Nebraska saw nine long-term care facility closures in 2022, second only to 13 in Texas.

In the past three years, Nebraska has lost a combined 29 assisted living facilities and nursing homes. Inadequate funding for Medicaid patients, workforce issues and the rising costs of goods and services have all contributed to these closures.

Two bills to be heard in the Unicameral's Appropriations Committee today would mean substantial increases in state and federal funding for both types of facilities.

Jalene Carpenter, Nebraska Health Care Association CEO, says additional funding is crucial to stem the state's long-term care crisis.

"In Nebraska, 15 counties do not have a nursing home or an assisted-living [facility], and we are really starting to see a 'care desert' be created. And that causes significant issues for Nebraska seniors, " Carpenter expressed.

LB-941 would increase the daily reimbursement rate for assisted living residents on the Medicaid Waiver program. The new daily rate of just under $79 is based on a Nebraska Department of Health and Human Services study. LB-942 would increase the nursing home Medicaid reimbursement rate by about 5% over the next year. Both bills were introduced by state Sen. Myron Dorn, R-Adams.

Carpenter says the COVID-impacted long-term care workforce is improving in the state, but she stresses Medicaid reimbursement rates play a large part.

"A large portion of the Medicaid rate -- when you look at what it covers -- it's primarily going towards labor and benefits. Nursing-facility and assisted-living care is very hands-on, and we need adequate rates to be able to attract and retain team members," she added.

Carpenter said the state, educational institutions and organizations, including the Nebraska Health Care Association, are also focused on building the long-term care workforce -- including introducing young people to careers in health care and strengthening Certified Nursing Assistant programs.

"We're trying not only to increase the rates so that our facilities can attract and retain (employees), but then also, as an association, to look at other ways to drive people into the workforce for this profession, " she said.

In 2023, Gov. Jim Pillen approved a one-year, 3% increase in the Medicaid reimbursement rate, but vetoed the Legislature's 2% increase for the second year.

Dozens of mine safety field offices in Kentucky and across the country would close under a proposal by the federal Department of Government Efficiency.

According to an analysis by the nonprofit Appalachian Citizens' Law Center, offices in Barbourville and Harlan are on a list of seven in Kentucky slated for closure.

Brendan Muckian-Bates, policy and advocacy associate at the law center, said closing the offices could turn a 30-minute drive to inspect a rural coal mine into a 3- to 4-hour round trip.

"With the proposed consolidations in Kentucky, some of these offices that would be left would essentially make it near impossible for an MSHA field inspector to conduct the mandatory 4-times-a-year underground mine safety inspections," Muckian-Bates contended.

News outlets first reported last month the Department of Government Efficiency had listed the leases of dozens of Mine Safety and Health Administration field offices across the country for cancellation. Trump administration officials and adviser Elon Musk said lease terminations are part of cost-cutting efforts to eliminate waste, fraud and abuse.

Thousands of coal-mining jobs have been lost in recent decades but inspectors remain busy. More than 16,000 inspections were conducted last year, accounting for more than 234,000 hours on site at mines.

Muckian-Bates added proposed cuts to the National Institute for Occupational Safety and Health would make inspections more challenging.


"Every day that these layoffs remain in effect, that NIOSH offices are closed, more miners will become sick and potentially die," Muckian-Bates argued.

Congress created the federal mine safety agency as part of the Mine Safety Act of 1977, after the deaths of 26 miners in two underground explosions at the Scotia Mine in Letcher County the year prior.

This story is based on original reporting by Liam Niemeyer for the Kentucky Lantern.


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A bipartisan group of lawmakers in Congress is joining advocates for energy assistance across the country to warn a dangerous situation is brewing for low-income households.

Federal staffing cuts have stalled the distribution of key funding. The Trump administration's layoffs of 10,000 Health and Human Services workers include the entire office overseeing the Low Income Energy Assistance Program, which gives eligible households a break on their monthly bills to avoid utility shutoffs.

Mark Wolfe, executive director of the National Energy Assistance Directors Association, which works with states on the issue, said the layoffs have blocked the latest round of aid from getting to them.

"Many states have told us that they've either run out of money or they're very close to it," Wolfe reported. "They need these additional funds to help families pay off the remaining winter heating bills or get ready for summer cooling programs, or both."

Minnesota is among the states to report an imminent "zero balance" if action is not taken soon. It has been more than two weeks since the layoffs were announced and Wolfe noted there is no word on funding status. Congress had authorized $378 million to round out the current cycle.

Thirteen U.S. senators have signed a letter asking the administration to get LIHEAP staff back in place and the money moving again.

Wolfe stressed keeping energy bills current is about more than staying cool when the temperature spikes. He noted utility shutoffs can produce dire consequences for some households.

"The loss of access to refrigeration, for example, you can't keep your food safe, or some medications need to be refrigerated," Wolfe outlined.

There was added pressure this past winter on some state programs where there were much colder temperatures. Each year, LIHEAP helps more than 6 million low-income households and seniors on fixed incomes across the country cover their energy bills.


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According to state data, as Medicaid and the Supplemental Nutrition Assistance Program, or SNAP, face cuts, Michigan's most vulnerable stand to lose the most.

In the Great Lakes state, more than 2 million people count on Medicaid, and more than 1 million of them are kids. When it comes to putting food on the table, more than 1 million Michiganders rely on SNAP benefits, including one in four children.

Amber Bellazaire, senior policy analyst with the Michigan League for Public Policy, emphasized the ripple effects of these proposed cuts could create widespread challenges, even for those not directly enrolled in Medicaid or SNAP.

"If a rural hospital closes because they're operating on razor-thin margins and have lost a significant amount of their funding, because of Medicaid cuts, that hospital closes not just for Medicaid enrollees but for all folks in that community," she explained.

Supporters of the cuts contend that these programs place a heavy burden on the federal budget, discourage work and self-reliance, and are susceptible to fraud and abuse.

MLPP reports that Medicaid is relied on across all Michigan counties and congressional districts, especially in rural and northern areas. The state also ranks high for SNAP participation among veterans, with 41,000 enrolled.

Bellazaire noted that the proposed cuts won't make health care more efficient or affordable - and if she had a seat at the table where budget decisions are made, she'd offer a more balanced perspective.

"I think that there is opportunity to discuss the balance between fiscal responsibility and protecting and improving upon the successes that we've seen come from the Medicaid program and Medicaid expansion," she continued.

Those in favor of the cuts maintain that private markets and local solutions are more effective than government run programs - and states should have more control over program management, rather than relying on the federal government.