As we roll into the final weeks of Medicare's open enrollment, some Missourians may not realize they qualify for a specific type of health insurance to save money.

People who qualify for both Medicare and Medicaid coverage may be able to get what's known as a Dual Special Needs Plan. It includes extra benefits to buy healthy foods, over-the-counter items like pain relievers and toothpaste and even pay utility bills.

Deb Rambo, an advisor for the company Local Insurance Advisors in Branson West, said she often works with people struggling to make ends meet.

"I primarily work in Stone and Taney County, Missouri," Rambo noted. "We have many individuals who that food makes all the difference as to whether they get healthy food, or they're running through some drive-through with a dollar menu, hoping they can get enough to fill their stomach."

Almost 13 million people in the country received health coverage under both Medicare and Medicaid in 2021 but last year, only 5.2 million dual-eligible individuals were enrolled in a Dual Special Needs Plan.

Marian Cabanillas of UnitedHealthcare Community and State, pointed out health coverage is not just about doctor visits and preventive care but other key factors affecting a person's ability to get the care they need.

"Transportation, money, education, all of those pieces," Cabanillas outlined. "What we're trying to do is make sure that we're breaking down those barriers and making sure that people have access to all of the basic benefits that they need."

The Medicare annual enrollment period ends Dec. 7. You must enroll by then to have coverage take effect on Jan. 1.

Open enrollment for health insurance is underway, and in Wyoming, the number of enrollees so far this year is just below last year's rate. Experts advise there's an important deadline this weekend. According to the Centers for Medicare and Medicaid Services, nearly 988,000 new U.S. consumers enrolled in health plans through the Marketplace between November 1st and December 4th. In Wyoming, nearly 14,000 new and returning consumers enrolled during that time.

Caleb Smith, marketing director with Enroll Wyoming, said those who want coverage starting January 1st must enroll by this Sunday, December 15th.

"This deadline is something that we ask people to be mindful of so they can hopefully avoid a gap in health coverage. I'd hate for people to delay action or just forgo trying to get medical help just because they weren't covered," he said.

Open enrollment runs until January 15th. But those who wait until the last month to sign up won't be covered under their new plans until February 1st.

Smith added some Wyoming families are surprised at the discounts they qualify for following pandemic-era increases to advanced premium tax credits. Enroll Wyoming can help anyone navigate the Marketplace, whether they're enrolling for the first time or if they've done it before.

"I certainly know a number of people, they've done this a couple times," he said. They just appreciate somebody kind of looking over their homework to go like, 'Yeah, you got it.'"

Wyomingites can quickly be connected to a navigator by dialing 2-1-1.

Nationwide, Black women face a maternal mortality rate three times higher than white women.

To address the disparity, the Maternity Care Coalition is providing doulas to women in underserved rural areas in Pennsylvania.

Jamiylah Miller, doula program manager for the coalition, said its doula and lactation program supports families from pregnancy to three months postpartum, helping during labor and delivery, pain management and adjusting to a newborn.

However, some families who are not connected with a doula through community organizations like theirs, struggle with the cost of doula services. Recent legislation extended Medicaid coverage to help offset the cost.

"The cost varies depending on the doulas private rates, and some of those can be in the thousands," Miller explained. "We're learning that a lot of the families who need support from a doula, or who would benefit the most, are those who can't afford those prices. "

Miller noted their doula services are free to expecting families in the community. She advocated for more organizations to provide doula services to families facing financial barriers.

Miller pointed out their network of 116 doulas, including 29 certified in Pennsylvania, are independent contractors who bring specialized expertise to their services. The organization also offers doula and lactation community health worker training for those interested.

In anticipation of the growing trend of insurance reimbursement for doula services, which began earlier than expected in February 2024, they have been proactively expanding the program.

"We offered both our current doulas that are in our network, as well as our training doulas to become state certified," Miller emphasized. "We've been able to support them in getting all the components of the application that they need, including CPR training, HIPAA training. We've been able to help with the application fees."

Miller added the coalition offers vital resources to new parents including diapers, wipes, formula, breast pumps when available, and home visiting services. Additionally, they use community resources like Cribs for Kids and the Children's Hospital of Philadelphia car seat program to support families. They are working to expand language services by recruiting more bilingual doulas to better support diverse families.


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By Dawn Attride for Sentient.
Broadcast version by Shanteya Hudson for California News Service reporting for the Sentient-Public News Service Collaboration

Avian flu, also known as H5N1, continues to infect hundreds of cattle, and is making its way into humans. Since avian flu isn't as easily spread among people for now, the main concern is for those in contact with cows, such as the dairy workers who have reported infections. However, as of November 13, 2024, a teenager in British Columbia -- who seemingly had no contact with animals - is now in critical condition, making it Canada's first human case of bird flu.

Since 2022, the current strain of the virus in the United States has infected over 100 million birds and is remarkable in its "scope and scale" to move beyond its usual avian host, and into mammals at a concerning rate, experts say. Wastewater detection shows the virus present in California, Texas and Michigan, among other states. As of this writing, there have been 53 confirmed human cases in the United States. All, except one, were exposed to infected cattle or birds, according to the CDC. Unlike Canada's critical patient, all U.S. cases reported mild symptoms.

A Potential 'Win-Win' Solution

"No matter how you look at it, we're in a pretty unique and extraordinary position. We've never had an outbreak of an animal-borne virus this large in the last five to 10,000 years of human history since we first domesticated animals for food," Maurice Pitesky, an associate professor and expert in poultry disease modeling at the UC Davis School of Veterinary Medicine, tells Sentient.

One of the main reasons for that is how we farm, he says. A California-native, Pitesky has seen hundreds of dairy facilities in the Central Valley alone overlapping or overtaking natural wild bird habitats, such as wetlands. As a result, these wild birds, particularly waterfowl, start congregating near dairy and poultry farms, leading to more interactions with farmed animals, and increasing the risk of avian flu spread.

Pitesky's lab researches how we can shift waterfowl habitat away from livestock farms, for example by restoring wetlands.

"In many ways, that's kind of a win-win solution. It creates a natural habitat for waterfowl - which we've lost a lot of - and then also reduces and mitigates the potential for exposure to viruses," Pitesky says. (It's also good for mitigating climate change.)

Another concern is that avian flu spread to a pig in a backyard farm for the first time in the U.S. this October. Pigs can pick up multiple infections at the same time, which can create a perfect storm in terms of creating a virus that can be easily spread among humans - an example being the swine flu pandemic in 2009.

More needs to be done on the public health side, Pitesky tells Sentient, to avoid human-animal interaction. "An RNA virus [such as avian flu] can mutate really easily. The more that we keep tempting fate by having the virus interact with humans, the greater the potential for the virus to eventually get snake eyes - if you will - as far as how it can adapt to different hosts, including us."

A Resurgence of Raw Milk Could Help the Virus Spread

Marjorie Taylor Greene, a controversial far-right politician, recently promoted drinking raw milk on X, citing the Republican movement to "Make America Healthy Again." Robert F. Kennedy Jr., who President-elect Donald Trump has nominated to lead the Department of Health and Human Services, is also a proponent of raw milk. Raw milk can contain a host of other microbes that cause infection and should be avoided to prevent avian flu infection, seeing as a growing number of cattle herds now have the virus. The U.S. Department of Agriculture recently announced they will start testing bulk raw milk for the virus.

The CDC continues to say the current public health risk of avian flu is low, but that hasn't stopped health organizations from gearing up to be prepared. In Canada, several influenza vaccines are "authorized for use," as is a federal manufacturing agreement to scale up vaccine production if there is an avian flu pandemic. In early October, the U.S. invested $72 million in vaccines against avian flu "as part of national preparedness." With the upcoming change in national leadership, however, time will tell if preparing for avian flu remains a priority.

As the virus continues to spread, Pitesky recommends those with backyard chickens or other wild birds use caution when handling birds. For now, anyway, the CDC still advises consumers to avoid raw milk, practice good hygiene and avoid poultry and dairy farms, if possible.


Dawn Attride wrote this article for Sentient.


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