Four years after the COVID-19 pandemic closed schools and upended child care, the CDC says parents can start treating the virus like other respiratory illnesses.
Gone are mandated isolation periods and masking. But will schools and child care centers agree?
In case you’ve lost track: Before Friday, all Americans, including school children, were supposed to stay home for at least five days if they had COVID-19 and then mask for a set period of time, according to the Centers for Disease Control and Prevention.
Now, with COVID deaths and hospitalizations dropping, the CDC says children can go back to school when their overall symptoms improve and they’re fever-free for 24 hours without taking medication. Students are “encouraged” to wear a mask when they return.
Still, the change may not affect how individual schools urge parents to react when their children fall sick. Schools and child care providers have a mixed record on following CDC recommendations and often look to local authorities for the ultimate word. And sometimes other goals, such as reducing absences, can influence a state or district’s decisions.
The result can be a confusing array of policies among states and districts, not to mention workplaces — confounding parents whose lives have long been upended by the virus.
“This is so confusing,” said Gloria Cunningham, a single mom in the Boston area. “I just don’t know what I should think of COVID now. Is it still a monster?”
Cunningham, who manages a local store for a national restaurant chain, said her company requires her to take off 10 days if she gets COVID-19. And the school system where her son is in second grade has still been sending home COVID test kits for kids to use before returning to school after long breaks.
“I feel like we should just do away with anything that treats COVID differently or keep all of the precautions,” she said.
The public education system has long held varying policies on COVID. During the 2021-22 school year, 18 states followed CDC recommendations for mask-wearing in class. When the CDC lifted its masking guidelines in February 2022, states such as Massachusetts followed suit, but California kept the mask requirement for schools.
And in the child care world, some providers have long used more stringent testing and isolation protocols than the CDC has recommended. Reasons have ranged from trying to prevent outbreaks to keeping staff healthy — both for their personal safety and to keep the day care open.
Some states moved to more lenient guidelines ahead of the CDC. California and Oregon recently rescinded COVID-19 isolation requirements, and many districts followed their advice.
In an attempt to minimize school absences and address an epidemic of chronic absenteeism, California has encouraged kids to come to school when mildly sick and said that students who test positive for coronavirus but are asymptomatic can attend school. Los Angeles and San Diego’s school systems, among others, have adopted that policy.
But the majority of big-city districts around the country still have asked parents to isolate children for at least five days before returning to school. Some, including Boston and Atlanta, have required students to mask for another five days and report positive COVID-19 test results to the school.
Some school leaders suggest the CDC’s previous five-day isolation requirement was already only loosely followed.
Official policy in Burlington, Massachusetts, has been to have students stay home for five days if they test positive. But Superintendent Eric Conti said the real policy, in effect, is: “It’s a virus. Deal with it.”
That’s because COVID is managed at home, using the honor system.
“Without school-based testing, no one can enforce a five-day COVID policy,” he said via text message.
Ridley School District in the Philadelphia suburbs was already using a policy similar to the new CDC guidelines, said Superintendent Lee Ann Wentzel. Students who test positive for COVID must be fever-free without medication for at least 24 hours before returning to school. When they come back, they must mask for five days. Wentzel said the district is now considering dropping the masking requirement because of the new CDC guidance.
A school or day care’s specific guidelines are consequential for working parents who must miss work if their child can’t go to school or child care. In October 2023, during simultaneous surges of COVID, respiratory syncytial virus and influenza, 104,000 adults reported missing work because of child care issues, the highest number in at least a decade. That number has fallen: Last month, child care problems meant 41,000 adults missed work, according to the Bureau of Labor Statistics.
Melissa Colagrosso’s child care center in West Virginia dropped special guidelines for COVID about a year ago, she said. Now, they’re the same as other illnesses: A child must be free of severe symptoms such as fever for at least 24 hours before returning to the center.
“We certainly are treating COVID just like we would treat flu or hand, foot and mouth” disease, said Colagrosso, CEO of A Place To Grow Children’s Center in Oak Hill.
As for kids without symptoms who test positive for COVID? Most parents have stopped testing kids unless they have symptoms, Colagrasso said, so it’s a quandary she has not encountered.
Still, some parents worry the relaxed rules put their communities at greater risk. Evelyn Alemán leads a group of Latino and Indigenous immigrant parents in Los Angeles County. The parents she represents, many of whom suffer from chronic illnesses and lack of access to health care, panicked when California did away with isolation requirements in January.
“I don’t think they’re considering what the impact will be for our families,” she said of California officials. “It feels like they don’t care — that we’re almost expendable.”
Other impacts of the pandemic linger, too, even as restrictions are lifted. In Ridley, the Philadelphia-area district, more students are reclusive and struggle to interact in-person with peers, said Wentzel, the superintendent. Interest in school dances has plummeted.
“Emotionally,” Wentzel said, “they’re having trouble.”
Four years after the COVID-19 pandemic closed schools and upended child care, the CDC says parents can start treating the virus like other respiratory illnesses.
Gone are mandated isolation periods and masking. But will schools and child care centers agree?
In case you’ve lost track: Before Friday, all Americans, including school children, were supposed to stay home for at least five days if they had COVID-19 and then mask for a set period of time, according to the Centers for Disease Control and Prevention.
Now, with COVID deaths and hospitalizations dropping, the CDC says children can go back to school when their overall symptoms improve and they’re fever-free for 24 hours without taking medication. Students are “encouraged” to wear a mask when they return.
Still, the change may not affect how individual schools urge parents to react when their children fall sick. Schools and child care providers have a mixed record on following CDC recommendations and often look to local authorities for the ultimate word. And sometimes other goals, such as reducing absences, can influence a state or district’s decisions.
The result can be a confusing array of policies among states and districts, not to mention workplaces — confounding parents whose lives have long been upended by the virus.
“This is so confusing,” said Gloria Cunningham, a single mom in the Boston area. “I just don’t know what I should think of COVID now. Is it still a monster?”
Cunningham, who manages a local store for a national restaurant chain, said her company requires her to take off 10 days if she gets COVID-19. And the school system where her son is in second grade has still been sending home COVID test kits for kids to use before returning to school after long breaks.
“I feel like we should just do away with anything that treats COVID differently or keep all of the precautions,” she said.
The public education system has long held varying policies on COVID. During the 2021-22 school year, 18 states followed CDC recommendations for mask-wearing in class. When the CDC lifted its masking guidelines in February 2022, states such as Massachusetts followed suit, but California kept the mask requirement for schools.
And in the child care world, some providers have long used more stringent testing and isolation protocols than the CDC has recommended. Reasons have ranged from trying to prevent outbreaks to keeping staff healthy — both for their personal safety and to keep the day care open.
Some states moved to more lenient guidelines ahead of the CDC. California and Oregon recently rescinded COVID-19 isolation requirements, and many districts followed their advice.
In an attempt to minimize school absences and address an epidemic of chronic absenteeism, California has encouraged kids to come to school when mildly sick and said that students who test positive for coronavirus but are asymptomatic can attend school. Los Angeles and San Diego’s school systems, among others, have adopted that policy.
But the majority of big-city districts around the country still have asked parents to isolate children for at least five days before returning to school. Some, including Boston and Atlanta, have required students to mask for another five days and report positive COVID-19 test results to the school.
Some school leaders suggest the CDC’s previous five-day isolation requirement was already only loosely followed.
Official policy in Burlington, Massachusetts, has been to have students stay home for five days if they test positive. But Superintendent Eric Conti said the real policy, in effect, is: “It’s a virus. Deal with it.”
That’s because COVID is managed at home, using the honor system.
“Without school-based testing, no one can enforce a five-day COVID policy,” he said via text message.
Ridley School District in the Philadelphia suburbs was already using a policy similar to the new CDC guidelines, said Superintendent Lee Ann Wentzel. Students who test positive for COVID must be fever-free without medication for at least 24 hours before returning to school. When they come back, they must mask for five days. Wentzel said the district is now considering dropping the masking requirement because of the new CDC guidance.
A school or day care’s specific guidelines are consequential for working parents who must miss work if their child can’t go to school or child care. In October 2023, during simultaneous surges of COVID, respiratory syncytial virus and influenza, 104,000 adults reported missing work because of child care issues, the highest number in at least a decade. That number has fallen: Last month, child care problems meant 41,000 adults missed work, according to the Bureau of Labor Statistics.
Melissa Colagrosso’s child care center in West Virginia dropped special guidelines for COVID about a year ago, she said. Now, they’re the same as other illnesses: A child must be free of severe symptoms such as fever for at least 24 hours before returning to the center.
“We certainly are treating COVID just like we would treat flu or hand, foot and mouth” disease, said Colagrosso, CEO of A Place To Grow Children’s Center in Oak Hill.
As for kids without symptoms who test positive for COVID? Most parents have stopped testing kids unless they have symptoms, Colagrasso said, so it’s a quandary she has not encountered.
Still, some parents worry the relaxed rules put their communities at greater risk. Evelyn Alemán leads a group of Latino and Indigenous immigrant parents in Los Angeles County. The parents she represents, many of whom suffer from chronic illnesses and lack of access to health care, panicked when California did away with isolation requirements in January.
“I don’t think they’re considering what the impact will be for our families,” she said of California officials. “It feels like they don’t care — that we’re almost expendable.”
Other impacts of the pandemic linger, too, even as restrictions are lifted. In Ridley, the Philadelphia-area district, more students are reclusive and struggle to interact in-person with peers, said Wentzel, the superintendent. Interest in school dances has plummeted.
“Emotionally,” Wentzel said, “they’re having trouble.”
New technologies are making it easier for companies to fix prices and discriminate against individual consumers, the Biden administration’s top consumer watchdog said Tuesday.
Algorithms make it possible for companies to fix prices without explicitly coordinating with one another, posing a new test for regulators policing the market, said Lina Khan, chair of the Federal Trade Commission, during a media event hosted by KFF.
“I think we could be entering a somewhat novel era of pricing,” Khan told reporters.
Khan is regarded as one of the most aggressive antitrust regulators in recent U.S. history, and she has paid particular attention to the harm that technological advances can pose to consumers. Antitrust regulators at the FTC and the Justice Department set a record for merger challenges in the fiscal year that ended Sept. 30, 2022, according to Bloomberg News.
Last year, the FTC successfully blocked biotech company Illumina’s over $7 billion acquisition of cancer-screening company Grail. The FTC, Justice Department, and Health and Human Services Department launched a website on April 18, healthycompetition.gov, to make it easier for people to report suspected anticompetitive behavior in the health care industry.
The American Hospital Association, the industry’s largest trade group, has often criticized the Biden administration’s approach to antitrust enforcement. In comments in September on proposed guidance the FTC and Justice Department published for companies, the AHA said that “the guidelines reflect a fundamental hostility to mergers.”
Price fixing removes competition from the market and generally makes goods and services more expensive. The agency has argued in court filings that price fixing “is still illegal even if you are achieving it through an algorithm,” Khan said. “There’s no kind of algorithmic exemption to the antitrust laws.”
By simply using the same algorithms to set prices, companies can effectively charge the same “even if they’re not, you know, getting in a back room and kind of shaking hands and setting a price,” Khan said, using the example of residential property managers.
Khan said the commission is also scrutinizing the use of artificial intelligence and algorithms to set prices for individual consumers “based on all of this particular behavioral data about you: the websites you visited, you know, who you had lunch with, where you live.”
And as health care companies change the way they structure their businesses to maximize profits, the FTC is changing the way it analyzes behavior that could hurt consumers, Khan said.
Hiring people who can “help us look under the hood” of some inscrutable algorithms was a priority, Khan said. She said it’s already paid off in the form of legal actions “that are only possible because we had technologists on the team helping us figure out what are these algorithms doing.”
Traditionally, the FTC has policed health care by challenging local or regional hospital mergers that have the potential to reduce competition and raise prices. But consolidation in health care has evolved, Khan said.
Mergers of systems that don’t overlap geographically are increasing, she said. In addition, hospitals now often buy doctor practices, while pharmacy benefit managers start their own insurance companies or mail-order pharmacies — or vice versa — pursuing “vertical integration” that can hurt consumers, she said.
The FTC is hearing increasing complaints “about how these firms are using their monopoly power” and “exercising it in ways that’s resulting in higher prices for patients, less service, as well as worse conditions for health care workers,” Khan said.
Policing Noncompetes
Khan said she was surprised at how many health care workers responded to the commission’s recent proposal to ban “noncompete” clauses — agreements that can prevent employees from moving to new jobs. The FTC issued its final rule banning the practice on Tuesday. She said the ban was aimed at low-wage industries like fast food but that many of the comments in favor of the FTC’s plan came from health professions.
Health workers say noncompete agreements are “both personally devastating and also impeded patient care,” Khan said.
In some cases, doctors wrote that their patients “got really upset because they wanted to stick with me, but my hospital was saying I couldn’t,” Khan said. Some doctors ended up commuting long distances to prevent the rest of their families from having to move after they changed jobs, she said.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
USE OUR CONTENT
This story can be republished for free (details).
New technologies are making it easier for companies to fix prices and discriminate against individual consumers, the Biden administration’s top consumer watchdog said Tuesday.
Algorithms make it possible for companies to fix prices without explicitly coordinating with one another, posing a new test for regulators policing the market, said Lina Khan, chair of the Federal Trade Commission, during a media event hosted by KFF.
“I think we could be entering a somewhat novel era of pricing,” Khan told reporters.
Khan is regarded as one of the most aggressive antitrust regulators in recent U.S. history, and she has paid particular attention to the harm that technological advances can pose to consumers. Antitrust regulators at the FTC and the Justice Department set a record for merger challenges in the fiscal year that ended Sept. 30, 2022, according to Bloomberg News.
Last year, the FTC successfully blocked biotech company Illumina’s over $7 billion acquisition of cancer-screening company Grail. The FTC, Justice Department, and Health and Human Services Department launched a website on April 18, healthycompetition.gov, to make it easier for people to report suspected anticompetitive behavior in the health care industry.
The American Hospital Association, the industry’s largest trade group, has often criticized the Biden administration’s approach to antitrust enforcement. In comments in September on proposed guidance the FTC and Justice Department published for companies, the AHA said that “the guidelines reflect a fundamental hostility to mergers.”
Price fixing removes competition from the market and generally makes goods and services more expensive. The agency has argued in court filings that price fixing “is still illegal even if you are achieving it through an algorithm,” Khan said. “There’s no kind of algorithmic exemption to the antitrust laws.”
By simply using the same algorithms to set prices, companies can effectively charge the same “even if they’re not, you know, getting in a back room and kind of shaking hands and setting a price,” Khan said, using the example of residential property managers.
Khan said the commission is also scrutinizing the use of artificial intelligence and algorithms to set prices for individual consumers “based on all of this particular behavioral data about you: the websites you visited, you know, who you had lunch with, where you live.”
And as health care companies change the way they structure their businesses to maximize profits, the FTC is changing the way it analyzes behavior that could hurt consumers, Khan said.
Hiring people who can “help us look under the hood” of some inscrutable algorithms was a priority, Khan said. She said it’s already paid off in the form of legal actions “that are only possible because we had technologists on the team helping us figure out what are these algorithms doing.”
Traditionally, the FTC has policed health care by challenging local or regional hospital mergers that have the potential to reduce competition and raise prices. But consolidation in health care has evolved, Khan said.
Mergers of systems that don’t overlap geographically are increasing, she said. In addition, hospitals now often buy doctor practices, while pharmacy benefit managers start their own insurance companies or mail-order pharmacies — or vice versa — pursuing “vertical integration” that can hurt consumers, she said.
The FTC is hearing increasing complaints “about how these firms are using their monopoly power” and “exercising it in ways that’s resulting in higher prices for patients, less service, as well as worse conditions for health care workers,” Khan said.
Policing Noncompetes
Khan said she was surprised at how many health care workers responded to the commission’s recent proposal to ban “noncompete” clauses — agreements that can prevent employees from moving to new jobs. The FTC issued its final rule banning the practice on Tuesday. She said the ban was aimed at low-wage industries like fast food but that many of the comments in favor of the FTC’s plan came from health professions.
Health workers say noncompete agreements are “both personally devastating and also impeded patient care,” Khan said.
In some cases, doctors wrote that their patients “got really upset because they wanted to stick with me, but my hospital was saying I couldn’t,” Khan said. Some doctors ended up commuting long distances to prevent the rest of their families from having to move after they changed jobs, she said.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
USE OUR CONTENT
This story can be republished for free (details).
Four years after the COVID-19 pandemic closed schools and upended child care, the CDC says parents can start treating the virus like other respiratory illnesses.
Gone are mandated isolation periods and masking. But will schools and child care centers agree?
In case you’ve lost track: Before Friday, all Americans, including school children, were supposed to stay home for at least five days if they had COVID-19 and then mask for a set period of time, according to the Centers for Disease Control and Prevention.
Now, with COVID deaths and hospitalizations dropping, the CDC says children can go back to school when their overall symptoms improve and they’re fever-free for 24 hours without taking medication. Students are “encouraged” to wear a mask when they return.
Still, the change may not affect how individual schools urge parents to react when their children fall sick. Schools and child care providers have a mixed record on following CDC recommendations and often look to local authorities for the ultimate word. And sometimes other goals, such as reducing absences, can influence a state or district’s decisions.
The result can be a confusing array of policies among states and districts, not to mention workplaces — confounding parents whose lives have long been upended by the virus.
“This is so confusing,” said Gloria Cunningham, a single mom in the Boston area. “I just don’t know what I should think of COVID now. Is it still a monster?”
Cunningham, who manages a local store for a national restaurant chain, said her company requires her to take off 10 days if she gets COVID-19. And the school system where her son is in second grade has still been sending home COVID test kits for kids to use before returning to school after long breaks.
“I feel like we should just do away with anything that treats COVID differently or keep all of the precautions,” she said.
The public education system has long held varying policies on COVID. During the 2021-22 school year, 18 states followed CDC recommendations for mask-wearing in class. When the CDC lifted its masking guidelines in February 2022, states such as Massachusetts followed suit, but California kept the mask requirement for schools.
And in the child care world, some providers have long used more stringent testing and isolation protocols than the CDC has recommended. Reasons have ranged from trying to prevent outbreaks to keeping staff healthy — both for their personal safety and to keep the day care open.
Some states moved to more lenient guidelines ahead of the CDC. California and Oregon recently rescinded COVID-19 isolation requirements, and many districts followed their advice.
In an attempt to minimize school absences and address an epidemic of chronic absenteeism, California has encouraged kids to come to school when mildly sick and said that students who test positive for coronavirus but are asymptomatic can attend school. Los Angeles and San Diego’s school systems, among others, have adopted that policy.
But the majority of big-city districts around the country still have asked parents to isolate children for at least five days before returning to school. Some, including Boston and Atlanta, have required students to mask for another five days and report positive COVID-19 test results to the school.
Some school leaders suggest the CDC’s previous five-day isolation requirement was already only loosely followed.
Official policy in Burlington, Massachusetts, has been to have students stay home for five days if they test positive. But Superintendent Eric Conti said the real policy, in effect, is: “It’s a virus. Deal with it.”
That’s because COVID is managed at home, using the honor system.
“Without school-based testing, no one can enforce a five-day COVID policy,” he said via text message.
Ridley School District in the Philadelphia suburbs was already using a policy similar to the new CDC guidelines, said Superintendent Lee Ann Wentzel. Students who test positive for COVID must be fever-free without medication for at least 24 hours before returning to school. When they come back, they must mask for five days. Wentzel said the district is now considering dropping the masking requirement because of the new CDC guidance.
A school or day care’s specific guidelines are consequential for working parents who must miss work if their child can’t go to school or child care. In October 2023, during simultaneous surges of COVID, respiratory syncytial virus and influenza, 104,000 adults reported missing work because of child care issues, the highest number in at least a decade. That number has fallen: Last month, child care problems meant 41,000 adults missed work, according to the Bureau of Labor Statistics.
Melissa Colagrosso’s child care center in West Virginia dropped special guidelines for COVID about a year ago, she said. Now, they’re the same as other illnesses: A child must be free of severe symptoms such as fever for at least 24 hours before returning to the center.
“We certainly are treating COVID just like we would treat flu or hand, foot and mouth” disease, said Colagrosso, CEO of A Place To Grow Children’s Center in Oak Hill.
As for kids without symptoms who test positive for COVID? Most parents have stopped testing kids unless they have symptoms, Colagrasso said, so it’s a quandary she has not encountered.
Still, some parents worry the relaxed rules put their communities at greater risk. Evelyn Alemán leads a group of Latino and Indigenous immigrant parents in Los Angeles County. The parents she represents, many of whom suffer from chronic illnesses and lack of access to health care, panicked when California did away with isolation requirements in January.
“I don’t think they’re considering what the impact will be for our families,” she said of California officials. “It feels like they don’t care — that we’re almost expendable.”
Other impacts of the pandemic linger, too, even as restrictions are lifted. In Ridley, the Philadelphia-area district, more students are reclusive and struggle to interact in-person with peers, said Wentzel, the superintendent. Interest in school dances has plummeted.
“Emotionally,” Wentzel said, “they’re having trouble.”
Four years after the COVID-19 pandemic closed schools and upended child care, the CDC says parents can start treating the virus like other respiratory illnesses.
Gone are mandated isolation periods and masking. But will schools and child care centers agree?
In case you’ve lost track: Before Friday, all Americans, including school children, were supposed to stay home for at least five days if they had COVID-19 and then mask for a set period of time, according to the Centers for Disease Control and Prevention.
Now, with COVID deaths and hospitalizations dropping, the CDC says children can go back to school when their overall symptoms improve and they’re fever-free for 24 hours without taking medication. Students are “encouraged” to wear a mask when they return.
Still, the change may not affect how individual schools urge parents to react when their children fall sick. Schools and child care providers have a mixed record on following CDC recommendations and often look to local authorities for the ultimate word. And sometimes other goals, such as reducing absences, can influence a state or district’s decisions.
The result can be a confusing array of policies among states and districts, not to mention workplaces — confounding parents whose lives have long been upended by the virus.
“This is so confusing,” said Gloria Cunningham, a single mom in the Boston area. “I just don’t know what I should think of COVID now. Is it still a monster?”
Cunningham, who manages a local store for a national restaurant chain, said her company requires her to take off 10 days if she gets COVID-19. And the school system where her son is in second grade has still been sending home COVID test kits for kids to use before returning to school after long breaks.
“I feel like we should just do away with anything that treats COVID differently or keep all of the precautions,” she said.
The public education system has long held varying policies on COVID. During the 2021-22 school year, 18 states followed CDC recommendations for mask-wearing in class. When the CDC lifted its masking guidelines in February 2022, states such as Massachusetts followed suit, but California kept the mask requirement for schools.
And in the child care world, some providers have long used more stringent testing and isolation protocols than the CDC has recommended. Reasons have ranged from trying to prevent outbreaks to keeping staff healthy — both for their personal safety and to keep the day care open.
Some states moved to more lenient guidelines ahead of the CDC. California and Oregon recently rescinded COVID-19 isolation requirements, and many districts followed their advice.
In an attempt to minimize school absences and address an epidemic of chronic absenteeism, California has encouraged kids to come to school when mildly sick and said that students who test positive for coronavirus but are asymptomatic can attend school. Los Angeles and San Diego’s school systems, among others, have adopted that policy.
But the majority of big-city districts around the country still have asked parents to isolate children for at least five days before returning to school. Some, including Boston and Atlanta, have required students to mask for another five days and report positive COVID-19 test results to the school.
Some school leaders suggest the CDC’s previous five-day isolation requirement was already only loosely followed.
Official policy in Burlington, Massachusetts, has been to have students stay home for five days if they test positive. But Superintendent Eric Conti said the real policy, in effect, is: “It’s a virus. Deal with it.”
That’s because COVID is managed at home, using the honor system.
“Without school-based testing, no one can enforce a five-day COVID policy,” he said via text message.
Ridley School District in the Philadelphia suburbs was already using a policy similar to the new CDC guidelines, said Superintendent Lee Ann Wentzel. Students who test positive for COVID must be fever-free without medication for at least 24 hours before returning to school. When they come back, they must mask for five days. Wentzel said the district is now considering dropping the masking requirement because of the new CDC guidance.
A school or day care’s specific guidelines are consequential for working parents who must miss work if their child can’t go to school or child care. In October 2023, during simultaneous surges of COVID, respiratory syncytial virus and influenza, 104,000 adults reported missing work because of child care issues, the highest number in at least a decade. That number has fallen: Last month, child care problems meant 41,000 adults missed work, according to the Bureau of Labor Statistics.
Melissa Colagrosso’s child care center in West Virginia dropped special guidelines for COVID about a year ago, she said. Now, they’re the same as other illnesses: A child must be free of severe symptoms such as fever for at least 24 hours before returning to the center.
“We certainly are treating COVID just like we would treat flu or hand, foot and mouth” disease, said Colagrosso, CEO of A Place To Grow Children’s Center in Oak Hill.
As for kids without symptoms who test positive for COVID? Most parents have stopped testing kids unless they have symptoms, Colagrasso said, so it’s a quandary she has not encountered.
Still, some parents worry the relaxed rules put their communities at greater risk. Evelyn Alemán leads a group of Latino and Indigenous immigrant parents in Los Angeles County. The parents she represents, many of whom suffer from chronic illnesses and lack of access to health care, panicked when California did away with isolation requirements in January.
“I don’t think they’re considering what the impact will be for our families,” she said of California officials. “It feels like they don’t care — that we’re almost expendable.”
Other impacts of the pandemic linger, too, even as restrictions are lifted. In Ridley, the Philadelphia-area district, more students are reclusive and struggle to interact in-person with peers, said Wentzel, the superintendent. Interest in school dances has plummeted.
“Emotionally,” Wentzel said, “they’re having trouble.”
En una estrecha calle de townhouses y un taller mecánico en el vecindario Kensington, en el norte de Philadelphia, Marsella Elie subió los escalones y golpeó fuerte las puertas de las casas.
Un hombre de mediana edad abrió, con mirada cautelosa.
“Hola, señor, ¿cómo está hoy?”, le preguntó Elie, que tenía puesta una chaqueta con el logo de la Campana de la Libertad, del gobierno de la ciudad. “Mi nombre es Marsella. Estoy trabajando con la ciudad. ¿Ha oído hablar de las sobredosis que están ocurriendo en el vecindario, verdad?”.
El hombre asintió. Elie señaló los folletos que tenía sobre sobredosis de drogas y programas de tratamiento para la adicción. Levantó una caja de Narcan, una marca de naloxona, que puede revertir una sobredosis de opioides.
“Lo que estamos tratando de hacer es que esto llegue a todos los hogares. ¿Alguna vez ha oído hablar de esto antes?”, preguntó Elie antes de entregarle al hombre una bolsa de tela llena de folletos, tiras de prueba de fentanilo y la caja de Narcan.
Elie y otros trabajadores de medio tiempo de la ciudad y voluntarios forman parte de una campaña puerta a puerta a gran escala en Philadelphia que tiene como objetivo equipar los hogares con naloxona y otros suministros para prevenir sobredosis de drogas.
Los funcionarios de la ciudad esperan que este enfoque proactivo transforme a la naloxona en un artículo que esté en los botiquines, para evitar que las personas mueran por sobredosis, especialmente los residentes negros.
En Philadelphia, en 2022, según datos de la ciudad, un récord de 1,413 personas murieron por sobredosis de drogas. Entre los residentes negros, las muertes aumentaron un 20% respecto al año anterior, y muchas ocurrieron en casas.
“Lo mejor que podemos hacer para que estos productos sean más accesibles es simplemente dárselos a las personas”, dijo Keli McLoyd, subdirectora de la Unidad de Respuesta a Opioides de la ciudad, hablando sobre la bolsa de tela con naloxona y otros suministros.
“No le estamos preguntando si está usando drogas. El objetivo aquí es realmente construir una responsabilidad colectiva. Como personas de comunidades minoritarias, como vimos durante la epidemia de covid, nadie viene a salvarnos. Para nosotros, esta es una herramienta que podemos usar para salvarnos a nosotros mismos”.
Esta iniciativa de distribución tiene como objetivo llevar suministros de prevención directamente a personas que de otro modo no los buscarían por sí mismas, y concientizar sobre las sobredosis más allá de Kensington, el epicentro de la epidemia de adicción de la ciudad.
Los encuestadores planean golpear más de 100,000 puertas en los “puntos calientes” de Philadelphia, códigos postales con tasas crecientes de sobredosis de opioides, muchos en comunidades minoritarias.
El aumento de las disparidades raciales en las muertes por sobredosis es una de las consecuencias a largo plazo de la guerra contra las drogas, dijo McLoyd. Las políticas de esa campaña nacional llevaron a décadas de tácticas policiales agresivas, perfil racial y largas condenas de prisión, afectando de manera desproporcionada a personas de color y a sus comunidades.
La investigación muestra que los afroamericanos siguen representando un número desproporcionado de arrestos por drogas y servicios de protección infantil.
“Por eso, está muy claro por qué las personas de minorías podrían ser reacias a levantar la mano y decir: ‘Soy una persona que usa drogas, necesito esos recursos’”, dijo McLoyd.
Otras comunidades han distribuido naloxona y otros suministros, aunque en menor escala que Philadelphia. Lo que está haciendo Philadelphia podría convertirse en un modelo para otros lugares densamente poblados, dijo Daliah Heller, vicepresidenta de iniciativas sobre el uso de drogas en Vital Strategies, una organización de salud pública que trabaja con gobiernos locales en siete estados para abordar la epidemia de opioides.
“Hay algo intensamente personal en un compromiso humano”, dijo Heller. “Y que alguien toque a tu puerta para hablar sobre el uso de drogas y el riesgo de sobredosis y que haya algo que se pueda hacer, creo que es realmente poderoso”.
A lo largo de los años, la naloxona se ha vuelto más accesible que nunca, apuntó Heller. Ahora se puede pedir por internet y se puede recibir por correo, está disponible en máquinas expendedoras especializadas y algunas farmacias ahora venden el spray nasal de Narcan sin receta.
Pero decenas de miles de estadounidenses siguen muriendo por sobredosis de opioides cada año.
Eso significa que los esfuerzos de prevención y los mensajes sobre la crisis aún no llegan a algunas personas, dijo Heller. Y para Heller, llegar a las personas significa ir donde están. “Tenemos que pensar así cuando pensamos en la distribución de naloxona”.
El proyecto de divulgación en Philadelphia está financiado en parte por los pagos de acuerdos de demandas nacionales contra fabricantes y distribuidores de opioides, parte de los cuales recibió la ciudad.
Se espera que la ciudad reciba alrededor de $200 millones en aproximadamente 18 años de acuerdos con AmerisourceBergen, Cardinal Health, McKesson y Johnson & Johnson.
De la iniciativa forman parte muchas de las mismas personas que comenzaron a hacer divulgación como parte del censo de 2020.
No todos responden a la puerta. Algunos no están en casa. En esos casos, los trabajadores dejan un volante en el picaporte de la puerta que ofrece información sobre los riesgos de las sobredosis, y contactos para obtener más recursos.
Los equipos de encuestadores, a menudo con intérpretes de idiomas, hacen una segunda ronda de visitas en el vecindario para llegar a las personas que no vieron la primera vez.
En un jueves reciente, los encuestadores de Philadelphia estaban tocando puertas en los vecindarios de Franklinville y Hunting Park. Según datos de la ciudad, en este código postal, aproximadamente 85 personas murieron por sobredosis de drogas en 2022. Eso es menos que las 193 personas que murieron por sobredosis en Kensington el mismo año, pero mucho más que las pocas muertes vistas en los vecindarios más ricos de la ciudad.
Los encuestadores se acercaron a una residente, Katherine Camacho, en la acera, cuando salía de su garage. Camacho les dijo que estaba al tanto del problema de las sobredosis en su comunidad y luego aceptó con entusiasmo una caja de Narcan. “Voy a llevar esto conmigo, porque, como dije, a veces estás en la calle conduciendo a algún lugar y podrías salvar una vida”, les dijo Camacho.
En cuanto al esfuerzo de divulgación de Philadelphia, Camacho dijo que cree que “Dios está poniendo a estas personas para ayudar”. Mientras entraba en su casa llevando la caja de Narcan, agregó que quería hacer su parte para ayudar.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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En una estrecha calle de townhouses y un taller mecánico en el vecindario Kensington, en el norte de Philadelphia, Marsella Elie subió los escalones y golpeó fuerte las puertas de las casas.
Un hombre de mediana edad abrió, con mirada cautelosa.
“Hola, señor, ¿cómo está hoy?”, le preguntó Elie, que tenía puesta una chaqueta con el logo de la Campana de la Libertad, del gobierno de la ciudad. “Mi nombre es Marsella. Estoy trabajando con la ciudad. ¿Ha oído hablar de las sobredosis que están ocurriendo en el vecindario, verdad?”.
El hombre asintió. Elie señaló los folletos que tenía sobre sobredosis de drogas y programas de tratamiento para la adicción. Levantó una caja de Narcan, una marca de naloxona, que puede revertir una sobredosis de opioides.
“Lo que estamos tratando de hacer es que esto llegue a todos los hogares. ¿Alguna vez ha oído hablar de esto antes?”, preguntó Elie antes de entregarle al hombre una bolsa de tela llena de folletos, tiras de prueba de fentanilo y la caja de Narcan.
Elie y otros trabajadores de medio tiempo de la ciudad y voluntarios forman parte de una campaña puerta a puerta a gran escala en Philadelphia que tiene como objetivo equipar los hogares con naloxona y otros suministros para prevenir sobredosis de drogas.
Los funcionarios de la ciudad esperan que este enfoque proactivo transforme a la naloxona en un artículo que esté en los botiquines, para evitar que las personas mueran por sobredosis, especialmente los residentes negros.
En Philadelphia, en 2022, según datos de la ciudad, un récord de 1,413 personas murieron por sobredosis de drogas. Entre los residentes negros, las muertes aumentaron un 20% respecto al año anterior, y muchas ocurrieron en casas.
“Lo mejor que podemos hacer para que estos productos sean más accesibles es simplemente dárselos a las personas”, dijo Keli McLoyd, subdirectora de la Unidad de Respuesta a Opioides de la ciudad, hablando sobre la bolsa de tela con naloxona y otros suministros.
“No le estamos preguntando si está usando drogas. El objetivo aquí es realmente construir una responsabilidad colectiva. Como personas de comunidades minoritarias, como vimos durante la epidemia de covid, nadie viene a salvarnos. Para nosotros, esta es una herramienta que podemos usar para salvarnos a nosotros mismos”.
Esta iniciativa de distribución tiene como objetivo llevar suministros de prevención directamente a personas que de otro modo no los buscarían por sí mismas, y concientizar sobre las sobredosis más allá de Kensington, el epicentro de la epidemia de adicción de la ciudad.
Los encuestadores planean golpear más de 100,000 puertas en los “puntos calientes” de Philadelphia, códigos postales con tasas crecientes de sobredosis de opioides, muchos en comunidades minoritarias.
El aumento de las disparidades raciales en las muertes por sobredosis es una de las consecuencias a largo plazo de la guerra contra las drogas, dijo McLoyd. Las políticas de esa campaña nacional llevaron a décadas de tácticas policiales agresivas, perfil racial y largas condenas de prisión, afectando de manera desproporcionada a personas de color y a sus comunidades.
La investigación muestra que los afroamericanos siguen representando un número desproporcionado de arrestos por drogas y servicios de protección infantil.
“Por eso, está muy claro por qué las personas de minorías podrían ser reacias a levantar la mano y decir: ‘Soy una persona que usa drogas, necesito esos recursos’”, dijo McLoyd.
Otras comunidades han distribuido naloxona y otros suministros, aunque en menor escala que Philadelphia. Lo que está haciendo Philadelphia podría convertirse en un modelo para otros lugares densamente poblados, dijo Daliah Heller, vicepresidenta de iniciativas sobre el uso de drogas en Vital Strategies, una organización de salud pública que trabaja con gobiernos locales en siete estados para abordar la epidemia de opioides.
“Hay algo intensamente personal en un compromiso humano”, dijo Heller. “Y que alguien toque a tu puerta para hablar sobre el uso de drogas y el riesgo de sobredosis y que haya algo que se pueda hacer, creo que es realmente poderoso”.
A lo largo de los años, la naloxona se ha vuelto más accesible que nunca, apuntó Heller. Ahora se puede pedir por internet y se puede recibir por correo, está disponible en máquinas expendedoras especializadas y algunas farmacias ahora venden el spray nasal de Narcan sin receta.
Pero decenas de miles de estadounidenses siguen muriendo por sobredosis de opioides cada año.
Eso significa que los esfuerzos de prevención y los mensajes sobre la crisis aún no llegan a algunas personas, dijo Heller. Y para Heller, llegar a las personas significa ir donde están. “Tenemos que pensar así cuando pensamos en la distribución de naloxona”.
El proyecto de divulgación en Philadelphia está financiado en parte por los pagos de acuerdos de demandas nacionales contra fabricantes y distribuidores de opioides, parte de los cuales recibió la ciudad.
Se espera que la ciudad reciba alrededor de $200 millones en aproximadamente 18 años de acuerdos con AmerisourceBergen, Cardinal Health, McKesson y Johnson & Johnson.
De la iniciativa forman parte muchas de las mismas personas que comenzaron a hacer divulgación como parte del censo de 2020.
No todos responden a la puerta. Algunos no están en casa. En esos casos, los trabajadores dejan un volante en el picaporte de la puerta que ofrece información sobre los riesgos de las sobredosis, y contactos para obtener más recursos.
Los equipos de encuestadores, a menudo con intérpretes de idiomas, hacen una segunda ronda de visitas en el vecindario para llegar a las personas que no vieron la primera vez.
En un jueves reciente, los encuestadores de Philadelphia estaban tocando puertas en los vecindarios de Franklinville y Hunting Park. Según datos de la ciudad, en este código postal, aproximadamente 85 personas murieron por sobredosis de drogas en 2022. Eso es menos que las 193 personas que murieron por sobredosis en Kensington el mismo año, pero mucho más que las pocas muertes vistas en los vecindarios más ricos de la ciudad.
Los encuestadores se acercaron a una residente, Katherine Camacho, en la acera, cuando salía de su garage. Camacho les dijo que estaba al tanto del problema de las sobredosis en su comunidad y luego aceptó con entusiasmo una caja de Narcan. “Voy a llevar esto conmigo, porque, como dije, a veces estás en la calle conduciendo a algún lugar y podrías salvar una vida”, les dijo Camacho.
En cuanto al esfuerzo de divulgación de Philadelphia, Camacho dijo que cree que “Dios está poniendo a estas personas para ayudar”. Mientras entraba en su casa llevando la caja de Narcan, agregó que quería hacer su parte para ayudar.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
USE OUR CONTENT
This story can be republished for free (details).
Four years after the COVID-19 pandemic closed schools and upended child care, the CDC says parents can start treating the virus like other respiratory illnesses.
Gone are mandated isolation periods and masking. But will schools and child care centers agree?
In case you’ve lost track: Before Friday, all Americans, including school children, were supposed to stay home for at least five days if they had COVID-19 and then mask for a set period of time, according to the Centers for Disease Control and Prevention.
Now, with COVID deaths and hospitalizations dropping, the CDC says children can go back to school when their overall symptoms improve and they’re fever-free for 24 hours without taking medication. Students are “encouraged” to wear a mask when they return.
Still, the change may not affect how individual schools urge parents to react when their children fall sick. Schools and child care providers have a mixed record on following CDC recommendations and often look to local authorities for the ultimate word. And sometimes other goals, such as reducing absences, can influence a state or district’s decisions.
The result can be a confusing array of policies among states and districts, not to mention workplaces — confounding parents whose lives have long been upended by the virus.
“This is so confusing,” said Gloria Cunningham, a single mom in the Boston area. “I just don’t know what I should think of COVID now. Is it still a monster?”
Cunningham, who manages a local store for a national restaurant chain, said her company requires her to take off 10 days if she gets COVID-19. And the school system where her son is in second grade has still been sending home COVID test kits for kids to use before returning to school after long breaks.
“I feel like we should just do away with anything that treats COVID differently or keep all of the precautions,” she said.
The public education system has long held varying policies on COVID. During the 2021-22 school year, 18 states followed CDC recommendations for mask-wearing in class. When the CDC lifted its masking guidelines in February 2022, states such as Massachusetts followed suit, but California kept the mask requirement for schools.
And in the child care world, some providers have long used more stringent testing and isolation protocols than the CDC has recommended. Reasons have ranged from trying to prevent outbreaks to keeping staff healthy — both for their personal safety and to keep the day care open.
Some states moved to more lenient guidelines ahead of the CDC. California and Oregon recently rescinded COVID-19 isolation requirements, and many districts followed their advice.
In an attempt to minimize school absences and address an epidemic of chronic absenteeism, California has encouraged kids to come to school when mildly sick and said that students who test positive for coronavirus but are asymptomatic can attend school. Los Angeles and San Diego’s school systems, among others, have adopted that policy.
But the majority of big-city districts around the country still have asked parents to isolate children for at least five days before returning to school. Some, including Boston and Atlanta, have required students to mask for another five days and report positive COVID-19 test results to the school.
Some school leaders suggest the CDC’s previous five-day isolation requirement was already only loosely followed.
Official policy in Burlington, Massachusetts, has been to have students stay home for five days if they test positive. But Superintendent Eric Conti said the real policy, in effect, is: “It’s a virus. Deal with it.”
That’s because COVID is managed at home, using the honor system.
“Without school-based testing, no one can enforce a five-day COVID policy,” he said via text message.
Ridley School District in the Philadelphia suburbs was already using a policy similar to the new CDC guidelines, said Superintendent Lee Ann Wentzel. Students who test positive for COVID must be fever-free without medication for at least 24 hours before returning to school. When they come back, they must mask for five days. Wentzel said the district is now considering dropping the masking requirement because of the new CDC guidance.
A school or day care’s specific guidelines are consequential for working parents who must miss work if their child can’t go to school or child care. In October 2023, during simultaneous surges of COVID, respiratory syncytial virus and influenza, 104,000 adults reported missing work because of child care issues, the highest number in at least a decade. That number has fallen: Last month, child care problems meant 41,000 adults missed work, according to the Bureau of Labor Statistics.
Melissa Colagrosso’s child care center in West Virginia dropped special guidelines for COVID about a year ago, she said. Now, they’re the same as other illnesses: A child must be free of severe symptoms such as fever for at least 24 hours before returning to the center.
“We certainly are treating COVID just like we would treat flu or hand, foot and mouth” disease, said Colagrosso, CEO of A Place To Grow Children’s Center in Oak Hill.
As for kids without symptoms who test positive for COVID? Most parents have stopped testing kids unless they have symptoms, Colagrasso said, so it’s a quandary she has not encountered.
Still, some parents worry the relaxed rules put their communities at greater risk. Evelyn Alemán leads a group of Latino and Indigenous immigrant parents in Los Angeles County. The parents she represents, many of whom suffer from chronic illnesses and lack of access to health care, panicked when California did away with isolation requirements in January.
“I don’t think they’re considering what the impact will be for our families,” she said of California officials. “It feels like they don’t care — that we’re almost expendable.”
Other impacts of the pandemic linger, too, even as restrictions are lifted. In Ridley, the Philadelphia-area district, more students are reclusive and struggle to interact in-person with peers, said Wentzel, the superintendent. Interest in school dances has plummeted.
“Emotionally,” Wentzel said, “they’re having trouble.”
Four years after the COVID-19 pandemic closed schools and upended child care, the CDC says parents can start treating the virus like other respiratory illnesses.
Gone are mandated isolation periods and masking. But will schools and child care centers agree?
In case you’ve lost track: Before Friday, all Americans, including school children, were supposed to stay home for at least five days if they had COVID-19 and then mask for a set period of time, according to the Centers for Disease Control and Prevention.
Now, with COVID deaths and hospitalizations dropping, the CDC says children can go back to school when their overall symptoms improve and they’re fever-free for 24 hours without taking medication. Students are “encouraged” to wear a mask when they return.
Still, the change may not affect how individual schools urge parents to react when their children fall sick. Schools and child care providers have a mixed record on following CDC recommendations and often look to local authorities for the ultimate word. And sometimes other goals, such as reducing absences, can influence a state or district’s decisions.
The result can be a confusing array of policies among states and districts, not to mention workplaces — confounding parents whose lives have long been upended by the virus.
“This is so confusing,” said Gloria Cunningham, a single mom in the Boston area. “I just don’t know what I should think of COVID now. Is it still a monster?”
Cunningham, who manages a local store for a national restaurant chain, said her company requires her to take off 10 days if she gets COVID-19. And the school system where her son is in second grade has still been sending home COVID test kits for kids to use before returning to school after long breaks.
“I feel like we should just do away with anything that treats COVID differently or keep all of the precautions,” she said.
The public education system has long held varying policies on COVID. During the 2021-22 school year, 18 states followed CDC recommendations for mask-wearing in class. When the CDC lifted its masking guidelines in February 2022, states such as Massachusetts followed suit, but California kept the mask requirement for schools.
And in the child care world, some providers have long used more stringent testing and isolation protocols than the CDC has recommended. Reasons have ranged from trying to prevent outbreaks to keeping staff healthy — both for their personal safety and to keep the day care open.
Some states moved to more lenient guidelines ahead of the CDC. California and Oregon recently rescinded COVID-19 isolation requirements, and many districts followed their advice.
In an attempt to minimize school absences and address an epidemic of chronic absenteeism, California has encouraged kids to come to school when mildly sick and said that students who test positive for coronavirus but are asymptomatic can attend school. Los Angeles and San Diego’s school systems, among others, have adopted that policy.
But the majority of big-city districts around the country still have asked parents to isolate children for at least five days before returning to school. Some, including Boston and Atlanta, have required students to mask for another five days and report positive COVID-19 test results to the school.
Some school leaders suggest the CDC’s previous five-day isolation requirement was already only loosely followed.
Official policy in Burlington, Massachusetts, has been to have students stay home for five days if they test positive. But Superintendent Eric Conti said the real policy, in effect, is: “It’s a virus. Deal with it.”
That’s because COVID is managed at home, using the honor system.
“Without school-based testing, no one can enforce a five-day COVID policy,” he said via text message.
Ridley School District in the Philadelphia suburbs was already using a policy similar to the new CDC guidelines, said Superintendent Lee Ann Wentzel. Students who test positive for COVID must be fever-free without medication for at least 24 hours before returning to school. When they come back, they must mask for five days. Wentzel said the district is now considering dropping the masking requirement because of the new CDC guidance.
A school or day care’s specific guidelines are consequential for working parents who must miss work if their child can’t go to school or child care. In October 2023, during simultaneous surges of COVID, respiratory syncytial virus and influenza, 104,000 adults reported missing work because of child care issues, the highest number in at least a decade. That number has fallen: Last month, child care problems meant 41,000 adults missed work, according to the Bureau of Labor Statistics.
Melissa Colagrosso’s child care center in West Virginia dropped special guidelines for COVID about a year ago, she said. Now, they’re the same as other illnesses: A child must be free of severe symptoms such as fever for at least 24 hours before returning to the center.
“We certainly are treating COVID just like we would treat flu or hand, foot and mouth” disease, said Colagrosso, CEO of A Place To Grow Children’s Center in Oak Hill.
As for kids without symptoms who test positive for COVID? Most parents have stopped testing kids unless they have symptoms, Colagrasso said, so it’s a quandary she has not encountered.
Still, some parents worry the relaxed rules put their communities at greater risk. Evelyn Alemán leads a group of Latino and Indigenous immigrant parents in Los Angeles County. The parents she represents, many of whom suffer from chronic illnesses and lack of access to health care, panicked when California did away with isolation requirements in January.
“I don’t think they’re considering what the impact will be for our families,” she said of California officials. “It feels like they don’t care — that we’re almost expendable.”
Other impacts of the pandemic linger, too, even as restrictions are lifted. In Ridley, the Philadelphia-area district, more students are reclusive and struggle to interact in-person with peers, said Wentzel, the superintendent. Interest in school dances has plummeted.
“Emotionally,” Wentzel said, “they’re having trouble.”
Un equipo de investigadores de Montana está jugando un papel clave en el desarrollo de una vacuna más efectiva contra la tuberculosis, una enfermedad infecciosa que ha matado a más personas que ninguna otra.
La BCG (Bacille Calmette-Guérin), desarrollada en 1921, sigue siendo la única vacuna contra la tuberculosis (TB). Si bien tiene una eficacia del 40% al 80% en niños pequeños, su efectividad es muy baja en adolescentes y adultos, lo que impulsó un esfuerzo mundial para encontrar una vacuna que sea más potente.
El Centro de Medicina Translacional de la Universidad de Montana está llevando a cabo una iniciativa en este sentido. El Centro se especializa en mejorar y crear vacunas, agregando los que se denominan “adyuvantes novedosos”.
Un adyuvante es una sustancia que se incluye en la vacuna, por ejemplo moléculas grasas o sales de aluminio, y que potencia la respuesta inmunitaria. Los adyuvantes novedosos son los que aún no se han utilizado en humanos. Los científicos están comprobando que estos adyuvantes generan una inmunidad más fuerte, precisa y duradera que los antígenos, que solo crean anticuerpos.
Provocar respuestas específicas del sistema inmunológico, y profundizar y ampliar su efectividad con adyuvantes, es algo que se conoce como “vacunación de precisión”.
“No es una solución única para todos, no se trata de una vacuna única”, explicó Ofer Levy, profesor de Pediatría de la Universidad de Harvard y director del Programa de Vacunas de Precisión del Hospital Infantil de Boston. “Una vacuna puede funcionar de forma diferente en un recién nacido, un adulto mayor o en una persona de mediana edad”, agregó.
Una vacuna de precisión definitiva, según Levy, brindaría protección de por vida contra una enfermedad con un solo pinchazo. “Una protección de una sola dosis que fuera efectiva contra la gripe o contra el covid sería el Santo Grial”, enfatizó Levy.
Jay Evans dirige el Centro de la Universidad de Montana y, a la vez, es cofundador y director científico y de estrategias, de Inimmune, una empresa privada de biotecnología de Missoula. Evans contó que su equipo lleva 15 años trabajando en una vacuna contra la tuberculosis y que aún faltan cinco años para que ésta pueda distribuirse ampliamente. La asociación público-privada está desarrollando vacunas e intentando mejorar las existentes, afirmó.
En el Centro no ha pasado inadvertido que este trabajo de investigación y producción de vacunas de vanguardia se realiza en Montana, el estado que aprobó una de las leyes antivacunas más extremas del país en 2021, durante la pandemia.
La ley prohíbe a empresas y gobiernos dar un trato diferente a las personas que no estén vacunadas contra covid u otras enfermedades. De hecho, prohíbe a los empleadores públicos y privados que les exijan a los trabajadores que se vacunen contra covid o cualquier otra enfermedad. Un juez federal dictaminó después que la ley no puede aplicarse en entornos sanitarios, como hospitales y consultas médicas.
A mediados de marzo, el Instituto de Investigación Médica Bill y Melinda Gates anunció que había iniciado en siete países la tercera y última fase de los ensayos clínicos de la nueva vacuna contra la tuberculosis. Los ensayos tardarán unos cinco años en completarse. La investigación y la producción se están llevando a cabo en varios lugares, incluida una planta de fabricación en Hamilton, propiedad de GSK, un gigante farmacéutico.
Conocida como “la pandemia olvidada”, la tuberculosis, a pesar de que se puede prevenir y tratar, mata hasta a 1,6 millones de personas al año, la mayoría en zonas empobrecidas de Asia y África.
En Estados Unidos se ha producido un aumento de esta enfermendad en la última década. Muchos inmigrantes tienen TB sin saberlo; en 2022 el número de casos aumentó un 16%. La tuberculosis es la principal causa de muerte entre las personas que viven con VIH, cuyo riesgo de contraer esta enfermedad es 20 veces mayor que el de las personas sin el virus.
“La tuberculosis es un patógeno complejo que ha acompañado a los seres humanos durante siglos”, dijo Alemnew Dagnew, que dirige el programa para la nueva vacuna en el Instituto de Investigación Médica Gates. “Debido a esta situación, ha evolucionado y ha podido desarrollar mecanismos para evadir al sistema inmunológico. Y la inmunología de la TB aún no se comprende completamente”.
En conjunto, el Centro de Medicina Translacional de la Universidad de Montana e Inimmune tienen 80 empleados especializados en la investigación de una variedad de adyuvantes con el propósito de comprender los detalles de las respuestas inmunitarias a diferentes sustancias. “Hay que adaptarlos al patógeno contra el que se vacuna, como si fueran un instrumento en una caja de herramientas”, dijo Evans. “Tenemos toda una biblioteca de moléculas y formulaciones de adyuvantes”.
Las vacunas se vuelven en gran medida más precisas mediante el uso de adyuvantes. Hay tres tipos básicos de adyuvantes naturales: sales de aluminio; escualeno, que se obtiene del hígado de tiburón; y algunos tipos de saponinas, que son moléculas grasas. No se sabe muy bien cómo estimulan el sistema inmunitario. El Centro de Missoula también ha creado y patentado un adyuvante sintético, el UM-1098, que induce un tipo específico de respuesta inmunitaria y que se añadirá a las nuevas vacunas.
Una de las moléculas más prometedoras que se están utilizando para potenciar la respuesta del sistema inmunológico a las vacunas es una molécula de saponina de la corteza del árbol de quillay, recolectada en Chile de árboles que tienen por lo menos una década.
Estas moléculas fueron utilizadas por Novavax en su vacuna contra covid y por GSK en Shingrix, su vacuna contra la culebrilla (shingles), de uso generalizado. Estas moléculas también son un componente clave en la nueva vacuna contra la tuberculosis, conocida como la vacuna M72.
Pero hay margen para mejorar.
“La vacuna muestra una eficacia del 50%, lo que no parece mucho, pero como actualmente se carece de otra vacuna más efectiva, el 50% es bastante mejor que lo que hay”, sostuvo Evans. “Buscamos aprovechar lo que aprendimos de ese desarrollo de la vacuna con adyuvantes adicionales para tratar de mejorarla y llevar ese índice desde el 50% hasta el 80% o más”.
Las vacunas contra el sarampión, en cambio, han alcanzado una efectividad del 95%.
Según el sitio web Medscape, en este momento se están desarrollando alrededor de 15 vacunas que son candidatas a reemplazar la BCG, y tres de ellas se encuentran en la fase 3 de ensayos clínicos.
Una alternativa que el Centro de Evans está investigando para mejorar la eficacia de la nueva vacuna es tomar una parte de la bacteria que causa la tuberculosis, sintetizarla y combinarla con el adyuvante QS-21, elaborado a partir del árbol de quillay. “Estimula el sistema inmunológico de una manera específica para la tuberculosis y genera una respuesta inmune que se acerca aún más a lo que obtenemos de las infecciones naturales”, dijo Evans.
Por su parte, el Centro de la Universidad de Montana está investigando el tratamiento de varias afecciones que generalmente no se consideran susceptibles de ser abordadas mediante vacunación. Por ejemplo, están ingresando en la primera fase de ensayos clínicos para una vacuna contra las alergias y para otra, contra el cáncer.
Avanzado este año, comenzarán los ensayos clínicos para obtener vacunas capaces de bloquear los efectos de opioides como la heroína y el fentanilo. La Universidad de Montana recibió la mayor subvención de su historia, $33 millones, para investigar una vacuna contra los opioides. Funciona creando un anticuerpo que se une a la droga en el torrente sanguíneo, evitando que entre al cerebro y produzca el efecto de euforia.
Por ahora, sin embargo, los expertos en salud de todo el mundo tienen sus ojos puestos en los ensayos de las nuevas vacunas contra la tuberculosis, que, si tienen éxito, podrían ayudar a salvar innumerables vidas en las regiones más pobres del mundo.
Un equipo de investigadores de Montana está jugando un papel clave en el desarrollo de una vacuna más efectiva contra la tuberculosis, una enfermedad infecciosa que ha matado a más personas que ninguna otra.
La BCG (Bacille Calmette-Guérin), desarrollada en 1921, sigue siendo la única vacuna contra la tuberculosis (TB). Si bien tiene una eficacia del 40% al 80% en niños pequeños, su efectividad es muy baja en adolescentes y adultos, lo que impulsó un esfuerzo mundial para encontrar una vacuna que sea más potente.
El Centro de Medicina Translacional de la Universidad de Montana está llevando a cabo una iniciativa en este sentido. El Centro se especializa en mejorar y crear vacunas, agregando los que se denominan “adyuvantes novedosos”.
Un adyuvante es una sustancia que se incluye en la vacuna, por ejemplo moléculas grasas o sales de aluminio, y que potencia la respuesta inmunitaria. Los adyuvantes novedosos son los que aún no se han utilizado en humanos. Los científicos están comprobando que estos adyuvantes generan una inmunidad más fuerte, precisa y duradera que los antígenos, que solo crean anticuerpos.
Provocar respuestas específicas del sistema inmunológico, y profundizar y ampliar su efectividad con adyuvantes, es algo que se conoce como “vacunación de precisión”.
“No es una solución única para todos, no se trata de una vacuna única”, explicó Ofer Levy, profesor de Pediatría de la Universidad de Harvard y director del Programa de Vacunas de Precisión del Hospital Infantil de Boston. “Una vacuna puede funcionar de forma diferente en un recién nacido, un adulto mayor o en una persona de mediana edad”, agregó.
Una vacuna de precisión definitiva, según Levy, brindaría protección de por vida contra una enfermedad con un solo pinchazo. “Una protección de una sola dosis que fuera efectiva contra la gripe o contra el covid sería el Santo Grial”, enfatizó Levy.
Jay Evans dirige el Centro de la Universidad de Montana y, a la vez, es cofundador y director científico y de estrategias, de Inimmune, una empresa privada de biotecnología de Missoula. Evans contó que su equipo lleva 15 años trabajando en una vacuna contra la tuberculosis y que aún faltan cinco años para que ésta pueda distribuirse ampliamente. La asociación público-privada está desarrollando vacunas e intentando mejorar las existentes, afirmó.
En el Centro no ha pasado inadvertido que este trabajo de investigación y producción de vacunas de vanguardia se realiza en Montana, el estado que aprobó una de las leyes antivacunas más extremas del país en 2021, durante la pandemia.
La ley prohíbe a empresas y gobiernos dar un trato diferente a las personas que no estén vacunadas contra covid u otras enfermedades. De hecho, prohíbe a los empleadores públicos y privados que les exijan a los trabajadores que se vacunen contra covid o cualquier otra enfermedad. Un juez federal dictaminó después que la ley no puede aplicarse en entornos sanitarios, como hospitales y consultas médicas.
A mediados de marzo, el Instituto de Investigación Médica Bill y Melinda Gates anunció que había iniciado en siete países la tercera y última fase de los ensayos clínicos de la nueva vacuna contra la tuberculosis. Los ensayos tardarán unos cinco años en completarse. La investigación y la producción se están llevando a cabo en varios lugares, incluida una planta de fabricación en Hamilton, propiedad de GSK, un gigante farmacéutico.
Conocida como “la pandemia olvidada”, la tuberculosis, a pesar de que se puede prevenir y tratar, mata hasta a 1,6 millones de personas al año, la mayoría en zonas empobrecidas de Asia y África.
En Estados Unidos se ha producido un aumento de esta enfermendad en la última década. Muchos inmigrantes tienen TB sin saberlo; en 2022 el número de casos aumentó un 16%. La tuberculosis es la principal causa de muerte entre las personas que viven con VIH, cuyo riesgo de contraer esta enfermedad es 20 veces mayor que el de las personas sin el virus.
“La tuberculosis es un patógeno complejo que ha acompañado a los seres humanos durante siglos”, dijo Alemnew Dagnew, que dirige el programa para la nueva vacuna en el Instituto de Investigación Médica Gates. “Debido a esta situación, ha evolucionado y ha podido desarrollar mecanismos para evadir al sistema inmunológico. Y la inmunología de la TB aún no se comprende completamente”.
En conjunto, el Centro de Medicina Translacional de la Universidad de Montana e Inimmune tienen 80 empleados especializados en la investigación de una variedad de adyuvantes con el propósito de comprender los detalles de las respuestas inmunitarias a diferentes sustancias. “Hay que adaptarlos al patógeno contra el que se vacuna, como si fueran un instrumento en una caja de herramientas”, dijo Evans. “Tenemos toda una biblioteca de moléculas y formulaciones de adyuvantes”.
Las vacunas se vuelven en gran medida más precisas mediante el uso de adyuvantes. Hay tres tipos básicos de adyuvantes naturales: sales de aluminio; escualeno, que se obtiene del hígado de tiburón; y algunos tipos de saponinas, que son moléculas grasas. No se sabe muy bien cómo estimulan el sistema inmunitario. El Centro de Missoula también ha creado y patentado un adyuvante sintético, el UM-1098, que induce un tipo específico de respuesta inmunitaria y que se añadirá a las nuevas vacunas.
Una de las moléculas más prometedoras que se están utilizando para potenciar la respuesta del sistema inmunológico a las vacunas es una molécula de saponina de la corteza del árbol de quillay, recolectada en Chile de árboles que tienen por lo menos una década.
Estas moléculas fueron utilizadas por Novavax en su vacuna contra covid y por GSK en Shingrix, su vacuna contra la culebrilla (shingles), de uso generalizado. Estas moléculas también son un componente clave en la nueva vacuna contra la tuberculosis, conocida como la vacuna M72.
Pero hay margen para mejorar.
“La vacuna muestra una eficacia del 50%, lo que no parece mucho, pero como actualmente se carece de otra vacuna más efectiva, el 50% es bastante mejor que lo que hay”, sostuvo Evans. “Buscamos aprovechar lo que aprendimos de ese desarrollo de la vacuna con adyuvantes adicionales para tratar de mejorarla y llevar ese índice desde el 50% hasta el 80% o más”.
Las vacunas contra el sarampión, en cambio, han alcanzado una efectividad del 95%.
Según el sitio web Medscape, en este momento se están desarrollando alrededor de 15 vacunas que son candidatas a reemplazar la BCG, y tres de ellas se encuentran en la fase 3 de ensayos clínicos.
Una alternativa que el Centro de Evans está investigando para mejorar la eficacia de la nueva vacuna es tomar una parte de la bacteria que causa la tuberculosis, sintetizarla y combinarla con el adyuvante QS-21, elaborado a partir del árbol de quillay. “Estimula el sistema inmunológico de una manera específica para la tuberculosis y genera una respuesta inmune que se acerca aún más a lo que obtenemos de las infecciones naturales”, dijo Evans.
Por su parte, el Centro de la Universidad de Montana está investigando el tratamiento de varias afecciones que generalmente no se consideran susceptibles de ser abordadas mediante vacunación. Por ejemplo, están ingresando en la primera fase de ensayos clínicos para una vacuna contra las alergias y para otra, contra el cáncer.
Avanzado este año, comenzarán los ensayos clínicos para obtener vacunas capaces de bloquear los efectos de opioides como la heroína y el fentanilo. La Universidad de Montana recibió la mayor subvención de su historia, $33 millones, para investigar una vacuna contra los opioides. Funciona creando un anticuerpo que se une a la droga en el torrente sanguíneo, evitando que entre al cerebro y produzca el efecto de euforia.
Por ahora, sin embargo, los expertos en salud de todo el mundo tienen sus ojos puestos en los ensayos de las nuevas vacunas contra la tuberculosis, que, si tienen éxito, podrían ayudar a salvar innumerables vidas en las regiones más pobres del mundo.
Four years after the COVID-19 pandemic closed schools and upended child care, the CDC says parents can start treating the virus like other respiratory illnesses.
Gone are mandated isolation periods and masking. But will schools and child care centers agree?
In case you’ve lost track: Before Friday, all Americans, including school children, were supposed to stay home for at least five days if they had COVID-19 and then mask for a set period of time, according to the Centers for Disease Control and Prevention.
Now, with COVID deaths and hospitalizations dropping, the CDC says children can go back to school when their overall symptoms improve and they’re fever-free for 24 hours without taking medication. Students are “encouraged” to wear a mask when they return.
Still, the change may not affect how individual schools urge parents to react when their children fall sick. Schools and child care providers have a mixed record on following CDC recommendations and often look to local authorities for the ultimate word. And sometimes other goals, such as reducing absences, can influence a state or district’s decisions.
The result can be a confusing array of policies among states and districts, not to mention workplaces — confounding parents whose lives have long been upended by the virus.
“This is so confusing,” said Gloria Cunningham, a single mom in the Boston area. “I just don’t know what I should think of COVID now. Is it still a monster?”
Cunningham, who manages a local store for a national restaurant chain, said her company requires her to take off 10 days if she gets COVID-19. And the school system where her son is in second grade has still been sending home COVID test kits for kids to use before returning to school after long breaks.
“I feel like we should just do away with anything that treats COVID differently or keep all of the precautions,” she said.
The public education system has long held varying policies on COVID. During the 2021-22 school year, 18 states followed CDC recommendations for mask-wearing in class. When the CDC lifted its masking guidelines in February 2022, states such as Massachusetts followed suit, but California kept the mask requirement for schools.
And in the child care world, some providers have long used more stringent testing and isolation protocols than the CDC has recommended. Reasons have ranged from trying to prevent outbreaks to keeping staff healthy — both for their personal safety and to keep the day care open.
Some states moved to more lenient guidelines ahead of the CDC. California and Oregon recently rescinded COVID-19 isolation requirements, and many districts followed their advice.
In an attempt to minimize school absences and address an epidemic of chronic absenteeism, California has encouraged kids to come to school when mildly sick and said that students who test positive for coronavirus but are asymptomatic can attend school. Los Angeles and San Diego’s school systems, among others, have adopted that policy.
But the majority of big-city districts around the country still have asked parents to isolate children for at least five days before returning to school. Some, including Boston and Atlanta, have required students to mask for another five days and report positive COVID-19 test results to the school.
Some school leaders suggest the CDC’s previous five-day isolation requirement was already only loosely followed.
Official policy in Burlington, Massachusetts, has been to have students stay home for five days if they test positive. But Superintendent Eric Conti said the real policy, in effect, is: “It’s a virus. Deal with it.”
That’s because COVID is managed at home, using the honor system.
“Without school-based testing, no one can enforce a five-day COVID policy,” he said via text message.
Ridley School District in the Philadelphia suburbs was already using a policy similar to the new CDC guidelines, said Superintendent Lee Ann Wentzel. Students who test positive for COVID must be fever-free without medication for at least 24 hours before returning to school. When they come back, they must mask for five days. Wentzel said the district is now considering dropping the masking requirement because of the new CDC guidance.
A school or day care’s specific guidelines are consequential for working parents who must miss work if their child can’t go to school or child care. In October 2023, during simultaneous surges of COVID, respiratory syncytial virus and influenza, 104,000 adults reported missing work because of child care issues, the highest number in at least a decade. That number has fallen: Last month, child care problems meant 41,000 adults missed work, according to the Bureau of Labor Statistics.
Melissa Colagrosso’s child care center in West Virginia dropped special guidelines for COVID about a year ago, she said. Now, they’re the same as other illnesses: A child must be free of severe symptoms such as fever for at least 24 hours before returning to the center.
“We certainly are treating COVID just like we would treat flu or hand, foot and mouth” disease, said Colagrosso, CEO of A Place To Grow Children’s Center in Oak Hill.
As for kids without symptoms who test positive for COVID? Most parents have stopped testing kids unless they have symptoms, Colagrasso said, so it’s a quandary she has not encountered.
Still, some parents worry the relaxed rules put their communities at greater risk. Evelyn Alemán leads a group of Latino and Indigenous immigrant parents in Los Angeles County. The parents she represents, many of whom suffer from chronic illnesses and lack of access to health care, panicked when California did away with isolation requirements in January.
“I don’t think they’re considering what the impact will be for our families,” she said of California officials. “It feels like they don’t care — that we’re almost expendable.”
Other impacts of the pandemic linger, too, even as restrictions are lifted. In Ridley, the Philadelphia-area district, more students are reclusive and struggle to interact in-person with peers, said Wentzel, the superintendent. Interest in school dances has plummeted.
“Emotionally,” Wentzel said, “they’re having trouble.”
Four years after the COVID-19 pandemic closed schools and upended child care, the CDC says parents can start treating the virus like other respiratory illnesses.
Gone are mandated isolation periods and masking. But will schools and child care centers agree?
In case you’ve lost track: Before Friday, all Americans, including school children, were supposed to stay home for at least five days if they had COVID-19 and then mask for a set period of time, according to the Centers for Disease Control and Prevention.
Now, with COVID deaths and hospitalizations dropping, the CDC says children can go back to school when their overall symptoms improve and they’re fever-free for 24 hours without taking medication. Students are “encouraged” to wear a mask when they return.
Still, the change may not affect how individual schools urge parents to react when their children fall sick. Schools and child care providers have a mixed record on following CDC recommendations and often look to local authorities for the ultimate word. And sometimes other goals, such as reducing absences, can influence a state or district’s decisions.
The result can be a confusing array of policies among states and districts, not to mention workplaces — confounding parents whose lives have long been upended by the virus.
“This is so confusing,” said Gloria Cunningham, a single mom in the Boston area. “I just don’t know what I should think of COVID now. Is it still a monster?”
Cunningham, who manages a local store for a national restaurant chain, said her company requires her to take off 10 days if she gets COVID-19. And the school system where her son is in second grade has still been sending home COVID test kits for kids to use before returning to school after long breaks.
“I feel like we should just do away with anything that treats COVID differently or keep all of the precautions,” she said.
The public education system has long held varying policies on COVID. During the 2021-22 school year, 18 states followed CDC recommendations for mask-wearing in class. When the CDC lifted its masking guidelines in February 2022, states such as Massachusetts followed suit, but California kept the mask requirement for schools.
And in the child care world, some providers have long used more stringent testing and isolation protocols than the CDC has recommended. Reasons have ranged from trying to prevent outbreaks to keeping staff healthy — both for their personal safety and to keep the day care open.
Some states moved to more lenient guidelines ahead of the CDC. California and Oregon recently rescinded COVID-19 isolation requirements, and many districts followed their advice.
In an attempt to minimize school absences and address an epidemic of chronic absenteeism, California has encouraged kids to come to school when mildly sick and said that students who test positive for coronavirus but are asymptomatic can attend school. Los Angeles and San Diego’s school systems, among others, have adopted that policy.
But the majority of big-city districts around the country still have asked parents to isolate children for at least five days before returning to school. Some, including Boston and Atlanta, have required students to mask for another five days and report positive COVID-19 test results to the school.
Some school leaders suggest the CDC’s previous five-day isolation requirement was already only loosely followed.
Official policy in Burlington, Massachusetts, has been to have students stay home for five days if they test positive. But Superintendent Eric Conti said the real policy, in effect, is: “It’s a virus. Deal with it.”
That’s because COVID is managed at home, using the honor system.
“Without school-based testing, no one can enforce a five-day COVID policy,” he said via text message.
Ridley School District in the Philadelphia suburbs was already using a policy similar to the new CDC guidelines, said Superintendent Lee Ann Wentzel. Students who test positive for COVID must be fever-free without medication for at least 24 hours before returning to school. When they come back, they must mask for five days. Wentzel said the district is now considering dropping the masking requirement because of the new CDC guidance.
A school or day care’s specific guidelines are consequential for working parents who must miss work if their child can’t go to school or child care. In October 2023, during simultaneous surges of COVID, respiratory syncytial virus and influenza, 104,000 adults reported missing work because of child care issues, the highest number in at least a decade. That number has fallen: Last month, child care problems meant 41,000 adults missed work, according to the Bureau of Labor Statistics.
Melissa Colagrosso’s child care center in West Virginia dropped special guidelines for COVID about a year ago, she said. Now, they’re the same as other illnesses: A child must be free of severe symptoms such as fever for at least 24 hours before returning to the center.
“We certainly are treating COVID just like we would treat flu or hand, foot and mouth” disease, said Colagrosso, CEO of A Place To Grow Children’s Center in Oak Hill.
As for kids without symptoms who test positive for COVID? Most parents have stopped testing kids unless they have symptoms, Colagrasso said, so it’s a quandary she has not encountered.
Still, some parents worry the relaxed rules put their communities at greater risk. Evelyn Alemán leads a group of Latino and Indigenous immigrant parents in Los Angeles County. The parents she represents, many of whom suffer from chronic illnesses and lack of access to health care, panicked when California did away with isolation requirements in January.
“I don’t think they’re considering what the impact will be for our families,” she said of California officials. “It feels like they don’t care — that we’re almost expendable.”
Other impacts of the pandemic linger, too, even as restrictions are lifted. In Ridley, the Philadelphia-area district, more students are reclusive and struggle to interact in-person with peers, said Wentzel, the superintendent. Interest in school dances has plummeted.
“Emotionally,” Wentzel said, “they’re having trouble.”
KALISPELL, Mont. — On a cold February morning at the Flathead Warming Center, Tashya Evans waited for help with her Medicaid application as others at the shelter got ready for the day in this northwestern Montana city.
Evans said she lost Medicaid coverage in September because she hadn’t received paperwork after moving from Great Falls, Montana. She has had to forgo the blood pressure medication she can no longer pay for since losing coverage. She has also had to put off needed dental work.
“The teeth broke off. My gums hurt. There’s some times where I’m not feeling good, I don’t want to eat,” she said.
Evans is one of about 130,000 Montanans who have lost Medicaid coverage as the state reevaluates everyone’s eligibility following a pause in disenrollments during the covid-19 pandemic. About two-thirds of those who were kicked off state Medicaid rolls lost coverage for technical reasons, such as incorrectly filling out paperwork. That’s one of the highest procedural disenrollment rates in the nation, according to a KFF analysis.
Even unsheltered people like Evans are losing their coverage, despite state officials saying they would automatically renew people who should still qualify by using Social Security and disability data.
As other guests filtered out of the shelter that February morning, Evans sat down in a spare office with an application counselor from Greater Valley Health Clinic, which serves much of the homeless population here, and recounted her struggle to reenroll.
She said that she had asked for help at the state public assistance office, but that the staff didn’t have time to answer her questions about which forms she needed to fill out or to walk her through the paperwork. She tried the state’s help line, but couldn’t get through.
“You just get to the point where you’re like, ‘I’m frustrated right now. I just have other things that are more important, and let’s not deal with it,’” she said.
Evans has a job and spends her free time finding a place to sleep since she doesn’t have housing. Waiting on the phone most of the day isn’t feasible.
There’s no public data on how many unhoused people in Montana or nationwide have lost Medicaid, but homeless service providers and experts say it’s a big problem.
Those assisting unsheltered people who have lost coverage say they spend much of their time helping people contact the Montana Medicaid office. Sorting through paperwork mistakes is also a headache, said Crystal Baker, a case manager at HRDC, a homeless shelter in Bozeman.
“We’re getting mail that’s like, ‘Oh, this needs to be turned in by this date,’ and that’s already two weeks past. So, now we have to start the process all over again,” she said. “Now, they have to wait two to three months without insurance.”
Montana health officials told NPR and KFF Health News in a statement that they provided training to help homeless service agencies prepare their clients for redetermination.
Federal health officials have warned Montana and some other conservative states against disenrolling high rates of people for technicalities, also known as procedural disenrollment. They also warned states about unreasonable barriers to accessing help, such as long hold times on help lines. The Centers for Medicare & Medicaid Services said if states don’t reduce the rate of procedural disenrollments, the agency could force them to halt their redetermination process altogether. So far, CMS hasn’t taken that step.
Charlie Brereton, the director of the Montana health department, resisted calls from Democratic state lawmakers to pause the redetermination process. Redetermination ended in January, four months ahead of the federal deadline.
“I’m confident in our redetermination process,” Brereton told lawmakers in December. “I do believe that many of the Medicaid members who’ve been disenrolled were disenrolled correctly.
Health industry observers say that both liberal-leaning and conservative-leaning states are kicking homeless people off their rolls and that the redetermination process has been chaotic everywhere. Because of the barriers that unsheltered people face, it’s easy for them to fall through the cracks.
Margot Kushel, a physician and a homeless researcher at the University of California-San Francisco, said it may not seem like a big deal to fill out paperwork. But, she said, “put yourself in the position of an elder experiencing homelessness,” especially those without access to a computer, phone, or car.
If they still qualify, people can usually get their Medicaid coverage renewed — eventually — and it may reimburse patients retroactively for care received while they were unenrolled.
Kushel said being without Medicaid for any period can be particularly dangerous for people who are homeless. This population tends to have high rates of chronic health conditions.
“Being out of your asthma medicine for three days can be life-threatening. If you have high blood pressure and you suddenly stop your medicine, your blood pressure shoots up, and your risk of having a heart attack goes way up,” she said.
When people don’t understand why they’re losing coverage or how to get it back, that erodes their trust in the medical system, Kushel said.
Evans, the homeless woman, was able to get help with her application and is likely to regain coverage.
Agencies that serve unhoused people said it could take years to get everyone who lost coverage back on Medicaid. They worry that those who go without coverage will resort to using the emergency room rather than managing their health conditions proactively.
Baker, the case manager at the Bozeman shelter, set up several callbacks from the state Medicaid office for one client. The state needed to interview him to make sure he still qualified, but the state never called.
“He waited all day long. By the fifth time, it was so stressful for him, he just gave up,” she said.
That client ended up leaving the Bozeman area before Baker could convince him it was worth trying to regain Medicaid.
Baker worries his poor health will catch up with him before he decides to try again.
This article is from a partnership that includes MTPR, NPR, and KFF Health News.
KALISPELL, Mont. — On a cold February morning at the Flathead Warming Center, Tashya Evans waited for help with her Medicaid application as others at the shelter got ready for the day in this northwestern Montana city.
Evans said she lost Medicaid coverage in September because she hadn’t received paperwork after moving from Great Falls, Montana. She has had to forgo the blood pressure medication she can no longer pay for since losing coverage. She has also had to put off needed dental work.
“The teeth broke off. My gums hurt. There’s some times where I’m not feeling good, I don’t want to eat,” she said.
Evans is one of about 130,000 Montanans who have lost Medicaid coverage as the state reevaluates everyone’s eligibility following a pause in disenrollments during the covid-19 pandemic. About two-thirds of those who were kicked off state Medicaid rolls lost coverage for technical reasons, such as incorrectly filling out paperwork. That’s one of the highest procedural disenrollment rates in the nation, according to a KFF analysis.
Even unsheltered people like Evans are losing their coverage, despite state officials saying they would automatically renew people who should still qualify by using Social Security and disability data.
As other guests filtered out of the shelter that February morning, Evans sat down in a spare office with an application counselor from Greater Valley Health Clinic, which serves much of the homeless population here, and recounted her struggle to reenroll.
She said that she had asked for help at the state public assistance office, but that the staff didn’t have time to answer her questions about which forms she needed to fill out or to walk her through the paperwork. She tried the state’s help line, but couldn’t get through.
“You just get to the point where you’re like, ‘I’m frustrated right now. I just have other things that are more important, and let’s not deal with it,’” she said.
Evans has a job and spends her free time finding a place to sleep since she doesn’t have housing. Waiting on the phone most of the day isn’t feasible.
There’s no public data on how many unhoused people in Montana or nationwide have lost Medicaid, but homeless service providers and experts say it’s a big problem.
Those assisting unsheltered people who have lost coverage say they spend much of their time helping people contact the Montana Medicaid office. Sorting through paperwork mistakes is also a headache, said Crystal Baker, a case manager at HRDC, a homeless shelter in Bozeman.
“We’re getting mail that’s like, ‘Oh, this needs to be turned in by this date,’ and that’s already two weeks past. So, now we have to start the process all over again,” she said. “Now, they have to wait two to three months without insurance.”
Montana health officials told NPR and KFF Health News in a statement that they provided training to help homeless service agencies prepare their clients for redetermination.
Federal health officials have warned Montana and some other conservative states against disenrolling high rates of people for technicalities, also known as procedural disenrollment. They also warned states about unreasonable barriers to accessing help, such as long hold times on help lines. The Centers for Medicare & Medicaid Services said if states don’t reduce the rate of procedural disenrollments, the agency could force them to halt their redetermination process altogether. So far, CMS hasn’t taken that step.
Charlie Brereton, the director of the Montana health department, resisted calls from Democratic state lawmakers to pause the redetermination process. Redetermination ended in January, four months ahead of the federal deadline.
“I’m confident in our redetermination process,” Brereton told lawmakers in December. “I do believe that many of the Medicaid members who’ve been disenrolled were disenrolled correctly.
Health industry observers say that both liberal-leaning and conservative-leaning states are kicking homeless people off their rolls and that the redetermination process has been chaotic everywhere. Because of the barriers that unsheltered people face, it’s easy for them to fall through the cracks.
Margot Kushel, a physician and a homeless researcher at the University of California-San Francisco, said it may not seem like a big deal to fill out paperwork. But, she said, “put yourself in the position of an elder experiencing homelessness,” especially those without access to a computer, phone, or car.
If they still qualify, people can usually get their Medicaid coverage renewed — eventually — and it may reimburse patients retroactively for care received while they were unenrolled.
Kushel said being without Medicaid for any period can be particularly dangerous for people who are homeless. This population tends to have high rates of chronic health conditions.
“Being out of your asthma medicine for three days can be life-threatening. If you have high blood pressure and you suddenly stop your medicine, your blood pressure shoots up, and your risk of having a heart attack goes way up,” she said.
When people don’t understand why they’re losing coverage or how to get it back, that erodes their trust in the medical system, Kushel said.
Evans, the homeless woman, was able to get help with her application and is likely to regain coverage.
Agencies that serve unhoused people said it could take years to get everyone who lost coverage back on Medicaid. They worry that those who go without coverage will resort to using the emergency room rather than managing their health conditions proactively.
Baker, the case manager at the Bozeman shelter, set up several callbacks from the state Medicaid office for one client. The state needed to interview him to make sure he still qualified, but the state never called.
“He waited all day long. By the fifth time, it was so stressful for him, he just gave up,” she said.
That client ended up leaving the Bozeman area before Baker could convince him it was worth trying to regain Medicaid.
Baker worries his poor health will catch up with him before he decides to try again.
This article is from a partnership that includes MTPR, NPR, and KFF Health News.
Four years after the COVID-19 pandemic closed schools and upended child care, the CDC says parents can start treating the virus like other respiratory illnesses.
Gone are mandated isolation periods and masking. But will schools and child care centers agree?
In case you’ve lost track: Before Friday, all Americans, including school children, were supposed to stay home for at least five days if they had COVID-19 and then mask for a set period of time, according to the Centers for Disease Control and Prevention.
Now, with COVID deaths and hospitalizations dropping, the CDC says children can go back to school when their overall symptoms improve and they’re fever-free for 24 hours without taking medication. Students are “encouraged” to wear a mask when they return.
Still, the change may not affect how individual schools urge parents to react when their children fall sick. Schools and child care providers have a mixed record on following CDC recommendations and often look to local authorities for the ultimate word. And sometimes other goals, such as reducing absences, can influence a state or district’s decisions.
The result can be a confusing array of policies among states and districts, not to mention workplaces — confounding parents whose lives have long been upended by the virus.
“This is so confusing,” said Gloria Cunningham, a single mom in the Boston area. “I just don’t know what I should think of COVID now. Is it still a monster?”
Cunningham, who manages a local store for a national restaurant chain, said her company requires her to take off 10 days if she gets COVID-19. And the school system where her son is in second grade has still been sending home COVID test kits for kids to use before returning to school after long breaks.
“I feel like we should just do away with anything that treats COVID differently or keep all of the precautions,” she said.
The public education system has long held varying policies on COVID. During the 2021-22 school year, 18 states followed CDC recommendations for mask-wearing in class. When the CDC lifted its masking guidelines in February 2022, states such as Massachusetts followed suit, but California kept the mask requirement for schools.
And in the child care world, some providers have long used more stringent testing and isolation protocols than the CDC has recommended. Reasons have ranged from trying to prevent outbreaks to keeping staff healthy — both for their personal safety and to keep the day care open.
Some states moved to more lenient guidelines ahead of the CDC. California and Oregon recently rescinded COVID-19 isolation requirements, and many districts followed their advice.
In an attempt to minimize school absences and address an epidemic of chronic absenteeism, California has encouraged kids to come to school when mildly sick and said that students who test positive for coronavirus but are asymptomatic can attend school. Los Angeles and San Diego’s school systems, among others, have adopted that policy.
But the majority of big-city districts around the country still have asked parents to isolate children for at least five days before returning to school. Some, including Boston and Atlanta, have required students to mask for another five days and report positive COVID-19 test results to the school.
Some school leaders suggest the CDC’s previous five-day isolation requirement was already only loosely followed.
Official policy in Burlington, Massachusetts, has been to have students stay home for five days if they test positive. But Superintendent Eric Conti said the real policy, in effect, is: “It’s a virus. Deal with it.”
That’s because COVID is managed at home, using the honor system.
“Without school-based testing, no one can enforce a five-day COVID policy,” he said via text message.
Ridley School District in the Philadelphia suburbs was already using a policy similar to the new CDC guidelines, said Superintendent Lee Ann Wentzel. Students who test positive for COVID must be fever-free without medication for at least 24 hours before returning to school. When they come back, they must mask for five days. Wentzel said the district is now considering dropping the masking requirement because of the new CDC guidance.
A school or day care’s specific guidelines are consequential for working parents who must miss work if their child can’t go to school or child care. In October 2023, during simultaneous surges of COVID, respiratory syncytial virus and influenza, 104,000 adults reported missing work because of child care issues, the highest number in at least a decade. That number has fallen: Last month, child care problems meant 41,000 adults missed work, according to the Bureau of Labor Statistics.
Melissa Colagrosso’s child care center in West Virginia dropped special guidelines for COVID about a year ago, she said. Now, they’re the same as other illnesses: A child must be free of severe symptoms such as fever for at least 24 hours before returning to the center.
“We certainly are treating COVID just like we would treat flu or hand, foot and mouth” disease, said Colagrosso, CEO of A Place To Grow Children’s Center in Oak Hill.
As for kids without symptoms who test positive for COVID? Most parents have stopped testing kids unless they have symptoms, Colagrasso said, so it’s a quandary she has not encountered.
Still, some parents worry the relaxed rules put their communities at greater risk. Evelyn Alemán leads a group of Latino and Indigenous immigrant parents in Los Angeles County. The parents she represents, many of whom suffer from chronic illnesses and lack of access to health care, panicked when California did away with isolation requirements in January.
“I don’t think they’re considering what the impact will be for our families,” she said of California officials. “It feels like they don’t care — that we’re almost expendable.”
Other impacts of the pandemic linger, too, even as restrictions are lifted. In Ridley, the Philadelphia-area district, more students are reclusive and struggle to interact in-person with peers, said Wentzel, the superintendent. Interest in school dances has plummeted.
“Emotionally,” Wentzel said, “they’re having trouble.”
Four years after the COVID-19 pandemic closed schools and upended child care, the CDC says parents can start treating the virus like other respiratory illnesses.
Gone are mandated isolation periods and masking. But will schools and child care centers agree?
In case you’ve lost track: Before Friday, all Americans, including school children, were supposed to stay home for at least five days if they had COVID-19 and then mask for a set period of time, according to the Centers for Disease Control and Prevention.
Now, with COVID deaths and hospitalizations dropping, the CDC says children can go back to school when their overall symptoms improve and they’re fever-free for 24 hours without taking medication. Students are “encouraged” to wear a mask when they return.
Still, the change may not affect how individual schools urge parents to react when their children fall sick. Schools and child care providers have a mixed record on following CDC recommendations and often look to local authorities for the ultimate word. And sometimes other goals, such as reducing absences, can influence a state or district’s decisions.
The result can be a confusing array of policies among states and districts, not to mention workplaces — confounding parents whose lives have long been upended by the virus.
“This is so confusing,” said Gloria Cunningham, a single mom in the Boston area. “I just don’t know what I should think of COVID now. Is it still a monster?”
Cunningham, who manages a local store for a national restaurant chain, said her company requires her to take off 10 days if she gets COVID-19. And the school system where her son is in second grade has still been sending home COVID test kits for kids to use before returning to school after long breaks.
“I feel like we should just do away with anything that treats COVID differently or keep all of the precautions,” she said.
The public education system has long held varying policies on COVID. During the 2021-22 school year, 18 states followed CDC recommendations for mask-wearing in class. When the CDC lifted its masking guidelines in February 2022, states such as Massachusetts followed suit, but California kept the mask requirement for schools.
And in the child care world, some providers have long used more stringent testing and isolation protocols than the CDC has recommended. Reasons have ranged from trying to prevent outbreaks to keeping staff healthy — both for their personal safety and to keep the day care open.
Some states moved to more lenient guidelines ahead of the CDC. California and Oregon recently rescinded COVID-19 isolation requirements, and many districts followed their advice.
In an attempt to minimize school absences and address an epidemic of chronic absenteeism, California has encouraged kids to come to school when mildly sick and said that students who test positive for coronavirus but are asymptomatic can attend school. Los Angeles and San Diego’s school systems, among others, have adopted that policy.
But the majority of big-city districts around the country still have asked parents to isolate children for at least five days before returning to school. Some, including Boston and Atlanta, have required students to mask for another five days and report positive COVID-19 test results to the school.
Some school leaders suggest the CDC’s previous five-day isolation requirement was already only loosely followed.
Official policy in Burlington, Massachusetts, has been to have students stay home for five days if they test positive. But Superintendent Eric Conti said the real policy, in effect, is: “It’s a virus. Deal with it.”
That’s because COVID is managed at home, using the honor system.
“Without school-based testing, no one can enforce a five-day COVID policy,” he said via text message.
Ridley School District in the Philadelphia suburbs was already using a policy similar to the new CDC guidelines, said Superintendent Lee Ann Wentzel. Students who test positive for COVID must be fever-free without medication for at least 24 hours before returning to school. When they come back, they must mask for five days. Wentzel said the district is now considering dropping the masking requirement because of the new CDC guidance.
A school or day care’s specific guidelines are consequential for working parents who must miss work if their child can’t go to school or child care. In October 2023, during simultaneous surges of COVID, respiratory syncytial virus and influenza, 104,000 adults reported missing work because of child care issues, the highest number in at least a decade. That number has fallen: Last month, child care problems meant 41,000 adults missed work, according to the Bureau of Labor Statistics.
Melissa Colagrosso’s child care center in West Virginia dropped special guidelines for COVID about a year ago, she said. Now, they’re the same as other illnesses: A child must be free of severe symptoms such as fever for at least 24 hours before returning to the center.
“We certainly are treating COVID just like we would treat flu or hand, foot and mouth” disease, said Colagrosso, CEO of A Place To Grow Children’s Center in Oak Hill.
As for kids without symptoms who test positive for COVID? Most parents have stopped testing kids unless they have symptoms, Colagrasso said, so it’s a quandary she has not encountered.
Still, some parents worry the relaxed rules put their communities at greater risk. Evelyn Alemán leads a group of Latino and Indigenous immigrant parents in Los Angeles County. The parents she represents, many of whom suffer from chronic illnesses and lack of access to health care, panicked when California did away with isolation requirements in January.
“I don’t think they’re considering what the impact will be for our families,” she said of California officials. “It feels like they don’t care — that we’re almost expendable.”
Other impacts of the pandemic linger, too, even as restrictions are lifted. In Ridley, the Philadelphia-area district, more students are reclusive and struggle to interact in-person with peers, said Wentzel, the superintendent. Interest in school dances has plummeted.
“Emotionally,” Wentzel said, “they’re having trouble.”
KALISPELL, Mont. — On a cold February morning at the Flathead Warming Center, Tashya Evans waited for help with her Medicaid application as others at the shelter got ready for the day in this northwestern Montana city.
Evans said she lost Medicaid coverage in September because she hadn’t received paperwork after moving from Great Falls, Montana. She has had to forgo the blood pressure medication she can no longer pay for since losing coverage. She has also had to put off needed dental work.
“The teeth broke off. My gums hurt. There’s some times where I’m not feeling good, I don’t want to eat,” she said.
Evans is one of about 130,000 Montanans who have lost Medicaid coverage as the state reevaluates everyone’s eligibility following a pause in disenrollments during the covid-19 pandemic. About two-thirds of those who were kicked off state Medicaid rolls lost coverage for technical reasons, such as incorrectly filling out paperwork. That’s one of the highest procedural disenrollment rates in the nation, according to a KFF analysis.
Even unsheltered people like Evans are losing their coverage, despite state officials saying they would automatically renew people who should still qualify by using Social Security and disability data.
As other guests filtered out of the shelter that February morning, Evans sat down in a spare office with an application counselor from Greater Valley Health Clinic, which serves much of the homeless population here, and recounted her struggle to reenroll.
She said that she had asked for help at the state public assistance office, but that the staff didn’t have time to answer her questions about which forms she needed to fill out or to walk her through the paperwork. She tried the state’s help line, but couldn’t get through.
“You just get to the point where you’re like, ‘I’m frustrated right now. I just have other things that are more important, and let’s not deal with it,’” she said.
Evans has a job and spends her free time finding a place to sleep since she doesn’t have housing. Waiting on the phone most of the day isn’t feasible.
There’s no public data on how many unhoused people in Montana or nationwide have lost Medicaid, but homeless service providers and experts say it’s a big problem.
Those assisting unsheltered people who have lost coverage say they spend much of their time helping people contact the Montana Medicaid office. Sorting through paperwork mistakes is also a headache, said Crystal Baker, a case manager at HRDC, a homeless shelter in Bozeman.
“We’re getting mail that’s like, ‘Oh, this needs to be turned in by this date,’ and that’s already two weeks past. So, now we have to start the process all over again,” she said. “Now, they have to wait two to three months without insurance.”
Montana health officials told NPR and KFF Health News in a statement that they provided training to help homeless service agencies prepare their clients for redetermination.
Federal health officials have warned Montana and some other conservative states against disenrolling high rates of people for technicalities, also known as procedural disenrollment. They also warned states about unreasonable barriers to accessing help, such as long hold times on help lines. The Centers for Medicare & Medicaid Services said if states don’t reduce the rate of procedural disenrollments, the agency could force them to halt their redetermination process altogether. So far, CMS hasn’t taken that step.
Charlie Brereton, the director of the Montana health department, resisted calls from Democratic state lawmakers to pause the redetermination process. Redetermination ended in January, four months ahead of the federal deadline.
“I’m confident in our redetermination process,” Brereton told lawmakers in December. “I do believe that many of the Medicaid members who’ve been disenrolled were disenrolled correctly.
Health industry observers say that both liberal-leaning and conservative-leaning states are kicking homeless people off their rolls and that the redetermination process has been chaotic everywhere. Because of the barriers that unsheltered people face, it’s easy for them to fall through the cracks.
Margot Kushel, a physician and a homeless researcher at the University of California-San Francisco, said it may not seem like a big deal to fill out paperwork. But, she said, “put yourself in the position of an elder experiencing homelessness,” especially those without access to a computer, phone, or car.
If they still qualify, people can usually get their Medicaid coverage renewed — eventually — and it may reimburse patients retroactively for care received while they were unenrolled.
Kushel said being without Medicaid for any period can be particularly dangerous for people who are homeless. This population tends to have high rates of chronic health conditions.
“Being out of your asthma medicine for three days can be life-threatening. If you have high blood pressure and you suddenly stop your medicine, your blood pressure shoots up, and your risk of having a heart attack goes way up,” she said.
When people don’t understand why they’re losing coverage or how to get it back, that erodes their trust in the medical system, Kushel said.
Evans, the homeless woman, was able to get help with her application and is likely to regain coverage.
Agencies that serve unhoused people said it could take years to get everyone who lost coverage back on Medicaid. They worry that those who go without coverage will resort to using the emergency room rather than managing their health conditions proactively.
Baker, the case manager at the Bozeman shelter, set up several callbacks from the state Medicaid office for one client. The state needed to interview him to make sure he still qualified, but the state never called.
“He waited all day long. By the fifth time, it was so stressful for him, he just gave up,” she said.
That client ended up leaving the Bozeman area before Baker could convince him it was worth trying to regain Medicaid.
Baker worries his poor health will catch up with him before he decides to try again.
This article is from a partnership that includes MTPR, NPR, and KFF Health News.
KALISPELL, Mont. — On a cold February morning at the Flathead Warming Center, Tashya Evans waited for help with her Medicaid application as others at the shelter got ready for the day in this northwestern Montana city.
Evans said she lost Medicaid coverage in September because she hadn’t received paperwork after moving from Great Falls, Montana. She has had to forgo the blood pressure medication she can no longer pay for since losing coverage. She has also had to put off needed dental work.
“The teeth broke off. My gums hurt. There’s some times where I’m not feeling good, I don’t want to eat,” she said.
Evans is one of about 130,000 Montanans who have lost Medicaid coverage as the state reevaluates everyone’s eligibility following a pause in disenrollments during the covid-19 pandemic. About two-thirds of those who were kicked off state Medicaid rolls lost coverage for technical reasons, such as incorrectly filling out paperwork. That’s one of the highest procedural disenrollment rates in the nation, according to a KFF analysis.
Even unsheltered people like Evans are losing their coverage, despite state officials saying they would automatically renew people who should still qualify by using Social Security and disability data.
As other guests filtered out of the shelter that February morning, Evans sat down in a spare office with an application counselor from Greater Valley Health Clinic, which serves much of the homeless population here, and recounted her struggle to reenroll.
She said that she had asked for help at the state public assistance office, but that the staff didn’t have time to answer her questions about which forms she needed to fill out or to walk her through the paperwork. She tried the state’s help line, but couldn’t get through.
“You just get to the point where you’re like, ‘I’m frustrated right now. I just have other things that are more important, and let’s not deal with it,’” she said.
Evans has a job and spends her free time finding a place to sleep since she doesn’t have housing. Waiting on the phone most of the day isn’t feasible.
There’s no public data on how many unhoused people in Montana or nationwide have lost Medicaid, but homeless service providers and experts say it’s a big problem.
Those assisting unsheltered people who have lost coverage say they spend much of their time helping people contact the Montana Medicaid office. Sorting through paperwork mistakes is also a headache, said Crystal Baker, a case manager at HRDC, a homeless shelter in Bozeman.
“We’re getting mail that’s like, ‘Oh, this needs to be turned in by this date,’ and that’s already two weeks past. So, now we have to start the process all over again,” she said. “Now, they have to wait two to three months without insurance.”
Montana health officials told NPR and KFF Health News in a statement that they provided training to help homeless service agencies prepare their clients for redetermination.
Federal health officials have warned Montana and some other conservative states against disenrolling high rates of people for technicalities, also known as procedural disenrollment. They also warned states about unreasonable barriers to accessing help, such as long hold times on help lines. The Centers for Medicare & Medicaid Services said if states don’t reduce the rate of procedural disenrollments, the agency could force them to halt their redetermination process altogether. So far, CMS hasn’t taken that step.
Charlie Brereton, the director of the Montana health department, resisted calls from Democratic state lawmakers to pause the redetermination process. Redetermination ended in January, four months ahead of the federal deadline.
“I’m confident in our redetermination process,” Brereton told lawmakers in December. “I do believe that many of the Medicaid members who’ve been disenrolled were disenrolled correctly.
Health industry observers say that both liberal-leaning and conservative-leaning states are kicking homeless people off their rolls and that the redetermination process has been chaotic everywhere. Because of the barriers that unsheltered people face, it’s easy for them to fall through the cracks.
Margot Kushel, a physician and a homeless researcher at the University of California-San Francisco, said it may not seem like a big deal to fill out paperwork. But, she said, “put yourself in the position of an elder experiencing homelessness,” especially those without access to a computer, phone, or car.
If they still qualify, people can usually get their Medicaid coverage renewed — eventually — and it may reimburse patients retroactively for care received while they were unenrolled.
Kushel said being without Medicaid for any period can be particularly dangerous for people who are homeless. This population tends to have high rates of chronic health conditions.
“Being out of your asthma medicine for three days can be life-threatening. If you have high blood pressure and you suddenly stop your medicine, your blood pressure shoots up, and your risk of having a heart attack goes way up,” she said.
When people don’t understand why they’re losing coverage or how to get it back, that erodes their trust in the medical system, Kushel said.
Evans, the homeless woman, was able to get help with her application and is likely to regain coverage.
Agencies that serve unhoused people said it could take years to get everyone who lost coverage back on Medicaid. They worry that those who go without coverage will resort to using the emergency room rather than managing their health conditions proactively.
Baker, the case manager at the Bozeman shelter, set up several callbacks from the state Medicaid office for one client. The state needed to interview him to make sure he still qualified, but the state never called.
“He waited all day long. By the fifth time, it was so stressful for him, he just gave up,” she said.
That client ended up leaving the Bozeman area before Baker could convince him it was worth trying to regain Medicaid.
Baker worries his poor health will catch up with him before he decides to try again.
This article is from a partnership that includes MTPR, NPR, and KFF Health News.