians enrolled in CalAIM, an endeavor Gavin Newsom, the state’s Democratic governor, is spearheading to transform its Medicaid program, called Medi-Cal, into a new kind of safety net that provides housing and other services for people who are homeless or at risk of becoming homeless and have complicating conditions like mental illness or chronic disease that can make it difficult to manage life.

California launched the initiative in early 2022, rolling it out quietly, with health insurers and community groups scrambling to provide social services and benefits that fall outside traditional health care. It’s a five-year, $12 billion social experiment that Newsom is betting will eventually cut soaring health care spending in Medi-Cal, the largest Medicaid program in the country with 15.5 million enrollees.

The state is contracting the work to its 23 Medi-Cal managed-care health insurance companies. They are responsible for delivering a slew of new benefits to the most vulnerable enrollees: not only those with housing insecurity, but also people with mental health or addictive disorders; formerly incarcerated people transitioning back to society; seniors and people with disabilities; children in foster care; and Californians who frequent hospital emergency rooms or are admitted often to short-term skilled nursing facilities.

While only a sliver of the state’s Medi-Cal patients are enrolled in CalAIM, tens of thousands of low-income Californians could qualify for the new benefits. They’re eligible for help in finding housing and for paying rental move-in costs like security deposits.

But the help goes beyond housing. The state is also providing the most at-risk patients with intensive case management, alongside pioneering social services — such as healthy home-delivered meals for diabetes patients and mold removal in homes of patients with severe asthma.

Top state health officials say that with such an ambitious program — using Medicaid to help solve homelessness and combat chronic disease — they expected the rollout to be bumpy. After 2026, when the initiative’s funding ends, the state plans to prove the experiment works and permanently adopt the benefits. Meanwhile, other states are closely watching California, hoping to learn from its successes and failures.

“California is a leader, and it’s always experimenting in new and interesting ways,” said Dr. Georges Benjamin, executive director of the American Public Health Association. “What it can do is provide proof of concept, and then this can grow to other states.”

Insurers, in essence, are building a new health care workforce, contracting with nonprofit and for-profit organizations to enroll the most vulnerable — and expensive — Medi-Cal patients. They’re hiring social workers and case managers to find those who rack up extreme health care costs in hospital emergency rooms, nursing homes, prisons, jails, and mental health crisis centers.

As Newsom sees it, the immense investment will pay off for taxpayers. Targeting people cycling in and out of costly institutions will reduce health care spending, he argues, while also helping people get healthy. State health officials say 5% of high-need Medi-Cal patients account for roughly half of all health care spending in the low-income health care program.

The most important currency in pulling off this massive health care experiment is trust. And that is being built on the ground, with community outreach workers scouring hospitals and homeless encampments, for example, to find those eligible for CalAIM.

The most at-risk Medi-Cal patients are being linked to specialized teams deployed under a new entitlement benefit at the heart of the initiative called “enhanced care management.” While other services like covering security deposits are optional, this is not. Health insurers are required to accept people who are most in need and provide a wide range of health and social services.

It can be simple things like arranging an Uber to get to a medical appointment or buying a computer for an enrollee looking for a job. Or purchasing a bike for a low-income kid. But it also involves intensive, one-on-one work that can require case managers to take patients to get an identification card, make nighttime phone calls to ensure patients are taking medications, and hunt down available apartments.

“This is the missing piece, and it’s the hardest work — the most costly work,” Newsom said in an interview with KFF Health News. “People on the streets and sidewalks, they’ve lost trust. They’ve become socially isolated. They’ve lost connection, and so developing that is so foundational.”

‘My Own Prison’

McEwen, who was a tight end for the NFL team now known as the Washington Commanders and later for the San Diego Chargers, was hailed as a “legacy.” But playing professional football took an extreme toll.

“My position was to block for the quarterback, and back in the day, you were allowed to hit people in the head,” McEwen said, recalling regular concussions on the field that he’d snap himself out of by sniffing ammonia packets. He helped lead the Washington team to a Super Bowl victory in 1987, but in the decades since, his health has deteriorated.

McEwen has struggled for years to find regular work while dealing with thoughts of suicide, anger, forgetfulness, and depression that he says stem from traumatic brain injuries sustained during his football career. At 57, he endures continual pain from ruptured disks in his neck and spine, along with shortness of breath from severe heart disease.

He’d holed up in his apartment for years, with curtains nailed to his windows, drowning his pain with alcohol. “I basically created my own prison,” he said.

After he was evicted last July, a longtime friend swooped in to let him stay temporarily in a spare bedroom at his family’s house just outside San Diego. But McEwen’s financial and emotional struggle to find stable housing hasn’t ended.

“We don’t call it fear. Us ballplayers, we call it excitement,” McEwen said on a rainy morning in early March, his eyes swelling with tears. “I’m excited. I know what’s at stake. My life is at stake.”

Housing instability is just one part of it. He’d often forget to take his medications for high cholesterol and clogged arteries. He felt paralyzing anxiety and his brain was so scrambled he’d miss important doctor appointments — a side effect, he said, of the concussions.

McEwen knew he needed help.

He’d learned from a friend that California was helping Medi-Cal patients with not just medical needs but also social services, and he started making calls, insisting on getting in. “I said wait, you’re giving people a coach? Someone who can make appointments for me and go to my doctor visits with me?”

Weeks after receiving his eviction notice, his Medi-Cal insurer, Molina Healthcare, connected him with a personal care manager, whom McEwen calls “my advocate, someone who can teach me how to do for myself and give myself a life worth living.”

But who gets in the program is often a roll of the dice, depending largely on which Medi-Cal insurance company a person is enrolled in. Persistence plays a big role.

Despite early glimmers of hope, the rollout has been chaotic. Providers on the ground scramble to find any available housing for enrollees. Groups implementing the initiative say inadequate funding and dire health workforce shortages have severely constrained their ability to serve all those in need. And enrollment by health insurers is uneven, with some quickly approving new benefits for their members while others are denied. Some insurers provide on-the-spot Uber rides for doctor appointments while others offer only a bus pass.

“What is being offered is insufficient, and this program is not set up to support those who are actually the most vulnerable and need the most intensive support,” said Nancy Behm, associate director of CalAIM for a San Diego nonprofit called People Assisting the Homeless, or PATH.

Operating under contracts with Blue Shield of California, Molina Healthcare, and Health Net, PATH launched intensive case management and housing services in January 2022. But it has since stopped providing intensive case management benefits largely due to a lack of sufficient funding to do the grueling work of connecting with homeless people living in encampments. “We’re hitting barriers on every front,” Behm said.

Newsom, with his soaring political ambitions, is promising to help the most vulnerable Californians. Termed out in 2026, speculation is mounting that the two-term governor is eyeing a presidential run, and he’s using health care as a core issue to elevate his national profile. In reality, his Medi-Cal initiative is falling far short.

“This is an extremely ambitious program, but it doesn’t come close to helping the entirety of the population it’s targeting,” said Doug Herman, who worked for former President Barack Obama and former Los Angeles Mayor Eric Garcetti. “This isn’t a policy solution big enough to really make a dent in homelessness.”

No Walk in the Park

On a brisk morning in late February, Jeannine Nash pulled into the drive-thru of a Jack in the Box in Chula Vista, just south of San Diego. She dug in her wallet to find $8.17 for 10 breakfast sandwiches to hand out to homeless people on her regular rounds visiting encampments.

“It helps me to come out here before work, to get an idea of what the needs are,” Nash said as she approached a nearby homeless woman slumped over on a sidewalk who had nothing with her but a brand-new walker and hospital discharge paperwork tucked in a plastic bag.

Nash is director of referrals for Serene Health, a for-profit health care company that is one of nearly 500 provider organizations being paid to link homeless people or those at risk with intensive case management, housing, and other services.

A recovering addict herself, Nash said her life experience has helped her connect with people living outside and struggling with substance use disorders. She figures out how to get those who appear resistant to accept services. “So many people are distrustful of authority,” said Nash, who has a son who is homeless.

“This is very, very dear to my heart,” Nash said. In her decades since becoming sober, she has gained deep experience getting the people most at risk of spiraling deeper into crisis into treatment beds and even apartments. She’s cultivated relationships with housing and nursing home agencies so she can quickly identify openings.

But her job comes with extraordinary challenges. She often has to level with people living outside, telling them there is simply nowhere for them to go. “There’s just not enough beds or housing out there,” she said. “And if you don’t have an income, it’s not going to happen.”

Nash handed the homeless woman in the doorway two sandwiches, coaxing her to eat. The woman, Christina Gallegos, 38, was suffering from extreme liver damage due to chronic drinking and had crawled the few blocks from Scripps Mercy Hospital in Chula Vista, where she was discharged the night before.

She had been in the emergency room, her hospital discharge paperwork showed — one of several ER trips she’d made in the past month. She was given the walker but couldn’t walk and dragged it into a doorway for shelter.

“We see this all the time. It’s getting really bad,” Nash said, texting her contacts to find a bed for Gallegos. “She’s definitely eligible. It’s just finding somewhere for her to go that is going to be hard.”

Gallegos has Medi-Cal but hasn’t been enrolled in the new benefits California is offering. She was among an estimated 8,500 homeless people identified in San Diego County in 2022, a 10% increase since 2020.

San Diego County is massive and populous, and while homeless encampments permeate suburban enclaves like Chula Vista, homeless people are largely clustered in San Diego’s downtown neighborhood and its parks.

One popular place to pitch a tent is Balboa Park near the San Diego Zoo. Its canyons and sprawling green lawns are peppered with tent communities, whose inhabitants plead for help from community groups. Many hang on to business cards from homeless outreach workers in hopes of scoring a shelter bed or permanent housing. While some people do get housing, many feel as if outreach efforts amount to broken promises.

One man, David Lloyd, pulled from his pocket a phone number for an outreach worker from the homeless services provider PATH, who told him that he was on a waiting list for housing but that he could be waiting in the queue for years.

“It’s a big list,” said Lloyd, 66. “I just want to get off the streets. I’m tired of the cops harassing me all the time.”

Cally Wood, 35, said she is addicted to fentanyl and has been on the waiting list for housing for more than a year. “It just feels really impossible,” she said. “There’s nothing affordable.”

Health insurance executives, including Martha Santana-Chin, Medi-Cal president for Health Net in California, said Medi-Cal managed-care plans are making progress in helping get people off the streets and into services. Yet she acknowledged the initial rollout falls short.

“We just don’t have the housing supply that we need,” Santana-Chin said, “to be confident that all of these folks who need support and services are going to get permanently placed.”

Hampered by Sweeps

Across the region, sweeps of homeless encampments are common and becoming part of everyday life for people living outside. Deteriorating and unsanitary conditions on the streets fuel public frustration.

Newsom has ratcheted up the practice of clearing encampments, arguing that people dealing with homelessness should not be allowed to live outdoors, despite a dearth of alternatives. He’s allocating state funding to cities and counties to remove tents from streets and sidewalks and move people into any shelter or housing available. San Diego Mayor Todd Gloria, also a Democrat, is unapologetic about adopting the approach.

“We’re doing the cleanups that are necessary for public safety,” Gloria told KFF Health News. “These conditions are unsanitary, and it puts people’s health and safety at risk, and it leads to people dying. Some people disagree with me under the guise of caring for these individuals, but the sidewalk is not a home.”

Outreach workers on the ground, however, say the enforcement crackdown only makes their jobs harder. One of the most critical goals of the new Medi-Cal initiative is to regularly visit people on the streets, build relationships with them, and help them with health care needs, all while preparing them for housing — if it becomes available.

“This really takes a lot of time. Sometimes you start with just bringing someone socks or a bottle of water. It can take 70 encounters for someone to accept our help,” said Andrea Karrer, an outreach worker with PATH. “But that time is what allows you to build trust with someone, and when they have to constantly move, you have to find that person, and sometimes start all over.”

And the disruptions ultimately cause people without housing to get sicker and visit the ER more often, she and other outreach workers said.

“When you have to move every two or three days, getting to the doctor or staying on medication is not the biggest priority. You’re in survival mode,” Karrer said.

A Labor-Intensive Effort

Serene Health is one of hundreds of providers enrolling Medi-Cal patients into intensive case management. Together, they have signed up 108,000 patients statewide so far, according to California’s Department of Health Care Services, which administers Medi-Cal. An additional 28,000 are receiving the new housing services such as security deposit payments and help identifying affordable housing.

“A lot of the stuff we’re doing is just really new to health care,” said Jacey Cooper, the state’s Medicaid director. She said that health insurers are offering housing services in all 58 counties, yet she acknowledged that the need exceeds capacity.

“It takes time for that infrastructure to come to fruition,” Cooper said of the challenge of identifying housing for Medi-Cal patients who frequent hospital ERs. “We are in a massive education moment of even making sure people understand who’s eligible and how to refer, and educating the entire delivery system, from hospitals to providers.”

Meanwhile, Newsom is asking the Biden administration for permission to add another housing benefit that would cover up to six months of direct rent payments.

Veronica Ortiz, a lead care manager for Serene Health, has Craig McEwen on her roster of about 60 patients — a large caseload that is difficult to manage.

But Ortiz bubbles with compassion and energy and said working with patients like McEwen has given her even more drive to make a difference. The work is arduous, but McEwen is quickly becoming more independent, she said.

“When we come into their lives, we’re strangers, so we have to spend a lot of time meeting face-to-face with people and helping with anything they need, otherwise they’re not going to trust us.”

But help didn’t come fast enough for Donna Fontenot, a San Diego County resident who is being evicted from her apartment this month. Her landlord told her she had to leave following repeated ER trips, hospitalizations, and skilled nursing home stays stemming from an initial fall in 2022 that left her in a wheelchair.

“I’m petrified and absolutely panicking, I have nowhere to go,” Fontenot said. With one hospitalization alone costing an average of $18,000 in California, Fontenot, who is on Medi-Cal, has racked up high health care costs.

She has been hospitalized eight times since March 2022, she said. And on five occasions, her injuries to her feet and legs were so extreme that she needed placement in a nursing home.

Yet her Medi-Cal insurer, the San Diego-based Community Health Group, instituted a rule that to qualify for some housing services, she must have a child under 18. So she isn’t receiving housing assistance that could help her. She is, however, enrolled in intensive case management. But she was not aware of that until KFF Health News informed her.

“I feel like I won the lottery,” she said. “Is it going to help me?”

Her care manager hasn’t been as involved in her life as Ortiz has been with McEwen. Fontenot continues to search on her own for housing, and recently asked to be switched into Serene Health to get more hands-on assistance. “I’ve never needed help like this before. I feel so broken,” she said in tears. “Where am I going to go?”

Today, Ortiz is helping McEwen search for housing. She also has focused on helping him get his heart condition under control and find more stable work.

In March, he landed a job as a security guard patrolling sporting events, including at football stadiums. And he scored a hard-to-get surgery appointment for late this month to help unclog the arteries in his heart.

“Before Veronica, I was waiting to die. I was eating and drinking to die. But she showed up for me. Somebody cared about me. And that gave me the courage to share with her what my dream would be,” McEwen said. “I thought I needed football to be loved — then I’d be worth it.

“But I know now that my true purpose is to be of service and to be there for my daughter. I decided to get back on the field, instead of sitting on the sidelines.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

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

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By: Angela Hart
Title: California’s Medicaid Experiment Spends Money to Save Money — And Help the Homeless
Sourced From: kffhealthnews.org/news/article/california-homelessness-calaim-program-medicaid-experiment/
Published Date: Wed, 19 Apr 2023 09:00:00 +0000

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US Judge Names Receiver To Take Over California Prisons’ Mental Health Program

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kffhealthnews.org – Don Thompson – 2025-03-20 12:46:00

SACRAMENTO, Calif. — A judge has initiated a federal court takeover of California’s troubled prison mental health system by naming the former head of the Federal Bureau of Prisons to serve as receiver, giving her four months to craft a plan to provide adequate care for tens of thousands of prisoners with serious mental illness.

Senior U.S. District Judge Kimberly Mueller issued her order March 19, identifying Colette Peters as the nominated receiver. Peters, who was Oregon’s first female corrections director and known as a reformer, ran the scandal-plagued federal prison system for 30 months until President Donald Trump took office in January. During her tenure, she closed a women’s prison in Dublin, east of Oakland, that had become known as the “rape club.”

Michael Bien, who represents prisoners with mental illness in the long-running prison lawsuit, said Peters is a good choice. Bien said Peters’ time in Oregon and Washington, D.C., showed that she “kind of buys into the fact that there are things we can do better in the American system.”

“We took strong objection to many things that happened under her tenure at the BOP, but I do think that this is a different job and she’s capable of doing it,” said Bien, whose firm also represents women who were housed at the shuttered federal women’s prison.

California corrections officials called Peters “highly qualified” in a statement, while Gov. Gavin Newsom’s office did not immediately comment. Mueller gave the parties until March 28 to show cause why Peters should not be appointed.

Peters is not talking to the media at this time, Bien said. The judge said Peters is to be paid $400,000 a year, prorated for the four-month period.

About 34,000 people incarcerated in California prisons have been diagnosed with serious mental illnesses, representing more than a third of California’s prison population, who face harm because of the state’s noncompliance, Mueller said.

Appointing a receiver is a rare step taken when federal judges feel they have exhausted other options. A receiver took control of Alabama’s correctional system in 1976, and they have otherwise been used to govern prisons and jails only about a dozen times, mostly to combat poor conditions caused by overcrowding. Attorneys representing inmates in Arizona have asked a judge to take over prison health care there.

Mueller’s appointment of a receiver comes nearly 20 years after a different federal judge seized control of California’s prison medical system and installed a receiver, currently J. Clark Kelso, with broad powers to hire, fire, and spend the state’s money.

California officials initially said in August that they would not oppose a receivership for the mental health program provided that the receiver was also Kelso, saying then that federal control “has successfully transformed medical care” in California prisons. But Kelso withdrew from consideration in September, as did two subsequent candidates. Kelso said he could not act “zealously and with fidelity as receiver in both cases.”

Both cases have been running for so long that they are now overseen by a second generation of judges. The original federal judges, in a legal battle that reached the U.S. Supreme Court, more than a decade ago forced California to significantly reduce prison crowding in a bid to improve medical and mental health care for incarcerated people.

State officials in court filings defended their improvements over the decades. Prisoners’ attorneys countered that treatment remains poor, as evidenced in part by the system’s record-high suicide rate, topping 31 suicides per 100,000 prisoners, nearly double that in federal prisons.

“More than a quarter of the 30 class-members who died by suicide in 2023 received inadequate care because of understaffing,” prisoners’ attorneys wrote in January, citing the prison system’s own analysis. One prisoner did not receive mental health appointments for seven months “before he hanged himself with a bedsheet.”

They argued that the November passage of a ballot measure increasing criminal penalties for some drug and theft crimes is likely to increase the prison population and worsen staffing shortages.

California officials argued in January that Mueller isn’t legally justified in appointing a receiver because “progress has been slow at times but it has not stalled.”

Mueller has countered that she had no choice but to appoint an outside professional to run the prisons’ mental health program, given officials’ intransigence even after she held top officials in contempt of court and levied fines topping $110 million in June. Those extreme actions, she said, only triggered more delays.

The 9th U.S. Circuit Court of Appeals on March 19 upheld Mueller’s contempt ruling but said she didn’t sufficiently justify calculating the fines by doubling the state’s monthly salary savings from understaffing prisons. It upheld the fines to the extent that they reflect the state’s actual salary savings but sent the case back to Mueller to justify any higher penalty.

Mueller had been set to begin additional civil contempt proceedings against state officials for their failure to meet two other court requirements: adequately staffing the prison system’s psychiatric inpatient program and improving suicide prevention measures. Those could bring additional fines topping tens of millions of dollars.

But she said her initial contempt order has not had the intended effect of compelling compliance. Mueller wrote as far back as July that additional contempt rulings would also be likely to be ineffective as state officials continued to appeal and seek delays, leading “to even more unending litigation, litigation, litigation.”

She went on to foreshadow her latest order naming a receiver in a preliminary order: “There is one step the court has taken great pains to avoid. But at this point,” Mueller wrote, “the court concludes the only way to achieve full compliance in this action is for the court to appoint its own receiver.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

The post US Judge Names Receiver To Take Over California Prisons’ Mental Health Program appeared first on kffhealthnews.org

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Amid Plummeting Diversity at Medical Schools, a Warning of DEI Crackdown’s ‘Chilling Effect’

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kffhealthnews.org – Annie Sciacca – 2025-03-20 04:00:00

The Trump administration’s crackdown on DEI programs could exacerbate an unexpectedly steep drop in diversity among medical school students, even in states like California, where public universities have been navigating bans on affirmative action for decades. Education and health experts warn that, ultimately, this could harm patient care.

Since taking office, President Donald Trump has issued a handful of executive orders aimed at terminating all diversity, equity, and inclusion, or DEI, initiatives in federally funded programs. And in his March 4 address to Congress, he described the Supreme Court’s 2023 decision banning the consideration of race in college and university admissions as “brave and very powerful.”

Last month, the Education Department’s Office for Civil Rights — which lost about 50% of its staff in mid-March — directed schools, including postsecondary institutions, to end race-based programs or risk losing federal funding. The “Dear Colleague” letter cited the Supreme Court’s decision.

Paulette Granberry Russell, president and CEO of the National Association of Diversity Officers in Higher Education, said that “every utterance of ‘diversity’ is now being viewed as a violation or considered unlawful or illegal.” Her organization filed a lawsuit challenging Trump’s anti-DEI executive orders.

While California and eight other states — Arizona, Florida, Idaho, Michigan, Nebraska, New Hampshire, Oklahoma, and Washington — had already implemented bans of varying degrees on race-based admissions policies well before the Supreme Court decision, schools bolstered diversity in their ranks with equity initiatives such as targeted scholarships, trainings, and recruitment programs.

But the court’s decision and the subsequent state-level backlash — 29 states have since introduced bills to curb diversity initiatives, according to data published by the Chronicle of Higher Education — have tamped down these efforts and led to the recent declines in diversity numbers, education experts said.

After the Supreme Court’s ruling, the numbers of Black and Hispanic medical school enrollees fell by double-digit percentages in the 2024-25 school year compared with the previous year, according to the Association of American Medical Colleges. Black enrollees declined 11.6%, while the number of new students of Hispanic origin fell 10.8%. The decline in enrollment of American Indian or Alaska Native students was even more dramatic, at 22.1%. New Native Hawaiian or other Pacific Islander enrollment declined 4.3%.

“We knew this would happen,” said Norma Poll-Hunter, AAMC’s senior director of workforce diversity. “But it was double digits — much larger than what we anticipated.”

The fear among educators is the numbers will decline even more under the new administration.

At the end of February, the Education Department launched an online portal encouraging people to “report illegal discriminatory practices at institutions of learning,” stating that students should have “learning free of divisive ideologies and indoctrination.” The agency later issued a “Frequently Asked Questions” document about its new policies, clarifying that it was acceptable to observe events like Black History Month but warning schools that they “must consider whether any school programming discourages members of all races from attending.”

“It definitely has a chilling effect,” Poll-Hunter said. “There is a lot of fear that could cause institutions to limit their efforts.”

Numerous requests for comment from medical schools about the impact of the anti-DEI actions went unreturned. University presidents are staying mum on the issue to protect their institutions, according to reporting from The New York Times.

Utibe Essien, a physician and UCLA assistant professor, said he has heard from some students who fear they won’t be considered for admission under the new policies. Essien, who co-authored a study on the effect of affirmative action bans on medical schools, also said students are worried medical schools will not be as supportive toward students of color as in the past.

“Both of these fears have the risk of limiting the options of schools folks apply to and potentially those who consider medicine as an option at all,” Essien said, adding that the “lawsuits around equity policies and just the climate of anti-diversity have brought institutions to this place where they feel uncomfortable.”

In early February, the Pacific Legal Foundation filed a lawsuit against the University of California-San Francisco’s Benioff Children’s Hospital Oakland over an internship program designed to introduce “underrepresented minority high school students to health professions.”

Attorney Andrew Quinio filed the suit, which argues that its plaintiff, a white teenager, was not accepted to the program after disclosing in an interview that she identified as white.

“From a legal standpoint, the issue that comes about from all this is: How do you choose diversity without running afoul of the Constitution?” Quinio said. “For those who want diversity as a goal, it cannot be a goal that is achieved with discrimination.”

UC Health spokesperson Heather Harper declined to comment on the suit on behalf of the hospital system.

Another lawsuit filed in February accuses the University of California of favoring Black and Latino students over Asian American and white applicants in its undergraduate admissions. Specifically, the complaint states that UC officials pushed campuses to use a “holistic” approach to admissions and “move away from objective criteria towards more subjective assessments of the overall appeal of individual candidates.”

The scrutiny of that approach to admissions could threaten diversity at the UC-Davis School of Medicine, which for years has employed a “race-neutral, holistic admissions model” that reportedly tripled enrollment of Black, Latino, and Native American students.

“How do you define diversity? Does it now include the way we consider how someone’s lived experience may be influenced by how they grew up? The type of school, the income of their family? All of those are diversity,” said Granberry Russell, of the National Association of Diversity Officers in Higher Education. “What might they view as an unlawful proxy for diversity equity and inclusion? That’s what we’re confronted with.”

California Attorney General Rob Bonta, a Democrat, recently joined other state attorneys general to issue guidance urging that schools continue their DEI programs despite the federal messaging, saying that legal precedent allows for the activities. California is also among several states suing the administration over its deep cuts to the Education Department.

If the recent decline in diversity among newly enrolled students holds or gets worse, it could have long-term consequences for patient care, academic experts said, pointing toward the vast racial disparities in health outcomes in the U.S., particularly for Black people.

A higher proportion of Black primary care doctors is associated with longer life expectancy and lower mortality rates among Black people, according to a 2023 study published by the JAMA Network.

Physicians of color are also more likely to build their careers in medically underserved communities, studies have shown, which is increasingly important as the AAMC projects a shortage of up to 40,400 primary care doctors by 2036.

“The physician shortage persists, and it’s dire in rural communities,” Poll-Hunter said. “We know that diversity efforts are really about improving access for everyone. More diversity leads to greater access to care — everyone is benefiting from it.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

The post Amid Plummeting Diversity at Medical Schools, a Warning of DEI Crackdown’s ‘Chilling Effect’ appeared first on kffhealthnews.org

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Tribal Health Leaders Say Medicaid Cuts Would Decimate Health Programs

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kffhealthnews.org – Jazmin Orozco Rodriguez – 2025-03-19 04:00:00

As Congress mulls potentially massive cuts to federal Medicaid funding, health centers that serve Native American communities, such as the Oneida Community Health Center near Green Bay, Wisconsin, are bracing for catastrophe.

That’s because more than 40% of the about 15,000 patients the center serves are enrolled in Medicaid. Cuts to the program would be detrimental to those patients and the facility, said Debra Danforth, the director of the Oneida Comprehensive Health Division and a citizen of the Oneida Nation.

“It would be a tremendous hit,” she said.

The facility provides a range of services to most of the Oneida Nation’s 17,000 people, including ambulatory care, internal medicine, family practice, and obstetrics. The tribe is one of two in Wisconsin that have an “open-door policy,” Danforth said, which means that the facility is open to members of any federally recognized tribe.

But Danforth and many other tribal health officials say Medicaid cuts would cause service reductions at health facilities that serve Native Americans.

Indian Country has a unique relationship to Medicaid, because the program helps tribes cover chronic funding shortfalls from the Indian Health Service, the federal agency responsible for providing health care to Native Americans.

Medicaid has accounted for about two-thirds of third-party revenue for tribal health providers, creating financial stability and helping facilities pay operational costs. More than a million Native Americans enrolled in Medicaid or the closely related Children’s Health Insurance Program also rely on the insurance to pay for care outside of tribal health facilities without going into significant medical debt. Tribal leaders are calling on Congress to exempt tribes from cuts and are preparing to fight to preserve their access.

“Medicaid is one of the ways in which the federal government meets its trust and treaty obligations to provide health care to us,” said Liz Malerba, director of policy and legislative affairs for the United South and Eastern Tribes Sovereignty Protection Fund, a nonprofit policy advocacy organization for 33 tribes spanning from Texas to Maine. Malerba is a citizen of the Mohegan Tribe.

“So we view any disruption or cut to Medicaid as an abrogation of that responsibility,” she said.

Tribes face an arduous task in providing care to a population that experiences severe health disparities, a high incidence of chronic illness, and, at least in western states, a life expectancy of 64 years — the lowest of any demographic group in the U.S. Yet, in recent years, some tribes have expanded access to care for their communities by adding health services and providers, enabled in part by Medicaid reimbursements.

During the last two fiscal years, five urban Indian organizations in Montana saw funding growth of nearly $3 million, said Lisa James, director of development for the Montana Consortium for Urban Indian Health, during a webinar in February organized by the Georgetown University Center for Children and Families and the National Council of Urban Indian Health.

The increased revenue was “instrumental,” James said, allowing clinics in the state to add services that previously had not been available unless referred out for, including behavioral health services. Clinics were also able to expand operating hours and staffing.

Montana’s five urban Indian clinics, in Missoula, Helena, Butte, Great Falls, and Billings, serve 30,000 people, including some who are not Native American or enrolled in a tribe. The clinics provide a wide range of services, including primary care, dental care, disease prevention, health education, and substance use prevention.

James said Medicaid cuts would require Montana’s urban Indian health organizations to cut services and limit their ability to address health disparities.

American Indian and Alaska Native people under age 65 are more likely to be uninsured than white people under 65, but 30% rely on Medicaid compared with 15% of their white counterparts, according to KFF data for 2017 to 2021. More than 40% of American Indian and Alaska Native children are enrolled in Medicaid or CHIP, which provides health insurance to kids whose families are not eligible for Medicaid. KFF is a health information nonprofit that includes KFF Health News.

A Georgetown Center for Children and Families report from January found the share of residents enrolled in Medicaid was higher in counties with a significant Native American presence. The proportion on Medicaid in small-town or rural counties that are mostly within tribal statistical areas, tribal subdivisions, reservations, and other Native-designated lands was 28.7%, compared with 22.7% in other small-town or rural counties. About 50% of children in those Native areas were enrolled in Medicaid.

The federal government has already exempted tribes from some of Trump’s executive orders. In late February, Department of Health and Human Services acting general counsel Sean Keveney clarified that tribal health programs would not be affected by an executive order that diversity, equity, and inclusion government programs be terminated, but that the Indian Health Service is expected to discontinue diversity and inclusion hiring efforts established under an Obama-era rule.

HHS Secretary Robert F. Kennedy Jr. also rescinded the layoffs of more than 900 IHS employees in February just hours after they’d received termination notices. During Kennedy’s Senate confirmation hearings, he said he would appoint a Native American as an assistant HHS secretary. The National Indian Health Board, a Washington, D.C.-based nonprofit that advocates for tribes, in December endorsed elevating the director of the Indian Health Service to assistant secretary of HHS.

Jessica Schubel, a senior health care official in Joe Biden’s White House, said exemptions won’t be enough.

“Just because Native Americans are exempt doesn’t mean that they won’t feel the impact of cuts that are made throughout the rest of the program,” she said.

State leaders are also calling for federal Medicaid spending to be spared because cuts to the program would shift costs onto their budgets. Without sustained federal funding, which can cover more than 70% of costs, state lawmakers face decisions such as whether to change eligibility requirements to slim Medicaid rolls, which could cause some Native Americans to lose their health coverage.

Tribal leaders noted that state governments do not have the same responsibility to them as the federal government, yet they face large variations in how they interact with Medicaid depending on their state programs.

President Donald Trump has made seemingly conflicting statements about Medicaid cuts, saying in an interview on Fox News in February that Medicaid and Medicare wouldn’t be touched. In a social media post the same week, Trump expressed strong support for a House budget resolution that would likely require Medicaid cuts.

The budget proposal, which the House approved in late February, requires lawmakers to cut spending to offset tax breaks. The House Committee on Energy and Commerce, which oversees spending on Medicaid and Medicare, is instructed to slash $880 billion over the next decade. The possibility of cuts to the program that, together with CHIP, provides insurance to 79 million people has drawn opposition from national and state organizations.

The federal government reimburses IHS and tribal health facilities 100% of billed costs for American Indian and Alaska Native patients, shielding state budgets from the costs.

Because Medicaid is already a stopgap fix for Native American health programs, tribal leaders said it won’t be a matter of replacing the money but operating with less.

“When you’re talking about somewhere between 30% to 60% of a facility’s budget is made up by Medicaid dollars, that’s a very difficult hole to try and backfill,” said Winn Davis, congressional relations director for the National Indian Health Board.

Congress isn’t required to consult tribes during the budget process, Davis added. Only after changes are made by the Centers for Medicare & Medicaid Services and state agencies are tribes able to engage with them on implementation.

The amount the federal government spends funding the Native American health system is a much smaller portion of its budget than Medicaid. The IHS projected billing Medicaid about $1.3 billion this fiscal year, which represents less than half of 1% of overall federal spending on Medicaid.

“We are saving more lives,” Malerba said of the additional services Medicaid covers in tribal health care. “It brings us closer to a level of 21st century care that we should all have access to but don’t always.”

This article was published with the support of the Journalism & Women Symposium (JAWS) Health Journalism Fellowship, assisted by grants from The Commonwealth Fund.

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

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