By Katheryn Houghton, Bram Sable-Smith, KFF Health News

When President Donald Trump signed a law adding work requirements for some Medicaid recipients, he may have undercut lawmakers in at least 14 states who were designing their own plans, according to health industry observers.

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Georgia is the only state with a work requirement in place for Medicaid, but several states have been pursuing such a policy for years, only to be blocked by courts or, most recently, the Biden administration. Some seek state-specific touches to the new rules. Others aim to implement work requirements before the federal law takes effect at the end of 2026.

These states’ moves and Trump’s massive tax-and-spending law share one demand: To keep their Medicaid health coverage, adults who can work must prove they’re logging a minimum number of hours at a job or school, or else qualify for one of the few exemptions.

But now, states that jumped ahead need to ensure their proposals, which require federal approval, don’t stray too far from Trump’s law.

“The statute sets both the floor and ceiling” for work requirements, said Sara Rosenbaum, a health law and policy professor with George Washington University.

South Dakota, for example, announced in July that it would not submit an application for work requirements as previously planned amid concerns that the state’s laxer rules would not be allowed under the new federal law. The state’s Department of Social Services secretary had warned that working on a state proposal while the federal rules are being hashed out could be “an exercise in futility.”

Arkansas’ plan, on the other hand, is more stringent than the federal law. There are no exemptions to its work requirements in the application, which is pending with the Centers for Medicare & Medicaid Services.

Arizona’s proposal also includes something that’s not in the federal law: a ban on “able-bodied adults” receiving Medicaid benefits for longer than five years total in their lives.

Arkansas and Arizona government officials said they were working with federal officials to square their plans with the new standards.

Andrew Nixon, a spokesperson for the U.S. Department of Health and Human Services, said the department is analyzing how the new federal standards interact with state waivers.

The federal health department must release rules by next June that outline how states are to implement work requirements, according to Elizabeth Hinton, who has been tracking such waivers as part of the Program on Medicaid and the Uninsured at KFF, a health information nonprofit that includes KFF Health News.

“We don’t exactly know what that will cover,” Hinton said.

It’s unclear how federal officials will respond to the states’ requests, she added, but “we are aware that some folks think there is no wiggle room here.”

States can tweak their Medicaid programs through what are known as demonstration waivers, which are subject to federal approval. The waivers are designed to test new ideas in policy gray areas.

The states that have filed or plan to file such applications with work requirements include Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kentucky, Montana, New Hampshire, North Carolina, Ohio, South Carolina, South Dakota, and Utah.

Congressional Republicans who passed the budget reconciliation bill left room for states to use waivers to fast-track the national standards. Tara Sklar, a professor leading the University of Arizona’s Health Law & Policy Program, said she expects states seeking certain stricter requirements to have a chance of approval, while more lenient ones may face denials.

Federal officials may look favorably on Arizona’s plan, Sklar said, as a five-year lifetime Medicaid limit is different from work requirements. Even if the federal government greenlights stricter work requirements than the federal law calls for, those programs are likely to face legal challenges, she added.

The federal law includes an 80-hour-per-month minimum for work or education, with exemptions for certain adults, including people who are medically frail and parents with young, dependent children.

Montana is the first state to draft a waiver application since Congress finalized national work requirements. State lawmakers first approved work requirements — called “community engagement” standards under the state plan — in 2019, but the state’s application stalled through the end of the first Trump term and the Biden administration.

After Trump was elected again, Montana lawmakers lifted the 2025 expiration date of its Medicaid expansion program, making permanent the program that covered more than 76,000 adults in April, with the expectation that the Trump administration would approve work requirements. In mid-July, state officials released their draft plan to make that a reality “as soon as is practicable.”

The Montana plan largely aligns with the federal law, but it would create additional exemptions, including for people who are homeless or fleeing domestic violence.

Republican state Sen. Gayle Lammers said work requirements that also protect such people who need Medicaid were a big part of persuading legislators to keep the expansion program. At the time, officials didn’t know where the federal government would land on work requirements. And now, Lammers said, it makes sense for Montana to stick to its plan.

“The state should have a say,” Lammers said. “We’re very independent, and everyone is different.”

In South Carolina, state officials are seeking to roll out work requirements for a limited number of newly eligible Medicaid beneficiaries. South Carolina is one of 10 states that has not expanded Medicaid eligibility under the Affordable Care Act, and yet the state submitted a request with the federal government in June for a partial Medicaid expansion that includes a work requirement component that largely reflects the new federal standards.

In a letter to Health and Human Services Secretary Robert F. Kennedy Jr., South Carolina Gov. Henry McMaster, a Republican, called South Carolina’s proposal “a state-specific solution.”

The only state with an active work requirement program now wants to scale it back and awaits federal approval to do so. “Georgia Pathways to Coverage” expires at the end of September unless CMS greenlights an extension of the program with a key change: requiring enrollees to document once a year that they’re working, not monthly. That’s a pivot away from the program’s initial design but also differs from the new federal rules, which call for checks every six months.

Fiona Roberts, a spokesperson for Georgia’s Medicaid agency, said the state is still waiting to hear whether it needs to alter its plan.

So Georgia is among the states in limbo, awaiting guidance from the federal government.

KFF Health News correspondents Sam Whitehead and Lauren Sausser contributed to this report.

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

By Amanda Hernández, Stateline.org

Police officers may face hundreds of traumatic incidents over the course of their careers, but many still hesitate to seek mental health support when they need it.

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Despite growing investments in wellness programs by law enforcement agencies across the country, a recent study of just over 100 surveyed officers from the Fargo Police Department in North Dakota found that stigma remains a major barrier to mental health care for officers.

The study found that 60% of surveyed officers said most of their peers wouldn’t disclose a mental health condition to a colleague, and nearly three-quarters believed officers wouldn’t tell a supervisor. Slightly more than half agreed that most officers would expect to face discrimination at work if they disclosed they were experiencing mental illness.

Carol Archbold, the study’s author and a criminal justice professor at North Dakota State University, said officers may avoid disclosing mental health struggles because doing so also conflicts with societal expectations that they remain strong and unemotional.

“The nature of [police officers’] work really, really makes it difficult and important for them to have services available and for them to actually utilize them,” Archbold told Stateline, adding that departments also need to foster a culture where officers feel comfortable using the support available to them.

Departments across the country have expanded access to services like counseling, peer support, therapy, substance use programs, and on-site gyms in response to growing concerns about post-traumatic stress disorder or PTSD, depression, and suicide among officers. The Fargo Police Department, for example, hired its first-ever health and wellness coordinator last year.

While the department offers a wide range of mental health-related services and programs, the study found that relatively few officers are using them.

Eighty-four percent of surveyed officers were aware of the department’s new health and wellness coordinator, but only 22 had interacted with them, and 19 found the interaction helpful. About 68% knew about the Employee Assistance Program; 20 had used it, with 17 reporting it was helpful. Awareness of the peer support program was higher at 93%, yet only 42 officers had used it, and 36 said it was helpful.

Still, stigma and fears about career repercussions may discourage some officers from using such services.

About half of all U.S. adults will experience at least one traumatic event in their lifetimes, though most will not develop PTSD, according to the National Institute of Mental Health. For police officers, the rate of exposure is significantly higher. Research suggests police officers may experience about three traumatic events every six months, or roughly 180 over a 30-year career.

Repeated exposure to traumatic events has been linked to a wide range of health issues in first responders, including poor sleep quality, depression, alcohol misuse and a heightened risk of PTSD.

In the Fargo survey, 53% of officers agreed that most police officers view being treated for a mental illness as a sign of personal weakness and would not seek professional help if they were experiencing mental health issues.

Forty percent believed that having a history of mental illness would negatively affect an officer’s chances for promotion. Many officers also disagreed with the idea that mental illness would lead to mistrust or social exclusion among peers. Sixty-four percent of officers disagreed with statements suggesting that most officers would avoid partnering with or think less of a colleague who had experienced a mental illness.

While agencies have expanded mental health resources in recent years, the study’s findings suggest that organizational culture remains a key factor in whether officers feel comfortable using those services.

The U.S. law enforcement system includes more than 17,000 federal, state, county and local agencies. While smaller and rural departments may be less likely to offer robust mental health services, Archbold said that does not reflect a lack of interest from leadership. Many departments — regardless of size — struggle to meet officer wellness needs within existing budgets and often must seek additional funding to support mental health programs.

“It’s likely that police chiefs would like to have these services available, but they just don’t have the money to be able to do that –– to provide those services,” Archbold said.

Stateline reporter Amanda Hernández can be reached at ahernandez@stateline.org.

©2025 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

By Caroline Petrow-Cohen, Los Angeles Times

Michael Buday has one eye on the calendar as he makes plans to purchase a used Tesla. The Orange County, California, resident has two months left to take advantage of a federal tax credit that could save him thousands of dollars if he buys an electric vehicle.

The federal government will stop paying a $7,500 incentive for new electric vehicles and a $4,000 credit for used ones on Sept. 30. It’s an abrupt reversal by the Trump administration of Biden-era efforts to address climate change emissions from gasoline cars. The details are laid out in the “Big Beautiful Bill” that passed this month.

The tax credits have been available for cars that plug in but also have a gas tank, such as the Toyota Rav4 Prime and the Chrysler Pacifica Hybrid.

Transportation is the largest contributor to climate change both in California and nationally, and experts say it must get much cleaner to preserve a recognizable climate. About 1 in 4 cars sold in California is fully electric or plug-in hybrid, according to the California Energy Commission.

The elimination of the credits is expected to further stunt EV sales that have already slowed amid plateauing interest in California and steep auto tariffs. Industry analysts and auto dealers predict they’ll see a spike in interest in electric vehicles while people can still get the credits.

Buday, who is looking to buy his second Tesla after purchasing a Model 3 two years ago, said he wants to stay ahead of the curve.

“People tend to not pay attention until it’s getting close to a deadline,” Buday said. “There’s hundreds and hundreds of Teslas even within 60 miles for sale, but I think once people catch on to the fact that these credits are going away, there may be a rush to snap them up.”

The tax credits can be applied to most electric vehicles for sale, including the SUVs and trucks on display at Camino Real Chevrolet in Monterey Park. Dealership president Robb Hernandez said he hasn’t yet seen a significant jump in EV sales yet. Manufacturers are estimating an increase over the coming weeks, he said.

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About 20% of the dealership’s total sales come from its electric offerings, Hernandez said, including the popular Chevy Blazer and Equinox. Competition in the electric vehicle space has become increasingly fierce as major auto makers release lines of electric vehicles alongside their gas-powered cars, including Ford and Porsche. Electric-only companies including Rivian and Lucid further crowd the field of competitors.

Hernandez is bracing for a drop-off in sales at his dealership with the expiration of the tax credits but said he’s confident in Chevrolet’s foothold in California.

“We’re kind of anticipating there will be a surge, and then possibly after the expiration of the EV credits, there might be a lull,” Hernandez said. “Hopefully it will all even out.”

Tesla is using the credits’ expiration to try to motivate potential customers, with marketing emails that say, “Order soon to get your $7,500.”

Tesla Chief Executive Elon Musk said in an earnings call this month that the elimination of the credits could hurt his company’s sales and lead to “a few rough quarters.”

The electric vehicle leader has been turning its attention to robotics and autonomous driving technology as vehicle sales falter. Tesla reported a 16% year-over-year decline in automotive sales last quarter.

The news that the credits are expiring may also be drowned out by the overall price volatility consumers are dealing with.

“Most people in this economy are reading the news and struggling to make purchase decisions based on all these moving targets,” said Dominick Miserandino, a consumer behavior expert and chief executive of Retail Tech Media Nexus.

“The average person is just trying to make sense of it all,” he said.

©2025 Los Angeles Times. Visit at latimes.com. Distributed by Tribune Content Agency, LLC.

It was the late 1990s, and Kate DiCamillo was discouraged about ever having a writing career. Working as a “book picker” fulfilling orders at the Bookmen distribution company in Minneapolis, she had accumulated more than 450 rejections for her short stories and other writing. She was tired; her legs ached from standing all day. She belonged to a writers group where award-winning children’s author Jane Resh Thomas believed in her. But nothing was happening.

Then came the phone call that changed her life.

“I took the call in my boss’s office on the third floor of the Bookmen, among the remainders,” DiCamillo recalled during a conversation from her home in Minneapolis’s Linden Hills neighborhood. “They told me they wanted to publish ‘Because of Winn-Dixie.’ I couldn’t believe it.”

Minnesota author Kate DiCamillo celebrates the 25th anniversary of her novel “Because of Winn-Dixie” Aug. 19, 2025, at The Riverview Theater in Minneapolis. The event includes showing of the film based on the much-loved novel. (Courtesy of Dina Kantor)

She learned her manuscript had been found by a young editor in a pile on the desk of someone on maternity leave and the editor fell in love with the book.

DiCamillo’s tender/humorous story is about Opal Buloni, a lonely, motherless girl living with her father in a small Florida town who befriends a smelly, dirty dog she names Winn-Dixie after the grocery store where they meet. As the unlikely pair roams the streets getting to know people, Opal creates her own community.

When the book was published, DiCamillo couldn’t have known it would become a beloved story. It won an American Library Association Newbery Honor, a remarkable achievement for a debut author, and was made into a film starring Jeff Daniels, Cecily Tyson and Eva Marie Saint.

DiCamillo is celebrating the 25th anniversary of “Winn-Dixie” on Aug. 19 at the Riverview Theater in Minneapolis, presented by St. Paul’s Red Balloon Bookshop. Tickets include a paperback edition of either “Because of Winn-Dixie” or “Ferris,” a story about Ferris Wilkey’s summer before fifth grade when his little sister wants to become an outlaw, his Uncle Ted is writing the history of the world in the basement, and Grandma is seeing ghosts.

” ‘Ferris’ and ‘Because of Winn-Dixie” are almost bookends of my whole writing life,” DiCamillo says. ” ‘Ferris’ is the first book I wrote that starts with a complete family, with parents in place.”

“Because of Winn-Dixie” led to a career during which DiCamillo has written more than 60 books, with more than 43 million in print. She’s one of six authors to win two Newbery Awards, for “The Tale of Despereaux,” about a mouse who loves a princess, and “Flora & Ulysses,” featuring a squirrel who gains powers after being sucked into a vacuum cleaner.

“The Miraculous Journey of Edward Tulane,” detailing the adventures of a china rabbit, was produced by Minnesota Opera, and her series about Mercy, a toast-loving pig, was adapted for the stage by Children’s Theatre Company. As if that isn’t enough, DiCamillo is a former National  Ambassador for Young People’s Literature appointed by the Library of Congress.

DiCamillo, 61, is sort of stunned to be meeting the second, and a few third-generation, readers of “Because of Winn-Dixie.”

“The first time this happened, it was flat-out unbelievable, overwhelming,” she recalls. “I was doing a signing, and a woman told me she was a fourth-grade teacher whose fourth-grade teacher had read it to her. A youngster handed me an old copy, telling me, ‘This was my mother’s book when she was a kid and my grandmother read it to her, and now my mother is reading it to me.’ It was a moment of gratitude for me.”

In the beginning

DiCamillo grew up in a small town in Florida. Her parents — dad an orthodontist and mother a teacher — were divorced, and she lived with her mom.

Their house was filled with books, and young Kate read everything from “The Secret Garden” to “Wuthering Heights.” She majored in English at the University of Florida in Gainesville, where professors told her she had writing talent.

“All through my miserable 20s, I talked about writing, called myself a writer, and sat around wanting to be discovered,” DiCamillo revealed in a 2023 Pioneer Press interview. “At 29, I figured out I wasn’t going to get published unless I wrote something. So I adopted an (athletic) exercise philosophy about it, writing two pages a day. And I still do that.”

DiCamillo was about 30 when she followed a friend to Minnesota, figuring her boyfriend would ask her to marry him if she moved north. That didn’t happen, and this native of the Sunshine State arrived during one of Minnesota’s coldest winters with no job and no socks. She thought she’d freeze to death the first time she had to gas up the car.

Despite the weather, DiCamillo stayed and got a job at the Bookmen, where she learned a lot about the publishing industry and discovered children’s books.

“When I read Christopher Paul Curtis’ 1963 book “The Watsons Go to Birmingham,”  I thought I could do something like this, and I started writing ‘Because of Winn-Dixie,’ ” she recalls.

Then, everything in DiCamillo’s life came together quickly. In 1998, she received a $10,000 McKnight Foundation grant, her first short story appeared in a literary magazine, and “Winn-Dixie” was sold. A few years later, she won the Loft’s first award for children’s writing.

A big inspiration for the story of Opal and Winn-Dixie came from DiCamillo’s longing for her dog and Florida.

“At the time, I wasn’t aware of assuaging those longings. The story just came,” she recalls. “In retrospect, I see this is what I was doing. It was a terrible winter and the first prolonged period of my life without access to a dog. What a child like Opal longs for is community and feeling embraced and loved. I think about the dogs and people in my neighborhood interacting. You see how you can make community and, in a weird way, a blueprint about how to be in the world. We need each other and we forget that. Opal’s story shows us what we need and want.”

And then

(Courtesy of Candlewick Press)

After “Winn-Dixie” was sold to Candlewick Press, DiCamillo stayed on for a while at the Bookmen, where bookstore owners and librarians shopped. One day, she mentioned to Michele Cromer-Poire, then co-owner of the Red Balloon Bookshop, that she had a book coming out.

“Michele hosted my first signing at the store, and it was wonderful,” DiCamillo recalls. “They had a cake showing the book cover. That was huge. My best friend I grew up with came and a third-grade teacher told me she never had such an enthusiastic group of kids.”

DiCamillo quickly learned that being a newbie author facing a class of students is not without pitfalls. She vividly remembers her first school visit for “Winn-Dixie:”

“The teacher introduced me as the person who wrote the book and said they were going to talk about the themes. I thought, ‘We are?’ I had no idea about themes, and I was supposed to talk intelligently. The class decided the themes were family, forgiveness and friendship. I raced to my car and wrote it down so I could tell the next class what the themes were.”

That anecdote illustrates DiCamillo’s insistence that she doesn’t worry about the age of her readers or things like themes when she’s writing. She just tells stories.

As DiCamillo’s career took off, she became comfortable talking with her young fans and parents. At just over 5 feet tall, she is almost eye-level to some of the kids, and she takes them and their questions seriously.

“Talking with everybody, answering questions, that’s what I like,” she says. “That’s what I’ll do at the 25th anniversary celebration.”

Holly Weinkauf, owner of the Red Balloon, says DiCamillo’s books are a staple in her store, where she has hosted many events for Kate. She’s watched the magic happen between author and young readers.

“Kate is so good at doing events, so good at responding to the kids,” Weinkauf says. “She thinks about it as being there for them. She listens carefully and always answers with a great sense of humor. The kids know she is for real. She takes it seriously but doesn’t take herself too seriously.”

When it comes to Dicamillo’s writing, Weinkauf is a fan:

“She writes great stories with so much feeling about complex and often difficult topics with care that makes them very accessible. And she writes with the exact amount of words. She really focuses on the heart of the story she is telling.  And there is so much hope in her books. We need her gifts.”

And now?

DiCamillo has been as busy as ever lately. The third in her Norendy Tales series, “Lost Evangeline,” has just been published (after “The Puppets of Spelhorst” and “The Hotel Balzaar”). She’s working on a novel and has finished her contribution to a book of loosely-connected fairytales to be published by Candlewick. In April, “Orris and Timble: Lost and Found” was published. It’s the second in an early chapter book trilogy about a rat and an owl who are best friends.

Kate also spends time reading the dozens of letters she gets from young readers. One of the most often-asked questions is whether she will write a sequel to “Because of Winn-Dixie.”

“Much as you can say what you will or won’t do, I don’t think I will ever write a sequel,” she replies. “If I had been at a bigger publisher, I might have been pushed to do it, and I probably would have. Candlewick never did that. They embraced whatever direction I wanted to go. So I tell my readers that things didn’t turn out exactly as Opal wanted, but she is happy, safe, and loved.”

DiCamillo seems a little incredulous when the topic of retirement is raised.

“What does retirement even mean? I don’t know,” she says. “Why would I retire? I want to keep on writing.”

If You Go

What: 25th anniversary celebration for “Because of Winn-Dixie”

When/Where: 5 p.m. Aug. 19, Riverview Theater, 3800 42nd Ave. S., Mpls.

Program: Screening of the 2005 movie based on the book, Q&A with  Kate DiCamillo and book signings.

Cost: $20, includes paperback copy of either “Because of Winn-Dixie” or “Ferris”

Ticket information: redballoonbookshop.com

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