Philadelphia is addressing its opioid crisis by deploying mobile medical units to provide Medicaid-funded "street medicine" to the unhoused population.

This initiative was made possible by a recent Pennsylvania policy change, allowing the city to bill Medicaid for outreach site medicine.

Maire St. Ledger, family nurse practitioner from Project HOME's Epstein Street Medicine program, said the opioid epidemic has significantly increased homelessness in Philadelphia, and its mobile units aim to offer both essential care and dignity to unhoused people.

"There are a number of organizations that are providing medical care to people who are unhoused," said St. Ledger. "But we're the only team that we know of providing primary care. So, there are a lot of people that will go out with vans who will do point-of-care testing for HIV, for example. There's another van that just does wound care, but we do all of that."

St. Ledger highlighted the program's significant impact on participants -- aiming to improve medical outcomes, build trust, and enhance access to health-care and support services with holistic, trauma-informed and harm-reduction care.

She noted a few years ago, MPOX spread rapidly, but collaboration with the local health department and community partners helped prevent further spread through vaccination.

St. Ledger said they rely heavily on their outreach teams to build relationships with the participants, which helps the mobile unit assist people by providing them with resources.

"They try to engage with patients or with people who were unhoused," said St. Ledger. "It might just be, in the beginning, bringing them some water, bringing them clean socks or a blanket - building those relationships, getting them referred to housing, to shelters, to detox, to rehab, whatever it might be."

Dr. Judy Chertok is a Family Medicine and Addiction Medicine Physician and Associate Professor at the University
of Pennsylvania collaborating with Prevention Point Philadelphia on the Overdose Surge Response Bus, launched in the summer of 2020.

Using city data to identify overdose hotspots, the team deploys its mobile unit to provide crucial resources to the hardest-hit communities.

"We collaboratively work to do some canvassing and provide lots of harm-reduction supplies, Narcan," said Chertok, "and then, for people that are interested, they can meet with the doctor and do same day starts of medication like Buprenorphine for addiction."

Chertok said a new survey on the Mobile Overdose Response Program examines several aspects, including the general demographics of the first 237 patients.


It also analyzes housing rates, substance-use severity, and assessed for predictors of engagement and care after using the mobile unit.

"So the unit sees people for a few weeks, and then links them to ongoing care," said Chertok. "And so we try to look to see if there are any facilitators of what help someone get from this mobile space into ongoing care and stay on medication."

Support for this reporting was provided by The Pew Charitable Trusts.




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Groups fighting for immigrants' rights and health care access asked lawmakers in Sacramento on Tuesday to reject proposed cuts to Medi-Cal for undocumented adults.

In his updated May budget, Gov. Gavin Newsom proposed freezing enrollment, charging people $100 a month for coverage and dropping dental, in-home care and long-term care benefits.

Maribel Cruz, associate director of the Long Beach-based nonprofit Órale, said the consequences could be dire.

"People are going to die because of this because they're not getting primary care," Cruz contended. "So many diseases are preventable if they are detected early enough. And how are you going to detect a disease when you can't even access a doctor? Most folks are going to end up in emergency rooms. This is people's lives, and this is real."

Gov. Newsom said the cuts are needed to balance the state budget, which faces a shortfall that he blames on tariffs and on higher-than-expected enrollment in Medi-Cal. Republicans in Congress are considering major cuts to Medicaid and a huge drop in funding to states offering health care to undocumented immigrants.

Rachel Linn Gish, communications director for the advocacy group Health Access California, thinks the state should not pull back on its goal of universal health coverage or balance the budget on the backs of the most vulnerable families.

"These are people that are scraping down the last penny to afford rent, to afford groceries, to make sure they have gas in their car, to get their kids to school or get themselves to work," Gish emphasized. "Asking them to spend another $100 a month to access the health care that they currently receive is cruel."

Masih Fouladi, executive director of the California Immigrant Policy Center, said it is unjust to deny or charge people more for health care because of their immigration status.

"We don't see that as fair or equitable or aligned with California values," Fouladi stressed. "Especially given the impact that immigrants have, and what they do to make California the fourth-largest economy in the world."

Fouladi added he believes the proposed budget would take California backward and compromise the health of families and communities.

A new report found women of childbearing age in rural areas rely more on Medicaid for health care coverage than their urban counterparts and cuts to Medicaid could threaten services.

The report by the Georgetown University Center for Children and Families found nearly a quarter of Virginia women in small towns and rural areas get health care through Medicaid. Republicans lawmakers are now considering a $625 billion cut to Medicaid, which many believe will eliminate health care for thousands in the Commonwealth. Virginia expanded Medicaid coverage in 2019 but any decrease in Medicaid funds automatically triggers the expansion to end.

Joan Alker, executive director of the center, said cuts would threaten rural communities.

"Rural communities tend to have lower income than metro areas," Alker pointed out. "Medicaid, as important as it is for moms and babies nationwide, is even more important in rural areas and small towns."

Republican lawmakers have proposed the Medicaid cuts to redirect $4.5 trillion to other programs and tax cuts. Rep. Mike Johnson, R-La., the Speaker of the House said Congress is addressing government waste and abuse.

Cuts to Medicaid could affect rural women not on Medicaid, too. One study showed rural hospitals are at least 60% more likely to remain open in states that have expanded Medicaid. In Virginia, only eight rural hospitals have labor and delivery units.

Victoria Richardson, staff attorney for the Virginia Poverty Law Center, said rural hospitals depend on Medicaid coverage to keep their doors open.

"It's important to keep those hospitals open, not just for women covered under Medicaid but also for pregnant women in general," Richardson contended. "If a hospital closes, that affects everybody in the community, no matter what source of coverage you have."

A poll by The Associated Press and NORC Center for Public Affairs Research found 55% of U.S. adults believe the government is spending too little on Medicaid, compared to 15% who believe it is spending too much.

Lipscomb University's College of Pharmacy is poised to launch Tennessee's first Certified Anesthesiologist Assistant master's degree program pending Gov. Bill Lee's signature.

House Bill 979 would address the shortage of anesthesiologists in Tennessee by allowing hospitals in counties with fewer than 105,000 residents to directly employ physician anesthesiologists.

Tom Campbell, dean of the College of Pharmacy at Lipscomb University in Nashville, said Certified Anesthesiologist Assistants play a key role alongside anesthesiologists in patient care during surgery. He stressed the school's 24-month curriculum is designed to prepare students for the high standards of the profession.

"They are fully trained in how to manage the airways, how to manage emergency situations that would require cardiac life support, whether that be in an adult or a pediatric or neonatal patient," Campbell outlined.

With more than 500 health care firms in Nashville, Lipscomb's new degree fills a gap. Campbell added the school's program is one of 14 national institutions overseeing 24 independent campuses. Campbell is optimistic about legislation allowing certified assistants to work in Tennessee. If signed, the law would take effect January 2026 and classes would start in the summer, pending accreditation approval.

Josie Turk, a second-year pharmacy student, grew up in a small town with limited medical resources, which fueled a passion for health care. She is interested in the master's program and said it would coincide with her current field of study in pharmacy.

"Why would you not want to be a part of that team, that anesthesiology team?" Turk asked. "The overall goal is for patients' experience and having the ability to give good health care to patients and make sure their safety is the number one thing that we look at. And I think that's what drew me to it."

She noted the program would replace other requirements and add two years of additional study after she completes the pharmacy program.

Campbell added Lipscomb has connected with several existing programs offering guidance on launching the curriculum.

"We will work alongside anesthesiologists to make sure that this program addresses exactly what they want from the anesthesiologist assistant and the care of the patients," Campbell emphasized. "It's going to be designed in such a way that the anesthesiologist assistant and the anesthesiologist are on the same wavelength."

Campbell added many anesthesiologist assistants employers will help repay debt the students incurred while earning their degree.