Amy Lindgren

Now and then I like to write about random thoughts that are too small or personal to make into a column. Holiday weeks are a good time for small bits, so here are some things currently on my mind.

Playful job titles

Shoot, I thought we were done with this. A recent press release tells me that companies are “adopting playful job titles (and seeing results).” Well isn’t that special?

I know that’s snarky but consider my position. Having written résumés professionally through at least two eras of made-up job titles, I’m pretty much over it.

I don’t know which was worse — the soulless “Administrative Clerk II, Class C” type of titles from the ’80s or the hard-to-take-seriously “Chief Custodial Engineer” titles that came later. From my perspective, both swings of the pendulum risk the reader not knowing what the heck the candidate does for a living.

Now a press agent announces that five “quirky” titles are making a difference for companies as they seek to distinguish themselves to job seekers. Curious? Here they are — see if you can guess what the more standard version would be:

• Chief Happiness Officer

• Director of First Impressions

• Growth Hacker

• Brand Evangelist

• Digital Overlord

Ready for the answers? A Chief Happiness Officer focuses on employee wellbeing — so maybe that used to be human resources, if it existed at all. The Director of First Impressions used to be called a receptionist or front desk manager; a Growth Hacker might be the marketing manager; the Brand Evangelist might be replacing public relations or sales but “with almost religious fervor”; and the Digital Overlord is a souped-up website manager.

Quoted in the release is Mark Baldwin, CEO of Baldwin Digital: “Creative job titles can … communicate company values clearly, energize existing team members, and attract talent who resonate with your organizational culture.” He does advise thoughtful implementation, with an eye toward employee acceptance and industry culture.

I’m not a fan, but I guess I can’t disparage what’s working for other people. And besides, the press release itself was exceptionally well-written with fairly credible arguments. Dani K., the press agent from Journalist Insights requested a link to her client, which is only fair for giving me column fodder: https://www.baldwindigital.ie. You won’t find the release itself on the site, so tell me if you’d like me to forward that to you.

Time to stretch

Are you sitting at a desk, or perhaps hunched over a phone while you read this? Perhaps you’re like me, eager to unfold an actual newspaper each morning, but still hunching over to read it. Apparently we’re not doing ourselves any favors. I don’t have a specific resource on this, but I’ve been reading (peering at my computer screen) about how stiff we’re all getting.

Hours at our desks, more hours on the couch, and endless, endless hours driving if you have teenagers in sports … it all adds up to pretzel bodies that we need to stretch while we still can. Personally, I can barely squat down anymore to feed the cat or clean up the aftermath — tasks I wouldn’t mind giving up, but you see my point.

Spring is the ideal time to get back into some kind of shape. You’re creative, you can figure this out: Stand at your desk, wave your arms during Zoom meetings (off-camera!), practice squats while you watch a show. I’ve already started by getting one of those sit-stand things for my desktop computer. Now I can overwork at multiple heights. Baby steps.

Going to your happy place

A lot of folks are struggling with the country’s sense of upheaval right now. You don’t have to follow a particular political party to be suffering the effects of high prices, unexpected layoffs and ricocheting national policies.

To combat his feelings of helplessness and occasional fury, one of my clients has started taking a daily writing retreat. His practice of stealing 30 minutes to capture his thoughts reminds me of the old commercial where the harried mother sinks into a bubble bath, murmuring “Take me away, Calgon.”

After my client described the positive effects, I decided to start a retreat of my own. Now I end each day with soft music and a light whodunit. It’s a sad comment that reading about murder and mayhem is a better sleep aid than my own thoughts gathered from the day, but there you have it.

Comments?

Those are my random bits for the moment. What are yours?

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Amy Lindgren owns a career consulting firm in St. Paul. She can be reached at alindgren@prototypecareerservice.com.

It’s beyond disingenuous, even by the standards of the Tim Walz administration, to deprive private schools of $109 million in the upcoming budget preparation in the name of reflecting “positive balances on the bottom line.’’

You want to take way the pocket change that has been helping private schools for 50 years? You could find $109 million in the couch cushions at the Department of Education or Health and Human Services or at Walz’s office or any authorities or agencies that have watched, incompetently, money fraudulently leak out of the Capitol to the tune now of more than $600 million.

That $109 million is all the private schools get, by the way. It is used for busing and some textbooks and counseling and nursing. Nursing. You know, for when the governor mandates masks and vaccines and things like that. The taxpayers are already paying for these services on top of the sacrifices they make to pay for the private school tuition. And we’re supposed to believe that after Walz signed off on blowing a more than $17 billion budget surplus and presiding over more than $600 million in taxpayer money lost to fraud that he suddenly developed a keen interest in fiduciary responsibility. And he wants to take it out on private school kids, or more to the point, their parents, who know when they sign up they are paying twice, for their kid and a public school kid.

It is far more likely that Walz finds private education disagreeable to his ideological flirtations and that he can look smart to Education Minnesota, the union that supports him and whose members cannot possibly educate a child as inexpensively as a private school.

Back in 1969 state statute required public school districts to provide private school children with transportation within the public school’s districts in an effort to provide equality of treatment in transportation. In 1975 Minnesota began providing nonpublic student aid in the form of textbooks, instructional materials, standardized tests and some guidance counseling and health services. It’s been on the books for 50 years. It absolutely could not happen today. The people we’ve managed to elect are most often appalled at the idea of education other than what the state commands.

Private schools are not burdened by the layers and layers and layers of bureaucratic balderdash from the state. They don’t have five assistant principals. Usually one principal and she’ll wonder why your uniform shirt isn’t tucked in. They can operate streamlined, thus more efficiently and at less cost. A bulletproof argument can be made that private schools save the state money. Using figures I’ve been intimately familiar with during the 50 years in question, the private schools can educate a kid for about $10,000 a year, while it approaches $30,000 a year in the public academies.

It should not go unmentioned that the state is facing a $6 billion budget shortfall. I suppose it stands to reason that if you irresponsibly blow an unimaginably huge surplus on God knows how many new state programs the till is bound to be short a few bucks come the next budget cycle.

That’s the cycle we’re in, the next one. The bills are due from that wild DFL frat party you all had to celebrate your trifecta. You’re short by an astounding $6 billion. Boy, that’s some governing. And this guy is out on tour hoping to get noticed as a presidential hopeful.

Cutting the pittance set aside for private schools could land only a very soft blow to $6 billion. Why, $6 billion won’t even feel the punch. It’s typical of how the Walz administration treats the taxpayers.

It’s an insult.

Joe Soucheray can be reached at jsoucheray@pioneerpress.com. Soucheray’s “Garage Logic’’ podcast can be heard at garagelogic.com.

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By Sam Whitehead, Phil Galewitz and Katheryn Houghton, KFF Health News

For many years, Eric Wunderlin’s health issues made it hard to find stable employment.

Struggling to manage depression and diabetes, Wunderlin worked part-time, minimum-wage retail jobs around Dayton, Ohio, making so little he said he sometimes had to choose between paying rent and buying food.

But in 2018, his CareSource Medicaid health plan offered him help getting a job. It connected him to a life coach, who helped him find full-time work with health benefits. Now, he works for a nonprofit social service agency, a job he said has given him enough financial stability to plan a European vacation next year.

“I feel like a real person and I can go do things,” said Wunderlin, 42. “I feel like I pulled myself out of that slump.”

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Republicans in Congress and several states, including Ohio, Iowa, and Montana, are pushing to implement work requirements for nondisabled adults, arguing a mandate would encourage enrollees to find jobs. And for Republicans pushing to require Medicaid enrollees to work, Wunderlin’s story could be held up as evidence that government health coverage can help people find employment and, ultimately, reduce their need for public assistance.

Yet his experience is rare. Medicaid typically does not offer such help, and when states do try to help, such efforts are limited.

And opponents point out that most Medicaid recipients already have jobs and say such a mandate would only kick eligible people off Medicaid, rather than improve their economic prospects. Nearly two-thirds of Medicaid enrollees work, with most of the rest acting as caregivers, going to school, or unable to hold a job due to disability or illness, according to KFF, a health information nonprofit that includes KFF Health News.

Existing efforts to help Medicaid recipients get a job have seen limited success because there’s not a lot of “room to move the needle,” said Ben Sommers, a professor of health care economics at the Harvard T.H. Chan School of Public Health. Most Medicaid enrollees already work — just not in jobs with health benefits, he said.

“The ongoing argument that some folks make is that there are a lot of people freeloading in Medicaid,” he said. “That’s just not supported by the evidence.”

Using health programs to encourage work

The GOP-controlled Congress could allow or require states to implement a Medicaid work requirement as part of revamping and downsizing Medicaid. The first Trump administration encouraged those work mandates, but many were struck down by federal judges who said they were illegal under federal law.

Policy experts and state officials say more attention should be paid to investments that have helped people find better jobs — from personalized life coaching to, in some cases, health plans’ directly hiring enrollees.

They argue work requirements alone are not enough. “The move to economic mobility requires a ladder, not a stick,” said Farah Khan, a fellow with the Brookings Institution, a nonpartisan think tank.

While Medicaid work requirements have been debated for decades, the issue has become more heated as 40 states and Washington, D.C., have expanded Medicaid eligibility under the Affordable Care Act to the vast majority of low-income adults. More than 20 million adults have gained coverage as a result — but Republicans are now considering eliminating the billions in extra federal funding that helped states extend eligibility beyond groups including many children, pregnant women, and disabled people.

Only Georgia and Arkansas have implemented mandates that some Medicaid enrollees work, volunteer, go to school, or enroll in job training. But a study Sommers co-authored showed no evidence work requirements in Arkansas’ program led to more people working, in part because most of those who could work already were.

In Arkansas, more than 18,000 people lost coverage under the state’s requirement before the policy was suspended by a federal judge in 2019 after less than a year. Those who lost their Medicaid health care reported being unaware or confused about how to report work hours. Since 2023, Arkansas has been giving Medicaid health plans financial incentives to help enrollees train for jobs, but so far few have taken advantage.

Some plans, including Arkansas Blue Cross and Blue Shield’s, offer members $25 to $65 to complete a “career readiness” certificate. In 2024, some Arkansas health plans offered enrollees educational videos about topics including taxes and cryptocurrency.

Health plans don’t have an incentive to help someone find a better-paying job, because that could mean losing a customer if they then make too much to qualify for Medicaid, said Karin VanZant, a vice president at Clearlink Partners, a health care consulting company.

Rather than offering incentives for providing job training, some states, such as California and Ohio, require the insurance companies that run Medicaid to help enrollees find work.

In Montana, where some lawmakers are pushing to implement work requirements, a promising optional program nearly collapsed after state lawmakers required it be outsourced to private contractors.

Within the program’s first three years, the state paired 32,000 Medicaid enrollees with existing federally funded job training programs. Most had higher wages a year after starting training, the state found.

But enrollment has plummeted to just 11 people, according to the latest data provided by the state’s labor department.

Sarah Swanson, who heads the department, said several of the nonprofit contractors that ran the program shuttered. “There was no real part in this for us to deliver direct services to the folks that walked through our door,” she said. The state hopes to revive job training by allowing the department to work alongside contractors to reach more people.

The hunt for results

State officials say they don’t have much data to track the effectiveness of existing job programs offered by Medicaid plans.

Stephanie O’Grady, a spokesperson for the Ohio Department of Medicaid, said the state does not track outcomes because “the health plans are not employment agencies.”

Officials with CareSource, which operates Medicaid plans in multiple states, say it has about 2,300 Medicaid and ACA marketplace enrollees in its JobConnect program — about 1,400 in Ohio, 500 in Georgia, and 400 in Indiana.

The program connects job seekers with a life coach who counsels them on skills such as “showing up on time, dressing the part for interviews, and selling yourself during the interview,” said Jesse Reed, CareSource’s director of life services in Ohio.

Since 2023, about 800 people have found jobs through the program, according to Josh Boynton, a senior vice president at CareSource. The health plan itself has hired 29 Medicaid enrollees into customer service, pharmacy, and other positions — nearly all full-time with benefits, he said.

In 2022, California started offering nontraditional health benefits through Medicaid — including help finding jobs — for enrollees experiencing homelessness or serious mental illness, or who are otherwise at risk of avoidable emergency room care. As of September, it had served nearly 280,000 enrollees, but the state doesn’t have data on how many became employed.

The University of Pittsburgh Medical Center, which is among the largest private employers in Pennsylvania, running both a sprawling hospital system and a Medicaid plan, has hired over 10,000 of its Medicaid enrollees since 2021 through its training and support services. Among other jobs, they took positions as warehouse workers, customer service representatives, and medical assistants.

The vast majority left low-paying jobs for full-time positions with health benefits, said Dan LaVallee, a senior director of UPMC Health Plan’s Center for Social Impact. “Our Pathways to Work program is a model for the nation,” he said.

Josh Archambault, a senior fellow with the conservative Cicero Institute, said Medicaid should focus on improving the financial health of those enrolled.

While the first Trump administration approved Medicaid work requirements in 13 states, the Biden administration or federal judges blocked all except Georgia’s.

“I don’t think states have been given ample chance to experiment and try to figure out what works,” Archambault said.

KFF Health News senior correspondent Angela Hart contributed to this report.

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

By Shalina Chatlani, Stateline.org

Republicans in Congress are eyeing $880 billion in cuts to Medicaid, the joint federal-state government health care program for lower-income people.

Depending on how states respond, a Republican proposal that would slash the 90% federal contribution to states’ expanded Medicaid programs would end coverage for as many as 20 million of the 72 million people on Medicaid — or cost states $626 billion over the next decade to keep them on the rolls. More than 5 million people could lose coverage if the feds impose work requirements.

In recent months, this complicated government program has increasingly come under the spotlight, so Stateline has put together a guide explaining what Medicaid is and how it operates.

1. Medicaid is not Medicare.

Medicaid serves people with lower incomes or who have a disability. Medicare focuses primarily on older people, no matter their income.

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Medicaid and Medicare were created in 1965 under President Lyndon B. Johnson. Medicare is the federal health insurance program for people who are 65 or older, though younger people with special circumstances, such as permanent kidney failure or ALS, may be eligible earlier.

Medicare is a supplemental insurance program that’s limited in scope. It doesn’t pay for long-term care, most dental care or routine physical exams. Around 68.4 million people are enrolled in Medicare.

Medicaid is a more comprehensive government insurance plan that’s jointly funded by the federal government and states. Medicaid covers most nursing home care as well as home- and community-based long-term care. People on Medicaid generally don’t have any copayments. Only people and families with incomes under certain thresholds are eligible for Medicaid. About 72 million people, or a fifth of people living in the United States, receive Medicaid benefits.

2. Medicaid eligibility varies from state to state.

In its original form, Medicaid was generally only available to children and parents or caretakers of eligible children with household incomes below 100% of the federal poverty line ($32,150 for a family of four in 2025). Over the years, the program was expanded to include some pregnant women, older adults, blind people and people with disabilities.

States have to follow broad federal guidelines to receive federal funding. But they have significant flexibility in how they design and administer their programs, and they have different eligibility rules and offer varying benefits.

In 2010, President Barack Obama signed into law the Affordable Care Act, also known as Obamacare, which allowed states to expand their eligibility thresholds to cover adults with incomes up to 138% of the federal poverty line (about $21,000 for one person today), in exchange for greater federal matching funds. The District of Columbia covers parents and caretakers who earn up to 221% of the federal poverty line.

Only 10 states (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming) have chosen not to expand coverage. In the non-expansion states, eligibility for caretakers and parents ranges from 15% of the federal poverty line in Texas to 105% in Tennessee. In Alabama, people can only get Medicaid if they earn at or below 18% of the federal poverty line — $4,678 a year for a three-person household.

3. Traditional Medicaid exists alongside a health insurance program for children called CHIP.

Low-income children have always been eligible for Medicaid. But in 1997, Congress created CHIP, or the Children’s Health Insurance Program. The law gave states an opportunity to draw down enhanced federal matching funds to extend Medicaid coverage to children within families who earn too much money to qualify for traditional Medicaid coverage, but make too little money to afford commercial health care.

Like Medicaid, CHIP is jointly funded by the federal government and states, but it’s not an entitlement program. CHIP is a block grant program, meaning states receive a fixed amount of federal money every year and aren’t obligated to cover everyone who meets the eligibility requirements. States get to decide, within broad federal guidelines, how their CHIP programs will work and what the income limits will be. Some states have chosen to keep their CHIP and Medicaid programs separate, while others have decided to combine them by using CHIP funds to expand Medicaid eligibility.

4. Medicaid and CHIP are significant portions of state budgets.

In 2024, the federal government spent less on Medicaid and CHIP than on Medicare, with Medicare spending accounting for 12%, or $847.5 billion, of the federal benefit budget, and Medicaid and CHIP accounting for 8%, or $584.5 billion.

But at the same time, Medicaid is the largest source of federal funds for states, accounting for about a third of state budgets, on average, and 57% of all federal funding the states received last year.

5. Federal funding varies by state.

Before the Affordable Care Act, federal Medicaid funding to states mostly depended on a formula known as the FMAP, or the federal medical assistance percentage, which is based on the average personal income of residents. States with lower average incomes get more financial assistance. For example, the federal government reimburses Mississippi, which is relatively poor, nearly $8 for every $10 it spends, for a net state cost of $2. But New York is only reimbursed $5. By law the FMAP can’t be less than 50%.

The ACA offered states the opportunity to expand eligibility and receive an even greater federal matching rate. In expansion states, the federal government covers 90% of costs for expansion adults. If Republicans in Congress reduce that percentage, states would have to use their own money to make up for lost federal dollars. They might have to scale back Medicaid coverage for some groups, eliminate optional benefits or reduce provider payment rates. Alternatively, they could raise taxes or make cuts in other large budget items, such as education.

Another possibility is that states that have adopted Medicaid expansion would reverse it. Nine states (Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah and Virginia) already have “trigger” laws in place that would automatically rescind expansion if the federal match rate dips below 90%. Other states are considering similar legislation.

One new analysis from KFF, a health research policy group, found that if Congress reduced the federal match for the expansion population to the percentages states get for the traditional Medicaid population— 50% for the wealthiest states and 77% for the poorest ones — it would cost states $626 billion over the next decade to keep everyone eligible under Medicaid expansion on the rolls.

6. Medicaid is the largest source of health coverage, especially for people with low incomes.

Medicaid is the single largest health payer in the nation, and is particularly important for people in poverty. Almost a fifth of people living in the United States are covered through Medicaid. But nearly half of all adults with incomes at or below the federal poverty line are insured through the program. Medicaid covers 4 out of every 10 children overall, but it covers 8 out of every 10 children below the federal poverty line. Medicaid also provides coverage for people experiencing homelessness or who are leaving incarceration.

7. Medicaid covers essential services, such as childbirth.

In exchange for receiving federal funds, states are obligated to cover essential health care services, including inpatient and outpatient hospital services, doctor visits, laboratory work and home health services, among other things. States get to decide which optional services, such as prescription drugs and physical therapy, they want to cover.

Medicaid is a significant payer of essential services. For example, the program covers 41% of all childbirths in the U.S. and covers health care services for the 40% of all adults ages 19-65 with HIV.

8. The majority of Medicaid spending goes to people with disabilities and to pay for long-term care.

ACA expansion adults — about 1 out of every 4 enrollees — accounted for 21% of total Medicaid expenditures in 2021. Children, who make up about 1 out of every 3 enrollees, only accounted for 14% of spending.

People who qualify for Medicaid because of a disability or because they are over the age of 65 make up about 1 out of every 4 enrollees. But they accounted for more than half of all Medicaid spending. That’s because these populations typically experience higher rates of chronic illness and require more complex medical care. Older people are also more likely to use nursing homes and other long-term care facilities, which can be expensive.

Cuts could also mean that older people relying on Medicaid for home-based care and long-term nursing home services could be significantly affected.

9. Some state Medicaid programs cover people who are living in the country illegally.

People who are in the country illegally are ineligible for traditional Medicaid or CHIP. But some states have carved out exceptions to extend coverage to them using state dollars.

As of January, 14 states and the District of Columbia provide Medicaid coverage to children regardless of their immigration status. And 23 states plus the District of Columbia use CHIP to cover pregnant enrollees regardless of their immigration status.

Also, seven states provide Medicaid to some adults who are here illegally. New York opted to cover those who meet the income requirements and are over the age of 65, regardless of immigration status And California provides coverage to any adults ages 19-65 who are under the income threshold, regardless of immigration status.

10. The majority of the public holds favorable views of Medicaid.

According to surveys from KFF, two-thirds of Americans say that someone close to them has received health coverage from Medicaid at some point in their lives. Half of the public also say they or someone in their family have been covered through Medicaid.

Generally, around 3 out of every 4 people — regardless of political party — say that Medicaid is very important, though Republicans are less likely than Democrats and independents to share that opinion. At the same time, a third or less of people want to see any decrease in spending on the Medicaid program. In fact, the majority of people living in states that have not expanded Medicaid under the ACA want their states to do so.

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

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