About a year into the process of redetermining Medicaid eligibility after the COVID-19 public health emergency, more than 20 million people have been kicked off the joint federal-state program for low-income families.

A chorus of stories recount the ways the unwinding has upended people’s lives, but Native Americans are proving particularly vulnerable to losing coverage and face greater obstacles to reenrolling in Medicaid or finding other coverage.

“From my perspective, it did not work how it should,” said Kristin Melli, a pediatric nurse practitioner in rural Kalispell, Montana, who also provides telehealth services to tribal members on the Fort Peck Reservation.

The redetermination process has compounded long-existing problems people on the reservation face when seeking care, she said. She saw several patients who were still eligible for benefits disenrolled. And a rise in uninsured tribal members undercuts their health systems, threatening the already tenuous access to care in Native communities.

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One teenager, Melli recalled, lost coverage while seeking lifesaving care. Routine lab work raised flags, and in follow-ups Melli discovered the girl had a condition that could have killed her if untreated. Melli did not disclose details, to protect the patient’s privacy.

Melli said she spent weeks working with tribal nurses to coordinate lab monitoring and consultations with specialists for her patient. It wasn’t until the teen went to a specialist that Melli received a call saying she had been dropped from Medicaid coverage.

The girl’s parents told Melli they had reapplied to Medicaid a month earlier but hadn’t heard back. Melli’s patient eventually got the medication she needed with help from a pharmacist. The unwinding presented an unnecessary and burdensome obstacle to care.

Pat Flowers, Montana Democratic Senate minority leader, said during a political event in early April that 13,000 tribal members had been disenrolled in the state.

Native American and Alaska Native adults are enrolled in Medicaid at higher rates than their white counterparts, yet some tribal leaders still didn’t know exactly how many of their members had been disenrolled as of a survey conducted in February and March. The Tribal Self-Governance Advisory Committee of the Indian Health Service conducted and published the survey. Respondents included tribal leaders from Alaska, Arizona, Idaho, Montana, and New Mexico, among other states.

Tribal leaders reported many challenges related to the redetermination, including a lack of timely information provided to tribal members, patients unaware of the process or their disenrollment, long processing times, lack of staffing at the tribal level, lack of communication from their states, concerns with obtaining accurate tribal data, and in cases in which states have shared data, difficulties interpreting it.

Research and policy experts initially feared that vulnerable populations, including rural Indigenous communities and families of color, would experience greater and unique obstacles to renewing their health coverage and would be disproportionately harmed.

“They have a lot at stake and a lot to lose in this process,” said Joan Alker, executive director of the Georgetown University Center for Children and Families and a research professor at the McCourt School of Public Policy. “I fear that that prediction is coming true.”

Cammie DuPuis-Pablo, tribal health communications director for the Confederated Salish and Kootenai Tribes in Montana, said the tribes don’t have an exact number of their members disenrolled since the redetermination began, but know some who lost coverage as far back as July still haven’t been reenrolled.

The tribes hosted their first outreach event in late April as part of their effort to help members through the process. The health care resource division is meeting people at home, making calls, and planning more events.

The tribes receive a list of members’ Medicaid status each month, DuPuis-Pablo said, but a list of those no longer insured by Medicaid would be more helpful.

Because of those data deficits, it’s unclear how many tribal members have been disenrolled.

“We are at the mercy of state Medicaid agencies on what they’re willing to share,” said Yvonne Myers, consultant on the Affordable Care Act and Medicaid for Citizen Potawatomi Nation Health Services in Oklahoma.

In Alaska, tribal health leaders struck a data-sharing agreement with the state in July but didn’t begin receiving information about their members’ coverage for about a month — at which point more than 9,500 Alaskans had already been disenrolled for procedural reasons.

“We already lost those people,” said Gennifer Moreau-Johnson, senior policy adviser in the Department of Intergovernmental Affairs at the Alaska Native Tribal Health Consortium, a nonprofit organization. “That’s a real impact.”

Because federal regulations don’t require states to track or report race and ethnicity data for people they disenroll, fewer than 10 states collect such information. While the data from these states does not show a higher rate of loss of coverage by race, a KFF report states that the data is limited and that a more accurate picture would require more demographic reporting from more states.

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Tribal health leaders are concerned that a high number of disenrollments among their members is financially undercutting their health systems and ability to provide care.

“Just because they’ve fallen off Medicaid doesn’t mean we stop serving them,” said Jim Roberts, senior executive liaison in the Department of Intergovernmental Affairs of the Alaska Native Tribal Health Consortium. “It means we’re more reliant on other sources of funding to provide that care that are already underresourced.”

Three in 10 Native American and Alaska Native people younger than 65 rely on Medicaid, compared with 15% of their white counterparts. The Indian Health Service is responsible for providing care to approximately 2.6 million of the 9.7 million Native Americans and Alaska Natives in the U.S., but services vary across regions, clinics, and health centers. The agency itself has been chronically underfunded and unable to meet the needs of the population. For fiscal year 2024, Congress approved $6.96 billion for IHS, far less than the $51.4 billion tribal leaders called for.

Because of that historical deficit, tribal health systems lean on Medicaid reimbursement and other third-party payers, like Medicare, the Department of Veterans Affairs, and private insurance, to help fill the gap. Medicaid accounted for two-thirds of third-party IHS revenues as of 2021.

Some tribal health systems receive more federal funding through Medicaid than from IHS, Roberts said.

Tribal health leaders fear diminishing Medicaid dollars will exacerbate the long-standing health disparities — such as lower life expectancy, higher rates of chronic disease, and inferior access to care — that plague Native Americans.

The unwinding has become “all-consuming,” said Monique Martin, vice president of intergovernmental affairs for the Alaska Native Tribal Health Consortium.

“The state’s really having that focus be right into the minutiae of administrative tasks, like: How do we send text messages to 7,000 people?” Martin said. “We would much rather be talking about: How do we address social determinants of health?”

Melli said she has stopped hearing of tribal members on the Fort Peck Reservation losing their Medicaid coverage, but she wonders if that means disenrolled people didn’t seek help.

“Those are the ones that we really worry about,” she said, “all of these silent cases. … We only know about the ones we actually see.”

SIOUX FALLS, S.D. (Dakota News Now) – In South Dakota high school track and field teamwork has made the dream work for the Sioux Falls Christian girls who, for the second straight year, pulled off an impressive feat on their way to a third consecutive State A team championship.

During last weekend’s SDHSAA State Meet the Chargers won all five relay races, taking the 4×800 and Sprint Medley on Thursday before capturing the 4×200, 4×100 and 4×400 relays on Saturday.

It’s the second consecutive year that Sioux Falls Christian has swept the relay races, helping them increase their team point total from last year by four to 130.5, and put them 75 points ahead of runner up Lennox.

No matter who graduates or is running, the Chargers say they’re always chasing greatness, and each other, while building towards each championship finish.

“One of the keys to having those strong relays is having a team with depth. And we’ve got a great group of coaches that make our track and field team a place that kids want to be a part of and, when you have a lot of kids on your team, you’re able to put together great relays.” Sioux Falls Christian Head Coach Luke VanderLeest says.

”A championship, like that is the goal, but that’s not something to be stressed throughout the season. Just getting better every day, each step at a time and our coaches do a really good job at taking the weight off. This doesn’t just come from a one person team, this comes from all of us.” Sioux Falls Christian Junior Anna Vyn says.

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As the summer travel season approaches, new parents may be navigating airports with their babies — and the complexities of keeping them fed. Despite federal guidelines for airport agents laying out how to treat nursing moms, stories about problem encounters with security sometimes go viral.

In 2023, actress and singer Keke Palmer said she was at Houston airport when she faced threats to throw out her 16 ounces of breast milk. A year earlier, engineer and science TV host Emily Calandrelli said U.S. Transportation Security Administration officers escorted her out of line and made her check her partially thawed ice packs, which are used to keep breast milk cool.

“It was a very traumatizing experience, and it also didn’t align with what the TSA policies were, which state that you’re allowed to have them for medically necessary purposes,” Calandrelli told States Newsroom.

In May 2022, she went on her first work trip away from her 10-week-old baby and was traveling from Los Angeles to Washington, D.C. Calandrelli planned on pumping after going through security at LAX, but TSA officers drilled her with questions about what the ice packs were for and said it wouldn’t have been an issue if her breast milk was already pumped.

“I spoke to three different males who worked at TSA, and I requested to speak to a woman but wasn’t able to,” she said.

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Like Palmer, she shared the experience with her legions of social media followers. Calandrelli said the agency later apologized. TSA issued a statement shortly after the incident: “Our employees go through regular training to effectively engage and screen diverse traveler populations, including those who are breastfeeding and/or traveling with breast milk.”

Both women’s experiences violate TSA guidelines: formula, breast milk, toddler drinks and baby food are allowed on planes and carry-ons in quantities greater than 3.4 ounces. Breast milk, formula and ice packs — along with other cooling accessories — are considered medically necessary. Passengers are advised to let TSA officers know they’re carrying these items when arriving at airport security.

Even though these protections exist, many lactating parents still encounter problems during air travel, and these issues carry physical and emotional side effects, according to Tina Sherman, a doula and interim executive director at the U.S. Breastfeeding Committee.

“Lactating parents have to pump on a fairly regular basis to be able to continue to keep up their supply,” Sherman said.

When they can’t express milk or that cycle is interrupted, mothers experience pain or breast leaks, she said. In some cases, long delays in pumping can lead to mastitis — an infection that causes swelling in the breasts and cracked nipples. Emotionally, being prevented or delayed from expressing milk can make parents feel anxious, embarrassed and stressed, Sherman said.

Calandrelli’s plight two years ago led her to reach out to her local California congresswoman. U.S. Democratic Rep. Katie Porter first introduced legislation to strengthen existing protections for breastfeeding parents in August 2022.

“You have to have clear instructions and clear rules, and have people follow them in order for moms to be able to meet the standards,” Porter said. “There’s a lot of obstacles to breastfeeding. There’s a lot of challenges to feeding a baby and traveling with a baby.”

The Bottles and Breastfeeding Equipment Screening (BABES) Enhancement Act would require “hygienic handling of breast milk and baby formula” by TSA officers and private security companies. Porter’s bill would direct airport officials to “minimize the risk for contamination” of breast milk, formula and infant drinks, along with ice or freezer packs and related cooling accessories.

Under the proposal, the agency must consult with maternal health organizations — March of Dimes, Association of Maternal and Child Health Programs, American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine — to determine what policies and regulations need to be updated as pumping technology and best practices for breast milk storage evolve, she said.

BABES Act is an update to a 2016 law that required TSA training on special screening procedures for nursing parents. The original law also made it legal to carry larger amounts of breast milk, formula and infant drink — juice or purified water — in airports and on planes.

Reps. Maria Elvira Salazar, a Florida Republican, and Eric Swalwell, a California Democrat, are the lead co-sponsors in the House. Democratic Sens. Tammy Duckworth of Illinois and Mazie Hirono of Hawaii, along with GOP Sens. Steve Daines of Montana and Ted Cruz of Texas sponsored the bill in the upper chamber.

The bipartisan bill didn’t go anywhere last session, but Porter reintroduced the proposal. She said the bill is set to be heard in the Senate Commerce, Science and Transportation Committee soon.

As a mother of three, Porter is acutely familiar with the problems that come with traveling with infants. Her children are adolescents and teens now, but when they were babies, lactation stations in airports were uncommon. She said a flight attendant once told her to stop nursing her baby while the plane was still on the ground. Porter said she was angry and scared, but mostly “worried about my baby, who was hungry.”

As for her bill, she recognizes that TSA agents have a hard job. But the BABES Act will help them “have clear rules and better training so that they’re not put in challenging situations when they’re dealing with frustrated parents,” she said.

Making travel for lactating parents easier could chip away at larger stigma about breastfeeding, advocates said. More than 80% of babies are breastfed in infancy, and 58% are still getting some breast milk by the time they’re 6-months-old, according to the U.S. Centers for Disease Control and Prevention.

Still, earlier this month, an ad for lactation cookies featuring a cooking star’s covered breasts and pregnant belly was temporarily removed from a Times Square billboard, according to The New York Times.

“Normalizing breastfeeding and lactation is really critical to families being able to meet their breastfeeding goals,” Sherman said.