“It would not matter if the governor himself walked in and said, ‘I need to get this prescription filled,’” said Clint Hopkins, a pharmacist and co-owner of Pucci’s Pharmacy in Sacramento, California. “If I’m losing money on it, it’s a no.”

A regulation that took effect in January changes prescription prices for Medicare beneficiaries. For years, prices included pharmacy performance incentives, possible rebates, and other adjustments made after the prescription was filled. Now the adjustments are made first, at the pharmacy counter, reducing the overall cost for patients and the government. But the new system means less money for pharmacies that acquire and stock medications, pharmacists say.

Pharmacies are already struggling with staff shortages, drug shortages, fallout from opioid lawsuits, and rising operating costs. While independent pharmacies are most vulnerable, some big chain pharmacies are also feeling a cash crunch — particularly those whose parent firms don’t own a pharmacy benefit manager, companies that negotiate drug prices between insurers, drug manufacturers, and pharmacies.

A top official at the Centers for Medicare & Medicaid Services said it’s a matter for pharmacies, Medicare insurance plans, and PBMs to resolve.

“We cannot interfere in the negotiations that occur between the plans and pharmacy benefits managers,” Meena Seshamani, director of the Center for Medicare, said at a conference on June 7. “We cannot tell a plan how much to pay a pharmacy or a PBM.”

Nevertheless, CMS has reminded insurers and PBMs in several letters that they are required to provide the drugs and other benefits promised to beneficiaries.

Several independent pharmacists told Ģ��ӰԺ Health News they’ll soon cut back on the number of medications they keep on shelves, particularly brand-name drugs. Some have even decided to stop accepting certain Medicare drug plans, they said.

As he campaigns for reelection, President Joe Biden has touted his administration’s moves to make prescription drugs more affordable for Medicare patients, hoping to appeal to voters troubled by rising health care costs. His achievements , the Inflation Reduction Act, that caps the price of insulin at $35 a month for Medicare patients; caps Medicare patients’ drug spending at $2,000 a year, beginning next year; and allows the program to bargain down drug prices with manufacturers.

More than 51 million people have Medicare drug coverage. CMS officials estimated the new rule reducing pharmacy costs would save beneficiaries $26.5 billion from 2024 through 2032.

Medicare patients’ prescriptions can account for at least 40% of pharmacy business, according to a by the National Community Pharmacists Association.

Independent pharmacists say the new rule is causing them financial trouble and hardship for some Medicare patients. Hopkins, in Sacramento, said that some of his newer customers used to rely on a local grocery pharmacy but came to his store after they could no longer get their medications there.

The crux of the problem is cash flow, the pharmacists say. Under the old system, pharmacies and PBMs reconciled rebates and other behind-the-scenes transactions a few times a year, resulting in pharmacies refunding any overpayments.

Now, PBM clawbacks happen immediately, with every filled prescription, reducing pharmacies’ cash on hand. That has made it particularly difficult, pharmacists say, to stock brand-name drugs that can cost hundreds or thousands of dollars for a month’s supply.

Some patients have been forced to choose between their pharmacy and their drug plan. Kavanaugh Pharmacy in Little Rock, Arkansas, no longer accepts Cigna and Wellcare Medicare drug plans, said co-owner and pharmacist Scott Pace. He said the pharmacy made the change because the companies use Express Scripts, a PBM that has cut its reimbursements to pharmacies.

“We had a lot of Wellcare patients in 2023 that either had to switch plans to remain with us, or they had to find a new provider,” Pace said.

Pace said one patient’s drug plan recently reimbursed him for a fentanyl patch $40 less than his cost to acquire the drug. “Because we’ve had a long-standing relationship with this particular patient, and they’re dying, we took a $40 loss to take care of the patient,” he said.

Conceding that some pharmacies face cash-flow problems, Express Scripts recently decided to accelerate payment of bonuses for meeting the company’s performance measures, said spokesperson Justine Sessions. She declined to answer questions about cuts in pharmacy payments.

Express Scripts, which is owned by The Cigna Group, last year, second to CVS Health, which had 34% of the market.

In North Carolina, pharmacist Brent Talley said he recently lost $31 filling a prescription for a month’s supply of a weight control and diabetes drug.

To try to cushion such losses, Talley’s Hayes Barton Pharmacy sells CBD products and specialty items like reading glasses, bath products, and books about local history. “But that’s not going to come close to making up the loss generated by the prescription sale,” Talley said.

His pharmacy also delivers medicines packaged by the dose to Medicare patients at assisted living facilities and nursing homes. Reimbursement arrangements with PBMs for that business are more favorable than for filling prescriptions in person, he said.

When Congress added drug coverage to Medicare in 2003, lawmakers privatized the benefit by requiring the government to contract with commercial insurance companies to manage the program.

Insurers offer two options: Medicare Advantage plans, which usually cover medications, in addition to hospital care, doctor visits, and other services; as well as stand-alone drug plans for people with traditional Medicare. The insurers then contract with PBMs to negotiate drug prices and pharmacy costs with drug manufacturers and pharmacies.

The terms of PBM contracts are generally secret and restrict what pharmacists can tell patients — for example, if they’re asked why a drug is out of stock. (It took an act of Congress in 2018 to eliminate restrictions on disclosing a drug’s cash price, which can sometimes be less than an insurance plan’s copayment.)

The Pharmaceutical Care Management Association, a trade group representing PBMs, warned CMS repeatedly “that pharmacies would likely receive lower payments under the new Medicare Part D rule,” spokesperson Greg Lopes said. His group opposes the change.

Recognizing the new policy could cause cash-flow problems for pharmacies, Medicare officials had delayed implementation for a year before the rule took effect, giving them more time to adjust.

“We have heard pharmacies saying that they have concerns with their reimbursement,” Seshamani said.

But the agency isn’t doing enough to help now, said Ronna Hauser, senior vice president of policy and pharmacy affairs at the National Community Pharmacists Association. “They haven’t taken any action even after we brought potential violations to their attention,” she said.

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Si este mes se aprueban las nuevas reglas de protección laboral contra el calor extremo, los empleadores del estado más poblado del país tendrán que buscar el modo de proporcionar alivio a las personas que trabajan en almacenes asfixiantes, cocinas llenas de vapor y otros espacios peligrosamente calurosos.

Estas mismas normas se extenderán a las escuelas, donde profesores, conserjes, quienes atienden las cafeterías y otros empleados suelen trabajar sin aire acondicionado, igual que sus alumnos.

“Nuestras condiciones de trabajo son las mismas que las de los estudiantes”, dijo Jeffery Freitas, presidente de la Federación de Maestros de California, que representa a más de 120.000 docentes y otros empleados de la educación. “Estamos asistiendo a un cambio sin precedentes en el medio ambiente y sabemos a ciencia cierta que cuando hace demasiado calor, los niños no pueden aprender”.

Está previsto que el 20 de junio una junta estatal de seguridad laboral vote las nuevas normas. Si así fuera, es probable que estén vigentes para el verano.

La medida, que muestra el último esfuerzo del gobernador demócrata Gavin Newsom por responder a los crecientes impactos del cambio climático y el calor extremo, pondría a California a la delantera del gobierno federal y de la mayoría del país en la creación de leyes sobre el calor excesivo.

Estas normas van a exigir que los lugares de trabajo en interiores se mantengan refrigerados por debajo de los 87 grados Fahrenheit cuando los empleados estén presentes. En aquellos lugares donde los trabajadores llevan ropa protectora o están expuestos al calor radiante, como ocurre con los hornos, la temperatura no debería superar los 82 grados.

Las escuelas y otros lugares de trabajo que no dispongan de equipos de aire acondicionado podrán utilizar ventiladores, rociadores y otros métodos que ayuden a reducir la temperatura ambiente.

Las normas permiten soluciones alternativas para las empresas que no pueden refrigerar suficientemente sus lugares de trabajo, incluidos los aproximadamente 1.000 distritos escolares del estado.

En esos casos, los empleadores deben proporcionar a los trabajadores agua, descansos, zonas donde puedan refrescarse, chalecos refrigerantes u otros medios para evitar que los empleados sufran de calor excesivo.

“El calor es un peligro mortal, independientemente del tipo de trabajo que se realice”, afirma Laura Stock, miembro del Consejo de Normas de Seguridad y Salud en el Trabajo. “Si tienes un espacio laboral interior poblado tanto por trabajadores como por el público, o en este caso por niños, ellos tendrían los mismos riesgos para su salud que los que tienen los trabajadores”.

Históricamente, las olas de calor golpeaban fuera del ciclo escolar. Pero el las está haciendo más largas, frecuentes e intensas.

El año pasado fue y las de todo Estados Unidos cerraron de forma intermitente durante la primavera y el verano, incapaces de mantener frescos a los alumnos.

Y los científicos dicen que este año .

En mayo, las autoridades escolares de Vicksburg, en Mississippi, dieron por antes de lo previsto por problemas con los aparatos de aire acondicionado. En California, la primera ola de calor de la temporada se está produciendo cuando algunas escuelas todavía están dando clases, con temperaturas que alcanzan los .

Varios estados, entre ellos y , exigen que las escuelas tengan aparatos de aire acondicionado en buenas condiciones, pero no que los hagan funcionar. Mississippi exige que , pero no especifica a qué temperatura debe ser colocado.

Las escuelas de Hawaii deben tener las aulas a una “temperatura aceptable para facilitar el aprendizaje de los alumnos”, pero no se especifica cuál es esa temperatura. Cuando el termómetro en el interior de las escuelas marca los 80 grados, deben intentar refrescar las aulas, por ejemplo, usando ventiladores, y deben proporcionar a los profesores y a otros empleados formas de refrescarse, como agua y períodos de descanso.

Cuando el sol recalienta la biblioteca en Bridges Academy en Melrose, una escuela pública en el este de Oakland que tiene poca sombra y pocos árboles, Christine Schooley cierra las cortinas y apaga las computadoras para enfriar su aula. Dejó de usar un ventilador después que el cabello largo de una niña quedó atrapado en él.

“Mi biblioteca es el lugar más caluroso del campus porque por aquí pasan 120 chicos al día”, explica Schooley. “Aquí hace calor. Y eso también me pone de mal humor e irritable”.

Un análisis realizado en 2021 por el Center for Climate Integrity sugiere que casi 14.000 escuelas públicas alrededor del país que no necesitaban aire acondicionado en 1970 ahora sí lo necesitan, porque experimentan anualmente 32 días de temperaturas superiores a los 80 grados. Adaptar el sistema costaría más de .

Los investigadores calcularon que instalar aire acondicionado en 678 escuelas de California obligaría a gastar unos .

No está claro cuántas escuelas de California podrían necesitar instalar aire acondicionados u otros equipos de refrigeración para cumplir las nuevas normas, porque el estado no hace un seguimiento de las que ya los tienen, dijo V. Kelly Turner, directora asociada del Centro Luskin para la Innovación de la Universidad de California-Los Ángeles.

Un distrito escolar del norte del estado no se enfrentaría a los mismos desafíos que otro situado en las ciudades desérticas de Needles o Palm Springs, dijo Naj Alikhan, vocero de la Asociación de Administradores Escolares de California, que no se ha pronunciado sobre las normas propuestas.

Un encargado por la junta estatal de seguridad laboral proporcionó estimaciones de costos para una serie de industrias, como almacenamiento, manufactura y construcción. Pero este estudio no tenía una estimación para los distritos escolares, que conforman uno de los sistemas de más grandes del estado y ya enfrentan un en las actualizaciones necesarias.

El Departamento de Educación estatal no se ha pronunciado sobre la propuesta y un portavoz, Scott Roark, declinó hacer comentarios sobre el posible costo para las escuelas.

Este año, el gobierno de Newsom se negó a aprobar las normas de calefacción interior después que las proyecciones mostraran que adecuar las prisiones estatales a las temperaturas extremas tendría un costo multimillonario. Desde entonces, para decenas de miles de empleados de prisiones y cárceles, así como para los reclusos.

Tampoco está claro si la normativa se aplicará a los autobuses escolares, muchos de los cuales no tienen aire acondicionado. El Departamento de Relaciones Industriales, que supervisa la junta de seguridad de los trabajadores, no ha respondido a las preguntas de los funcionarios escolares ni de Ģ��ӰԺ Health News.

Libia García está preocupada por su hijo de 15 años, que pasa al menos una hora al día viajando en un autobús escolar caluroso y mal ventilado desde su casa en la comunidad rural de Huron, en el Valle Central, hasta su instituto y viceversa. “Cuando mi hijo llega a casa, está agotado y deshidratado”, dijo García. “No tiene energía ni para hacer los deberes ni para nada”.

La está presionando a los legisladores estatales para que aprueben un proyecto de ley de . Esto le exigiría al estado que desarrolle un plan maestro para actualizar los sistemas de calefacción y aire acondicionado de las escuelas. El año pasado, Newsom similar, alegando su costo.

Las campañas para bajar la temperatura en las escuelas en otros estados han dado resultados desiguales. Este año, las leyes de y fracasaron. En tanto, en , la norma pasó a la Asamblea estatal.

El mes pasado, un sindicato docente de Nueva York llevó un sauna portátil al Capitolio del estado para demostrar cuánto calor puede hacer dentro de las aulas. “Sólo una cuarta parte tiene aire acondicionado”, explicó Melinda Person, presidenta de la Unión de Maestros del Estado de Nueva York.

“Existen límites de temperatura para los refugios de animales. ¿Cómo es que no los tenemos para las aulas?”, dijo Chris Eachus, miembro demócrata de la Asamblea de Nueva York, cuyo proyecto de ley obligaría a las escuelas a tomar medidas de alivio cuando las aulas y los edificios escolares alcancen los 82 grados. “Tenemos que proteger la salud y la seguridad de los niños”, declaró.

El calor extremo es la primera causa de muerte relacionada con el clima en Estados Unidos, más mortífera que los huracanes, las inundaciones y los tornados. El estrés térmico puede causar insolación, paro cardíaco e insuficiencia renal.

Los Centros para el Control y Prevención de Enfermedades (CDC) informaron que en 2021 relacionadas con el calor, lo que probablemente sea una cifra inferior a la real porque los profesionales de salud no están obligados a notificarlas. No está claro cuántas de estas muertes están relacionadas con el trabajo, ya sea en ámbitos laborales interiores o al aire libre.

En California, las normas de protección para los empleados que trabajan al aire libre ante temperaturas rigen . Las reglas para los que trabajan en lugares cerrados han estado en desarrollo desde 2016, aunque se han retrasado en parte por la pandemia de covid.

A nivel federal, la administración Biden ha tardado en publicar una normativa para proteger a los trabajadores de interior y exterior de la exposición a los calores extremos. Aunque un funcionario dijo que se espera un borrador este año, su futuro podría depender de las elecciones presidenciales de noviembre. Si gana el ex presidente Donald Trump, es poco probable que las normas que afectan a las empresas salgan adelante.

El gobierno federal celebró en abril una cumbre sobre . Allí, altos funcionarios animaron a los distritos escolares a aplicar una inyección de nuevos fondos federales para mejorar las infraestructuras educativas envejecidas. La administración también dio a conocer una para que los distritos escolares aprovechen los fondos federales.

“La forma en que invertimos en nuestros edificios y predios escolares marca la diferencia en la vida de nuestros alumnos”, declaró en la cumbre Roberto Rodríguez, subsecretario del Departamento de Educación de EE. UU. “Ellos son los primeros en sentir el impacto”.

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It was the first time Xcel Energy preemptively switched off electricity in Colorado as a wildfire prevention tool, according to a company official. The practice, also known as public safety power shut-offs, has and is as a way to keep downed and damaged power lines from sparking blazes and fueling the West’s more frequent and intense wildfires.

In Boulder, Frasier staff and residents heard about the planned outage from news reports. A Frasier official called the utility to confirm and was initially told the home’s power would not be affected. The utility then called back to say the home’s power would be cut, after all, said Tomas Mendez, Frasier’s vice president of operations. The home had just 75 minutes before Xcel Energy shut off the lights on April 6.

Staff rushed to prepare the 20-acre campus home to nearly 500 residents. Generators kept running the oxygen machines, most refrigerators and freezers, hallway lights, and Wi-Fi for phones and computers. But the heating system and some lights stayed off as the overnight temperature dipped into the 30s.

Power was restored to Frasier after 28 hours. During the shut-off, staff tended to nursing home and assisted living residents, many with dementia, Mendez said.

“These are the folks that depend on us for everything: meals, care, and medications,” he said.

Not knowing when power would be restored, even 24 hours into the crisis, was stressful and expensive, including the next-day cost of refilling fuel for two generators, Mendez said.

“We’re lucky we didn’t have any injuries or anything major, but it is likely these could happen when there are power outages — expected or unexpected. And that puts everyone at risk,” Mendez said.

As preemptive power cuts become more widespread, nursing homes are being forced to evaluate their preparedness. But it shouldn’t be up to the facilities alone, according to industry officials and academics: Better communication between utilities and nursing homes, and including the facilities in regional disaster preparedness plans, is critical to keep residents safe.

“We need to prioritize these folks so that when the power does go out, they get to the front of the line to restore their power accordingly,” said David Dosa, chief of geriatrics and professor of medicine at UMass Chan Medical School in Worcester, Massachusetts, of nursing home residents.

Restoring power to hospitals and nursing homes was a priority throughout the windstorm, wrote Xcel Energy spokesperson Tyler Bryant in an email. But, he acknowledged, public safety power shut-offs can improve, and the utility will work with community partners and the Colorado Public Utilities Commission to help health facilities prepare for extended power outages in the future.

When the forecast called for wind gusts of up to 100 mph on April 6, Xcel Energy implemented a public safety power shut-off. Nearly 275,000 customers were without power from the windstorm.

Officials had adapted after the Marshall Fire killed two people and destroyed or damaged more than 1,000 homes in Boulder and the neighboring communities of Louisville and Superior two and a half years ago. Two fires converged to form that blaze, and electricity from an Xcel Energy power line that detached from its pole in hurricane-force winds “” of one of them.

“A preemptive shutdown is scary because you don’t really have an end in mind. They don’t tell you the duration,” said Jenny Albertson, director of quality and regulatory affairs for the Colorado Health Care Association and Center for Assisted Living.

More than half of nursing homes in the West are within 3.1 miles of an area with elevated wildfire risk, according to a . Yet, nursing homes with the greatest risk of fire danger in the Mountain West and Pacific Northwest had poorer compliance with federal emergency preparedness standards than their lower-risk counterparts.

Under federal guidelines, nursing homes must have disaster response plans that include or building evacuation. Those plans don’t necessarily include contingencies for public safety power shut-offs, in the past five years but are still relatively new. And nursing homes in the West are rushing to catch up.

In California, a more stringent law to bring emergency power in nursing homes up to code is expected by the California Association of Health Facilities to . But the state has not allocated any funding for these facilities to comply, said Corey Egel, the association’s director of public affairs. The association is asking state officials to delay implementation of the law for five years, to Jan. 1, 2029.

Most nursing homes operate on a razor’s edge in terms of federal reimbursement, Dosa said, and it’s incredibly expensive to retrofit an old building to keep up with new regulations.

Frasier’s three buildings for its 300 residents in independent living apartments each have their own generators, in addition to two generators for assisted living and skilled nursing, but none is hooked up to emergency air conditioning or heat because those systems require too much energy.

Keeping residents warm during a minus-10-degree night or cool during two 90-degree days in Boulder “are the kinds of things we need to think about as we consider a future with preemptive power outages,” Mendez said.

Federal audits of emergency preparedness at nursing homes in and found facilities lacking. In Colorado, eight of 20 nursing homes had deficiencies related to emergency supplies and power, according to the report. These included three nursing homes without plans for alternate energy sources like generators and four nursing homes without documentation showing generators had been properly tested, maintained, and inspected.

For Debra Saliba, director of UCLA’s Anna and Harry Borun Center for Gerontological Research, making sure nursing homes are part of emergency response plans could help them respond effectively to any kind of power outage. Her after a magnitude 6.7 earthquake that shook the Los Angeles area in 1994 motivated LA County to integrate nursing homes into community disaster plans and drills.

Too often, nursing homes are forgotten during emergencies because they are not seen by government agencies or utilities as health care facilities, like hospitals or dialysis centers, Saliba added.

Albertson said she is working with hospitals and community emergency response coalitions in Colorado on disaster preparedness plans that include nursing homes. But understanding Xcel Energy’s prioritization plan for power restoration would also help her prepare, she said.

Bryant said Xcel Energy’s prioritization plan for health facilities specifies not whether their electricity will be turned off during a public safety power shut-off — but how quickly it will be restored.

Julie Soltis, Frasier’s director of communications, said the home had plenty of blankets, flashlights, and batteries during the outage. But Frasier plans to invest in headlamps for caregivers, and during a town hall meeting, independent living residents were encouraged to purchase their own backup power for mobile phones and other electronics, she said.

Soltis hopes her facility is spared during the next public safety power shut-off or at least given more time to respond.

“With weather and climate change, this is definitely not the last time this will happen,” she said.

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In April, in a 3-2 vote, the FTC prohibiting contracts that prevent an employee from taking a job with a competitor. Calling the noncompete agreements “a widespread and often exploitative practice,” an agency announcement described them as an unfair method of competition that depresses wages and hinders new business formation.

The rule bars employers in most industries, including health care, from using contract clauses that block employees from leaving for other jobs or starting a competing business in the same geographic area for a fixed period of time.

But that doesn’t help many health professionals, because the FTC Act gives the agency authority over companies organized to operate for profit but not over nonprofit, charitable organizations, which are also tax-exempt.

Still, the agency noted some nonprofits could be bound by the rule if they do not operate as true charities. The rule establishes a two-part test to determine if the FTC has jurisdiction over a nonprofit — whether the organization is carrying on business for only charitable purposes, and whether its income goes to public rather than private interests.

“Our rulemaking record includes powerful stories from health care workers who are employed by nonprofits about how noncompetes hurt patients and providers,” said FTC Commissioner Rebecca Kelly Slaughter, one of three Democratic commissioners, before the April 23 vote. “I do not think there is a good justification for them to be excluded from this rule.”

Noncompete contract terms for physicians, nurse practitioners, and other medical professionals in hospitals and various health care facilities. Some providers say these agreements have forced them to leave their communities and patients behind if they wanted to exit unethical or unsafe workplace conditions.

of U.S. community hospitals are nonprofits or government-owned, and they employ many of the nation’s medical professionals. As of 2022, nearly three-quarters of U.S. physicians were employed by , both nonprofit and for-profit.

Based on their designation as charities that don’t have to pay income or property taxes, U.S. nonprofit hospitals received a total estimated tax exemption of , according to Ģ��ӰԺ, a nonpartisan research organization.

That exceeded the estimated $16 billion they spent on charity care for patients unable to afford their medical bills, Ģ��ӰԺ said.

Physician and nursing groups say it makes no sense to treat nonprofit hospitals differently because they are just as money-driven as for-profit hospitals. Patients, they say, will benefit if providers are free to call out unsafe conditions and change jobs. “Giving physicians freedom of movement will force hospitals to compete to improve working conditions,” said Jonathan Jones, immediate past president of the American Academy of Emergency Medicine.

Chad Golder, general counsel and secretary of the American Hospital Association, which represents mostly nonprofit hospitals, said the rule would increase health care costs and reduce patient access by triggering hospital bidding wars for physicians. He predicted the FTC would try to apply the rule to both nonprofit and for-profit hospitals.

“They aren’t saying exactly what they’ll do, but it’s a pretty significant move for them to say we’ll apply our own test to determine if we can regulate a nonprofit,” Golder said. “Nonprofit entities now will need to be extra careful.”

In addition, some nonprofit hospitals have joint ventures with for-profit hospitals and medical groups. That could create complicated questions about whether their employee contracts come under the rule, said Chip Kahn, president and CEO of the Federation of American Hospitals, which represents for-profits.

The new rule arose from President Joe Biden’s 2021 executive order to curb the unfair use of noncompete agreements, part of his broader mandate to boost U.S. economic competition and worker mobility.

The FTC argued that banning noncompetes, which it said cover 1 in 5 American workers, would lower health care costs by up to $194 billion over the next decade. It will ensure Americans “freedom to pursue a new job, start a new business, or bring a new idea to market,” FTC Chair Lina Khan said.

The rule also prohibits contract terms that function like noncompetes to stop employees from leaving to work for competing companies or start their own businesses. These might include overbroad nondisclosure agreements, training repayment provisions, and nonsolicitation clauses.

“No one should be trapped in an unsafe job by onerous contracts that prevent them from taking another job,” said Brynne O’Neal, a regulatory policy specialist at National Nurses United, the profession’s largest dedicated labor union in the U.S. Hospitals, she said, use that require nurses to pay as much as $30,000 in training costs if they leave, essentially locking them in their jobs.

California, Minnesota, North Dakota, and Oklahoma already ban enforcement of noncompete clauses for all employees of both nonprofits and for-profits, while prohibit noncompetes for physicians. Even in states without bans, when they have found them to be overbroad or unreasonable.

Hospital executives argue that the noncompete rule will force them to compete against each other to hire physicians and other providers and ultimately cost them more, and that it advantages nonprofits over for-profits. “All it would do is increase the price of labor in a field that already has labor shortages and thin margins,” Golder said.

“The nonprofit hospital across the street could pursue our employees, while their employees would be protected, and that’s a basic fairness issue,” Kahn said.

But Clifford Atlas, an employment attorney with Jackson Lewis in New York, said that argument against the noncompete rule “won’t fly” in court because preventing competition for the services of physicians or other workers is not a business interest that’s protected by law or public policy.

The rule is set to take effect in September, though business groups against it in Texas and . Many legal experts predict that conservative judges will strike down the rule on the grounds that it .

Physician and nurses’ groups hope the FTC rule, whatever its fate in the courts, helps persuade hospitals and other health care employers to stop using noncompetes and to prohibit them.

“We’re telling our members it could be struck down, but we’re asking them to renegotiate their contracts,” said Jones of the American Academy of Emergency Medicine. “They should be asking their employers, ‘Wouldn’t you like to be on the right side and not to be seen as fighting against physicians and patients?’”

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Billings-based RiverStone Health is eliminating 42 jobs this spring, cutting nearly 10% of its workforce. The cuts have shuttered an inpatient hospice facility, will close a center for patients managing high blood pressure, and removed a nurse who worked within rural schools. It also reduced the size of the clinic’s behavioral health care team and the number of staffers focused on serving people without housing.

RiverStone Health CEO Jon Forte said clinic staffers had anticipated a shortfall as the cost of business climbed in recent years. But a $3.2 million loss in revenue, which he largely attributed to Montana officials disenrolling a high number of patients from Medicaid, pushed RiverStone’s deficit much further into the red than anticipated.

“That has just put us in a hole that we could not overcome,” Forte said.

RiverStone is one of federally funded clinics in the U.S. that adjust their fees based on what individuals can pay. They’re designed to reach people who face disproportionate barriers to care. Some are in rural communities, where offering primary care can come at a financial loss. Others concentrate on vulnerable populations falling through cracks in urban hubs. Altogether, these clinics serve more than 30 million people.

The health centers’ lifeblood is revenue received from Medicaid, the state-federal subsidized health coverage for people with low incomes or disabilities. Because they serve a higher proportion of low-income people, the federally funded centers tend to have a larger share of patients on the program and rely on those reimbursements.

But Medicaid enrollment is undergoing a seismic shift as states reevaluate who is eligible for it, a process known as the Medicaid “unwinding.” It follows a two-year freeze on disenrollments that protected people’s access to care during the covid public health emergency.

As of May 23, people had lost coverage, including about 134,000 in Montana — 12% of the state’s population. Some no longer met income eligibility requirements, but the vast majority were booted because of paperwork problems, such as people missing the deadline, state documents going to outdated addresses, or system errors.

That means health centers increasingly offer care without pay. Some have seen patient volumes drop, which also means less money. When providers like RiverStone cut services, vulnerable patients have fewer care options.

Jon Ebelt, communications director of the Montana Department of Public Health and Human Services, said the agency isn’t responsible for individual organizations’ business decisions. He said the state is focused on maintaining safety-net systems while protecting Medicaid from being misused.

Nationwide, health centers face a similar problem: a perfect financial storm created by a sharp rise in the cost of care, a tight workforce, and now fewer insured patients. In recent months, clinics in California and Colorado have also announced cuts.

“It’s happening in all corners of the country,” said Amanda Pears Kelly, CEO of Advocates for Community Health, a national advocacy group representing federally qualified health centers.

Nearly a quarter of community health center patients who rely on Medicaid were cut from the program, from George Washington University and the National Association of Community Health Centers. On average, each center lost about $600,000.

One in 10 centers either reduced staff or services, or limited appointments.

“Health centers across the board try to make sure that the patients know they’re still there,” said Joe Dunn, senior vice president for public policy and advocacy at the National Association of Community Health Centers.

Most centers operate on shoestring budgets, and some started reporting losses as the workforce tightened and the cost of business spiked.

Meanwhile, federal assistance — money designed to cover the cost of people who can’t afford care —remained largely flat. Congress increased those funds in March to roughly $7 billion over 15 months, though health center advocates said that still doesn’t cover the tab.

Until recently, RiverStone in Montana had been financially stable. Before the pandemic, the organization was making money, according to financial audits.

In summer 2019, a $10 million expansion was starting to pay off. RiverStone was serving more patients through its clinic and pharmacy, a revenue increase that more than offset increases in operating costs, according to documents.

But in 2021, at the height of the pandemic, those growing expenses — staff pay, building upkeep, the price of medicine, and medical gear — outpaced the cash coming in. By last summer, the company had an operational loss of about $1.7 million. With the Medicaid redetermination underway, RiverStone’s pool of covered patients shrank, eroding its financial buffer.

Forte said the health center plans to ask state officials to increase its Medicaid reimbursement rates, saying existing rates don’t cover the continuum of care. That’s a tricky request after the state slightly last year following much debate around which services needed more money.

Some health center cuts represent a return to pre-pandemic staffing, after temporary federal pandemic funding dried up. But others are rolling back long-standing programs as budgets went from stretched to operating in the red.

California’s Petaluma Health Center in March laid off 32 people hired during the pandemic, reported, or about 5% of its workforce. It’s one of the largest primary care providers in Sonoma County, based on where people live and poverty is more prevalent in largely Hispanic neighborhoods.

Clinica Family Health, which has clinics throughout Colorado’s Front Range, laid off 46 people, or about 8% of its staff, in October. It has consolidated its dental program from three clinics to two, closed a walk-in clinic meant to help people avoid the emergency room, and ended a home-visit program for patients recently discharged from the hospital.

Clinica said 37% of its patients on Medicaid before the unwinding began lost their coverage and are now on Clinica’s discount program. This means the clinic now receives between $5 and $25 for medical visits that used to bring in $220-$230.

“If it’s a game of musical chairs, we’re the ones with the last chair. And if we have to pull it away, then people hit the ground,” said CEO Simon Smith.

Stephanie Brooks, policy director of the Colorado Community Health Network, which represents Colorado health centers, said some centers are considering consolidating or closing clinics.

Colorado and Montana have among the nation’s . Officials in both states have defended their Medicaid redetermination process, saying most people dropped from coverage likely no longer qualify, and they point to low unemployment rates as a factor.

In many states, health providers and patients alike have provided examples in which people cut from coverage still qualified and had to spend months entangled in system issues to regain access.

Forte, with RiverStone, said reducing services on the heels of a pandemic adds insult to injury, both for health care workers who stayed in hard jobs and for patients who lost trust that they’ll be able to access care.

“This is so counterproductive and counterintuitive to what we’re trying to do to meet the health care needs of our community,” Forte said.

Ģ��ӰԺ Health News correspondent Rae Ellen Bichell in Longmont, Colorado, contributed to this report.

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As of May 30, only three people in the United States had tested positive after being exposed to a wave of bird flu spreading among cows. Those people, dairy farm workers in Texas and Michigan, experienced eye irritation. One of them also had a cough and sore throat.

Scientists warn the virus could mutate to spread from person to person like the seasonal flu, which could spark a pandemic. By keeping tabs on farmworkers, researchers could track infections, learn how dangerous they are, and be alerted if the virus becomes more infectious.

But people generally get tested when they seek treatment for illnesses. Farmworkers rarely do that, because many lack health insurance and paid sick leave, said Elizabeth Strater, director of strategic campaigns for the national group United Farm Workers. They are unlikely to go to a doctor unless they become very ill.

Strater said about 150,000 people work in U.S. dairies. She said many worker advocates believe the virus has spread to more people than tests are showing. “The method being used to surveil at-risk workers has been very passive,” she said.

Federal officials told reporters May 22 that just 40 people connected to U.S. dairy farms had been tested for the virus, although others are being “actively monitored” for symptoms.

Federal authorities they would pay farmworkers $75 each to be tested for the virus, as part of a new program that also offers incentives for farm owners to allow testing of their dairy herds.

Officials of the federal Centers for Disease Control and Prevention said they recognize the importance of gaining cooperation and trust from front-line dairy employees.

CDC spokesperson Rosa Norman said in an email that the incentive payment compensates workers for their time contributing to the monitoring of how many people are infected, how sick they become, and whether humans are spreading the virus to each other.

She noted the CDC believes the virus currently poses a .

But Strater is skeptical of the incentive for farmworkers to be checked for the virus. If a worker tests positive, they’d likely be instructed to go to a clinic then stay home from work. She said they couldn’t afford to do either.

“That starts to sound like a really bad deal for 75 bucks, because at the end of the week, they’re supposed to feed their families,” she said.

Katherine Wells, director of public health in Lubbock, Texas, said that in her state, health officials would provide short-term medical care, such as giving farmworkers the flu treatment Tamiflu. Those arrangements wouldn’t necessarily cover hospitalization if it were needed, she said.

She said the workers’ bigger concern appears to be that they would have to stay home from work or might even lose their jobs if they tested positive.

Many farmworkers , and they often labor in grueling conditions for little pay.

They may fear attention to cases among them will inflame anti-immigrant fervor, said Monica Schoch-Spana, a medical anthropologist at the Johns Hopkins Center for Health Security.

Societies have a long marginalized communities for the spread of contagious diseases. Latino immigrants were verbally attacked during the H1N1 “swine flu” pandemic in 2009, for example, and some media personalities used the outbreak to push for a crackdown on immigration.

Bethany Boggess Alcauter, director of research and public health programs at the National Center for Farmworker Health, said many workers on dairy farms have been told very little about this new disease spreading in the cows they handle. “Education needs to be a part of testing efforts, with time for workers to ask questions,” she said.

These conversations should be conducted in the farmworkers’ language, with people they are likely to trust, she said.

Georges Benjamin, executive director of the American Public Health Association, said public health officials must make clear that workers’ immigration status will not be reported as part of the investigation into the new flu virus. “We’re not going to be the police,” he said.

Dawn O’Connell, an administrator at the Department of Health and Human Services, said in a press conference May 22 that nearly 5 million doses of a vaccine against H5N1, the bird flu virus circulating in cattle, are being prepared, but that officials have not decided whether the shots will be offered to farmworkers when they’re ready later this year.

The CDC asked states in early May to share personal protective equipment with farm owners, to help them shield workers from the bird flu virus. State health departments in California, Texas, and Wisconsin, which have large dairy industries, all said they have offered to distribute such equipment.

Chris Van Deusen, a Texas health department spokesperson, said four dairy farms had requested protective equipment from the state stockpile. He said other farms may already have had what they needed. Spokespeople for the California and Wisconsin health departments said they did not immediately receive requests from farm owners for the extra equipment.

Strater, the United Farm Workers official, said protective equipment offerings need to be practical.

Most dairy workers already wear waterproof aprons, boots, and gloves, she said. It wouldn’t be realistic to expect them to also wear N95 face masks in the wet, hot conditions of a milking operation, she said. Plastic face shields seem like a better option for that environment, especially to prevent milk from spraying into workers’ eyes, where it could cause infection, she said.

Other types of agricultural workers, including those who work with chickens, also face potential infection. But scientists say the version of the virus spreading in cows could be particularly dangerous, because it has adapted to live in mammals.

Strater said she’s most worried about dairy workers, who spend 10 to 12 hours a day in enclosed spaces with cows.

“Their faces are approximately 5 inches away from the milk and the udders all day long,” she said. “The intimacy of it, where their face is so very close to the infectious material, is different.”

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Hasta ahora, solo dos personas en Estados Unidos han dado positivo después de estar expuestas a una ola de gripe aviar que se está propagando entre vacas. Estas personas, trabajadores de granjas lecheras , experimentaron irritación en los ojos.

Los científicos advierten que el virus podría mutar para propagarse de persona a persona como la gripe estacional, lo que podría desencadenar una pandemia. Monitoreando a los trabajadores agrícolas, los investigadores podrían rastrear infecciones, aprender cuán peligrosas son y estar alertas si el virus se vuelve más contagioso.

Pero las personas generalmente se hacen pruebas cuando buscan tratamiento para enfermedades. Y los trabajadores agrícolas rara vez lo hacen, porque muchos no tienen seguro médico ni licencia por enfermedad remunerada, dijo Elizabeth Strater, directora de campañas estratégicas del grupo nacional United Farm Workers.

Es poco probable que vayan al médico a menos que se enfermen mucho.

Strater dijo que aproximadamente 150,000 personas trabajan en tambos en el país. Agregó que muchos defensores de estos trabajadores creen que el virus se ha propagado a más personas de las que muestran las pruebas. “El método que se está utilizando para vigilar a los trabajadores en riesgo ha sido muy pasivo”, dijo.

El 22 de mayo, funcionarios federales dijeron a periodistas que solo 40 personas relacionadas con tambos habían sido evaluadas para el virus, aunque otras están siendo “monitoreadas activamente” para detectar síntomas.

Las autoridades federales que pagarían $75 a cada trabajador agrícola para que se hiciera la prueba para detectar la gripe aviar, como parte de un nuevo programa que también ofrece incentivos para que los propietarios de granjas permitan la prueba en sus rebaños lecheros.

Oficiales de los Centros para el Control y Prevención de Enfermedades (CDC) dijeron que reconocen la importancia de obtener cooperación y confianza de los empleados lecheros de primera línea.

Rosa Norman, vocera de los CDC, dijo en un correo electrónico que el pago es un incentivo que compensa a los trabajadores por su tiempo contribuyendo al monitoreo de cuántas personas están infectadas, cuánto se enferman y si el virus se está propagando entre humanos.

Señaló que los CDC creen que el virus actualmente representa .

Pero Strater es escéptica respecto al incentivo para que los trabajadores agrícolas se hagan la prueba para detectar el virus. Si un trabajador da positivo, probablemente se le indicaría que vaya a una clínica, y luego que se quedara en casa. Asegura que no podrían permitirse ninguna de las dos cosas.

“Eso empieza a sonar como un trato muy malo por $75, porque al final de la semana, se supone que deben alimentar a sus familias”, dijo.

Katherine Wells, directora de salud pública en Lubbock, Texas, dijo que en su estado, los funcionarios de salud ofrecerían atención médica de corto plazo, como dar a los trabajadores agrícolas el tratamiento con el antigripal Tamiflu. Este acuerdo no necesariamente cubriría la hospitalización si fuera necesaria, agregó.

Expresó que la mayor preocupación de los trabajadores parece ser que tendrían que quedarse en casa o podrían incluso perder sus trabajos si dan positivo.

Muchos trabajadores agrícolas y a menudo trabajan en condiciones agotadoras, por muy poco dinero.

También pueden temer que el foco de atención en ellos reavive el fervor anti-inmigrante, dijo Monica Schoch-Spana, antropóloga médica del Centro de Seguridad Sanitaria de Johns Hopkins.

Las sociedades tienen de culpar a las comunidades marginadas por la propagación de enfermedades contagiosas. Por ejemplo, los inmigrantes latinos fueron insultados durante la pandemia de gripe H1N1, la gripe porcina, en 2009, y algunas personalidades de los medios usaron el brote para presionar por una campaña anti inmigrante.

Bethany Boggess Alcauter, directora de programas de investigación y salud pública en el Centro Nacional de Salud para Trabajadores Agrícolas, dijo que muchos trabajadores en tambos han recibido muy poca información sobre esta nueva enfermedad que se está propagando entre las vacas que manejan. “La educación necesita ser parte de los esfuerzos por las pruebas, con tiempo para que los trabajadores hagan preguntas”, dijo.

Estas conversaciones deben ser en el idioma de los trabajadores agrícolas, con personas en las que sea más probable que confíen, dijo.

Georges Benjamin, director ejecutivo de la Asociación Americana de Salud Pública, dijo que los funcionarios deben dejar claro que el estatus migratorio de los trabajadores no será reportado como parte de la investigación sobre el nuevo virus de la gripe. “No vamos a ser la policía”, dijo.

Dawn O’Connell, administradora en el Departamento de Salud y Servicios Humanos, dijo en una conferencia de prensa el 22 de mayo que se están preparando casi 5 millones de dosis de una vacuna contra el H5N1, el virus de la gripe aviar que circula entre el ganado, pero que los funcionarios no han decidido si las inyecciones se ofrecerán a los trabajadores agrícolas cuando estén listas más adelante este año.

A principios de mayo, los CDC pidieron a los estados que compartieran equipo de protección personal con los propietarios de granjas, para ayudarlos a proteger a los trabajadores del virus de la gripe aviar. Los departamentos de salud estatales en California, Texas y Wisconsin, que tienen grandes industrias lecheras, dijeron que han ofrecido distribuir estos equipos.

Chris Van Deusen, vocero del Departamento de Salud de Texas, dijo que cuatro granjas lecheras habían solicitado equipo de protección del stock estatal. Dijo que otras granjas tal vez ya tienen lo que necesitan. Los voceros de los departamentos de salud de California y Wisconsin dijeron que no recibieron pedidos inmediatos de los propietarios de granjas para obtener equipo adicional.

Strater, la funcionaria de United Farm Workers, dijo que las ofertas de equipo de protección deben ser prácticas.

La mayoría de los trabajadores de la industria lechera ya usan delantales impermeables, botas y guantes, dijo. No sería realista esperar que también usen mascarillas N95 en las condiciones húmedas y calurosas de una operación de ordeñe, dijo. Los protectores faciales de plástico parecen una mejor opción para ese entorno, especialmente para evitar que la leche salpique en los ojos de los trabajadores, donde podría causar una infección, dijo.

Otros tipos de trabajadores agrícolas, incluidos aquellos que trabajan con pollos, también enfrentan posibles infecciones. Pero los científicos dicen que la versión del virus que se está propagando en el ganado podría ser particularmente peligrosa, porque ya se ha adaptado para vivir en mamíferos.

Strater dijo que le preocupa más los trabajadores en tambos, que pasan de 10 a 12 horas al día en espacios cerrados con vacas.

“Sus caras están aproximadamente a 5 pulgadas de la leche y las ubres durante todo el día”, dijo. “La cercanía, en donde sus caras están tan cerca del material infeccioso, es diferente”.

¿Trabajas en un tambo? ¿Te preocupa la exposición a la gripe aviar en el trabajo? Ģ��ӰԺ Health News quiere saber sobre tí. Cuéntanos tus experiencias , para nuestras historias.

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BRIDGEPORT, Conn. — Milagros Aquino was trying to find a new place to live and had been struggling to get used to new foods after she moved to Bridgeport from Peru with her husband and young son in 2023.

When Aquino, now 31, got pregnant in May 2023, “instantly everything got so much worse than before,” she said. “I was so sad and lying in bed all day. I was really lost and just surviving.”

Aquino has lots of company.

Perinatal depression affects as many as 20% of women in the United States during pregnancy, the postpartum period, or both, . In some states, anxiety or depression afflicts nearly a quarter of new mothers or pregnant women.

Many women in the U.S. go untreated because there is no widely deployed system to screen for mental illness in mothers, despite widespread recommendations to do so. Experts say the lack of screening has driven higher rates of mental illness, suicide, and drug overdoses that are now the leading causes of death in the first year after a woman gives birth.

“This is a systemic issue, a medical issue, and a human rights issue,” said Lindsay R. Standeven, a perinatal psychiatrist and the clinical and education director of the Johns Hopkins Reproductive Mental Health Center.

Standeven said the root causes of the problem include racial and socioeconomic disparities in maternal care and a lack of support systems for new mothers. She also pointed a finger at a shortage of mental health professionals, insufficient maternal mental health training for providers, and insufficient reimbursement for mental health services. Finally, Standeven said, the problem is exacerbated by the absence of national maternity leave policies, and the access to weapons.

Those factors helped drive a in postpartum depression from 2010 to 2021, according to the American Journal of Obstetrics & Gynecology.

For Aquino, it wasn’t until the last weeks of her pregnancy, when she signed up for acupuncture to relieve her stress, that a social worker helped her get care through the Emme Coalition, which connects girls and women with financial help, mental health counseling services, and other resources.

Mothers diagnosed with perinatal depression or anxiety during or after pregnancy are at about three times the risk of suicidal behavior and six times the risk of suicide compared with mothers without a mood disorder, according to recent U.S. and international studies in and .

The toll of the maternal mental health crisis is particularly acute in rural communities that have become maternity care deserts, as small hospitals close their labor and delivery units because of plummeting birth rates, or because of financial or staffing issues.

This week, the Maternal Mental Health Task Force — co-led by the Office on Women’s Health and the Substance Abuse and Mental Health Services Administration and formed in September to respond to the problem — that could serve as hubs of integrated care and birthing facilities by building upon the services and personnel already in communities.

The task force will soon determine what portions of the plan will require congressional action and funding to implement and what will be “low-hanging fruit,” said Joy Burkhard, a member of the task force and the executive director of the nonprofit Policy Center for Maternal Mental Health.

Burkhard said equitable access to care is essential. The task force recommended that federal officials identify areas where maternity centers should be placed based on data identifying the underserved. “Rural America,” she said, “is first and foremost.”

There are shortages of care in “unlikely areas,” including Los Angeles County, where some maternity wards have recently closed, said Burkhard. Urban areas that are underserved would also be eligible to get the new centers.

“All that mothers are asking for is maternity care that makes sense. Right now, none of that exists,” she said.

Several pilot programs are designed to help struggling mothers by training and equipping midwives and doulas, people who provide guidance and support to the mothers of newborns.

In Montana, rates of maternal depression before, during, and after pregnancy are higher than the national average. From 2017 to 2020, approximately 15% of mothers experienced postpartum depression and 27% experienced perinatal depression, according to the The state had the sixth-highest maternal mortality rate in the country in 2019, when it received a federal grant to begin training doulas.

To date, the program has trained 108 doulas, many of whom are Native American. Native Americans make up 6.6% of Montana’s population. Indigenous people, particularly those in rural areas, have of severe maternal morbidity and mortality compared with white women, according to a study in Obstetrics and Gynecology.

Stephanie Fitch, grant manager at Montana Obstetrics & Maternal Support at Billings Clinic, said training doulas “has the potential to counter systemic barriers that disproportionately impact our tribal communities and improve overall community health.”

and Washington, D.C., have Medicaid coverage for doula care, according to the National Health Law Program. They are California, Florida, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, Oklahoma, Oregon, Rhode Island, and Virginia. Medicaid pays for about in the U.S., according to the Centers for Disease Control and Prevention.

Jacqueline Carrizo, a doula assigned to Aquino through the Emme Coalition, played an important role in Aquino’s recovery. Aquino said she couldn’t have imagined going through such a “dark time alone.” With Carrizo’s support, “I could make it,” she said.

Genetic and environmental factors, or a past mental health disorder, can increase the risk of depression or anxiety during pregnancy. But mood disorders can happen to anyone.

Teresa Martinez, 30, of Price, Utah, had struggled with anxiety and infertility for years before she conceived her first child. The joy and relief of giving birth to her son in 2012 were short-lived.

Without warning, “a dark cloud came over me,” she said.

Martinez was afraid to tell her husband. “As a woman, you feel so much pressure and you don’t want that stigma of not being a good mom,” she said.

In recent years, programs around the country have started to help doctors recognize mothers’ mood disorders and learn how to help them before any harm is done.

One of the most successful is the Massachusetts Child Psychiatry Access Program for Moms, which began a decade ago and has since spread to 29 states. The program, supported by federal and state funding, provides tools and training for physicians and other providers to screen and identify disorders, triage patients, and offer treatment options.

But the expansion of maternal mental health programs is taking place amid sparse resources in much of rural America. Many programs across the country have run out of money.

The federal task force proposed that Congress fund and create consultation programs similar to the one in Massachusetts, but not to replace the ones already in place, said Burkhard.

In April, Missouri became the latest state to adopt the Massachusetts model. Women on Medicaid in Missouri are 10 times as likely to die within one year of pregnancy as those with private insurance. From 2018 through 2020, an average of 70 Missouri women died each year while pregnant or within one year of giving birth, according to state .

Wendy Ell, executive director of the Maternal Health Access Project in Missouri, called her service a “lifesaving resource” that is free and easy to access for any health care provider in the state who sees patients in the perinatal period.

About 50 health care providers have signed up for Ell’s program since it began. Within 30 minutes of a request, the providers can consult over the phone with one of three perinatal psychiatrists. But while the doctors can get help from the psychiatrists, mental health resources for patients are not as readily available.

The task force called for federal funding to train more mental health providers and place them in high-need areas like Missouri. The task force also recommended training and certifying a more diverse workforce of community mental health workers, patient navigators, doulas, and peer support specialists in areas where they are most needed.

A new in reproductive psychiatry is designed to help psychiatry residents, fellows, and mental health practitioners who may have little or no training or education about the management of psychiatric illness in the perinatal period. A small that the curriculum significantly improved psychiatrists’ ability to treat perinatal women with mental illness, said Standeven, who contributed to the training program and is one of the study’s authors.

Nancy Byatt, a perinatal psychiatrist at the University of Massachusetts Chan School of Medicine who led the launch of the Massachusetts Child Psychiatry Access Program for Moms in 2014, said there is still a lot of work to do.

“I think that the most important thing is that we have made a lot of progress and, in that sense, I am kind of hopeful,” Byatt said.

Cheryl Platzman Weinstock’s reporting is supported by a grant from the National Institute for Health Care Management Foundation.