By Tony Leys, KFF Health News

PLEASANTVILLE, Iowa — Zach Mecham has heard politicians demand that Medicaid recipients work or lose their benefits. He also has run into a jumble of Medicaid rules that effectively prevent many people with disabilities from holding full-time jobs.

“Which is it? Do you want us to work or not?” he said.

Mecham, 31, relies on the public insurance program to pay for services that help him live on his own despite a disability caused by muscular dystrophy. He uses a wheelchair to get around and a portable ventilator to breathe.

A paid assistant stays with Mecham at night. Then a home health aide comes in the morning to help him get out of bed, go to the bathroom, shower, and get dressed for work at his online marketing business. Without the assistance, he would have to shutter his company and move into a nursing home, he said.

Zach Mecham gets ready for his workday with the help of Courtnie Imler, a home health aide who comes to his house in Pleasantville, Iowa. (Tony Leys/KFF Health News/TNS)

Private health insurance plans generally do not cover such support services, so he relies on Medicaid, which is jointly financed by federal and state governments and covers millions of Americans who have low incomes or disabilities.

Like most other states, Iowa has a Medicaid “buy-in program,” which allows people with disabilities to join Medicaid even if their incomes are a bit higher than would typically be permitted. About two-thirds of such programs charge premiums, and most have caps on how much money participants can earn and save.

Some states have raised or eliminated such financial caps for people with disabilities. Mecham has repeatedly traveled to the Iowa Capitol to lobby legislators to follow those states’ lead. The “Work Without Worry” bill would remove income and asset caps and instead require Iowans with disabilities to pay 6% of their incomes as premiums to remain in Medicaid. Those fees would be waived if participants pay premiums for employer-based health insurance, which would help cover standard medical care.

Disability rights advocates say income and asset caps for Medicaid buy-in programs can prevent participants from working full time or accepting promotions. “It’s a trap — a poverty trap,” said Stephen Lieberman, a policy director for the United Spinal Association, which supports the changes.

Lawmakers in Florida, Hawaii, Indiana, Iowa, Maine, Mississippi, and New Jersey have introduced bills to address the issue this year, according to the National Conference of State Legislatures.

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Several other states have raised or eliminated their program’s income and asset caps. Iowa’s proposal is modeled on a Tennessee law passed last year, said Josh Turek, a Democratic state representative from Council Bluffs. Turek, who is promoting the Iowa bill, uses a wheelchair and earned two gold medals as a member of the U.S. Paralympics basketball team.

Proponents say allowing people with disabilities to earn more money and still qualify for Medicaid would help ease persistent worker shortages, including in rural areas where the working-age population is shrinking.

Turek believes now is a good time to seek expanded employment rights for people with disabilities, since Republicans who control the state and federal governments have been touting the value of holding a job. “That’s the trumpet I’ve been blowing,” he said with a smile.

The Iowa Legislature has been moving to require many nondisabled Medicaid recipients to work or to document why they can’t. Opponents say most Medicaid recipients who can work already do so, and the critics say work requirements add red tape that is expensive to administer and could lead Medicaid recipients to lose their coverage over paperwork issues.

Iowa Gov. Kim Reynolds has made Medicaid work requirements a priority this year. “If you can work, you should. It’s common sense and good policy,” the Republican governor told legislators in January in her “Condition of the State Address.” “Getting back to work can be a lifeline to stability and self-sufficiency.”

Her office did not respond to KFF Health News’ queries about whether Reynolds supports eliminating income and asset caps for Iowa’s buy-in program, known as Medicaid for Employed People with Disabilities.

National disability rights activists say income and asset caps on Medicaid buy-in programs discourage couples from marrying or even pressure them to split up if one or both partners have disabilities. That’s because in many states a spouse’s income and assets are counted when determining eligibility.

In Iowa, for example, the monthly net income cap is $3,138 for a single person and $4,259 for a couple.

Iowa’s current asset cap for a single person in the Medicaid buy-in plan is $12,000. For a couple, that cap rises only to $13,000. Countable assets include investments, bank accounts, and other things that could be easily converted to cash, but not a primary home, vehicle, or household furnishings.

“You have couples who have been married for decades who have to go through what we call a ‘Medicaid divorce,’ just to get access to these supports and services that cannot be covered in any other way,” said Maria Town, president of the American Association of People with Disabilities.

Town said some states, including Massachusetts, have removed income caps for people with disabilities who want to join Medicaid. She said the cost of adding such people to the program is at least partially offset by the premiums they pay for coverage and the increased taxes they contribute because they are allowed to work more hours. “I don’t think it has to be expensive” for the state and federal governments, she said.

Congress has considered a similar proposal to allow people with disabilities to work more hours without losing their Social Security disability benefits, but that bill has not advanced.

Although most states have Medicaid buy-in programs, enrollment is relatively low, said Alice Burns, a Medicaid analyst at KFF, a health information nonprofit that includes KFF Health News.

Fewer than 200,000 people nationwide are covered under the options, Burns said. “Awareness of these programs is really limited,” she said, and the income limits and paperwork can dissuade potential participants.

In states that charge premiums for Medicaid buy-in programs, monthly fees can range from $10 to 10% of a person’s income, according to a KFF analysis of 2022 data.

The Iowa proposal to remove income and asset caps has drawn bipartisan backing from legislators, including a 20-0 vote of approval from the House Health and Human Services Committee. “This aligns with things both parties are aiming to do,” said state Rep. Carter Nordman, a Republican who chaired a subcommittee meeting on the bill. Nordman said he supports the idea but wants to see an official estimate of how much it would cost the state to let more people with disabilities participate in the Medicaid buy-in program.

Mecham, the citizen activist lobbying for the Iowa bill, said he hopes it allows him to expand his online marketing and graphic design business, “Zach of All Trades.”

On a recent morning, health aide Courtnie Imler visited Mecham’s modest house in Pleasantville, a town of about 1,700 people in an agricultural region of central Iowa. Imler chatted with Mecham while she used a hoist to lift him out of his wheelchair and onto the toilet. Then she cleaned him up, brushed his hair, and helped him put on jeans and a John Deere T-shirt. She poured him a cup of coffee and put a straw in it so he could drink it on his own, swept the kitchen floor, and wiped the counters. After about an hour, she said goodbye.

Home health aide Courtnie Imler uses a mechanical hoist to lift Zach Mecham out of his wheelchair as she helps him get cleaned up and ready for work at the marketing business he runs out of his home in Pleasantville, Iowa. (Tony Leys/KFF Health News/TNS)

After getting cleaned up and dressed, Mecham rolled his motorized wheelchair over to his plain wooden desk, fired up his computer, and began working on a social media video for a client promoting a book. He scrolled back and forth through footage of an interview she’d done, so he could pick the best clip to post online. He also shoots video, takes photos, and writes advertising copy.

Mecham loves feeling productive, and he figures he could work at least twice as many hours if not for the risk of losing Medicaid coverage. He said he’s allowed to make a bit more money than Iowa Medicaid’s standard limit because he signed up for a federal option under which he eventually expects to work his way off Social Security disability payments.

There are several such options for people with disabilities, but they all involve complicated paperwork and frequent reports, he said. “This is such a convoluted system that I have to navigate to build any kind of life for myself,” he said. Many people with disabilities are intimidated by the rules, so they don’t apply, he said. “If you get it wrong, you lose the health care your life depends on.”

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

By JONEL ALECCIA, Associated Press

More than a dozen years after higher-fat milk was stripped from school meals to slow obesity in American kids and boost their health, momentum is growing to put it back.

Federal lawmakers have revived bills that would allow whole and 2% milk to be served again in schools, in addition to the skim and low-fat milk mandated since 2012. A U.S. Senate committee hosted a hearing Tuesday on a bill that has bipartisan support.

“Kids need wholesome, nourishing food to grow strong and stay healthy, and whole milk is packed with the nutrients they need,” said Sen. John Fetterman, a Pennsylvania Democrat who is co-sponsoring the legislation.

Health Secretary Robert F. Kennedy Jr. has called the federal dietary guidelines requiring low-fat milk “antiquated” and last month encouraged “full fat/whole milk” to be used in Head Start programs for the nation’s youngest children.

Health and Human Services Secretary Robert F. Kennedy Jr. speaks during an event announcing proposed changes to SNAP and food dye legislation, Friday, March 28, 2025, in Martinsburg, W. Va. (AP Photo/Stephanie Scarbrough)

The Obama-era move to require skim and low fat milk in schools was aimed at cutting kids’ consumption of saturated fat and calories, which can increase the risk of heart disease and obesity.

But some nutrition experts, lawmakers and the dairy industry argue that whole milk has been unfairly vilified, and that some studies suggest kids who drink whole milk are less likely to have obesity. Critics also contend that many children don’t like the taste of lower-fat milk and don’t drink it, leading them to miss valuable nutrients.

Here’s what you need to know about the debate over whole milk in school meals:

Why was whole milk removed from school meals?

In 2010, Congress passed the Healthy, Hunger-Free Kids Act, which aimed to reduce childhood obesity and cut health risks for kids. It required school meals to include more whole grains, fruits and vegetables, protein and low-fat dairy and less sugar, sodium and fat.

Starting in 2012, whole and 2% milk was not permitted in school meals because those products are higher in saturated fat and calories than lower-fat options.

Nutrition experts said that skim and low-fat milk gave kids the benefits of necessary nutrients like calcium and Vitamin D with less fat and fewer calories.

How are school meal guidelines set?

The U.S. Agriculture Department sets nutrition guidelines for the national school lunch and breakfast programs, which serve nearly 30 million students each school day.

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The nutrition standards are required to meet the federal Dietary Guidelines for Americans, which are reviewed and revised every five years. Since 1985, those guidelines have recommended that Americans older than age 2 consume low-fat or fat-free dairy.

The 2025-2030 dietary guidelines are set for revision this year under a joint effort by USDA and the Department of Health and Human Services. A panel of scientific experts who reviewed evidence regarding milk fat content recommended that the U.S. policy remain the same.

One reason was that research has shown changes in the federal nutrition program after the 2010 law have slowed the rise in obesity among U.S. kids — even teenagers, said Deanna Hoelscher, a nutrition expert and researcher at the University of Texas Health Science Center who served on the dietary guidelines committee.

“We didn’t find enough definitive evidence to change a policy that’s been in place that has shown good outcomes to date,” Hoelscher said.

Although there was limited evidence that consuming higher-fat dairy rather than lower-fat dairy could benefit very young children, there wasn’t enough evidence to make a conclusion for older kids and teens, she said. There were “substantial concerns” with the consistency, quantity and risk of bias in the existing research, the report concluded.

What’s behind the push for whole milk in schools?

Some nutrition experts point to recent research suggesting that kids who drink whole milk could be less likely to be overweight or develop obesity than children who drink lower-fat milk. One 2020 review of 28 studies suggested that the risk was 40% less for kids who drank whole milk rather than reduced-fat milk, although the study authors noted that the research couldn’t say whether milk consumption was the reason.

One top nutrition expert, Dr. Dariush Mozaffarian of Tufts University, noted that the dietary guidelines panel found “no evidence that whole fat dairy is worse than low-fat dairy,” but they retained the recommendations, citing the need for more research.

“Saturated fat in dairy has not been linked to any adverse health outcomes,” Mozaffarian said.

The pending bills in Congress stipulate that milk fat would not be considered as part of the saturated fat limits required in school meals. That’s because the saturated fatty acids in dairy have a different composition than beef fat, Mozaffarian said, adding that dairy has other beneficial compounds that could offset theoretical harms.

In addition, Mozaffarian noted current USDA guidelines ban whole milk but allow skim and low-fat chocolate and other flavored milk sweetened with added sugars. Last year, the USDA agreed to limit added sugars in school foods for the first time.

Dairy industry advocates say participation in school meals programs and consumption of milk have declined since whole milk was removed.

What’s next?

The USDA and HHS must issue the new dietary guidelines this year. Kennedy and Agriculture Secretary Brooke Rollins have said they are conducting “a line-by-line review” of the scientific report issued under the previous administration — but whether that means a new acceptance of whole milk remains unclear.

Versions of the “Whole Milk for Healthy Kids Act” are pending in both chambers of Congress.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

Actor Josh Brolin and director Michael Mann are among those paying tribute to Val Kilmer, who died Tuesday at age 65. Here’s a look at some of the reactions.

“See ya, pal. I’m going to miss you. You were a smart, challenging, brave, uber-creative firecracker. There’s not a lot left of those. I hope to see you up there in the heavens when I eventually get there. Until then, amazing memories, lovely thoughts.” — Josh Brolin on Instagram.

“He was a wonderful person to work with and a joy to know — I will always remember him.” — Francis Ford Coppola on Instagram.

“While working with Val on ‘Heat’ I always marvelled at the range, the brilliant variability within the powerful current of Val’s possessing and expressing character. After so many years of Val battling disease and maintaining his spirit, this is tremendously sad news.” — Michael Mann, in a statement.

“A long time ago, I was auditioning for the movie ‘The Doors’ It was kind of a cattle call. They paired together potential Jims with potential Pamela‘s. And they were running behind so we were spilling out of the casting office, sitting on the porch, the lawn, and the driveway. All of a sudden, a Sixties convertible came screeching up, blaring Doors music at top volume. And a guy jumped out and strode inside: He had wild hair and he was barefoot, shirtless, and wearing nothing but a pair of tight leather pants. We all looked at each other like… Who is this guy? We were more than a little shook by the sheer audacity of his entrance. Well, of course, it was Val Kilmer and from that minute on, nobody else stood a chance. Rip King.” — Jennifer Tilly on X.

“Remembering Val Kilmer, whose indelible cinematic mark spanned genres and generations. RIP Iceman.” — The “Top Gun” account on X.

“RIP Val Kilmer. Thank you for defining so many of the movies of my childhood. You truly were an icon.” — actor Josh Gad on Instagram.

“Rest in peace VAL KILMER. A brilliant actor and a good man.” — author Don Winslow on X.

“RIP Val Kilmer. If it wasn’t for our chance encounter at the Source in 1985, I may never have been cast in FULL METAL JACKET. Thanks, Val.” — Actor Matthew Modine on X. The Source was a Hollywood restaurant.

“Listen, Val Kilmer had me wanting to fly fighter jets, be Batman, rob banks, and hunt lions as a kid. They don’t make too many movie stars like him anymore. Generational.” — Writer-direct Dylan Park-Pettiford on X.

“Rest in peace to our former campus mate, the great Val Kilmer (1959-2025), who at 17 was the youngest drama student ever admitted to The Julliard School’s Drama Division.” — Film at Lincoln Center on X.

By MARTHA BELLISLE, Associated Press

The U.S. Olympic & Paralympic Committee has fired a coach and a director after The Associated Press reported that the coach was accused of sexually abusing a young biathlete, causing her so much distress that she attempted suicide.

“Following our thorough internal evaluation, we can confirm that Gary Colliander and Eileen Carey are no longer affiliated with the USOPC,” spokesman Jon Mason told the AP. He refused to provide a reason, saying only that Colliander was put on administrative leave from the Paralympic team in December — days after the AP report on the alleged misconduct. The two were fired on March 14.

Colliander was accused of sexually abusing Grace Boutot, a biathlete he coached at the Maine Winter Sports Center over four years beginning in 2006 when she was 15, the AP reported. Colliander quit the job after Boutot’s October 2010 suicide attempt and was later hired by the U.S. Paralympic Nordic team.

FILE – Biathlon competition medals, credentials and media clippings belonging to Grace Boutot, silver medalist in Youth World Championships in 2009, are displayed for a photograph at her home on Oct. 17, 2024, in Boston. (AP Photo/Steven Senne, File)

Carey was the Maine center’s vice president at the time of the abuse and had discussed it with Boutot’s mother. After leaving the center in December 2010, Carey was hired as a coach and later promoted to director of the Paralympic team. She was there when Colliander came onboard.

Mason declined to say whether Carey hired Colliander or how the Paralympic team vets the coaches they hire. The U.S. Center for SafeSport, created to investigate sex-abuse allegations in Olympic sports in the aftermath of the Larry Nassar U.S. Gymnastics scandal, launched an investigation into Colliander in December.

“Please note that Mr. Colliander’s case remains active with SafeSport,” Mason told the AP.

Colliander’s lawyer, Simone Montoya, said officials did not tell Colliander why he was fired and he “adamantly denies any wrongdoing or inappropriate behavior, as alleged.”

Colliander “is committed to full and transparent cooperation into this matter,” Montoya told the AP in an email. “He denies any conduct in violation of the SafeSport Code or applicable laws and policies and maintains that he has always upheld professional standards throughout his career.”

AP phone and email messages seeking comment from Carey were not immediately returned.

Boutot was among a half-dozen Olympians and other biathletes who came forward after the AP reported last year that Olympian Joanne Reid was sexually abused and harassed for years, according to SafeSport findings. Biathlon is a winter sport that combines cross-country skiing with target shooting.

The AP generally does not identify victims of sexual abuse except in cases where they publicly identify themselves or share their stories openly.

Boutot, 34, told the AP that when Colliander began coaching her, he gave her a lot of attention, including inappropriate touching. The conduct escalated after she turned 18 to “kissing, sexual fondling and oral sex,” according to a treatment summary by her therapist, Jacqueline Pauli-Ritz, shared with the AP.

Boutot said she begged Colliander to stop but he ignored her. She became severely depressed and started cutting herself, according to the therapist’s notes. In September 2010, Pauli-Ritz contacted Colliander and told him Boutot was suffering from major depression and he should stop coaching her, the treatment summary said.

“He did not do this until after the suicide attempt,” Pauli-Ritz wrote, referring to Boutot’s Oct. 7, 2010, overdose on antidepressants during a Utah training camp.

Colliander resigned the next day. He took a coaching job in Colorado and was hired in December 2016 by the U.S. Paralympic team. He was associate director of high performance for U.S. Paralympics Nordic Skiing before being fired.

Boutot tried to keep racing but faced discrimination by the center’s staff and teammates, who blamed her for his departure, according to a letter she wrote to the Maine Sports Center’s board in January 2011.

Boutot’s mother, Karen Gorman, had repeated discussions and email exchanges with Carey and the center’s CEO, Andy Shepard, about the abuse her daughter suffered, Gorman told the AP.

In an Oct. 22, 2010, email, Gorman told them, “the issue of any coach-athlete relationships … must be scrutinized” by the Maine sports center.

Carey responded that she was “working really hard” to make that happen. “I am very supportive of having positive things come out of this situation for everyone involved,” she said in an Oct. 25, 2010, email.

But, Boutot told the AP, no investigation was ever conducted.

In a 2011 complaint she filed with the Maine Human Rights Commission, Boutot accused the Maine sports center of failing to prevent Colliander’s sexual misconduct and retaliating against her when she reported it — denying her coaching and ending financing of equipment, travel, athlete housing and other U.S. Biathlon competition-related expenses.

The center settled for $75,000 in September 2011 and Boutot quit racing.

EDITOR’S NOTE — This story includes discussion of suicide. If you or someone you know needs help, the national suicide and crisis lifeline in the U.S. is available by calling or texting 988. There is also an online chat at 988lifeline.org