By JENNIFER McDERMOTT

GENEVA (AP) — Environmentalists and Indigenous leaders held signs Tuesday in front of the United Nations buildings in Geneva, where talks for a global accord to end plastic pollution are taking place, asking nations to show courage and agree to a strong treaty.

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Most were from organizations that are part of the Break Free From Plastic movement. They said they wanted their voices to be heard as the talks wind down in Switzerland. Nations are crafting the first global, legally binding treaty on plastics pollution.

“We’ve invested a lot into coming all the way to Geneva, away from our communities, away from our families, because we understand how important an issue this is and how crucial a moment this is,” said Juressa Lee, who is from New Zealand and was representing the Aotearoa Plastic Pollution Alliance. “It’s a once-in-a-lifetime plastics treaty.”

They urged delegates to vote on the treaty if consensus can’t be reached and the process becomes paralyzed. Every nation must agree for any proposal to be included in the treaty.

The talks are scheduled to conclude Thursday.

“To date the process has been broken,” said Brett Nadrich, spokesperson from Break Free From Plastic. “Civil society leaders from around the world, together with those most impacted, are speaking with a unified voice that we need to show courage, not compromise, and fix the process.”

The head of Panama’s delegation to the talks, Juan Carlos Monterrey Gomez, cheered them on as he walked by.

“We need that all over the world,” he told The Associated Press. “We need people outside of here to tell their countries to speak up for what it is that they’re standing for. Are they standing for them, their citizens, or big oil?”

The biggest issue is whether the treaty should impose caps on producing new plastic or focus instead on things like better design, recycling and reuse. Panama is helping to lead an effort to include plastic production in the treaty.

“We’re going to be pushing until the end,” Monterrey Gomez said. “Because if there is no production, there’s no treaty.”

Magnus Heunicke, the Danish environment minister, and Jessika Roswall, the European commissioner for the environment, held a news conference to stress the European Union is in Geneva to get a legally binding, international agreement on how plastic is produced, consumed and disposed. Denmark holds the rotating presidency of the Council of Europe.

“We are here to make a deal, our aim is to make it as ambitious as possible,” Heunicke said. “If it was only up to the EU, then we all know how high ambitious it would be. It is not, however, up to the EU.”

Heunicke didn’t specify what they would do if plastic production isn’t in the treaty, since the negotiations are ongoing. Roswall said the EU is ready to deal, though not at any cost, and in any negotiation all parties always have the option to walk away.

Most plastic is made from fossil fuels. Powerful oil-producing nations are strongly opposed to including plastic production in the treaty. So is the plastics industry.

“The negotiators need to focus on ending plastic pollution in the environment,” said Chris Jahn, president and CEO of the American Chemistry Council. “If they do that, there is a landing zone and a deal is possible. If we try to address every single issue that every single country has, they will not reach a deal here.”

Momentum has been growing for a proposal led by Mexico and Switzerland for an article to address problematic plastic products, including single-use plastics, and chemicals.

Camila Zepeda, who is leading negotiations on that article for Mexico, said there is an understanding there are harmful additives contained in plastics and some plastics not essential for everyday life that could be managed and eventually phased out.

Tuesday’s sessions are “very intense” as negotiators work against the clock, Zepeda said.

“It’s slow progress,” she said. “But hopefully we still manage to get an agreement. I do see an appetite to finish and to get an outcome here at Geneva.”

The Associated Press’ climate and environmental coverage receives financial support from multiple private foundations. AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.

SAND WASH BASIN, Colorado — Robin Wadhams reviews the list of wild horses that still need to be darted this summer before she sets up for target practice.

Each mare has a name: Angel, Bisbee, Calamity, Dust Devil, Eeyore, Kamchatka. Next to them are notes on whether the horse needs a first dose of contraceptive, or just a booster.

Some notes offer more specific guidance. For Gretchen: “Hard to dart — not a priority unless opportunity presents.”

Robin Wadhams, left, takes a practice shot with her dart air gun as her husband, Gary Wadhams, watches to see where the dart hits the target. The couple was preparing for a day of volunteering in the Sand Wash Basin Herd Management Area near Maybell, Colorado, where they shoot mares with darts containing birth control to help manage the population, on July 22, 2025. (Photo by RJ Sangosti/The Denver Post)

About 10 times a year, Robin and her husband, Gary, make the four-hour trip from their home in Hotchkiss to the Sand Wash Basin Herd Management Area in the state’s far-northwest corner. There, in the sagebrush plains and dusty, endless hills roamed by about 400 horses, they set out to dispense fertility treatments via dart gun.

For years, dedicated volunteers like them — and the fertility treatments they administer — have served as a partial solution to an enduring controversy in the West: what to do with the ever-growing population of thousands of wild horses that call the region home.

Only a tiny fraction of the more than 53,000 wild horses roaming the West receive fertility treatments, which are intended to help keep the population numbers below the level the Bureau of Land Management has determined is healthy for the herds and the ecosystem. So the BLM relies heavily on roundups of excess horses and the payment of tens of millions of dollars to keep them in captivity off the range — a drain on the budget for the program that also makes it difficult to address the underlying reproductive problem.

“Seeing new foals used to be so fun and exciting, but now I just cry,” Robin Wadhams, who has been visiting the Sand Wash Basin herd since 2012, said on a recent morning in July while preparing to dart more horses. “I’ve cried more out here than I have in my whole life.”

State and federal leaders in Colorado are trying out a new approach. A series of new state laws comes with an aim of elevating the state’s role in managing the 1,400 wild horses within its borders. The state will pay the federal government to deploy paid, professional darters to supplement the fertility control work long performed by volunteers.

The expanded darting program is intended to help address the root of the herds’ growing population by reducing the number of foals born every year.

“It’s a part of the heritage of the West, so I think it’s important for the state to step up,” said Wayne East, the wildlife programs manager for the Colorado Department of Agriculture.

The new arrangement is a model for states across the West, according to lawmakers, horse advocates and land managers. But it’s unclear where the money to sustain the efforts will come from, especially with the state’s budget in shambles and continued federal cost-cutting by the Trump administration.

“I know there’s a more permanent solution,” said Colorado House Majority Leader Monica Duran, a Jefferson County Democrat who led the legislative effort in recent years. “What that is, we’re going to figure it out. It all revolves around funding.”

* * *

At 10 a.m. during their recent outing, the Wadhamses’ 4Runner has a flat. Robin hears the hissing air first.

She and Gary have already mixed the fertility vaccines and placed them back in a cooler before noticing their new tire problem. The vaccine, called PZP, stimulates female horses’ immune systems to prevent pregnancy but requires an annual booster.

The Wadhamses also have already completed target practice that morning with their air rifles, launching darts into a target shaped like a horse rump that’s tacked to the side of a corral.

To successfully dart a horse, they must be able to get within about 40 yards of the wild animal, then hope it stands still — and keeps its flank visible. They also have to accurately gauge the wind’s effect on the flying dart and hit a target that measures about 2 feet by 2 feet.

The Wadhamses have led the fertility control effort in the management area since 2017, volunteering hundreds of hours. They are some of the most experienced volunteer darters in the state and usually get between three and 10 horses each day they are on the range. As of late July, they had darted at least 50 this year.

Robin and Gary Wadhams stop their car to identify a group of wild horses while volunteering in the Sand Wash Basin Herd Management Area near Maybell on July 22, 2025. (Photo by RJ Sangosti/The Denver Post)

Before the Wadhamses dart a horse, however, they have to find the animals on the expansive 250-square-mile range — about 1.5 times the size of Denver and full of gullies, draws and plateaus.

“It’s not a zoo, there are no schedules,” Robin says. “You don’t know where they will be.”

But the search that day will have to wait a bit. They need to drive 30 minutes back to the nearest town, Maybell, and see if the town’s handyman is home to fix their flat.

* * *

About 1,400 wild horses roam the BLM’s four herd management areas in western Colorado — more than the approximately 800 mustangs the federal agency estimates would make for a sustainable population.

Two of the herd management areas — Piceance-East Douglas and Sand Wash Basin — have more horses than the BLM thinks the land can support. Two others have populations within the BLM’s limits: the herds in Little Book Cliffs and Spring Creek Basin.

Where herd numbers outstrip the appropriate management levels determined by the BLM, federal agencies use helicopters or bait to remove horses from the wild. The BLM estimates the West has 47,500 more wild burros and horses than the landscape can support.

Range conditions deteriorate in places where too many horses roam, said Doug Vilsack, the BLM’s Colorado state director. The horses — the descendants of escaped domestic horses and not a species native to the West — have no natural predators and their populations can expand rapidly. That degrades vegetation and water sources relied upon by other wildlife and livestock that graze the public lands.

“The fundamental challenge that we deal with is biology and ecology,” he said.

Once captured, the BLM moves horses to short-term holding facilities — like the 3,000-horse holding area on the Colorado Department of Corrections’ campus in Cañon City — and makes them available for adoption. Those that aren’t adopted or aren’t suitable for adoption are sent for life to long-term holding facilities in the Midwest.

Nationwide, more wild horses are now held in federal facilities than are free-roaming in the West.

Wild horses roam the Sand Wash Basin Herd Management Area near Maybell on July 22, 2025. (Photo by RJ Sangosti/The Denver Post)

“It’s a tragic kind of failure of the system,” said Scott Wilson, the Colorado-based director of strategy and awareness for American Wild Horse Conservation, an advocacy group for the equines.

The costs of keeping those horses off the range eats up two-thirds of the BLM’s spending, leaving little money to address the underlying issue. More than 60,000 horses sit in holding facilities, which cost taxpayers more than $100 million a year.

Funding for fertility treatments, in contrast, is limited to no more than $11 million a year.

“The BLM is faced with rising costs in off-range animal care, meaning the share of the program’s budget dedicated to off-range corrals and pastures will increase at the expense of other vital program operations, such as conducting removals to more immediately address overpopulation on the range,” agency leaders wrote in a budget request for the 2025 fiscal year, which ends Sept. 30.

Nearly everyone involved in wild horse management in Colorado wants to minimize the use of roundups and long-term holding.

Wild horse advocates say helicopter roundups stress horses as they are chased for long distances, and the activity can lead to serious injuries or death as they flee. It also can split up family structures. Land managers, for their part, are wary of the controversy the roundups draw.

“The fewer horses that are coming off the range, the better outcomes for holding and adoptions,” East said.

Gary Wadhams draws PZP, a birth control vaccine, into a syringe after retrieving it from a cooler of ice, where it is kept frozen until ready to be loaded into a dart, on July 22, 2025. (Photo by RJ Sangosti/The Denver Post)

Colorado’s new strategy aims to “break the cycle” of roundups by implementing more robust fertility darting, Vilsack said. Darting is something that can work, he said. The Spring Creek Basin herd outside Norwood — the smallest of Colorado’s herds — has not needed a roundup for 20 years because of dedicated and effective darting by volunteers, he said.

The addition of paid darters will put more boots on the ground and will add consistency to the state’s darting program as volunteers come and go.

“It’s really been on the shoulders of these volunteers for many, many years,” Vilsack said.

* * *

About noon, after an hour-long detour to get the flat tire fixed, the Wadhamses are back on the dirt roads of the herd management area. They’ve been driving for more than an hour without any evidence of the horses, except for piles of excrement and a sign at a pullout that explains to visitors the problem with horse overpopulation.

As a massive dirt devil blasts grit in their eyes, the couple checks nearby water sources to make sure they’re still full. The area’s natural ponds have long since dried in the sun, leaving pits of cracked mud behind. Instead, the horses rely on well water drawn from the ground by solar-powered pumps paid for by the BLM.

It’s difficult to find other volunteers willing to spend their days darting horses, Robin says. It can take months to improve one’s accuracy with the dart gun and years to learn all the horses. Darting means long, hot days of dusty, difficult work.

Robin Wadhams tosses sage into the air to test the wind before taking a practice shot with her dart gun in the Sand Wash Basin Herd Management Area near Maybell on July 22, 2025. (Photo by RJ Sangosti/The Denver Post)

At times, she and Gary have been the only active volunteers in the basin.

Gary recently retired from his work in the lumber industry, and the couple is now wondering what’s next for them — and how darting will fit into this next phase of life.

“We’ve always known that we needed help,” she says. “We can’t be here every day.”

* * *

Colorado’s recent progress on the wild horse problem accelerated when Sandra Hagen Solin and her mom visited Sand Wash Basin in 2021 and saw wild horses running across the sagebrush.

Solin, a Colorado lobbyist for 30 years, had heard about the roundups. After seeing the horses on the range, she went to work to find out what could be done to make herd sizes more sustainable and minimize the roundups.

“Quite often, the response is that it’s a federal issue (and) ‘I can’t do anything about it,’ ” said Wilson of American Wild Horse Conservation. “Credit to the governor for actually saying, no, these are federal horses in our state — and the state cares about these horses and their well-being.”

Behind-the-scenes conversations with lawmakers, wild horse advocates and Gov. Jared Polis’ office in 2023 resulted in a bipartisan law. It created a working group that examined potential long-term solutions and set aside $1.5 million for the issue. The members’ task: to recommend ways to better manage horses once they are taken off the range and to improve fertility control.

Wild horses roam the Sand Wash Basin Herd Management Area near Maybell on July 22, 2025. (Photo by RJ Sangosti/The Denver Post)

Localizing the group’s efforts to Colorado was the key to making tangible progress on a highly controversial and emotional issue, said Solin, who served on the working group. It showed that old, deeply entrenched divides between wild horse advocates, agricultural interests, the BLM and state leaders could be bridged.

Lawmakers enacted the working group’s recommendations in May with a second bill. Wild horse advocates said it established Colorado as a leader in the arena.

The law created a wild horse program inside the Colorado Department of Agriculture and established a permanent advisory committee in the department.

The 2025 law also earmarked part of the $1.5 million to help pay for workers from the U.S. Department of Agriculture’s Wildlife Services program to supplement volunteer efforts to dart horses.

The BLM could not say how many wild horses the USDA team had darted this season. It said the volunteers and the federal workers, combined, had darted 172 horses across the state this fiscal year.

“(The state partnership) has given us a little more resources and a little more flexibility to set us on a path to solving the problem here in Colorado, rather than just keeping our heads above water,” Vilsack said.

But how the state will pay for the program in the long term is unclear.

“Finding funding sources is first and foremost, without having to rely on state funding — because, frankly, we don’t have it,” said Duran, the state lawmaker.

Gary Wadhams walks into the sagebrush to see if he can get into position for a dart shot while volunteering in the Sand Wash Basin wild horse management area near Maybell on July 22, 2025. (Photo by RJ Sangosti/The Denver Post)

* * *

At 12:45 p.m., Robin Wadhams hops out of the 4Runner, quickly rattling off the names of the seven horses she sees staring back at them. Chewie is the stallion of this band, but the lead mare is wary of humans and is quick to drive the group away.

“She knows the darting game,” Robin says.

Gary tries anyway — three of the mares in the band need to be darted. As soon as he moves toward them, however, they move.

Gary Wadhams lines up a shot but decides not to take it due to unfavorable conditions while volunteering in the Sand Wash Basin wild horse management area near Maybell on July 22, 2025. (Photo by RJ Sangosti/The Denver Post)

The couple hops back in the car. About an hour later, they find two more bands of horses — both of them equally difficult to approach.

Gary and Robin walk out into the sagebrush, their boots crunching on dry grass, in hopes of pushing the two groups closer together. Maybe the horses will be so busy paying attention to one another that they won’t pay as much attention to the approaching people.

The horses move, and they don’t allow the couple near. One of the bands canters down a ridge and out of sight.

“They don’t like us very much,” Robin jokes, getting back in the SUV to continue the search.

Wild horses roam the Sand Wash Basin Herd Management Area near Maybell on July 22, 2025. (Photo by RJ Sangosti/The Denver Post)

* * *

So far, the efforts of lawmakers and wild horse advocates have not been enough to fully curb the use of roundups in Colorado.

Since the legislature passed the first wild horse law in 2023, the BLM has completed three roundups in the state.

The BLM used helicopters to round up an entire herd of 122 horses in Rio Blanco County in 2023. In 2024 — while the working group was meeting — the agency sent a helicopter to capture 140 horses from the Little Book Cliffs Wild Horse Range outside Grand Junction. The helicopters chase the horses into chutes and then into corrals, where they are then loaded into trailers for transport.

One mare was euthanized after severely injuring her leg during the roundup

The BLM also used a bait-and-trap method in the Sand Wash Basin to remove 10 horses in 2024, and another 42 last month. In bait-and-trap operations, BLM workers lure horses into corrals with food and water, then close the gates.

Another roundup will likely be needed at the Piceance-East Douglas Herd Management Area, Vilsack said, but he hoped that could be the last one for a while — if government leaders and local volunteers can stick the landing with the birth control program.

“We’re not out of the woods yet, but the goal is a world — at least here in Colorado — where we can spend more time celebrating wild horses as opposed to sending letters back and forth about challenges we have,” he said.

But both the state program and the money for the professional darting are limited.

The state program has no dedicated staff, East said, though he will oversee the advisory committee when it begins next year. He oversees the program, along with three other programs in the state Department of Agriculture.

The state has an $800,000 contract with the USDA’s Wildlife Services for darting in 2025 and another $300,000 earmarked to continue that work through 2028, to augment the volunteer efforts.

East said he had a little bit of money left to support the advisory committee created by the 2025 law, but “otherwise the money is pretty much all been spent.”

“I would love to see down the road, when the state’s finances get better, a staffed wild horse program at CDA with dedicated staff,” he said.

If Colorado can achieve and maintain herd populations below the BLM’s limit, it would serve as an example to other states across the West that fertility control is effective and possible, Wilson said.

“That’s such a brilliant goal for this program for Colorado,” he said, “and would actually prove to other states around the nation that this is the model.”

Gary Wadhams walks into the sagebrush to see if he can get into position for a dart shot while volunteering in the Sand Wash Basin wild horse management area near Maybell on July 22, 2025. (Photo by RJ Sangosti/The Denver Post)

* * *

At 2:45 p.m. under a hot sun, the breeze has the effect of a hair dryer as the Wadhamses look down into a gully at two horses at a watering hole. The horses don’t seem to mind their presence, but they are both males.

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Another band stares down at the couple from a nearby ridge, refusing to come to the water until the couple leaves.

After a four-hour drive from home and more than seven hours in the basin, no mares have been darted. The horses are more scattered this time of year, Robin says, as they seek shade and cooler weather.

The Wadhamses would’ve given up years ago if they didn’t love the land and the horses, she says. The first time the couple came to the basin, they saw more than 100 horses galloping across the fields. They were hooked.

“We go through this sometimes,” she says. “Then we laugh about it and come back out the next day.”

Before returning to town, the Wadhamses will drive a few more hours to the northern edge of the herd management area, near the Wyoming border.

They want to know where the horses are and set themselves up for better luck the next day.

By Jess Mador, WABE, KFF Health News

Now that the Republicans’ big tax-and-spending bill has become law, new bureaucratic hurdles have emerged for millions of Americans who rely on Medicaid for health coverage. A provision in the new law dictates that, in most states, for the first time, low-income adults must start meeting work requirements to keep their coverage.

Some states have already tried doing this, but Georgia is the only state that has an active system using work requirements to establish Medicaid eligibility — and recipients must report to the system once a month.

When she first started using the system, Tanisha Corporal, a social worker in Atlanta, wasn’t opposed to work requirements — in principle.

But when she left her job at a faith-based nonprofit to start her own project, the Be Well Black Girl Initiative, she needed health coverage. She soon came face-to-face with how daunting it can be to prove you are meeting the state’s work requirements.

“I would have never thought that I was going to run into the challenges that I did, with trying to get approved, because I’m like, I know the process,” Corporal said. “I’ve been in human services.”

Corporal has been a social worker for more than two decades in Georgia and was familiar with the state’s social service programs. For years, it had been her job to help others access benefit programs.

But her challenges with paperwork and the process had only begun.

Health advocates point to Georgia’s system as a sign that the new law will lead to excessive red tape, improper denials, and lost health coverage.

Beginning in 2027, the law will require adults on Medicaid who are under 65 to report how they engaged in at least 80 hours per month of work, education, or volunteer activities. Alternatively, these adults could submit documentation showing they qualify for an exemption, such as being a full-time caregiver.

Most states will have to set up verification systems similar to Georgia’s, which can be expensive to implement and run. In the two years since launching its program, Georgia has spent more than $91 million in state and federal funds, according to state data. More than $50 million of that was spent on building and operating the eligibility reporting system. Right now, just under 7,500 people are enrolled in Georgia.

For Corporal, 48, forgoing coverage wasn’t an option. She had been diagnosed with pre-diabetes and had other medical concerns.

“I have breast cancer in my family history,” she said. “So it was like, I gotta get my mammograms.”

On paper, it looked as if she qualified for Georgia’s program, called Georgia Pathways to Coverage.

It offers Medicaid to adults — who otherwise wouldn’t qualify for traditional Medicaid in Georgia — with incomes up to the federal poverty level ($15,650 per year for an individual, or $26,650 per year for a family of three), as long as they can show that for at least 80 hours a month they’re working, attending school, training for a job, or volunteering.

Corporal was eager to apply. She was already volunteering at least that much, including with the nonprofit Focused Community Strategies, and helping with other South Atlanta community improvement efforts.

She gathered up the various documents and forms needed to verify her duties and volunteer hours, then submitted them through Georgia’s online portal.

“And we were denied. I was like, this makes no sense,” said Corporal, who has a master’s degree in social work. “I did everything right.”

In the end, it took eight months fighting to prove that she and her son, a full-time college student in Georgia, qualified for Medicaid. She repeatedly uploaded their documents, only for them to bounce back or seemingly disappear into the portal. She went through numerous rounds of denials and appeals.

Corporal recently pulled up one of the denial notices on her cellphone to read aloud: “Your case was denied because you didn’t submit the correct documents. And you didn’t meet the qualifying activity requirement,” she read from the email.

When she tried to call the state Medicaid agency for answers, it was difficult reaching anyone who could explain what was wrong with her application paperwork, she said.

“Or, they’ll say they called you, and we look at our call log. Nobody called me,” she said. “And the letter will say, you missed your appointment, and it’ll come on the same day” as it was scheduled.

Corporal’s Pathways to Coverage application was finally approved in March after she spoke about her experience at a public hearing covered by Atlanta news outlets.

When asked about the delays and difficulties Corporal experienced, Ellen Brown, a spokesperson for Georgia’s Department of Human Services, emailed this statement: “Due to state and federal privacy laws, we cannot confirm or deny our involvement with any person related to a benefits case.”

Brown added that Georgia is implementing tech fixes to streamline the uploading and processing of participants’ documents. They include “rolling out a refresh to the Gateway Customer Portal in late July that will include easier navigation and training videos for users as well as built-in prompts to ask customers to upload required documents.”

Now that Corporal has coverage, she is having to recertify her volunteer hours every month using the same glitchy reporting system. It’s stressful, she said.

“It’s still a nightmare, even once I got through the red tape and got approved,” Corporal said. “Now maintaining it is bringing another level of anxiety.”

But she wonders how anyone without her professional background manages to get into the program at all.

“I think the system has to be simplified,” she said.

Because Georgia set up its work requirement before the recently passed law, it needed permission from the federal government through a special waiver.

It is now seeking an extension of that waiver to continue the Pathways program beyond its current expiration of September 2025. In the application, officials said they would reduce the frequency by which participants needed to reverify their hours from once a month to once per year.

But for now, Corporal’s experience remains typical. And many health advocates fear it will be replicated under Trump’s budget law with its new national Medicaid work mandate.

“In Georgia, we have seen that people just can’t get enrolled in the first place. And some folks who do get enrolled lose their coverage because the system thinks they didn’t file their paperwork or there’s been some other glitch,” said Laura Colbert , who leads the advocacy group Georgians for a Healthy Future.

Another state, Arkansas, tried work requirements in 2018.

But it didn’t go any better there, said Joan Alker, who leads the Center for Children and Families at Georgetown University.

“A lot of the problems were similar to Georgia,” she said, “in terms of the website closed at night, people couldn’t get a hold of people.”

Some Republicans who backed the spending and tax legislation said the idea behind the national Medicaid work mandate was to ensure that as many people as possible who can work, do work. And to eliminate what the Trump administration deems waste, fraud, and abuse.

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“What we’re doing is restoring common sense to the programs in order to preserve them because Medicaid is intended to be a temporary safety net for people who desperately need it,” U.S. House Speaker Mike Johnson said during a June appearance on “The Megyn Kelly Show.” “You’re talking about the elderly, disabled, you know, young single pregnant moms who are down on their luck, right? But it’s not being used for those purposes because it’s been expanded under the last two Democrat presidents and to cover everybody. So, you’ve got a bunch of able-bodied young men, for example, who are on Medicaid and not working. So what we’re doing is restoring work requirements to Medicaid. OK, this is common sense.”

National work requirements are unlikely to actually boost employment, Alker said, because more than two-thirds of Medicaid recipients ages 19-64 already have jobs. The remainder includes students, or those who are too sick or disabled to work.

“Work requirements don’t work, except to cut people off of health insurance,” she said.

The logistical steps required to report one’s activities assume that a recipient has reliable internet or transportation to travel to an agency — things that low-income Georgians may not have.

The paperwork requirements to gain coverage are time-consuming, said one Medicaid recipient, Paul Mikell.

Mikell is a licensed truck driver but does not have coverage through that job. He’s also an electrician who currently does property maintenance in exchange for free housing.

Mikell has had Medicaid through Pathways for nearly two years and has had problems navigating the Pathways web portal.

“And I know it wasn’t my device because I would go to the library and use the computer, I would try different devices, and I’ve had the same issues,” he said. “Regardless of the device, it’s something with the website.”

Another time, he said, his attempt to recertify his work hours was delayed because of paperwork issues.

“They said I was ineligible for everything because of a typo in the system or something, I don’t know what it was. I eventually was able to speak to someone and she fixed it,” he said.

This article is from a partnership with WABE and NPR.

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

Amid furious debate among supporters of President Donald Trump over the H-1B visa for foreign workers, federal authorities are making in-person interviews mandatory for renewals in visa holders’ home countries.

Technology companies say the visas — intended for workers with specialized skills, and requiring renewal every three years — are key to maintaining competitiveness, but critics charge they are used to suppress wages and replace U.S. workers.

Currently, H-1B holders with no visa changes can drop off renewal applications at consulates in their home countries or foreign countries, or renew remotely through federal field offices in the U.S. Under the new rule, in-person interviews are required for overseas applications, and the option to renew in countries other than the applicants’ own appears to have been taken away. It was not immediately clear if an interview requirement would be imposed for renewals at field offices in the U.S.

Immigration lawyers expect the change, taking effect Sept. 2, will cause delays at overseas consulates and also in U.S. field offices.

“It was a really great process — if everything was the same there’s really no point in asking them all of those questions and having them coming in for an interview,” said Kelli Duehning, a partner in the BAL immigration law firm’s San Francisco office, who spent 17 years as a lawyer for U.S. Citizenship and Immigration Services.

Alternatively, at the discretion of federal authorities, H-1B workers could renew visas at U.S. consulates in other countries not their own, including Canada and Mexico, but Duehning believes the new rule eliminates that option.

U.S. Citizenship and Immigration Services referred questions about the new rule to the U.S. State Department. The department said visa applicants should check embassy and consulate websites for information about visa application requirements and procedures.

“An in-person interview with a consular officer overseas remains one of the most important tools for the Department of State to detect fraud, misrepresentation, and other indicators that an applicant is not qualified for the visa class sought,” the department said.

Thousands of H-1B workers, mostly Indian citizens, work at Silicon Valley technology companies. Visa holders have been reluctant to speak out on the issue, fearing it could jeopardize their status.

“We can only anticipate that the wait times at the consulates in India are going to get very, very long,” Duehning said. “If they don’t get an appointment in time, they could lose their work authorization.”

Most H-1B holders also can renew visas in the U.S., and Duehning expects the mandatory interview rule will boost the number of H-1B workers applying in this country, likely leading to delays in U.S. Citizenship and Immigration Services field offices.

“Their field offices are already overwhelmed,” Duehning said.

Meanwhile, federal hiring freezes and the departures of federal workers in the State Department and Citizenship and Immigration Services mean reduced staffing, even as the Trump administration heightens scrutiny of H-1B applications and renewals, Duehning said. Applications for renewals made overseas, and at field offices, are drawing increased numbers of “requests for evidence” that the applications are valid, Duehning said, similar to what occurred during the first Trump administration.

“It will continue to increase the lack of efficiency and consistency that businesses need for their foreign national workforce, and of course, just continues to increase the angst of foreign workers,” Duehning said.

Controversy over the H-1B visa exploded late last year, as anti-immigrant conservatives faced off against advocates from the tech industry who are close to Trump. The president — who in the past criticized the visa and oversaw a dramatic boost in denial rates during his first term — came out in support of the H-1B.

In Silicon Valley, Google, Meta and Apple are among the top users of the visa. Last year, Google received approval for some 5,300 new and continuing H-1Bs, according to federal government data. Meta received nearly 5,000 approvals, Apple close to 4,000, Intel about 2,500 and Oracle more than 2,000. Seattle’s Amazon topped the list, with more than 11,000. All told, nearly 80,000 workers were approved last year to work in the U.S. for about 10,000 California companies.

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Duehning believes the change to the renewal rule arises from an “extreme-vetting” approach to visa workers, intended to root out fraud, combined with a belief by some officials in the Trump administration that the H-1B displaces American workers.

The Trump administration recently signaled it may scrap the lottery that awards 85,000 new H-1B visas each year, possibly replacing it with a system tying visas to salaries.

While tech firms push to expand the annual cap on new visas, arguing that they use the H-1B to secure the world’s top talent, research suggests the visa may push down wages, and staffing and outsourcing firms — which supply many H-1B workers to Silicon Valley tech companies — have been accused of replacing U.S. workers with visa holders.