By Samantha Young for KFF Health News.
Broadcast version by Eric Tegethoff for Oregon News Service reporting for the KFF Health News-Public News Service Collaboration

Oregon is shipping air conditioners, air purifiers, and power banks to some of its most vulnerable residents, a first-in-the-nation experiment to use Medicaid money to prevent the potentially deadly health effects of extreme heat, wildfire smoke, and other climate-related disasters.

The equipment, which started going out in March, expands a Biden administration strategy to move Medicaid beyond traditional medical care and into the realm of social services.

At least 20 states, including California, Massachusetts, and Washington, already direct billions of Medicaid dollars into programs such as helping homeless people get housing and preparing healthy meals for people with diabetes, according to KFF. Oregon is the first to use Medicaid money explicitly for climate-related costs, part of its five-year, $1.1 billion effort to address social needs, which also includes housing and nutrition benefits.

State and federal health officials hope to show that taxpayer money and lives can be saved when investments are made before disaster strikes.

"Climate change is a health care issue," so helping Oregon's poorest and sickest residents prepare for potentially dangerous heat, drought, and other extreme weather makes sense, said Health and Human Services Secretary Xavier Becerra on a visit to Sacramento, California, in early April.

Becerra said the Biden administration wants states to experiment with how best to improve patient health, whether by keeping someone housed instead of homeless, or reducing their exposure to heat with an air conditioner.

But Medicaid's expansion into social services may duplicate existing housing and nutrition programs offered by other federal agencies, while some needy Americans can't get essential medical care, said Gary Alexander, director of the Medicaid and Health Safety Net Reform Initiative at the Paragon Health Institute.

"There are 600,000 or 700,000 intellectually disabled people in the United States waiting for Medicaid services. They're on a waitlist," said Alexander, who oversaw state health agencies in Pennsylvania and Rhode Island. "Meanwhile Medicaid has money for housing and food and air conditioners for recipients. Seems to me that we should serve the intellectually disabled first before we get into all of these new areas."

Scientists and public health officials say climate change poses a growing health risk. More frequent and intense floods, droughts, wildfires, extreme temperatures, and storms cause more deaths, cardiovascular disease from poor air quality, and other problems, according to the federal government's Fifth National Climate Assessment.

The mounting health effects disproportionately hit low-income Americans and people of color, who are often covered by Medicaid, the state-federal health insurance program for low-income people.

Most of the 102 Oregonians who died during the deadly heat dome that settled over the Pacific Northwest in 2021 "were elderly, isolated and living with low incomes," according to a report by the Oregon Health Authority, which administers the state's Medicaid program, with about 1.4 million enrollees. The OHA's analysis of urgent care and emergency room use from May through September of 2021 and 2022 found that 60% of heat-related illness visits were from residents of areas with a median household income below $50,000.

"In the last 10-plus years, the amount of fires and smoke events and excessive heat events that we've had has shown the disproportionate impact of those events on those with lower incomes," said Dave Baden, the OHA's deputy director for programs and policy.

And, because dangerously high temperatures aren't common in Oregon, many residents don't have air conditioning in their homes.

Traditionally, states hit by natural disasters and public health emergencies have asked the federal government for permission to spend Medicaid dollars on back-up power, air filters, and other equipment to help victims recover. But those requests came after the fact, following federal emergency declarations.

Oregon wants to be proactive and pay for equipment that will help an estimated 200,000 residents manage their health at home before extreme weather or climate-related disaster hits, Baden said. In addition to air conditioning units, the program will pay for mini fridges to keep medications cold, portable power supplies to run ventilators and other medical devices during outages, space heaters for winter, and air filters to improve air quality during wildfire season.

In March, the Oregon Health Plan, the state's Medicaid program, began asking health insurers to find patients who might need help coping with extreme weather. Recipients must meet federal guidelines that categorize them as "facing certain life transitions," a stringent set of requirements that disqualify most enrollees. For example, a person with an underlying medical condition that could worsen during a heat wave, and who is also at risk for homelessness or has been released from prison in the past year, could receive an air conditioner. But someone with stable housing might not qualify.

"You could be in a housing complex, and your neighbor qualified for an air conditioner and you didn't," Baden said.

At the offices of insurer AllCare Health in Grants Pass, Oregon, air conditioners, air filters, and mini fridges were piled in three rooms in mid-April, ready to be handed over to Medicaid patients. The health plan provided equipment to 19 households in March. The idea is to get the supplies into people's homes before the summer fire season engulfs the valley in smoke.

Health plans don't want to find themselves "fighting the masses" at Home Depot when the skies are already smoky or the heat is unbearable, said Josh Balloch, AllCare's vice president of health policy.

"We're competing against everybody else, and you can't find a fan on a hot day," he said.

Oregon and some other states have already used Medicaid money to buy air conditioners, air purifiers, and other goods for enrollees, but not under the category of climate change. For example, California offers air purifiers to help asthma patients and New York just won federal approval to provide air conditioners to asthma patients.

Baden said Oregon health officials will evaluate whether sending air conditioners and other equipment to patients saves money by looking at their claim records in the coming years.

If Oregon can help enrollees avoid a costly trip to the doctor or the ER after extreme weather, other state Medicaid programs may ask the federal government if they can adopt the benefit. Many states haven't yet used Medicaid money for climate change because it affects people and regions differently, said Paul Shattuck, a senior fellow at Mathematica, a research organization that has surveyed state Medicaid directors on the issue.

"The health risks of climate change are everywhere, but the nature of risk exposure is completely different in every state," Shattuck said. "It's been challenging for Medicaid to get momentum because each state is left to their own devices to figure out what to do."

A California state lawmaker last year introduced legislation that would have required Medi-Cal, the state's Medicaid program, to add a climate benefit under its existing social services expansion. The program would have been similar to Oregon's, but AB 586, by Assembly member Lisa Calderon, died in the Assembly Appropriations Committee, which questioned in a staff analysis whether "climate change remediation supports can be defined as cost-effective."

The cost savings are clear to Kaiser Permanente. After the 2021 heat wave, it sent air conditioners to 81 patients in Oregon and southwest Washington whose health conditions might get worse in extreme heat, said Catherine Potter, community health consultant at the health system. The following year, Kaiser Permanente estimated it had prevented $42,000 in heat-related ER visits and $400,000 in hospital admissions, she said.

"We didn't used to have extreme heat like this, and we do now," said Potter, who has lived in the temperate Portland area for 30 years. "If we can prevent these adverse impacts, we should be preventing them especially for people that are going to be most affected."


Samantha Young wrote this story for KFF Health News.


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New Mexico farmers finding it more difficult to grow historic crops are taking up conservation techniques to meet the challenge.

Drought, water scarcity, and extreme weather events combine to require growers to adopt new methods and modern tools.

John Idowu, extension agronomist specialist at New Mexico State University, shows farmers how to improve soil health and help control wind erosion. For long term success, he said they need to focus on sustainable, regenerative practices.

"How can I optimize my system and make it more resilient to climate change, to weather changes?" Idowu explained. "Once we have all those things worked out, farmers will tend to stay in business for longer."

Earlier this year, a NOAA satellite captured an image of winds lifting vast amounts of dust and dirt from New Mexico's dry farmlands. Some forecasters compared it to images last seen in the 1930s Dust Bowl.

Plowing agricultural fields annually was a common practice until the Dust Bowl period but in recent decades no-till or low-till farming operations have gained traction.

Bonnie Hopkins Byers, program director for the San Juan County Extension Service, encouraged New Mexico farmers to get a soil analysis and consider adopting the less aggressive approach. She said it could mean they do not need to till every year.

"One of the biggest problems is that people do something because that's the way they've always done it, or because it's the way their parents have done it, or their grandparents," Hopkins Byers acknowledged. "My philosophy has always been if you're going to till something over, till something in."

Intense dust storms known as "haboobs" were originally thought to be confined to Africa's Sudan but are becoming more common in other arid regions such as the Southwest.

Idowu stressed it makes the adoption of regenerative practices more urgent, as topsoil on New Mexico farmland disappears due to drought, land use changes and wind, which he noted has been particularly strong this year.

"The wind has been a major force, especially in the spring, so many days where you couldn't do anything outside because of the wind," Idowu observed. "You have a lot of dust and that means a lot of erosion and that is exactly what you don't like when it comes to crop production."

The New Mexico Healthy Soil Working Group formed to help farmers improve their land and livelihoods.


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By Carolyn Beans for Lancaster Farming.
Broadcast version by Mark Richardson for Keystone State News Connection reporting for the Lancaster Farming-MIT Climate Change Engagement Program-Public News Service Collaboration

At Mountain View Holsteins in Bethel, Pennsylvania, owner Jeremy Martin is always working to make his dairy more efficient.

Currently, he has his sights set on a manure solid-liquid separator. He'd like to use the solid portion of his manure as bedding for his 140 cows and the liquid as fertilizer.

But the project is pricey - he expects the equipment alone will run around $100,000. So Martin hopes to defray the cost through grant funding for dairy projects that reduce greenhouse gas emissions. Removing much of the solids from manure reduces the feed for the methane-producing microbes that thrive in the anaerobic conditions of liquid manure.

The approach is just one of many dairy practices now considered "climate-smart" because they could cut production of climate-warming gases.

For Martin, a manure separator wouldn't be possible without a grant.

"Once it's in place and going, I think some of these practices will pay for themselves, but the upfront cost is more than I can justify," he says. "If there's money out there to pay that upfront cost to get started, it makes sense to me to do it."

Across Pennsylvania, dairy farmers are learning more about climate-smart practices and funding opportunities, and weighing whether these changes are really sustainable for their businesses as well as the environment.

The Latest Buzzword

USDA has defined climate-smart agriculture as an approach that reduces or removes greenhouse gas emissions, builds resilience to the changing climate, and sustainably increases incomes and agricultural productivity.

"Before climate-smart was a thing, we called it conservation. We called it stewardship," says Jackie Klippenstein, a senior vice president at Dairy Farmers of America.

Indeed, long before the Food and Agriculture Organization of the United Nations coined the term "climate-smart agriculture" in 2010, Pennsylvania dairy farmers had adopted many of the practices that now fall under the label.

For dairy, climate-smart practices largely include strategies that reduce greenhouse gases emitted from cows, manure or fields. Tried and true conservation practices like cover cropping and reduced tillage count.

So do newer practices like using the feed additive Bovaer to reduce methane production in a cow's rumen, or precision nitrogen management to reduce nitrous oxide emissions from fields.

Paying for Climate-Smart

"Margins are very tight on the dairy farm," says Jayne Sebright, the executive director of the Center for Dairy Excellence, a public-private partnership to strengthen Pennsylvania's dairy industry. "Some of these (climate-smart practices) are good for the climate, but they don't make good economic sense until they're subsidized."

In 2022, the center joined a Penn State-run program called "Climate-smart Agriculture that is profitable, Regenerative, Actionable and Trustworthy" to provide dairy farmers with funds for switching to climate-smart practices.

CARAT was launched with a $25 million USDA Partnerships for Climate-Smart Commodities grant, but the future of the Pennsylvania project is in doubt. In April, USDA canceled the partnership program, suggesting that recipients reapply to a new USDA initiative called Advancing Markets for Producers.

Over 60 dairy farmers across Pennsylvania, including Martin, had already applied and been accepted into the first phase of CARAT. This initial phase was intended to help farmers identify the best climate-smart practices for their operations. In the second phase, farmers would have applied for funding to implement those practices. One farmer was already paid for his project before the USDA canceled the partnership program.

"There are fewer funding sources for climate-smart projects than in the last administration. However, private organizations and other entities are funding climate-smart projects," Sebright says. "Depending on what the practice is, (climate-smart) could also be conservation projects. It could be water quality projects."

Sebright suggests that dairy farmers also look for support through state-level funding, such as Pennsylvania's Resource Enhancement and Protection program, which offers tax credits for implementing practices that benefit farms and protect water quality.

Pennsylvania dairy farmers can also contact their county conservation districts to ask about funding opportunities for climate-smart projects, says Amy Welker, a project manager and grant writer for Pennsylvania-based Jones Harvesting, which operates Maystone Dairy in Newville and Molly Pitcher Milk in Shippensburg.

In the next year, Jones Harvesting plans to install a methane digester and solid-liquid separator at a site near Maystone Dairy. The digester is funded with an Agricultural Innovation Grant from the state and an Environmental Quality Incentives Program grant from USDA, along with private funds.

There's money out there for farmers who implement climate-smart practices, says Welker. But "you can't just look at one source."

Long-Term Payoffs

Ultimately, for climate-smart projects to make economic sense, they must continue paying for themselves long after the initial investment. One major goal of the USDA's Partnerships for Climate-Smart Commodities program was to develop markets where farmers adopting these practices could earn a premium.

Some dairy farmers might see that return in the carbon market. National checkoff organization Dairy Management Inc. and its partners have pledged to shrink the industry's net greenhouse gas production to zero by 2050. There are growing opportunities for companies working toward that goal in the dairy supply chain to pay farmers for their contributions.

Early last year, Texas dairy farmer Jasper DeVos became the first to earn credits through the livestock carbon insetting marketplace. DeVos earned carbon credits by reducing methane emissions with a feed protocol that included the feed additive Rumensin. Dairy Farmers of America then purchased those credits through Athian, a carbon marketplace for the livestock industry.

Increased Efficiency

Even without direct monetary payoff, many farmers who adopt climate-smart practices reap rewards in improved efficiency and productivity.

"When you look at climate-smart, you also have to look at what's farm smart," Sebright says. She suggests that farmers choose practices that benefit their farms, not just the climate.

A farmer might decide to put a cover and flare system on a manure pit, not only because it reduces methane emissions but also because it keeps rainwater out of the pit and reduces the number of times each year the pit must be emptied.

Andy Bollinger of Meadow Spring Farm in Lancaster County has been running a manure separator since 2009. The liquid fertilizes his fields, and a portion of the solids becomes bedding for his cows.

He estimates the system saves him at least $20,000 a year in bedding costs.

"We put a fresh coating of it onto the stalls that our cows lay in every day and scrape the old stuff out," says Bollinger, who is also the vice president of the Professional Dairy Managers of Pennsylvania. "It seems to work quite well, and it saves us from buying other bedding products."

No-till farming is also a cost saver because it reduces field passes with equipment, says James Thiele of Thiele Dairy Farm in Cabot, which has been 100% no-till for at least six years. The practice saves him money on fuel and herbicides.

"You're saving your environment, and you're also saving green," he says.

But Thiele questions whether some other climate-smart practices like methane digesters would be practical for his farm, which has 75 to 80 cows.

"I don't know if it'd be worth it for somebody as small as I am," he says.

"I think over the next few years, we'll rapidly see (climate-smart) tools become more available, and we'll see more organizations like DFA talking to our small to mid-sized farmers to make sure they understand they've got a place in this, they can benefit from it, and the practices and tools are affordable to them as well," Klippenstein says.

Weighing Climate-Smart

Many dairy farmers wonder whether some of the practices championed as climate-smart will really support their businesses.

Donny Bartch of Merrimart Farms in Loysville has adopted environmental practices from cover cropping to a manure management plan.

"I want to protect the environment. I want to keep my nutrients here on the farm and be sustainable for another five generations," Bartch says. "But we have to make sure that we're making the right decisions to keep the business going. And to do some of these (climate-smart) practices, the only way they pencil out is to have those subsidies."

There is also frustration with a system that rewards climate-smart improvements made today without acknowledging the contributions of farmers who were climate-smart before anyone put a name on it.

"You come around and want to start rewarding people for doing these things. You really need to start with the ones that have been doing it for a long time, but that's really not what happens," says Jim Harbach of Schrack Farms in Loganton, whose farm has been no-till for 50 years.

Climate-smart grant money and carbon credits are typically awarded for the implementation of new practices.

"It's just the unfortunate way that all of the policies and regulations were written," Sebright says. "What I would say is, if you do a climate-smart plan, maybe there are practices or things you can do to enhance or support or take what you're doing a step further."

Scientific Measurements on Real Farms

Some dairy farmers also want to know more about how climate-smart practices will affect their farms before jumping in.

Steve Paxton remembers participating in a government program to improve timber over 50 years ago on his family dairy, Irishtown Acres in Grove City. His family members were paid to climb up into their white pines and saw off many of the bottom branches.

The goal was to create a cleaner log. Instead, more sunlight shown through, which caused grape vines to climb up and topple the trees.

"The bottom line is, there was research done, it looked good, but it hadn't had enough time to follow through and see just really what the end results would be," Paxton says.

When Paxton sees estimates of how some practices might reduce greenhouse gases emitted from cows, he wonders how much of that research has been tested on actual dairies.

"I think some of it now is just kind of a textbook estimate of what's happening," he says.

More meaningful data is needed to show how climate-smart practices reduce greenhouse gases on individual dairies, Sebright says.

As part of the CARAT program, Penn State researchers planned to place greenhouse gas sensors on a dozen dairies and test how much greenhouse gas production falls as farmers experiment with different practices. The researchers intended to then use that data to build models that predict how those practices may affect emissions on other farms. They will still measure emissions this spring on one farm that is experimenting with a new approach for spreading manure in fields of feed crops.

"The real goal of (CARAT) is to have research that says, if you put a cover and flare (manure storage system) on a 500-cow dairy, this is how greenhouse gas emissions will change," Sebright says. "Or if you use Bovaer on a 90-cow herd, here's how this will affect greenhouse gas emissions."

Martin of Mountain View Holsteins has his own personal beliefs about where a dairy farmer's responsibilities to the planet begin and end. But from a business perspective, he feels compelled to adopt climate-smart practices because he expects the industry will eventually require them.

"Climate concerns are coming whether I'd like it or not," he says. "So my thought is, I might as well get started on it while there's funding to do it."


Carolyn Beans wrote this article for Lancaster Farming.


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Oregon's new state budget cuts funding for programs intended to protect residents from extreme weather and make renewable energy more accessible.

Climate justice advocates said it is a major setback after years of progressive climate policies.

Ben Brint, senior climate program director for the Oregon Environmental Council, is disappointed to lose funding for the Community Renewable Energy Grant Program, which supports a variety of projects tailored to communities, including microgrids and solar storage.

"We felt legislators didn't fund climate resilience programs while fires are raging, people's houses are burning down and the state has already experienced record heat waves in June," Brint pointed out. "Legislators don't see we are in an actual climate emergency and chose inaction."

Brint said the grant program aimed to help low-income, rural and communities of color, those most impacted by climate disasters. Lawmakers attributed the cuts to budget shortfalls and uncertainty over federal funding.

Joel Iboa, executive director of the Oregon Just Transition Alliance, said the Community Resilience Hub program, which creates networks as well as physical places to protect people from extreme cold, heat and smoke also lost funding this session. He argued the hubs are effective because communities design them to meet their unique needs.

"Whether it be a place to plug in your phone or a place to go get diapers or get an air conditioner or whatever your community may need," Iboa outlined. "Depending on what's going on."

A heat pump program for rental housing, aimed at making energy-efficient heating and cooling more affordable, was also cut this session.

Brint added he realizes legislators have to make tough decisions about how to fund health care and housing but emphasized climate change is connected to those issues.

"When we're talking about heat pumps or the C-REP program, we're talking about people's health and livelihoods and saving lives in the face of climate fueled disaster," Brint stressed.

Brint added since climate change is not going away, the movement to push for climate resilience will not either.


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