Many health-care advocates tout the benefits of home-based care rather than sending loved ones to nursing homes or other facilities. For Medicaid recipients in Florida, however, home-based care can be difficult to find because of long waiting lists and high turnover among underpaid home-care workers. There's some hope that lawmakers in Congress could agree - and pass a new, "slimmed down" version of President Joe Biden's Build Back Better plan, with $150 billion for Home and Community-based Services.

Miriam Haramatz, founder and advocacy director for the Florida Health Justice Project, said the funding needs are critical because too many people are fending for themselves.

"One of our clients had to go days without services," she said. "She is in bed after a stroke; she needs aides to come and operate a Hoyer lift. She was going virtually every weekend without any aid."

Harmatz said caregivers often are paid less than $11 an hour to provide intense, round-the-clock care while juggling other duties. She said she sees an infusion of federal funding as a way to help states take people off wait lists, increase worker pay and provide other critical services.

Amber Christ, director of Health Policy and Advocacy for the group Justice in Aging, said chronic underfunding is making it difficult for Floridians to get the proper care they need where they want to receive it - at home with loved ones.

"From an older adult perspective," she said, "this lack of investment in home- and community-based services in effect pushes older adults into nursing facilities, unnecessarily."

Democrats in Tallahassee have put forward a bill to establish a Medicaid "buy-in" program for people between ages 16 and 64 who earn too much to qualify for Medicaid. They've also proposed a bill requiring the state's Social Services Estimating Conference to develop 'iBudget' enrollment and cost projections, so state economists can better track the number of folks on wait lists, which averages around 22,000.

Washington lawmakers and Gov. Robert Ferguson disagree about how to address the state's $16 billion revenue shortfall.

The House and Senate have both passed budgets which would tax wealthy residents and corporations in order to balance the budget.

In contrast, Ferguson's plan cuts social programs and furloughs employees to save the state $7 billion.

Jeffrey Gustaveson is an organizer with Firelands Workers United, an advocacy group for rural Washingtonians. He said he supports lawmaker's efforts to make the tax system more fair.

"They're saying we should support working people," said Gustaveson, "and we're going to unlock new sources of money by increasing taxes on giant corporations, and some of the wealthiest human beings in the face of the planet."

As budget negotiations move forward, Ferguson called relying on untested taxes irresponsible. Lawmakers have until April 27 to finalize a budget acceptable to the Governor.

David Henson, a retired veteran and volunteer for Firelands, highlighted what's known as the Tax on Wall Street, which would apply to people who own stocks and bonds worth over $50 million.

Democrats say it would generate about $4 billion a year for the state.

"But it only affects 4,300 people in the state of Washington," said Henson. "They only pay 4% -- where we're paying, on average, 14% of our income on taxes. I don't think it's robbery."

Ferguson says his budget does not include reductions to vital services. But, Gustaveson countered, the governor's definition of vital is narrow.

He said a 6% cut from all state agencies will harm many services Washington residents rely on including healthcare, housing, and transit.

"There's a very clear message, I think, from the public right now," said Gustaveson, "that they support public programs and they support funding those public programs with fair taxes."

Democratic lawmakers say their proposed taxes would generate $17 billion over two years, bringing the state out of the red.

As many Minnesotans dig out from an early Spring snowstorm, the future of a federal program that helps low-income households pay their heating bills is less certain. State-level voices cite new spending cuts under the Trump administration. The most recent mass layoffs may include the entire staff that administers the Low-Income Home Energy Assistance Program - according to reports seen by the Citizens Utility Board of Minnesota. The "LIHEAP" funds are sent to state agencies for distribution.

Annie Levenson-Falk, Citizens Utility Board of Minnesota director, worries about payment delays for Minnesotans in need if federal staff isn't there.

"It's pretty concerning to see just the complete elimination of the staff on what is a vital and extremely popular program," she explained.

In an e-mailed statement, the Minnesota Commerce Department says so far this season, the program has helped about 107,000 households cover their utility bills. Amid the staffing upheaval, it anticipates running out of funds to help new applicants as early as mid-April.

The loss of LIHEAP staff comes at a time when energy customers are bracing for potentially higher bills economists link to the escalating trade war pursued by President Donald Trump. Levenson-Falk said her organization is watching to see how this region could be affected as America's trade partners respond to sweeping tariffs.

"It's going to really vary depending on where you live. Some utilities get a lot of electricity from Canada and some get much less, but I do think it could have a substantial effect on a lot of Minnesotans," she continued.

Minnesota officials are not only worried about the effects as the last bit of winter weather hangs on. There is also concern about what will happen this summer to households at risk, between the disruption of energy assistance and tariff-induced price hikes.

Levensen-Falk encouraged people who are eligible for aid to keep applying, and reaching out to service providers with questions.


get more stories like this via email

Backlash is mounting across the U.S. in response to the Trump administration's consistent push to cut federal staffing and programs. North Dakotans not happy with these moves will join another wave of protests this weekend. On Saturday, organizers in towns and cities nationwide will lead what are billed as "Hands Off" events. Demonstrators want to bring renewed focus to the level of cuts pursued by the White House, and the abrupt manner in which they're being carried out.

Lyn Dockter-Pinnick, lead of the grassroots group Red River United Indivisible, feels uneasy about what she calls a "slash and burn" mentality within the administration.

"And so, the concept of "Hands Off" is really not only saying, 'This isn't right, this isn't OK,' but also just concern over the speed and the upheaval that is happening," she said.

She is worried about services for military veterans, such as suicide prevention. The White House says it wants to root out waste and fraud. Dockter-Pinnick says reform is important, but adds that checks and balances are being ignored, citing the influence of wealthy adviser Elon Musk and the Department of Government Efficiency. Regional events this Saturday will be held in Fargo, Grand Forks, Bismarck and Minot.

While North Dakota residents express their frustration, state agencies and nonprofits are adjusting on the fly as cuts are announced. This week, federal officials began laying off ten-thousand Health and Human Services workers.

Seth O'Neill, executive director of the North Dakota Domestic & Sexual Violence Coalition, says that includes staffers who oversee grants his network of crisis centers relies on.

"It's unnerving when you don't know who to call to get answers because you don't know who is still employed at the federal government," he explained.

While the actual prevention grants haven't been cut yet, O'Neill is still worried about their fate. He notes that for these crisis centers, federal funding makes up 30% of their budget. Late last month, North Dakota Health and Human Services officials were left scrambling after being notified that several grants, focusing on substance abuse and mental-health treatment, were terminated early.


get more stories like this via email