By Henry Larweh, KFF Health News

Fentanyl, the deadly synthetic opioid driving the nation’s high drug overdose rates, is also caught up in another increasingly serious problem: misinformation.

False and misleading narratives on social media, in news reports, and even in popular television dramas suggesting people can overdose from touching fentanyl — rather than ingesting it — are now informing policy and spending decisions.

In an episode of the CBS cop drama “Blue Bloods,” for instance, Detective Maria Baez becomes comatose after accidentally touching powdered fentanyl. In another drama, “S.W.A.T.,” Sgt. Daniel “Hondo” Harrelson warns his co-workers: “You touch the pure stuff without wearing gloves, say good night.”

While fentanyl-related deaths have drastically risen over the past decade, no evidence suggests any resulted from incidentally touching or inhaling it, and little to no evidence that any resulted from consuming it in marijuana products. (Recent data indicates that fentanyl-related deaths have begun to drop.)

There is also almost no evidence that law enforcement personnel are at heightened risk of accidental overdoses due to such exposures. Still, there is a steady stream of reports — which generally turn out to be false — of officers allegedly becoming ill after handling fentanyl.

“It’s only in the TV dramas” where that happens, said Brandon del Pozo, a retired Burlington, Vermont, police chief who researches policing and public health policies and practices at Brown University.

In fact, fentanyl overdoses are commonly caused by ingesting the drug illicitly as a pill or powder. And most accidental exposures occur when people who use drugs, even those who do not use opioids, unknowingly consume fentanyl because it is so often used to “cut” street drugs such as heroin and cocaine.

Despite what scientific evidence suggests about fentanyl and its risks, misinformation can persist in public discourse and among first responders on the front lines of the crisis. Daniel Meloy, a senior community engagement specialist at the drug recovery organizations Operation 2 Save Lives and QRT National, said he thinks of misinformation as “more of an unknown than it is an anxiety or a fear.”

“We’re experiencing it often before the information” can be understood and shared by public health and addiction medicine practitioners, Meloy said.

Some state and local governments are investing money from their share of the billions in opioid settlement funds in efforts to protect first responders from purported risks perpetuated through fentanyl misinformation.

In 2022 and 2023, 19 cities, towns, and counties across eight states used settlement funds to purchase drug detection devices for law enforcement agencies, spending just over $1 million altogether. Two mass spectrometers were purchased for at least $136,000 for the Greeley, Colorado, police department, “to protect those who are tasked with handling those substances.”

Del Pozo, the retired police chief, said fentanyl is present in most illicit opioids found at the scene of an arrest. But that “doesn’t mean you need to spend a lot of money on fentanyl detection for officer safety,” he said. If that spending decision is motivated by officer safety concerns, then it’s “misspent money,” del Pozo said.

Fentanyl misinformation is affecting policy in other ways, too.

Florida, for instance, has on the books a law that makes it a second-degree felony to cause an overdose or bodily injury to a first responder through this kind of secondhand fentanyl exposure. Similar legislation has been considered by states such as Tennessee and West Virginia, the latter stipulating a penalty of 15 years to life imprisonment if the exposure results in death.

Public health advocates worry these laws will make people shy away from seeking help for people who are overdosing.

“A lot of people leave overdose scenes because they don’t want to interact with police,” said Erin Russell, a principal with Health Management Associates, a health care industry research and consulting firm. Florida does include a caveat in its statute that any person “acting in good faith” to seek medical assistance for someone they believe to be overdosing “may not” be arrested, charged, or prosecuted.

And even when public policy is crafted to protect first responders as well as regular people, misinformation can undermine a program’s messaging.

Take Mississippi’s One Pill Can Kill initiative. Led by the state attorney general, Lynn Fitch, the initiative aims to provide resources and education to Mississippi residents about fentanyl and its risks. While it promotes the availability and use of harm reduction tools, such as naloxone and fentanyl test strips, Fitch has also propped up misinformation.

At the 2024 Mississippi Coalition of Bail Sureties conference, Fitch said, “If you figure out that pill’s got fentanyl, you better be ready to dispose of it, because you can get it through your fingers,” based on the repeatedly debunked belief that a person can overdose by simply touching fentanyl.

Officers on the ground, meanwhile, sometimes are warned to proceed with caution in providing lifesaving interventions at overdose scenes because of these alleged accidental exposure risks. This caution is often evidenced in a push to provide first responders with masks and other personal protective equipment. Fitch told the crowd at the conference: “You can’t just go out and give CPR like you did before.” However, as with other secondhand exposures, the risk for a fentanyl overdose from applying mouth-to-mouth is negligible, with no clinical evidence to suggest it has occurred.

Her comments underscore growing concerns, often not supported by science, that officers and first responders increasingly face exposure risks during overdose responses. Her office did not respond to questions about these comments.

Health care experts say they are not against providing first responders with protective equipment, but that fentanyl misinformation is clouding policy and risks delaying critical interventions such as CPR and rescue breathing.

“People are afraid to do rescue breathing because they’re like, ‘Well, what if there’s fentanyl in the person’s mouth,’” Russell said. Hesitating for even a moment because of fentanyl misinformation could delay a technique that “is incredibly important in an overdose response.”

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

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.”

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.

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©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.

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.

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

By Natalie Skowlund, KFF Health News

SILVERTHORNE, Colo. — When Adolfo Román García-Ramírez walks home in the evening from his shift at a grocery store in this central Colorado mountain town, sometimes he thinks back on his childhood in Nicaragua. Adults, he recollects, would scare the kids with tales of the “Mona Bruja,” or “Monkey Witch.” Step too far into the dark, they told him, and you might just get snatched up by the giant monstrous monkey who lives in the shadows.

Now, when García-Ramírez looks over his shoulder, it’s not monster monkeys he is afraid of. It’s U.S. Immigration and Customs Enforcement officers.

“There’s this constant fear that you’ll be walking down the street and a vehicle rolls up,” García-Ramírez, 57, said in Spanish. “They tell you, ‘We’re from ICE; you’re arrested,’ or, ‘Show me your papers.’”

Silverthorne, a commuter town between the ski meccas of Breckenridge and Vail, has been García-Ramírez’s home for the past two years. He works as a cashier at the grocery and shares a two-bedroom apartment with four roommates.

The town of nearly 5,000 has proved a welcome haven for the political exile, who was released from prison in 2023 after Nicaragua’s authoritarian government brokered a deal with the U.S. government to transfer more than 200 political prisoners to the U.S. The exiles were offered temporary residency in the U.S. under a Biden administration humanitarian parole program.

García-Ramírez’s two-year humanitarian parole expired in February, just a few weeks after President Donald Trump issued an executive order to end the program that had permitted temporary legal residency in the U.S. for hundreds of thousands of Cubans, Haitians, Nicaraguans, and Venezuelans, putting him at risk of deportation. García-Ramírez was stripped of his Nicaraguan citizenship when he came to the U.S. Just over a year ago, he applied for political asylum. He is still waiting for an interview.

“I can’t safely say I’m calm, or I’m OK, right now,” García-Ramírez said. “You feel unsafe, but you also feel incapable of doing anything to make it better.”

Vail and Breckenridge are world famous for their ski slopes, which attract millions of people a year. But life for the tourism labor force that serves Colorado’s mountain resorts is less glamorous. Residents of Colorado’s mountain towns experience high rates of suicide and substance use disorders, fueled in part by seasonal fluctuations in income that can cause stress for many in the local workforce.

The Latino communities who make up significant proportions of year-round populations in Colorado’s mountain towns are particularly vulnerable. A recent poll found more than 4 in 5 Latino respondents in the Western Slope region, home to many of the state’s rural ski resort communities, expressed “extremely or very serious” concern about substance use. That’s significantly higher than in rural eastern Colorado’s Morgan County, which also has a sizable Latino population, and in Denver and Colorado Springs.

Statewide, concerns about mental health have surged among Latinos in recent years, rising from fewer than half calling it an extremely or very serious problem in 2020 to more than three-quarters in 2023. Health care workers, researchers, and community members all say factors such as language differences, cultural stigma, and socioeconomic barriers may exacerbate mental health issues and limit the ability to access care.

“You’re not getting regular medical care. You’re working long hours, which probably means that you can’t take care of your own health,” said Asad Asad, a Stanford University assistant professor of sociology. “All of these factors compound the stresses that we all might experience in daily life.”

Add sky-high costs of living and an inadequate supply of mental health facilities across Colorado’s rural tourist destinations, and the problem becomes acute.

Now, the Trump administration’s threats of immigration raids and imminent deportation of anyone without legal U.S. residency have caused stress levels to soar. In communities around Vail, advocates estimate, a vast majority of Latino residents do not have legal status. Communities near Vail and Breckenridge have not experienced immigration raids, but in neighboring Routt County, home to Steamboat Springs, at least three people with criminal records have been detained by ICE, according to news reports. Social media posts falsely claiming local ICE sightings have further fueled concerns.

Yirka Díaz Platt, a bilingual social worker in Silverthorne originally from Peru, said a pervasive fear of deportation has caused many Latino workers and residents to retreat into the shadows. People have begun to cancel in-person meetings and avoid applying for government services that require submitting personal data, according to local health workers and advocates. In early February, some locals didn’t show up to work as part of a nationwide “day without immigrants” strike. Employers wonder whether they will lose valuable employees to deportation.

Some immigrants have stopped driving out of fear they will be pulled over by police. Paige Baker-Braxton, director of outpatient behavioral health at the Vail Health system, said she has seen a decline in visits from Spanish-speaking patients over the last few months.

“They’re really trying to keep to themselves. They are not really socializing much. If you go to the grocery stores, you don’t see much of our community out there anymore,” Platt said. “There’s that fear of, ‘No, I’m not trusting anyone right now.’”

Juana Amaya is no stranger to digging in her heels to survive. Amaya immigrated to the Vail area from Honduras in 1983 as a single mother of a 3-year-old and a 6-month-old. She has spent more than 40 years working as a house cleaner in luxury condos and homes around Vail, sometimes working up to 16 hours a day. With barely enough time to finish work and care for a family at home, she said, it is often hard for Latinos in her community to admit when the stress has become too much.

“We don’t like to talk about how we’re feeling,” she said in Spanish, “so we don’t realize that we’re dealing with a mental health problem.”

The current political climate has only made things worse.

“It’s had a big impact,” she said. “There are people who have small children and wonder what they’ll do if they’re in school and they are taken away somewhere, but the children stay. What do you do?”

Asad has studied the mental health impacts of deportation rhetoric on Latino communities. He co-authored a study, published last year in the journal Proceedings of the National Academy of Sciences, that found escalated deportation rhetoric may cause heightened levels of psychological distress in Latino noncitizens and even in Latino citizens.

Asad found that both groups may experience increased stress levels, and research has borne out the negative consequences of a parent’s lack of documentation on the health and educational attainment of their children.

“The inequalities or the hardships we impose on their parents today are the hardships or inequalities their children inherit tomorrow,” Asad said.

Despite heightened levels of fear and anxiety, Latinos living and working near Vail still find ways to support one another and seek help. Support groups in Summit County, home to Breckenridge and less than an hour’s drive from Vail, have offered mental health workshops for new immigrants and Latina women. Building Hope Summit County and Olivia’s Fund in Eagle County, home to Vail, help those without insurance pay for a set number of therapy sessions.

Vail Health plans to open a regional inpatient psychiatric facility in May, and the Mobile Intercultural Resource Alliance provides wraparound services, including behavioral health resources, directly to communities near Vail.

Back in Silverthorne, García-Ramírez, the Nicaraguan exile, takes things one day at a time.

“If they deport me from here, I’d go directly to Nicaragua,” said García-Ramírez, who said he had received a verbal death threat from authorities in his native country. “Honestly, I don’t think I would last even a day.”

In the meantime, he continues to make the routine trek home from his cashier job, sometimes navigating slick snow and dark streets past 9 p.m. When nightmarish thoughts about his own fate in America surface, García-Ramírez focuses on the ground beneath his feet.

“Come rain, shine, or snow,” he said, “I walk.”

This article was published with the support of the Journalism & Women Symposium (JAWS ) Health Journalism Fellowship, assisted by grants from The Commonwealth Fund.

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

By Kacie Goff, Bankrate.com

Per the 2024 National Association of Realtors (NAR) Member Profilec, a typical agent had 10 transactions in the last year. With roughly one deal closing per month, the agent you hire should theoretically have bandwidth to provide you with the best possible service.

If that doesn’t ring true for your current experience, however, it could be time for a change. You might be wondering when to fire your Realtor. Or, more pressingly, how to fire your real estate agent.

Let’s take a look at when to make that call — and how to navigate a firing legally.

How to know when to fire your Realtor

We’re all only human, so it’s OK if an agent makes a mistake or two. But you may want to consider finding a new real estate rep if you spot several of these red flags:

• They don’t communicate well. Your agent should be reachable and communicative with you. If they take a long time to get back to you, it can impact your ability to see listings and put in offers before the competition. And if you feel like they’re not being straightforward with you, or possibly even lying, that’s a deal-breaker. Speaking in jargon is another issue — politely ask them to explain anything you don’t understand.
• They’re not marketing your home well. Today, real estate pros have a wide range of options they can use to get the word out about your listing. If your home isn’t turning up on leading listing sites or is otherwise poorly positioned, you might want to figure out how to fire your real estate agent.
• There’s a personality clash. Your agent is navigating one of the biggest decisions of your life with you. You want to feel comfortable working with them. If your personalities don’t mesh well, you might be better served by finding someone else. Trust your instincts. If it doesn’t feel right, it probably isn’t.
• They’re overly pushy or aggressive. An agent’s job is to advocate for you — not against you. Someone who is argumentative or tries to pressure you into things you feel uncomfortable with is not a good fit.
• They act unprofessional. Everyone has a different work style, but there are a few behaviors that just won’t fly. If they consistently show up late to appointments (or not at all), come unprepared, lack knowledge about the property or seem distracted during your interactions, be wary. This shows a lack of respect for you as a client.
• They’re unfamiliar with the market. A good agent stays informed about their local market. If they don’t know about current market trends in your area, how can they help you find the best place or make the best deal possible? Make sure to arrange regular and continual updates from your agent on market conditions, recent sales, new listings, available inventory and price trends.
• They demonstrate a lack of skills. Whether it’s helping you stage your for-sale home or negotiating on price, you want an agent who knows what they’re doing. No one likes to feel like they left money on the closing table, whether you’re the buyer or the seller.

How to fire your real estate agent

Don’t leap to a firing right away. If you’re unhappy with your agent, you may still be able to mend the relationship: Try communicating with them openly in a non-confrontational way about the issues you have. If the issues persist, it’s probably time to let them go. You’ll need to do so legally, ensuring you’re in compliance with any agreements or contracts you signed. The last thing you want is an expensive court battle.

Once you know when to fire your Realtor or real estate agent, you can take certain steps. Those vary slightly between buyers and sellers, so we outline them separately below.

If you follow these steps, be polite and respectful. Your dissatisfaction with the agent will reflect badly on them and probably hurt their career, so be mindful not to make the impact of your feedback worse.

If you’re a buyer

If you had someone helping you buy a home, figuring out how to fire your real estate agent means:

• Checking if you’ve signed anything: If nothing’s in writing and your dealings with the agent have remained informal, then you’re in the clear to walk away.
• Reviewing what you’ve signed: If you’ve signed a buyer’s agent agreement, you’re bound by the criteria in that agreement.
• Pursuing termination rights: Agreements do typically spell out termination rights, though, so review those carefully. If the agent hasn’t held up their end of the bargain (e.g., has missed appointments or made mistakes on documentation), you may be within your legal rights to terminate the relationship before the agreement ends. If you have a real estate attorney, you may want to have them write the termination letter to avoid any complications or liability.
• Trying to make things work: If you have a written agreement with the agent that you can’t get out of, go directly to the agent. Tell them what you need to see change. Writing a list of the issues at hand might help them understand the situation and where they need to make adjustments. Then, give the agent some time to see if they improve. Be constructive and show them you’re interested in creating a positive relationship that works for both of you.
• Escalating the issue as needed: If you’re somewhat stuck and can’t get anywhere with the agent on your own, now’s a good time to escalate the issue to the agent’s brokerage, or the company for which they work. The broker there functions somewhat like the agent’s boss, and may be able to help you and the agent find a better path forward.
• Seeing if they’ll agree to termination: Sometimes, the agent or their broker will allow you to terminate your agreement early when things aren’t going well. You can request that and hope they agree.
• Waiting out the timeline: Buyer’s agreements usually tie you to your agent until the time period specified in the agreement runs out. That probably means sticking with that agent for several months if you haven’t found resolution with them or their broker.

If you’re a seller

For folks who’ve been working with an agent to sell, the process is similar but comes with some differences. Go through these steps if you’re a seller trying to figure out how to fire your real estate agent.

• Checking if you’ve signed anything: If you’ve just been informally chatting, you’re under no obligation. But if your home is already on the market, you’ve likely signed with a listing agent. A listing agent, also called a seller’s agent, usually invests more time and effort in your property upfront, such as pulling comps, marketing the home and holding open houses. This investment makes it trickier to break up with them.
• Figuring out what you’ve signed: The most common agreement a seller would have with a listing agent is an exclusive right to sell, meaning the agent is solely responsible for bringing in prospective buyers and selling your property. It also usually means you’re responsible for paying their commission.
• Seeing if you can get out of it: Your agreement with the agent might lay out requirements for them, and termination rights for you if they don’t live up to those. Make sure they are unambiguous. You may be able to dissolve the agreement if any of those termination rights apply to your situation.
• Raising your complaints with the agent: If no termination rights apply, write down what’s going wrong for you. Craft a letter or list you can share with the agent to help them understand what you need from them. Sharing this with them in a face-to-face, non-confrontational discussion is probably best. Don’t be accusatory or attempt to place blame.
• Going to their broker: Real estate agents legally have to work under the supervision of a broker. This person essentially acts as their boss, so getting them involved can help redirect the agent. They don’t want to lose the listing or suffer the reputational damage, so they should go out of their way to solve the problems and accommodate you.
• Asking for termination: With your list of issues in hand, you can ask the agent and/or their broker if they’re willing to terminate your agreement with them early. If the situation is difficult, they might agree. If they agree, get a written release and a waiver of liability. Also, get a list of all the people they have shown your home to. If any of those people subsequently buy your house, you’ll have to pay a commission.
• Waiting out the agreement: If nothing else works, you’ll need some patience. Your exclusive right to sell agreement should have an expiration date. After that point, you’re free to work with another agent.

Tips for hiring the right agent

You’ve been burned — it’s OK, it happens. But now you want to make sure it doesn’t happen again, and find someone who you really click with.

When you’re looking for a new real estate agent, make sure you do your research. Ask friends and family for recommendations. Search online and read reviews. Once you narrow it down to a few candidates, schedule time to interview them, and don’t be afraid to ask questions. Find out about their experience and market knowledge. And trust your gut — working with someone you genuinely like is always best.

Bottom line

Know the signs of a bad real estate agent. You don’t have to settle for someone you don’t like and don’t work well with, or someone who isn’t doing a good job for you. Walk away or figure out how to terminate or wait out the contract. Then, take your time to find a new agent who will meet your needs and work to get you what you want.

FAQs

How do you write a termination letter to a real estate agent?

The letter should have a header that provides your contact information so the brokerage can know which agreement you want to terminate. In the letter, explain why you’re terminating the agreement. Refer specifically to the factual elements that are the basis for termination. Don’t elaborate or exaggerate. Make sure to also mention the specific termination clause from the agreement that you’re calling on.

How do you deal with an unprofessional Realtor?

First, be clear and direct with them. If they’re late for an appointment, for example, tell them that it made you feel disrespected as a client. If they don’t respond to your feedback, escalate the issue to their broker. It is always good to keep a written record of issues and conversations with the agent.

What is unethical Realtor behavior?

If someone is a Realtor, it means they’ve agreed to abide by the NAR’s Code of Ethics. Anything outside of that code, then, is considered unethical. Some common issues here include misrepresenting or concealing facts, discriminating, an unwillingness to work with other agents when it best serves the client and not being transparent about any kickbacks they receive.

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©2025 Bankrate.com. Distributed by Tribune Content Agency, LLC.

By Vinod Sreeharsha, Miami Herald

Carnival Corp. is putting the finishing touches on a new destination for cruise passengers.

Beginning in July, Doral-based Carnival will send ships between PortMiami and Celebration Key, a private development in the Bahamas.

Described by the cruise ship company as “a new destination from the ground up,” Celebration Key is on the southern side of Grand Bahama island and about 17 miles northeast of Freeport.

When finished, the resort will have its own pier with two berths where Carnival’s largest ships can dock. In 2026, the pier at Celebration Key will add two more berths so a total of four Carnival ships can dock at the same time.

The resort will feature water slides for kids, scuba diving and other sports, and excursions. And there will be restaurants and bars that passengers can reach by walking or swimming.

Costing $600 million, the destination is the latest in major cruise carriers betting big time on private islands or resorts built from the ground up. The new stops give cruisers more beach time, expand group activities and bring in more money.

Royal Caribbean, also based in Miami, is developing a third private space in Mexico that’s expected to be ready in 2027. The company’s other two private resorts are in Labadee, Haiti, and Coco Cay in the Bahamas. Norwegian Cruise Line has Great Stirrup Cay, also in the Bahamas.

Carnival is so keen on Celebration Key that 20 of its 27 ships plan to sail there, including all five ships that call PortMiami home: Carnival Celebration, Carnival Horizon, Carnival Sunrise, Carnival Conquest and Carnival Magic. Ships sailing from Baltimore, New Orleans and Galveston will also head there this year.

Carnival Conquest, which does three-and four-day trips to the Bahamas, will be the first PortMiami-based ship to visit Celebration Key, departing South Florida on July 18.

At the construction site

“Celebration Key represents a new chapter for Carnival and its construction builds on our close partnership with the Bahamas,” Christine Duffy, president of Carnival Cruise Line, said in a statement. “Seeing it transform from vision to reality is incredible.”

Duffy visited the under-construction Celebration Key in February, along with Carnival Corp. Chief Executive Officer Josh Weinstein and Chief Maritime Officer Lars Ljoen. The cruise executives joined leaders from the organization Plant a Tree and replanted about 1,000 sabal palms, a nod to the role their industry needs to play in increasing sustainability.

Duffy also took part in “the ceremonial filling of one of two expansive freshwater lagoons, the largest in the Caribbean.” These will be sustained by Celebration Key’s desalination system that converts seawater into freshwater. The lagoons span over seven acres and hold about seven million gallons of water.

Carnival broke ground on the project less than three years ago. About 500 Bahamian workers are on the 65-acre site around the clock to make sure the resort is ready by July.

The cruises from Miami that will stop at Celebration Key range from a three-day weekend cruise on Carnival Conquest to a 13-day trip starting from Barcelona on Carnival Journeys. Carnival Celebration will offer a variety of seven-day cruises to the eastern and western Caribbean that stop at the new resort.

The resort expects to have more than 30 restaurants and bars, from full-service sit-downs to self-ordering food trucks.

The development is broken down into different areas.

Paradise Plaza is the welcoming area. Starfish Lagoon has recreation and relaxation. Calypso Lagoon has an adult-only area with a DJ island and a large swim-up bar. Pearl Cove Beach Club is a premium adult-only space with an infinity pool and beachfront cabanas. Pearl Cove Beach Club will offer beachfront daybeds, private cabanas and Super Villas, each of which includes access to the club’s open bar service, infinity pool, full-service restaurant and beachfront.

Here is a rundown on the food and drinks:

Food on Carnival’s Celebration Key

Calypso Lagoon

—Mingo’s Tropical Bar & Kitchen, named after the Bahamas’ national bird the flamingo, is a full-service, Carnival-run restaurant offering Bahamian favorites including fried fish and conch fritters, as well as burgers, seafood, tacos, steak and sandwiches. Mingo’s bar will serve tropical frozen drinks and cocktails.

—Mingo’s Express food truck, just outside the restaurant, has self-ordering kiosks and shaded seating, and to-go hamburgers, salads and fish sandwiches.

—Surf N’ Sauce BBQ & Brews is a full-service dining spot serving slow-smoked meat prepared in an outdoor smoker. A full-service bar pours craft beer from Bahamian breweries.

Starfish Lagoon

—Gill’s Grill, a full-service restaurant and full bar, cooks up Caribbean seafood including seafood baskets, local fish, lobster, steamed crab and shrimp, chicken, burgers and kids’ meals.

—Captain’s Galley Food Hall features five outlets serving burgers, hot dogs, fried chicken, pizza, Mediterranean bowls, tacos and burritos.

—Food trucks with self-ordering kiosks offer chicken sandwiches, burgers and conch fritters.

Pearl Cove Beach Club

—Pearl Cove Beach Club restaurant in an area for guests 18 and older.

Beverages on Celebration Key

Calypso Lagoon

—Long Necks Bar is where you can grab one of 100 seats and order a frozen drink, beer or Bahamian cocktail while a DJ spins tunes.

—The Sunshine Swings Bar has 40 swings and offers a “chill vibe.”

—The Parrotfish Swim-Up Bar has seating in-water and out-of-water and serves frozen cocktails and mocktails with tropical fruit juice.

Pearl Cove Beach Club

—An infinity pool overlooks the beach and a swim-up bar

Paradise Plaza

—A welcome area where you can get your caffeine fix or energy boost with coffee and ice cream.

Carnival cruise reservations

You can book sailings taking place into 2027. To learn more about sailings and make reservations, visit the Carnival website at carnival.com.

©2025 Miami Herald. Visit miamiherald.com. Distributed by Tribune Content Agency, LLC.

By Scott S. Greenberger, Stateline.org

Working-age adults who live in small towns and rural areas are more likely to be covered by Medicaid than their counterparts in cities, creating a dilemma for Republicans looking to make deep cuts to the health care program.

About 72 million people— nearly 1 in 5 people in the United States — are enrolled in Medicaid, which provides health care coverage to low-income and disabled people and is jointly funded by the federal government and the states. Black, Hispanic and Native people are disproportionately represented on the rolls, and more than half of Medicaid recipients are people of color.

Nationwide, 18.3% of adults who are between the ages of 19 and 64 and live in small towns and rural areas are enrolled, compared with 16.3% in metro areas, according to a recent analysis by the Center for Children and Families at Georgetown University.

In 15 states, at least a fifth of working-age adults in small towns and rural areas are covered by Medicaid, and in two of those states — Arizona and New York — more than a third are. Eight of the 15 states voted for President Donald Trump.

Twenty-six Republicans in the U.S. House represent districts where Medicaid covers more than 30% of the population, according to a recent analysis by The New York Times. Many of those districts have significant rural populations, including House Speaker Mike Johnson’s 4th Congressional District in Louisiana.

Republican U.S. Rep. David Valadao of California, whose Central Valley district is more than two-thirds Hispanic and where 68% of the residents are enrolled in Medicaid, has spoken out against potential cuts.

“I’ve heard from countless constituents who tell me the only way they can afford health care is through programs like Medicaid, and I will not support a final reconciliation bill that risks leaving them behind,” Valadao said to House members in a recent floor speech.

U.S. House Republicans are trying to reduce the federal budget by $2 trillion as they seek $4.5 trillion in tax cuts. GOP leaders have directed the House Energy and Commerce Committee, which oversees Medicaid and Medicare, to find $880 billion in savings.

Trump has ruled out cuts to Medicare, which covers older adults. That leaves Medicaid as the only other program big enough to provide the needed savings — and the Medicaid recipients most likely to be in the crosshairs are working-age adults. But targeting that population would have a disproportionate impact on small towns and rural areas, which are reliably Republican.

Furthermore, hospitals and other health care providers in rural communities are heavily reliant on Medicaid. Many rural hospitals are struggling, and nearly 200 have closed or significantly scaled back their services in the past two decades.

Before the Affordable Care Act was enacted in 2010, there were far fewer working-age adults on the Medicaid rolls: The program mostly covered children and their caregivers, people with disabilities and pregnant women. But under the ACA, states are allowed to expand Medicaid to cover adults making up to 138% of the federal poverty level — about $21,000 a year for a single person. As an inducement to expand, the federal government covers 90% of the costs — a greater share than what the feds pay for the traditional Medicaid population.

Last year, there were about 21.3 million people who received coverage through Medicaid expansion.

One GOP cost-saving idea is to reduce the federal match for that population to what the feds give states for the traditional Medicaid population, which ranges from 50% for the wealthiest states to 77% for the poorest ones. That would reduce federal spending by $626 billion over a 10-year period, according to a recent analysis by KFF, a health research group.

Nine states — Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah and Virginia — have so-called trigger laws that would automatically end Medicaid expansion if the feds reduce their share. Three other states — Idaho, Iowa and New Mexico — would require other cost-saving steps.

“States will not be able to cover those shortfalls,” said Jennifer Driver, senior director of reproductive rights at the State Innovation Exchange, a left-leaning nonprofit that advocates on state legislative issues. “It’s not cutting costs. It is putting people in real danger.”

Studies have shown that Medicaid expansion has improved health care for a range of issues, including family planning, HIV care and prevention, and postpartum health care.

Another idea is to require able-bodied Medicaid recipients to work. That would affect an average of 15 million enrollees each year, and 1.5 million would lose eligibility for federal funding, resulting in federal savings of about $109 billion over 10 years.

In heavily rural North Carolina, which has a trigger law, there are about 3 million people on Medicaid, and 640,000 of them are eligible under the state’s expansion program. About 231,000 of the expansion enrollees live in rural counties. Black residents make up about 36% of new enrollees under the state’s eligibility expansion, but only about 22% of the state’s population.

Brandy Harrell, chief of staff at the Foundation for Health Leadership & Innovation, an advocacy group based in Cary, North Carolina, that focuses on rural issues, said the proposed Medicaid cuts would “deepen the existing disparities” between white people and Black people and urban and rural residents.

“It would have a profound effect on working families by reducing access to essential health care, increasing financial strain and jeopardizing children’s health,” Harrell said. “Cuts could lead to more medical debt, and also poorer health outcomes for our state.”

Two of the North Carolina lawmakers with about 30% of their constituents on Medicaid, U.S. Reps. Virginia Foxx and Greg Murphy, represent heavily rural districts in western and coastal North Carolina, respectively.

Foxx has supported GOP budget priorities in social media posts. Murphy, a physician and co-chair of the GOP Doctors Caucus in the House, has focused his statements on taking care of what he says is abuse and fraud in the Medicaid system.

But North Carolina Democratic Gov. Josh Stein sent a letter to U.S. House and Senate leaders of both parties, saying the state’s rural communities disproportionately rely on Medicaid and that cuts would upend an already fragile landscape for rural hospitals in the state.

“The damage to North Carolina’s health care system, particularly rural hospitals and providers, would be devastating, not to mention to people who can no longer afford to access health care,” Stein wrote.

In Nebraska, 27% of residents live in rural areas, and state lawmakers are already scrambling to make up for reduced federal Medicaid funding.

Dr. Alex Dworak, a family medicine physician who works at an Omaha health clinic that serves low-income and uninsured people, said a dearth of health care options in rural Nebraska already hurts residents. He has one patient who drives up to three hours from his rural community to the clinic.

“It wouldn’t be just bad for marginalized communities, but it would be worse for marginalized communities — because things were already worse for them,” Dworak said of proposed Medicaid cuts. “It will be an utter disaster.”

Stateline reporter Nada Hassanein and Stateline’s Barbara Barrett contributed to this report. Scott S. Greenberger can be reached at sgreenberger@stateline.org.

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

By Mia Taylor, TravelPulse

Anxiety surrounding air travel has been growing among the public in recent weeks and months.

With the deadly crash in Washington, D.C., earlier this year and several near misses, as well as FAA staff being slashed by the new U.S. president, it’s not exactly surprising that uneasiness is spiking.

If turbulence is one of the factors that causes you anxiety when flying, here is some news to notice: A new study has been released that identifies the most turbulent air travel routes globally.

The study was conducted by turbulence tracking company Turbli and is based on a review of turbulence forecast data provided by NOAA and the UK Met Office. The result of this effort is a ranking of the most unstable flight routes worldwide.

And coming in at the top of the list (meaning the most turbulent flight route) is the route from Mendoza, Argentina, and Santiago, Chile. The eddy dissipation rate (EDR), which is essentially turbulence intensity, associated with this route is 24.684.

To put that into some context, that’s 4 EDR greater than the second most turbulent flight path identified by the research. Coming in second is the route between Cordoba, Argentina and Santiago, Chile, which has an EDR of 20.214.

As it turns out the third most turbulent route on the list is also an Argentina-based route. It is the route between Mendoza, Argentina and Salta, Argentina. This flight route has an EDR of 19.825.

Turbulence is an irregular motion of the air resulting from eddies and vertical currents, according to the National Weather Service.

“Turbulence is one of the most unpredictable of all the weather phenomena that are of significance to pilots,” says the National Weather Service website. “It may be as insignificant as a few annoying bumps or severe enough to momentarily throw an airplane out of control or to cause structural damage.”

Turbulence is associated with fronts, wind shear and thunderstorms.

Here are the top 10 most turbulent routes globally

• Mendoza (MDZ) – Santiago (SCL) 
EDR: 24.684
• Cordoba (COR) – Santiago (SCL) 
EDR: 20.214
• Mendoza (MDZ) – Salta (SLA) 
EDR: 19.825
• Mendoza (MDZ) – San Carlos de Bariloche (BRC) 
EDR: 19.252
• Kathmandu (KTM) – Lhasa (LXA) 
EDR: 18.817
• Chengdu (CTU) – Lhasa (LXA) 
EDR: 18.644
• Santa Cruz (VVI) – Santiago (SCL) 
EDR: 18.598
• Kathmandu (KTM) – Paro (PBH) 
EDR: 18.563
• Chengdu (CTU) – Xining (XNN) 
EDR: 18.482
• San Carlos de Bariloche (BRC) – Santiago (SCL) 
EDR: 18.475

©2025 Northstar Travel Media, LLC. Visit at travelpulse.com. Distributed by Tribune Content Agency, LLC.