LITTLE ROCK, Ark. — A request by Arkansas officials to waive Medicaid rules is being met with skepticism by health-care advocates, who say it would hurt more people than it would help.

Gov. Asa Hutchinson has asked federal officials to lower the income threshold for eligibility in the state's Arkansas Works program, as well as add a requirement that most recipients work.

Bruno Showers, a policy fellow at Arkansas Advocates for Children and Families, said he believes the proposed changes are designed to cut the number of people on Medicaid in the state.

"In other waiver requests, they're pretty much admitting that the work requirements are going to help lower their Medicaid rolls. And I think that that's the goal in Arkansas,” Showers said. “If the goal is to make people less reliant on government and more likely to have a job, I don't think work requirements are a good way to satisfy that."

In addition, state officials have said lowering the eligibility from 138 percent to 100 percent of the poverty level would cut about 60,000 people from the rolls.

Hutchinson said the work requirements would help the unemployed prepare to rejoin the workforce. But Showers said according to a recent report, while the state claims those people could find new coverage in the insurance marketplace, they would most likely become uninsured.

Dianne Skaggs, director of the Mental Health Council of Arkansas, said the state's network of 14 community-based mental health centers would be forced to absorb the patients who lose coverage.

"We serve probably 70,000 folks a year. We're the safety net for the public mental health system in Arkansas,” Skaggs said. “So, community mental health centers would do our best to serve the people that need to be served. But it's really complicated."

Showers said more than half of the state's Medicaid beneficiaries would likely be exempt under the work requirements.

"Given that the state has a poor track record with some of its administrative outreach, and given that there's really not an additional investment in workforce services to help these people meet the requirement, I assume it will be significant, but I just can't give you an exact figure,” he said.

The Trump administration recently signaled its willingness to consider Medicaid changes, and granted the first waiver to Kentucky last week. Federal officials say Arkansas's request is still under review.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.

The California State Assembly is considering a bill to require schools to have a cardiac arrest response plan. Assembly Bill 2887 would make sure schools update their safety plans to include CPR training and an automatic external defibrillator or AED onsite.

Dr. Stephen Sanko, a professor of clinical emergency medicine at USC, and a founding member of the Cardiac Arrest Survivor Alliance, is a volunteer expert for the American Heart Association. He said having a plan in place is critical.

"The American Heart Association is promoting that schools have a cardiac arrest response plan. A written protocol for what to do in order to decrease the likelihood that if somebody collapses, that they die," he said.

Two years ago, 15-year-old Cash Hennessy collapsed on the football field due to a previously unknown heart defect. Two off-duty medics in the stands gave him CPR. The school brought out its AED - but it was useless, because the batteries were dead.

Hennessy said the experience was traumatic.

"I feel blessed that I had people there for me, that could give me C-P-R. But I think about if those people weren't there and that was another kid, who knows what would have happened? Because there wouldn't have been an AED to save them," he explained.

An AED walks people through the steps to deliver a life-saving shock to a person's heart until an ambulance arrives. Studies show that 70% of kids who suffer sudden cardiac arrest at school recover if an AED is deployed correctly - whereas the survival rate for kids and adults not in the hospital is less than 12%.