By Rae Ellen Bichell and Sam Whitehead, KFF Health News

This summer, the state of Louisiana texted just over 13,000 people enrolled in its Medicaid program with a link to a website where they could confirm their incomes.

The texts were part of a pilot run to test technology the Trump administration says will make it easier for some Medicaid enrollees to prove they meet new requirements — working, studying, job training, or volunteering at least 80 hours a month — set to take effect in just over a year.

But only 894 people completed the quarterly wage check, or just under 7% of enrollees who got the text, according to Drew Maranto, undersecretary for the Louisiana Department of Health.

“We’re hoping to get more to opt in,” Maranto said. “We plan to raise awareness.”

The clock is ticking for officials in 42 states — excluding those that did not expand Medicaid at all — and Washington, D.C., to figure out how to verify that an estimated 18.5 million Medicaid enrollees meet rules included in President Donald Trump’s tax and spending law. They have until the end of next year, and federal officials are giving those jurisdictions a total of $200 million to do so.

The policy change is one of several to free up money for Trump’s priorities, such as increased border security and tax breaks that mainly benefit the wealthy.

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The nonpartisan Congressional Budget Office has said the work rules will be the main reason millions of people won’t be able to access health insurance over the next decade. It estimates changes to the Medicaid program will result in 10 million fewer Americans covered by 2034 — more than half of them because of the eligibility rules.

For now, state officials, health policy researchers, and consumer advocates are watching the pilot program in Louisiana and another in Arizona. Mehmet Oz, director of the Centers for Medicare & Medicaid Services, has touted those test-drives and said they will allow people to verify their incomes “within seven minutes.”

“There have been efforts to do this in the past, but they haven’t been able to achieve what we can achieve because we have technologies now,” said Oz, during a television appearance in August.

Brian Blase, the president of the conservative Paragon Health Institute and a key architect of Medicaid changes in the new law, has chimed in, saying during a recent radio appearance that with today’s artificial intelligence “people should be able to seamlessly enter how they are spending their time.”

KFF Health News found scant evidence to support such claims. Federal and state officials have offered little insight into what new technology the two pilots have tested. They do say, however, that it connects directly with the websites of Medicaid enrollees’ payroll providers, rather than using artificial intelligence to draw conclusions about their activities.

Oz said the Trump administration’s efforts started “as soon as the bill was signed” in July. But work on the pilot programs began under the Biden administration.

And Medicaid is a state-federal program: The federal government contributes most of the funds, but it is up to the states to administer them, not the federal government.

“Oz can say, ‘Oh no, we’re going to fix this. We’re going to do this.’ Well, they don’t actually run the program,” said Joan Alker, a health policy researcher at Georgetown’s Center for Children and Families.

Officials have also offered few details about the pilots’ effectiveness in assisting enrollees in Medicaid or other public benefit programs.

The shortage of information has some state officials and health policy researchers worried that the Trump administration lacks viable solutions to help states implement the work rules. As a result, they say, people with a legal right to Medicaid benefits could lose access to them.

“What actually keeps me up at night is the fear that members that are eligible for Medicaid and are trying to get health care services would fall through the cracks and lose coverage,” said Emma Sandoe, Oregon’s Medicaid director.

Officials involved in the Louisiana and Arizona projects declined to answer many specific questions about their efforts, instead directing KFF Health News to federal officials.

Spokespeople for Arizona’s Medicaid and Economic Security departments — Johnny Córdoba and Brett Bezio, respectively — did not share data on how many people participated in the state’s pilot test nor describe the outcome. They said the pilot had been used to verify eligibility only for the federal Supplemental Nutrition Assistance Program, a smaller program than Medicaid.

The Community Food Bank of Southern Arizona, a nonprofit that helps people sign up for such SNAP benefits, hadn’t heard of the pilot program.

State officials and health policy researchers said neither pilot program could confirm whether a person meets other qualifying activities — such as community service — or any of the numerous exemptions. The tools being tested can verify only income.

Andrew Nixon, director of communications for the U.S. Department of Health and Human Services, which oversees Oz’s agency, wrote in a statement that the digital tools officials aim to share with states “are largely under development.”

One person doing that development is Michael Burstein, a software engineer who, until recently, worked at the U.S. Digital Service, which later became known as the Department of Government Efficiency.

As the U.S. Digital Service was turned into DOGE, Burstein and other staffers left and started a nonprofit called Digital Public Works to finish supporting the technology to make it easier for people to verify their incomes for Medicaid enrollment.

But without permission from state officials, Burstein would not describe the tool in development, aside from saying that it’s mobile-first, can quickly verify income for a new or returning client, “and we’re pretty happy with it.”

The state agencies that manage benefit programs, such as Medicaid and SNAP, are understaffed, and they use different eligibility systems, many of which need updating, which makes improving them “a challenging task,” he said.

The $200 million in start-up costs the federal government has earmarked for systems to track work requirements equals roughly four times what it cost to administer Georgia’s Medicaid work requirement program alone.

That state, which has the nation’s only active work requirement program, called Georgia Pathways to Coverage, in September was granted a temporary extension, despite a recent report from a federal watchdog saying it hadn’t received enough federal oversight. A complicated sign-up process has kept enrollment in the program far below Georgia’s own projections.

Trump’s tax and spending law allows states to ask for extra time — until the end of 2028 — to start enforcing the rules, but only with the approval of HHS Secretary Robert F. Kennedy Jr. It also allows counties with high unemployment rates to be exempted, but states must apply for that exemption.

Even with an app that states can use to prove people are eligible for Medicaid, enrollees would still need to know that app existed and how to use it — neither of which is a given, Alker said. There is also no guarantee they’d have reliable cell service or internet access. As KFF Health News has reported, millions of Americans live in rural areas without reliable internet.

Private vendors also have been working on such apps, said Jennifer Wagner, who researches Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities. Wagner said she has seen several vendors demonstrate products they plan to pitch to states for the work rules. Many are limited in scope, she said, like those in the pilot tests.

“Nobody has a magical solution that’ll make sure eligible people don’t lose coverage,” she said.

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

With a major funding question before St. Paul voters on the Nov. 4 ballot, the St. Paul Public Schools have rolled out their own white yard signs stamped with school district logo and a QR code that takes visitors to the district website. Once there, voters find a rousing YouTube video with parent, teacher and student interviews about the proposed special 10-year tax levy, set to stirring music.

“Vote Nov. 4. Protect their future. Invest in our community,” read the the district’s yard signs, which are popping up on lawns, school grounds and outside rec centers, mirroring the wording on the district website’s central landing page. “To continue providing high quality education to all of our students, we are asking all of our community to vote on an operating levy.”

Elsewhere on the district website, staff are “invited” to collect yard signs from district headquarters, post them in their front lawns and share them with neighbors.

Campaign finance report

It’s an aggressive push for one side of the ballot question, and apparently backed by taxpayer funds. There’s no record of a campaign finance report detailing manhours, expenses or funding sources behind the school district effort, which is distinct from that of the parent-and-teacher driven “Vote Yes for Strong Schools” campaign, which has rolled out yellow lawn signs.

“Their stuff says ‘Vote Yes.’ Our stuff says ‘Vote’,” said Erica Wacker, a spokesperson for the St. Paul Public Schools, who confirmed that the district is using an as-yet-untallied amount of its own funds for the white signs. “It’s still an ongoing project, so there hasn’t been a final (expenditure) report on the referendum, so it would take some time to compile.”

Some supporters and critics alike of the 10-year, $37 million-per-year special property tax levy have been taken aback by the degree to which the school district may have crossed the line from sharing impartial information to advocacy.

Peter Butler, who lodged a complaint against the St. Paul DFL this month around an unrelated campaign flier issue, said he has not been intimately involved in the school levy question, but he was surprised by the degree of the district’s involvement.

For ballot matters, “the attorney general is very good at saying … you can’t be using taxpayer money (to reach out) just on one side of the issue,” Butler said. “You can inform people, but you can’t advocate. It certainly sounds like they’ve crossed the line there.”

Muddy legal waters

Historically, public agencies in Minnesota have been barred from promoting either side in levy referendums, constitutional amendments and ballot questions, though they are allowed to distribute factual, impartial information, such as the size of a levy proposal and how the money will be spent. By statute, districts must send voters a mailer spelling out those particulars.

During the 2021 ballot initiative around a new citywide rent control ordinance, members of the St. Paul City Council were allowed to use their personal Facebook pages to advocate for or against its passage, but they were told not to use their official council office websites or even their political ward’s Facebook pages in that manner.

“Until recently, the question of whether public funds could be used for such activity seemed settled: With rare exceptions, the answer was no,” reads a previously-published opinion by State Auditor Julie Blaha, which was updated in June.

A 2012 case muddied the legal waters.

In “Abrahamson v. St. Louis County School District,” the Minnesota Court of Appeals and Minnesota Supreme Court ruled that rather than avoid promotion outright, school districts must follow campaign finance reporting laws when they advocate for or against ballot measures to the same extent as a campaign committee.

In other words, expenditures for materials that support a particular outcome can trigger requirements to file campaign finance reports detailing expenses, donors and donation amounts, among other state campaign finance regulations. By state statute, most campaign materials larger than a bumper sticker must be labeled “Prepared and paid for by the (named) committee,” and no campaigning is allowed within 100 feet of a polling place.

St. Paul’s ordinances — which cover city government — go even further to ban campaigning on government property: “It shall be unlawful for any person to use city property for a political purpose.”

Yard signs, website, video

St. Paul Public Schools has been heavily disseminating word of its $37.2 million levy proposal on the Nov. 4 ballot, with no campaign finance record-keeping in sight. The school district has encouraged staff to distribute lawn signs to their neighbors.

“A limited number of SPPS Referendum yard signs are available at the District Administration Building, 360 Colborne Street, by the front entrance,” reads The Bridge, the district’s online newsletter. “Staff are invited to pick up a yard sign to put in their yards or give to neighbors who live in St. Paul.”

Elsewhere, the school district website urges “let’s work together to protect the opportunities our students need” and explains, under the sub-headline “What’s at stake?”, that “without additional revenue, the programs that make our schools strong will be forced to take significant budget reductions or be eliminated entirely.”

The website features a public letter from Schools Superintendent Stacie Stanley, which urges readers to watch a four-minute YouTube video featuring testimonials from levy supporters, including state Rep. Maria Isa Perez-Vega and school board chair Halla Henderson, as well as a parent, teacher and students.

After about three minutes of highlighting the importance of school funding, a narrator explains the estimated property tax impacts on a median-value St. Paul home ($289,000), which would be $309 per year, in addition to the school district’s normal annual levy.

Stanley herself then appears in the video and encourages voters to go to the polls, though she never explicitly tells the viewer to “vote yes.”

‘If this doesn’t pass’

Quentin Wathum-Ocama, a school district employee who chairs the independent “Vote Yes for Strong Schools” campaign, confirmed that the school district has made stacks of yard signs available at school building open houses. He said he was not otherwise intimately familiar with the mechanics of the district’s efforts, such as whether it used its in-house print shop and marketing budget for the white yard signs, which are distinct from his campaign’s yellow yard signs.

“I can’t speak on behalf of the district,” he said, “but I know they’re walking the line and trying to do what they can within the confines of the law. They’re trying to explain what happens if it passes and what happens if it doesn’t. It feels political because the district is being really upfront and saying ‘if this doesn’t pass, we will cut programs.’ Some people say that feels like a very ‘Vote Yes!’ (effort), but it’s also the truth.”

“I do appreciate the district not sugar coating why they are asking for this,” Wathum-Ocama added. “Let’s say it doesn’t pass, and then the district says ‘we’re going to close this school.’ People will say ‘Nobody told me!’”

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By SYLVIE CORBET

PARIS (AP) — A delegation of French senators visited the Louvre on Tuesday and acknowledged that the museum’s security was “not in line” with modern standards, calling for improved measures at the Paris landmark that was the scene of a stunning heist earlier this month.

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Thieves took less than eight minutes on Oct. 19 to steal jewels valued at 88 million euros ($102 million) from the world’s most-visited museum. French officials described how the intruders used a basket lift to scale the Louvre’s façade, forced open a window, opened a breach in display cases and fled.

Two suspects were arrested on Sunday and are being questioned by police.

Sen. Laurent Lafon, head of the Culture Committee at the Senate, said “we all noticed that the security equipment is not suitable for a 21st-century museum such as the Louvre. It is our flagship, it must be exemplary, and today we cannot describe the security conditions at the Louvre as exemplary.”

Speaking to reporters after visiting the Louvre with fellow senators, Lafon said “there are many improvements to be made. Our security system does not meet nowadays’ standards.”

Lafon acknowledged there was a “weakness” regarding outdoor cameras that allowed the robbery, but would not enter into further details for “confidentiality reasons.”

The senators called for a speedy start of massive renovation work that was already planned — as soon as possible, since France’s budget for 2026 is currently being debated in the parliament.

The decade-long “Louvre New Renaissance” plan, which includes security improvements, was launched earlier this year. It is estimated it would cost up to 800 million euros ($933 million) to modernize infrastructure, ease crowding and give the famed Mona Lisa a dedicated gallery by 2031.

By CALEIGH WELLS, Associated Press

Amanda Porretto isn’t sure she’ll ever have children.

At 27, she is the average age of new mothers in the United States, according to the Centers for Disease Control and Prevention. She’s feeling the pressure as an only child. Her father wants to be a grandfather and her mother, before she died, always told Porretto that she would eventually want to be a mom.

“Some people think it’s a bad thing” not to have a child, said Porretto, who works in advertising. “I just don’t think I need to bring more people into (the world) when there’s so much here currently that we need to fix.”

Younger generations of Americans are increasingly citing climate change as making them reticent to have children, according to several studies. They are worried about bringing children into a world with increasing and more intense extreme weather events, a result of climate change, which is caused by the release of greenhouse gases like carbon dioxide when oil, gas coal are burned. And they are concerned about the impact their offspring will have on the planet.

In a 2024 Lancet study of people 16 to 25 years old, the majority of respondents were “very” or “extremely” worried about climate change. The study also found that 52% said they were hesitant to have children because of climate change. Adults under 50 years old without children were four times more likely than adults over 50 without children to say that climate plays a factor in their decision, according to a Pew Research Center report published last year. And a study published this year in the Proceedings of the National Academy of Sciences found more than half of respondents said “yes” or “maybe” to whether climate change made them question having children.

Climate impact of children

Parenthood and climate change are related not just because of fears for a child’s well-being, but also by concern for the planet’s well-being.

Compared to the carbon emissions of all the other decisions, “having a child is by far, by orders of magnitude, larger,” said Nandita Bajaj, executive director of Population Balance, which is a nonprofit focused on humans’ environmental impact.

Unlike other choices, procreation comes with something that bioethics professor Travis Rieder of Johns Hopkins University calls “carbon legacy.”

“You’re not only doing carbon expensive activities like buying a larger house and a larger car and diapers and all that,” said Rieder. “You’re also creating someone who is going to have their own carbon footprint for the rest of their lives.”

That child might have children, and those children might have children, creating an impact that lasts generations, Rieder added. Of course, the logical extreme of minimizing an environmental footprint means having no children, Rieder said, which he is not advocating.

It’s tricky to quantify the impact of a child. That’s because there’s no consensus on what percentage of their impact is the parent’s responsibility, and partly because the impact of that child depends on their parents’ lifestyle.

“One of the best predictors of how carbon-expensive they’ll be is how wealthy you are,” Rieder said.

For example, the U.S. emits 123 times more carbon emissions than Ghana, according to the Emissions Database for Global Atmospheric Research. Adjusted for population size, that means the average American emits more than 12 times as much as the average Ghanan.

Why is it taboo to talk about?

Procreation might have the largest climate impact, but when it comes to actions people can take to reduce their personal contribution to global warming, having fewer children often isn’t discussed.

Researchers who study climate change and family planning give two reasons.

“If a person tells you that they’re expecting or that they are pregnant, the immediate response is to offer some kind of support, congratulate them, that sort of thing,” said Trevor Hedbert, who teaches moral philosophy at the University of Arizona.

The other factor, said Rieder: the impact of procreation sometimes is tied to conversations about overpopulation. The environmental movement in the 1970s expressed fears that there were too many people for the planet’s resources, which led to racism and eugenics, which garnered severe backlash.

Taboo or not, climate is factoring into people’s choices

Ash Sanders, 43, knew when she was young that she didn’t want to have a baby. Then she got pregnant.

“I didn’t want to add another person to the world and have them have more of an impact on a world that was already overstressed and strained by the number of humans that were here,” she said.

Sanders, a freelance writer who covers religion and environment, wanted an abortion but felt pressure by her Mormon upbringing and by the father to have the baby. She said she was called a bad person for not wanting a kid.

She placed her child in an open adoption and sees her regularly. Today she feels conflicted about her decision.

“I feel guilt for bringing her into the world. I mean she likes the world, she’s a happy kid, she’s very cool. I’m a big fan. But I feel guilt all the time,” she said.

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Juan Jaramillo said the environment was always a factor in his parenthood calculus, even when he was a teenager in the 1970s. He later went to school to become a marine biologist.

“Pollution and climate change was not an issue just yet, but all of the rest of the problems that we have now were there back then,” he said.

Plus, he just didn’t want kids. So he got a vasectomy and hasn’t regretted the decision. His decision not to have children and his environmental concerns lined up.

That’s not the case for Rieder, the bioethics professor, who has spent years studying that impact, and still very much wanted to be a dad.

“Having children is a deeply meaningful and important activity to people. It’s also carbon expensive,” he said. “So how do you weigh these things out?”

For Rieder, finding that balance meant having just one child.

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.