The decision by federal officials, citing authority granted under President Donald Trump’s signature tax-and-spending law, suggests the GOP-led state’s predicament could foretell other repercussions in how states are allowed to run the program under federal waivers.

Nearly every state has at least one waiver to run its Medicaid program differently than required by federal law, such as allowing the use of private managed-care plans or expanding eligibility for mental health or long-term care services. Some Medicaid waivers have stretched decades, renewed by presidential administrations of both parties, effectively making the demonstration programs they created permanent.

Arkansas is one of a dozen states with a waiver expiring Dec. 31 that face the additional restrictions the Trump administration has placed on new or renewed waivers.

Though it has yet to finalize its decision, the federal Centers for Medicare & Medicaid Services said Arkansas’ 13-year-old waiver does not comply with new “budget neutrality” rules that take effect in January, said Gavin Lesnick, a spokesperson for the Arkansas Department of Human Services. The rules tighten a policy forbidding Medicaid waivers from increasing federal spending on the program beyond what it would have increased without the waiver.

The state is now seeking a two-year extension after hearing from CMS that its request for a five-year renewal would not be granted. If its Medicaid expansion waiver is not renewed, Arkansas officials have said they will continue offering expanded eligibility through existing Medicaid law, a change that could leave enrollees with access to fewer doctors and other health providers.

Rather than place more people in its traditional Medicaid program serving largely children, pregnant women, and disabled people, Arkansas obtained a waiver to buy Affordable Care Act marketplace policies from private insurers for adults covered by the Medicaid expansion. This “private option” gave enrollees greater choice of doctors and other health providers, because some doctors are more willing to see patients with private coverage, which generally pays more than regular Medicaid.

The move helped cut the state’s uninsured rate by nearly half, but it also ended up costing more than if beneficiaries were covered under Medicaid’s traditional, fee-for-service program.

Critics characterize the new waiver rules as part of a Trump administration effort to dramatically shrink Medicaid, the government program for those who are low-income or disabled, which grew rapidly under Presidents Barack Obama and Joe Biden.

“What we have here is a sneaky way to cut Medicaid expansion and the Medicaid program,” said Nicole Huberfeld, a professor of health law at Boston University.

Medicaid enrollees won’t know whom to blame if they lose coverage because the administration is using arcane regulatory processes to make the changes, Huberfeld said.

At issue are waivers granted by the government that allow states flexibility from existing Medicaid law in how they cover low-income residents, as long as the changes will not increase what Medicaid costs the federal government.

Pivoting from the long-standing practice of checking only retroactively whether states were keeping their budget promises, the Trump administration that it would not renew or approve any waivers unless CMS first certified that they would not increase costs to the federal government.

In its , the agency said the new waiver rules are expected to reduce federal spending.

“Characterizing enforcement of a statutory budget neutrality requirement as a cut misrepresents both the law and this guidance,” CMS spokesperson Timothy Foster said in an email to Ñî¹óåú´«Ã½Ò•îl Health News. The federal waivers are intended “to test innovative approaches to delivering care, not provide an open-ended mechanism for increasing federal spending.”

Other states with waivers expiring at the end of December include Georgia, which has added about 18,000 low-income people to Medicaid under its waiver, and California, which has used its waiver to expand coverage of social services including food and housing.

California and Georgia Medicaid officials told Ñî¹óåú´«Ã½Ò•îl Health News that they are still working with CMS in hopes of renewing their waivers. The loss of federal waiver approval could cause states to curtail benefits or eligibility expansions.

In Arkansas, it would mean redesigning the state’s Medicaid expansion program.

Arkansas’ initial waiver was granted in 2013, when its Democratic governor at the time worked with a Republican-controlled legislature to adopt a pioneering style of Medicaid expansion under the Affordable Care Act.

It was one of the first Southern states to expand Medicaid, granting coverage to many low-income residents. Forty states and Washington, D.C., have also fully expanded Medicaid to cover more low-income adults under the law also known as Obamacare.

The state’s Medicaid expansion enrollees were already facing a confusing time. Starting in January, they will need to prove they work or meet an exemption to be eligible for coverage under Trump’s law, the One Big Beautiful Bill Act. And one of the state program’s two private health insurers — Centene — announced in July that it was pulling out at the end of the year.

Sam Dubke, a spokesperson for Republican Arkansas Gov. Sarah Huckabee Sanders, told Ñî¹óåú´«Ã½Ò•îl Health News that the Sanders administration is trying to negotiate a temporary extension of its waiver “to ensure impacted Arkansans maintain access to quality, affordable healthcare during this transition period.”

“Looking ahead to the next legislative session, CMS has provided the state with an opportunity for bold, conservative healthcare reform, and the governor will work with her partners in the legislature to build a sustainable model that maintains the same high quality of care and saves taxpayer dollars,” Dubke said.

The Trump administration’s new restrictions on waivers, implemented under the same law that imposes work requirements as a condition of eligibility and reduces Medicaid spending by about $900 billion over a decade, could affect millions of enrollees and billions in spending. About a third of the almost $600 billion in federal spending on Medicaid and the Children’s Health Insurance Program in 2024 supported programs created by waivers, according to CMS.

In a , the Government Accountability Office found that the three-year spending limit the federal government approved for Arkansas’ Medicaid waiver was nearly $800 million more than what the state would have spent through its traditional Medicaid program.

Arkansas is one of several states that expanded Medicaid under the ACA using a waiver, with others including Indiana, Michigan, New Hampshire, and Iowa.

States will have to clear several more bureaucratic hurdles to retain waivers under the new CMS guidance, said Alice Lam, a managing director with consulting and legal firm Manatt. That could lead to fewer benefits or reduce the number of people eligible for Medicaid, she said.

Robert Nelb, director of policy at America’s Essential Hospitals, which represents safety net hospitals, said he and most experts believed when it passed that the One Big Beautiful Bill Act was merely codifying CMS policy on budget neutrality.

But the Trump administration has interpreted the law to restrict states’ use of waivers, he said.

Nelb said many long-standing waivers that have been renewed multiple times are now at risk and that the loss of state waivers could threaten money hospitals rely on to cover uninsured patients and improve care in their communities.

“There is a real concern that this will put added burdens on states up front and slow down new innovations in Medicaid,” Nelb said.

In 2025, the Trump administration told states it would no longer renew Medicaid waivers to help enrollees with job training or to allow continuous eligibility for adults and children for specific time periods without verifying their income eligibility.

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

The wristbands are part of a growing initiative first launched by North Carolina-based ECU Health as Congress sought to address the nation’s growing maternal mortality crisis during the covid pandemic. , and the state’s health department have begun distributing the wristbands, to give mothers and care providers a visual reminder of the life-threatening health risks after birth.

The Connecticut state health department; large health systems in Arkansas, Georgia, and Mississippi; and hospitals in at least 24 other states have also embraced the program. The wristbands are intended to make emergency workers aware of postpartum risks, ensure better treatment, and help lower maternal mortality rates in the U.S., where happen after the day of delivery — and nearly 40% happen after the six-week mark.

This year, North Carolina plans to expand the initiative with part of the through the Rural Health Transformation Program, a provision of President Donald Trump’s signature One Big Beautiful Bill Act, also known as HR 1.

Tamika Auguste, a physician and the board chair at the American College of Obstetricians & Gynecologists Foundation, praised the wristbands as a useful tool “to increase awareness and education around postpartum health.” But she and others who focus on maternal health said efforts like the wristband campaigns are only part of what’s needed to combat the broader maternal mortality crisis in the U.S.

And they noted the wristbands’ popularity is emerging as Trump’s 2025 law is expected to reduce Medicaid spending by over 10 years, according to a Congressional Budget Office analysis. Medicaid, the federal-state program that covers healthcare for low-income families, pays for .

Elisabeth Wright Burak, a policy researcher at Georgetown University’s Center for Children and Families, said Trump’s tax-and-spending law is stifling the momentum states had been gaining with maternal care since 2022. That’s when Congress allowed states to extend postpartum Medicaid coverage , which nearly every state did.

Now, those extensions could end up on the chopping block, Burak said, as states seek ways to manage Medicaid losses.

“There is no question that HR 1 risks setting the clock back for maternal health,” Burak said.

warned that postpartum patients have more to worry about with the new law than simply cuts to Medicaid. States are also setting up systems that may not adequately track pregnant and postpartum enrollees who should be exempt from the law’s new work requirements, erroneously dropping them from coverage, Burak’s report said.

Maternal Mortality

U.S. maternal mortality rates have risen and fallen over the past seven years, with 649 maternal deaths in 2024, according to the most recent . Tennessee had the worst maternal mortality rate in the nation from 2020 to 2024, around 42 deaths per 100,000 births, according an analysis of CDC data by the . North Carolina’s rate was about 29 in 100,000, with a national average of 23.

In its , North Carolina said the initiative creating the “I Gave Birth” wristbands reduced postpartum readmissions by nearly a third at ECU Health Medical Center in Greenville, without elaborating. In online promotions, some hospitals the can , though many have recently launched and their impact has yet to be studied.

“Additional research is needed to conclusively confirm the outcomes of such initiatives,” said Hannah Jones, a spokesperson for the North Carolina health department.

Hospitals to patients who have given birth and instruct them to wear it for weeks or months, hoping they’ll be reminded to check in with a physician if they feel chest pain, have headaches, or start bleeding. The accessory resembles the yellow , part of a cancer awareness campaign launched by cyclist Lance Armstrong’s foundation. A nurse also talks through postpartum risks with the patients, and they’re sent home with pamphlets and guidebooks on how to care for their new child and themselves.

“The bracelet itself is simply a reminder of, ‘Hey, I got education,’” said Jessica Noble, a nurse with East Carolina University-connected ECU Health who pioneered the initiative.

It’s also intended to alert first responders and other healthcare providers that a woman has recently given birth and to check for postpartum complications, such as low blood pressure, bleeding, or infections. and sometimes don’t have adequate training to recognize postpartum complications, research shows, which can be dangerous when those patients end up in an emergency room.

Postpartum wristbands gained traction across the country through health awareness campaigns fueled by social media posts and evening news segments. New mothers appeared in promotional photos and videos wearing the wristband and raving about the accessory, saying it celebrated childbirth.

Some postpartum patients who faced traumatic births or mental health struggles saw it differently.

‘So Many Risks’

Alexandra Mellon gave birth last year. Her daughter was stillborn. Devastated, she sought out a therapist, donated her breast milk, and tried to find meaning in her circumstances. She spent a year feeling isolated, she said, often because people don’t know what to say.

Mellon said wearing one of the wristbands would have been a painful reminder of her loss.

Now she works as a doula in Asheville, North Carolina. Mellon said what she thinks new moms need most is community and emotional support. The wristband could help encourage that for some patients, she said, but isn’t for everyone.

“There are so many risks, and it’s just like you almost become invisible,” she said.

More than 80% of pregnancy-related deaths , according to the CDC. The Centers for Medicare & Medicaid Services in March , developed during the Biden administration, that urged hospitals to create better emergency department protocols to catch postpartum complications and to measure their work against state and national maternal health data.

But those efforts faced a major threat last year when the Trump administration CDC funding for state-level maternal mortality data in its proposed 2026 budget. While Congress rejected that move, the administration did tracking postpartum patients’ health.

The Trump administration $113.5 million in CDC maternal health research in its proposed 2027 budget. Congress has instead proposed increasing funding to .

Without more research, it’s unclear how effective the wristbands are in encouraging postpartum patients to seek care when they need it. A of mass media campaigns to improve health outcomes, such as preventing risky substance use or encouraging exercise, found that the campaigns didn’t change behaviors. found that the U.S. “Back to Sleep” campaign, which educates parents on safe sleeping practices with babies, dramatically reduced rates of sudden infant death syndrome for several years after it launched in 1994, though rates .

In 2020, the CDC tried , “Hear Her,” aimed at helping women speak up when something felt wrong after delivery.

The CDC released years later that said it “had the unintended consequence of appearing to put the burden on the people who are pregnant or postpartum to speak up.”

ECU Health Medical Center created the wristband initiative in 2021 and . In it the authors noted the pregnancy-related readmission rate at the Greenville hospital fell 0.77%. It attributed the change to the “education provided to patients, family members, and medical personnel” in the initiative, without elaborating.

Campaigns like the “I Gave Birth” initiative are far from a final solution to maternal mortality, said Noble, the campaign’s architect and lead author on the ECU Health study. If she “had a magic wand,” she said, North Carolina would not just have better postpartum care but would also address the root causes of pregnancy complications. “But I don’t have one, and I can’t make system-level change immediately.”

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

Céline Gounder, Ñî¹óåú´«Ã½Ò•îl Health News’ editor-at-large for public health, discussed the cyclosporiasis outbreak on CBS News’ CBS Mornings on Aug. 5. Gounder discussed New Mexico’s measles outbreak on CBS News 24/7’s The Daily Report on Aug. 4. She also discussed peptides on Ideastream Public Media/WKSU’s Sound of Ideas on Aug. 3.

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Ñî¹óåú´«Ã½Ò•îl Health News chief Washington correspondent Julie Rovner discussed the end of a Biden-era Medicare Part D subsidy on WBUR’s Here & Now on Aug. 3.

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Ñî¹óåú´«Ã½Ò•îl Health News Southern correspondent Sam Whitehead discussed the new medical frailty work requirements on WUGA’s The Georgia Health Report on July 31.

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• Read Whitehead’s “Doctors ‘Cringe’ at Possibility of Documenting Which Medicaid Enrollees Too Sick To Work.”

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Céline Gounder, Ñî¹óåú´«Ã½Ò•îl Health News’ editor-at-large for public health, discussed how children’s caffeine consumption is affecting their health on CBS News’ CBS Mornings on July 30.

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Ñî¹óåú´«Ã½Ò•îl Health News senior correspondent Arthur Allen discussed the recent Anthony Fauci Senate hearing on CBS News 24/7 on July 29.

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Ñî¹óåú´«Ã½Ò•îl Health News chief Washington correspondent Julie Rovner discussed the Fauci hearing on WBUR’s Here & Now on July 29. Rovner also discussed exceptional Affordable Care Act enrollment in New Mexico on KJZZ’s The Show on July 29.

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Ñî¹óåú´«Ã½Ò•îl Health News national public health correspondent Amy Maxmen discussed the FDA potentially easing restrictions on peptide drugs on CBS News 24/7 on July 24.

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Ñî¹óåú´«Ã½Ò•îl Health News Georgia correspondent Briah Lumpkins discussed the local impact of the loss of Environmental Protection Agency grant money on WUGA’s The Georgia Health Report on July 24.

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• Read Lumpkins’ “Public Health Improvements Stall Amid Trump’s DEI Crackdown.”

Ñî¹óåú´«Ã½Ò•îl Health News HawaiÊ»i correspondent Ashley Mizuo discussed the challenge of finding placement for prisoners after their compassionate release from detention on HawaiÊ»i Public Radio’s The Conversation on July 22.

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• Read Mizuo’s “Severely Ill Prisoners Granted Early Release Are Left Stuck Behind Bars.”

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The majority of California’s roughly 300,000 teachers don’t have access to the state-funded paid leave program that most new parents in the private sector do. Instead, many local school districts deduct the cost of a substitute teacher from educators’ pay during parental leave.

Because her daughter arrived before the school year ended, Blustein used 10 of her accrued sick days — paid time off she wanted to bank for later to bond with her baby or to care for her if she got sick.

Now, California lawmakers have given public school and community college employees up to 14 weeks of paid pregnancy leave in the education bill accompanying the , after Gov. Gavin Newsom this year.

It’s a reversal for Newsom in his final year in office. In 2019, the governor that would have given school employees at least six weeks of paid leave, and a similar Assembly bill that died on the Senate floor in 2024. Several analysts said the issue appeals to voters on both sides of the aisle, ahead of Newsom’s potential 2028 presidential run.

State Department of Finance spokesperson H.D. Palmer said in an email that “educator workforce recruitment and retention has been a priority for the administration since the governor’s first day in office” but that the funding was not previously available.

Paid leave policies for educators and other state workers have garnered bipartisan support in recent years, including in conservative-led states such as Alabama, Louisiana, and Georgia, and blue states such as , said Vicki Shabo, a senior fellow specializing in gender equity and paid leave at the think tank New America.

After the Supreme Court’s 2022 Dobbs decision overturned the constitutional right to abortion, some conservative lawmakers in states that banned abortion embraced paid leave for public employees to signal support for babies after they were born, Shabo said. Many limited the benefit to state employees and framed it as a tool to recruit and retain them.

Elizabeth Gedmark, a vice president at A Better Balance, a nonprofit that advocates for workplace equality, said paid leave “polls incredibly well across all political lines, because everyone agrees that you shouldn’t have to go back to work a day after you had a baby.”

In 2019, President Donald Trump signed into law a bill that of paid leave. But Shabo said the current administration hasn’t made any moves to expand paid leave.

Palmer, of the Department of Finance, said the state can now afford the roughly $218 million leave program because of billions of dollars in unexpected tax revenue, largely tied to tech workers’ stock options. Much of that revenue is constitutionally guaranteed to schools, so it can’t cover other public workers who are also shut out of California’s paid leave system.

Many school district administrators have largely opposed paid leave in the past because of the cost. The state’s plan calls for districts to pay for the leave out of their annual cost-of-living raise, which this year is bigger than the law requires.

David Roth, superintendent of Buckeye Union School District in El Dorado County, said the math still isn’t great for some schools, and that “the real value reaching the classroom is smaller than the headline number suggests.”

The California Association of School Business Officials had opposed previous related legislation, saying it would create an “unfunded mandate,” but largely supports the new plan now that the start date has been pushed from July 1 to January 2027. The organization’s chief governmental relations officer, Sara Pietrowski, said concerns remain but that the group would work with the state to avoid additional fiscal challenges.

The proposal would close a gap that many Californians don’t realize exists. The state was one of the first to offer — under its current program, eligible workers get of their pay for up to 20 weeks of combined leave and disability benefits.

But most California teachers, , are shut out. The program is funded through a payroll deduction for state disability insurance, and public agencies are . Districts can opt in, but the move must be bargained collectively, as in the Los Angeles Unified School District.

Most educators must use up their accrued sick days before receiving a fraction of their pay for the remainder of their leave, under a provision of the .

Because of that, it’s not uncommon for teachers to plan their pregnancy leave for summer breaks to try to avoid burning up their sick leave. But that can be challenging for those who have pregnancy complications or early deliveries, like Blustein, or those who experience challenges getting pregnant.

Erika Jones, an elementary school teacher in Los Angeles and the secretary-treasurer of the California Teachers Association, said her colleagues routinely teach until they go into labor, which can be disruptive.

It took one colleague around seven years to bank 77 sick days to use for a single pregnancy.

“Women go back sooner than they should have, because they don’t have the days,” Jones said. “You end up in this deficit zone.”

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

Ñî¹óåú´«Ã½Ò•îl Health News senior correspondent Julie Appleby discussed the affordability of Affordable Care Act health insurance plans on Connecticut Public’s The Wheelhouse on July 22.

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Céline Gounder, Ñî¹óåú´«Ã½Ò•îl Health News’ editor-at-large for public health, discussed tick bites on CBS’ CBS Mornings on July 20. She also discussed wildfire smoke and severe heat on CBS’ The Daily Report on July 16.

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Ñî¹óåú´«Ã½Ò•îl Health News senior correspondent Renuka Rayasam discussed the effects of soaring health costs in Georgia on WUGA’s The Georgia Health Report on July 17.

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• Read Rayasam’s “Patients Face a Thicket of Red Tape Trying To Maintain Consistent Health Coverage.”

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Homes that once belonged to friends, family, and neighbors had siding covered in mold. Some were boarded up. Others had holes in their roofs.

Black churches once used Oquina Creek, which runs along the border of the neighborhood, to baptize their congregants. Today, fecal bacteria and other contaminants have made the water unsafe due to an aging wastewater system.

“Sometimes you get the feeling like you’re in a Third World country,” Williams said. After three decades in Washington, D.C., he returned four years ago with a mission to revitalize communities such as Dewey City, which he said are “part of what makes Thomasville, Thomasville.”

A $19.8 million Community Change Grant from the Environmental Protection Agency was supposed to shift the tides of the neighborhood Williams grew up in.

The city and the , where Williams formerly served as community development director, applied for the grant in 2024. It was part of a $2 billion effort to help disadvantaged communities address environmental health risks and create clean energy and climate resiliency projects.

But three months after winning the grant, Thomasville became one of across the country — from to to — to see the funding stripped as priorities shifted in Donald Trump’s second presidency.

On the first day of his second term, Trump signed an executive order titled “.” It stated that the Biden administration “forced illegal and immoral discrimination” through diversity, equity, and inclusion programs.

In an emailed statement, EPA spokesperson Mike Bastasch said the administration is “fully committed to being a great steward of taxpayer dollars.” He added that the “radical agenda” of DEI and environmental justice “preferencing” are not within the agency’s core mission of protecting human health and the environment.

Environmental health advocates argue, though, that the decision to cut the grants was not rooted in science. They say that equating environmental justice to DEI is an act of bad faith and that withholding the money forces disenfranchised communities to delay long-overdue updates needed to protect public health for marginalized populations.

“I unfortunately believe we’re going to see a reversal in the health profile of this country,” said , an associate professor at the University of Michigan who served in the Biden administration as the first federal chief environmental justice officer.

“This current federal regime has decided that humanity and public health and justice don’t mean anything,” she said.

‘Why Us?’

Thomasville, near Georgia’s southwestern border, is home to just over 18,600 people.

The city had hoped to improve health outcomes in neighborhoods on its southern and western sides where, according to the grant proposal, “historical redlining created a legacy of disinvestment.”

Those areas have a deep history: Dewey City, for example, was the first neighborhood in the city where Blacks could build homes after the Civil War. It’s also home to the closed Douglass High School — the first public school for Blacks in Thomasville, established in 1902.

“This place has been neglected,” said Williams, who occasionally hosts historical walks through the community. “But it’s worth bringing it back online.”

The proposed “Restoring Resiliency” project featured a plan to remove toxic substances such as mold, lead paint, and asbestos from homes, repair a nearly 82-year-old wastewater system, and convert part of a shuttered high school band room into a health clinic.

“This was a long and storied attempt to bend the arc of justice closer,” said Jeremy Rich, a Thomas County commissioner and the pastor at First Missionary Baptist Church. “Justice in healthcare. Justice in environmental impact.”

Having a clinic in the community would be a “game changer,” Rich said. During the covid pandemic, he said, older residents who rely on public transit were reluctant to go to the nearby hospital or the county health department to get vaccinated. When his church offered shots from Black nurses, he said, vaccination rates improved.

Many residents don’t have the financial means to remove mold, lead paint, and other toxic materials, said Thomasville Mayor Pro Tem Lucinda Brown. “They just have money to live with every day. That’s it,” she said. “If they can make that happen.”

The grant meant hope, and its reversal left many asking, “Why us?” Williams said.

In the EPA’s May 2025 letter announcing the grant termination, it said Thomasville’s project promoted “initiatives that conflict with the Agency’s policy of prioritizing merit, fairness, and excellence.” The grant was “inconsistent with, and no longer effectuates, Agency priorities,” the letter said.

Environmental justice projects are rooted in science, not DEI, said Jillian Blanchard, the senior vice president of climate change and environmental justice at , a national nonprofit that provides pro bono legal assistance in focus areas such as health equity, immigration, and environmental health.

“Where is the water dirty? Where is the air unclean?” she said. “That is where the money should go.”

In June of last year, nearly two dozen communities and organizations around the country filed a to get the Community Change Grants reinstated. The lawsuit argued that the projects — such as efforts to create energy-efficient housing in Kalamazoo, Michigan, and empower Houston residents in the pollution permitting process — were vital.

The case was dismissed by a federal district judge in 2025 but is being appealed.

Thomasville was not named in that lawsuit. But the city did appeal the EPA’s decision on its project with the support of Blanchard’s group. The city and the EPA continue to dispute the issue.

This March, the EPA’s deputy inspector general, which serves as an independent watchdog for the agency, concluding that the process for determining the awardees was fair.

Such federal funding is needed because large-scale change is difficult for small municipalities to achieve without getting stuck with high-interest loans, Blanchard said.

“It’s next to impossible,” she said. “That’s one of the reasons the things haven’t been done.”

‘It’s Not Over’

The city of Thomasville has found other ways to make some improvements in the meantime. With the help of a nearly $3 million federal Community Development Block Grant from the Department of Housing and Urban Development, it made repairs to portions of Dewey City’s sewer, water, and drainage systems.

The Thomasville Community Development Corp. has begun building affordable housing in Dewey City and intends to convert a portion of the closed Douglass school into apartments for seniors.

The corporation has also applied for $764,000 in through the office of Sen. Jon Ossoff (D-Ga.) that it hopes to use to construct a community health clinic in Dewey City. Decisions on these funding requests will be made this fall.

“It’s not over,” said Williams, whose legacy in Thomasville runs deep. At the center of what locals call The Bottom — a two-block stretch of downtown where independent Black and other minority-owned businesses once thrived — is a plaque honoring his father, Earl Williams Jr., the city’s first Black mayor.

As he peered at his father’s memorial on a muggy afternoon, he reaffirmed his intentions.

“There’s more work to be done, and I’m able,” he said. “I like pouring into the community.”

But he has little hope the initial grant will be restored under the current administration.

“That was our shot. We didn’t do anything to miss it,” he said. “We just did it during the wrong period of time.”

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

In February, ±á²¹·É²¹¾±â€˜i’s parole board granted the now-52-year-old compassionate release, which allows prisoners to receive early probation to seek .

But without a long-term care facility willing to accept him, Alameda has not been able to leave.

As of June, at least three other prisoners granted release to tend to their medical needs were living indefinitely in the infirmary after long-term care facilities were unwilling to accept them, primarily because of their criminal backgrounds, the state parole authority said.

“This is a challenge across the country,” said Molly Crane, an attorney for FAMM, which advocates for .

Every state allows for prisoners, though HawaiÊ»i is the only one without a specific law, relying instead on an internal policy. The prisoners who typically qualify for compassionate release can’t care for themselves or have terminal illnesses and may need an assisted living center, a nursing home, or hospice.

But many long-term care facilities nationwide decline to take such prisoners, leaving them incarcerated for months — or years — after they were granted release.

In , a study found that rejections from nursing homes soared after they were told that a patient was coming from prison. , prisoners with extensive medical needs stayed an average of 200 days after being granted parole, because of denials from long-term care centers. And in , prisoners granted parole sued the state when they couldn’t get placed in nursing homes.

President Donald Trump’s signature One Big Beautiful Bill Act further strains long-term care providers’ ability to take people from incarceration. Prisoners don’t qualify for Medicaid, so parolees after they’re granted the release. The law, enacted last summer, reduces the window in which facilities can get reimbursed from three months to before they apply. That means facilities risk not getting paid for new Medicaid patients whose applications are not submitted within the reduced timeframe.

The Centers for Medicare & Medicaid Services “encourages providers and beneficiaries to prioritize timely application submission to maximize coverage,” CMS spokesperson Timothy Foster said.

‘Risk Is Just Too High’

Most nursing homes nationwide already have a waiting list for new residents, according to a by the American Health Care Association and the National Center for Assisted Living. Those waitlists are another hurdle to getting prisoners placed, said Bob Merce, a former attorney who advocates for prisoners’ compassionate release.

“We tell the nursing homes that most of the people who we are talking about cannot hurt somebody,” Merce said.

Some of the prisoners staying at the Halawa infirmary in June couldn’t walk or dress themselves. One man couldn’t recall what his illness was. Another with brain cancer couldn’t coherently respond to questions.

Sean Sanada, the OÊ»ahu Region CEO with the HawaiÊ»i Health Systems Corp., oversees the region’s two state-funded long-term care facilities, Leahi Hospital and Maluhia. Sanada said that the health system has reviewed dozens of compassionate release referrals but has never accepted any of them.

Sanada said the facilities don’t discriminate based on where the resident comes from. His main concerns, he said, were his staff’s safety and the lack of resources to adequately care for the patient.

“The risk is just too high in most of those instances,” Sanada said.

Violent incidents in long-term care facilities have been well documented. A observing 14 assisted living facilities found that in just one month, 15% of residents experienced resident-to-resident aggression.

When long-term care facilities refuse to accept prisoners who have been granted compassionate release, it leaves state taxpayers footing a larger bill. The annual cost to incarcerate an individual in ±á²¹·É²¹¾±â€˜i with complex needs is up to eight times the $112,505 average of housing one person in prison, according to FAMM. In comparison, the average Medicaid reimbursement for a long-term care patient at a HawaiÊ»i Health Systems Corp. facility is about .

Four states — Connecticut, Georgia, Massachusetts, and Vermont — contract with nursing facilities to take prisoners who are granted compassionate release, according to FAMM.

The iCare Health Network’s MissionCare Health, which operates nursing homes for people coming out of prison, secured contracts in three of those states. David Skoczulek, iCare’s vice president of business development and communication, estimated that its rates are $100 to $350 a day more per patient than the average nursing home rates in the states where they operate.

In Hawaiʻi, the correctional department determines recommendations to send to the parole board, which decides whether to grant the release. Prisoners who are granted the early probation can be released to family members who commit to caring for them or to a long-term care facility.

Corey Reincke, head of the HawaiÊ»i Paroling Authority, said that in his 24-year career he couldn’t recall getting anyone placed into a long-term care facility without family intervening, for instance by contacting facilities themselves.

“Parole has to find a facility that can meet their medical needs and is also willing to take them,” Reincke said. “That’s where we’re hitting the roadblocks.”

For one parolee, Reincke called more than 100 care homes, he said, but they all declined to accept the patient, over safety concerns. According to a 2024 state report, while HawaiÊ»i’s long-term care facilities use about workforce strains make it difficult to maintain even those levels.

HawaiÊ»i Prisoners’ Refuge: Family

Last year, 69-year-old Paul Kupihea died at a hospital five days after the state granted him compassionate release to his family. He died before he could get on a flight to his home island.

In July 2025, Lahela Kruse, the mother of Kupihea’s child, received a call from a Honolulu hospital informing her that his condition had become severe. By then he had been diagnosed with an incurable form of cancer and had been in and out of the hospital while still in custody.

Kruse and their daughter flew to Oʻahu to see him and were shocked when they saw how sick he was. Their daughter agreed to take him into her home in Hilo, on Hawaiʻi Island, despite not having a relationship with him for most of her life.

“She knew he was sick,” Kruse said. “I told her that, but she didn’t know the severity of it. I didn’t truly know.”

Her daughter’s willingness to take him prompted his compassionate release. But Kruse said the notification about Kupihea’s illness came too late.

FAMM’s Crane has been working on expanding compassionate release laws in states to allow for more prisoners to qualify and strengthen transparency in the process. HawaiÊ»i lawmakers have tried for years to pass bills on compassionate release, but none has succeeded.

Crane said without a law that outlines a formal process and who qualifies, even family support isn’t enough. Prisoners can still face life-threatening delays, she said.

“The absence of a compassionate release statute means that people who need compassionate release languish and even die in prison,” Crane said.

In Alameda’s cell, two beds stood about 3 feet apart, with a seatless metal toilet in the corner and a window looking out on a concrete wall. The smell of bleach permeated the room. Alameda said he hoped to see his daughter soon. She recently turned 5.

“I made some mistakes in my life,” said Alameda, who has been incarcerated since 2024 for drug possession, driving a stolen vehicle, and jumping bail. “I tried when my daughter was born, but I know I’ll change, because she needs me out of here.”

Merce, the former attorney, is still trying to find a place for Alameda, who committed no violent crimes. Merce became aware of prisoners’ struggles through his work as a trial lawyer. He said he has helped about 15 prisoners leave HawaiÊ»i correctional facilities for medical treatment.

He said he’s seen cases in which people have waited years to get out.

“The ones that stick with me, though,” Merce said, “are the ones that I never found placements for.”

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

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