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Beyond insulin: Medi-Cal expands patient access to diabetes supplies

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Beyond insulin: Medi-Cal expands patient access to diabetes supplies

June Voros sprang from her couch as a high-pitched beep warned that she needed a quick dose of sugar.

Her blood sugar was plummeting, and the beep came from a continuous glucose monitor attached to her abdomen. The small but powerful device alerts Voros when her blood sugar is dangerously high or low.

“My blood sugar is at 64. It’s too low and still dropping,” Voros, 32, said on a bright October afternoon. She checks the monitor up to 80 times a day to help prevent complications from Type 1 diabetes.

But the monitor means little without the supplies that make it work, including a receiver, a sensor and a transmitter — some of which must be replaced every 10 to 30 days. Voros also has an insulin pump, which delivers a steady supply of that hormone to her body, and it requires supplies, too.

Until recently, Voros — who is covered by Medi-Cal, California’s Medicaid program for people with low incomes or disabilities — spent countless hours on the phone with her endocrinologists, her Medi-Cal insurer, Health Net, and a medical supply company to obtain separate approvals for each item. At times, her authorizations expired too quickly, leaving her short on supplies and compelling her to ration and seek donations on social media from other diabetes patients.

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Voros, who has Type 1 diabetes, wears a continuous glucose monitor to keep tabs on her blood sugar and an insulin pump to ensure her body gets a steady supply of the essential hormone.

(Angela Hart / KFF Health News)

Last year, she received only enough supplies to last six months.

“I’ve had to put in hundreds of hours over the phone in the past few years, and I’ve changed my insurance group twice because of this,” Voros said before slugging apple juice in her studio apartment in Mission Hills. “It’s exhausting. It makes you want to give up. But I can’t. I’ll literally die.”

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Starting in October, Medi-Cal began relaxing prior-authorization requirements that have caused life-threatening delays for Voros and others with diabetes.

Previously, authorizations for medications and supplies lasted six months, though for some patients like Voros, they expired sooner. Under the new rules, authorizations are supposed to last one year from the date of approval and can include all needed supplies — ending the scramble to secure separate authorizations for each piece of equipment. Patients can receive 90 days’ worth of supplies and medications at once.

The state is also formalizing a policy that allows patients to obtain approvals from their healthcare providers by phone or video.

“Before, California’s requirements were four pages long, and now it’s just a little more than a page,” said Lisa Murdock, chief advocacy officer for the American Diabetes Assn., who helped push for the changes. “This is a really important step forward. It means not having to constantly guess how blood sugars are doing.”

Over the last two years, the state also started making continuous glucose monitors and related supplies available to many more people, including all patients with Type 1 diabetes, a chronic autoimmune disease that attacks insulin-producing cells in the pancreas, and those with Type 2 diabetes, gestational diabetes and hypoglycemia, or chronic low blood sugar. Before last year, the monitors were available to only some patients on a case-by-case basis, according to the state Department of Health Care Services, which administers Medi-Cal.

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The enhanced coverage extends to newer, more advanced devices, such as the popular Dexcom G7 and its components, which retail for about $700 on Amazon for a 30-day supply without insurance. Medi-Cal pays roughly $400 for the same equipment.

June Voros with her service dog, Artemis.

Voros has a service dog, Artemis, who alerts her with a gentle nudge when her blood sugar is out of whack.

(Angela Hart / KFF Health News)

Diabetes and prediabetes are on the rise in California. About 3.2 million Californians have been diagnosed with diabetes. The Department of Health Care Services says about 1.2 million Medi-Cal enrollees have the disease, according to the latest data available.

Before these changes, Medi-Cal recipients had a harder time securing medication and supplies than people with private insurance, Murdock said.

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“Diabetes is a really heartbreaking and costly disease, and to take care of themselves, people with diabetes need easy access to insulin, but also the supplies to manage the disease,” she said.

Patient advocates and state health officials say the changes will save money and lives by giving those with diabetes more control over their blood sugar, and by preventing complications such as organ failure and foot and toe amputations.

This expansion in coverage “improves access and member outcomes, reduces hospitalizations and comorbidities, and improves members’ quality of life with better disease management and less finger sticks,” said Ann Carroll, a Medi-Cal spokesperson. The state, she said, wants to ensure all diabetes patients get “the care they need to lead healthy, fulfilling lives.”

Before Voros got her monitor about three years ago, she made repeated visits to an emergency room for seizures and was hospitalized with other diabetic complications. She also lost nerve function in her stomach — which prevents digestion of high-fiber foods such as vegetables — as her disease advanced.

“I haven’t had to go to the intensive care unit in almost two years. It has literally saved my life,” she said.

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But the bureaucratic hurdles that kept Voros from getting supplies for her monitor were a constant source of stress. That’s changing since she switched to a new medical supply company and Medi-Cal has debuted its new preauthorization process, amid a broader revamp of its pharmacy system.

Getting her supplies on time means peace of mind, Voros said.

“I used to be so afraid to go to sleep at night because of the seizures I’d get from low blood sugar,” she said. “I’ve been really close to death, but now I feel better than I ever have.”

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues.

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Cluster of farmworkers diagnosed with rare animal-borne disease in Ventura County

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Cluster of farmworkers diagnosed with rare animal-borne disease in Ventura County

A cluster of workers at Ventura County berry farms have been diagnosed with a rare disease often transmitted through sick animals’ urine, according to a public health advisory distributed to local doctors by county health officials Tuesday.

The bacterial infection, leptospirosis, has resulted in severe symptoms for some workers, including meningitis, an inflammation of the brain lining and spinal cord. Symptoms for mild cases included headaches and fevers.

The disease, which can be fatal, rarely spreads from human to human, according to the U.S. Centers for Disease Control and Prevention.

Ventura County Public Health has not given an official case count but said it had not identified any cases outside of the agriculture sector. The county’s agriculture commissioner was aware of 18 cases, the Ventura County Star reported.

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The health department said it was first contacted by a local physician in October, who reported an unusual trend in symptoms among hospital patients.

After launching an investigation, the department identified leptospirosis as a probable cause of the illness and found most patients worked on caneberry farms that utilize hoop houses — greenhouse structures to shelter the crops.

As the investigation to identify any additional cases and the exact sources of exposure continues, Ventura County Public Health has asked healthcare providers to consider a leptospirosis diagnosis for sick agricultural workers, particularly berry harvesters.

Rodents are a common source and transmitter of disease, though other mammals — including livestock, cats and dogs — can transmit it as well.

The disease is spread through bodily fluids, such as urine, and is often contracted through cuts and abrasions that contact contaminated water and soil, where the bacteria can survive for months.

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Humans can also contract the illness through contaminated food; however, the county health agency has found no known health risks to the general public, including through the contact or consumption of caneberries such as raspberries and blackberries.

Symptom onset typically occurs between two and 30 days after exposure, and symptoms can last for months if untreated, according to the CDC.

The illness often begins with mild symptoms, with fevers, chills, vomiting and headaches. Some cases can then enter a second, more severe phase that can result in kidney or liver failure.

Ventura County Public Health recommends agriculture and berry harvesters regularly rinse any cuts with soap and water and cover them with bandages. They also recommend wearing waterproof clothing and protection while working outdoors, including gloves and long-sleeve shirts and pants.

While there is no evidence of spread to the larger community, according to the department, residents should wash hands frequently and work to control rodents around their property if possible.

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Pet owners can consult a veterinarian about leptospirosis vaccinations and should keep pets away from ponds, lakes and other natural bodies of water.

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Political stress: Can you stay engaged without sacrificing your mental health?

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Political stress: Can you stay engaged without sacrificing your mental health?

It’s been two weeks since Donald Trump won the presidential election, but Stacey Lamirand’s brain hasn’t stopped churning.

“I still think about the election all the time,” said the 60-year-old Bay Area resident, who wanted a Kamala Harris victory so badly that she flew to Pennsylvania and knocked on voters’ doors in the final days of the campaign. “I honestly don’t know what to do about that.”

Neither do the psychologists and political scientists who have been tracking the country’s slide toward toxic levels of partisanship.

Fully 69% of U.S. adults found the presidential election a significant source of stress in their lives, the American Psychological Assn. said in its latest Stress in America report.

The distress was present across the political spectrum, with 80% of Republicans, 79% of Democrats and 73% of independents surveyed saying they were stressed about the country’s future.

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That’s unhealthy for the body politic — and for voters themselves. Stress can cause muscle tension, headaches, sleep problems and loss of appetite. Chronic stress can inflict more serious damage to the immune system and make people more vulnerable to heart attacks, strokes, diabetes, infertility, clinical anxiety, depression and other ailments.

In most circumstances, the sound medical advice is to disengage from the source of stress, therapists said. But when stress is coming from politics, that prescription pits the health of the individual against the health of the nation.

“I’m worried about people totally withdrawing from politics because it’s unpleasant,” said Aaron Weinschenk, a political scientist at the University of Wisconsin–Green Bay who studies political behavior and elections. “We don’t want them to do that. But we also don’t want them to feel sick.”

Modern life is full of stressors of all kinds: paying bills, pleasing difficult bosses, getting along with frenemies, caring for children or aging parents (or both).

The stress that stems from politics isn’t fundamentally different from other kinds of stress. What’s unique about it is the way it encompasses and enhances other sources of stress, said Brett Ford, a social psychologist at the University of Toronto who studies the link between emotions and political engagement.

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For instance, she said, elections have the potential to make everyday stressors like money and health concerns more difficult to manage as candidates debate policies that could raise the price of gas or cut off access to certain kinds of medical care.

Layered on top of that is the fact that political disagreements have morphed into moral conflicts that are perceived as pitting good against evil.

“When someone comes into power who is not on the same page as you morally, that can hit very deeply,” Ford said.

Partisanship and polarization have raised the stakes as well. Voters who feel a strong connection to a political party become more invested in its success. That can make a loss at the ballot box feel like a personal defeat, she said.

There’s also the fact that we have limited control over the outcome of an election. A patient with heart disease can improve their prognosis by taking medicine, changing their diet, getting more exercise or quitting smoking. But a person with political stress is largely at the mercy of others.

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“Politics is many forms of stress all rolled into one,” Ford said.

Weinschenk observed this firsthand the day after the election.

“I could feel it when I went into my classroom,” said the professor, whose research has found that people with political anxiety aren’t necessarily anxious in general. “I have a student who’s transgender and a couple of students who are gay. Their emotional state was so closed down.”

That’s almost to be expected in a place like Wisconsin, whose swing-state status caused residents to be bombarded with political messages. The more campaign ads a person is exposed to, the greater the risk of being diagnosed with anxiety, depression or another psychological ailment, according to a 2022 study in the journal PLOS One.

Political messages seem designed to keep voters “emotionally on edge,” said Vaile Wright, a licensed psychologist in Villa Park, Ill., and a member of the APA’s Stress in America team.

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“It encourages emotion to drive our decision-making behavior, as opposed to logic,” Wright said. “When we’re really emotionally stimulated, it makes it so much more challenging to have civil conversation. For politicians, I think that’s powerful, because emotions can be very easily manipulated.”

Making voters feel anxious is a tried-and-true way to grab their attention, said Christopher Ojeda, a political scientist at UC Merced who studies mental health and politics.

“Feelings of anxiety can be mobilizing, definitely,” he said. “That’s why politicians make fear appeals — they want people to get engaged.”

On the other hand, “feelings of depression are demobilizing and take you out of the political system,” said Ojeda, author of “The Sad Citizen: How Politics is Depressing and Why it Matters.”

“What [these feelings] can tell you is, ‘Things aren’t going the way I want them to. Maybe I need to step back,’” he said.

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Genessa Krasnow has been seeing a lot of that since the election.

The Seattle entrepreneur, who also campaigned for Harris, said it grates on her to see people laughing in restaurants “as if nothing had happened.” At a recent book club meeting, her fellow group members were willing to let her vent about politics for five minutes, but they weren’t interested in discussing ways they could counteract the incoming president.

“They’re in a state of disengagement,” said Krasnow, who is 56. She, meanwhile, is looking for new ways to reach young voters.

“I am exhausted. I am so sad,” she said. “But I don’t believe that disengaging is the answer.”

That’s the fundamental trade-off, Ojeda said, and there’s no one-size-fits-all solution.

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“Everyone has to make a decision about how much engagement they can tolerate without undermining their psychological well-being,” he said.

Lamirand took steps to protect her mental health by cutting social media ties with people whose values aren’t aligned with hers. But she will remain politically active and expects to volunteer for phone-banking duty soon.

“Doing something is the only thing that allows me to feel better,” Lamirand said. “It allows me to feel some level of control.”

Ideally, Ford said, people would not have to choose between being politically active and preserving their mental health. She is investigating ways to help people feel hopeful, inspired and compassionate about political challenges, since these emotions can motivate action without triggering stress and anxiety.

“We want to counteract this pattern where the more involved you are, the worse you are,” Ford said.

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The benefits would be felt across the political spectrum. In the APA survey, similar shares of Democrats, Republicans and independents agreed with statements like, “It causes me stress that politicians aren’t talking about the things that are most important to me,” and, “The political climate has caused strain between my family members and me.”

“Both sides are very invested in this country, and that is a good thing,” Wright said. “Antipathy and hopelessness really doesn’t serve us in the long run.”

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Video: SpaceX Unable to Recover Booster Stage During Sixth Test Flight

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Video: SpaceX Unable to Recover Booster Stage During Sixth Test Flight

President-elect Donald Trump joined Elon Musk in Texas and watched the launch from a nearby location on Tuesday. While the Starship’s giant booster stage was unable to repeat a “chopsticks” landing, the vehicle’s upper stage successfully splashed down in the Indian Ocean.

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