Ben Zdencanovic, University of Cambridge

California and Minnesota Face $1B Medicaid Funding Hold

The Trump administration announced on July 21, 2026, that it’s withholding US$867 million in federal healthcare funding for California and $200 million for Minnesota – a total of more than $1 billion.

Federal officials said the two states had failed to provide sufficient evidence that a number of disputed medical claims were legitimate. These include bills for in-home care and other services covered by the two states’ Medicaid programs for low-income residents.

Medicaid administrators say the funds can be recovered if the states supply the requested documentation. But the action is highly unusual: Typically, Medicaid officials partner with states to conduct an audit when they suspect fraud, a careful process that often takes years.

It’s the second time in 2026 that the Trump administration has withheld or deferred federal Medicaid funds for several states, including California and Minnesota, because of alleged fraud and abuse. The Democratic governors of those states have called the decision a politically motivated attack on their constituents.

I’m a historian of social policy who led the first comprehensive historical overview of Medi-Cal, California’s statewide Medicaid system. I’ve found that U.S. leaders have long used the language of fraud and abuse to blur the line between correcting very real failures within Medicaid and – as I believe the Trump administration is currently doing – discrediting and defunding the program itself.

Slashing the safety net

The Medicaid restrictions are part of the Trump administration’s overall efforts to slash federal funding for the safety net.

The large tax-and-spending bill that Trump signed into law in July 2025 as the cornerstone of his second-term agenda pared eligibility for Medicaid by introducing work requirements for some adults. It is cutting close to $1 trillion in federal spending on the program over the next decade.

Researchers estimate that almost 12 million people, on top of the estimated 28 million without health insurance in 2025, could become uninsured by 2034 due to these changes. By mid-2026, more than 3 million people had already lost their insurance coverage due to Republican changes to the Affordable Care Act.

‘Padlocking’ the ‘cookie jar’

In February 2026, Vice President JD Vance, Health Secretary Robert F. Kennedy Jr. and Dr. Mehmet Oz, the administrator of the Centers for Medicare & Medicaid Services, or CMS, announced a new anti-fraud initiative called Comprehensive Regulations to Uncover Suspicious Healthcare.

Also known by its rather unsubtle acronym, CRUSH, this initiative is taking unprecedented steps to withhold and defer funds in response to suspected fraud. “CMS is done trying to catch fraudsters with their hands in the cookie jar,” Oz said in announcing CRUSH’s formation. “Instead, we’re padlocking the jar and letting them starve.”

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To be sure, Medicaid fraud, waste and abuse – such as providers billing Medicaid for services that are unnecessary or never rendered – are very real problems that cost taxpayers billions of dollars annually. They do divert funds from the low-income and disabled Americans enrolled in the program.

But the Trump administration’s latest moves are part of a much broader history of weaponizing Medicaid fraud and abuse – both real and imagined. I see them as a politicized attempt to prove that Medicaid itself is wasteful, that state governments cannot be trusted to administer federal money, and that public benefits inevitably invite dishonesty.

Providing little oversight at the start

Medicaid was established, along with Medicare for older adults, in 1965 as part of President Lyndon B. Johnson’s “Great Society” reforms. Despite providing millions of Americans with health insurance coverage for the first time, these programs had few centralized mechanisms for the kind of federal oversight that could prevent and catch fraud and abuse.

And the sheer scale and complexity of the Medicaid system – joint federal-state funding, varying eligibility requirements, millions of enrollees and thousands of providers – created opportunities for questionable billing practices among providers.

The 1970s saw a number of highly publicized Medicaid scandals involving nursing homes, laboratories, pharmacies and so-called “Medicaid mills” – healthcare providers that sought to bill the government for large numbers of Medicaid patients for shoddy and often fraudulent care.

A series of high-profile congressional investigations spurred demand for stronger Medicaid oversight and enforcement. That led to the Medicare-Medicaid Anti-Fraud and Abuse Amendments of 1977, which established the national Medicaid Fraud Control Units program.

The state-run Medicaid Fraud Control Units received generous federal matching funds to investigate and prosecute fraud.

The most serious Medicaid fraud was generally committed by healthcare providers and contractors, not patients. Medicaid Fraud Control Units were principally responsible for investigating providers, while also prosecuting the abuse and neglect of patients whose care was billed to Medicaid.

At the same time, however, Medicaid was becoming entangled in a broader political debate over social spending, whether many Americans were becoming too dependent on government benefits, and the alleged use of benefits by people who should not have received them. In the 1980s and 1990s, widely circulated stories about Medicaid exposed fraud and malfeasance by providers.

But disproportionately, they also highlighted the comparatively few instances of fraud by people enrolled in the program, such as cases where they submitted false receipts for covered medically related travel or sold drugs they obtained through Medicaid for free or at low cost.

Using Medicare fraud to justify spending cuts

The distinction between Medicaid and cash assistance programs, such as the Aid to Families with Dependent Children “welfare” program, frequently disappeared in political rhetoric. False or exaggerated stories that portrayed African American single mothers living extravagantly while fraudulently claiming welfare benefits became potent symbols of supposed government failure.

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While campaigning as a presidential candidate, Ronald Reagan seized on this trope of the “welfare queen” in his attacks on social spending.

By the mid-1990s, opposition to welfare programs had become increasingly bipartisan. Politicians in both parties often used tales of Medicaid fraud on the part of providers and recipients to justify tighter eligibility rules and spending cuts.

Federal oversight expanded further with the Deficit Reduction Act of 2005, which created the Medicaid Integrity Program and strengthened federal oversight of state programs. The Affordable Care Act, the landmark healthcare legislation Congress passed in 2010, added new measures to screen providers and verify billing.

Concerns about Medicaid’s “integrity” became highly politicized in the debates surrounding the ACA. Critics of Medicaid expansion argued that increasing the number of people who could get health insurance through the program would increase fraud and improper enrollment. Supporters of expanding Medicaid to help more Americans gain health insurance maintained that anti-fraud rhetoric often disguised ideological opposition to the program’s expansion.

Blurring distinctions then and now

For the six decades that this program has helped millions of low-income Americans get healthcare, politicians have blurred the distinction between protecting Medicaid from abuse and using abuse to discredit Medicaid itself.

In my view, the Trump administration’s campaigns against California and Minnesota continue that pattern. It is using real weaknesses within Medicaid to advance much broader political arguments: that Democratic states cannot be trusted, that public benefits naturally invite abuse, and that withholding funds is itself a form of reform.

The result will no doubt be that fewer low-income Americans will be able to get the healthcare they need.

Ben Zdencanovic, Assistant Professor of U.S. History, University of Cambridge

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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8 Daily Habits to Support Your Heart, Kidney and Metabolic Health

(Feature Impact) When it comes to protecting your heart, supporting your kidney function and improving your metabolic health, you’ll find the advice for each one looks similar. That’s because your body’s systems are deeply interconnected: what affects one will have ripple effects across the others.

Cardiovascular-kidney-metabolic health, or CKM health, is a perfect example. When any one of these systems is compromised, it can lead to problems with the others. Therefore, it’s not uncommon for health problems like heart disease, stroke, diabetes and kidney disease to develop or worsen simultaneously – a condition collectively known as CKM syndrome.

The reverse is also true, so habits that are healthy for your heart will have a positive effect on your kidneys and metabolic system and vice versa. Consider these simple strategies that align with the American Heart Association’s Life’s Essential 8, a list of healthy steps that can improve overall health. Learn more about how these habits and health measures affect your CKM health at Heart.org.

1. Choose Healthy Foods – Food is your body’s fuel, so fill your tank wisely. Certain types of foods can help your blood pressure, cholesterol, blood glucose and triglycerides stay within healthy ranges, while poor nutrition can push those numbers into more dangerous territory. Focus on vegetables, fruits, whole grains, plant-based proteins (e.g. beans, legumes and nuts) and lean animal proteins (e.g. seafood, skinless poultry and low-fat dairy). Drink plenty of water throughout the day and limit added sugar and salty or fatty foods.

1. Stay Physically Active – Exercise doesn’t have to feel like a chore – in fact, some of your favorite hobbies may already count. The American Heart Association recommends aiming for 150 minutes per week of moderate physical activity like dancing, gardening or walking, moving quickly enough to elevate your heart rate and break a light sweat. Alternatively, choose 75 weekly minutes of vigorous exercise that gets you breathing hard and fast; think running, swimming, playing tennis or riding your bike on hilly terrain.

1. Avoid Nicotine – Tobacco and other nicotine products can raise your blood pressure, damage blood vessels and increase your risk of heart attack and stroke, which are all bad news for your CKM health. If you’re currently trying to quit, you aren’t alone, so don’t be afraid to seek out support groups and resources to help. 

1. Prioritize Healthy Sleep – Sleep gives your body a chance to rest and recover from the day, but it’s often one of the first things people sacrifice when life gets busy. Poor sleep can increase your risk for heart disease, weight gain and other issues. Aim for a solid 7-9 hours a night. Keep your bedroom cool, dark and comfortable, and do your best to limit distractions like late-night smartphone scrolling.

1. Watch Your Blood Pressure – When your blood pressure is high, it forces your heart to work harder to pump blood through the body, which can weaken it over time. It can also damage the delicate arteries in and around the kidneys, putting CKM health further at risk. Information is power, so check your blood pressure frequently to know whether further action is needed to keep it under control.

1. Manage Your Blood Sugar – High blood sugar can damage the kidneys, eyes, blood vessels and more, thereby increasing your chance of developing harmful CKM conditions. Controlling blood sugar is particularly important for people with diabetes. If you don’t have diabetes and still experience frequent blood sugar spikes and crashes, talk to your doctor.

1. Control Your Cholesterol – Cholesterol comes in both “bad” (LDL) and “good” (HDL) forms, requiring a balancing act to keep your levels within a healthy range. If LDL is high and HDL is low, your risk of clogged blood vessels, heart attack and stroke are higher. Healthy levels keep blood flowing to your heart and kidneys, supporting your metabolic health in the process. See your doctor for regular bloodwork so you can monitor cholesterol changes.

1. Maintain a Healthy Weight – Since excess body weight puts pressure on the heart, kidneys and other organs, a healthy body weight helps lower your risk of CKM syndrome. Whether you’re hoping to maintain or reduce your weight, regular exercise, healthy eating and quality sleep are all great ways to achieve your goals.

SOURCE:

American Heart Association

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3 Steps to Support Mental Health for Rural Youth

(Feature Impact) Young people face a growing number of pressures, including academic expectations, social responsibilities, complex family situations and uncertainty about their own futures. Mental health support is important for all – but in many rural areas, those pressures are even greater.

According to the Centers for Disease Control and Prevention, the suicide rate for rural youth ages 15-19 is 74% higher than their urban counterparts. Barriers like limited insurance coverage, unreliable internet for telehealth, scarce providers, long drive times and lack of public transportation make it harder to get mental healthcare when it’s needed. Plus, asking for help can feel like opening oneself up to judgment and stigmatization.

That’s why Rural Minds, the only nonprofit focused on mental health for rural communities, created the Rural Youth Mental Wellness pilot program supported by Boehringer Ingelheim. It was developed by an advisory committee made up of rural youth to provide their peers with practical, free, accessible mental health resources. Incorporating feedback on the pilot, the updated program sponsored by the Sompo Foundation is now launching its national rollout.

“A young person’s ZIP code should never determine whether they can access meaningful mental health support where and when they need it,” said Jessica L. Schleider, Ph.D., director, Lab for Scalable Mental Health, Northwestern University. “Our lab is thrilled to partner with Rural Minds as they champion evidence-based, anonymous, freely available support tools designed to overcome barriers to help-seeking faced by rural youth across the country.”

If the rural mental health crisis affects you or a loved one, consider these ways to help.

Break the Stigma Surrounding Mental Health

In communities where self-reliance is valued, asking for help can sometimes be viewed as a sign of weakness. Young people who feel unheard and unsupported often struggle with being vulnerable, so they continue carrying their increasingly heavy burdens alone.

Parents, educators, healthcare providers, community leaders and peers can work to change that culture by normalizing mental health conversations. This includes helping teenagers feel seen and accepted by educating them on mental health issues and coping strategies, listening to their experiences without judgment, sharing your own stories and reminding them it’s courageous to seek support.

Consider Single-Session Interventions

The first step is always the hardest when it comes to seeking mental health support, and not every struggling young person is ready or able to see a therapist. With access to free, confidential, self-guided materials to begin building mental wellness skills, the first step may be less scary.

Single-Session Interventions (SSIs) are brief, structured online courses designed to teach youth practical skills for handling stress, low mood, self-image and more. The Rural Youth Mental Wellness Program offers SSIs in partnership with Project YES (Youth Empowerment and Support), a free digital resource developed with Northwestern University’s Lab for Scalable Mental Health at the Feinberg School of Medicine.

Anonymous access to SSIs through the partnership provides strategies for:

• Improving mood
• Rethinking body image
• Reframing negative thoughts
• Knowing your power to change
• Taking steps toward goals
• Protecting LGBTQ+ pride
• Handling self-harm urges
• Staying safe amid dark thoughts

Each SSI typically takes 5-10 minutes. Although SSIs are not a replacement for therapy, they provide a research-backed source of support for young people experiencing bouts of stress or low-to-moderate distress.

Know When to Seek Professional Help

Self-guided resources and supportive conversations are a valuable starting point, but sometimes young people need qualified professional help. Look for symptoms like worsening mood or behavior, substance use, self-harm or difficulty managing everyday tasks, and take teens seriously when they express dark feelings.

Doctors and counselors can provide personalized support for youth in crisis, and the 988 Suicide and Crisis Lifeline offers free, confidential 24/7 support for mental health by dialing 9-8-8.

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“I grew up in a small town where mental health was almost taboo,” said committee member Asheton Medlin. “Being part of the committee that built this program let me help make sure rural youth today have the support I didn’t. I’m excited to help bring these resources to them because this generation deserves the chance to grow up and change the world.”

Find more information at RuralMinds.org.

Photos courtesy of Shutterstock

SOURCE:

Rural Minds

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