Adventurous travelers seeking beauty and budget thrills should look no further than Guatemala: a friendly country that remains largely unexplored by many Americans.

A question I fielded several times before my late February trip: Why Guatemala?

My partner and I have made a habit of planning at least one international trip each year. Actually, I’ll shoulder most of the blame — nothing scratches my travel itch like a new passport stamp. But because we’re early-career professionals, with limited stockpiles of paid time off and inevitable bills, a month-long vacation to Southeast Asia or Eastern Europe is out of the question (for now).

Last summer, I found myself in a rabbit hole of research: Panama, Aruba, Curaçao. Slowly, the pieces fell together for Guatemala.

Compared to my other potential destinations, Denver International Airport offers inexpensive connecting flights to Guatemala City that take a minimum of around six hours of travel time. I started to hear about this friend or that roommate who had visited — or even temporarily moved to — the Central American country over the past few years and couldn’t get enough of it.

Residents of Antigua, Guatemala, wake up every Sunday during Lent, and create alfombras — intricately designed “carpets” made of flower petals and sawdust dyed in every color. (Megan Ulu-Lani Boyanton/The Denver Post)

Social media platform TikTok features videos of jet-setters of every creed successfully journeying through the tourist destinations of Antigua and Lake Atitlán, offering tips on how to navigate the nation. By August, our accommodations were booked.

Both sets of our parents initially balked at the idea. My dad had previously flown to Guatemala City on business, and was confined within the limits of Central America’s largest metropolis. Like others in the baby boomer and Generation X demographics, much of what they’d grown up hearing about the country was related to its conditions during the Guatemalan Civil War, which lasted 36 years.

However, over the past decade, the nation’s tourism industry has consistently grown — minus a setback during the COVID-19 pandemic, according to data-gathering platform Statista. And I was hearing piqued interest from millennials and zoomers about making the trip south. Days before my trip, a shopping center clerk peppered me with questions about my itinerary as she considered doing the same.

After my editors gave me the green light to briefly chase a story on the ground, the trip became both work and play — four days off, two days on. I took the necessary precautions learned on my last reporting trip to Peru in the pre-COVID era: monitor travel advisories with the U.S. State Department, submit my itinerary to the agency’s Smart Traveler Enrollment Program and set an appointment with a travel clinic to get relevant vaccines.

With interviews set and bags packed, we hopped on our 6 a.m. American Airlines flight, then stopped briefly at the Dallas Fort Worth International Airport, before touching down in the early afternoon at La Aurora International Airport in Guatemala City. On the flight, our seat neighbor — a Guatemalan who planned to visit her family for a long weekend before heading back to the U.S. — excitedly shared her recommendations, then led us through the winding halls of the airport to customs and immigration.

Guatemala’s cash economy

After a quick and easy process, we were set to embark into a new country — and learned lessons pretty quickly. We brought cash because Guatemala is a cash-reliant economy, particularly outside of its capital city. The airport provides several opportunities to exchange dollars for quetzales, with $1 worth about 8 quetzales, as of mid-April. It’s best to fork over the added exchange fee there and avoid the inconvenience of hunting for a bank like we did later.

More than three million people reside in the city’s urban area, which is made up of 21 zones — some of which tourists are advised against visiting. We stayed one night in Zone 4, which a travel blog calls “the upcoming hipster area.” Zones 9 and 10 come highly recommended, too. We felt safe and relaxed in the neighborhood around our Airbnb — a unit in a modern apartment complex, with its own private patio.

Our plans for that first day were ambitious: see the National Palace of Culture, stop by the city’s market and eat dinner at steakhouse Hacienda Real Zona 10. Instead, we took in the sunset views on the rooftop of restaurant Los Tres Tiempos in the city’s historical district, cocktails and croquetas de pache — mozzarella croquettes made of Guatemalan potato dough — in hand, before turning in. But if you’re short on time or not a big city person, then you can skip visiting the capital like most tourists do.

Disclaimer: I’m not sure what it would be like to travel through Guatemala without a Spanish speaker by my side. Spanish and even some Mayan dialects take precedence over English throughout the country. Because that’s my partner’s first language, I didn’t have to put my rudimentary skills to the test. However, I encountered plenty of Europeans and North Americans who managed to make it from Point A to Point B.

Antigua

The next morning started with the one-hour drive west to the colonial city of Antigua. Visitors have several options for transportation. Uber is available, and we used it for a short ride in Guatemala City, but I’d read enough mixed reviews for me to largely opt against it. The bravest — and stingiest — of travelers sometimes ride the chicken buses: decorated buses that serve as public transportation. However, I’d also seen a litany of online grievances, as the buses can often run unreliably and feel crowded, with the risk of pickpockets.

Instead, we used private cars and shared shuttle services to travel from town to town, which are affordable by American standards. Viator Travel served as a trusty resource for finding highly-reviewed drivers, who often arrived early and provided a smooth ride.

Our two nights in Antigua left us wishing for more time. There, activities abound — sightseeing at the famous Santa Catalina Arch and Central Park, bartering at the massive Mercado Central and eating so many piping-hot tortillas. My go-to breakfast for days in a row: plantains, refried beans, farmer’s cheese and eggs soaked in salsa, scooped into tortillas and washed down with that famous Guatemalan coffee.

Explore the sprawling Mercado Central in Antigua, Guatemala, which has indoor and outdoor sections. (Megan Ulu-Lani Boyanton/The Denver Post)

Antigua is the place to buy souvenirs. I scored a Mayan cookbook, plus trinkets for my family like handmade worry dolls: tiny dolls that you tuck under your pillow to whisk away your stresses as you dream. It’s also the spot for nightlife, with several dozen bars and restaurants concentrated in a walkable area that’s both spotless and safe.

Speaking of walking, follow our lead and bring a duffle or weekend bag, instead of a suitcase. Otherwise, navigating the cobblestone roads can quickly turn into the bane of your existence. And wear comfortable sneakers. We walked almost 9 miles one day, but that’s the best way to find hole-in-the-wall joints like restaurant Cafeteria La Concepcion, which is where I tried the traditional dish of pepián de pollo, a Guatemalan chicken stew.

Depending on the timing of your trip, you could also experience a local festival. I was delighted to realize that we visited ahead of Semana Santa, or Holy Week, with Guatemala considered a deeply Christian country. Street vendors sell cheap delicacies, such as empanadas de leche, or sweet cream empanadas. Antigua residents wake up every Sunday during Lent and create alfombras — intricately designed “carpets” made of flower petals and sawdust dyed in every color — on the streets before the evening’s religious procession. Then, just hours later, the temporary creations are stepped on and swept up.

From Antigua, you can admire the surrounding peaks of towering volcanoes, and tour operators like OX Expeditions take hikers on excursions to Pacaya, Acatenango and Agua volcanoes. We signed up for an easy sunset hike up to Pacaya and its lava fields. The other two are known as longer, more intense endeavors. I would strongly advise any hiking hopefuls to cough up the money and join a group because robberies of solo tourists are common along the trails.

Lake Atitlán

My first work day was spent reporting in Jocotenango, a town on the outskirts of Antigua, with the team at the nonprofit Education for the Children Foundation. They run the School of Hope, a free private school for disadvantaged students. I chatted with pupils and teachers during the school day. Then, U.S. executive director Sara Miller drove me around town and up to La Vista Hermosa, a shantytown of homes built illegally on the hillside where about 150 of the school’s families reside.

As a journalist, I’m grateful to have spent those hours getting the perspective that tourists often don’t see, but, for that reason, I won’t highlight Jocotenango as a place that visitors need on their itineraries. Then, we hopped in a shared shuttle — a small van that fits 10 passengers — for the three-hour ride to Lake Atitlán. If you get car sick, then it is absolutely necessary to bring non-drowsy motion sickness medicine to survive the winding roads.

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Lake Atitlán is often referred to as “the Lake Como of Latin America,” referencing the Italian lake in the Alps’ foothills. It’s also held sacred by the nation’s Mayan population — Guatemala’s largest Indigenous group. Outside of Guatemala City, Native people in their traditional garb are a common sight. A Mayan woman typically wears a corte (skirt), huipil (blouse) and faja (belt), and you come across shops selling the clothing in different colors and patterns.

Upon arriving at the lake, you’re typically dropped off in Panajachel — one of almost a dozen towns and villages sitting on the water’s edge. There, I spent my final day of reporting at the headquarters of nonprofit Friendship Bridge, which works with Indigenous women entrepreneurs to provide loans, business training and more.

Nicknamed Pana, the town is accessible by car, but several of the most popular destinations can only be reached by boat. Before departing Pana for other lakeside locations, stock up on sunscreen, beer or any other desirable products because the small stores in the remote villages offer limited stock.

Public and private lanchas, or boats, float at the main dock to ferry locals and tourists across the lake. Beeline for the cheap public option, which costs 10 to 25 quetzales, or you could be swindled by a private captain into paying hundreds of quetzales for your own boat. It’s a longer wait as the water taxi loads up on passengers, but it’s worthwhile for your wallet.

The lake is a place to relax, swim and hop from village to village, which is exactly what my partner and I did on our last day of vacation. Boats are ever reliable on the lake, and you can flag one down at the nearest dock. But I wanted to try out a tuk-tuk — a doorless, three-wheeled vehicle, manned by a driver, who can transport you between towns. I highly recommend the very Guatemalan experience.

Our favorite village: San Juan La Laguna, which bursts with art, restaurants and merchants. Our least favorite: San Marcos La Laguna — a hippie haven, known for its yoga retreats and meditation centers. However, it felt very gentrified to me.

We didn’t get the chance to visit Santa Catarina Palopó, where the houses are painted in eye-popping colors. Cerro Tzankujil Nature Reserve has a prime spot for cliff jumping into the lake, which I’d add to my list when we return.

And that’s “when,” not “if,” because I’d happily fly back to Guatemala for a much longer trip in the future. Not only did I feel welcome and safe during my travels, but I also experienced an adventure that I won’t soon forget.

IF YOU GO

Where to eat:

Los Tres Tiempos, 6ta. Avenida “A” 10-13 Zona 01, Azotea Del Edificio Centro Vivo, Cuidad de Guatemala: A chic rooftop restaurant, this is the ideal spot to watch the sun set in Guatemala City’s historical district. Enjoy 360-degree views of the Central American metropolis on the outdoor patio.

Cafeteria La Concepcion, H75F+5C4, Antigua: This unpretentious, hole-in-the-wall restaurant offers a limited menu for low prices, with top-tier Guatemalan food like pepián de pollo.

Restaurante 7 Caldos, 3a Calle Oriente 24, Antigua: Enter through the cobblestone street into an open-air restaurant where you can watch as your tortillas are made fresh. The expansive menu, which includes cocktails, is sure to satisfy most cravings.

Café 22, 6a Calle Poniente 8, Antigua: This small café feels like your own private courtyard. Stop by for a cup of Guatemalan espresso and lunch.

Casa Troccoli, H758+773, 5a Avenida Norte, Antigua: With its romantic architecture and expansive garden, date night should go smoothly at Casa Troccoli. Its red sangria is a great way to cool off, so check it out for a quick drink or a meal.

Matt Vasilogambros | Stateline.org (TNS)

In April, Wisconsin joined 27 other states that have banned or restricted local governments’ use of private donations to run cash-strapped election offices, buy voting equipment or hire poll workers for Election Day.

All of the state laws came in the past four years, pushed by conservative lawmakers and activists who claim that Democratic voters disproportionately benefited from hundreds of millions of dollars in grants primarily funded by Facebook founder Mark Zuckerberg and his wife, Priscilla Chan, during the 2020 presidential election.

Courts and federal regulators have rejected those claims, but the debate over the role of outside money reveals a broader worry among election experts, who say there are significant shortcomings in local government funding of election offices. That includes not just Election Day duties and vote counting, but also the year-round administrative work of maintaining voter rolls and taking care of and updating voting equipment.

Local municipal budgets are tight, and they vary depending on the tax base. It can be hard to justify a new ballot-counting machine when there are potholes to fix or schools to fund.

The ongoing funding uncertainty is untenable, said Tammy Patrick, the chief executive officer for programs at the National Association of Election Officials. Election officials need to have consistent funding to know they can replace outdated equipment and provide a secure and efficient voting experience, she said.

“Ultimately and ideally, we wouldn’t need to run such a critical function of our democracy relying on volunteers or donations,” said Patrick, who is leading a national initiative to promote election funding. “Everyone wants our elections to be secure, accessible, legitimate. And in order to have that, we have to support our election administrators.”

Funding democracy

Counting ballots at 2:30 a.m. on election night in 2020, Dusty Farmer, the election clerk of Oshtemo Township, Michigan, realized she should have chosen a high-speed ballot tabulator.

When Michigan voters amended the state constitution in 2018 to allow for voting absentee without having to provide an excuse to officials, the number of mail-in ballots shot up and townships had to find a way to process those new ballots. Farmer opted for the less expensive, slower ballot processors.

After two years of lobbying her local board, she was able to secure the $40,000 high-speed counting machines last year — a “big investment” ahead of the 2024 election, she said.

“This isn’t a situation where we can just overcome it with pure grit and buck up and get it done,” Farmer said. “We need the tools to get it done.”

Money from Congress has been limited. This year, congressional leaders agreed to provide $55 million in election grant funding for states to distribute locally. That is around as much as Los Angeles County alone spent conducting a gubernatorial recall election in 2021.

State and local election officials could breathe easier about some of the cybersecurity challenges if they had more funding from Congress, Arizona Democratic Secretary of State Adrian Fontes said to a room of fellow secretaries of state at a Washington, D.C., meeting in February.

“This is an unfunded federal mandate, the only part of our critical infrastructure that does not have sustained federal funding,” he said.

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State money for elections varies widely. Lawmakers in some states do not allocate any of their budget to local election officials. In many cases, states just distribute federal grants for improving election security or as reimbursement for new equipment. Often, however, states hold onto federal grants dollars because they are unsure when the next installment from Congress might come.

Other states do allocate some local election funding in their budgets, but often not at a level that would allow for major equipment replacement, said Matthew Weil, executive director of the Democracy Program at the Bipartisan Policy Center, a D.C.-based think tank.

States such as Alabama, Colorado, Hawaii and Louisiana also reimburse localities for a portion of elections where statewide candidates are on the ballot, according to the National Conference of State Legislatures. Alaska and Delaware pay for all expenses of state and federal elections, while other states will pay for statewide special elections or presidential primary elections.

Funding elections mostly at the local level is not the model that is going to work for the future, Weil said.

But asking state governments to use their limited budgets on election equipment is politically tough, he added; it’s hard to cut a ribbon on a new $100 million voting system. Local governments spend as much on elections as they do to maintain parking facilities, according to a report by the MIT Election Data and Science Lab to the U.S. Election Assistance Commission in 2021.

“I don’t necessarily disagree with banning private funding in elections,” Weil said. “But that does require that counties, states and the federal government step up and fund elections at the levels they need to provide the services that voters have come to expect.”

Banning private money in elections

Four years ago, as thousands of Americans died every day during the height of the COVID-19 pandemic, local election officials hurriedly prepared for the 2020 presidential election, not knowing whether they had the money needed to allow voters to safely cast a ballot and for their staff to safely count those votes.

Foreseeing a democratic disaster, the Center for Tech and Civic Life, a Chicago-based nonprofit, used $350 million from Zuckerberg and Chan to hand out grants to nearly 2,500 local election offices across 49 states.

Local clerks, like Robin Cleveland of Williamstown Township, Michigan, used that money to buy personal protective equipment, pay and train temporary election workers, and run voter education campaigns.

The $5,000 private grant was essential for getting “desperately needed” supplies for her small community east of Lansing, Cleveland said. Though she feels supported by her township board, she has not been able to pay election workers more competitive wages nor replace “ancient” equipment — except in 2018, when she got a federal grant for new ballot tabulators.

“Basically, the money has to come from somewhere if we’re going to have safe, secure and accurate elections,” she wrote to Stateline in an email about private grants.

In Wisconsin, more than 200 communities received a collective $10 million in private grants. Green Bay, Kenosha, Madison, Milwaukee and Racine — the state’s most populous cities — received 86% of that money, according to a report by the Wisconsin Institute for Law & Liberty, a conservative litigation group that supported the ballot question to ban private donations for election administration. Those five cities accounted for nearly 18% of the state’s total registered voters.

It was important to prevent outside groups from potentially dictating terms for grants or giving the impression that the money is helping a certain political party, said Rick Esenberg, president of the Wisconsin Institute for Law & Liberty.

“It creates an appearance of impropriety, and it undermines confidence in the outcome of the election,” he said. “Elections are a public function that have to be undertaken with scrupulous neutrality.”

Esenberg doesn’t think elections are underfunded. If local election officials feel like they need more money, he said, they should go to their state legislature.

Voters approved the state’s new constitutional amendment by more than 54%.

Of the 28 states that have now enacted bans, only Pennsylvania supplemented its measure with more election funding. In 2022, then-Democratic Gov. Tom Wolf signed into law the compromise measure, which invested$45 million in local elections.

‘A total lifeline’

Before Wisconsin’s ban went into effect, Cities Forward, a nonprofit based in the state, awarded an$800,000 grant to Milwaukee for new ballot tabulators, text messaging services to reach voters and polling place upgrades. Madison was also able to spend$1.5 million from Center for Tech and Civic Life and U.S. Alliance for Election Excellence grants before the ban went into place.

The need hasn’t dissipated, said Tiana Epps-Johnson, founder and executive director of the Center for Tech and Civic Life, the nonprofit that drew conservative ire. Election officials need equipment, such as fast-counting ballot processing machines, to prevent delays in results that can fuel misinformation, she said.

“We hear from election officials in every corner of the country who are severely underfunded,” she said. “Right now, election officials run the risk of having equipment that is not up to the task of the demand that they’re going to see from voters this fall.”

Although the Center for Tech and Civic Life is not issuing grants this election cycle, it is a founding partner of the U.S. Alliance for Election Excellence, which has been distributing money to local offices in states that allow it in the years since the last presidential election.

Macoupin County, Illinois, a downstate farming community halfway between St. Louis and Springfield, recently received a $500,000 grant to create a new early voting center — an amount equivalent to two years of the county’s election budget.

The voting center, which opened in January, is in a building that used to house an insurance agency and law office. It sits across the street from the courthouse, where early voters used to have to cast ballots in cramped hallways, next to people waiting for their court dates. Election equipment was stored under staircases in a hallway or in the boiler room.

“It was a total lifeline that otherwise never would have happened,” said Pete Duncan, the county clerk. “While we would love for it to have been federal or state funding that came in to help get this accomplished, that’s just not something that the feds or states are interested in doing.”

Stateline is part of States Newsroom, a national nonprofit news organization focused on state policy.

©2024 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

Unlikely pop star Billie Eilish will return to St. Paul’s Xcel Energy Center for a two-night stand on Nov. 10 and 11. The massive world tour currently has 82 dates scheduled to run through July 2025.

Tickets go on sale for the Nov. 10 show at noon Friday followed by the Nov. 11 show at 1 p.m. Friday through Ticketmaster. American Express cardholders have access to a presale that runs from 1 p.m. Tuesday through 11 a.m. Friday. Neither the promoter nor the venue announced prices.

In an effort to thwart scalpers, the tour is using Ticketmaster’s Face Value Exchange, where fans can only resell tickets at face value. All tickets will be mobile only and restricted from transfer.

Eilish, 22, was born into an entertainment family, as both her parents are actors and musicians. Eilish and her older brother Finneas were both homeschooled and encouraged by their parents to explore songwriting. She penned her first song, inspired by the zombie TV series “The Walking Dead,” at age 11.

In 2015, Eilish released the song “Ocean Eyes” online and soon earned record label interest. The song later went triple platinum in the States and found success around the world. She has since issued more than 30 singles, many finding a similar reception, including “Bad Guy,” “Everything I Wanted,” “Therefore I Am” and “Happier than Ever.”

Despite her odd, downbeat songs and whispered (and/or mumbled) vocals, Eilish has also been embraced by the music industry. At the 2020 Grammy Awards, Eilish became the youngest (and second ever after Christopher Cross in 1981) to win the four major categories — best new artist and record, album and song of the year — on the same night. After further wins in 2021 and 2024, Eilish now has a total of nine Grammys. She also won best original song Oscars for her James Bond theme “No Time to Die” and “What Was I Made For?” from the “Barbie” soundtrack.

Eilish made her Twin Cities concert debut in April 2018 when she sold out 7th Street Entry. The following summer, she pulled off the same feat in the much-larger Armory and drew nearly 15,000 fans to her March 2022 debut at the X.

“Hit Me Hard and Soft,” Eilish’s third album, is due out May 17. For the tour, she is focusing on sustainability and is continuing her longtime relationship with environmental nonprofit Reverb, to which she’ll donate a portion of proceeds from ticket sales. She’s also encouraging fans to carpool or take public transportation to her concerts and to wear thrifted or borrowed clothing rather than purchasing new. Fans are also invited to bring an empty reusable water bottle as there will be free refill stations at the venue.

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Aaron Bolton, MTPR | KFF Health News (TNS)

KALISPELL, Mont. — On a cold February morning at the Flathead Warming Center, Tashya Evans waited for help with her Medicaid application as others at the shelter got ready for the day in this northwestern Montana city.

Evans said she lost Medicaid coverage in September because she hadn’t received paperwork after moving from Great Falls, Montana. She has had to forgo the blood pressure medication she can no longer pay for since losing coverage. She has also had to put off needed dental work.

“The teeth broke off. My gums hurt. There’s some times where I’m not feeling good, I don’t want to eat,” she said.

Evans is one of about 130,000 Montanans who have lost Medicaid coverage as the state reevaluates everyone’s eligibility following a pause in disenrollments during the COVID-19 pandemic. About two-thirds of those who were kicked off state Medicaid rolls lost coverage for technical reasons, such as incorrectly filling out paperwork. That’s one of the highest procedural disenrollment rates in the nation, according to a KFF analysis.

Even unsheltered people like Evans are losing their coverage, despite state officials saying they would automatically renew people who should still qualify by using Social Security and disability data.

As other guests filtered out of the shelter that February morning, Evans sat down in a spare office with an application counselor from Greater Valley Health Clinic, which serves much of the homeless population here, and recounted her struggle to reenroll.

She said that she had asked for help at the state public assistance office, but that the staff didn’t have time to answer her questions about which forms she needed to fill out or to walk her through the paperwork. She tried the state’s help line, but couldn’t get through.

“You just get to the point where you’re like, ‘I’m frustrated right now. I just have other things that are more important, and let’s not deal with it,’” she said.

Evans has a job and spends her free time finding a place to sleep since she doesn’t have housing. Waiting on the phone most of the day isn’t feasible.

Tashya Evans waits outside the Flathead Warming Center, a low-barrier shelter in Kalispell, Montana, on March 5, 2024. Evans had just finished work in time to join the line for a bed that evening. (Aaron Bolton/MTPR/TNS)

There’s no public data on how many unhoused people in Montana or nationwide have lost Medicaid, but homeless service providers and experts say it’s a big problem.

Those assisting unsheltered people who have lost coverage say they spend much of their time helping people contact the Montana Medicaid office. Sorting through paperwork mistakes is also a headache, said Crystal Baker, a case manager at HRDC, a homeless shelter in Bozeman.

“We’re getting mail that’s like, ‘Oh, this needs to be turned in by this date,’ and that’s already two weeks past. So, now we have to start the process all over again,” she said. “Now, they have to wait two to three months without insurance.”

Montana health officials told NPR and KFF Health News in a statement that they provided training to help homeless service agencies prepare their clients for redetermination.

Federal health officials have warned Montana and some other conservative states against disenrolling high rates of people for technicalities, also known as procedural disenrollment. They also warned states about unreasonable barriers to accessing help, such as long hold times on help lines. The Centers for Medicare & Medicaid Services said if states don’t reduce the rate of procedural disenrollments, the agency could force them to halt their redetermination process altogether. So far, CMS hasn’t taken that step.

Charlie Brereton, the director of the Montana health department, resisted calls from Democratic state lawmakers to pause the redetermination process. Redetermination ended in January, four months ahead of the federal deadline.

“I’m confident in our redetermination process,” Brereton told lawmakers in December. “I do believe that many of the Medicaid members who’ve been disenrolled were disenrolled correctly.

Health industry observers say that both liberal-leaning and conservative-leaning states are kicking homeless people off their rolls and that the redetermination process has been chaotic everywhere. Because of the barriers that unsheltered people face, it’s easy for them to fall through the cracks.

Margot Kushel, a physician and a homeless researcher at the University of California-San Francisco, said it may not seem like a big deal to fill out paperwork. But, she said, “put yourself in the position of an elder experiencing homelessness,” especially those without access to a computer, phone, or car.

If they still qualify, people can usually get their Medicaid coverage renewed — eventually — and it may reimburse patients retroactively for care received while they were unenrolled.

Kushel said being without Medicaid for any period can be particularly dangerous for people who are homeless. This population tends to have high rates of chronic health conditions.

“Being out of your asthma medicine for three days can be life-threatening. If you have high blood pressure and you suddenly stop your medicine, your blood pressure shoots up, and your risk of having a heart attack goes way up,” she said.

When people don’t understand why they’re losing coverage or how to get it back, that erodes their trust in the medical system, Kushel said.

Evans, the homeless woman, was able to get help with her application and is likely to regain coverage.

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Agencies that serve unhoused people said it could take years to get everyone who lost coverage back on Medicaid. They worry that those who go without coverage will resort to using the emergency room rather than managing their health conditions proactively.

Baker, the case manager at the Bozeman shelter, set up several callbacks from the state Medicaid office for one client. The state needed to interview him to make sure he still qualified, but the state never called.

“He waited all day long. By the fifth time, it was so stressful for him, he just gave up,” she said.

That client ended up leaving the Bozeman area before Baker could convince him it was worth trying to regain Medicaid.

Baker worries his poor health will catch up with him before he decides to try again.

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.