BOISE, Idaho — The public comment period is open on Idaho's application to the federal government to add work reporting requirements to its expanded Medicaid program.

State lawmakers passed a bill this year requiring that recipients age 19-59 work at least 20 hours a week to maintain Medicaid eligibility. But the waiver must first be approved by the Center for Medicare and Medicaid Services.

Liz Woodruff is a coordinator with Close the Gap Idaho, a network of more than 300 health-care and service organizations. She called the work benchmarks "punitive red tape" that would mean fewer Idahoans have health coverage.

"Idaho would be one of the most restrictive programs in the country,” Woodruff said. “It's a 'one-strike-you're-out' policy – so you miss your reporting for one month, you miss turning in your paperwork, and you lose your health coverage."

There are exemptions to the proposal, including parents of children under 18, people receiving disability insurance and caretakers. Supporters of the waiver are convinced it would encourage self-reliance among recipients.

The public comment period ends November 2.

Work requirements were struck down by federal judges in Arkansas, Kentucky and New Hampshire, and Woodruff said she expects Idaho's provision will also go to court if approved. She said the Idaho Department of Health and Welfare reviewed more than 700 pages of comments on the proposal – many from detractors – in just four days.

"We were disappointed that there were technical points made about how the work requirements would be administered, the costs that might be incurred,” she said. “The fact that Idaho is a large rural state, that would make it complicated for people to report. And, while they had a section in their new application that tried to ease our concerns over that, there were no actual changes made to the application itself."

The new application acknowledges that an estimated 16,000 Idahoans would be affected by the requirements. A federal decision on the proposal could take months or years.

Woodruff noted Medicaid expansion is going ahead as planned, with open enrollment starting Nov. 1 for coverage beginning in 2020.


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As summer kicks into full gear, North Carolina dentists stressed the importance of maintaining children's dental health.

Dr. Miranda Kalaskey, a dentist in Raleigh and member of the North Carolina Dental Society, said with more outdoor activities and changing routines, dental care can often be neglected, leading to cavities and dental trauma. Her advice is for parents to keep up with preventive care and encourage healthier eating habits.

"Try to pick a healthy summer snack. That can be fruit. That can be vegetables. Just not something dry, not something processed," Kalaskey outlined. "And the more processed you have, the more dried it is, the more likely it is to stick to their teeth."

She pointed out left-behind food can cause cavities. Tooth decay is the most common chronic disease among children in the U.S., with more than half of eight-year-olds having had at least one cavity in their baby teeth, according to the Centers for Disease Control and Prevention.

Warmer weather also means more outdoor play. Kalaskey highlighted the rise in dental trauma cases during the summer because of increased outdoor play and sports activities.

"Oftentimes, kids are going and playing basketball, and sometimes high schools are really good about, 'Hey, here's a mouth guard,' or 'You need to get a mouth guard for practice,'" Kalaskey noted. "But during the summer, a lot of times kids will play with other kids, which is great, but making sure they're aware that tooth trauma is a thing."

If a tooth gets knocked out, contact your dentist immediately. If it is after hours, she suggested the ToothSOS app for guidance.

She added another major key to dental hygiene for kids over the summer is a consistent schedule.

"Summer oftentimes is going to change that routine but your brushing, flossing routine does not need a change," Kalaskey recommended. "You still want to do brushing twice a day, flossing at least once a day. So kind of making sure we incorporate that, even though the kids might be waking up at 10 o'clock."

Kalaskey emphasized routine is also important for dental visits. She advised children should be seen by a dentist when they get their first tooth and then every six months afterward. In addition to keeping teeth healthy, she stressed it also builds a good relationship with dental visits in the long term.


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A Virginia community health center is part of a program addressing food scarcity.

The National Association of Community Health Centers' 2024 Innovation Incubator creates ways to expand healthy food access. Tri-Area Community Health Center's Laurel Fork location will have funding and guidance from experts to help them design and test community-based solutions.

Merrill Warschoff Press, senior vice president of partnership, development and innovation for the National Association of Community Health Centers, said the centers are uniquely suited to address local food issues.

"Health centers are highly effective and innovated with integrated models of care," Press explained. "They reach far beyond the walls of the traditional exam room, not only to prevent illness and treat it but to really address the social drivers that may cause poor health."

Food insecurity has grown since pandemic-era programs ended in 2023. Emergency allotments provided SNAP recipients with an added $95 per month for 470,000 families statewide. However, some people are above or below SNAP's qualifying threshold.

Other issues stem from food prices. The Consumer Price Index shows food prices grew between 2022 and 2023 but in recent months, prices have been declining.

A primary goal of the Innovation Incubator is to discover best practices for providing care for millions of people and share them with health centers nationwide. Press noted the methods being worked out can help varying populations.

"There are many health centers who have large populations of patients who come from other countries and are used to certain foods, and have different preferences," Press observed. "Being able to work with them in their own language with the foods that they like and trust is really valuable to improving access to food that'll make a difference in their lives."

Food pantries have been key to reducing food insecurity wherever possible. Virginia food banks saw a 5% to 10% increase in demand at the end of 2022, which is problematic since food banks nationwide are seeing donations decline and reduced commodities from the Emergency Food Assistance Program.

A southeast Arkansas healthcare system is using grant money to help increase its patients' access to healthy foods.

Mainline Health Systems will use the funds to focus on healthy eating habits for people who are expecting.

Work will include showing families how to grow their own fruits and vegetables, and establishing farmers markets that cater specifically to the needs of pregnant women and new mothers.

Health System Registered Dietitian Jane Pelkki said they will teach new moms the basics of eating healthy.

"Eating healthy doesn't have to cost a lot, that it's doable and that there are food assistance programs such as WIC and SNAP, food stamps," said Pelkki. "And we're also going to provide some food to help moms understand what a healthy meal looks like."

Mainline is one of eight health systems nationwide to participate in the National Innovation Incubator program.

It's sponsored by the National Association of Community Health Centers and the global healthcare company, Abbott.

Research shows almost 13% of U.S. households experience food insecurity - or don't have access to an affordable, nutritious diet.

Merrill Warschoff-Press - senior vice president at NACHC - said the facilities play an integral part in improving the overall health of patients, and address social issues that may cause illnesses.

"They reach far beyond the walls of the traditional exam room, not only to prevent illness and treat it, but also to really address the social drivers that may cause poor health," said Warschoff-Press, "so whether it's food insecurity and poor nutrition or even housing, joblessness, mental illness, substance use disorders."

At the end of the six-month pilot program, results will be shared with 1,400 health centers nationwide. That could impact the overall health of more than 31 million patients across the country.