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.

Aggressive immigration practices, including detention, deportation, and workplace raids are causing widespread emotional trauma among children. So says a study by a team of mental health professionals at UC Riverside’s School of Medicine.

The report, published July 25 in Psychiatric News, suggests that “acute psychological risks” — among both immigrant and U.S.-born children living in mixed-status households — develop from forced family separations, particularly those resulting from immigration enforcement actions, such as detention and deportation.

The researchers propose that immigration enforcement in the United States is a public health emergency for millions of children.

Citing clinical case studies and community-based data, researches said trauma is transmitted across generations and shaped by conditions such as poverty, discrimination, and fear of enforcement.

“We are witnessing the effects of chronic fear, disrupted attachment, and intergenerational trauma on a massive scale,” Dr. Lisa Fortuna, professor and chair of psychiatry and neuroscience at the UCR School of Medicine and the lead psychiatrist behind the report, said in statement accompanying the report. “The threat or reality of separation from a caregiver fundamentally reshapes a child’s development and mental health.”

For instance, researchers cited a national study of 547 U.S.-born adolescents, ages 11 to 16, which found that having a detained or deported family member was associated with elevated risk for suicidal thoughts, “externalizing behaviors,” and alcohol use.

Families who have experienced recent raids have noted behaviors such as anxiety attacks, bursts of tears, and abrupt changes in normal behavior.

That echoes the report, which said that in young children, abrupt caregiver loss has been linked to sleep and appetite disturbances.

The authors note that both pre- and post-migration family separations harm children’s emotional development and academic performance.

Immigrant caregivers, especially mothers, often suffer from trauma, which limits their ability to support their children emotionally.

“Psychiatry, as both a clinical discipline and a social institution, cannot remain on the periphery,” the authors wrote. “The current moment calls for a reexamination of how structural and intergenerational trauma are diagnosed, understood, and treated.”

Immigration raids have amplified due to the Trump administration’s pledge to target drug cartels and hardened criminals, the “worst of the worst” in the U.S. They point to decreased border crossings as evidence the raids are working.

As Department of Homeland Security officials noted on Thursday, U.S. Immigration and Customs Enforcement (ICE) officers have arrested several criminal illegal aliens “convicted of heinous crimes including assault, child sex offenses, larceny, and burglary.”

“Just yesterday, ICE arrested rapists, thieves, and other violent offenders. These are the scumbags our law enforcement are arresting and getting out of our country every single day,” said DHS Assistant Secretary of Public Affairs Tricia McLaughlin.

Trump administration officials say the nationwide crackdown is the answer to “invasion” of undocumented immigrants.

And while advocacy groups say most of the people being arrested are not criminals, federal authorities say the crackdown is working, pointing to falling numbers of border crossings and daily web posts of hardened criminals who have been apprehended.

In an email response to questions about children impacted by ICE enforcement, an agency spokesperson this week pointed to a policy of non-separation. But they did not address the emotional impact on children.

“U.S. Immigration and Customs Enforcement does not separate families or deport U.S. citizens, but removable parents — absent indications of abuse or neglect — can choose to take their children with them, regardless of the children’s immigration statuses,” the statement said. “Parents who choose to leave their children in the U.S. have the option to designate a third-party caregiver. This has always been the case.”

But as federal agents’ dragnet has blanketed Southern California, and the nation, they have often separated families from a breadwinner of the family, and at times also a key source of stability for a child, advocates say. In many cases, the families say that detainees who are also the heads of a households are often not hardened criminal, but people who have built lives, with families and homes in the U.S.

Advocates and detainees say many of the detentions have lacked due process and led to the detainment of U.S. citizens or those on a legal track toward residency or citizenship.

As national debates around immigration continue, the UC Riverside report urged policymakers and clinicians to confront the human costs of enforcement-driven immigration systems and to prioritize the emotional wellbeing of the youngest and most vulnerable.

The report also outlined methodology that is proving more effective and ethical than traditional mental health interventions, such as systems of care and community-partnered approaches.

“Healing for immigrant children and families arises not only from clinical intervention but from the restoration and reinforcement of the protective relationships, cultural traditions, and communal ties that support resilience,” according to the study.

“Psychiatry must take an active role — not just in treatment, but in advocacy,” co-author Dr. Kevin Gutierrez, an assistant clinical professor of health sciences in the UCR Department of Psychiatry and Neuroscience, said. “The mental health of immigrant children is inseparable from the systems that shape their lives.”

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Staff Writer Anissa Rivera contributed to this report.

By TIFFANY STANLEY and PETER SMITH, Associated Press

WASHINGTON (AP) — Defense Secretary Pete Hegseth says he’s proud to be part of the Communion of Reformed Evangelical Churches, an archconservative network of Christian congregations.

Hegseth recently made headlines when he shared a CNN video on social media about CREC, showing its pastors arguing women should not have the right to vote.

Pastor Doug Wilson, a CREC co-founder, leads Christ Church in Moscow, Idaho, the network’s flagship location. Jovial and media-friendly, Wilson is no stranger to stirring controversy with his church’s hard-line theology and its embrace of patriarchy and Christian nationalism.

Wilson told The Associated Press on Monday he was grateful Hegseth shared the video. He noted Hegseth’s post was labeled with Christ Church’s motto: “All of Christ for All of Life.”

“He was, in effect, reposting it and saying, ‘Amen,’ at some level,” Wilson said.

Hegseth, among President Donald Trump’s most controversial Cabinet picks, attends Pilgrim Hill Reformed Fellowship, a CREC member church in a suburb outside Nashville, Tennessee. His pastor, Brooks Potteiger, prayed at a service Hegseth hosted at the Pentagon.

CREC recently opened a new outpost in the nation’s capital, Christ Church DC, with Hegseth attending its first Sunday service.

Pentagon chief spokesman Sean Parnell confirmed Hegseth’s CREC affiliation and told the AP that Hegseth “very much appreciates many of Mr. Wilson’s writings and teachings.”

Pastor Doug Wilson stands for a portrait after Sunday services at the new campus for Christ Church and its Logos School, Sunday, April 6, 2025, in Moscow, Idaho. (AP Photo/Lindsey Wasson)

Here are other things to know about the church network:

What does Wilson’s church say about women?

Wilson’s church and wider denomination practice complementarianism, the patriarchal idea that men and women have different God-given roles. Women within CREC churches cannot hold church leadership positions, and married women are to submit to their husbands.

Wilson told the AP he believes the 19th Amendment granting women the right to vote “was a bad idea.” Still, he said his wife and daughters vote.

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He would prefer the United States follow his church’s example, which allows heads of households to vote in church elections. Unmarried women qualify as voting members in his church.

“Ordinarily, the vote is cast by the head of the household, the husband and father, because we’re patriarchal and not egalitarian,” Wilson said. He added that repealing the 19th Amendment is not high on his list of priorities.

Hegseth’s views on women have been in the spotlight, especially after he faced sexual assault allegations, for which no charges were filed. Before his nomination to lead the Defense Department, Hegseth had questioned women serving in combat roles in the military.

Wilson, a Navy veteran who served on submarines, also questions women serving in some military roles.

“I think we ought to find out the name of the person who suggested that we put women on those submarines and have that man committed,” Wilson said. “It’s like having a playpen that you put 50 cats in and then drop catnip in the middle of it. Whatever happens is going to be ugly. And if you think it’s going to advance the cause of women and make sailors start treating women less like objects, then you haven’t been around the block very many times.”

What is the Communion of Reformed Evangelical Churches?

Founded in 1998, CREC is a network of more than 130 churches in the United States and around the world.

CREC ascribes to a strict version of Reformed theology — rooted in the tradition of 16th-century Protestant reformer John Calvin — that puts a heavy emphasis on an all-powerful God who has dominion over all of society.

Wilson and CREC are also strongly influenced by a 20th-century Reformed movement called Christian Reconstructionism, according to Julie Ingersoll, a religion professor at the University of North Florida who wrote about it in her 2015 book “Building God’s Kingdom.”

She sees that theology reflected in the Wilson slogan Hegseth repeated on social media.

“When he says, ‘All of life,’ he’s referencing the idea that it’s the job of Christians to exercise dominion over the whole world,” Ingersoll said.

Since the 1970s, Wilson’s ministry and influence have grown to include the Association of Christian Classical Schools and New Saint Andrew’s College in Moscow, Idaho.

The ministry has a robust media presence, including Canon Press, publisher of books like “The Case for Christian Nationalism” and “It’s Good to Be a Man: A Handbook for Godly Masculinity.”

What is the connection to Christian nationalism?

Wilson wants the United States to be a Christian nation. He does not mind being called a Christian nationalist.

“I am more than happy to work with that label because it’s a better label than what I usually get called,” Wilson said.

“If I get called a white nationalist or a theo-fascist or a racist bigot, misogynist thug, I can’t work with them except to deny them,” he said. “I’m a Christian, and I’m a patriot who loves my country. How do I combine those two things? How do they work together?”

U.S. Christian nationalism is a fusion of American and Christian identity, principles and symbols that typically seeks a privileged place for Christian people and ideas. Wilson contends that early America was Christian, a notion historians dispute.

“If we succeed, this will be Christian America 2.0,” Wilson wrote in 2022.

American Christian nationalism involves overlapping movements. Among them are evangelicals who view Trump, a Republican, as a champion, some of whom are influenced by Christian Reconstructionist ideas; a charismatic movement that sees politics as part of a larger spiritual war; and a Catholic postliberal movement envisioning a muscular government promoting traditional morality.

CREC now has a closer relationship to the upper echelons of government. This has renewed scrutiny of Wilson’s other controversial views, including his downplaying of the horrors of Southern slavery in the U.S. But it’s also given Wilson a bigger stage.

Hegseth and Wilson have spoken approvingly of each other. Wilson said they have only met in person once, when they talked informally after Wilson preached at Hegseth’s home church in Tennessee this year.

Wilson said CREC’s new Washington church began as a way to serve church members who relocated to work in the Trump administration.

“This is the first time we’ve had connections with as many people in national government as we do now,” Wilson said. “But this is not an ecclesiastical lobbying effort where we’re trying to meet important people. We’re trying to give some of these people an opportunity to meet with God.”

Smith reported from Pittsburgh.

Associated Press religion coverage receives support through the AP’s collaboration with The Conversation US, with funding from Lilly Endowment Inc. The AP is solely responsible for this content.