CONCORD, N.H. — Last week, Gov. Chris Sununu signed a bill to continue New Hampshire's Medicaid program for another five years, but it includes a new work requirement which may not be legal.

On Friday, a similar policy failed the litmus test in Kentucky — the first state to attach a work requirement to Medicaid coverage. The Trump administration's Center for Medicare and Medicaid Services approved it, but it was blocked by a federal judge for not factoring in how many people would lose coverage.

The decision raises similar questions about work requirements in the Granite State, according to Dawn McKinney, policy director at New Hampshire Legal Assistance.

"They're contrary to federal law. The Medicaid Act is a health program, not a work program, and we are concerned about moving forward with the work requirements in New Hampshire,” McKinney said. “And the judge's decision to stop Kentucky from moving forward validates our concerns around the legality of doing so."

State lawmakers also will be watching to see if the ruling in Kentucky has an impact. The Medicaid expansion is expected to provide health coverage to about 52,000 people in New Hampshire.

Another concern is how a work requirement would be verified and the administrative roadblocks it could create, with new deadlines and paperwork jeopardizing coverage for applicants. According to McKinney, just trying to document that a resident meets the number of work hours needed is a problem - even for a large percentage of people on Medicaid who are already working or who live in working households.

"Anytime you add an administrative hurdle — whether it's filing paper, providing identification or pay stubs or any sort of administrative hurdle — is going to cause some people to lose coverage who are, in fact, eligible and are in need of health coverage,” she said.

New Hampshire's change in Medicaid eligibility is set to take effect in January. McKinney said there's a lot to be done between now and then - and given the Kentucky court decision, she said that should include a careful review of the work requirement mandate.


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It is National Rural Health Day and experts are flagging research showing increasing health disparities between urban and rural places, including in South Dakota.

A new advisory from the American Heart Association shows between 2010 and 2022, cardiovascular death rates increased a whopping 21% among young adults in rural areas, especially after the onset of COVID-19. In urban areas, the rate increased only 3%.

Dr. Karen Joynt-Maddox, associate professor of medicine at Washington University, chairs the association's presidential advisory committee and said the change is due to a mixed bag of increased risk factors in rural areas.

"If you put that on top of a real problem with health care infrastructure and access in rural areas, you sort of have a perfect storm for worsening cardiovascular health."

Joynt-Maddox noted traditional risk factors include high blood pressure, diabetes and obesity, which have been increasing in rural areas over the last few decades. Other contributing factors, she said, include poverty, food insecurity, depression and substance use disorder.

Tim Nikolai, Midwest senior rural health director for the American Heart Association, said rural communities have less access to resources like health care and grocery stores with fresh produce. Even access to high speed internet contributes to health outcomes. Health care providers are stretched thin, Nikolai added.

"It stretched hospitals and health care providers to try to serve the needs of their community the best way they can," Nikolai observed. "And that's something we're trying to collaborate with them on, is how can they meet people where they are?"

Nikolai listed some work happening in South Dakota including offering blood pressure monitoring at local libraries, installing four new Public Health AmeriCorps members across the state and the town of Spearfish prioritizing public CPR training and AED access.

More than 38 million Americans live with diabetes, including nearly 1 million Georgians.

The Georgia Department of Public Health estimates another 230,000 people in the state may have diabetes but don't know it.

During National Diabetes Month, Dr. Griffin Rodgers - director of the National Institute of Diabetes, Digestive, and Kidney Diseases at the National Institutes of Health - emphasized the importance of managing diabetes early to prevent serious health complications.

"Diabetes can damage blood vessels and nerves," said Rodgers, "so the patients that have it have a higher risk of developing conditions like a heart attack or a stroke, diseases of the kidneys and the eyes and the teeth, as well as the lower extremities."

Between 2014 and 2018, diabetes led to over 100,000 hospitalizations and 154,000 emergency-room visits in Georgia.

But Rodgers said diabetes is preventable and manageable. He added that regular wellness visits - where blood sugar, blood pressure, and cholesterol are checked - are key to staying healthy.

Rodgers said a healthy diet is a major part of managing or preventing diabetes.

He suggested eating plenty of fresh produce, whole grains, and lean proteins like fish - and cutting back on sugary drinks by choosing water instead.

Regular exercise and seven to eight hours of sleep each night are also important.

"On the physical activity side, 30 minutes a day, five days a week for most adults is what's
generally recommended," said Rodgers. "Just walking. And if you can't do the 30 minutes all at one time, breaking it into either two 15, or three 10-minute intervals is sufficient."

Early signals that diabetes could be a problem include frequent urination, constant thirst or hunger, fatigue, blurry vision, nausea, unexpected weight loss, or tingling in your hands and feet.

Rodgers said managing diabetes can be as simple as focusing on "the A-B-Cs of care" - checking your A1C, blood pressure and cholesterol levels, and quitting smoking.




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California could be in for some big cuts to health care for low-income families under a second Trump administration, according to health experts.

Policy specialists at the nonprofit KFF said they are bracing for Trump allies in Congress to make major reductions to Medicaid expansion under the Affordable Care Act, in order to pay for big tax cuts promised by the president-elect.

Larry Levitt, executive vice president of health policy at KFF, said it would force states to backfill or raise costs.

"For the ACA, simply letting enhanced financial aid expire after next year would result in big out-of-pocket premium increases, reduced enrollment and more people uninsured," Levitt projected.

Robert F. Kennedy Jr., President-elect Trump's choice for Health and Human Services Secretary, did not say much on the campaign trail about funding for Medicaid or the Affordable Care Act, so his positions are unclear. Kennedy has expressed skepticism about vaccines and has said the U.S. should stop putting fluoride in drinking water.

Jennifer Kates, senior vice president and director of the Global Health and HIV Policy Program for KFF, said the Centers for Disease Control and Prevention cannot require states to follow its recommendations on vaccines and fluoridation.

"That's up to states and local governments," Kates explained. "But CDC can recommend, and if those recommendations are not being made or being watered down or changed, that sends a message to states, to schools, to parents."

Health advocates are also raising concerns DACA recipients could lose access to health plans sold on the state marketplaces created under the Affordable Care Act. Changes to so-called "public charge" rules could make families with mixed immigration status hesitant to use Medicaid benefits.


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